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HomeMy WebLinkAboutFEMA Application 2002-6-28 O\-lt3~ eERAL EMERGENCY MANAGEMENT A Ay NATIONAL FLOOD INSURANCE PROG':1ff ELEVATION CERTIFICATE . Important: Read the ins~~t~c:ns.~~ pages 1 - i. SECTION A - PROPERTY U~~.~: INKJRMAnON BUILDING OWNER'S NAME BUILDING STRE:T ADDRESS (Incuding Apt, Unit Suile. and/or Eldg. No.) OR P.O. ROUTi:AND SUA NV. ~74~ :Jarnb Lo~~ _ CITY . ('. . ST"8f<2.. <:::"LP'( ~ 11' <: \d . ....._ P~+-7Y DECbRiPTION ILot and Blod< Numoers. Tax P=I 1'<l1llICUI. ~esc:iption. =J \ \,e:y i L<'i.II1dI,^~ 1"'4 MA, , _,'.. , BUILDING USE. (e.g., ~identi;1l. Non-residential, Addition, Accessory, etc. Use c,rrunenrs.5eCXl.u II r1ews:sc;ry.) 1?l'?oSC ~\Q<:'\ . _n. .__._ '_ _.. LATITUDEilONGITUDE (OPTIONAl) HORIZONTAl UAI UM: "UU",""" U U?~ (i'ype), ( 11#" - #If -11#.11#" or 1I#.###IIIf') U HAD 1927 U NAn 1983 . U USGS Quad Map O,M,B. No. 3067-0077 Expires July 31, 2002 I For InsWClnce Company Use: I Poiic/ Number I Company NAIC Numb~r ZlP CO~ 7 4'7 '7 U Other. .. , SECTION B - FLOOD INSURANCE RAIE MAP (ARM) INFORMATION Bl. N, FIP COMIj\UNIlY NAME & COMMUNITY NUMBER 52 COUNTY NAMh . I 83. STATE ,0 ('l~_~ S0"""'&if.;et 4-15;; z, L4"'P LOu""T"! ...:' df<'.... I 84. MAP AND PANEL I ss: SUFFix B6. FIRM INDEX I B7. ARM PANEL 88. FLOOD ,- 89. BASE FLOOD ELEVATlON(SJ NUMBER DATE EFFECTIVE1REV1SEDDATE ZONE(S) (ZoneAO. use depth offlooding) LlIO-::jqc...\ \(Ap 'P' T~'lolq1q :::r~t, l11Q. AE 513.5 B10. Indicate the source ~8ase Flood 8evation (8FE) data or base flood oepth enler.!d in 89. U FIS Profile RM " U Community Determined . U Other (Desenbe): Bl'. Indicate the elevation datum used for the BPE in 89: ~ NGVD 1929 U NAVD '~ U Other (Descnbe): 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or CthenoJSe Protected Area (OPA)? U Yes ~o Designation Date: . . ' SECTION C. BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) , ~. Building elevations are based on: UConstruc:ion Drawings" ~Building Under Construction" UFinished ConStruction "A new Elevation Certificate ~I be required when construction of the building is compie!e., . C2. Building Oiagram Number -11- (Select the bUDding diagram most similar to the building for whicil this cenrncate is being completed _ see pages 6 and 7. If no diagram accurately represents the building. provide a sketc!l or photograph.) C3. Elevations-Zones A1-A3D, AE, AH, A (with BFE). VE. V1-V30. V (with BPE). AR.AAJA. ARlAE. ARlA1-A:lO. ARlAH. ARlAO Complete Items C3a-i below according to the building diagram specified in Item C2. State .the darum used. If t1e datum is different from the datum used for the BPE in Section B convert the datum to that used forthe'eF:. Show fie!d measurements and datum conve",'on 'calcUlation. Use the space provided or the Comments area oi Section D or Sedion G. as appropriate. to cocumen! the datum o:mve",ion. Datum 'oC010'2."1 Conve",ionlComments <::'~p ;:<!CV~Y'iiL EI9€'~on re.ierence mark uselt~t7,.. JC,r.,~ Dces the ele'r.nion reierem:"marx used a~pearon the FIRM? U Yes Jkl No ref Jil'f lOp 01 bottom flooc Qnduoing basement or encosure) c:; I Z ,tz.. i".(1') 'li ~b) Top oinexthignerflccr 51'S. ,..Lft.(I:'l)::; r REGISTERED "- o .f) Bottom oi lowest horizontal struc:'~rai member IY zones cnly) 'u, 4, _ it( ~ ~ PROFESSIONAL g' 9l Attached garage (top of slab) z:; /2> . fJ.... 1\.( ~ 11 LANJ) SURVEVOFi rff .; ~~:~;i~~;e;:~:~i~i~;acilinery anClcr equipment .5 / &, ..Q fl.(,) ~ i' /0 ~ a /ff €:( j) Lowest adjacent grade (LA,G) ,'512- . J... 1\.( ~ l OREGON'-' j ~p( ~ H' , ,. c; i '2cJ2-fl ( ) ~.. JULY 20,1993 - .Igne:t aCjacent grade (HAG) ," ' ,:..:;<..,' "';; REXA BE1Z I<( bl' No. cr permanent openings (i1cec vems) within 1 iI. aoove aOjacant grace _ "'\ /I?!;Ofl , .:(i)' Total area oi all permanent openings (flocd vents) in C3h . C; 01./.. sq. in. (~) C:Yr.> I zJ 31/ CJ:S SECTION D - SURVEYOR. ENGINEER, OR ARCHITECT CERTIFICATION This certirication is to be signed and sealed by a land surveyor, engineer, Oi orc:hitec: aLrthcrized by law to cerJfy elevation information. I cenify that the information in Sections A. B, and C on this certificate represents fD'/ best efforts to interpret the data available. enderstand that anv false statement may be punishable by fine or imprisonment under 18 U.S. Code. Section 1001. RTIFIER'S NAM~ A _ r.l J... . UCENSE NUMEER PL<" /7 / . e~ \')&\'2- ._ _......_ ./ ~6 (p TITLE. C I I (;UMI-'Aj~1 NP..o".~ ~(_ C'\. _ -r-J .) U. yy e'1 AJI, 4 III '? 'C' (v CITY 1')'( a.1 ~ _!::- """" I ,;.., ~ Gy ""'" ..1--Ct.c, , ADDRESS 3\n -:S,..Ft-l,.. S\v--e,./,f' , __'50{'\""'1 h'C\"'t~AI"orZ ZIPCOOEd7l.f-7'7 SIGNATURE ~o/.. -a. /;7~' ..JlA,e '2 ~/'O/'1a 'eL:PHON9_ '\ ' . ') .. <'.;?.<I' .. 7t.vv--P '{1. t:,-",-, <-- (~i.{l ) 7'1-GrD0 J 7 . .",. _.....~ ~=,\.lA l='1"\"""'" R1.;1 ^,.rr-.--;:;;; -. ro""~ r"'\"" 1~.f"'CC cIne: t:'()Q rn...r.-"\III.'.,...I......~1 n.......... . ___ ... _ _ _. '. .. IMPORTANT: In these spaces. eopy th.sponding information from See~on A. , 6UILDI~G STRE"T ADD~ (Incuding Api" Unit. Suite, and/or 61Cg. No,) OR P.O. ROUTe AND 60X NO. . (0 /4 ~ ~\..fL-'. '" I.~ 1= /. V'l ~ _ .. CITY r .. STATE Z:t-1 CODE "S O("\Y"\C,il-clJ ()J'Z Chll77 I Fer Insurance Company Use: PoliC'f Numcer C.:mpany NAIC Numce! . SECTION D.. SURVEYOR. ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate fcr (1) communiiy offical. (2) insurance agenUcompany, and (3) building owner. :>:\(:co~~lf~T,s of C;P'-;'V,<' 'b:e\l) Bc"V\~'" )JuvL ~el"',,\ c, cl\\ \e.leA """"'.L.<.4Ve. (I'<-L+ l~ -tk , r r r.l.::' r' .t::. -Thl' ~Lde.., t".N Ct..O'-h <,t -\'1...17 W\iJ?Cl\',t ,.r ('-'....i-? ,-c::.ll.l.('h ",7 -t~ <;oLctlt..;ed CO(\UY 0.1 (,7tL, CW\d nu,,,.~t(lY\ \->::III""-!:, aYl elc:va.tio..... (!J.f 51'2..,..f;;\ <2.,:'n-! O"tt..""" I'J-",dt:<d;v<.h( ~ e(e-vt-ntV\ '71::3.1\ A}(:.Vr)'l,,! \.VbS u<,t:) a<, w.~"suS",feIBVAhti\o1<, trev~o"'. U Check here ii attachments SECTION E - 8UILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO and ZONE A (WlTHOIJT 8FE) For Zone AO and Zone A (without 8FE). complete Items E1 through E3. If the Bevation Certiiicale is intendedforuse as supporting information for a LOMA or LOMR-F. Section C must be completed. . E1. Building Diagram Number ~ (Seled the bUJlding lfsagram most similarlD the building Iilrwhich this certificate is bei~g completed- see pages 6 and 7. ,If no diagram accUrately represents the bwllflDg, provide a sketdl or p;_;....Q~h.) E2. The top of the bottom'floor [lDc!I,zding basement or enclosure) of the building is LU ft.(m) LUin.(cn) U above or.. U below (check one) the highest adjaCent grade. E3. For Zone AO only: If no flood depth number is aV3Jlable, is the top of the bottom floor eIeYated in Q_.';",.cewith the community's floodolain management c;~~~,,~? I, I Yes I J No LI uriknown. The Iccat oflicial must certify this ~.;~,,_~"" in section G. , : SECTION F _ PROPERlY-OWNER (OR OWNER'S REPRESENTATIVE) CERTIACATION The property owner or owner's authorized represen1ative who completes Sections A. B,and E fer Zone A (without a FEMA-issued or community-issued BFE) or Zone AO ri1ust sign here. ' ADDRESS <.;1.1 SlATE ZIP CODE . PROPERTY OWNER'S OR OWNER'SAUTHORIZED REPRESENTATIVE:':; NAMe SIGNATURE DA.:: i EtEPHONE COMMENTS I~ 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 c:::lmpie!s Sections A. 8. C (or Ej. and G of this Elevation Certificate. Complete the applicabie itemis) and sign beiow. G'i. U The information in Section C was taken irom othercdcCJmentaticn that has"be<"'..!l signed and embossed by a licensed surve'lor, engineer. or architectwno"is auttlonzed by Slate or lccallaw to certify eievaticn iniolUICUcn. (Indicate the SCl.rrcs and date ~i the e!e~ation data in the CommentS area below.) G2. U A community offidal compieted Section E fer a buiiding lcc:zted in Zane A (YlithClIt a Fa1J1.-issued cr c::mmunity-issuec E:==) cr Zone AO. G3. L! The foilowing information (Items G+G~) is proviced fer ~r:1mur:ity ticcd~iain management pu~cses. I, G4. FERj\'lIT NUMEE~ I G3. DAIt: FE::\MIT ISSUcC ; \.:0. O~~ ;:~;;-;;;C;;':I~ OF COMFLlANCEiCCCUPANCY 11<::-::: n=:"'", ! ----- G7. This permit has been issued f~~ U N~w CcnstrucJcn U Subs;:anriai Im!=rovemem Ga. Elevation of as-built lowest floor ~nc::uding basement) oi me buiiding is: G9. EF" or 0n Zone AO) depth of flceding at the building site is: LOCAL OFFICIAL'S NAME . _ ft.(m) Datum: '_ ft.(m) Datum: TIi"t.= COMMUNITY NAME j-C:i?HONE SiGNATURE DATe . COMMENTS I I Check hele if attachments ....-..- ....--.......... ...,........... REPlA(~F~ All PRFYIOUS EDITIONS