Laserfiche WebLink
ELEVATION CERTIFICATE <br />OMB No. I M-0008 <br />Expiration Date: November 30, 2022 <br />IMPORTANT: In these spaces, copy the corresponding information From Seatlon A. <br />FOR INSURANCE COMPANY USE <br />Ti Idi ng Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. <br />P0116Y Number. <br />2011 Roan Drive <br />City State ZIP Code <br />Company NAIC Number <br />Ellensburg Washington 98926 <br />SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) <br />C1. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Constmotion' ❑x Finished Construction <br />*A new Elevation Certificate will be required when construction of the building Is complete. <br />C2. Elevations - Zones Aim, AE, AH, A (with BFE), VE, VI--V30, V (with BFE), AR, ARIA, AR/AE, ARIA1-430, ARIAH, AR/AO. <br />Complete Items C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meter& <br />Benchmark Utilized: Center of 8 27, T 18 N, R'18 E Vertical Datum: NAVD 1988 <br />Indicate elevation datum used for the elevations In Items a) through h) below. <br />❑ NGVD 1929 Fj] NAVD 1988 ❑ OthedSource: <br />Datum used for building elevations must be the same as that used for the BFE. <br />Check the measurement used. <br />a) Top of bottom floor (including basement, crawlapace, or enclosure floor) 1601.3 M feet ❑ meters <br />b) Top of The next higher floor NIA ❑ feet ❑ meters <br />o) Bottom of the lowest horizontal structural member (V Zones only) NIA ❑ feet ❑ meters <br />d) Attached garage (top of slab) 1601.3 x❑ feet ❑ meters <br />e) Lowest elevation of machinery or equipment earvking the building 1601.5 feet ❑meters <br />(Describe type of equipment and location In Comments) <br />f) Lowest adjacent (finished) grade next to building (LAG) 1599.8 x❑ feet ❑ meters <br />g) Hlghest adjacent (finished) grade next to building (HAG) 1600,E feet ❑ meters <br />h) Lowest adjacent grade at lowest elevation of deck or stain's, Including NIA ❑feet ❑meters <br />structural support - <br />SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION <br />This certification Is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation h0ormation. <br />I aediry that the Information on this Cerffficate ►represents my best eftorfs to Inte�rot the data available. I understand that any false <br />staterhent may be pwd4mble by fine or Imprisonment under 18 U.S. Code, Ssctfon IW I. <br />Were latitude and longitude in Section A provided by a licensed land sunreyor? 0 Yes ❑ ND ❑ Check here I attachments. <br />Certifiers Name License Number <br />Rick Skinner 43819 <br />I'is� QS�M!�?►I S <br />, j NWAsji�'�1� <br />Title <br />Professional Land Surveyor <br />� <br />pi <br />�! <br />Company Name <br />Western Paoiflc Engineering & Survey, Inc. <br />v, ZE x <br />! A3G19 Q { <br />Address <br />1224 S. Pioneer Way <br />gL i,AN <br />Cli state ZIP Code <br />Y <br />Moses Lak Washington 98837 <br />1�t <br />i t <br />Signatu Date Telephone t=xt <br />I&VX A I i_..._...... [/ 1' (609) 76&1023 <br />Copy all palges of I& Elevation Certificate and ail attachments fo (1) coinmurfity official, (2) Insurance agenticompany, and (3) building owner. <br />Comments (including type of equipment and location, per C2(e), If applicable) <br />The elevation of the heat pump located outside of home was measured by using a GPS and then adding the height of the legs for the <br />heat pump. <br />FEMA Form 0864-33 (12119) Replaces all previous editions, corm Page 2 of 5 <br />