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EC? 3 U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program OMB No. 1660-0008 Expiration Date: November 30, 2018 ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. Copy all pages of this Elevation Certificate and all attachments for community official, insurance agent/company, and building owner. SECTION A - PROPERTY INFORMATION FOR INSURANCE COMPANY USE A1. Building Owner's Name Moscow Mountain Sports & Physical Therapy Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 904 East White Ave Company NAIC Number: City State Idaho ZIP Code 83843 Moscow A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) S1/2 of lots 27&28 of Whites Acre Subdivision A4. Building Use Residential, Non-Residential, Addition, Accessory, etc.) Non-Residential Addition - Substantial Improvement A5. Latitude/Longitude; Lat. 46.72310 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) b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 25 c) Total net area of flood openings in A8.b d) Engineered flood openings? □ Yes IE! No Long.-116.98698 Horizontal Datum; □ NAD 1927 IXj NAD 1983 9 3343.00 sq ft 3400.00 sq In A9. For a building with an attached garage: a) Square footage of attached garage 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 d) Engineered flood openings? Q Yes [Xl No N/A sq ft N/A sq in SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B3. State Idaho B1. NFIP Community Name & Community Number City of Moscow 160090 B2. County Name Latah B9. Base Flood Elevation(s) (Zone AO, use Base Flood Depth) B8. Flood Zone(s) B4. Map/Panel Number B7. FIRM Panel Effective/ Revised Date 04-15-2002 B5. Suffix B6. FIRM Index Date 2579.0 AE [PHONE REDACTED] 05-15-1980 D B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: □ FIS Profile [Xl 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 No □ CBRS □ OPA Designation Date: Form Page 1 of 6 FEMA Form 086-0-33 (7/15) Replaces all previous editions. ---PAGE BREAK--- OMB No. 1660-0008 Expiration Date: November 30, 2018 ELEVATION CERTIFICATE IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 904 East White Ave FOR INSURANCE COMPANY USE Policy Number: City State Idaho Company NAIC Number ZIP Code 83843 Moscow SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: □ Construction Drawings* □ Building Under Construction* [jgj 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), VE, 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-29 Indicate elevation datum used for the elevations in items a) through h) below. IXI NGVD 1929 □ NAVD 1988 □ Other/Source: Datum used for building elevations must be the same as that used for the BFE. Vertical Datum: NGVD 1929 Check the measurement used. □ meters □ meters □ meters □ meters feet 2578.50 a) Top of bottom floor (including basement, crawlspace, or enclosure floor) b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) g) Highest adjacent (finished) grade next to building (HAG) h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support feet 2581.90 □ feet □ feet N/A N/A [2 feet □ meters Q meters □ meters 2580.70 0 feet 2579.70 [3 feet 2580.50 meters feet 2579.80 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. Were latitude and longitude in Section A provided by a licensed land surveyor? 0Yes Q No □ Check here if attachments. Certifier's Name John L. Dunn, PLS License Number 10162 AXfi Title Land Surveyor Company Name Rim Rock Consulting, Inc. 10162 On 50 & Address 129 W 3rd St. Ste. 102 City State ZIP Code 83843 Moscow Idaho Signature Telephone (208) 883-5339 Ext. Date , Copy all pages of this Elevation Certificate and all attachments for community official, insurance agent/company, and building owne Comments (including type of equipment and location, per C2(e), if applicable) Form Page 2 of 6 FEMA Form 086-0-33 (7/15) Replaces all previous editions. ---PAGE BREAK--- BUILDING PHOTOGRAPHS OMBNo. 1660-0008 Expiration Date: November 30, 2018 ELEVATION CERTIFICATE See Instructions for Item A6. IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 904 East White Ave FOR INSURANCE COMPANY USE Policy Number: City Moscow State Idaho ZIP Code 83843 Company NAIC Number 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 "RearView"; 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. . si s i pi i. 11 r •r,’y Photo One Clear Photo One Photo One Caption SOUTHEAST CORNER OF 904 E. WHITE AVE. FACING NORTHWEST - 04/03/2014 ' Vi , . . JP Wflti t . . mm m 1 i 1 ■ 1 11 . i ■ : v i . If ; IK <1 v m ii . - 1 t i m j M m . itv;1 . - i; i-i v> , mm Photo Two Photo Two Caption SOUTHWEST CORNER OF 904 E. WHITE AVE. FACING NORTHEAST - 04/03/2014 Clear Photo Two Form Page 5 of 6 FEMA Form 086-0-33 (7/15) Replaces all previous editions. ---PAGE BREAK--- BUILDING PHOTOGRAPHS * OMB No. 1660-0008 Expiration Date: November 30, 2018 ELEVATION CERTIFICATE Continuation Page IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 904 East White Ave FOR INSURANCE COMPANY USE Policy Number: City Moscow State Idaho ZIP Code 83843 Company NAIC Number 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. i f \ •1 Vmk y JS fe’- j . o i i IS r t31, > . Iva-' & ! Kit 3 f i vm ■ >n > ■ ■ ,'A.m ;II: : 5 j. B : i ■ •mm 344; HUM Photo Three Clear Photo Three Photo Three Caption NORTHWEST CORNER OF 904 E. WHITE AVE. FACING SOUTHEASST - 04/03/2014 [U j w . jew.' \I J : V & y : ■ ■ * ’ \ : .v.rV I'i.y ■ V.-i> .’is -•ft*1; y?]c 81 TV: ''hnih rtf* v ■ SUSSft Photo Four Photo Four Caption NORTHEAST CORNER OF 904 E. WHITE AVE. FACING SOUTHWEST - 04/03/2014 Clear Photo Four Form Page 6 of 6 FEMA Form 086-0-33 (7/15) Replaces all previous editions.