HomeMy WebLinkAboutFEMA Application 2002-2-21
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PO~GE-ENGINEERING .~a~:S41-4SS-S624 Apr 12 i 9:00
FEO~L EMERGENCY MANAGEMENT AGENCY .
: NATtpNAI. FLOOO INSURANCE PROGRAM
EUEVATION CERTIFICATE
Impart4nt: Raid the In.trUdlo~ an P;!!L1IS 1 .7. . .
SE~"jCN A, PROP?TY OWNEI\ Il~FORMATIOH
aUll.DlNCl C;. NER'S NAMi
~ ....i~ co-c.'T' ~~: . ." ' '
,_ SliILOING-$i'RET ACO~SS OncludlnG ApL, vnll, SlIlB, .nellor Slllg. NO.) OR P.O. RoVTEANO aex NO.
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-CITY STAre.
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PRO~i"'" .;IESCFlIPTitJNl,".::'''' BlockNu_ TlIxP....N_. Loull~n. olC.l . - l?e ' ~
LdT \10 l.e'J1 ~ ,.. ZI:U' AO ~l~ 'IS ~...I ,0;,'1.. II':> ~i- (.oVIoLT"'l' PL'" ,"'-...
8Ull..OINGUSi(..;'.~oS;';~_idontill; "OlI.~.ell;.' Com- W-'YJ .
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l,.OlmJU;,',C:.GlT1JOE (OPTIONAl.)
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O.M.S. No: 3067..0077
i:Jlpires July 31. 2002
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HOkLzOl'lTAL CAruM:
u NAC.11127 W NAO 1as:l
st:Il.JI'Q!: U GI'$ (T~~
U usGS Quad Map W OIl*'
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. SECTION B ',,!-OOO INSURAHCE RATE M.AP (FIRMlINFORMATlON
,-;,. NFIP CG;';MUNIT't' NAME & CCMMUN . NUM8 , 82. COUrm' ~E' a3. STAT!!
?1l"12.".U!.~I.o!!."'l:> 4, '59'I"t.- I. l.A.\.le.-. O~C:lQl
" 1l4.W\PJlNOP"", 85;S\! IX a.FIR INDEX I 1.FIRMPANa -'1 'BB.F\.oOO ai.IlASEFLCOOCU;VAnCN\S)
NUMBER . ,CAT!' EI'l'ecTl\lElREVlSl!OOATI! ZONE(S) (Zon..AD.... doplll offtoadlng)
. 41O'Ylc:. I \0.;0;. ~ "" 2.'14\"1 ,,"' Z 'C\C!' . >' . '510:"1
810. l.clcat. ltle 10urce of tile Ball flOod EJClllalloil (aFE) data or Oaae &oed dep\ll entMlod In 89.
, U FIS Pra~I. U FIRM ~ Co~munity Oe!eI"I\'linecl LJ Olller (Oesa1lle):
B11. Indlcal. the .I...tion datum used for 111. BFeiln B9: l.J::rNGVD 11l29' U NAVO 1988 U Other (Oll8Q1be):
812. I. .he buDding loc8led,ln a CO""'lIl a.",ar R..iourcers system (CBRSi .",. or Otherwise Proteded AreiI (CPA)? U V.. i;:!I-No
Designation Date:' . -
SeCT1?N C. BUI ING eLEVATION INFORMATION (SURVEY REQUIREDI
, '. Iluildlng ilIBII.,;.ono Ira based on: WCon.lnI 'on OrawingS" ~eullcli"9 Under Ccnolnldiono . UFiniohed ConslnJdicn
oA new Sevation Cttll!o:ate wiQlle roquinld ""'~ :onatruclfon 01111. buUding is ccmploto.
:2. BuRdlnV Diagnlm Numb.- ~ (SeleOIlhll b~dini dlagiam most similar \0 the building !or whi:h lhla c:erllflr;ate Is being Cllfllp/eted . .... '
pag.. e Ind 1. If, no diagram a<=nloty ~ 1IIe bulldlnll. provtde. Ikltr:h or photograph.) , -. ~ '
;3. ElBIIll1ions-ZOtl... Al-.0.30. AE.AH.A (wi.... Bf'F). VE V1-V30. V (wi1h BFe). AR. APJA.AAJAE. ARiA1-A30. mAH; AAlAO
Complstl ,ltSns C3.-i beloW I=rdln; ID tile bqildlng ~grSl1l spedlled I'; ham C2- Stal. tile dalum used. If th. datum-' is diff.eront,frcin
ltI. cla\Um used !or lMe aFe In Sec:lIon a. COIl'l~ 1111 dall/II' \0 that uoed for th. BFe. Show ftold meaauremenlll and datum ccnversiOn
c:olc:ulll1ion. Usall1e spaco pro'olded or 1111 eonr,.nts area' Qt SeelIon'O or Seclfon G. u appropriato.to dOCUmenlllle d:alum -.. ~~<>n.
Datum. .....,-..' C--Slot1lCommri IA~ c>."!>' "to L<CAv QO.-TV,^ -= ~1"'.e~"", Di'o'rUM -' .
Elevation rw1erenCl mark used oM!2. ~""I!."'''''' eo.. the e1lM1t1on niferenC8 mark usee .appear~, "I .... ....JlNG
o a) Top of bo!\O"' fto.r (inducing bllemont oi endosure) '5.p." :. ~ ft./lIo) 1 - p .ij~AL'
Q b) Top of nOXllligl181' ftoor "'i \0.\. ,.:i. ft.(wa) - ,-!,N r WIIW'&YO lit
o 0) BolIom of lowest horizontal stNd1JnII member ~ :on"" only) . \o.l ,!A.-'. _ ft.(m) .!
Q ~Attached,9arwge(lopofllab)., '!II"!o .-L1l~):1'.~..... (J~_
Q e) LoweGI e1_don af machinerY and/or equillmont '-: ~
serviCIng Ills buadiri9 OS I ~ . ..:. 11.(-> If l
a I) Lowe8t ad)ac:enl glWda (l.AG) "!II 'I. . i ft.(tI) j i . oM: '" I" )
a III Highest adjacent gnds (HAG), ' , ~ I"> ...:k ft.(m) ! ~~ A,0AJ<fS
C h) No. af permlllent openings (ftood vents) wjtIIln 1ll. above adjacent grade I c.. ! ' T ,
o OTo!8llreaofaDperma...."topenJn~(ftOod~)inC3h ZitS _sq,in.~ - ~. ~'. 'ZI:O?.=:..
- SECTION 0: SURhvoR, ~tlGINEER; Of! ARCHITeCT CERTIFICATION. ' "
nus cenJ1ICIIllon Is to be .igned and GllIllId. oy'. iank surveyor. ""Vin-. or architect authori:od by law 19 cerllfy elevation i~a1i"".
cMfJfy //lar /tle /rJfonn,ffcn in SodJcN A. S. ",e C bn this cerfi/lt:8/8 ~PfII3enfS my best .trotts to iIlfOtpt8t tIie data iiveJtb/O. ' -
lJflder.!:/elld rhot an fals. s~ternerit ma be al1l1 b .t>e Of,jm' onment undrIr Iii U,S. CcGe. Ser:llorr 1001.
ER'S NAME , i LJCeNIiE NuuBl!R .
. -JO\..JMt.IA-I A..~. OCZ ' ~-:-~~.ZtoS
1TUi ' ",' COMPANY NAME:
__"-!..QD;O~I~ ~"'l'-.,~!~V'_'.:~ '~-~ ~"".':,.o.!Sfi'.I2.l"'" ~ 1P<l'll>le.YI"-'Co ,""C..o.'
~~ CITY' lITATi" UJCOOE:
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.ONA TUN:; . ~ I.. 1. r, /1 QA' Tl!UIPHClNli
JlOdoft _ ~ /.....AlJ.. ~. 301 . b'!,. -.Al . 4<tS . 4'5OS
......' -. POAGE E~INEER!NG aFax:S41-485-5624
. ~ I ' . _ . Rpr 12j 9:01 P.Cl5
IPORT A/'oT: In mese ap"CSS. copy lite .. s",,~dlng 'n~rma\:ion frcm sectlon.A. ::~y":",,,:,;;. '. .""7.-.-,.."-,'
uILD1NG sTJUiET ADOf'eSS (Inotoclrq.oo\.. unil. Soitll. ...,or _ .....l O~ P.C. ~OlJTEANO BOX NO. ~ "'.
~",1<:t .Jk.cfe-;-~li- '_ . 7s;;,.
fry . ST~TE tIP COOE ;~
~"ILI~<:O~I~ " .._ 1 0," ...~" ~.
. _ Se<:T10N Cl_..u.......,...R. JIIGINEfFl, OR .ARCHITECT CERTlFlc.o.TlON (CO! fiNUED)
;~py both sid- of \!liS ElevatiOll Cettiftc3ta for (~) =*"rnUn!iy aft.,aal. (2) insunmc;e agent'CClTlpany, and (3) buildlns owner. '
lOMMeJ0iT5C.I,.,. t:F.-..,p""..u:o"\~"'~ ~AAQ.I<:- tlll'-,,",lUr.(U) ......~...\~ ~~ llo-l~"lOi> ~
:;- ~ ~ M ~ o\l.'O~\.1'T' O~ ~ c..u1Zb Q.Il!.]"UtAJ ~ ~j",. ~'<J. c.P~t!.1- (9~. I~!~"'~
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IF "11)!:. ..""TIt~~, t.4'T"( D<'o~.~' ~12.~ p~"" ~'^ S~.l\. 8A.R>i,.;r~QJ.':' ~ ......,~~
~ ~'-I~_~?',e../o'l.~. ~'^ ' I I Checl< h_lf a*"rhmenlS
-!,ECTION E _ BUIL-OI..." el.fVATlON INFORM.40TlON (SuRVEY NOT REQUIRED) F~~ONe AO AND ZONE" (WITHOuT II~ '
~r ZO(18 AO and Zone A '(willlout Bl'E). camplotlll"" II El \htOugh E4. if /fie e/eVaIian c./l'Iikm .Is lJtanded Ibr Il#8 .., ~
(om1adot1 for d LOMA or L.O~, S.cion C must II compIBt8d. ," ' " ,
1 '. Building Dia~ NUlTIbeI' _ (5eIeclltle bul1c ng diagram moat ~mn2l' to the bUildinll fer whlc:h \lIiS QlllIfIcate is belng OOI!'ptetBd:..
see pagd 6 and 1.. If ne diagram aa:lJl1Itely rep....... the.llUl1dlng, provide a skllldl or ~...;....<,>h.)
2. The top of!l'\e bo1Iorn ~0CI1' (1r1dudin9 basement a!llf!doaure) of~e bullcllng Is. LL]1l.(nI)'UJn.(cm) U abOVe or U'beIOW
, (cIleck one) lhe Ilfghest adjac:ei1t gnade. ' , . . ,
3. For Bu"dlng Dlagrams.8-6 wt1h OJ*1ings (... pa,e n,lIle oi>>d high8l'ftoor or e.evated noor (eIeIiallo~ b) Of the bul1Cing is
L.-L-I 1!.(m) L...LJIt1.(Cl1I) abCr<e IN highest lldjjloert gt8de. ' . .
4. For Zone AO O'11y. If no neod dep1!l number i. a'1iil1ble,lt. lIle top of 1lle bottom ~cer eevaled In accordance wt1h the ccmmunitYs
nocdplal" ",anegement ~ldln~~~?.bl Yes I,'~ No \,_1 Unl<no""'. ~ local otrldlll must cerlilY this Interm".n in Sec!i-;" G. ' .
. .' SEC!'..3"" _ PROPERTY WNER (OR OWNER'S REPRaSENTATlVE) CERTIFICATION '
"he ?ro~ ow"... or own81's auttlCriud ~r8Senll!1Ivd who completes Sedians A. B. IIIld E far Zo~e IS. (wi1IloUl a FEf,lA-issued et: '
:ommunJ1y-lsllUed BFE) or Zone ~O must, .Ign here.: . . '.
'ROPeR"'" ",..Ni:Ro;; v" ;)WN~; "lITHORIZl:O Re;1RESENT",TIVi:"3 ~E
ZIP COO!
.oORl'SS
0An;
STATa
raEP<1ONE
crrr
lNA~
tlMMENTS
4- ' U Check here if at'.ilc:Mmel'lts
, _ ,,, SECTION 4. COMMUNITY INFORMATION (O;;~i'lAL.l
e local c1llcial wno is a\Jlt1orizod by law Cf crdi~an~ lc admlnisiei- the c.emmunily's iio~ manag"",em ordmll""" can ....ll'IIlleIe .
e1ions A. a. C (or E). and G d:llia Elevation Certlfi,4a\e. Complete tile appliCable ~arn(.) and algi below. '. '
. U The Informllllon~ S.c.OlI ~ was till'" from fW' dOCJmanta\lCln that has been i;gned and embcssed by a Ucensed SUl'J8)ocr.
en,gln.eer,,,o!..!~~ ~ .~!ul/Iori%ed by stat. or IceaIIaW to c;ertify elevation 1rL;.... ,..~.n. pndicale the source and date Of lhe
. ,fllY3tion !lalllln-tl1e COll'm~ lirea belOW.)' " ",'. '.
. U tc;::~~.~~,,~~~r..~ ~O" E ~r ~ building IoClited In ZcneA (without a ~sau~ ~ CIOmmunfty-lSSUflC 9FE) or
, U'n'-'8 iohOw;"g'iniO;maiicin-~iiioTiG4-GS).,1o -p~ forccmlt'Unity nood~lain mana.., ,. PL!'l"l~' .,'
''''':''f'':'.!" "n-t'~_ [ ~~,,__re~~~
. ThIS parm~ na. ~:iGS~ fer. ~ New Con....CIlOn U Substantiallm~ro"ern."t
. Elevadcl'l ,of....bWl !~.1!ll!'! (indudlng *-fn!) "'tile bUild/rig ia:
BFE or (IrI Zene t.oj.d!'Pll1,qf.!kl9ding at the !luil~ Siie is: '
iCo!.l.OFFICI':!-:S ~ . :.,' . ".. '
)/ofIAUNITY ,..,.,...e
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JNAT\.IRE
TEl..5?HONli
OATE
lMMEN1"S
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