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U.S. DEPARTMENT OF HOMELAND SECURITY <br />Federal Emergency Management Agency <br />National Flood Insurance Program <br />ELEVATION CERTIFICATE <br />Important: Read the instructions on pages 1-9. <br />OMB No. 1660-0008 <br />Expires March 31, 2012 <br />SECTION A - PROPERTY INFORMATION <br />For Insurance Company Use: <br />Al. Building Owner's Name <br />Policy Number <br />A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. <br />1303 EMPIRE DRIVE <br />Company NAIC Number <br />City LOUISVILLE State CO ZIP Code 80027 <br />A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) <br />LOT 1 EMPIRE ROAD SUBDIVISION, COUNTY OF BOULDER, STATE OF COLORADO <br />A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) <br />A5. Latitude/Longitude: Lat. 39.9778 Long. -105.1257 <br />A6. Attach at least 2 photographs of the building if the Certificate is being used <br />A7. Building Diagram Number 1A <br />A8. For a building with a crawlspace or enclosure(s): <br />a) Square footage of crawlspace or enclosure(s) N/A sq ft <br />b) No. of permanent flood openings in the crawlspace or <br />enclosure(s) within 1.0 foot above adjacent grade <br />c) Total net area of flood openings in A8.b <br />d) Engineered flood openings? ❑ Yes ❑ No <br />sq in <br />NON-RESIDENTIAL <br />Horizontal Datum: <br />to obtain flood insurance. <br />❑ NAD 1927 ® NAD 1983 <br />A9. For a building with an attached garage: <br />a) Square footage of attached garage 3750 sq ft <br />b) No. of permanent flood openings in the attached garage <br />within 1.0 foot above adjacent grade 0 <br />c) Total net area of flood openings in A9.b N/A sq in <br />d) Engineered flood openings? 0 Yes ® No <br />SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION <br />B1. NFIP Community Name & Community Number <br />LOUISVILLE, CITY OF <br />B2. County Name <br />BOULDER <br />B3. State <br />CO <br />B4. Map/Panel Number <br />B5. Suffix <br />B6. FIRM Index <br />B7. FIRM Panel <br />B8. Flood <br />B9. Base Flood Elevation(s) (Zone <br />08013C0557 <br />G <br />Date <br />10-4-02 <br />Effective/Revised Date <br />10-4-02 <br />Zone(s) <br />A <br />AO, use base flood depth) <br />N/A <br />B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. <br />❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe) <br />B11. Indicate elevation datum used for BFE in Item B9: I NGVD 1929 ❑ NAVD 1988 0 Other (Describe) <br />B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? <br />Designation Date ❑ CBRS ❑ OPA <br />❑ Yes ® No <br />SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) <br />CI. Building elevations are based on: ❑ Construction Drawings* 0 Building Under Construction* ® Finished Construction <br />*A new Elevation Certificate will be required when construction of the building is complete. <br />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 <br />below according to the building diagram specified in Item A7. Use the same datum as the BFE. <br />Benchmark Utilized LP-4Vertical Datum NGVD-29 <br />Conversion/Comments <br />a) <br />b) <br />c) <br />d) <br />e) <br />f) <br />9) <br />h) <br />Top of bottom floor (including basement, crawlspace, or enclosure floor) 5310.6 <br />Top of the next higher floor <br />Bottom of the lowest horizontal structural member (V Zones only) <br />Attached garage (top of slab) <br />Lowest elevation of machinery or equipment servicing the building <br />(Describe type of equipment and location in Comments) <br />Lowest adjacent (finished) grade next to building (LAG) <br />Highest adjacent (finished) grade next to building (HAG) <br />Lowest adjacent grade at lowest elevation of deck or stairs, including <br />structural support <br />N/A. <br />NIA. <br />Check the measurement used. <br />® feet ❑ meters (Puerto Rico only) <br />® feet ❑ meters (Puerto Rico only) <br />❑ feet ❑ meters (Puerto Rico only) <br />5310.6 ® feet ['meters (Puerto Rico only) <br />5310.6 ® feet ❑ meters (Puerto Rico only) <br />5307.1 <br />5310.6 <br />5306.6 <br />® feet <br />® feet <br />® feet <br />❑ meters (Puerto Rico only) <br />❑ meters (Puerto Rico only) <br />❑ meters (Puerto Rico only) <br />SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION <br />This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation <br />information. I certify that the information on this Certificate represents my best efforts to interpret the data available. <br />I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. <br />❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a <br />licensed land surveyor? ® Yes ❑ No <br />Certifier's Name JOHN B. GUYTON License Number 16406 <br />Title CHAIRMAN & CEO Company Name FLATIRONS INC. (JOB NO. 11-58,802) <br />Address 3825 IRIS AVENUE <br />City BOULDER <br />State CO ZIP Code 80301 <br />Signature 1 <br />Date <br />,ZL kit Telephone (303) 443-7001 <br />FEMA Form 81\31, Mar 09 <br />See reverse side for continuation. <br />Replaces all previous editions <br />