HomeMy WebLinkAboutElevation Certificate Building JNational Flood Insurance Program
Elevation
Certificate
and Instructions
2023 EDITION
FEMA
OMB Control No. 1660-0008
U.S. DEPARTMENT OF HOMELAND SECURITY Expiration Date: 06/30/2026
Federal Emergency Management Agency
National Flood Insurance Program
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Public reporting burden for this data collection is estimated to average 3.75 hours per response. The burden estimate includes the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting this
form. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send
comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections
Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street SW, Washington, DC 20742,
Paperwork Reduction Project (1660-0008). NOTE: Do not send your completed form to this address.
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Authority: Title 44 CFR § 61.7 and 61.8.
Principal Purpose(s): This information is being collected for the primary purpose of documenting compliance with National Flood
Insurance Program (NFIP) floodplain management ordinances for new or substantially improved structures in designated Special Flood
Hazard Areas. This form may also be used as an optional tool for a Letter of Map Amendment (LOMA), Conditional LOMA (CLOMA),
Letter of Map Revision Based on Fill (LOMR-F), or Conditional LOMR-F (CLOMR-F), or for flood insurance rating purposes in any flood
zone.
Routine Use(s): The information on this form may be disclosed as generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act of
1974, as amended. This includes using this information as necessary and authorized by the routine uses published in DHS/ FEMA-003
— National Flood Insurance Program Files System of Records Notice 79 Fed. Reg. 28747 (May 19, 2014) and upon written request, written
consent, by agreement, or as required by law.
Disclosure: The disclosure of information on this form is voluntary; however, failure to provide the information requested may impact the
The Elevation Certificate is an important administrative tool of the NFIP. It can be used to provide elevation information necessary to
ensure compliance with community floodplain management ordinances, to inform the proper insurance premium, and to support a request
for a LOMA, CLOMA, LOMR-F, or CLOMR-F.
The Elevation Certificate is used to document floodplain management compliance for Post -Flood Insurance Rate Map (FIRM) buildings,
which are buildings constructed after publication of the FIRM, located in flood Zones Al—A30, AE, AH, AO, A (with Base Flood Elevation
(BFE)), VE, VI—V30, V (with BFE), AR, AR/A, AR/AE, AR/A1—A30, AR/AH, AR/AO, and A99. It may also be used to provide elevation
information for Pre -FIRM buildings or buildings in any flood zone.
As part of the agreement for making flood insurance available in a community, the NFIP requires the community to adopt floodplain
management regulations that specify minimum requirements for reducing flood losses. One such requirement is for the community to
obtain the elevation of the lowest floor (including basement) of all new and substantially improved buildings, and maintain a record of such
information. The Elevation Certificate provides a way for a community to document compliance with the community's floodplain
management ordinance.
Use of this certificate does not provide a waiver of the flood insurance purchase requirement. Only a LOMA or LOMR-F from the Federal
Emergency Management Agency (FEMA) can amend the FIRM and remove the federal mandate for a lending institution to require the
purchase of flood insurance. However, the lending institution has the option of requiring flood insurance even if a LOMA/LOMR-F has been
issued by FEMA. The Elevation Certificate may be used to support a LOMA, CLOMA, LOMR-F, or CLOMR-F request. Lowest Adjacent
Grade (LAG) elevations certified by a land surveyor, engineer, or architect, as authorized by state law, will be required if the certificate is
used to support a LOMA, CLOMA, LOMR-F, or CLOMR-F request. A LOMA, CLOMA, LOMR-F, or CLOMR-F request must be submitted
with either a completed FEMA MT-EZ or MT-1 application package, whichever is appropriate. If the certificate will only be completed to
support a LOMA, CLOMA, LOMR-F, or CLOMR-F request, there is an option to document the certified LAG elevation on the Elevation
Form included in the MT-EZ and MT-1 application.
This certificate is used only to certify building elevations. A separate certificate is required for floodproofing. Under the NFIP,
non-residential buildings can be floodproofed up to or above the BFE. A floodproofed building is a building that has been designed and
constructed to be watertight (substantially impermeable to floodwaters) below the BFE. Floodproofing of residential buildings is not
permitted under the NFIP unless FEMA has granted the community an exception for residential floodproofed basements. The community
must adopt standards for design and construction of floodproofed basements before FEMA will grant a basement exception. For both
floodproofed non-residential buildings and residential floodproofed basements in communities that have been granted an exception by
FEMA, a floodproofing certificate is required.
The expiration date on the form herein does not apply to certified and completed Elevation Certificates, as a completed Elevation
Certificate does not expire, unless there is a physical change to the building that invalidates information in Section A Items A8 or A9,
Section C, Section E, or Section H. In addition, this form is intended for the specific building referenced in Section A and is not invalidated
by the transfer of building ownership.
FEMA Form FF-206-FY-22-152 (formerly 086-0-33) (8/23) Form Page 1 of 8
OMB Control No. 1660-0008
Form Instructions U.S. DEPARTMENT OF HOMELAND SECURITY Expiration Date: 06/30/2026
Federal Emergency Management Agency
National Flood Insurance Program
IIrIIPORTPNT:.MUST�OLL T RLICTIQNS5MM
5)TRUrancO AGES 1-11
Copy all pages of this levatlon ertlflcate an all attac ments or 1 community agent/company, and (3) building
SECTION A- PROPERTY INFORMATION
FOR INSURANCE COMPANY USE
Al. Building Owner's Name: U-HAUL International
Policy Number:
AN2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box
3h North 2nd East Bldg. J
Company NAIC Number:
City: Rexburg State: ID ZIP Code: 83440
A3. Property Description (e.g., Lot and Block Numbers or Legal Description) and/or Tax Parcel Number:
RPR0000002001 A
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.): Commercial
A5. Latitude/Longitude: Lat. 43.8322 Long. 111.7758 Horiz. Datum: ❑ NAD 1927 ❑✓ NAD 1983 ❑ WGS 84
A6. Attach at least two and when possible four clear color photographs (one for each side) of the building (see Form pages 7 and 8).
A7. Building Diagram Number: 1B
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s): NA sq. ft.
b) Is there at least one permanent flood opening on two different sides of each enclosed area? ❑ Yes ❑ No ❑✓ N/A
c) Enter number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade:
Non -engineered flood openings: NA Engineered flood openings: NA
d) Total net open area of non -engineered flood openings in A8.c: NA sq. in.
e) Total rated area of engineered flood openings in A8.c (attach documentation - see Instructions): NA sq. ft.
f) Sum of A8.d and A8.e rated area (if applicable - see Instructions): NA sq. ft.
A9. For a building with an attached garage:
a) Square footage of attached garage: NA sq. ft.
b) Is there at least one permanent flood opening on two different sides of the attached garage? ❑ Yes ❑ No ❑✓ N/A
c) Enter number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade:
Non -engineered flood openings: NA Engineered flood openings: NA
d) Total net open area of non -engineered flood openings in A9.c: NA sq. in.
e) Total rated area of engineered flood openings in A9.c (attach documentation -see Instructions): NA sq. ft.
f) Sum of A9.d and A9.e rated area (if applicable - see Instructions): NA sq. ft.
SECTION B - FLOOD, INSURANCE, RATE MAP (FIRM) INFORMATION
B1.a. NFIP Community Name: Rexburg, City of B1.b. NFIP Community Identification Number: 160098
B2. County Name: Madison B3. State: ID B4. Map/Panel No.: 16065CO020 B5. Suffix: D
B6. FIRM Index Date: 0610311991 B7. FIRM Panel Effective/Revised Date: 0610311991
B8. Flood Zone(s): AE B9. Base Flood Elevation(s) (BFE) (Zone AO, use Base Flood Depth): 4867.2
B10. Indicate the source of the BFE data or Base Flood Depth entered in Item B9:
❑✓ FIS ❑ FIRM ❑ Community Determined ❑ Other:
B11. Indicate elevation datum used for BFE in Item B9: ❑✓ NGVD 1929 ❑ NAVD 1988 ❑ Other/Source:
B12. Is NsW14limlocated in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ❑✓ No
Date: ❑ CBRS ❑ OPA
B13. Is the building located seaward of the Limit of Moderate Wave Action (LiMWA)? ❑ Yes Z No
FEMA Form FF-206-FY-22-152 (formerly 086-0-33) (8/23) Form Page 2 of 8
Form Instructions ELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON INSTRUCTION PAGES 1-11
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.:
FOR INSURANCE COMPANY USE
Policy Number:
328 North 2nd East Bldg. J
City: Rexburg State: ID ZIP Code: 83440
Company NAIC Number:
SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ 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, AO, A (with BFE), VE, VI—V30, V (with BFE), AR, AR/A, AR/AE, AR/A1—A30, AR/AH, AR/AO,
A99. Complete Items C2.a—h below according to the Building Diagram specified in Item AT In Puerto Rico only, enter meters.
Benchmark Utilized: NA Vertical Datum: NAVD 1988
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): 4870.9 ❑✓ fee ❑ meter
b) Top of the next higher floor (see Instructions): NA ❑ fee ❑ metert
c) Bottom of the lowest horizontal structural member (see Instructions): NA ❑ fee El meter
t
d) Attached garage (top of slab): NA El{ee El
s
e) Lowest elevation of Machinery and Equipment (M&E) servicing the building
meter
(describe type of M&E and location in Section D Comments area): 4871.9 {ee ❑
f) Lowest Adjacent Grade (LAG) next to building: ❑✓ Natural ❑ Finished 4870.0 fee ❑ meter
g) Highest Adjacent Grade (HAG) next to building: ❑✓ Natural ❑ Finished 4870.6 fee ❑ meter
s
h) Finished LAG at lowest elevation of attached deck or stairs, including structural
meter
support: NA El{ee ❑
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. 1 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? ❑✓ Yes ❑ No
❑✓ Check here if attachments and describe in the Comments area.
Certifier's Name: Clint Jolley License Number: 15571
LA N#°e9�
Title: PLS
�r�`®�
Company Name: HLE
Address: 101 S Park Ave. Suite 210�
City: Idaho Falls State: ID ZIP Code: 83402
Telephone: (208) 524-0212 Ext.: Email: clintj@hleinc.com �yOF �`
R�U
Signature: Date: 1010112024 Place�8eal Here
Copy all pages of this Ele tion 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):
The lowest equipment is a power box.
FEMA Form FF-206-FY-22-152 (formerly 086-0-33) (8/23) Form Page 3 of 8
Form Instructions IELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON INSTRUCTION PAGES 1-11
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.:
FOR INSURANCE COMPANY USE
Policy Number:
328 North 2nd East Bldg. J
City: Rexburg State: ID ZIP Code: 83440
Company NAIC Number:
SECTION E - BUILDING MEASUREMENT INFORMATION (SURVEY NOT REQUIRED)
. FOR ZONE `AO, ZONE AR/AO, AND ZONE A (WITHOUT BFE)
For Zones AO, AR/AO, and A (without BFE), complete Items E1—E5. For Items E1—E4, use natural grade, if available. If the Certificate is
intended to support a Letter of Map Change request, complete Sections A, B, and C. Check the measurement used. In Puerto Rico only,
enter meters.
Building measurements are based on: ❑ Construction Drawings* ❑ Building Under Construction* ❑ Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
El. Provide measurements (C.2.a in applicable Building Diagram) for the following and check the appropriate boxes to show whether the
measurement is above or below the natural HAG and the LAG.
a) Top of bottom floor (including
meter
basement,crawlspace, or enclosure) is: El feet [I ❑ above or ❑ below the HAG.
s
b) Top of bottom floor (including
meter
basement,crawlspace, or enclosure) is: E] feet ❑ ❑ above or ❑ below the LAG.
s
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 (C2.b in applicable
meter
Building Diagram) of the building is: El feet ❑ ❑ above or ❑ below the HAG.
E3. Attached garage (top of slab) is: ❑ feet ❑ meter ❑ above or ❑ below the HAG.
s
E4. Top of platform of machinery and/or equipment meter
servicing the building is: El feet El El above or ❑ below the HAG.
s
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 ❑ No ❑ Unknown The local official must certify this information in Section G.
SECTION F = PROPERTY OWNER. OR OWNER'S AUTHORIZED REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without BFE) or Zone AO must
sign here. The statements in Sections A, B, and E are correct to the best of my knowledge
❑ Check here if attachments and describe in the Comments area.
Property Owner or Owner's Authorized Representative Name:
Address:
City: State: ID ZIP Code:
Telephone: Ext.: Email:
Signature: Date:
Comments:
FEMA Form FF-206-FY-22-152 (formerly 086-0-33) (8/23) Form Page 4 of 8
Form Instructions IELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON INSTRUCTION PAGES 1-11
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.:
FOR INSURANCE COMPANY USE
Policy Number:
328 North 2nd East Bldg. J
City: Rexburg State: ID ZIP Code: 83440
Company NAIC Number:
SECTION G —COMMUNITY INFORMATION (RECOMMENDED FOR COMMUNITY OFFICIAL COMPLETION)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
Section A, B, C, E, G, or H of this Elevation Certificate. Complete the applicable item(s) and sign below when:
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 state law to certify elevation information. (Indicate the source and date of the
elevation data in the Comments area below.)
G2.a. ❑ A local official completed Section E for a building located in Zone A (without a BFE), Zone AO, or Zone AR/AO, or when item
E5 is completed for a building located in Zone AO.
G2.b. ❑ A local official completed Section H for insurance purposes.
❑ Inthe Comments area of Section G, the local official describes specific corrections to the information in Sections A, B, E and
G3.
G4. ❑ The following information (Items G5—G11) is provided for community floodplain management purposes.
G5. Permit Number: G6. Date Permit Issued:
G7. Date Certificate of Compliance/Occupancy Issued:
G8. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement
G9.a. Elevation of as -built lowest floor (including basement) of the
building: ❑ feet ❑ meters Datum:
G9.b. Elevation of bottom of as -built lowest horizontal structural
member: ❑ feet ❑ meters Datum:
G10.a. BFE (or depth in Zone AO) of flooding at the building site: ❑ feet ❑ meters Datum:
G10.b. Community's minimum elevation (or depth in Zone
AO)requirement for the lowest floor or lowest horizontal
structural member:
❑ feet El meters Datum:
G11. Variance issued? ❑ Yes ❑ No If yes, attach documentation and describe in the Comments area.
The local official who provides information in Section G must sign here. 1 have completed the information in Section G and certify that it is
correct to the best of my knowledge. If applicable, I have also provided specific corrections in the Comments area of this section.
Local Official's Name: Title:
NFIP Community Name:
Telephone: Ext.: Email:
Address:
City: State: ZIP Code:
Signature: Date:
Comments (including type of equipment and location, per C2.e; description of any attachments; and corrections to specific information in
Sections A, B, D, E, or H):
FEMA Form FF-206-FY-22-152 (formerly 086-0-33) (8/23) Form Page 5 of 8
Form Instructions ELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON INSTRUCTION PAGES 1-11
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.:
FOR INSURANCE COMPANY USE
Policy Number:
328 North 2nd East Bldg. J
City: Rexburg State: ID ZIP Code: 83440
Company NAIC Number:
SECTION H - BUILDING'S FIRST FLOOR HEIGHT INFORMATION FOR ALL ZONES
(SURVEY NOT REQUIRED) (FOR INSURANCE,PURPOSES ONLY) '
The property owner, owner's authorized representative, or local floodplain management official may complete Section H for all flood zones
to determine the building's first floor height for insurance purposes. Sections A, B, and I must also be completed. Enter heights to the
nearest tenth of a foot (nearest tenth of a meter in Puerto Rico). Reference the Foundation Type Diagrams (at the end of Section H
Instructions) and the appropriate Building Diagrams (at the end of Section I Instructions) to complete this section.
H1. Provide the height of the top of the floor (as indicated in Foundation Type Diagrams) above the Lowest Adjacent Grade (LAG):
a) For Building Diagrams 1A, 1 B, 3, and 5-8. Top of bottom ❑ feet ❑ meters ❑ above the LAG
floor (include above -grade floors only for buildings with
crawlspaces or enclosure floors) is:
b) For Building Diagrams 2A, 213, 4, and 6-9. Top of next ❑ feet ❑ meters ❑ above the LAG
higher floor (i.e., the floor above basement, crawlspace, or
enclosure floor) is:
H2. Is all Machinery and Equipment servicing the building (as listed in Item H2 instructions) elevated to or above the floor indicated by the
H2 arrow (shown in the Foundation Type Diagrams at end of Section H instructions) for the appropriate Building Diagram?
❑ Yes ❑ No
SECTION I =; PROPERTY OWNER (OR OWNER'S AUTHORIZED REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B, and H must sign here. The statements in Sections
A, B, and H are correct to the best of my knowledge. Note: If the local floodplain management official completed Section H, they should
indicate in Item G2.b and sign Section G.
❑ Check here if attachments are provided (including required photos) and describe each attachment in the Comments area.
Property Owner or Owner's Authorized Representative Name:
Address:
City: State: ZIP Code:
Telephone: Ext.: Email:
Signature: Date:
Comments:
FEMA Form FF-206-FY-22-152 (formerly 086-0-33) (8/23) Form Page 6 of 8
Form_ Instructions ELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON INSTRUCTION PAGES 1-11
BUILDING PHOTOGRAPHS
See Instructions for Item A6.
FEMA Form FF-206-FY-22-152 (formerly 086-0-33) (8/23) Form Page 7 of 8
Form Instructions:]ELEVATION CERTIFICATE
IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON INSTRUCTION PAGES 1-11
BUILDING PHOTOGRAPHS
Continuation Page
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.: FOR INSURANCE COMPANY USE
328 North 2nd East Bldg. J
Policy Number:
City: Rexburg State: ID ZIP Code: 83440
Company NAIC Number:
Insert the third and fourth photographs below. Identify all photographs with the date taken and "Front View," 'Rear View," 'Right Side
View," or "Left Side View." When flood openings are present, include at least one close-up photograph of representative flood openings or
vents, as indicated in Sections A8 and A9.
Photo Three
Photo Three Caption:
Clear Photo Three
Photo Four
Photo Four Caption: Clear Photo Four
FEMA Form FF-206-FY-22-152 (formerly 086-0-33) (8/23) Form Page 8 of 8