HomeMy WebLinkAboutBuilding Miscellaneous 2013-3-26 U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
Federal Emergency Management Agency Expires March 31, 2012
National Flood Insurance Program Important: Read the instructions on pages 1-9.
SECTION A-PROPERTY INFORMATION For Insurance Company Use:
Al. Building Owner's Name SHAVER,JAY D&SHIRLEY A Policy Number
A2. Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. - Company NAIC Number
38 KREMONT AVENUE _
City SPRINGFIELD State OR ZIP Code 97477
A3. Properly Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
LOT 2, BLOCK 6,THIRD ADDITION TO FILBERT GROVE,BOOK 54, PAGE 30,LANE COUNTY DEEDS&RECORDS
A4. Building Use(e.g., Residential,Non-Residential,Addition,Accessory,etc.)RESIDENTIAL
A5. Latitude/Longitude:Lat.N44.027447 Long.W123.023937 Horizontal Datum: ❑ NAD 1927 N 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 6
A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) 1430 sq ft a) Square footage of attached garage sq ft
b) No.of permanent flood openings in the crawlspace or b) No.of permanent flood openings in the attached garage
enclosure(s)within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in
d) Engineered flood openings? El Yes ❑ No d) Engineered flood openings? El Yes El No
SECTION B- FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
81. NFIP Community Name&Community Number 82.County Name 63.State
LANE COUNTY, UNINCORPERATED AREA 415591 LANE OREGON
B4. Map/Panel Number 85. Suffix Be. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s)(Zone
41039C1144 F Date Effective/Revised Date Zone(s) AO,use base flood depth)
6/2/99 6/2/99 AE 450.6
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
FIS Profile El FIRM El Community Determined N Other(Describe)SEE NOTES
B11. Indicate elevation datum used for BFE in Item B9: N NGVD 1929 ❑ NAVD 1988 ❑ Other(Describe)
B12. Is the building located in a Coastal Barrier Resources System (CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes N No
Designation Date ❑ CBRS ❑ OPA
SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations are based on: El Construction Drawings* N Building Under Construction* El 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,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. Use the same datum as the BFE.
Benchmark Utilized LCCM 1233 Vertical Datum NGVD29
Conversion/Comments
Check the measurement used.
a) Top of bottom floor(including basement,crawlspace,or enclosure floor) 446.7 N feet El meters(Puerto Rico only)
b) Top of the next higher floor 452.2 N feet El meters(Puerto Rico only)
c) Bottom of the lowest horizontal structural member(V Zones only) El feet El meters(Puerto Rico only)
d) Attached garage(top of slab) ❑feet El meters(Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building El feet ❑meters(Puerto Rico only)
(Describe type of equipment and location in Comments)
f) Lowest adjacent(finished)grade next to building(LAG) 446.0 N feet El meters(Puerto Rico only)
g) Highest adjacent(finished)grade next to building(HAG) 446.7 N feet El meters(Puerto Rico only)
h) Lowest adjacent grade at lowest elevation of deck or stairs,including El feet El meters(Puerto Rico only)
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. /certify that the information on this Certificate represents my best efforts to interpret the data available.' ��0 PR�FFB
understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.N �4 �aGINStet wt
Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a y
licensed land surveyor? N Yes ❑ No 'i�'� "�
v
Certifier's Name RONALD D. RICE,PE,PLS License Number 19403PE ".414141W
Title SENIOR PRINCIPAL Company Name GEOMAX, INC i OREGON p
93 3 .
Address 806 NORTH NINTH S RF T City COTTAGE GROVE State OR ZIP Code 97424 tvOly n Ito
Signature � Date Telephone (541)942-0126 4L00.
EXPIRES: 2,31.13
FEMA Form 81-31, Mar 09 See reverse side for continuation. Replaces all previous editions
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
380 KREMONT AVENUE
City SPRINGFIELDState OR ZIP Code 97477 Company NAIC Number
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner.
Comments HORIZONTAL LOCATION WAS DERIVED BY USING GOOGLE MAPS.ONLY HALF OF THE MANUFATUCURED STRUCTURE
WAS PLACED AT THE TIME OF THIS CERTIFICATE.
Signature Date
❑ Check here if attachments
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.
El. 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 8-9 of Instructions),the next higher floor
(elevation C2.b in the diagrams)of the building is ❑feet ❑ meters ❑ above or ❑ below the HAG.
E3. Attached garage(top of slab)is ❑feet ❑ meters ❑ above or ❑ below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is ❑feet ❑ meters ❑above or❑ below the HAG.
E5. Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management
ordinance? ❑Yes ❑ No ❑ Unknown. The local official must certify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B,and E for Zone A(without a FEMA-issued or community-issued BFE)
or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge.
Property Owner's or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
❑ Check here if attachments
SECTION G-COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E).
and G of this Elevation Certificate. Complete the applicable item(s)and sign below. Check the measurement used in Items G8 and G9.
01.❑ 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-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: ❑ New Construction ❑ Substantial Improvement
G8. Elevation of as-built lowest floor(including basement)of the building: ❑feet ❑ meters(PR)Datum
G9. BFE or On Zone AO)depth of flooding at the building site: ❑ feet ❑ meters(PR)Datum
G10.Community's design flood elevation ❑ feet ❑meters(PR)Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments
❑ Check here if attachments
FEMA Form 81-31, Mar 09 Replaces all previous editions
OMB No. 1F'
�, ,.RTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE
Expires Marc
Management Agency e' !-g'
.dotal Emerdency Important: Read the instructi�Ins on Nay __— „•,_,„
Fa$I{ dali r.PriSarlYe-t)sel
rational Flood Insurance Program roc r z
SECTION A-PROPERTY INFORMATION �g� !Lt. >
s z
Al. Building Owners Name SHAVER,JAY D&SHIRLEY A _- °.@�- de9' .Rtiib€r. y
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.Na)or P.O.Route and Box N o. �. -—
ara
.36 KREMONT AVENUE
City SPRINGFIELD State OR ZIP Code 97477
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
NTH DEEDS.:rREi,ORDC
LOT 2,BLOCK 6,THIRD ADDITION TO FILBERT GROVE,.BOOK 54,PAGE 30,LANE COUNT NAD 1983
etc.)RESIDEN'�IAA,
A4. Building Use stud Residential,Non-Residential,V Addition,023937 Accessory, )
Horizontal0atunc ❑ NAD 1927
A5. Attach at l Latitude/Longitude:Lat. aphs of the Long.�-
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain A9°For a building vrith an attached garage: • sq ft
A7. Building building with Number 6 a) Square footage wit of attached a age:
A8. For a bu refo wag a of cra pace e or enclosure(s) 1430 sq ft a) No.of a mane t god opens gs i nthe crawl b) No.of permanent flood openings in the attached garage
within 1.0 foot above adjacent grade sq in
b) enclosure(s)of permanent flood foot above in dja crawispace or — c) Total net area of boved openings grade a in A9.b No
enclosures)within 1.0 foot above adjacent grade sq in
d) Engineered flood openings? ❑ Yes ❑
c) Engineered Total hered flood of flood openings in A8.b - No
d) Engineered flood openings? ❑ Yes ❑
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B3.State
- , OREGON
61. E C Community Name&Community AREA 4155 gg.Flood EG.Base Flood Elevation(s)(Zone
LANE COUNTY,Number Su AREA 4156. FIRM B7 FIRM Panel Zone(s) Base
use base El flood depth)
Date Effective/Revised Date ne 450 fl
64.Map/Panel Number 85.Suffix B6. FIRM In ex 6/2/99 AE
4103901144 6/2/99
Other(Describe)SEE NOTES
B10. Indicate the Profile of the Base Flood Elevation 0 (BFE)data or base
Determined flood depth entered in Item 89.
Other(Describe)
® FIS Profile ❑ FIRM ❑ NAVD 1988 ❑
NGVD 1929 ❑ � ❑ Yes ® No
area or Otherwise Protected Area(OPA)?611. Indicate elevation datum used for BFE in Item B9: 0 CBRS ❑ OPA
B12. Is the building located in a Coastal Barrier Resources System(CBRS)
Designation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Finished Construction
Construction Drawings* ❑ Building Under Construction" ❑
C.I. Building elevations are cased on: ® V the building
BFE),5 complete.plet ARIAS,AR/A1-A30,ARIAH,AR/AO. Complete Items C2.a-h
*A new Elevation-Zones s A1- 30 will AE,AN,,A w B E).construction-V30,V(e building is complete.
C2. below acc r Zon to the bull A1-A30,building diagram A
below according to the building diagram specified in Item A7. Use the same datum as the BFE.
Benchmark Utilized LCC Vertical Datum NGVD29 Check the measurement used.
Conversion/Comments_ - meters(Puerto Rico only)
,14 ._� 0 feet ❑meters(Puerto Rico only)
feet
a) Top of bottom floor(including basement,crawlspace,or enclosure Floor) 6'� ❑feet ❑meters(Puerto Rico only)
c) Top of the he l west ofloor --- ❑feet ❑meters(Puerto Rico only)
d) At a Bottom h df the ge(tot of slabtal structural member(V Zones only) ❑feet ❑meters(Puerto Rico only)
d) Lowest garage of of slab) servicing the building
e) Lowest eleype o of ipm finery and equipment 446 0 ®feet ❑meters(Puerto Rico only)
(Describe type t equipment grade ade location in Comments) 446 7 0 feet ❑meters(Puerto Rico only)
f)g) Lowest adjacent(finished)grade next to t b bulking (LAG)
h) Lowest adjacent (finished)aa t lowest west levatio building(HAG) --
❑feet ❑meters(Puerto Rico only)•
h) Lowest adjacent grade at lowest elevation of deck or stairs,including
structural sus sort ENGINEER,OR ARCHITECT CERTIFICATION
SECTION l-SURVEYOR, law to certify elevation _-
information. Ricertification is to be signed and sealed by a land surveyor,engineer,or architect authorized by Section l ablei unishable b fine o i epril onme t under 18 Ue. de,S A ion 100d by a CG9 ,j 1 certify that the information on this Certi(caf�represents my best efforts fo interpret the data availab e.understand that any false statement may be p No Q�_ 7
Check here if comments are provided on back of form. licensed land surveyor? ® Yes ❑
License Number 19403PE �"' 'I VkV.
Certifiers Name RONALD D.RICE,PE,PLS OREGON 2
Company Name GEOMAX,INC +, T
Title SENIOR PRINCIPAL State OR ZIP Code 97424 • `Z(2/ yj� �
Address 806 NORTH NINTHS ET City COTTAGE GROVE Telephone (541)942-0126 L22p•0
�- Date Z
Signs ure '�
no See reverse side for continuation.
•~. For Insurance,COmPany tfse
.NT: In these spaces,copy the corresponding information from Section A. o, dymbei
No.)or P.O.Route and Bux Nu. ~s 7 t., ',u�
d0 KR Street Address(including Apt.,Unit,Suite,and/or Bldg. ) _ __._ — • (�o'npany NAIG Number " a
City KREMONT AVENUE %+ +� ,.a4.
City SPRINGFIELDState OR ZIP Code 97477 �- -
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,aid(3)building u■mer.
Comments HORIZONTAL ONTAL OCA IONN AS.O FO OT) BY USING GOOGLE MAPS.A 3ENCHMARK WAS PROVIDED ON SITE AT AN ELEVATION OF
•
if 11 27 )
r r Date
❑ Check here if attachments
Signature
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BEE)
For Zones AO and A(without BFE),complete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B,
and C. For Items E1-E4,use natural grade,if available. Check the measurement used. In Puerto Rico only,enter meters.
E1. Provide elevation information for the following and check the appropriate boxes to show whet feet e❑elevation meters is
❑above obe❑below the HAG.adjacent
grade Top(HAG)bottom and m too lowest ing basement,grade(LAG). - ❑feet ❑meters ❑above or❑ below the LAG.
a)Top of bottom floor(including basement,crawlspace,or enclosure)is
F)For Building ld of bottom Diaram (including-9 win basement,flood openings below the 9 oHAG.
_ ❑feet ❑meters ❑above or ❑
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items-8 and/or 9(see pages 8-9 of Instructions),the next higher floor
(elevation garage in the of slabs)of the building is ❑feet ❑meters ❑above or ❑below the HAG.•
E3. Attached garage flop of Eery is _--
❑feet ❑meters ❑above or❑below the HAG.
E4. Top of AO only: If oflood de th number equipment ervicis t the p of the b __-
E5. Zone AO only: If no flood depth nuUnknown available,
The local official must certify thfls information in Son G accordance with the community's floodplain management
ordinance? 0 Yes ❑ No ❑
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 BEE)
or Zone AO must sign here. The statements in Sections A,B,and E are correct to the best of my knowledge.
Property Owner's or Owner's Authorized Representative's Name State ZIP Code
City
Address Telephone
elephone
Signature
Comments '
❑Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The local official who is authorized by law or ordinance ttoad min(t)and sign below.s floodplain
the mean rement Items G8 nce can
and G9.ter the
The Sections A,B,C(or E),
and G of this Elevation Certificate. Complete the applicable
G1.❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect o
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-G9)is provided for community floodplain manage Date u rtfi rposes.
Of Compliance/Occupancy Issued agement
G4.Permit Number G5. Date Permit Issued
Substantial Improvement
New Construction ❑feet ❑meters(PR)Datum•G7. This has been issued for: ❑ --
G8. Elevation permit tion ❑atiodo n of as-built lowest floor(including basement)of the buildin g ❑feet ❑meters(PR)Datum
G9. BFE or(in Zone AO)depth of flooding at the building site: —_ ❑feet ❑meters(PR)Datum
G10.Community's design flood elevation
Title
Local Official's Name Telephone
Community Name Date
Signature
Comments
❑Check h
_ ereifs
Replaces all previous editor
��... r..« n1_'31 Mar O9