Laserfiche WebLink
ELEVATION CERTIFICATE <br />OMB No.1660-0008 <br />Expiration Date: November 30, 2022 <br />IMPORTANT. In these spaces, copy the corresponding Information from Section A. <br />FOR INSURANCE COMPANY USE <br />Building Street Address (including Apt, Unit, Suite, andlor Bldg. No.) or P.O. Route and Box No. <br />Policy Number; <br />3010 Dapple Gray Way <br />City State ZIP Code <br />Company NAIC Number <br />Blensburg Washington 98926 <br />SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) <br />C1. Bultding elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* 0 Finished Construction <br />*A new Elevation Certificate will be required when construction of the building Is complete. <br />C2. Elevations — Zones Al—A30, AE, AH, A (with BFF), VE, Vi V30, V (with BFE), AR, ARIA, AR/AE, ARIA1—A30, ARIAH, ARIAO. <br />Complete Items C2.a—h below according to the building diagram specified In Item AT In Puerto Rico only, enter motors. <br />Benchmark Utilized: Center of S 27, T 18 N, R 18 E Vertical Datum: NAVD 1985 <br />Indicate elevation datum used for the elevations in items a) through h) below. <br />❑ NGVD 1929 ❑x NAVD 1988 ❑ OtherlScurce: <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, crawlspac:e, or enclosure floor) <br />1598.3 r❑ feet ❑ meters <br />b) Top of the next higher floor <br />NIA ❑ Feet ❑ meters <br />c) Bottom of the lowest horizontal structural member (V zones only) <br />N/A ❑ feet ❑ meters <br />d) Attached garage (top of slab) 1598.3 0 feet ❑ meters <br />e) Lowest elevation of machinery or equt ment servicing the building 1598,2 x❑ feet ❑ meters <br />(Describe type of equipment and location In Comments) <br />f) Lowest adjacent (finished) grade next to building (LAG) 1596.8 0 feet ❑ meters <br />g) Highest adjacent (finished) grade next to building (HAG) 1597.1 0 feet ❑ meters <br />h) Lowest adjacent grade at lowest elevation of dock or stairs, Including <br />N/A ❑feet El 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 Information. <br />I certify that the. Information on this Certificate represents my beat efforts fo Interpret the data available. I understand that any false <br />statement maybe punishable by fine orlmprisonment under 18 U.S. Code, Secllon 1001. <br />Were latitude and longitude in Section A provided by a licensed land surveyor? 0 Yes ❑ No <br />❑ Check here if attachments. <br />NNIONNOWN-1411dw oil <br />Certifier's Name License Number <br />43619 <br />— <br />Rick Skinner <br />„ . S <br />P � <p ,j <br />O� WAS <br />This <br />Professional Land Surveyor <br />;� O <br />Company Name <br />Western Pacific Engineering & Survey, Inc. <br />+CA `. z; nc <br />Address <br />1224 S. Pioneer Way <br />� <br />,rS'1'4`�.�•�� <br />City state ZIP Code <br />Moses Lake Washington 98837 <br />Signal /, „ '; Date Telephone <br />Ext. <br />i (509) 766-1023 <br />Copylall pages of this Elevatlo -Certificate and all attechme fo () community official, (2) Insurance agent/company, 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 lags for the <br />heat pump. <br />FEMA Form 086-0-33 (12119) Replaces all previous editions. Form Page z of 6 <br />