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Home My WebLink AboutPermit Building 2014-09-09SPRINGFIELD -- Issued ISSUED: 09109/2014 225 Fifth St STATUS DATE: CITY OF SPRINGFIELD Springfield,OR97477 SITE ADDRESS: 2056 HARBOR DR, Springfield, OR 97477 SCOPE: Single Family Residence Phone: 541-726-3753 oR6co 4 Building / Residential Permit Inspection Phone: 541-726-3769 OWNER: CALOIA NEAL JOHN & HEATHER RENEE Fax: 541-726-3676 ADDRESS: 2056 HARBOR DR PERMIT NO: 811-SPR2014-01338 SPRINGFIELD OR 97477 v ,,.springfield-or.gov parmilcenter@spnngfield-or.9ov PROJECT STATUS: Issued ISSUED: 09109/2014 EXPIRES: 03/0712015 STATUS DATE: 09/09/2014 APPLIED: 06/20/2014 SITE ADDRESS: 2056 HARBOR DR, Springfield, OR 97477 SCOPE: Single Family Residence ASSESOR'S PARCEL NO: 1803112203600 TYPE OF STRUCTURE: Residential PROJECT. DESCRIPTION:... S -. New.SFD•. replace existing VIF.home on site OWNER: CALOIA NEAL JOHN & HEATHER RENEE Phone Number: 541.915-9030 ADDRESS: 2056 HARBOR DR SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lie No Lic Exp Phone Plumbing Contractor RS PLUMBING CONTRACTOR INC CCB 103816 01/04/2016 541-461-4714 _.__. _____._.._.___.__._._—.-_ Electrical Contractor ._.._...._...___....._,.._...._r_,._..__......._�__.._.___-_..B--___ DAVID LEROY SYTSMA CCB -54-1--8-4 —7- 8 5-6 -0-- 160739 07/15/2016 541-847-8560 Mechanical Contractor MARSHALLS INC CCB 25790 T 12/23/2015 541-747-7445 General Contractor __..__---01 KELLY M KING CCB_ 85401 04127/2015 541-520-7922 INSPECTIONS REQUIRED Inspections 1020 Zoning Setbacks 1090 Street Trees - 1110 Footing Footing: After trenches are excavated. 1118 Footing Drain 1120 Foundation Foundatio: After forms are erected but prior to concrete placement. 1160 UFER Ground ,r„�\Ui Ground: Install ground rod at footing and call for inspection in ,oar' cdnjlinctlorS> i h footing and/or foundation inspection. 1220 Underfloor framing n ,-,,�{ N'. 1260 Framing-��E� , , I ,,. Framing Inspection: Prior to cover and after all rough in inspections have been 1410 Underflot �rUU$u�attorf 1A i . tl• �L 1420 InsulationAV BPI Ba?rier 1430 Insulation WaVk”"gt t` " t Wall Insulation: Prior to cover. 1440 Insulation Ceiling Ceiling Insulation: Prior to cover. c 1520 Interior Shearwall Shear Wall Nailing: Before covering sheathirgvqtt} - ICisti`r�ja�d�j 1530 Exterior Shearwall 1540 Gypsum Board/Lath/Drywall Drywall: Prior to taping. Latfi/AIA)ifb`r`\\�'�`�'0a JR d' �@�dell lathing and gypsum board, interior and exterior are) � ate b �iio �ifa'stering. 1999 Final Building Final Building: After all required i 4�iactior(O ve been requested and approved and the building is complete. Cine Springfield Building Permit 9/9/2014 2:05:35PM Page 1 of 2 W$PKINGfIELD tt to v6s4 OREGON vrvnv. springgeld-or.gov CITY OF SPRINGFIELD Building / Residential Permit PERMIT NO: 811-SPR2014-01338 225 Fifth Sl Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenter@sp6ng0eld.ocgov By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State or Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safely. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction. A , , / �A . , �4 Owner or Contractor Signature Date Springneld Building Permit 9/9/2014 2:05:35PM Page 2 of 2 LINELD — CI FY OP SPRINGFIELD 225 Fifth St TRANSACTION RECEIPTSpringfield,OR97477 OREOtlN 541-726-3753 811-S P R2014-01338 ww .spdngfield-or.gov 2056 HARBOR DR permitcenter@spdngfield-or.gov RECEIPT NO: 2014001977 RECORD NO: 811-SPR2014-01338 DATE: 09/09/2014 DESCRIPTION ACCOUNT CODE/TRANS CODE AMOUNT DUE Continuing Education Fee 224-00000-425606 2.50 Planning - Major Review - UGB 100-00000-425002 1231 286.00 Residential Fire (05 Per Sci Foot) 100-00000-424005 9111 149.25 SDC: Improvement Cost - Storm Drainage 440-00000-448028 1176 469.39 SDC: Reimbursement Cost - Storm Drainage 441-00000-448029 1177 322.79 SDC: Total Storm Administration Fee 719-00000-426604 1180 39.61 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 1099 195.97 Structural Building Permit Fee 224-00000-425602 1002 1,633.10 Technology fee (5% of permit total) 100-00000-425605 2099 81.66 TOTAL DUE: 3,180.27 PAYMENT TYPE PAYOR CASHIER: CCARPENTER COMMENTS AMOUNT PAID Credit Card CALOIA HEATHER R 3,180.27 00914z TOTAL PAID: 3,180.27 W NGFAORC �GON www.spdngfield-ocgov TRANSACTION RECEIPT 811-SPR2014-01338 2056 HARBOR DR CITY OF SPRINGFIELD 225 Fifth St Springfield,OR 97477 541-726-3753 permitce nter@springfield-o[. gov RECEIPT NO: 2014001349 RECORD NO: 811-SPR2014-01338 DATE: 06/20/2014 DESCRIPTION ACCOUNT CODE/TRANS CODE AMOUNT DUE Structural Plan Review Fee Residential 224-00000-425602 1061 1,061.52 TOTAL DUE: 1,061.62 PAYMENT TYPE PAYOR CASHIER: CCARPENTER COMMENTS AMOUNT PAID Check KELLY M KING 1,061.52 3450 TOTAL PAID: 1,061.52 .. r This permit is issued under OAR 918-460-0030. Permits expire if work is not started within 1 suspended for 180 days. LOCAL GOVERNMENT APPROVAL This project has final land -use approval. Signature: Date; This project has DEQ approval. Signature: Date: Zoning approval verified: ❑ Yes ❑ No Property is within flood plain: ❑ Yes ❑ No CATEGORY OF CONSTRUCTION ,Residential ❑ Government ❑ Commercial JOB SITE INFORMATION AND LOCATION Job site address: _-2,c6 �O v -81T— r City: R( State: ZIP: �7tO Subdivision: I Lot no.: Reference: g03 7- 1 TaxIot: ®3 400 ..1.. PROPERTY 'OWNER Name: rO Address: QS o City:" _ V -re State: 09, 1 ZIP:97V77 Phone:S /- lj-- O r- I Fax: - - E-mail:t 1 �p'i' i✓2�� Building Owner or Owner' gelVauthorizing is -application: Sign here: ❑ This installation is being made on residential orfarm e owned by me or a member of my immediate family, and is exempt from licensing requirements under ORS 70L010. CONTRACTOR INSTALLATION' Business name: I�jt1i e�5 Address: sr' r 4S r (a) Permit fee (use valuation table): I State: ®f, ZIP: y %7 Phone.6 - / %2 -2 1 Fax: - - E-mail: jYj/L txx pJ'S oy CCB license no.: c Print name: r - Signature: (e) Subtotal of fees above (2a through 2d): ' SUB-CONTRACTORINFORMATION . .` Name CCB License H Phone Number Electrical 00" � C ecir<< 03 1/-z c) 7—s y Plumbing CS 061A -64s $ YI 50]-2yOS Mechanical (a) Seismic fee, 1%(.01 x permit fee [2a]): gl_7y7.7 y I DEPARTMENT USE ONLY I Permit no.: Date: or if wnrk is -FEE SCHEDULE 1. Valuation information (a) Job description: MOO Fp Z-0 105�Pl&ce Occupancy ei w Construction type: Square feet: Cost per square foot: Other information: Type of Heat: Energy Path: [14ew ❑alteration ❑ addition (b) Foundation -only permit? ❑ Yes o Total valuation: 2. Building fees (a) Permit fee (use valuation table): $ (b) Investigative fee (equal to [2a]): $ (c) Reinspection ($ per hour): (number of hours x fee per hour) $ (d) Enter 12% surcharge (.12 x [2a+2b+2c]): $ (e) Subtotal of fees above (2a through 2d): $ 3. Plan review fees (a) Plan review (65%x permit fee [2a]): $ (ij/ 5'2- (b) Fire and life safety (40%x permit fee [2a]): $ (c) Subtotal of fees above (3a and 3b): $ 4 -Miscellaneous fees' (a) Seismic fee, 1%(.01 x permit fee [2a]): $. (b) Technology fee, 5%(.05 x permit fee[2a]): S .� (c) Continuing Education Fee $2.50 $2.50 TOTAL fees and surcharges (2e+3c+4a+4b+4c): S Z`) l V fp 041-11- LSPRINGFIELD � 225 Fifth St CITY OF SPRINGFIELD Spring0eld,OR97477 wy Phone:541-726-3753 oaecoN Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2014-01371 v .sprmgfield-or.gov permitcenter@spdngfield-ocgov PROJECT STATUS: Issued ISSUED: 09/09/2014 EXPIRES: 03/07/2015 STATUS DATE: 09/09/2014 APPLIED: 06/25/2014 SITE ADDRESS: 2056 HARBOR DR, Springfield, OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 18 0311 220 3600 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: P-. Now SFD- replace .existing .MF.home .onsite -3333.. 3323.. 3 3 33. 3333 OWNER: CALOIA NEAL JOHN & HEATHER RENEE Phone Number: 541.915.9030 ADDRESS: 2056 HARBOR DR SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lie Exp Phone Plumbing Contractor RS PLUMBING CONTRACTOR INC CCB 103816 01/04/2016 541-461-4714 Electrical Contraclof DAVID LEROY SYTSMA CCB 160739 07/15/2016 541-647-8560 Mechanical Contractor _.___._.--_—.--.__._—.__-...—__ MARSHALLS INC CCB 25790 12/23/2075 541-747-74445 General Contractor KELLY M KING CCB 65401 04!27/2015 541 520-1822 INSPECTIONS REQUIRED Inspections 3170 Underfloor Plumbing Underfloor Plumbing: Prior to insulation or decking. 3200 Sanitary Sewer Sanitary Sewer Line: Prior to filling trench and including required testing. 3315 Water Line ,IOU1,k,\o,, 3400 Storm Sewer Storm,191e1�er� rior to filling trench. e 3500 Rough Plumbing Rough,-Plurgbli�6. r to cover and including required testing. 3999 Final Plumbing Final Plifmfirilq: rlf,W,tien all plumbing work is complete. By signature, I state and agree, that I have carefully ezal}'h'' the completed application and do hereby certify that all information hereon is true and correct, and I,further,.cg/tify'tNat any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and they LadJS"Bi the State or Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of aper_;ttuctt're without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction, caner or Contractor Signature Date f W f\0 Spnngfeld Building Permit 9/9/2014 2:03:42PM Page i of 1 SPRINGFIELD --- CITY OP SPRINGFIELD 225 Fifth St TRANSACTION RECEIPT Springfeld,OR97477 ONEGON 541-726-3753 811-SPR2014-01371 mm.springheld-ocgov 2056 HARBOR DR permitcenter@spdngfield-or.gov RECEIPT NO: 2014001976 RECORD NO: 811-SPR2014-01371 DATE: 09/09/2014 DESCRIPTION ACCOUNT CODEITRANS CODE AMOUNT DUE' ' Continuing Education Fee 224-00000-425606 2.50 One or Two Family Dwelling with Three Bath 224-00000-425603 1005 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 1099 494.00 59.28 Technology fee (5% of permit total) 100-00000-425605 2099 24.70 TOTAL DUE: 580.48 PAYMENT TYPE PAYOR CASHIER: CCARPENTER COMMENTS AMOUNT PAID Credit Card CALOIA HEATHER R 580.48 00914z TOTAL PAID: 580.48 E v .springfield-orgov CITY OF SPRINGFIELD Building I Residential Permit PERMIT NO: 811-SPR2014-01372 225 Fifth Sl Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permilcenter@springfield-or.gov PROJECT STATUS: Issued ISSUED: 09/09/2014 EXPIRES: 03/07/2015 STATUS DATE: 09/09/2014 APPLIED: 06125/2014 SITE ADDRESS: 2056 HARBOR DR, Springfield, OR 97477 SCOPE: Mechanical Only ASSESOR'S PARCEL N0: 1803112203600 TYPE OF STRUCTURE: Residential -PROJECT DESCRIPTION: - -- M - New SFD•.replace existing MF home on site _..... _--..... OWNER: CALOIA NEAL JOHN & HEATHER RENEE ADDRESS: 2056 HARBOR DR SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Phone Numbor: 541-915.9030 Contractor Type Contractor Name Lie Type Lie No Lie Exp Phone Plumbing Contractor RS PLUMBING CONTRACTOR INC CCB 103816 01/04/2016 541-061-4714 Electrical Contractor J� DAVID LEROY BYTSMA ��w---�"'-___.__...._� CCB 160739 07/75/20164541-847-8560 Mechanical Contractor MARSHALLS INC CCB 25790 12/23/2015 541-747-7445 General Contractor KELLY AA KING CCB 65401 04/27/2075 541 520-1922 INSPECTIONS REQUIRED Inspections 2200 Underfloor Mechanical Underfloor Mechanical. Prior to insulation or decking and including required testing. 2300 Rough Mechanical Rou�gfir�(l�,pj1&15-i�a : �( to Cover en 2999 Final Mechanical Final MbM .'S0A � I mechanical work is complete. ,7ulr�-Fl`�yL-�V. Of� h By signature, I state and agree, that I have carefully eirail�ne�tjle 30pertaining pd application and do hereby certify that all information hereon is true and correct, and I further certify'-a�30YrdWrk performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the '$. �� 45�rA to the work described herein, and that NO OCCUPANCY will be made of any structure without perrniS i 3g14e Community Services Division, Building Safety. I further certify that only contractors and employees who re1, Ii nce with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are,fequested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction. Jte 2 - caner or Contractor Signature Date // qq I( �. V� ��1`, PI Rivlll ,;111\1 nl� �;;OPrl71 n IIItD f ` ' t �;QGlll Oi;15 .I,i,IiJUFd1U I �� Springfield Building Permit 9/9/2014 2:01:31PM Page 1 of 1 SPRINGFIELD -- CITY OF SPRINGFIELD k225 Fifth Sl TRANSACTION RECEIPT Springfield,01397477 OREGON 541-726-3753 811-SPR2014-01372 w .springfield-or.gov 2056 HARBOR DR permits nter@springfield-or.gov RECEIPT NO: 2014001974 RECORD NO: 811-SPR2014-01372 DATE: 09/09/2014 DESCRIPTION ACCOUNT CODE/TRANS CODE AMOUNT DUE Continuing Education Fee 224-00000-425606 2.50 First Appliance Fee 224-00000-425604 1006 82.00 Furnace - up to 100,000 BTU 224-00000-425604 1006 19.00 Range hood/other kitchen equipment 224-00000-425604 1006 15.00 Single -duct exhaust (bathrooms, toilet compartments, utility room: 224-00000-425604 1006 60.00 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 1099 21.12 Technology fee (5% of permit total) 100-00000-425605 2099 8.80 TOTAL DUE: 208.42 'PAYMENTTYPE PAYOR CASHIER:ccANPENTER COMMENTS AMOUNT PAID - Credit Card CALOIA HEATHER R 208.42 00914z TOTAL PAID: 208.42 S kq CITY OF SPRINGFIELD 225 Fifth St TRANSACTION RECEIPT Spnngfield,OR 97477 541-726-3753 811-S P R2014-01373 wmv.springfield-or.gov 2056 HARBOR DR permitcenter@spdngeeld-or.gov RECEIPT NO: 2014001975 RECORD NO: 811-SPR2014-01373 DATE: 09/09/2014 DESCRIPTION ACCOUNT CODE/TRANS CODE AMOUNT DUE Each added 500 sq. ft. or portion 224-00000-426102 1004 112.00 Electrical Continuing Education fee 224-00000-425606 1032 2.50 Residence wiring 1,000 sq. ft. or less 224-00000-426102 1004 151.00 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 1099 31.56 Technology fee (5% of permit total) 100-00000-425605 2099 13.15 TOTAL DUE: 310.21 PAYMENT TYPE PAYOR CASHIER:CCARPENTER COMMENTS AMOUNTPAID -.-.. Credit Card CALOIA HEATHER R 310.21 00914z TOTAL PAID: 310.21 Show Receipt Detail RECEIPT Springfield SPRINGFIELD 225 5TH STREET Dave Puent Set ID: 2056 HARBOR Set Name: 2056 HARBOR Page I of I Payment Method Ref Number Amount Paid Payment Date Receipt No. Cashier ID Cash Drawer ID Received Comments Credit Card $4,279.38 09/09/2014 6707 CCARPENTER DIB https:Hay.prod.oregon.accela.conilportletslfeel ecciptView.do?mode=viewSet&setReceiptN... 9/9/2014 U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY Norimal Flood Insurance Program IMPORTANT: Follow the Instructions on pages 1-9. OMB No. 1660-0008 Expiratlon Date: July 31, 2015 SECTION A - PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name NEAL JOHN & HEATHER RENEE CALOIA Policy Number: and/or Bldg. No.) or R0. Route and Box No. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NFlP Community Name & Community Number City SPRINGFIELD State OR ZIP Code 97477 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) N feet OREGON TAX MAP 18-03-11-22, TAX LOT 3600 B5. Suffix 86. RRM Index Date A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL Nfeet A5. Latitude/Longitude: Lar rid 0204E Long. -123.0246 Revised Date Horizontal Datum: ❑ NAD 1927 Fxj 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 R 07/27/2009 AE,X A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: 0 a) Square footage of crawlspace or enclosure(s) 1244 sq ft a) Square footage of attached garage 397 sq ft b) Number of permanent flood openings In the crawlspace 19 b) Number of permanent flood openings in the attached garage or enclosure(s) within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade 6 c) Total net area of flood openings in A8.b 1515 sq In c) Total net area of flood openings in A9.b 199 sq in d) Engineered flood openings? ❑ Yes N No d) Engineered flood openings? ❑ Yes N No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NFlP Community Name & Community Number B2. County Name N feet B3. State UNICORPORATED AREAS LANE N feet OREGON B4. Map/Panel Number B5. Suffix 86. RRM Index Date B7. FIRM Panel Effective/ 88. Flood Zone(s) 89. Base Flood Elevatlon(s) (Zone Nfeet ❑meters 452 , Revised Date Nfeet A0, use base flood depth) 410122/1144 F 06/02/1999 07/27/2009 AE,X 451.9 B10. Indicate the source of the Base Flood Elevation (BEE) data or base flood depth entered in Item B9: ❑ FIS Profile N FIRM ❑ Community Determined ❑ Other/Source: Bll. indicate elevation datum used for BEE in Item 89: ® NGVD 1929 ❑ NAVD 1988 ❑ Other/Source: B12. Is the building located Ina 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: N Construction Drawings* ❑ Building Under Construction* ❑ 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 BEE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/Al-A30, AR/AH, AR/A0. Complete Items C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: CITY OF SPRINGFIELD BM #486 Vertical Datum: 454.87 NAVD88 - SEE COMMENTS Indicate elevation datum used for the elevations in Items a) through h) below, N 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) b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) g) Highest adjacent (finished) grade next to building (HAG) h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 450 5 N feet ❑ meters 454 0 N feet ❑ meters NA El feet ❑meters 451 4 Nfeet ❑meters 452 , 9 Nfeet El meters 449. 7 Nfeet ❑meters _4�5 „ 8 Nfeet ❑meters 450. 0 ®feet ❑meters 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. ❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ❑ Check here if attachments. licensed land surveyor? ❑ Yes N No ENGINEERING SURVEYOR FEMA Form 086633 (Revised 7/12) See reverse side for continuation. Replaces all previous editions. ELEVATION CERTIFICATE, page 2 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 PO. Route and Box No. Policy Number: ZIP Code 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 ELEVATION DATUM ADJUSTED -3.65 FEET PER VERTCON TO MATCH FEMA MAP DATUM (NGVD29). FINISH FLOOR ELEVATION AND FLOOD OPENING INFORMATION PROVIDED BY CONTRACTOR Dale 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 E7 -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, cmvAspace, or enclosure) Is _ . _ []feet 0meters 0 above or 0 below the HAG. b) Top of bottom floor (Including basement, crawlspace, or enclosure) Is _. _ 0 feet Dealers 0 above or 0 below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A hems 8 and/or 9 (see pages 8-9 of Instructions), the next higher floor (elevation C2.b In the diagrams) of the building is _. 0 feet Cl meters 0 above or 0 below the HAG. E3. Attached garage (top of stab) Is _ . _ 0 feet 0 meters 0 above or 0 below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is _, _ 0 feet 0 meters ❑ above or 0 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 communitys floodplain management ordinance? OYes []No 0 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, 8, 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 Signature Dale Telephone Comments 0 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 -G70. In Puerto Rico ony, enter meters. Gl. 0 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. 0 A community offlclal completed Section E for a building located in Zone A (without a FEMA -Issued or community -Issued BFE) or Zone AO. G3. 0 The following Information (Items 04-G10) is provided for community floodplain management purposes. G7. This permit has been Issued for: 0 New Construction 0 Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: _, _ 0 feet 0 meters Datum 69. BFE or (in Zone AO) depth of flooding at the building site: _ . _ 0 feet 0 meters Datum GSO.Community's design flood elevation: _ . _ 0 reel 11 meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments 0 Check here If attachments. FEMA Form 086-0-33 (Revised 7/12) Replaces all previous editions.