Flood Control - Elevation Certificate - 975 W Back Forty Dr - Mace River Ranch Sub No 05 - 4/21/2017U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for (1) community official (2) insurance
OMB No. 1660-0008
Expiration Date: November 30, 2018
A 3 b
SECTION A— PROPERTY INFORMATION
an ( ) uIldlny uwner.
Al. Building Owner's Name
FOR INSURANCE COMPANY USE
Zambukos, Andrea
Policy Number:
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No.
Company NAIC Number:
975 W. Back Forty Dr.
City State ZIP Code
Eagle
Idaho 83616
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Lot 06 Block 07 Mace River Ranch Subdivision No. 05, Parcel No: R5421240460
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential
A5. Latitude/Longitude: Lat. N 43°41'17.0" Long. W 116°21'58.0" Horizontal Datum: ❑ NAD 1927 ❑x NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
AT Building Diagram Number 9
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) 1,785 sq It
b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 13
c) Total net area of flood openings in A8.b 1,119.45 sq in
d) Engineered flood openings? []Yes ❑x No
Ag. For a building with an attached garage:
a) Square footage of attached garage 1,008 sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A9.1b 0 sq in
d) Engineered flood openings? ❑ Yes 0 No
SECTION B—FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number
B2. County Name
B3. Stale
City of Eagle, 160003
Ada County
Idaho
B4. Map/Panel
Number
B5. Suffix
B6. FIRM Index
Date
B7. FIRM Panel
B8. Flood Zone(s)
89. Base Flood Elevation(s)
1600100153
H
Effective/
Revised Date
(Zone AO, use Base
Depth)
D2/19/2003
02/19/2003
AE
254914od
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9:
❑ FIS Profile x❑ FIRM ❑ Community Determined ❑ Other/Source:
811. Indicate elevation datum used for BFE in Item B9: p NGVD 1929 ❑x NAVD 1988 ❑ Other/Source:
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ❑x No
Designation Date: ❑ CBRS ❑ OPA
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V,,,. .00-U-oa 1rr 1o1 Replaces all previous editions. Form Page 1 of 6
ELEVATION CERTIFICATE
OMB No. 1660-0008
Expiration Date: November 30, 2018
IMPORTANT: In these spaces, copy the corresponding Information from Section A.
FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
Policy Number:
975 W. Back Forty Dr.
City State ZIP Code
Company NAIC Number
Eagle Idaho 83616
SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' ❑x 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: 0438 NGS Vertical Datum: NAVD 68
Indicate elevation datum used for the elevations in items a) through h) below.
❑ NGVD 1929 ❑x NAVD 1988 ❑ Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
Check the measurement used.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 2550.4
❑x feet ❑ meters
b) Top of the next higher floor 2554. 7
❑x feet ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only) N/A.
x❑ feet ❑ meters
d) Attached garage (top of slab) 2553. 2
X feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 2553. 0
❑x feet ❑ meters
(Describe type of equipment and location in Comments)
0 Lowest adjacent (finished) grade next to building (LAG) 2552. 3
❑x feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 2553, 1
❑K feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A.
_ ❑x feet ❑ meters
structural support
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 orimprisonment under 18 U.S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? Z Yes ❑ No
❑ Check here if attachments.
Certifier's Name License Number
Carl Porter 14221
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Title
PLS
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Sawtooth
Company Name
Land Surveying
.r11/1�6`/c'L"e :DAddress ' ��
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2030 S. Washington Ave.
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City State ZIP Code
Emmett Idaho 83617
Signature*a Dale Telephone
C, 04/21/2017 (208) 398-8104
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance
agent/company, and (3) building owner.
Comments (including type of equipment and location, per C2(e), if applicable)
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6
BUILDING PHOTOGRAPHS
ELEVATION CERTIFICATE See Instructions for Item A6, OMB No. 1660-0008
Expiration Date: November 30, 2018
IMPORTANT: In these spaces, copy the corresponding information from section A. FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number:
975 W. Back Forty Dr.
City - -- State-- ZIP Code - -- Company NAIC Number
Eagle Idaho 83616
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." When applicable, photographs must show the foundation with representative examples of the Flood openings or
vents, as indicated in Section AS. If submitting more photographs than will fit on this page, use the Continuation Page.
rnoto Une Caption Front View 04/21/207
Two Caption Rear View 04/2
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 5 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30, 2018
IMPORTANT: In these spaces, copy the corresponding Information from Section A.
FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, andlor Bldg. No.) or P.O. Route and Box No.
Policy Number:
975 W- Back Forty Dr.
City State ZIP Code
Company NAIC Number
Eagle Idaho 83616
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs
with: date taken; "Front View" and "Rear View": and, if required, "Right Side View" and "Left Side View." When applicable,
photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8.
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Phote One __
Photo One Caption Left View 04/21/2017
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Photo Two Caption Right View 04/21/2017
FEMA Form 086.0-33 (7/15) Replaces all previous editions. Form Page 6 of 6