HomeMy WebLinkAboutMiscellaneous Miscellaneous 6/24/2013 • From: 111106124/2013 08:59 #254 P.002/005
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U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE I 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
Al. Budding Owner's Name SHAVER,JAY 0&SHIRLEY A
A2. Building Street Address(including Apt.,Unit Suite,and/or Bldg.No.)or P.O.Route and Box No.
38 KREMONT AVENUE
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City SPRINGFIELD State OR ZIP Code 97477
A3. Property 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, •
.AS. Latitude/Longitude:Lat N44.027447 Long.W123.023937 Horizontal Datum: ❑ NAD 1927 ® 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
enclosure(s)within 1.0 foot above adjacent grade 14 p gs garage
within 1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b 2493 sq in c) Total net area of flood openings In A9.b sq in
d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes ❑ No
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61.NFIP Community Name&Community Number 82.County Name . 83.State
LANE COUNTY,UNINCORPERATED AREA 415591 LANE OREGON
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B4.Map/Panel Number 65.Suffix 136.FIRM Index B7.FIRM Panel 88.Flood B9.Base Flood Elevation(s)(Zone
4103901144 F Date Effective/Revised Date Zone(s) AO,use base flood depth )
• 6/2/99 6/2/99
450.6
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
® FIS Profile ❑ FIRM ❑ Community Determined ® Other(Describe)SEE NOTES
•
811. Indicate elevation datum used for BFE in Item 69: ® NGVD 1929 ❑ NAVD 1988 ❑ Other(Describe)
812. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)7 ❑ Yes ® No
Designation Date ❑ CBRS - ❑ OPA
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
Cl. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' ® Finished Construction •
'A new Elevation Certificate will be required when construction of the building Is complete.
C2. Elevations-Zones AI-A30,AE,All,A(with BFE),VE,V1-V30,V(with BFE),AR,ARIA,ARIAE,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 0)
•
Check the measurement used. 3- N
a) Top of bottom floor(including basement,crawlspace.or enclosure floor) 446.7 ®feet ❑meters(Puerto Rico only) (�(��
b) Top of the next higher floor 452.2_ ®feet ❑meters(Puerto Rico only) Cl
c) Bottom of the lowest horizontal structural member(V Zones only) __ ❑feet ❑meters(Puerto Rico only) r ((-DD
d) Attached garage(top of slab) ❑feet ❑meters(Puerto Rico only) ar
e) Lowest elevation of machinery or equipment servicing the building
❑feet 0 meters only)
G -
(Describe type of equipment and location In Comments) (Puerto Rico on /
f). Lowest adjacent(finished)grade next to building(LAG) 446.0 ®feet ❑meters(Puerto Rico only)
g) Highest adjacent(finished)grade nerd to building(HAG) _ 438.7 ®feet ❑meters(Puerto Rico only) /
h) Lowest adjacent grade at lowest elevation of deck or stairs,Including 446.0 ®feet ❑meters(Puerto Rico only) /�
structural support V
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. l certify that the infirmation on this Certificate represents my best efforts to Interpret the data available.( .10 PROF
understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001.0 ,��!- Rq�_
Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a 4 4M°I,
licensed land surveyor? IN Yes ❑ No 1'- :;'. L
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Certifier's Name RONALD D.RICE,PE,PLS License Number .19403PE
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Title SENIOR PRINCIPAL Company Name GEOMAX,INC
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Address 806 NORTH NINT TREET City COTTAGE GROW State OR ZIP Code 97424 /r 13
Sgna xl-ire Date Telephone (541)942-0126
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4-24.la
FEMA Form 81-31,Mar 09 See reverse side for continuation. ' «-A I i
ep es all previous o s editions
From: • 6/24/2013 08:59 #254 P.003/005
IMPORTANT: In these spaces,copy the corresponding information from Section A.
Building Street Address(Including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No
38 KREMONT AVENUE
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,and(3)building owner.
Comments HORIZONTAL LOCATION WAS DERIVED BY USING GOGGLE MAPS. BASE FLOOD ELEVATION FOR THIS STRUCTURE WAS
DETERMINED USING THE NEWLY PROVIDED FIS PROFILES PER LOMR DETERMINATION DOCUMENT(FEMA CASE#08-10-0649P).NO
MACHINERY WAS LOCATED ON THE OUTSIDE OF THE STRUCTURE,THEREFORE THE LOWEST ELEVATION OF ANY MACHINERY SERVICING
THE STRUCTURE AT THE TIME OF THIS CERTIFICATE WOULD MATCH THE FINISHED FLOOR ELEVATION(452.2').
Signattrs ��� Date
G ❑ 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 E1-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 owners 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
❑Checic 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,8,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.
Gt.❑ 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 05. 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(in 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
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Signature Date �
comments Date Received:
Planner: LM
•
❑Check here if attachments
FEMA Form 81-31, Mar 09 Replaces all previous editions
Pfom: • •06/24/2013 09:03 #254 P.005/005
Building Photographs
Continuation Page
For Insurance Company Use:
Building Street Address(including Apt., Unit, Suite,and/or Bldg. No.)or P.O.Route and Box No. Policy Number
38 KREMONT AVENUE
City SPRINGFIELD State OR ZIP Code 97477 Company NAlC Number
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."
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Date Received: Jq//'?
Planner: LM
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From:' • •6/24/2013 09:00 #254 P.004/005
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Building Photographs
See Instructions for Item A6.
For Insurance Company Use:
Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number
38 KREMCNT AVENUE
City SPRINGFIELD State OR ZIP Code 97477 Company NPJC Number
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two 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? If submitting more photographs than will fit on this page, use the Continuation Page,
following.
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Date Received: thti l 6
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Planner: LM
From: • *6/24/2013 08:59 #254 P.001/005
FAX. TRANSMISSION-
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PROFESSIONAL ENGINEERS
LAND SURVEYORS
BUILDING DESIGNERS
• 806 N.NINTH STREET COTTAGE GROW.OR 97424
PHONE(541)942-0126 FAX(541)942-7935
EMAIL:geomax @attglobal.net
To: Jay D. & Shirley A. Shaver Date: _ 06/24/13
•
Fax #: 541-741-0522 Pages: 5
From: Justin Demeter
•
Subject: Elevation Certificate
COMMENTS:
Dear Mr. Shaver:
This fax is intended to provide you with a copy of the Elevation Certificate for your property
located at 38 Kremont Avenue, Springfield, OR 97477. If you have any questions or concerns
please feel free to contact us at your convenience. Thank you for your time.
Yours truly, - -
Geomax, Inc
4.30
Justin Demeter
Survey Technician
•
•
Date Received: !-� �3
Planner: LM