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J. nRTMENT OF HOMELAND SECURITY ELEVATION CERTIFI
E OMB No. 16r
Expires Mart..
.decal Etnergency Management Agency Important: Read the instfUCti�rm c•n Nay — --g— a u�„ R ��-&
rational Flood Insurance Program SECTION A-PROPERTY INFORMATION ej r . .
':ci_
At. Building Owners Name SHAVER,JAY D&SHIRLEY A -- year.y � 'L �� ..
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No.
38KREMONT AVENUE
City SPRINGFIELD State OR ZIP Code 97477 •
Tax Parcel Number,Legal Description,etc.)
A3. Property Description(Lot and Block Numbers, .,
LOT 2,BLOCK 6,THIRD ADDITION TO FILBERT GROVE,BOOK 54,PAGE 30,LANE COUNT DEEDS u RE:.ORD..
A4. Building Use(e.g..Residential,Non-Residential,Addition,Accessary,etc.) NAD 1963
Horizuntai Datur,,: 0 1927
RESIDEN'IAA,
A5. Latitude/Longitude:Lat. aphs of the Long.if the Cer3937
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtaingflflood insurance.a building with an attached garage: sq ft
A7. Building Diagram Number 6 a) Square footage of attached garage
q8. For a building ef with a of cra pace e or enclosure(s) 1430 sq ft a) No.of footage enf flood opens gs enclsure b) No.of permanent flood openings in the attached garage
within 1.0 foot above adjacent grade sq in
b) No.of permanent flood foot above in dja crn grade or sq in c) Total net area of boved openings jac n g in e9.b No
Total net ar area of fl flood fpet above adjacent grade c) Engineered Total
n r flood flood ❑ Yes ❑ .
c) Total net area of flood openings in A8.b No
d) Engineered flood openings? ❑ Yes ❑ NCE RATE MAP(FIRM)INFORMATION
SECTION B-FLOOD INSURA g3.State
Number OREGON
B1.NFIP Community Name&Community g8.Flood 69.Base Flood Elevation(s)(Zone
LANE COUNTY,Number RPERATED AREA 415591 •
B7.FIRM Panel Zone(s) AO,use base flood depth)
B5.Suffix B6.FIRM Index Effective/Revised Date ne 450.6
fl AE 64.Map/Panel Number F Date 6/2/99
41039C1144 6/2199
810. Indicate the source of the Base Flood Elevation(BFE) or base flood depth entered in Item 89.
Community Determined ® Other(Describe)SEE NOTES
NAVD 1988 0 (Describe)
® FIl Profile ❑ FIRM ❑ ❑ Yes ® No
NGVD 1929 ❑
(CBRS)area or Otherwise Protected Area(OPA)?
Bt 1. Indicate elevation datum used for BFE in Item B9: ® ❑ CBRS ❑ OPA
B12. D the building located in a Coastal Barrier Resources System( )
Designation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
Construction Drawings' ❑ Building Under Construction` ❑
Finished Construction
C1. Building elevations are based on:
g tote. gR/AO. Complete Items C2.a-
Hnth BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,
'A new Elevation Certificate will be required B E)VE tV'I'V3D,V the buildin is w
C2. Elevations according Zones to the building ng diagram A
below according to the building diagram specified in Item A7. Use the same datum as the BFE. _-13 tp
Benchmark Utilized LCC3 Vertical Datum NGVD29 Check the measurement used..
Conversion/Comments _ ®feet ❑meters(Puerto Rico onn y
a) Top of bottom floor(including basement,crawls )n
452..E
0 feet ❑meters(Puerto Rico o
iiace,or enclosure floor)�6'-- ❑feet ❑meters(Puerto Rico 0 •c) Top of the the lowest floor —_-- ❑feet ❑meters(Puerto Rico only)c) Attached c of tae garage(top of slab) structural member(V Zones only) -- ❑feet ❑meters(Puerto Rico only)
d) owst evatio of a hinb) _—__
e) Lowest elevation of machinery or equipment servicing the building 446 0 ®feet ❑meters(Puerto Rico only)
Lowest adjacent type t equipment grade ade next on in ing(LA Comments) 446 7 0 feet ❑meters(Puerto Rico only
f) Lowest adjacent(finished)grade next tt building((HAG ❑feet ❑meters(Puerto Rico only)•
g) Highest adjacent (finished)dt lowest west next building ec(HAG) including
h) Lowest adjacent grade at lowest elevation of deck or stairs,
structural sus sort —
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION PROF�r,
a land surveyor,engineer,or architect authorized by law to certify elevation
This certification is to be signed and sealed by
best efforts to interpret the data Section av it bl e.! ���"�pI • �'O
punishable by fine or latitude imprisonment under 18 U.S.
in Section A n 100d by a �g �L.AC F 9 ,j
information. I certify that the information on this Certificat�represen s m
understand that any false statement may be p No •I -
Check here if comments are provided on back of form. licensed land surveyor? El Yes ❑
y
License Number 19403PE ( �:i�
Certifier's Name RONALD D.RICE,PE,PLS r, OREGON 2
Company Name GEOMAX, INC O 9�
Title SENIOR PRINCIPAL State OR ZIP Code 97424 - ICY 2j;
Address 806 NORTH NINTHS ET City COTTAGE GROVE `pp lik Date Telephone (541)942-0126�� 2 7
Signature --1
See • : '. -rtio
See reverse side for continuation.
FO.0.9s4 @nee Cempa USe';r' a ,'ag
.NT: In these spaces,copy the corresponding information from Secti M
;v^II�r ,Numtier-vxk
wilding Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Bux Nom. — — — iF- e t bersa A -.
;80 KREMONT AVENUE {�rV-p � :.Pe
City SPRINGFIELDState OR ZIP Code 97477 l, T pike:.=f
SECTION D-SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,aiti(3)building uwmer. 4 •
Comments HORIZONTAL LOCATION WAS DERIVED BY USING GOGGLE MAPS.A 3ENCYMARK'NAS.PHOVIDFD ON SITE AT AN ELEVATION OF
451.6 FEET(BASE FLOOD ELEVATION+ 1.0 FOOT) .
tr. • Z7 )
/\t• Date
• .. ❑ Check here if attachments
Signature
SECTION E-BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE)
For and C Zones
For Items E7 E4,use natura g grade,if available. Check the measurement used.u ed.to
In Puerto Rico only, LOMR-F complete Sections A,B,
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). ❑feet ❑meters ❑above or❑below the HAG.
a)Top of bottom floor(including basement,crawlspace,or enclosure)is --
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 ii❑n Section IItems Bad/o e(se❑below t9 of
HAG.Instructions),the next higher floor
(elevation C2.b in the diagrams)of the building is
E3. Attached garage(top of slab)is __ ❑feet ❑meters ❑above or ❑below the HAG.
E4. Top of platform If oflood depth number equipment r is available,,iis t the p of the bottom—_
❑feet ❑ meters ❑above or❑below the HAG.
E5. Zone AO only: If no flood depth nuUnknown. The local offic aP mustcertity n so information in Section G accordance with the community's floodplain management
ordinance? ❑Yes ❑ No ❑
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
owner or owner's authorized representative who completes Sections A,B,and E for Zone A(without a FEMA-issued or community-issued BFE)
P p
or Z property B, and E are correct to the best of my knowledge.
or Zone AO must sign here. The statements in Sections A,
Property Owners or Owners Authorized Representative's Name ZIP Code
City State
Address
Date Telephone
Signature
•
Comments
❑Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The local official who is authorized by law or ordinance item(s)administer
and con munw.nity's floodplain
the meal gement o se Items G6 and G9.ections A,Sections C(or E),n
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 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 BEE)or Zone AO.
G3.❑ The following information(Items G4-G9)is provided for community floodplain management purposes.
G4.Permit Number
G5. Date Perron Issued G6. Date Certificate Of Compliance/Occupancy Issued
G7. This permit has been issued for ❑ New Construction ❑Substantial Improvement •
_ ❑feet ❑ meters(PR)Datum ,_
G6. Elevation 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 • Date Received: all://t2
Plann- • ■
• ❑Check here if attachment
Replaces all previous edition
CC.An c.,.,,, 9 1_111. Mar 09
J.S.DEPARTMENT OF HOMELAND•JRITY ELEVATION CERTIMATE 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.
' 38 KREMONT AVENUE CompanyNAIC Number,
City SPRINGFIELD State OR ZIP Code 97477 t
A3. Property Description(Lot and Block Numbers,Tai 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
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. ® NAD 1983
A7. Building Diagram Number 6
A8. For a building with a crawispace or enclosure(s):
A9. For a building with attached garage:
a) Square footage of crawispace or enclosure(s) 1430 sq ft a) Square e footage of of attached garage sq ft
b) No.of permanent flood openings in the crawispace 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 s in
❑ No
d) Engineered flood openings? ❑ Yes ❑ No . d) Engineered flood openings? ❑ Yes q
SECTION B-FLOOD INSURANCE RATE MAP(FIRM) INFORMATION
81. NFIP Community Name&Community Number B2.County Name
LANE COUNTY, UNINCORPERATED AREA 415591 83.State
LANE ( OREGON
84. Map/Panel Number 85.Suffix 86. FIRM Index I 87.FIRM Panel
41039C1144 B8.Flood B9. Base Flood Elevation(s)(Zone
F Date Effective/Revised Date Zone(s) AO,use base flood depth)
6/2/99 6/2/99 - AE 450.6
810. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 89.
® FIS Profile ❑ FIRM ❑ Community Determined ® Other(Describe)SEE NOTES
B11. Indicate elevation datum used for BFE in Item 139: ® NGVD 1929 ❑ NAVD 1988 ❑ Other(Describe)
812. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes
Designation Date ❑ CBRS ID OPA ® No
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
Cl. Building elevations are based on: ❑ Construction Drawings' ® Building Under Construction'
*A new Elevation Certificate will be required when construction of the building is complete. ❑ Finished Construction
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 gag
below according to the building diagram specified in Item A7. Use the same datum as the BFE.
7 N
Benchmark Utilized LCCM 1233 Vertical Datum NGVD29
Conversion/Comments_ N
Check the measurement used. r 2
a) Top of bottom floor(including basement,crawispace,or enclosure floor) 446.7
® feet 0 meters(Puerto Rico only) z
b) Top of the next higher floor - 452.2 ®feet
c) Bottom of the lowest horizontal structural member(V Zones only) ❑meters(Puerto Rico only)
d) Attached garage(top of slab) ❑ feet ❑meters(Puerto Rico only) •�
• ❑feet ❑meters(Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building ❑feet
(Describe type of equipment and location in Comments) - ❑ meters(Puerto Rico only)
f) Lowest adjacent(finished)grade next to building(LAG) 446.0 ®feet
g) Highest adjacent(finished)grade next to building(HAG) 446.7 ❑ meters(Puerto Rico only) V
h) Lowest adjacent grade at lowest elevation of deck or stairs,including ®feet ❑meters(Puerto Rico only)
structural support ❑feet ❑meters(Puerto Rico only)
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.l
understand that any false statement maybe punishable by fine or imprisonment under 18 U.S. Code„Section 1001.® g'S SGINEF FBA,,
Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a
• fb 9
licensed land surveyor? ® Yes ❑ No • I- P y
Certifier's Name RONALD D. RICE,PE,PLS rb
License Number 19403PE ��a\,.
Title SENIOR PRINCIPAL Company Name GEOMAX, INC ON
I , ...93,406.:047 EGON ,3 •- 8
Address 806 NORTH NINTH S+T City COTTAGE GROVE State OR ZIP Code 97424 n
Signature �\ -
�.�`�`� Date 3•ZL�3 Telephone (541)942-0126 qID D.
FEMA Form 81-31, Mar 09 See EXPIRES: R. I0)3
ee reverse side for continuation. Replaces all previous editions
IMPORTANT: In these spaces, cote corresponding information from Sectiorilli ,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 SPRINGFIELDSIate 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.
2 3u ,3
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, 8, and E are correct to the best of my knowledge.
Property Owners 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.
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-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 ILL pate Received:
• Planner: LM
❑ Check here if attachments
FEMA Form 81-31, Mar 09 Replaces all previous editions