HomeMy WebLinkAboutFEMA Application 2002-2-21
. '. POAGE E~INEERING . Fa;< :541-485-5624 Apr 1_. S :59_
FEDERAL EMERGENCY MANAGEMENt AGENCY .
NATIONAl. FLOOD INSUAANCE PROGRAM
atvATION CERTlFICA TE
. Importaj.t Read tne lnatNctions on pall- 1 .7. .
SEC'flO; A. PROPERTY OWNER INFORMATIOJIl
BUIL.l)ING~.s KAME .
-,oM 'dl~' c..o~i '1o\oO~e."" .::' ."
BUn.olNG STREET AOPR!SS (lIldudIng Apt., Unit, Sul1o. u.d/Gt Bldg. NO.) 01'1 P.C. RGUnAI'IC Bex !'l0.
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CITY . . STAn,
. "04,."
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PROPER"" Ci'SCRi'Pii - (\.ot _ BIodl N~ TlfI Fa",", Num_. U;~I 0e0c1pll0n. 0lC.) . ~.~ ; ~ ,r-l't"( PlJ'o"I' 9 e' ..... 0 ~
1fr II' ~\ v.wn,%~:-,?~OI'TI~Le.1c::.. ~u~ ~\~?,.\I'S'? ........".-
'~UIl.CI!'lG USE (e.g., ResiQotIll...l,o.",,,,oJonlil. Addlllj;.._ry, ~ us. c"",menII_n f -oy.) .
I.Anl~~~~~IONAl.l HOfhu~-;-;.;,d;.I"...M: 50URCe: UGPS(TypIl~ .
(....""." or fIII./IIIIiffI') UI'Wl!sz7 UN,I.01883 UUSG3CtlallMap U~.
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P.03
. O.M.a. No;'3067~OTT
Elcpires July 31. 2002
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Zip CODE
"'1"14." ,
SECTION S. F OOD lHSU~Ce. AAT.!~ (FIRM) INFOIUolATlON
. al. NFlF COMMUNm NAME & COMMUNITY NU~ I Co COUNTY NMie.' .-. I h lITAili
"'P,",I..<a""~ 40\ '5'3"\'1- . ~E.- . _ . " . QIUO',o04
1M. """"..NO PANEL I 85. SUFFIX I es. F1!lM'NOI!X l 87. FIRM PANEL- I' 88. FLOOe I sa. BASe FI.OOe ~AnON(S)
. NUMB!Il CA~' =."..."JEJREVlSECCAT!! ZONElS) cz-AO,....~offtoodlllg)
. 410~ c:.IICtM . F Ii?' z.-~'. ""'Z.-"\"I" 't- . . ~Io.q
310.lndic:atelhe !lou_ClllleSase Flood 8411l1tior1 (eFE) dala orb;genood ~epth entered In B9_
W FIS Profile U FIRM ~ ecnjmunlty Cetermined W Other (OllSQ'ite):
311.lndic:atB the elevation datllm UPd lorllle eFE ~ e9: ~NGVO 192& .W NAVD 1988 U Other (Describe):. .
312_ I. the buildlng located in a Coastal earrier R"durces System (CaRS) area or Olh8!Wi.e Protected Area (OPA)? 'W v. ~ No'
Ceolgna1ion Oele: " .
SECTION C _ eUIL?ING !I.EV.ATION INFORM.AiION (SURVEY I\ECUIREC) .
BuildIng elevatlon. are cased on: WConstrJctJlln OnrNing.. tl:lBuildlng Under Con.truClion. UFlni$hed Con.truction
'A now EIevarlon Certificate wm be requfredwher ccrWnJctfon 01 the building I. campluta. '. , .
:2. Building Diagram Numb... ~ (Seled the buil~; diagram mc5t similar to the b~ildlng lor whiclllhis certiflc:Ite ia belli; completed. see .
pages 6 and T. ~ no d1all"'m accu,.leIy l'el'rueftt31he blllldlng. provide e ske\dl cr photegraph.) . -.. ":
:3_ Elevation. -Zones A1-A.:lO. AlE. A;H, A (with BFT ), ..c. V,.....30. V (with ePE), All. ARiA. .ARlAE. ARlA1-A30. ARJAH, AAJAO'
Complete Ilem. C3.~ btlaw according to the buding diagram spedned in "em C2_ Stab the dalllm used. If !he datum is dJn:er..".train
tile d:atum' used for the BFE In Section S. cornie, the d8tu/!l te that used fer the BFE. Shew fleld mellS\l"""en1e and dalIJm Conv.,;,lon
c:a1C\JI.tion. . Use tile space pro\lided or the Comments area at Section 0 or Section Q, a. app,.;priata, te .:ocument 1l1. datlln cctMlrSion.
ElO:tu..':: I ~ '~ed' .:..'~~m~e:.~t:>... oo'''!.'th''T\'lfY''''!'.:' ~;V"^ T'O~ ---...... ~~;.V .... Nrt-"M, ~.
""'.Wcnl.JarUllcemsu~us ~l..A.R'"UftKlal4(~ oes .efewtionrt:JI&rencema'IIousediil..... t'I ; J l' L... C
o .)Topo(bo!lomlloo,Qndudlngba.emerTtOtJondollR) ')lIt. ....!..,tt.(a)..-- LANtl.;(t~
o b) Top o(nexl high.-lIoor . ,,\1:1' ,iIL(..)", . :oft
o c) BollCm of/owes! h.:...:........: s1nJdunIl irll.ll!aer(V zonee only) ~~'_ ~.(m) 1, .~ ~
o ~ ArtacIled gms. ""P olsla~) .' 9..... . .....L 11.(.) J 1 ~. I J
o e) Lowes1 ehlVlltloll of mac:h/nery and/or oqu;pmetlt . ~.
.-. :..;'. ttte building ,. '!;\.... ..i. 1I.lIII) .J l MY'''''' )
(1) l..owatadjecerllgr;da(LAG) ...110 ..,Lft.(m) ~ JONATHAN A. OAKES
. Q g) High"'" edJao:ant gtIde (HAG), ...,.... . i 11.(111) I. ...ftoil.
Q h) No. of pennal1enl openings (flOod vents) + 1 II. above Idfacent grad. 10; ! __' t>~ ~( %a:>2.-
o 0 Total area oI.U pellTlanent openinge (llood ' enlI) in C3h Iq, ~ sq. in. (~ .
, .
SeCTION D .SUR~ EYOR. ENGINEER; OR ARCl-jITI!C1' CERTlFICATlON .
'his c8r1incati<:l" I. to c. Ilgned and sealed by a.lane, IUrveyor, engineer. or architect aulllortmd by law to certlfy ..evatlcn lnformnon.
car1ify /II., /he infOtmafiotl n Sedi:Jm.A, B. and C '*' IIlis ~ta 19pf8Senl:1 my but ~ 10 inlerptV/ 1M .1. tiva18b.. . .
undef'$iand that ellY fa/$e stllelMtit may be our,;,MbJe bv file or /mtJ1fson.'7lenl under 18 U. S. Code. s.cIJon 1001_
'.'ERnI'll!J'l'S NAMIO J A ~_"'~.. U~l! NUMBeR .
'- ~-f--T-~ c:Q..l.-h....~05
ITI.E . " . COMPANY NJlME l
P_IiI_OIU>n.- U'\W.l) ~e..~....oiL- l::l?...t"IL.'S'''-'U~..u:;,. '1 ~~~'f'11.I6 1>,IC...
..,lUi;SlI em STA~, Z1P,COCl:
. V.O'. ecno:- zs~, eu<!:l~~ ~. ,",,40'2..
!GNA TVJU: ,_, .d i 0. /I OA". TliIa'HONl:'
..... .w-->A. A... V1~ z,.u"O"Z.. <aA>\::~S.~....
..~ '. ~ffiE ENGlNEER~Far:541-485-5624 Rpr 12 9:00
,PORTANT: 'n thes. sp.ces, copy the~o....p.rjll1ng I..iCl~llon from Secllon A. . .-,-......~.
_. . .~. u' s. _.__...... "0.) OR P 0 ItOUTE 1\NO SOX NO.
m.DING s,,,,,,,,,",rAODjiUi,;,.;r\lnctloNIIlVAot.. nil. loll'., M_"" _..1- . . .
~~~~~ . . ZlPCOOl:
~ . . ST....~ .
II : . ~'1 '. r._ .
~.\Z.\I."l.~ e;..t- , ,00- ...
SECTION 0.. SUR'/ncJlC, QHGINI:eR. OR ARCMITECT cERT1FlCAT101l (CONTINUe.., . '
cip~ both .Icles of \!lis elevatlan Certillcate for (1) cokvnUmty 01lld8l. (Z) :. -,,; =e agen!lcompany, ancl (3) building own..- · .. .,
OMMEN'i:5 ' . , ~~ ~' -...--~ ~ "roC"
~df OP_o.u:."I~"l> ~,.IoUoMC" ~~ ~,.. c- . ~-- . - ,
.., ~ "",eob f>.Pr "T\t"1l-'.~IDPOl""'T' /F;~ (..IJfl.19 ~ ~ ~ '=>......<<>tl.>l"/L.. ~J!I'f...
~~P.~"To()Io" tJll- tl'"fll!:"''T'.''''1lIV~~~'ab. c.rN' PHN'^ 1:;''1..",\ ~eJiJ'_~~SI~_II: .
\.t.II"T1o+.1<'''''~ ~~~C~ ""ro ~e:.~,.a.. S>>n-vIA' I t C~ here Ifattachrnents ,
seCTION E .. BUILDING a!VATION INFOR .. o~ i;~RVEY NOT RI:~~OI FOR ZONE AO ANe ZONE A fN!THOUT B~ .
~ zone AO ancl ~e '" (Wiltlcut SFE), c:cmpltia 11-;' E1lhniugh E4. 11 /JIe ~etiot1 c;.ltili:ate is i1tBnQad for. un ~ suppotllng . .
'QImetionforaLOMAorLoMR-I',S<<:tiDnCmiJ8tbfr;t;>mpJeted., '.. . .
I. BuRd;"9 Diagram Number _ (Selecl tile buudlhg d1agr&m most sImilar Ie ilia building fa' 'Iotlien Illis cer1i1\C3l8 Is beil'lg compiSed-
.... pages Sand 7.. It nO diagram a=raleiy rlllnlsen!l'tha.building. ~da a skelen or photograph.)
!. 'ThalOp of the bgttom ~__ Onc:lud'lIlg basemen! ot endoSU1'8) of the building is L.LI !l.(m)' LLJin.(c:m) U above or U. beloW
(cI1eclc one) the hl9hest adfac:ein gnId... . .
I. For Building Oiagrams.s-8 wl1Il openings (see p~ 7), the ~Ut higher floor Or e1ev3leel Boor (e1fl1iatlon b) of tile building is
LLJ ft.(m) LLJln.(Q'll) above 111. hlgh..t adj;:.nt grade. . '.
I. For Zone AO on,1y: It no ftocd depth nurr,bar is ;r4n-. ,-the lOP of tile bottom floor ol_eeI in acconlancewl1llllle ~mmunily's
ftcodplain manaaement crdln&nCll? 1.-1 Yes L ~-1 UnknOWll. The local cffi,cial must cetIify 1h1a infermatipn In See1ion G.
SeCTION F . PROPERTYC NN!R (OR OWNER'S REPRESE!l11 ArlVE) CaRTIFlCATION
'he prllp.r:y owner or.,.,..ner'. authorized 'IICresental'la who ccmpl8te5 Sedicn' A. So and E for Zone A (Without a FEMA-iuueel or .
ommuni1y-I;sued B~Ei or ZOIle AD must .Ign ~ . . '.
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.cORE:;:;
'ROPEI<TY' OWNEJ<'S OR OWNE!<'S AtJniOA!ZEO RE?iutS.ENTATIVE'S ~.
..MElfl'S
crn
STATE
ZIP COOl!
u'lNA T\J~
CA Ti!
TEl.9HONI!
. i--I Check Mere If attschmertlS
,
. ". , SECTION G1..COMMUNIT'Y INFORMATION (OPTIONAl.l .
. local o1fic.a1 wMo i. autilorized I>f 1,*. or ordlnanCllIo administer tile ccmmumy'. floodplain mall8ll-ent ordinance can ccmple!lt .
::ion. A. B. C (or Ei. and I;; of this E1fM1tion ~t.. Complete !lie appllcabl. item(s) alld sign bel..... '.
. U 'The inforrnatJon i~ Sec!ionC was tak," from ointr doClJinentation lhlit has been signed and embcased by a rocensed su~.
. ,.giriiler:"~",~~whO ilaU!".orized by alai- or locollew Ie certil'i .,......tiO" info~a1lo". (Indicate the scur~ ar.d dllle of the
f"'!~tio.,.~I"lIIe.~"lmenl8.'" below.) , . . . . . "0 '. . .
, U ~ eommunity.<itlIdal eompleted ~edIon E fer a; bullcllng Icc:ated In Zone A (without a FEMA-1=eeI or o:ommUllity-iasued BFEi or
,Zci1e:AO.'''; ..... ,.....,_. \.II:. ...:' ,\0 . . .
o U 'The following informaUon Qt"';s ~9)..1. p..../;d.d fer ocmmunity floodplain management Pl!fPOS8L
I.PERMI\.~".!'1~~.... ." '1 G!. .CAn;?~"SSLJI!O '1 G6. CATECE?,TlFICATliOFCOMPLWlCE/OCCUPANCY
..' "", . .... ,. ISSUED
. This ;jermR,~ ~ i.SSJJ8C for: U New Consli\ldion L.J Sucstantiallmprovement
EllMItion"of ~buJ!lI~eat ftoor Onduding baurnlliQ of tile building Is:
BFE or (l1i'!one'j(Ol ilejlll'i Ollloo~ at Ilie ilulldlr,gsiieis: .
K;AL Of'F1CIA~'S -
. _1l..(m) Dannro:
, _ ft.(m) DatUm:
-n:r:u:
lMMUNITY NAMe
TEl.!PHONEi
CATi!
:;NA T'J1'lE
Ir.tMENTS
.1 Check here If atllicnmen~
RO:;>I Ar.l=l': AI r PRFVln' LI; PMmnNl'l
lA, """" ~1_'1 ..I In llll
.' ....,..