HomeMy WebLinkAboutREVISED ELEVATION CERTIFICATE - 22-00159 - Java Express Rexburg - Flood PlainELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON PAGES 9-19
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.: FOR INSURANCE COMPANY USE
Policy Number:
565 N 2nd E
City: Rexburg State: ID ZIP Code: 83440
Company NAIC Number:
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations are based on: Construction D raw i ngs * Building Under Construction* Z Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations - Zones A1—A30, AE, AH, AO, A (with BFE). VE. V1—V30, V (with BFE). AR, AR/A, AR/AE, AR/Al—A30. ARIAH, AR/AO,
A99. 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 NAVD 1988 Other:
Datum used for building elevations must be the same as that used for the BFE. Conversion factor used? Yes No
If Yes, describe the source of the conversion factor in the Section D Comments area.
Check the measurement used:
a)Top of bottom floor (including basement, crawlspace, or enclosure floor): 4,866.64 Z feet meters
b)Top of the next higher floor (see Instructions): feet meters
c)Bottom of the lowest horizontal structural member (see Instructions): feet meters
d)Attached garage (top of slab): feet meters
e)Lowest elevation of Machinery and Equipment (M&E) servicing the building
(describe type of M&E and location in Section D Comments area): 4,870.64 feet meters
f)Lowest Adjacent Grade (LAG) next to building: Natural Z Finished 4,866.51 feet meters
g)Highest Adjacent Grade (HAG) next to building: Natural N Finished 4,866.89 feet meters
h)Finished LAG at lowest elevation of attached deck or stairs, including structural
support: feet 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 state law to certify elevation
information. / certify that the information on this Certificate represents my best efforts to interpret the data available. / understand that any
false statement maybe 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? N Yes No
Check here if attachments and describe in the Comments area.
Certifier's Name: Frank W. Peterson License Number: 14750
Title: Owner/Operator G EN 61
Company Name: Peterson Land Surveying, PLLC. (L&
747 Address: 5234 Thunder Dr. j
City: Idaho Falls State: ID ZIP Code: 83406 \
Signature Date A
Telephone: (208) 313-5033 Ext.: N/A Email: fpeterson3@hotmail.com Place Seal Here
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company. and (3) building owner.
Comments (including source of conversion factor in C2: type of equipment and location per C2.e; and description of any attachments):
Lowest elevation of machinery or equipment servicing the building is a water heater inside the building.
HVAC units are located on the rooftop.
FEMA Form FF-206-FY-22-152 (formerly 086-0-33) (10/22) Page 3 of 19