Flood Control - Elevation Certificate - 323 E Riverside Drive - Advanced Healing Plaza Sub - 10/4/2006
U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE
Federal Emergency Management Agency
National Flood Insurance Program Important: Read the instructions on pages 1-8.
OMS No. 1660-0008
Exoires Februarv 28. 2009
SECTION A - PROPERTY INFORMATION For Insurance Company Use:
A1. Building Owner's Name St. Alphonsus Regional Medical Center, Inc. Policy Number
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number
323 East Riverside Drive
City Eagle
State Id ZIP Code 83616
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Advanced Healing Plaza Subdivision, Block 1, Lots 1 and 2
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Non
AS. Latitude/Longitude: Lat. N 43-41-20.2 Long. W 116-21-02.2 Horizontal Datum: D NAD 1927 18I 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 1
A8. For a building with a crawl space or enclosure(s), provide A9. For a building with an attached garage, provide:
a) Square footage of crawl space or enclosure(s) N/A sq ft a) Square footage of attached garage N/A sq ft
b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage
enclosure(s) walls within 1.0 foot above adjacent grade N/A walls within 1.0 foot above adjacent grade N/A
c) Total net area of flood openings in A8.b WA sq in c) Total net area of flood openings in A9.b WA sq in
SECTION B. FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number
City of Eagle 16001
B2. County Name
Ada County
B3. State
Idaho
B4. Map/Panel Number B5.Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone
Date Effective/Revised Date Zone(s) AO, use base flood depth)
0153 H 09-22-1999 02-19-2003 AE 2562
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9.
o FIS Profile 18I FIRM D Community Determined 0 Other (Describe) _
B11. Indicate elevation datum used for BFE in Item B9: 0 NGVD 1929 18I NAVD 1988 0 Other (Describe)_
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? DYes l8INo
Designation Date _ 0 CBRS DOPA
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: 0 Construction Drawings. 0 Building Under Construction. 18I Finished Construction
. A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations - Zones A 1-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, ARIA, ARlAE, ARIA 1-A30, ARlAH, ARlAO. Complete Items C2.a-g
below according to the building diagram specified in Item A7.
Benchmark Utilized Boise River StudY Vertical Datum NGVD 1988
Conversion/Comments Towill 128
Check the measurement used.
a) Top of bottom floor (including basement, crawl space, 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 in Comments)
f) Lowest adjacent (finished) grade (LAG)
g) Highest adjacent (finished) grade (HAG)
2562.30 18I feet 0 meters (Puerto Rico only)
~.30 18I feet 0 meters (Puerto Rico only)
N/A._ D feet D meters (Puerto Rico only)
N/A._ D feet 0 meters (Puerto Rico only)
N/A._ 0 feet 0 meters (Puerto Rico only)
2560.78
2562.10
181 feet 0 meters (Puerto Rico only)
181 feet 0 meters (Puerto Rico only)
Address 462 East Shore Drive., Suite 100
City Eagle
State Id
ZIP Code 83616
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. I 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.
o Check here if comments are provided on back of form.
Certifier's Name Dennis Lewis
License Number 11575
Title Professional Land Surveyor
Company Name The Land Group, inc.
Signature
Telephone (208) 939-4041
FEMA Form 81-31, February 2006
See reverse side for continuation.
Replaces all previous editions
IMPORTANT: In these spaces, copy the corresponding information from Section A. ForJnsuranceCompany Use:
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. POlicy Number
City State ZIP Code Company NAIC Number
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenUcompany, and (3) building owner.
Comments
Signature
Date
o Check here if attachments
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 E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A. B,
and C. For Items E1-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters.
E1. 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, crawl space, or enclosure) is _'_ D feet D meters 0 above or 0 below the HAG.
b) Top of bottom floor (including basement, crawl space, or enclosure) is _'_ D feet 0 meters 0 above or 0 below the LAG.
E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9 (see page 8 of Instructions), the next higher floor
(elevation C2.b in the diagrams) of the building is _'_ 0 feet 0 meters 0 above or 0 below the HAG.
E3. Attached garage (top of slab) is _'_ 0 feet 0 meters 0 above or 0 below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is _'_ 0 feet 0 meters 0 above or 0 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? 0 Yes 0 No 0 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, 8, and IE 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
D 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. and G9.
G1. 0 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. 0 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. 0 The following information (Items G4.-G9.) is provided for community floodplain management purposes.
G4. Permit Number
G5. Date Permit Issued
G6. Date Certificate Of Compliance/Occupancy Issued
G7. This permit has been issued for: 0 New Construction D Substantial Improvement
G8. Elevation of as-built lowest floor (including basement) of the building: _'_ _0 feet 0 meters (PR) Datum _
G9. BFE or (in Zone AO) depth of flooding at the building site: _'_ 0 feet 0 meters (PR) Datum _
.r
Local Official's Name
Title
Community Name
Signature
Telephone
Date
Comments
FEMA Form 81-31, February 2006
o Check here if attachments
Replaces all previous editions