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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. """"1'0 ~... t,.kU1!.- ' ." , CITY . . STAn, . "04,." . ~PQ.lWl'"t='-~~ ; 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~. ;-'" '" .- P.03 . O.M.a. No;'3067~OTT Elcpires July 31. 2002 I i 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 ~ . . '. .- .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 .' ....,..