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Home My WebLink AboutELEVATION CERTIFICATE 7/13/2022 - 21-00487 - 7 E 2nd N - ShopFEMA NATIONAL FLOOD INSURANCE PROGRAM MAIN 1 [111 1 11,111,11111: INSTRUCTIONS 2015 EDITION U.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008 Federal Emergency Management Agency Expiration Date: November 30, 2018 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 agent/company, and (3) building owner. SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Policy Number: Mark Kohler A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number: Box No. 7E2nd N City State ZIP Code Rexburg Idaho 83440 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Tax Parcel No. RPRRXB10153090, Lot 3 Blk 15, Rexburg Town Site, Tax 40 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Non -Residential, storage building A5. Latitude/Longitude: Lat. N 43 49'52.40" Long. W 111 47'03.47" Horizontal Datum: ❑ NAD 1927x❑ 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 IS 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 N/A c) Total net area of flood openings in A8.b N/A sq in d) Engineered flood openings? ❑ Yes ❑x No A9. For a building with an attached garage: a) Square footage of attached garage N/A sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A9.b N/A 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 Unincorporated Areas 160217 Madison Idaho B4. Map/Panel B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood 69. Base Flood Elevation(s) Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth) Revised Date 16065CO020 D 06-03-1991 06-03-1991 AE 4864.0 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: B11. Indicate elevation datum used for BFE in Item B9: ❑x NGVD 1929 ❑ 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 FEMA Form 086-0-33 (7/15) 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: 7E2nd N City State ZIP Code Company NAIC Number Rexburg Idaho 83440 SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑x Construction Drawings* ❑ Building Under Construction* ❑ 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, ARAE, 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: Rexburg CORS. Vertical Datum: Madison Flood Study Indicate elevation datum used for the elevations in items a) through h) below. Q NGVD 1929 ❑ 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) 4865.00 Q feet ❑ meters b) Top of the next higher floor ❑ feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) ❑ feet ❑ meters d) Attached garage (top of slab) ❑ feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building ❑ feet x (Describe type of equipment and location in Comments) 4869.00 ❑ meters f) Lowest adjacent (finished) grade next to building (LAG) 4865.00 ❑x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 4865.00 0 feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including ❑ structural support feet ❑ gg62.00 x meters 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. l 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? ❑x Yes ❑ No ❑ Check here if attachments. Certifier's Name License Number Mark Jon Hokanson Idaho PLS No. 13933 81J, Titleo%,AND Survey Project Manager �pj� �G i Ep ., !'�I O� Company Name Forsgren Associates Inc. O 33 0W- 1 Address 350 North 2nd East STA 1'EoF��Pa00 '9RkJON Ha�P City State ZIP Code'Li Rexburg Idaho 83440 Signature Date Telephone Ext. 07-13-2022 (208)356-9201 Copy all nPhes this Elevation Certificate and all attachments for (1) community official, (2) insurance agenticompany, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) C2 -E: Electrical panel boxes FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 BUILDING PHOTOGRAPHS OMB No. 1660-0008 ELEVATION CERTIFICATE See Instructions for Item A6. 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: 7E2nd N City State ZIP Code Company NAIC Number Rexburg Idaho 83440 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. Photo One Photo One Photo One Caption Clear Photo One Photo Two Photo Two Photo Two Caption Clear Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. 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