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BLD20140407 ELEVATION CERTIFICATE - FINAL.pdfMICROFILM U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION I I T IOMB N0. 1660-0008 FEDERAL EMERGENCY MANAGEMENT AGENCY Expiration Date. July 31, 2015 Nacional Flood Insurance Program IMPORTANT: Follow the instructions on pages 1-9. - SECTION A ® PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Ardsley Homes, LLC Policy Number: A2, BuildingStreet Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company MAIC Number: 732 - 243rd PL SW State ZIP Code 9,8026 City Edmonds WA A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 7 - plat of Shoreshire, as recorded under Snohomish County Auditor's File No. 201407165001 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Reside tial A5. Latitude/ Longitude: Lat. 47 7790° Long. -J 222-334�- 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 9_ A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: 1,598 s ft a) Square footage of attached garage 578 sq ft a) Square footage of crawlspace or enclosure(s) q b) Number of permanent flood openings in the crawlspace 16 b) Number of permanent flood openings in the attached garage or enclosure(s) within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade 1) c) Total net area of flood openings in A8.b 783 sq in c) Total net area of flood openings in A9.b 0 sq in d) Engineered flood openings? ❑ Yes R No d) Engineered flood openings? ❑ Yes R No acn,rnni o _ m nnn imci rRANflP RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name B3. State WA City of Edmonds 530163 B4. Map/Panel Number B5. Suffix B6. FIRM index Date Snohomish B7. FIRM Panel Effective/ _ 68. Flood Zone(s) B9. Base Flood Elevation(s) (Zone A0, use base flood depth) 53061C/1315 E 11/08/1999 Revised Date 11/08/1999 A 286.14 ft B10. Indicate the source of the Base Flood Elevation (uFL) data or base Ttooa aeprn C - — It I ,«,,, ❑ FIS Profile ❑ FIRM ® Community Determined ❑ Other/Source: - B11.Indicate elevation datum used for BFE in Item B9: ❑ 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 R No Designation Date: / / ❑ CBRS ❑ OPA C,1:f`Trn1d r- _ Rim nING ELEVATION INFORMATION (SURVEY REQUIRED) C1, Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* IN Fimsnea uonstrucuon *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, AR/AE, AR/Al-A30, AR/AH, AR/A0, Complete Items C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: WCCS SURVEY DATABASE Pt. ID 175 vertical Datum: NAVD 88 It (d Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 ® NAVD 1988 ❑ Other/Source: f 1 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) 286 , 20 _ 14 b) Top of the next higher floor 289 NI A NIA N/A N/ c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) 57 280 93 e) Lowest elevation of machinery or equipment servicing the building N1 feet (Describe type of equipment and location in Comments) 28710 f) Lowest adjacent (finished) grade next to building (LAG) 288 80 g) Highest adjacent (finished) grade next to building (HAG) — N/A N/A h) Lowest adjacent grade at lowest elevation of deck or stairs, including 'D t structural support ❑ meters ®feet ❑ meters r tf R feet ❑ meters 19 feet ❑ meters' t N1 feet 0 metersC f mm„^„r f R feet ❑ meters © feet ❑ meters 'D t ® feet ❑ meters d 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 law to certify elevation information. I 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. g Check here if comments are provided on back of form. Were latitude and longitude in section A provided by a Q Check here if attachments. licensed land surveyor? ® Yes ❑ No ;ertiflar's Name License Number 29291 Charles A. Richardson - ride Land Surveyor Company NameSummit Surveying Inc. 4ddress City state ZIP Cnde 12606 - 82nd Ave. NE Kirkland WA 98034 Signature Date Telephone A �� (� (425) 814-8487 A�. ELEVATION CERTIFICATE, page 2 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: 7532 - 243rd PL SW Company NAIC Number: City State ZIP Code Edmonds WA 98026 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Cnnv both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments Section C2.e Elevation measured on top of hot water heater platform on floor of garage. Signature - Date ® Z 1Z / SECTION E -BUIL G 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 LOMB -F request, complete Sections A, Rand 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). a) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawispace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. 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 ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F — PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION 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 Signature Date Telephone Comments ❑ Check here if attachments. 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 (withouta 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 G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: G9. BFE or (in Zone AO) depth of flooding at the building site: G10.Community's design flood elevation: Local Official's Name Community Name Signature Comments Title Telephone nate Date Certificate ❑ feet ❑ meters Datum ❑ feet ❑ meters Datum ❑ feet ❑ meters Datum Fl Check here if attachments. ELEVATION CERTIFICATE, page 3 BUILDING PHOTOGRAPHS See Instructions for Item A6. ELEVATION CERTIFICATE, page 4 BUILDING PHOTOGRAPHS Continuation Page