Flood Control - Elevation Certificate - 1209 N Grey Pebble Way - Clear Creek Crossing - 10/10/2013DEPJ RTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
National Flood Insurance Program Important: Read the instructions on pages 1-9.
ELEVATION CERTIFICATE
OMB No. 1660-0008
Expiration Date: July 31, 2015
SECTION A - PROPERTY INFORMATION
Al. Building Owner's Name Jayo Development Inc.
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
1209 N. Grey Pebble Way
City Eagle
State ID ZIP Code 83616'
FOR INSURANCE COMPANY USE
Policy Number
Company NAIC Number:
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Lot 2, Block 1 Clear Creek Crossing Subdivision
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential
A5. Latitude/Longitude: Lat. 116-20-28W Long. 43-41-56N Horizontal Datum: ❑ NAD 1927 ® NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 9
A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) 2816 sq ft a) Square footage of attached garage 1309 sq ft
b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage
or enclosure(s) within 1.0 foot above adjacent grade 0 within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b 0 sq in c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes ® No
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number
Ada County Idaho & Incorp. Areas -160003
B4. Map/Panel Number
16001C0153
B5. Suffix
H
B2. County Name
Ada
B6. FIRM Index Date
2-19-2003
B7. FIRM Panel
Effective/Revised Date
2-20-2013
B8. Flood
Zone(s)
B3. State
ID
B9. Base Flood Elevation(s) (Zone
AO, use base flood depth)
2584.7
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9.
❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ® NAVD 1988 ❑ Other/Source:
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No
Designation Date: ❑ CBRS ❑ OPA
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings* ® Building Under Construction* ® Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations - Zones Al-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a-h
below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: AH7375 Vertical Datum: NAVD 88
Indicate elevation datum used for the elevations in items a) through h) below. 0 NGVD 1929 El NAVD 1988 ❑ Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor)
b) Top of the next higher floor
c) Bottom of the lowest horizontal structural member (V Zones only)
d) Attached garage (top of slab)
e) Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG)
g) Highest adjacent (finished) grade next to building (HAG)
h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support
2584.4
2587.3
n/a.
2586.8
2586.8
2586.3
2586.6
2586.8
Check the measurement used.
• feet ❑ meters
® feet ❑ meters
❑ feet ❑ meters
® feet ❑ meters
® feet ❑ meters
® feet ❑ meters
® feet ❑ meters
® feet E meters
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation
information. / certify that the information on this Certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a
❑ Check here if attachments.
Certifier's Name Colleen Marks
Title Land Surveyor
Address 5300 W. Hill Road
licensed land surveyor? ® Yes ❑ No
License Number 7045
Company Name Marks Land Surveying, Inc.
City Boise
Sigt A fature ri ` Date
A a �' �
kg/A ��i� ( (9
FEMA Form 086-0-33 (7/121
State ID ZIP Code 83703
Telephone 208-378-7703
See reverse side for continuation. Replaces all previous editions.
�_��• rlfl wU• vI_I% I n wA I I, NaaJ. c
jMPOR =ANT: In these spaces, copy the corresponding information from Section A.
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
1209 N. Grey Pebble Way
City gAGLE
State id ZIP Code 83616
FOR INSURANCE COMPANY USE
Policy Number:
Company NAIC Number:
SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments
Signature Date
SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zones AO and A (without BFE), complete Items El—E5, If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B,
and C. For Items El—E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters.
El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent
grade (HAG) and the lowest adjacent grade (LAG).
a) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 8-9 of Instructions), the next higher floor
(elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management
ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G.
SECTION F — PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or community -issued BFE)
or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge.
Property Owner's or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
n Check here if attachments.
SECTION G — COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G
of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8—G10. In Puerto Rico only, enter meters.
G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who
is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA-issued or community -issued BFE) or Zone AO.
G3. ❑ The following information (Items G4—G10) is provided for community floodplain management purposes.
G4. Permit Number
G7. This permit has been issued for:
G5. Date Permit Issued
�: lictit/ 1.-3
❑ New Construction
G6. Date C�rtifiGate Of Compliance/Occupancy Issued
1C'latt=;
❑ Substantial Improvement
G8. Elevation of as -built lowest floor (including basement) of the building: ❑ feet ❑ meters Datum
G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet E meters Datum
G10. Community's design flood elevation: ❑ feet ❑ meters Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments
n Check here if attachments.
FFMA Fnrm (IRA-(1-2. (7/121 RPnlarac all nravinuc ariitinnc
E;,EV.'\TION CERTIFICATE, page 3
Building Photographs
See Instructions for Item A6.
IMPORTANT: In these spaces, copy the corresponding information from Section A.
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
1209 N. Grey Pebble Way
City iGAGLE
State id
ZIP Code 83616
IFOR INSURANCE COMPANY USE
IPolicy Number:
Company NAIC Number:
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions
for Item A6. Identify all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side
View." Wher
indicated in
_r .�_ r__� .._....;..gs or vents, as
FEMA Form 086-0-33 (7/12)
Replaces all previous editions.