The URL can be used to link to this page

Home My WebLink AboutFEMA Application 2003-4-11 .-..... B~..)J.j> O~..,lO\ .A(-l vi\ \ II ;--iOo-~: - . .~~~O~~~E~~~NDCI~~~;~~~~.~Y- ." . ELEVATION CERTIFICATE . a.M.B. No. 3067-0077... Expires July 31. 200:2 BUILDING OWNE."'S NAME . ". . .. . l~portanc- Read theins'uuctions on pages. 1. -7_....... .... . ... SECTION A. PROPERTY OWNERINFOP.MATION ..... I For Insurance. Company Use:' I Policy Number I t;o~pany NAIC.Numb~ i 8UILDING STREET ADDRESS (Induding Apt.. Unit. Su"e. and/or ~Idg. No.) OR P.O. ROUTE AND BOX NO. . (tJ7'2 \ ::Tacob. La>1e.. . ...:.;......:. CITY ('., "IA).l',L? 'S Oy r;y,1'\~ cIa. . UI'-. P~~HTY DESCRiPTION (LoI an~ BloC< NumO":-': Tax P=el Numoor: L"!jaJ ~c:1ption. etc.) "1\3 \:,eYI Ldl'ldl"'~ Z""d I\M'L~. . .,' 3UI.L~I~~ .~(e.g:;re~j~e.~~tln;~~d.en~I..J:.dtI~,:,.~ory,.-.e.~..~~_~~.I~~ secxxl~._II~ry.) . t=''5 d'~, \ _u _____ . '._ _ LA T1l1JDElLONGITUDE (OPTIONAL). . HORIZONTAL OAI UM: ~UUHL:l:; Ll G..SUype): (##"'##-#II.#Ir' or #II.#####!'), UNAJ).!.9:n:." LJ.NAD1983,~.UUS~~~Map'UOther: ZlP COD.); '. o 2'177 l I I .,":-, I B1.NF1P.COM~UNITYNAME'&CON:MUNCT'(..w-'MBEH' '--I:,~t..LJUNI",rt.~~~..-.,_.-_..._;+:_. _', __..,:,'~ 1__flj.SI~TE" .: .....-. f ' C,~ oJ. Sf"'h\"i Ae\l~~415r;'1'2>. .La:",p~,(0u"" . 'r""-::""":"';.".<dK.o ." '''~ .... 84. MAP AND PANEL : , B5.'SUFFIX" c. 86. ARM INDEX '. BT, FIRMPANE!;,'--' . 88: FLOOD':.. .B9:8ASEFLOODELEVATlON(S). . I 'I 0 ;;~~:': '\.1 ~], "..- c:~~.'--r.- ":'~~,' 6~~;:;~~~'~"Vll'~~'~::" :._ .:e~S).;':"'::<:,*,~A. C1,/IS"~d. floOOx'ingj" '-i ')'--1'\.-,,:::. ""~""~I""'--- '.,Jcv;",c.:'7r-r CJt"H", c,' "'-1 C(......_. ,1\,," ".. "VCMe U.c...o>1C': '.. B1 O. Indicateth~.sourcaof. theBase.F.IoodSfivation (BFE)dala oc base flood. depth,enl~irr~9_:~........2c:.... ....:'. .' .. . UFIS.I',,?fiI~-,-..__~IRM-:::52:::u'c'O.1iinJiiiiY oetiiriiuned': UOlher(DescilJe)~" ..' . "'., .. ". .. B1.1. Indicate the, elevation datum:used fcrtlleBFE-hB9: i;:iNGVD 1929- LJ NAVD.1~. LLOther (Descnbe):' B 12; Is the buildiri910cated in a,CoastalBanier Resources System (C8RS)areaorOthelWlSef'.~;~..;....; Area (OPA)?. U Yes; ~o,.':'" . Designation Date:' . .. '. '.' SECTION C. BUIlDING aEVATlON INFORMATlON'(SURVEYREQUIRED) '. .. Building e!eva110ns are based on~t:JConsiruction Drawings' ...' UBuilding' UnderConslruction,.J:t1F;niSlled Construction' , ~A new Elevation CertificatewiU be. required wherrconstrudion of the building is coll1plel!L.._ "_"_'''' ...:... .,___........ __ ...... . C2. B uiiding Diagram Number$. (SeJect the buiiding diaglam moSt similar to the build'rngforwhich this certificate is being compl~!~ _ se~ . pages 6 arid 7: "If no'dlagram accUratelY'represents uie building, provide:asketch or photograph.) . ..' . . C3. ElilVations- Zones A 1-A30,-AE. AH; A (will1BFE), 'IE. V1-V30, V.(wilh BFE). AR. ARlA,.ARlAE. ARIA 1-A30, ARlAH. ARlfl.O . .. .," . Complete. ItemsC3a-i below a=rding to ll1e building diagram speciiied in Item Cz. Stale the datum used. If the datum is different from ... . '. tile datum used for the BFE in Section B.convert the datlllit toothat Used fertile BFE.. ShcwiieJd measu. _..;_..~ and daium conversion . calaiiatiolT.' USr the space provided or the Comments area of S~on 0 orSection G; as appropriate; to documentll1e darum conversion. Datum.!J(?VO let ConversionlComrn}lnls ~ <:;'-ee k'eveY'se- EI~ation reference mark used-'\! ~. k' eV~se. Does the elevation reference mark used a~ron the FlRM? U Yes J2\i No l2"}l) Top ofbottomfioo[ OndUdingbasementoren=~ ..E!> 1'2- ..Lit( ) ~L I . BblTopofnexthigherfloor '. . C\"WVI~p..(~. 51t.1- . "'J ft ) ':(' .... . REGISTERED. II a. c) Bottom oi lowest horizontal slrucluraJ member ry zones only) ^...if"\,. o-ft( ) '~:.' ,PROFESSIONAL . ~'-"_'lro'"''''J '''3 .='" , LAHPSU~~_ e) Low:st elevation of machinery andlgr equipment .' . ~ ~.~'. #.. ,', . ~ servIcing the building 5/3. B ,e(. ) i!.a r~//, _ ~f) Lowest adjacent grade (LAGj . '5 /3 .~fl( ) ~[ OREGON/ . ~9)Highestadjacentgrade(HAG) '.' 5/3.a..ft()~' JULY20,1993 ~N . . 'h' 1ft . .. t . l7 ~ REXABETZ. . \Q _ O. 01 perm.anent openings (flood vents) wit In . ao"ove~olaQ!n graoe .', ~ '. ~ / o I otal area 01 all permanentopenrngs (floodvenlS) In C3h 2,0'2-::' sq. Uf. \.) //fv'. ~od" i zI~, /6 -:>, SECTION 0 - SURVEYOR. ENGINEER, OR )l;RCHITiOc r CErnFlCA TlON . SECTIONB - FLOOD INSURANCE RATE MAP_(FlRMj INFORMATlON" ... .,. ~~... ~~.v_ . This certirication is to be signed and sealed by. a land surveyor, engineer, or an:hitect ~oriz-Cl{j by law to cermy elevation infomiation. / certify that the inrormation in Sections A, B. and C on this certificate represents my best efforts to interpret the data available. .,. ndersta~d th~tany raise statement may be punishable by fine or imorisonment under ~8 U.S. Code, Section 1001. .. TIFIER S NAME-r-, A'~..L. . U~cNSE NUMBEH PI c" .-? / ( . - K"E'.IC - t"?eA"2- . L-') <-(o() !'l Tl~ .-. -. COMPANY NAM~. ~ _ _ ':\LLyvel Ua.II\Q,,;'ey- '_ 'pY'a",d;\ ~l-';"{'<::.Y'y,;..<; ~c. ADDRESS ,,:>\'/') 1==i~ I . CL_ 0.. C1H S . ~ r. \ ISlATE 10 ZIPCODE _; ....,. .7- 'J~t", ...J1Y -<e.J\ - (.N' """9 n <= "1 () I "-... ?J 71.f 7 I. SIGNATURE k . /? 01 ____ D)fP .1 II 7 ^ /J ?. TEL:PHONs,. '\. "'J . ':.?../l/' r /. /-. . YI , U/V -'- (<;'11 ) 71f& -Ofo ::; 7 F=MA Form 81-31,AUG 99- ~ '<::::==QCw::oc::=c:,n~'dho;"""'"""",,,,,,,,~,,,,,,, - . '!J -IMPORT ANT: In these spaces, copy the co.nding information from Section A. . . ',U1LDING STRET ADDRESS (IndudingApt. Unit. ,andlorBldg. No.) OR P.O. ROUTE AND BOX NO. (D..'J.. \ :::::ra.t: oh l...a '" e_ - . CITY . (' - - SIAl E ZlP \..ULJ~ "50'("Y\~Il"'dd ()~ 4,1ft! , . I For. lnsur.mce Company Use: Potic,,! Number .1 Company NAIC Number . .~, Copy both sides of this Elevation Certiiicaie for (1) community official. (2) insuranC! agentlc::>mpany. and (3) bUIldIng owner. . " - COMMENTS II'" C' ,I r~1 . . ~ (' ;t"" oJ' "':'O(''Yv.,,, n't',.\,) BpV\~ .AA4v~ 1:e'''IJ, 0.. <;:\A.i)e.\<=, ""'4'..<4ve: ('-<-<..+ I~ ~~. . 1 r' ) -, '. t r ..l.:' r ll. -,-"...l r -1-r--~' ~/e... I'M c.uyb'--:I -\:t." W\iJ~CI'k "r (',...q"'~ -rCILL0"' ri!l"""- SiJl.<.\o\loUe\,I.COT\o("',I'" Or (IJ 7.-tt.. (#'Ad nu;:.,to,,", \ (l\f~ "J ~Y1 e.l~va.t,,,,,,,. v.f 51'2...e\ C-l:~iO"-R"""Ofr'Ivfc<d,',,<,b( -10 e;(diJu.nw'.. S r:J, \ r otoVD'l"l \.))/6 u.,>da<,~ Q,"Sd<; cfEIe;;&.how')'[,je'V":eo~. . . U Checx.hereifalt3chments SECTlON E _ BUILDING ~L;"ATlON INFORMATION (SURVEY NOT REOUIRED) FOR ZONE AO and ZONE A (WITHOUT SFE] For Zone AO.and Zone A (without BFE)..compleie Items. HthtCugh E3.../ft/le Bevation Cerii5c:ate is iniendedfor use.as supporling. . information fora LOMA orLOMR'~="Sedio,;'ciiiiistbeCOOlpJeJed..~"...::':,:::"...::....' .... '. ...... E 1. -Building Diagram Number ~ (Seled the biJilcfll19 cfl3gram most sill1l1artO 1l1e. building ~Wiiid11hiS~-iS'~;;g .;;;mPieted.c.:' . seepages 6ancj;7~)f no diagram accUrately representsth~ bUIlding, pro..yide a sketch or pi~-aph,)...:. ,'.: ..' '. .'. :' . . E2.. The. top of iIlebottom'flooi-XtiidUcfuiQbiSeme;;t O;:'.;ndoslIii>j'of.t!iil buildiitg is:::' c..t:J !t(m) L:..LJin:(i::nF: [J abOve or-:.'O beloYi,::.:' . ';(ciiedcoiie)ihehigii;;staifriCilrt9iade::ll~.' '.;~,:.:',=,>,;:.:,,;,' .,:;; . .' ..:.,.. :.~..~>,:." E3. For Zone AO only: if no flood depth number'is available. is the top ~ the ~ floor e~ irr a=rdance with the commuility's. .". . ._. floodtilain' manage-men! ordiiianc.ii ,'.: I Yes-' I ~.i No:,'1 . I UrucnoWn. The local offici-alrnusl. certiffthis i..;_..~;;';n in SeCiiOiiG.-: ". . . SECTION.F _ PROPERTfOWNER-(OR OWNER'S REPRESENTATIVE) CERTlACATlON,.. Tne. property owner .or. owner's authorized 'representative who compIeies Sections Po, S'-.andEfor Zone A (wilhcuta.FEMA-lSSlled or , .,. c::>mmunity-'issuedBFE) orZcneAO rili.ist'Sigri herl1':';' : ., . . . .. . SECTION D _ SURVEYOR. ENGINE=-~. OR ARCHITECT CEmACATION (CONTINUED) .< . . PROPe.,,-TY OWNER'SOROWNER'SAUTHOR!ZED REPRESENTATIVE'S NAM~ DATE STATE '.' c. ZIP CODE: '.':, . . TELEPHONE- .' '.. ADDRESS . ... -, .' .. cm' SIGNATURE .,..--~. . ;'"'. COMMENTS ::';~\..1I0N;G'"COr.lMUNlTY'lNFORMATION,(0PT10NALl .. ...;"..,... . .. The local official who is authorized by law or ordinanC! io administer the c::>mmunity's floodplain management. ordinance can'c::>mplete Sections Po, 8, C (or E); 'and G. of this' 8evation Certiiicate. . cOmplete the applicable itlim(s) and sign' below. . . G 1. LJ The information in Secti~n C:.waS taken from otheidOC1Jrr.~. ,;.,~~., that has'been'signed and:~., .;....,.,ad by a 6censed-surveyor, . . engineer;:ora[Chitectwho:is.authorized by state or local Jaw to certiiy elevation information: (Indicate the sourceand:d-ate of.the elevation"cfata: in:ttle: Comme~ area beJow.) ." .' '. G2. U Acommunity offici3icompleted Section EJor a building located in Zone'A (without a F::MA-issued or cornmunily-isstiedBFE) or ..ZoneAO.. .. _..._.......-. . G3. U The foliewing information (Items G4-G9) is provided for c::>mmunity floodplain ma..~"~.~..;'pu",oses. I G4. PERMlTNUMBER -1'GS..DATEPERMITISSUEil I Go. DATi:C",,,,.,FiCATEOFCOMPUANCEiOCCUPANCY . . ..' ISSUED .' G7. Tnis pennit has been issued for: 'U New ConStruction U Substantial Improvement . Ga. Elevation of as.built lowest floor Oncuding basement) of the building is: Gg. BFE or On Zone AO) depth of flooding at the building site is: LOCAL OFFiCIAL'S NAME U Check here if attachments I . _it(m) Datum: . _ it(m) Datum: lTi1..E rcl.E.~HOt'lE COMMUNITY NAME DATE . SIGNAlURE COMMENTS LJ Check here if attachments REPLACES ALL PREVIOUS EDITIONS