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RC-0072-2022 S s Office Use Only ADDITION/ALTERATION PERMIT Permit it: APPLICATION Permit Fee: $ l-AQ •25 Town of Queensbury 742 Bay Road,Queensbury,NY 12804 Invoice#: 1�0�1(o P:518-761-8256 www.gueensbury.net ,n�� Flood Zone? N Reviewed Byt- Project Location: Tax Map ID#: 141 Subdivision Name: E C 15 n FEB 2 4 2022 PROJECT INFORMATION: TOWN OF QUEENSSURY / BUILDING&MODES � TYPE: Residential Commercial, Proposed Use: ��A� _Single-Family Two-Family _Multi-Family (#of units ) _Townhouse Business Office _Retail _ Industrial/Warehouse _Garage (#of cars_) Other(describe ) ADDITION SQUARE FOOTAGE: ALTERATION SQUARE FOOTAGE: 1st floor: 1st floor: 2nd floor: 2nd floor: 3rd floor: 3rd floor: Basement (habitable space): Basement (habitable space): Total sq ft: Total sq ft: Scope of work to be done: r �ccy� �� Pr ���s o Addition/Alteration Application Revised January 2021 ry ADDITIONAL PROJECT INFORMATION: �( 1. Estimated Cost of Construction: $ v� � `-` —Propane 2. Source of Heat (circle one): Gas Oil Solar Other — Fireplaces/inserts need a separate Fuel Burning Applian es & Chimney Application 3. Are there any structures not shown on the plot plan? YES NO Explain: 4. Are there any easements on the property? —YES VINO SITE INFORMATION: • Is this a corner lot? _YES i/ NO • Will the grade be changed as a result of the co truction? —YES /NO • What is the water source? _PUBLIC J PRIVATE WELL • What type of wastewater system is on the parcel? SEWER PRIVATE SEPTIC DECLARATION: 1. 1 acknowledge that no construction shall be commenced prior to the issuance of a valid permit and will be completed within a 12 month period.Any changes to the approved plans prior to/during construction will require the submittal of amended plans, additional reviews and re-approval. 2. If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of Queensbury.After 1 year from the initial application date, 100%of the fee is retained. 3. If the work is not completed by the 1 year expiration date the permit may be renewed, subject to fees and department approval. 4. 1 certify that the application, plans and supporting materials are a true and a complete statement and/or description of the work proposed,that all work will be performed in accordance with the NYS Building Codes, local building laws and ordinances, and in conformance with local zoning regulations. 5. 1 acknowledge that prior to occupying the facilities proposed I, or my agents, will obtain a certificate of occupancy. 6. 1 also understand that I/we are required to provide an as-built survey by a licensed land surveyor of all newly constructed facilities prior to issuance of a certificate of occupancy. I have read and agree to the above: PRINT NAME: �� 1G drl1 dKO of (6S Al 0 ?tqVr. �lf� ���• ��?� SIGNATURE: DATE: Addition/Alteration Application Revised January 2021 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • t•Applican ��--��� Name(s): Pro PeS%�onCCt' r1��� `J�-c�OUrabb o G('nv i Mailing Address, C/S/Z: 02o Cen fmI A-u ran u F� A(loanq I\ i iJJxe)T Cell Phone: ( 5c� ) 93Jc- � �f��{ Land Line: Email: 17 J P 4SS b A-01r-Co Ir Co ff) • Primary Owner(s): tt + Name(s): Mailing Address, C/S/Z: 11 _017N IP-11EW Via, I--ArC lqq Cell Phone: ( 5I6) &6 a NATO Land Line: _o) Email: r bg,I i 1 ;E.Z�'ir :4 Z 0 G ma:• ( . UAt, ❑ Check if all work will be performed by property owner only • Contractor(s): (list all additional contractors on the back of this form) Contact Name(s): Contractor Trade: &P-n-et-4 COnfratior w"a-lon Mailing Address, C/S/Z: OS ld.&Q h &, boaq q I LZos— Cell Phone:_( 507 ) q;5 049 Land Line: 61 ) ►,SZ Email: 1D H S be:�S Q �DL A ckrn PCR-S 9PrzS i, . co m "Workers' Comp documentation must be submitted with this application" • Arch itect(s)/Engineer(s): r A Business Name: If b 61 (-na-wtroa Contact Name(s): RAG of Mailing Address, C/S/Z: '337, urn4 HitkS 2-0-1-1- Cell Phone:_) Land Line: Email: �rYliPl «� O1C10 erl n-per fna • 60M -Contact Person for Compliance in regards to this project: l CA 6 r Yr1 eft Cell Phone: ( 51p ) �3 J� ��� Land Line: �) __'� Email: 111 ct fr(A �FCE%t Co m Addition/Alteration Application Revised January 2021 • Contractor(s): Workers' Comp documentation must be submitted with this application J2 , �h � SrContractor Name(s): Prb PC55�n 24rtcF_ Contractor Trade: C�eieraQ h' l B " 10 i rql Mailing Address, C/S/Z: ®5� (!,en AVE A16nj �tl 122©S Cell Phone: 611- 136 -M49 Land Line: l Email: , � KJbe,$GOADL . &M • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone: Land Line: Email: • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone: Land Line: Email: • . Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone: Land Line: • Contractor(s): Workers' Comp documentation must be submitted with this application Contractor Name(s): Contractor Trade: Mailing Address, C/S/Z: Cell Phone: Land Line: Email: Addition/Alteration Application Revised January 2021 -C�aM�s?q_ Residential Plan Review: 1- and 2- Family Dwellings Y/N/NA (1 of 2) l•= Two (2)full sets of plans Over 1,500 sq. ft. requires engineering stamp Design loads on plans: 115 Wind Floor Loads 40 psf LJE (North of Rte. 149 60) 50 Ground Snow Load Sleeping Areas &Attics 30 psf Calculations Decks 40 psf Wind design for lake front properties l �d Window schedule with glass size & main doors/Air leakage < .5 cfm for doors, < .3 cfm for I windows/Tempered glass in bathrooms N y4 Door schedule/Main entrance 36" door Emergency Escape or Bedrooms & Habitable Space Above-grade: 5.7 sq. ft. Grade: 5.0 sq. ft. 24" (h) x 20" (w) minimum 44" maximum height above door Window control devices 24" or less 2nd story or 72" above grade Egress window from basement 5.0 sq. ft. Floor system sizing per table 502.3.1 Residential check ERI or Prescriptive method �c Driveway length: 300' or more-12' width required/500' or more,turnaround required XjI)A- Foundation drainage on plans, if required 6" drop in 10' exterior grade Framing cross section for each roof line, vertical fire stopping every 10' where required/joist spans pg. 127 Ice &snow shield—24" from exterior wall ti Platforms at exterior doors Stairway headroom 6'8"; all stairs 36" width Stair run and rise f� Winder run and rise MA Spiral stairs meet requirements }� Smoke detectors—battery backup & proper location, interconnected f* Bathroom fixtures—proper clearance dfii �li Hall width-36" width (k Handrails more than four risers on open sides Railing& guards > 30"/basement stairs included/closed risers more than 4" in height Safety glazing notes for required areas _, Garage fire separation: %" gable end/5/8" under living space &%" on walls/20 min. door and closer Garage floor sloped AT>bk ti Attic access: gasket seal & R-value equal to roof insulation Roof over 30" —22"x 30"/Crawl spaces 18" x 24" access Continued on back-> 4 Residential Plan Review Revised October 2021 Residential Plan Review: 1- and 2- Family Dwellings Y/N/NA (2 of 2) A J Carbon Monoxide detector outside lowest sleeping area, on every level & interconnected �V within 15' of sleeping area Soil test results, if required Septic to well or water line separation All paperwork signed A- Note on plans energy saving light bulbs 90% Blower door test agency paperwork Floodplain Permit required—check map: 2 feet above flood elevation Hurricane clips required k Floors less than 2 x 10 covered by%" gypsum or 5/8" wood panel Manuals S &J required for heating system. Cold air return hard piped Separate room for draft HVAC or hot water heater with fresh air YJ } HRV shown and calculations Baffles at eaves for insulations and knee walls it Makeup air for range hood >400 cfm Continuous header for garage doors to end wall ( — (1-1� Chimney rain cap shown for fireplaces VJA Deck hold down shown not less than 4 lags and bolts per table 507.2 Residential Plan Review Revised October 2021 MAR 11 2022 TOWN OF QUEENSBURY BUILDING& CODES FEMA NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE AND INSTRUCTIONS 2019 EDITION q r OMB No.1660-0008 Expiration Date:November 30,2022 U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE AND INSTRUCTIONS Paperwork Reduction Act Notice 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. Privacy Act Statement Authority:Title 44 CFR§61.7 and 61.8. Principal Purpose(s): This information is being collected for the primary purpose of estimating the risk premium rates necessary to provide flood insurance for new or substantially improved structures in designated Special Flood Hazard Areas. 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 or Records Notice 73 Fed. Reg.77747(December 19,2008); DHS/ FEMA/NFIP/LOMA-1 —National Flood Insurance Program(NFIP)Letter of Map Amendment(LOMA)System of Records Notice 71 Fed. Reg.7990(February 15,2006);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 result in the inability to obtain flood insurance through the National Flood Insurance Program or the applicant may be subject to higher premium rates for flood insurance.Information will only be released as permitted by law. Purpose of the Elevation Certificate The Elevation Certificate is an important administrative tool of the National Flood Insurance Program (NFIP). It is to be used to provide elevation information necessary to ensure compliance with community floodplain management ordinances, to determine the proper insurance premium rate, and to support a request for a Letter of Map Amendment(LOMA) or Letter of Map Revision based on fill(LOMR-F). The Elevation Certificate is required in order to properly rate Post-FIRM buildings,which are buildings constructed after publication of the Flood Insurance Rate Map (FIRM), located in flood insurance Zones Al A30,AE,AH,A(with BFE), VE, V1 V30, V(with BFE),AR,AR/A,AR/AE,AR/A1 A30,AR/AH, and AR/AO.The Elevation Certificate is not required for Pre-FIRM buildings unless the building is being rated under the optional Post-FIRM flood insurance rules. 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 or LOMR-F request.Lowest floor and lowest adjacent grade elevations certified by a surveyor or engineer will be required if the certificate is used to support a LOMA or LOMR-F request. A LOMA or LOMR-F request must be submitted with either a completed FEMA MT EZ or MT-1 package,whichever is appropriate. 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 Base Flood Elevation (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. Additional guidance can be found in FEMA Publication 467-1, Floodplain Management Bulletin: Elevation Certificate,available on FEMA's website at https://www.fema.goy/media-library/assets/documents/3539?id=1727. FEMA Form 086-0-33(12/19) Replaces all previous editions. F-053 U.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008 Federal Emergency Management Agency Expiration Date:November 30,2022 National Flood Insurance Program ELEVATION CERTIFICATE Important:Follow the instructions on pages 1-9. Copy all pages of this Elevation Certificate and all attachments for(1)community official,(2)insurance agent/company,and(3)building owner. SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Policy Number: RICHARD J.BELLIZZI AND BEVERLY A.BELLIZZI A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Company NAIC Number: Box No. 17 DINEEN ROAD City State ZIP Code LAKE GEORGE New York 12845 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) TAX MAP PARCEL NO.289.7-1-62 WARREN COUNTY DEED BOOK 5062 AT PAGE 281 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) RESIDENTIAL A5. Latitude/Longitude: Lat.43.374507 Long.-73.663651 Horizontal Datum: ❑ NAD 1927 ❑x 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 3 A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) Sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s)within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b sq in d) Engineered flood openings? ❑Yes ❑ No A9. For a building with an attached garage: a) Square footage of attached garage sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade c) Total net area of flood openings in A9.b sq in d) Engineered flood openings? ❑Yes ❑ No SECTION B—FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name&Community Number B2.County Name B3. State QUEENSBURY,NEW YORK 360879 WARREN New York B4.Map/Panel B5.Suffix B6. FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s) Number Date Effective/ Zone(s) (Zone AO,use Base Flood Depth) Revised Date 360879 0020 C 08-16-1996 08-16-1996 AE 404 B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9: ❑ FIS Profile ❑x FIRM ❑Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item 139: 0 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 0 No Designation Date: ❑ CBRS ❑ OPA FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 1 of 6 i OMB No.1660-0008 ELEVATION CERTIFICATE Expiration Date:November 30,2022 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: 17 DINEEN ROAD City State ZIP Code Company NAIC Number LAKE GEORGE New York 12845 SECTION C—BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑Building Under Construction* ❑x Finished Construction *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,ARIA,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: FIRM ELEV.REF.MARKS,GPS Vertical Datum:NGVD29 Indicate elevation datum used for the elevations in items a)through h)below. ❑x NGVD 1929 ❑ NAVD 1988 ❑Other/Source: 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) 410.5 ❑x feet ❑ meters b) Top of the next higher floor 4193 ❑x feet ❑ meters c) Bottom of the lowest horizontal structural member(V Zones only) ❑ feet ❑meters d) Attached garage(top of slab) feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 411.8 ❑x feet El meters (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 410.5 ❑x fleet ❑ meters g) Highest adjacent(finished)grade next to building(HAG) 418.3 x❑ feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs,including ❑ feet ❑409.5 meters structural support 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? ❑Yes X No ❑Check here if attachments. Certifier's Name License Number RUSSELL HOWARD 050540 Title OWNER SCE) Company Name RUSSELL HOWARD LICENSED LAND SURVEYING Address Here 342 MAIN STREET City State ZIP Code HUDSON FALLS New York 12839 Signature Date Telephone Ext. 03-10-2022 (518)747-8747 Copy all pages of this Elevation Certificate and all attachments for(1)community official,(2)insurance agent/company,and(3)building owner. Comments(including type of equipment and location,per C2(e),if applicable) FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 2 of 6 OMB No. 1660-0008 ELEVATION CERTIFICATE Expiration Date:November 30,2022 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: 17 DINEEN ROAD City State ZIP Code Company NAIC Number LAKE GEORGE New York 12845 SECTION E—BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),complete Items El—E5.If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A,B,and C.For Items El—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, crawlspace,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 1-2 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 ffoodpfain management ordinance? ❑ Yes ❑ No ❑ Unknown. The focal 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 El Signature Date Telephone Comments ❑Check here if attachments. FEMA Form 086-0-33(12119) Replaces all previous editions. Form Page 3 of 6 OMB No.1660-0008 ELEVATION CERTIFICATE Expiration Date:November 30,2022 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. 17 DINEEN ROAD City State ZIP Code Company NAIC Number LAKE GEORGE New York 12845 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(without a 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 Issued G6. Date Certificate of Compliance/Occupancy Issued G7. This permit has been issued for: ❑New Construction ❑ Substantial Improvement G8. Elevation of as-built lowest floor(including basement) of the building: ❑feet ❑ meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑ meters Datum G10. Community's design flood elevation: ❑feet ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments(including type of equipment and location,per C2(e),if applicable) ❑ Check here if attachments. FEMA Form 086-0-33(12119) Replaces all previous editions. Form Page 4 of 6 BUILDING PHOTOGRAPHS OMB No. 1660-0008 ELEVATION CERTIFICATE See Instructions for Item A6. Expiration Date:November 30,2022 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: 17 DINEEN ROAD City State ZIP Code Company NAIC Number LAKE GEORGE New York 12845 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"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.If submitting more photographs than will fit on this page,use the Continuation Page. E �liilllfilll�!IIIII(IIIIII!!',IE:��11�16�i1i; t �I iy Photo One Photo One Caption FRONT i Clear Photo One ilob- r.= Photo Two Photo Two Caption SIDE Clear Photo Two FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 5 of 6 BUILDING PHOTOGRAPHS OMB No.1660-0008 ELEVATION CERTIFICATE Continuation Page Expiration Date:November 30,2022 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: 17 DINEEN ROAD City State ZIP Code Company NAIC Number LAKE GEORGE New York 12845 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. xy ej1!`4 -r Photo Three Photo Three Caption BACK t Clear Photo Three Photo Four Photo Four Photo Four Caption Clear Photo Four FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 6 of 6 U.S. DEPARTMENT OF HOMELAND SECURITY OMB No.1660-0008 Federal Emergency Management Agency Expiration Date:November 30,2022 National Flood Insurance Program Instructions for Completing the Elevation Certificate The Elevation Certificate is to be completed by a land surveyor,engineer,or architect who is authorized by law to certify elevation information when elevation information is required for Zones Al A30,AE,AH,A(with BFE), VE, V1 V30, V (with BFE), AR, AR/A, AR/AE, AR/A1 A30, AR/AH, or AR/AO. Community officials who are authorized by law or ordinance to provide floodplain management information may also complete this form. For Zones AO and A(without BFE), a community official, a property owner, or an owner's representative may provide information on this certificate, unless the elevations are intended for use in supporting a request for a LOMA or LOMR-F. Certified elevations must be included if the purpose of completing the Elevation Certificate is to obtain a LOMA or LOMR-F. The property owner, the owner's representative, or local official who is authorized by law to administer the community floodplain ordinance can complete Section A and Section B.The partially completed form can then be given to the land surveyor, engineer, or architect to complete Section C. the land surveyor, engineer, or architect should verify the information provided by the property owner or owner's representative to ensure that this certificate is complete. In Puerto Rico only,elevations for building information and flood hazard information may be entered in meters. SECTION A-PROPERTY INFORMATION Items Al-A4.This section identifies the building, its location,and its owner. Enter the name(s)of the building owner(s), the building's complete street address, and the lot and block numbers. If the building's address is different from the owner's address, enter the address of the building being certified. If the address is a rural route or a Post Office box number, enter the lot and block numbers, the tax parcel number, the legal description, or an abbreviated location description based on distance and direction from a fixed point of reference. For the purposes of this certificate,"building" means both a building and a manufactured(mobile)home. A map may be attached to this certificate to show the location of the building on the property. A tax map, FIRM, or detailed community map is appropriate. If no map is available, provide a sketch of the property location,and the location of the building on the property. Include appropriate landmarks such as nearby roads, intersections, and bodies of water. For building use, indicate whether the building is residential, non-residential,an addition to an existing residential or non- residential building, an accessory building (e.g., garage), or other type of structure. Use the Comments area of the appropriate section if needed,or attach additional comments. Item A5.Provide latitude and longitude coordinates for the center of the front of the building. Use either decimal degrees (e.g., 39.5043% -110.7585") or degrees, minutes, seconds (e.g_, 39" 30' 15.5", -110° 45' 30.7") format. if decimal degrees are used, provide coordinates to at least 5 decimal places or better. When using degrees, minutes, seconds, provide seconds to at least 1 decimal place or better.The latitude and longitude coordinates must be accurate within 66 feet. When the latitude and longitude are provided by a surveyor, check the "Yes" box in Section D and indicate the method used to determine the latitude and longitude in the Comments area of Section D. If the Elevation Certificate is being certified by other than a licensed surveyor, engineer, or architect,this information is not required. Provide the type of datum used to obtain the latitude and longitude.FEMA prefers the use of NAD 1983. Item A6.If the Elevation Certificate is being used to obtain flood insurance through the NFIP,the certifier must provide at least 2 photographs showing the front and rear of the building taken within 90 days from the date of certification. The photographs must be taken with views confirming the building description and diagram number provided in Section A.To the extent possible,these photographs should show the entire building including foundation. If the building has split-level or multi-level areas, provide at least 2 additional photographs showing side views of the building. In addition, when .applicable, provide a photograph of the foundation showing a representative example of the flood openings or vents.All photographs must be in color and measure at least 3"X 3".Digital photographs are acceptable. Item A7. Select the diagram on pages 7-9 that best represents the building. Then enter the diagram number and use the diagram to identify and determine the appropriate elevations requested in Items C2.a-h. If you are unsure of the correct diagram,select the diagram that most closely resembles the building being certified. Item A8.a. Provide the square footage of the crawlspace or enclosure(s) below the lowest elevated floor of an elevated building with or without permanent flood openings. Take the measurement from the outside of the crawlspace or enclosure(s). Examples of elevated buildings constructed with crawlspace and enclosure(s)are shown in Diagrams 6-9 FEMA Form 086-0-33(12/19) NFIP Elevation Certificate Instructions- Page 1 of 9 Instructions for Completing the Elevation Certificate(continued) on pages 8-9. Diagrams 2A, 213,4,and 9 should be used for a building constructed with a crawlspace floor that is below the exterior grade on all sides. Items A8.b—d. Enter in Item A8.b the number of permanent flood openings in the crawlspace or enclosure(s)that are no higher than 1.0 foot above the higher of the exterior or interior grade or floor immediately below the opening. (A permanent flood opening is a flood vent or other opening that allows the free passage of water automatically in both directions without human intervention.) If the interior grade elevation is used, note this in the Comments area of Section D. Estimate the total net area of all such permanent flood openings in square inches, excluding any bars, louvers, or other covers of the permanent flood openings, and enter the total in Item A8.c. If the net area cannot be reasonably estimated, provide the size of the flood openings without consideration of any covers and indicate in the Comments area the type of cover that exists in the flood openings. Indicate in Item A8.d whether the flood openings are engineered. If applicable, attach a copy of the Individual Engineered Flood Openings Certification or an Evaluation Report issued by the International Code Council Evaluation Service (ICC ES), if you have it. If the crawlspace or enclosure(s) have no permanent flood openings, or if the openings are not within 1.0 foot above adjacent grade, enter"N/A"for not applicable in Items A8.b—c. Item A9.a. Provide the square footage of the attached garage with or without permanent flood openings. Take the measurement from the outside of the garage. Items A9.b—d. Enter in Item A9.b the number of permanent flood openings in the attached garage that are no higher than 1.0 foot above the higher of the exterior or interior grade or floor immediately below the opening. (A permanent flood opening is a flood vent or other opening that allows the free passage of water automatically in both directions without human intervention.) If the interior grade elevation is used, note this in the Comments area of Section D.This includes any openings that are in the garage door that are no higher than 1.0 foot above the adjacent grade. Estimate the total net area of all such permanent flood openings in square inches and enter the total in Item A9.c. If the net area cannot be reasonably estimated, provide the size of the flood openings without consideration of any covers and indicate in the Comments area the type of cover that exists in the flood openings. Indicate in Item A9.d whether the flood openings are engineered. If applicable, attach a copy of the Individual Engineered Flood Openings Certification or an Evaluation Report issued by the International Code Council Evaluation Service (ICC ES), if you have it. If the garage has no permanent flood openings, or if the openings are not within 1.0 foot above adjacent grade, enter"N/A" for not applicable in Items A9.b—c. SECTION B—FLOOD INSURANCE RATE MAP(FIRM)INFORMATION Complete the Elevation Certificate on the basis of the FIRM in effect at the time of the certification. The information for Section B is obtained by reviewing the FIRM panel that includes the building's location. Information about the current FIRM is available from the Federal Emergency Management Agency (FEMA) by calling 1-800-358-9616. If a Letter of Map Amendment(LOMA)or Letter of Map Revision(LOMR-F)has been issued by FEMA, please provide the letter date and case number in the Comments area of Section D or Section G,as appropriate. For a building in an area that has been annexed by one community but is shown on another community's FIRM, enter the community name and 6-digit number of the annexing community in Item 61,the name of the county or new county, if necessary, in Item B2, and the FIRM index date for the annexing community in Item B6. Enter information from the actual FIRM panel that shows the building location, even if it is the FIRM for the previous jurisdiction, in Items B4, B5, B7, B8,and B9. If the map in effect at the time of the building's construction was other than the current FIRM,and you have the past map information pertaining to the building,provide the information in the Comments area of Section D. Item B1. NFIP Community Name & Community Number. Enter the complete name of the community in which the building is located and the associated 6-digit community number. For a newly incorporated community, use the name and 6-digit number of the new community. Under the NFIP, a "community" is any State or area or political subdivision thereof, or any Indian tribe or authorized native organization, that has authority to adopt and enforce floodplain management regulations for the areas within its jurisdiction. To determine the current community number, see the NFIP Community Status Book, available on FEMA's web site at https://www.fema.gov/national-flood-insurance- program/national-flood-insurance-program-community-status-book,or call 1-800-358-9616. FEMA Form 086-0-33(12119) NFIP Elevation Certificate Instructions— Page 2 of 9 Instructions for Completing the Elevation Certificate(continued) Item B2. County Name. Enter the name of the county or counties in which the community is located. For an unincorporated area of a county, enter"unincorporated area."For an independent city,enter"independent city." Item B3.State. Enter the 2-letter state abbreviation (for example,VA,TX, CA). Items 64-135. Map/Panel Number and Suffix. Enter the 10-character"Map Number" or"Community Panel Number" shown on the FIRM where the building or manufactured (mobile) home is located. For maps in a county-wide format, the sixth character of the "Map Number" is the letter"C"followed by a 4-digit map number. For maps not in a county- wide format, enter the"Community Panel Number"shown on the FIRM. Item B6.FIRM Index Date.Enter the effective date or the map revised date shown on the FIRM Index. Item B7. FIRM Panel Effective/Revised Date. Enter the map effective date or the map revised date shown on the FIRM panel. This will be the latest of all dates shown on the map. The current FIRM panel effective date can be determined by calling 1-800-358-9616. Item B8. Flood Zone(s). Eater the flood zone, or flood zones, in which the building is located. All flood zones containing the letter "A" or"V" are considered Special Flood Hazard Areas. The flood zones are A,AE, Al—A30, V, VE,.V1—V30,AH,AO,AR,AR/A,AR/AE,AR/A1—A30,AR/AH, and AR/AO. Each flood zone is defined in the legend of the FIRM panel on which it appears. Item B9.Base Flood Elevation(s). Using the appropriate Flood Insurance Study(FIS)Profile, Floodway Data Table, or FIRM panel, locate the property and enter the BFE (or base flood depth)of the building site. If the building is located in more than 1 flood zone in Item B8, list all appropriate BFEs in Item B9. BFEs are shown on a FIRM or FIS Profile for Zones Al—A30,AE,AH,V1—V30,VE,AR,ARIA,AR/AE,AR/A1—A30,AR/AH,and AR/AO;flood depth numbers are shown for Zone AO. Use the AR BFE if the building is located in any of Zones AR/A,AR/AE,AR/A1—A30,AR/AH, or AR/AO. In A or V zones where BFEs are not provided on the FIRM, BFEs may be available from another source. For example, the community may have established BFEs or obtained BFE data from other sources for the building site. For subdivisions and other developments of more than 50 lots or 5 acres, establishment of BFEs is required by the community's floodplain management ordinance. If a BFE is obtained from another source, enter the BFE in Item B9. In an A Zone where BFEs are not available, complete Section E and enter N/A for Section B, Item B9. Enter the BFE to the nearest tenth of a foot(nearest tenth of a meter, in Puerto Rico). Item B10. Indicate the source of the BFE that you entered in Item B9. If the BFE is from a source other than FIS Profile, FIRM, or community,describe the source of the BFE. Item B11. Indicate the elevation datum to which the elevations on the applicable FIRM are referenced as shown on the map legend.The vertical datum is shown in the Map Legend and/or the Notes to Users on the FIRM. Item B12. Indicate whether the building is located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA). (OPAs are portions of coastal barriers that are owned by Federal, State, or local governments or by certain non-profit organizations and used primarily for natural resources protection.) Federal flood insurance is prohibited in designated CBRS areas or OPAs for buildings or manufactured (mobile) homes built or substantially improved after the date of the CBRS or OPA designation. For the first CBRS designations, that date is October 1, 1983. Information about CBRS areas and OPAs may be obtained on the FEMA web site at https://www.fema.gov/ national-flood-insurance-program/coastal-barrier-resources-skstem. SECTION C—BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Complete Section C if the building is located in any of Zones Al—A30, AE, AH, A(with BFE), VE, V1 V30, V (with BFE),AR,ARIA,AR/AE,AR/A1—A30,AR/AH, or AR/AO, or if this certificate is being used to support a request for a LOMA or LOMR-F. If the building is located in Zone AO or Zone A (without BFE), complete Section E instead. To ensure that all required elevations are obtained, it may be necessary to enter the building (for instance, if the building has a basement or sunken living room,split-level construction, or machinery and equipment). Surveyors may not be able to gain access to some crawlspaces to shoot the elevation of the crawlspace floor. If access to the crawlspace is limited or cannot be gained,follow one of these procedures. • Use a yardstick or tape measure to measure the height from the floor of the crawlspace to the"next higher floor," and then subtract the crawlspace height from the elevation of the"next higher floor."If there is no access to the FEMA Form 086-0-33(12/19) NFIP Elevation Certificate Instructions— Page 3 of 9 Instructions for Completing the Elevation Certificate(continued) crawlspace, use the exterior grade next to the structure to measure the height of the crawlspace to the "next higher floor." • Contact the local floodplain administrator of the community in which the building is located.The community may have documentation of the elevation of the crawlspace floor as part of the permit issued for the building. • If the property owner has documentation or knows the height of the crawlspace floor to the next higher floor, try to verify this by looking inside the crawlspace through any openings or vents. In all 3 cases, use the Comments area of Section D to provide the elevation and a brief description of how the elevation was obtained. Item C1. Indicate whether the elevations to be entered in this section are based on construction drawings, a building under construction, or finished construction. For either of the first 2 choices, a post-construction Elevation Certificate will be required when construction is complete. If the building is under construction, include only those elevations that can be surveyed in Items C2.a-h. Use the Comments area of Section D to provide elevations obtained from the construction plans or drawings.Select"Finished Construction"only when all machinery and/or equipment such as furnaces,hot water heaters, heat pumps,air conditioners, and elevators and their associated equipment have been installed and the grading around the building is completed. Item C2. A field survey is required for Items C2.a-h. Most control networks will assign a unique identifier for each benchmark.For example,the National Geodetic Survey uses the Permanent Identifier(PID).For the benchmark utilized, provide the PID or other unique identifier assigned by the maintainer of the benchmark. For GPS survey, indicate the benchmark used for the base station, the Continuously Operating Reference Stations (CORS)sites used for an On-line Positioning User Service(OPUS)solution(also attach the OPUS report),or the name of the Real Time Network used. Also provide the vertical datum for the benchmark elevation.All elevations for the certificate, including the elevations for Items C2.a-h, must use the same datum on which the SFE is based. Show the conversion from the field survey datum used if it differs from the datum used for the BFE entered in Item B9 and indicate the conversion software used. Show the datum conversion,if applicable,in the Comments area of Section D. For property experiencing ground subsidence, the most recent reference mark elevations must be used for determining building elevations. However, when subsidence is involved, the BFE should not be adjusted. Enter elevations in Items C2.a-h to the nearest tenth of a foot(nearest tenth of a meter,in Puerto Rico). Items C2.a-d. Enter the building elevations (excluding the attached garage)indicated by the selected building diagram (Item A7)in Items C2.a-c. If there is an attached garage,enter the elevation for top of attached garage slab in Item C2.d. (Because elevation for top of attached garage slab is self-explanatory, attached garages are not illustrated in the diagrams.)If the building is located in a V zone on the FIRM,complete Item C2.c. If the flood zone cannot be determined, enter elevations for all of Items C2.a-h. For buildings in A zones, elevations a, b,d, and a should be measured at the top of the floor. For buildings in V zones, elevation c must be measured at the bottom of the lowest horizontal structural member of the floor(see drawing below). For buildings elevated on a crawlspace, Diagrams 8 and 9, enter the elevation BUILDING ON BUILDING WITH BUILDING ON PILES, SLAB BASEMENT PIERS,OR COLUMNS AZONES VZONES C2.a AZONES VZONES 1 / AZONES C2.a C2.c BASE FLOOD ELEVATION C2.c BASE FLOOD• ELEVATION ADJACENT GRADE ::.:;..:-•::::::: ;:;:.'..:•'::: FEMA Form 086-0-33(12/19) NFIP Elevation Certificate Instructions- Page 4 of 9 Instructions for Completing the Elevation Certificate(continued) of the top of the crawlspace floor in Item C2.a, whether or not the crawlspace has permanent flood openings (flood vents). If any item does not apply to the building, enter"N/A"for not applicable. Item C2.e. Enter the lowest platform elevation of at least 1 of the following machinery and equipment items: elevators and their associated equipment, furnaces, hot water heaters, heat pumps, and air conditioners in an attached garage or enclosure or on an open utility platform that provides utility services for the building. Note that elevations for these specific machinery and equipment items are required in order to rate the building for flood insurance. Local floodplain management officials are required to ensure that all machinery and equipment servicing the building are protected from flooding. Thus, local officials may require that elevation information for all machinery and equipment, including ductwork, be documented on the Elevation Certificate. If the machinery and/or equipment is mounted to a wall, pile, etc., enter the platform elevation of the machinery and/or equipment. Indicate machinery/equipment type and its general location, e.g., on floor inside garage or on platform affixed to exterior wall, in the Comments area of Section D or Section G, as appropriate. If this item does not apply to the building, enter"N/A"for not applicable. Items C2.f—g. Enter the elevation of the ground, sidewalk, or patio slab immediately next to the building. For Zone AO, use the natural grade elevation,if available.This measurement must be to the nearest tenth of a foot(nearest tenth of a meter,in Puerto Rico)if this certificate is being used to support a request for a LOMA or LOMR-F. Item C2.h. Enter the lowest grade elevation at the deck support or stairs. For Zone AO, use the natural grade elevation, if available. This measurement must be to the nearest tenth of a foot (nearest tenth of a meter, in Puerto Rico)if this certificate is being used to support a request for a LOMA or LOMR-F. SECTION D—SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION Complete as indicated. This section of the Elevation Certificate may be signed by only a land surveyor, engineer, or architect who is authorized by law to certify elevation information. Place your license number, your seal (as allowed by the State licensing board),your signature,and the date in the box in Section D.You are certifying that the information on this certificate represents your best efforts to interpret the data available and that you understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. Use the Comments area of Section D to provide datum,elevation,openings,or other relevant information not specified elsewhere on the certificate. SECTION E—BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) Complete Section E if the building is located in Zone AO or Zone A(without BFE).Otherwise,complete Section C instead. Explain in the Section F Comments area if the measurement provided under Items El—E4 is based on the"natural grade." Items E1.a and b. Enter in Item E1.a the height to the nearest tenth of a foot(tenth of a meter in Puerto Rico)of the top of the bottom floor(as indicated in the applicable diagram)above or below the highest adjacent grade (HAG). Enter in Item E1.b the height to the nearest tenth of a foot (tenth of a meter in Puerto Rico) of the top of the bottom floor (as indicated in the applicable diagram) above or below the lowest adjacent grade (LAG). For buildings in Zone AO, the community's floodplain management ordinance requires the lowest floor of the building be elevated above the highest adjacent grade at least as high as the depth number on the FIRM. Buildings in Zone A(without BFE) may qualify for a lower insurance rate if an engineered BFE is developed at the site. Item E2. For Building Diagrams 6-9 with permanent flood openings (see pages 8-9), enter the height to the nearest tenth of a foot (tenth of a meter in Puerto Rico) of the next higher floor or elevated floor(as indicated in the applicable diagram)above or below the highest adjacent grade(HAG). Item E3. Enter the height to the nearest tenth of a foot (tenth of a meter in Puerto Rico), in relation to the highest adjacent grade next to the building, for the top of attached garage slab. (Because elevation for top of attached garage slab is self-explanatory, attached garages are not illustrated in the diagrams.) If this item does not apply to the building, enter"NIA"for not applicable. Item E4. Enter the height to the nearest tenth of a foot (tenth of a meter in Puerto Rico), in relation to the highest adjacent grade next to the building, of the platform elevation that supports the machinery and/or equipment servicing the building. Indicate machinery/equipment type in the Comments area of Section F. If this item does not apply to the building, enter"N/A"for not applicable. FEMA Form 086-0-33(12/19) NFIP Elevation Certificate Instructions— Page 5 of 9 Instructions for Completing the Elevation Certificate(continued) Item E5. For those communities where this base flood depth is not available, the community will need to determine whether the top of the bottom floor is elevated in accordance with the community's floodplain management ordinance. SECTION F—PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION Complete as indicated. This section is provided for certification of measurements taken by a property owner or property owner's representative when responding to Sections A, B, and E.The address entered in this section must be the actual mailing address of the property owner or property owner's representative who provided the information on the certificate. SECTION G—COMMUNITY INFORMATION(OPTIONAL) Complete as indicated. The community 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. Section C may be filled in by the local official as provided in the instructions below for Item G1. If the authorized community official completes Sections C, E,or G,complete the appropriate item(s)and sign this section. Check Item G1 if Section C is completed with elevation data 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 of the elevation data and the date obtained in the Comments area of Section G. If you are both a community official and a licensed land surveyor, engineer,or architect authorized by law to certify elevation information, and you performed the actual survey for a building in Zones Al A30,AE,AH,A(with BFE),VE,V1 V30,V(with BFE),AR,AR/ A,AR/A1—A30,AR/AE,AR/AH,or AR/AO,you must also complete Section D. Check Item G2 if information is entered in Section E by the community for a building in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. Check Item G3 if the information in Items G4—G10 has been completed for community floodplain management purposes to document the as-built lowest floor elevation of the building.Section C of the Elevation Certificate records the elevation of various building components but does not determine the lowest floor of the building or whether the building, as constructed, complies with the community's floodplain management ordinance. This must be done by the community. Items G4—G 10 provide a way to document these determinations. Item G4. Permit Number. Enter the permit number or other identifier to key the Elevation Certificate to the permit issued for the building. Item G5.Date Permit Issued. Enter the date the permit was issued for the building. Item G6. Date Certificate of Compliance/Occupancy Issued. Enter the date that the Certificate of Compliance or Occupancy or similar written official documentation of as-built lowest floor elevation was issued by the community as evidence that all work authorized by the floodplain development permit has been completed in accordance with the community's floodplain management laws or ordinances. Item G7. New Construction or Substantial Improvement. Check the applicable box. "Substantial Improvement" means any reconstruction, rehabilitation, addition, or other improvement of a building, the cost of which equals or exceeds 50 percent of the market value of the building before the start of construction of the improvement. The term includes buildings that have incurred substantial damage, regardless of the actual repair work performed. Item G8. As-built lowest floor elevation. Enter the elevation of the lowest floor (including basement) when the construction of the building is completed and a final inspection has been made to confirm that the building is built in accordance with the permit, the approved plans, and the community's floodplain management laws or ordinances. Indicate the elevation datum used. Item G9. BFE. Using the appropriate FIRM panel, FIS Profile, or other data source, locate the property and enter the BFE(or base flood depth)of the building site.Indicate the elevation datum used. Item G10. Community's design flood elevation. Enter the elevation (including freeboard above the BFE) to which the community requires the lowest floor to be elevated.Indicate the elevation datum used. Enter your name, title, and telephone number, and the name of the community. Sign and enter the date in the appropriate blanks. FEMA Form 086-0-33(12119) NFIP Elevation Certificate instructions— Page 6 of 9 Building Diagrams The following diagrams illustrate various types of buildings. Compare the features of the building being certified with the features shown in the diagrams and select the diagram most applicable. Enter the diagram number in Item A7, the square footage of crawlspace or enclosure(s) and the area of flood openings in square inches in Items A8.a-c, the square footage of attached garage and the area of flood openings in square inches in Items A9.a-c, and the elevations in Items C2.a-h. In A zones,the floor elevation is taken at the top finished surface of the floor indicated;in V zones,the floor elevation is taken at the bottom of the lowest horizontal structural member(see drawing in instructions for Section C). DIAGRAM 1 A DIAGRAM 113 All slab-on-grade single-and multiple-floor buildings All raised-slab-on-grade or slab-on-stem-wall-with-fill (other than split-level)and high-rise buildings,either single-and multiple-floor buildings(other than split- detached or row type(e.g.,townhouses);with or level),either detached or row type(e.g.,townhouses); without attached garage. with or without attached garage. Distinguishing Feature—The bottom floor is at or above Distinguishing Feature—The bottom floor is at or above ground level(grade)on at least 1 side.* ground level(grade)on at least 1 side.* C2.b C2.a C2.b NEXT XT HIGHER NEXT HIGHER i FLOOR , FLOOR , r i BOTTOM FLOOR GRADE BOTTOM FLOOR GRADE :.:#detetrt7lnedhy.:;:: - - -�eteittitiz�d:`h C2.f—h -eici§iirt racte .. . .... -.. ..... .. , . CZ.—h - '- ......-_-.... ..__.r.:.. ....._ ...,.. .. ... 9'1 ) `e7dstiri8`gfad'�`�'� DIAGRAM 2A DIAGRAM 2B All single-and multiple-floor buildings with basement All single-and multiple-floor buildings with basement (other than split-level)and high-rise buildings with (other than split-level)and high-rise buildings with basement,either detached or row type basement,either detached or row type (e.g.,townhouses);with or without attached garage. (e.g.,townhouses);with or without attached garage. Distinguishing Feature-The bottom floor(basement Distinguishing Feature-The bottom floor(basement or or underground garage)is below ground level(grade)on underground garage)is below ground level(grade)on all all sides.* sides;most of the height of the walls is below ground level on all sides;and the door and area of egress are also C2.a ; ; below ground level on all sides.* C2.b NEXT HIGHER CZ.b FLOOR C2.a NEXT HIGHER FLOOR GRADE GRADE BOTTOM FLOOR BASEMENT :...... {::;::•;:; "ire:••;:4:;-.:!'.....-..:::::.::•..-.::r:d:;i:-'1'.....'.--_.:. C : ': _ BOTTOM FLOOR :::�;..-•:;:.:-:.:::� ' BASEMENT 77.mas -- Ri - d C2.f—h :eigsticfg�gi�e},:;i::;.?.::. .::_�:-.•:_::=:'_-::}; -;_ :,�:::: _.:; ::': A floor that is below ground level(grade)on all sides is considered a basement even if the floor is used for living purposes,or as an office, garage,workshop,etc. FEMA Form 086-0-33(12/19) NFIP Elevation Certificate Instructions- Page 7 of 9 Building Diagrams DIAGRAM 3 DIAGRAM 4 All split-level buildings that are slab-on-grade,either All split-level buildings(other than slab-on-grade), detached or row type(e.g.,townhouses);with or without either detached or row type(e.g.,townhouses);with or attached garage. without attached garage. Distinguishing Feature-The bottom floor(excluding Distinguishing Feature-The bottom floor(basement garage)is at or above ground level(grade)on at least or underground garage)is below ground level(grade)on 1 side.* all sides.* C2.a C2.b ' C2.b C2.a HIGHER i HIGHER FLOORS FLOORS NEXT HIGHER GRADE NEXT HIGHER GRADE FLOOR BOTTOM FLOOR FLOOR BOTTOM BASEMENT LOOR E n e my iitQetr Jm(r}@rftsyc':.,..,. C2.f-h ezisfiii' `fade.... ,::: ::•: _.•.. •-. .:•. ;..• existing gradej.. 99 )..........-. DIAGRAM 5 DIAGRAM 6 All buildings elevated on piers,posts,piles,columns, All buildings elevated on piers,posts,piles,columns, or parallel shear walls.No obstructions below the or parallel shear walls with full or partial enclosure elevated floor. below the elevated floor. Distinguishing Feature-For all zones,the area below the Distinguishing Feature-For all zones,the area below the elevated floor is open,with no obstruction to flow of floodwaters elevated floor is enclosed,either partially or fully. In A Zones,the (open lattice work and/or insect screening is permissible). partially or fully enclosed area below the elevated floor is with or without openings**present in the walls of the enclosure. Indicate information about enclosure size and openings in Section A- C2.b Property Information. NEXT HIGHER ' ; NEXT HIGHER FLOOR c FLOOR CZ.a C2.a C2.b ELEVATED ELEVATED FLOOR FLOOR AB.a-c GRADE GRADE \ E OSURE Determine \\,1 endosure size& openings•if any. di3te"rM t ed `.i3eTemiirie8`6-C2.f-tl ,'E Y? ,'.•`::::•:.;:•: ':c:;: C2.f-h' existing grade) C2.0 .F(ForVzones"onIV) existing grade) C2.0 (For V zones only) * A floor that is below ground level(grade)on all sides is considered abasement even if the floor is used for living purposes,or as an office, garage,workshop,etc. *'An"opening"is a permanent opening that allows for the free passage of water automatically in both directions without human intervention. Under the NFIP,a minimum of 2 openings is required for enclosures or crawispaces.The openings shall provide a total net area of not less than 1 square inch for every square foot of area enclosed,excluding any bars,louvers,or other covers of the opening.Alternatively,an Individual Engineered Flood Openings Certification or an Evaluation Report issued by the International Code Council Evaluation Service(ICC ES)must be submitted to document that the design of the openings will allow for the automatic equalization of hydrostatic flood forces on exterior walls.A window,a door,or a garage door is not considered an opening;openings may be installed in doors.Openings shall be on at least 2 sides of the enclosed area.If a building has more than 1 enclosed area,each area must have openings to allow floodwater to directly enter.The bottom of the openings must be no higher than 1.0 foot above the higher of the exterior or interior grade or floor immediately below the opening.For more guidance on openings,see NFIP Technical Bulletin 1. FEMA Form 086-0-33(12/19) NFIP Elevation Certificate Instructions-Page 8 of 9 Building Diagrams DIAGRAM 7 DIAGRAM 8 All buildings elevated on full-story foundation walls All buildings elevated on a crawlspace with the floor of with a partially or fully enclosed area below the elevated the crawlspace at or above grade on at least 1 side, floor.This Includes walkout levels,where at least 1 side with or without an attached garage. is at or above grade.The principal use of this building is located in the elevated floors of the building. Distinguishing Feature-For all zones,the area below the first floor is enclosed by solid or partial perimeter walls.In all A zones, Distinguishing Feature-For all zones,the area below the the crawlspace is with or without openings**present in the walls elevated floor is enclosed,either partially or fully.In A Zones,the of the crawlspace. Indicate information about crawlspace size partially or fully enclosed area below the elevated floor is with or and openings in Section A-Property Information. without openings**present in the walls of the enclosure.Indicate information about enclosure size and openings in Section A- Property Information. i C2.b C2.b C2.a NEXT HIGHER GRADE NEXT HIGHER FLOOR FLOOR G2.f C2.g GRADE WALKOUT C2.f (ENCLOSURE) C2.g CRA LSPACEA. - (ENCLOSURE) - A A8 b-c A8.b-c `._. ..._...._. _..: A8.a AS'b—C OPENINGS— OPENING' OPENINGS^ DIAGRAM 9 All buildings(other than split-level)elevated on a sub- grade crawlspace,with or without attached garage. Distinguishing Feature-The bottom(crawlspace)floor is below ground level(grade)on all sides.*(If the distance from the crawlspace floor to the top of the next higher floor is more than 5 feet,or the crawlspace floor is more than 2 feet below the grade[LAG]on all sides,use Diagram 2A or 2B.) r r C2.a I I B GRADE NEXT HIGHER 000 — FLOOR C2.f C2.g 8.b-c OPENINGS* * A floor that is below ground level(grade)on all sides is considered a basement even if the floor is used for living purposes,or as an office, garage,workshop,etc. **An'opening"is a permanent opening that allows for the free passage of water automatically in both directions without human intervention. Under the NFIP,a minimum of 2 openings is required for enclosures or crawispaces.The openings shall provide a total net area of not less than 1 square inch for every square That of area enclosed,excluding any bars,louvers,or other covers of the opening.Alternatively,an Individual Engineered Flood Openings Certification or an Evaluation Report issued by the International Code Council Evaluation Service(ICC ES)must be submitted to document that the design of the openings will allow for the automatic equalization of hydrostatic flood forces on exterior walls.A window,a door,or a garage door is not considered an opening;openings may be installed in doors.Openings shall be on at least 2 sides of the enclosed area.If a building has more than 1 enclosed area,each area must have openings to allow floodwater to directly enter.The bottom of the openings must be no higher than 1.0 foot above the higher of the exterior or interior grade or floor immediately below the opening.For more guidance on openings,see NFIP Technical Bulletin 1. FEMA Form 086-0-33(12119) NFIP Elevation Certificate Instructions- Page 9 of 9 Y - � U.S.DEPARTMENT OF HOMELAND SECURITY OMB No.1660-0008 Federal Emergency Management Agency Expiration Date:November 30,2022 National Flood Insurance Program ELEVATION CERTIFICATE Important:Follow the instructions on pages 1-9. Copy all pages of this Elevation Certificate and all attachments for(1)community official,(2)insurance agent/company,and(3)building owner. SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Policy Number: RICHARD J.BELLIZZI AND BEVERLY A.BELLIZZI A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Company NAIC Number: Box No. 17 DINEEN ROAD City State ZIP Code LAKE GEORGE New York 12845 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) TAX MAP PARCEL NO.289.7-1-62 WARREN COUNTY DEED BOOK 5062 AT PAGE 281 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) RESIDENTIAL A5. Latitude/Longitude: Lat.43.374507 Long.-73.663651 Horizontal Datum: ❑NAD 1927 ❑x 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 3 A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) sq ft b) Number of permanent flood openings in the crawlspace or enclosures)within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b sq in d) Engineered flood openings? ❑Yes ❑ No A9.For a building with an attached garage: a) Square footage of attached garage sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade c) Total net area of flood openings in A9.b sq in d) Engineered flood openings? ❑Yes ❑ No SECTION B—FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name&Community Number B2.County Name B3. State QUEENSBURY,NEW YORK 360879 WARREN New York B4.Map/Panel B5.Suffix B6. FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s) Number Date Effective/ Zone(s) (Zone AO,use Base Flood Depth) Revised Date 360879 0020 C 08-16-1996 08-16-1996 AE 404 B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 139: ❑FIS Profile ❑x FIRM ❑Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item 69: ❑X 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 ❑x No Designation Date: ❑ CBRS ❑ OPA FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 1 of 6 OMB No.1660-0008 ELEVATION CERTIFICATE Expiration Date:November 30,2022 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: 17 DINEEN ROAD City State ZIP Code Company NAIC Number LAKE GEORGE New York 12845 SECTION C—BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑Building Under Construction* ❑x Finished Construction *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,ARIA,AR/AE,AR/A1—A30,AR/AH,ARIAO. Complete Items C2.a—h below according to the building diagram specified in Item A7.In Puerto Rico only,enter meters. Benchmark Utilized: FIRM ELEV.REF.MARKS,GPS Vertical Datum:NGVD29 Indicate elevation datum used for the elevations in items a)through h)below. x❑ NGVD 1929 ❑ NAVD 1988 ❑Other/Source: 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) 410.5 x❑ feet ❑ meters b) Top of the next higher floor 419.3 ❑x feet ❑ meters c) Bottom of the lowest horizontal structural member(V Zones only) ❑ feet ❑meters d) Attached garage(top of slab) ❑x feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 411.8 ❑x feet ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 410.5 0 feet ❑ meters g) Highest adjacent(finished)grade next to building(HAG) 418.3 0 feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs,including ❑ feet ❑409.5 meters structural support 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. 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. Certifier's Name License Number RUSSELL HOWARD 050540 Title OWNER Company Name F RUSSELL HOWARD LICENSED LAND SURVEYING Address a�•«.•.- 342 MAIN STREET City State ZIP Code HUDSON FALLS New York 12839 Signature Date Telephone Ext. 03-10-2022 (518)747-8747 Copy all pages of this Elevation Certificate and all attachments for(1)community official,(2)insurance agent/company,and(3)building owner. Comments(including type of equipment and location,per C2(e),if applicable) FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 2 of 6 15167 Insp. Date: 4/5/2023 Appl #: SH220511 ELECTRICAL CERTIFICATE COMMONWEALTH ELECTRICAL INSPECTION SERVICE, INC. 176 DOE RUN ROAD, MANHEIM, PA 17545 TELEPHONE: (717) 664-2347 New York Office: (585) 624-2380 Premises of: RICHARD BELIZZI as GARAGE Address: 17 DINEEN ROAD, LAKE GEORGE/QUEENSBURY NY County of: WARREN Permit #: RC-0072 Installed by: ELI ELECTRICAL CONTRACTING LLC Apparatus: 14 SWITCHES, 1 I RECEPTACLES, 4 GFCI RECEPTACLES, 30 AMP RECEPTACLE, 13 LIGHTS, 150OW WALL HEATER, Gi+Ci BREAKER, 100 AMP PANEL. Inspected by: SCOTT HONSINGER The conditions following governed issuance of this certificate, and any certificate previously issued is cancelled Failure to have the property reinspected when additional equipment or wiring is added; or within one year from the date of the certificate shall void the certificate in its entirely and the company shall not be liable for any damages whatsoever, This certificate does not guarantee efficiency, wearing qualities, maintenance or repair and the company shall not be liable for any damages resulting from any defect or fault in the plans or specifica- tions, including repair, reconstruction, personal injury or for the death of any person; and. This certificate only covets visual inspection of wiring and does not cover manufacture or use of wiring. Inspectors of this Company shall have the privilege of making inspections at any tithe, and if its rules are violated, the Company shall have the right to revoke the certificate. 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