HomeMy WebLinkAboutFEMA Application 2002-2-21
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PCJlGE ENGINEERING .F~:541-485-5624 Apr 12 i' 8:57
FEDEAA' . EMERGENCY MANAGEMENt ,AGENCY'
. NATli 'riAL FLOOD INSURANce P.R.OGRAM
EL ;VATION'CERTlFICATE
tmportalrt: Read the instructlons on p;i e$ 1 .7. . .
- sl!CTiqN' A. PKU,.ERTY OWNER IIlFOflM.6.T10N .
BUI~CiJ'lG ':;;,NER'S HAM!! .
"TOM ~!J!- CD~ <;""OM.~ . . .' .
BlJII.OING~'" ACOIlESS (IntlllClingJIpL, Unit. Suilo, .nGlor 81d;. 1'10.) O~ P.O. !'loI.lTEANC SOX tlO.
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em' STATE
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PFlOPIOR)t :~scRtPT10H (~Ol .nd B:cei!< Nwnecrs; Tax pargol N~. L.egal Qescriplicn, et=.) .
(.0" ll:z. L..i"l y..,-!.c..~.e.. z,1:!Il Ai::o-'TIO..l PII.'!L"S -, t>2-":> \,....z '1I~ ~ c.ou....-n:
BUll.OtNG use (0.;', ~1lI1. tI.......idenU.I, Addilllll, _"I, elc, Use Covnm_ _n W ~'IY.)
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\,ATrTUof1t.c;.Gli1Jce (OPTiONAL) HO~NTAL o.o.TUM:
(..#11.","" or ".,.,.,." WNAD~1l27 WNAC19a:!
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0.M_B.No:3067.,)071
Ex;lires July 31. 2002
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. SECTION e .~COC INSUR.ANCE RATE MAP (Ft~M1INFORMAT10N .
81. NI'IP cu;,,;~.., JTY I'II\~ & COM/olUNm HUM . 62. COUNTY NAME' '. I B3. liTATIi
~P8't~6'Fte,L.~ 4\'59'1"2. . . . .~~ . oa.eA~""
_ &&. MAP AHO PAN 85. S\JFl'1X Be. FIRM,INDEX . S{FIRMPANet.. I ~. F\.OCO I as. ll<'SE Fl..OOO a.E'JA TiON(S)
NUMIIlO~ . 0A'lE' EFFEc=ElREVlSElJo.o.n: ,ZONE($). !Z"neAO..... dlllllll offtoocllng)
<\-IO~c:.. \l~r /P' z,1'Io<, ".-z...qc:, . ."...~""')C. CS'~\. \
- .._' '
!l10. Indicate lrle source of 1I1e !l~S8 Flgod 8J"atioli (BFE) data or base ~ocd depth entered In as. . .'
U FIS Profile U FlAM ~ Community OeIetmil1ed U Other (Dese:1~e):
911. Indlcate !tie e!ev8ll0n datum used for tile BF!: .. a9: 6NGVO 1929 U NAVO 1988 LJ OOer (Dw::1ll0)' .
~'2. Is the building 10Cllted In a Co;mal Sarrier RO$:lUr=! System (CBRSi are<! or Otherwise Protected AreiI (OPA)? U Yes ~N.
Desilr-ation Cate: .
'.. SECTION C. SUlurlNG !LEVAiION INFORMATIC'~-(SURVEY REQUiReD). .
'e,,1I0In9 elevations are :ased on: WConstnJctf>nOl'llWlnga' ~undb'lg Under Constructi.n' UF'oni.hed Construction
. A new eJeva~Dn Certifo<:a1a will be re<;ulred whoil """sWellon 01 the building is cem plaw. . '
:2. Building Diagram Numb'" ~ (Seed the tUlIlllng diagram most .imlar lCO ltla bli/ld1nll tor which this c:arti1Icate is being comllle\ecI- see
pages 8 and 7. If no diag~m aCClll'ltely /8llreseinta the bUlld;;,g. provic!8 a sketd1 cor photograph.) ,.'
;3. E18118l1.ns -Zones A1.A30, AS.~, A (with aFli), v:. V1.\i:lO,V (willi BFE). AA. ARJA.AAJAE. ARlA1-A3O, mAH; AAJAO
Ccomplote Iteina ~a-i bol~ ._rdinll to. the bu;ding dia;ram :Jpecffled in Item C2- State the dalllm used. If l/le clatum is dilferanl.rroin .
the datum'used tcr the BFE in Section a, CQnVer1lhed2l1Jm to thatllsed Iort,e 5FE. ShOw fteid measuremen1ll and datllm ccnvenllan
calculation. Use t/l8 SjlllCll provided or the Com.."ants area of section D or Sec!i"" <3, u appropriate, tCl doc:urn8ltt the datLpn;..... _.ion.
Datum '-"~ c~onlCom"',,"tS.""1?'" o.'!.'"l1:) l..DL#<<- r:>><~M ""? ~ ~.e.M.,Io. ~'" .
EJilvatIon referenCe m.rt used_ ~ ~~,., Doel &oe elevation reference marl< used appeat~.. -' '~^lo
o a) TQP oft:co!lOm n..r (lndlldIng t:aaem8tllarilndolunt) c;, l.... . .5L. ft.(aIj i ~9J~A~L 1
C b)Topofnuthi;herftoOl' c,\<4 .!l.,tl,t-l . LAN 80fW'I!;YOR
o ~)BotIomoflowest~.rl:or.tlIlstnJC!U""mem~er(Vzon_conty) w/^ ._1I.(m) II .
C~A:llIc.'1edsaraga(topofs/abl. . "il'!> .~1L(.)n'. I.....(,J. 1012
o e) LQWest el8118tion .f maCl1inety lIndibr equipment . ~ ~ Pro .
servic:in9 Itle building "II ~ - '" tl(Ja) f i M
o l) Lowest adjacent grade (I.AG) ~I,,? . \.'"1L(1IIIl I" .Ai.,,'~i ~ )
o g) Highest Idjao:enl grade (HAG) . '5\ ~ .;. ft.(.) J" \ JOHATH~ A. OAKES
o h) N.. at pem'lBllent copenings (nand vents) wi"in '1ft. above adjacent grade I d- . . _' . If .
C i) Total area of all permanent openings (ftcod """lIi" f3h \ ~<;;\ sq. In. ,""'-"';' ..... . os-.... ". ., I,.ZW?"
seCTION D. $URVErrOR, ENGINEER, OR m'HfTECT CERTIFICATION. . ' ... ..-
. rhis C8Ilincation II to be ~ned and .ealed by Ilan~ surveyor. engineer, or archilacllut/10~ by law to certify ei...".tion inIcorma1lcon.
oertii't /lIat itJe WcmwtJan'.. Sm:DonS A. S. ami C '!Il /JIjJ oertilfc8te rvpresants my but eff;xU to irltetjril 1M data iivaIabJe.
lJIldar.rtand tIlal an~ false sratemetit may b. Durosheble bv!ble .r.Im~Ontl78nt IJflder 1! U.s. Coda, Sedfoti 1001.
:l:lm~S NAME \ I rP\. ~ . UCS'l$1i NulolSER
__~-t\.~; oiL.l....,..~ot;
. E . .. . COMPANY w.r.ce
.pg.oC:~'J"" ~ ~O ~a..-.la;.,,04- PQk-- ~,!oJ,c.v;.G.I':!4.J. '!AA2.Ve"t'~ \~.
y. 0,' . L.~L.- 1 ,........:..vv:--- STAi1! I ZIP::ODe
IGNAnJlU: ~.A U,.~ bAn. reLl!I'HOHS
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. SOURce: W GPS (Type~
LJ USGS QII3CI Nap . W CI/ler-"-:
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..<"... POl=lGE ENGINEERINGafax:S41-48S-S624 l=I r 12 .
iPORT ,Iu"'T: In thlSe ~s. eOPY~llo~d1ng Infon'llation fl'om ~ee1ion "" p 12 ~
jllDll'IG $TREET ..cORA"" (In<ludlng AlI'., v"", 5>1... ._ Sl<Ig. NIt.) Oil P.O. PlOUTE ANO BOlt ;;o.W
_ Gr1.o1 -.Jk..eJe;;- ;::;"":""''"-_ ~. . ZiP ceOi . 0Iii
rTY .; $TA-re cn4,1 ~ .,!
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"..crION C. SURVEYOR, I;llGINEER. OR ~CHITi!CT CeRTIFICATION (CONTINUE...)
~id" Q1lh1s elevation CerIIlicate lOt (1) ~Unily crlltcial. (2) lnSuratlCll agonll=mpallY, and (3) b\lildinlI "",""'.
~. -~ ~ ~--"""""""..:! """'~ .... ". ~,........,.,...... .~ ..- ~P .. ......-
.v- Wf ~ ....\oPQI..r1' 'GlF-~ ~ ~'f~ M ~ ~. ~~ of. 1\'If. 1W.~~~'T")'?"'tl1=-
n"'''i!'. -f-rtW~IollZX:>. <:-IT'( t:>"""'';'I/I.~~\7._~I' .e."')..' ~'^ GI'!>.l' ~~'1.0I4? ~'<1~ '
~e ~o:.. c.o..Nu;t1!-O 'W ~.9.:.f04.,ja.. ~",. .\ 1Q1el;khel'll!.~ents
SE!CT10N! . BuILDING !l.EVATIOIllINPORM1T10N (SURVEY NOT REQUIREC) FOR Z?NE AO AIlO ZON~(Wn.""UT8FEl ;
"zoneAO and :zc"eJ;. (wi1I1OUI SFEl. ccmplelallCljts EIl/lrOIlgll E4. Iflha Sev<<lion c.ttJllcs/w is ~ forI'>> M$Ul1l1a1ting
'onnatJon(/lI'e.1.0MAorLOMR-F.s.ClfcnCJ7lll$tbjt~ .... '
I~ sufldir.g Dlagrom Number _ (Select In. bUI~9 dJagt8m (lloslsiml1ar Ie 1he building fgrwhidl thi$ ~c:ate is being~~'-
SeG paga e and 1. If no dl.gram s=unoteiy reprttenlSthe.bundln;. provide a sket<:ll or pholograph.) .
~ The!ep of the bOllom ftoar Oncludln; basemer.t oi 8lIdolUre)' of 1he bullc1lngls . LL11t(m)' LJJn-(cm) U ,bove or U below
(Checl< one) tlte hlglleit adjacairt gl'llle. :". ..'
3. For BIOndlng Oiagrame.~ with openings (_ paq. 7), the nPt higher nocr or elevated !loor (eleVation b). of the bullding;s
, L-Ll1L(m) L.-LJitI.,(cm).a~ the higheet adI;c:anl grade... . . . .
4. Fer ZOntl AO only: If no !loed depth ".mber is ....abIe. ~ tile tep 0(1118 buaom !loOt elowiltod In .....ccrdaMC8..nth the cammullily's
Aoodol.in manegem"," ordinance? U y... I J No '. ..JYnkn"",". Th,! local ofII<lal must cerlily lhlllnformation In Section G. .
. " ..ecrlON F. PROPERTVct.YNeR (OR OWNER'S KJOyRESENTJ;.TNE) CeRTlI'lCATION .
. -
lie property owner or own..... a~.._. :.... 'Illr..entaliv. whO c;ompleleSSectlons A, S, and E for Zone A (Wilhollt a FEMA-issued or
:l)nll"uni1Y-issuod BFE) or Zono AO must sign h.....' . ........
~OPEflT'r C.vNe.~ OR OWNER'S .....rr><cR~c R~ewrr...TJVn ~.
P.02 .
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;IGAA T\JRe
, AMeNTS
STAT!
ZIP COOIi
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OATE.
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.' SeCTION G _ COMMUNITY INFORMATiON (OPTIONAl.)
e local offlci.a1 who i, authonzod by l!iw or ordlnanee 0 admini$!er ;;;;community's fIoocllllain m~nagement ol'llinancs c:ari c;omplele . .
Clfons A,a, C (or El. and a of this Elevation Certl1l'ot& Complel"-the eppncable it8m(S) and sIgn below. . '. -
. . U The .ln1orme1llln I" S....en ~ W1IS takan from ~ei' doc:umentatlon tIuIl has been signed and embo$Sed by a ncensed s~, .
,"~",""!,,.~~~:-1.'.2.'5 aulhori:ed by ataje OlIOQII.w III eertlty elevation infonnatlon. (Indicate IMe sO\JraI and date Of tile
. . .e1...a~h;JIlItlt.iqJI".~mmOnt?'iree Ilelow.l i . . . ...... . ".'
. U P. c.'lm.~~o~da~=":~~~islldlon E for ~ b.1td1n9 located in Zone A (withOut a FeMA-lsSued or alrnmuni\y-iasued ElFE) or
.Zone"'O.. ..." ....,.. .. . . -. .
. U ,,;e'riiif~g.;ICi';'8tt.lrOlCi.is;G<I-G9)..is profided for =mmurrity ftoodp1.in managem..,t~seS.
4. PEAAlrr Nl.iM6ER G!. CATEPERM.i.ISSUEO .' G8. elA C8'1TIF1~ ce
.. . " ,. . : .. ISSI.Il!ll
. 1h1s.?enn~ ~.~sSu.od for: LU NIlW c~n 'w SubstantJallmprovement
. Elev.aUO" df'~ ~'fi~ftnd?din91l..emeitl of the building Is:.
. SFE or O~ne"'Ql d~.~ ft~ing lit tti. bUl1dit1l iita is:
lCAL ~1c;!AI:::i ~. '. '.
1-' Cheek Mere If ,:!ttadlll",(ll$
.NCEiOCCUPANCY
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._ft.(m)Oatum:
TITI.C
TE..ePhONE
;!MalIUNITY -
elATe
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r ChElcl< hen! if ,?~~menlS
~IO;II A(,';;.~ Al r PRl'\IInl ~"'.l=nmn....<;
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