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FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077 Expires December 31, 2005 ELEVATION CERTIFICATE For Insurance Company Use: Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION BUILDING OWNER'S NAME Policy Number MARK MCGURKIN BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. 1424 WHITE AVENUE Company NAIC Number CITY STATE IDAHO ZIP CODE 83843 MOSCOW. PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) QUIT CLAIM DEED #464985 BUILDING USE Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.) RESIDENTIAL/RETAIL LATITUDE/LONGITUDE (OPTIONAL) I - itti' - itit ittt" nr it# ( Jrtt rt tt trtr. rr rr oi it tt. rrrr it triT i HORIZONTAL DATUM: I_I NAD 1927 I_I NAD 1983 SOURCE: U GPS (Type): I_I USGS Quad Map I_J Other: SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER CITY OF MOSCOW 160090 B2. COUNTY NAME LATAH COUNTY B3. STATE IDAHO B4. MAP AND PANEL NUMBER [PHONE REDACTED] B5. SUFFIX B6. FIRM INDEX DATE &pril 15, 2002 B8. FLOOD ZONE(S) B7. FIRM PANEL EFFECTIVE/REVISED DATE APRIL 15, 2002 B9. BASE FLOOD ELEVATION(S) (Zone AO, use depth of flooding) 2584.0 AE D B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. I_I FIS Profile B11. Indicate the elevation datum used for the BFE in B9: IXI NGVD 1929 I NAVD 1988 I__I Other B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? I_I Yes I X I No Designation Date: IXI FIRM I_I Community Determined I_I Other (Describe): SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: Construction Drawings* I Building Under Construction* I_X_I Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number 1 (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. 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 C3a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum NGVD 1929 Conversion/Comments Elevation reference mark used _ o a) Top of bottom floor (including basement or enclosure) o b) Top of next higher floor o c) Bottom of lowest horizontal structural member (V zones only) o d) Attached garage (top of slab) o e) Lowest elevation of machinery and/or equipment servicing the building (Describe in Comments area.) o f) Lowest adjacent grade (LAG) o g) Highest adjacent grade (HAG) o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade o i) Total area of all permanent openings (flood vents) in C3h RM31 Does the elevation reference mark used appear on the FIRM? IXI Yes I_I No 2587 . ft.(m) 2597 . 8 ft.(m) ft.(m) ft.(m) 03 3003 OF <13 to -Oo> a- o 5 n E c LLi a: i—r $ CD £ -0 ~ §1 2 .5 NA . NA . . oG PS es Co 50 ~NAr . A. ft-(m) 2585 . ft.(m) 258!7_ . ft.(m) oc£\tP O' (A <13 CO NA C 8 sq. in.(sq. cm) NA 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 in Sections A, B, and C 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. CERTIFIER'S NAME LICENSE NUMBER LARRY J. HODGE IDAHO# 3003 COMPANY NAME TITLE CIVIL ENGINEER HODGE & ASSOCIATES ADDRESS CITY STATE ZIP CODE MOSCOW IDAHO 83843 TELEPHONE SIGNATURE DATE 12-02-04 (208)882-3520 -t SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS FEMA Form 81-3f/JArY2003 ---PAGE BREAK--- 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. NORTH WEST CORNER MOUNTAIN VIEW DRIVE & WHITE AVENUE Policy Number CITY STATE IDAHO ZIP CODE 83843 Company NAIC Number MOSCOW SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for community official, insurance agent/company, and building owner. COMMENTS SLAB ON GRADE STRUCTURES A c tuVrtS C cc&t ni aio \ goes.tr .rqcaha./t 1 ll'ZL I_I Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO and ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E1 through E3. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. Building Diagram Number see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) E2. The top of the bottom floor (including basement or enclosure) of the building is I_I_I ft.(m) I_I__Iin.(cm) I__I above or I_I below (check one) the highest adjacent grade. (Use natural grade, if available.) E3. For Building Diagrams 6-8 with openings (see page the next higher floor or elevated floor (elevation b) of the building is I_I__I ft.(m) I_I__Iin.(cm) I__I above the highest adjacent grade. Complete Items C3.h and C3.i on the front of form. E4. The top of the platform of machinery and/or equipment servicing the building is I__I_I ft.(m) I__I__Iin.(cm) I__I above or I_I below (check one) the highest adjacent grade. (Use natural grade, if available.) E5. For 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? I__I Yes I_I No I_I Unknown. The local official must certify this information in Section G. (Select the building diagram most similar to the building for which this certificate is being completed - SECTION F - PROPERTY OWNER (OR OWNER’S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, C (Items C3.h and C3.i only), and E for Zone A (without a FEMA-issued BFE) or community-issued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and E are correct tc the best of my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE’S NAME CITY STATE ZIP CODE ADDRESS TELEPHONE SIGNATURE DATE COMMENTS I__I 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 and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1. I_I The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. I_J A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or Zone AO. G3. I__I The following information (Items G4-G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This permit has been issued for: I__I New Construction I__I Substantial Improvement G8. Elevation of as-built lowest floor (including basement) of the building is: G9. BFE or (in Zone AO) depth of flooding at the building site is: . ^ ft.(m) Datum: W2Q ■ o ft.(m) Datum: ^gp (qz^j Q3S1 Uoh LOCAL OFFICIAL’S NAME TITLE Planner 1 TITLE COMMUNITY NAME TELEPHONEloft-£83-70^5 Qibj of \0('2G /Ifr SIGNATURE DATE COMMENTS Check here if attachments REPLACES ALL PREVIOUS EDITIONS FEMA Form 81-31, JAN 2003