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Home My WebLink AboutFLOOD CERTIFICATE - 19-00780 - 500 N 2nd E - DL Evans BankU.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program OMB No. 1660-0008 Expiration Date: November 30, 2022 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 agent/company, and (3) building owner. FEMA Form 086-0-33 (12/19) Replaces all previous editions.Form Page 1 of 6 A1. Building Owner's Name A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. City State ZIP Code Policy Number: Company NAIC Number: A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) A5. Latitude/Longitude:Lat. Long. 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 A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b sq in d) Engineered flood openings?Yes No A9. For a building with an attached garage: a) Square footage of attached garage sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade c) Total net area of flood openings in A9.b sq in d) Engineered flood openings?Yes No SECTION B – FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name B3. State B4. Map/Panel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel Effective/ Revised Date B8. Flood Zone(s) B9. Base Flood Elevation(s) (Zone AO, use Base Flood Depth) 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: NGVD 1929 NAVD 1988 Other/B11. Indicate elevation datum used for BFE in Item B9: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 FOR INSURANCE COMPANY USESECTION A – PROPERTY INFORMATION D.L. Evan's Bank 500 N 2nd E Rexburg Idaho 83440 Tax Parcel No. RPR6N40E204150 (0.636 Acres) Non-Residential 43-50-12.75140 111-46-37.90321 1A City of Rexburg 160098 Madison Idaho 0020 D 06-03-1991 06-03-1991 AE 4866.0 OMB No. 1660-0008 Expiration Date: November 30, 2022 ELEVATION CERTIFICATE 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: 500 N 2nd E City State ZIP Code Company NAIC Number Rexburg Idaho 83440 SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: Construction Drawings* 0 Building Under Construction* Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations - Zones A1—A30, AE, AH, A (with BFE), yE, 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: RM 3 Vertical Datum: NGVD 1929 Indicate elevation datum used for the elevations in items a) through h) below. NGVD 1929 D 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) 4868.8 feet fl meters b)Top of the next higher floor N/A fl feet fl meters c)Bottom of the lowest horizontal structural member (V Zones only) N/A D feet meters d)Attached garage (top of slab) N/A D feet meters e)Lowest elevation of machinery or equipment servicing the building N/A feet D meters (Describe type of equipment and location in Comments) f)Lowest adjacent (finished) grade next to building (LAG) 4868.2 NI feet E meters g)Highest adjacent (finished) grade next to building (HAG) 4868.8 NI feet fl meters h)Lowest adjacent grade at lowest elevation of deck or stairs, including N/A fl 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. / 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. Were latitude and longitude in Section A provided by a licensed land surveyor? NI Yes El No fl Check here if attachments. Certifier's Name License Number Frank W. Peterson 14750 pL LA \,\GEN Title Owner/Operator (14750 Company Name Peterson Land Surveying, PLLC. ) cs 0 Address 5234 Thunder Dr. OF City State ZIP Code Idaho Falls Idaho 83406 " PE ' Signature " Date Telephone Ext. A/i ip (208) 313-5033 N/A 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) HVAC located on roof. FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2022 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE FEMA Form 086-0-33 (12/19) Replaces all previous editions. State ZIP CodeCity Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number Policy Number: 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). b) Top of bottom floor (including basement, crawlspace, or enclosure) is a) Top of bottom floor (including basement, crawlspace, or enclosure) is feet meters above or below the HAG. metersfeet below the LAG.above or SECTION F – PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION E2. For Building Diagrams 6–9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 1–2 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is feet meters above or below the HAG. feet meters above or below the HAG.E3. Attached garage (top of slab) is 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 Unknown.No The local official must certify this information in Section G. 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 or Owner's Authorized Representative's Name Address City State ZIP Code Telephone Comments DateSignature Check here if attachments. Form Page 3 of 6 Idaho 83440Rexburg 500 N 2nd E N/A N/A N/A N/A N/A ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2022 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE FEMA Form 086-0-33 (12/19) Replaces all previous editions. ZIP CodeStateCity Company NAIC Number Policy Number:Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 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 G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued G7. This permit has been issued for:New Construction 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 meters Datum G10. Community's design flood elevation:feet meters Datum Comments (including type of equipment and location, per C2(e), if applicable) Local Official's Name Title TelephoneCommunity Name Date Check here if attachments. Signature Form Page 4 of 6 83440IdahoRexburg 500 N 2nd E ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2022 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE FEMA Form 086-0-33 (12/19) Replaces all previous editions. BUILDING PHOTOGRAPHS See Instructions for Item A6. Policy Number: Company NAIC NumberZIP CodeStateCity Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 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 A8. If submitting more photographs than will fit on this page, use the Continuation Page. Form Page 5 of 6 Photo One Photo One Caption Photo Two Photo Two Caption 83440IdahoRexburg 500 N 2nd E Front View Left View Clear Photo One Clear Photo Two ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2022 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE FEMA Form 086-0-33 (12/19) Replaces all previous editions. BUILDING PHOTOGRAPHS Continuation Page Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: Company NAIC NumberZIP CodeStateCity 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. Form Page 6 of 6 Photo Three Photo Three Caption Photo Four Photo Four Caption 500 N 2nd E 83440IdahoRexburg Rear View Right/Rear View Clear Photo Three Clear Photo Four