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Home My WebLink AboutFEMA Application 2000-11-2 BUILDING OWNER'S NAMEJ '-11.'P PeJi"r5oY'\ BUILDING STREET IiPDRE~ (Including Apt., Unit, Suite, and/or Bldg. No,) OR P.O. ROUTE AND BOX NO, ZOR.s HCI,("hor Dr,'",,- CITY 9,flr~V\8f,> kJ d;~~,,^ 9~~2J~ PROPERTY DI;J?CJ1IPTiON (Lot and BlockJllumbers, Tax Parcel Nunmer, t.e~1 Description, etc.) {' If':f''' ,A/"c.1( 2, ~;I.~r+ (?r()vf'..c;Lb AdrJ:J..",-" I on,,/.( i,&',Pc.r~r BUILDING USE (e,a" Residential, !'lon-residential, Addition, Accessory, etc, Use Comments section i(necessary,) Kp",:~IPvrlf" \ ,LATITUDElLONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: 0 GPS (Type): (##'-1#1'-##,##' or ##,#####') ~NADl927 DNADl983 DUSGSQ4adMap :B:fOther. 'L..LJL..I""-L..L..lflL.I\.UL..'''''''1 "'r'lI'l"'UL.IWIl..". MUL.I'lII'" I eATIONAL FLOOD INSURANCE PROGRAM.. ELEVATION CERTIFICATE. 1m portant: Read the instructions on pages 1 - 7, SECTION A - PROPERTY OWNER INFORMATION a.M.B, No, 3067-0077 Expires July 31,2002 For Insurance Company Use: Policy Number I Company NAIC Number 4 SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COM~UNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3, STATE 0 Lee ;t- LCl - re B4. MAP AND PANEL BS, SUFFIX I B6, FIRM INDEX 87, FIRM PANEL I 88, FLOOD 89, BASE FLOOD ELEVATION(S) 4 NUMBER . F DATE EFFECTIVElREVlSED DATE ZONE(S) (Zone AOl-use depth of nooding) fo 39C...1I 44 ' j, I~' 2. "I J nt'" 2./3:LQ -At=- 4:)0,"25' B10, Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. o FIS Profile )!:l FIRM 0 Community Detennined 0 other (Describe): B11, Indicate the elevation datum used for the BFE in B9:}a NGVD 1929 0 NAVD 1988 0 other (Describe): B12, Is the building located in a Coastal Barrier Resources System (CBRS) area or otherwise Protected Area {OPAl? 0 Ves J1l1 No Designation Date SECTION C - BUILDING ELEVATiON INFORMATiON (SURVEV REQUIRED) C1. Building elevations are based on: D Construction Drawings. D Building Under Construction. ~ Finished Construction 'A new Elevation Certificate will be required when construction of the building is compiete, C2, Building Diagram Number 8 (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7, If no diagram accurately represents the building, provide a sketch or photograph.) C3, Eievations - Zones A1-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, ARIA, ARlAE, ARlA1-A30, ARlAH, ARlAO Complete' Items C3a-i below according to the building diagram specified in ~em C2, State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion Calculation. Use the space provided or the CorTlj)'lents area of Section 0 or Section G, as appropriate, to document the datum conversion. Datum~ Conversion/Comments (.j"""",+' Spl'f"j.f;cJcJ 5",,<l-,'):\~rl<:..-Cl'\;,,~k.l ~.."'re "ToP t,,-c.IC ...f-c.-vb :7' tfi:> cP. ~ N,-, Gbr('er; O.f'- fo/""bor "'bel, ..,L....... (~~ lil'''451 01 Elevation reference mark used ~DoE!s' the ~evation refeTehce mark used appear on the FIRM U Ves t.2l No . o a) Top of bottom floor (including basement or enclosure) 4:2Z.....aft,(m) 'Ii o b) Top of next higher floor Ilk_ft.{m) ~ _1- .. o c) Bottom of lowest horizontal structurai member (V zones only) ~_ft,(m) ~ d o d)AIL_L~.:oarage (top of slab)U.., A+~c./"e~ #'l~ft.{m) ~~ wo o e) Lowest elevation of machinery andlor equipment ':.; servicing'the building 450, OCft,(m) ~ ~ "II~ ' c o f) Lowest adjacent grade (LAG) -:I.:ll..~.(m) z '" .'" o g) Highest adjacent grade (HAG) 450 3k.,ft,(m) ~ . o h) No. of pennanent openings (flood vents) within 1 ft. above adjacent grade 3, :3 o i) Total area of all pennanent openings (flood vents) in C3h.?aa.sq. in, (sq, cm) " SECTION D - SURVEVOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to cert~y elevation information, I certify that the information in SecUons A, B, end C on this certificate represents my bes! efforts to interpret the data available. I understand thai any false statement may be punishable by fine or imprisonment under 18 U. S, Coda. Section 1001, CERTIFIER'S NAME --r 0 I rJ I< LICENSE NUM8ER? 4 n f'> I <.-<"'.1'. C_, nq ~.r ",., TITLE Pr...c,;rJf',....+ COMPANVNAME.R~b~~~ S,,;:e,~..,~ :LV'lr ADDRESS p,n - Ro't. 7/.5S---CITY E....(";~.n;; STATEOr Z1l'co E "I74DI SIGNATURE ~_4. r2, L. . DATE I oj , , TELEPHONE ~f A-/ ~..r.t< I -? - 7DOD 34.'; - II 12. SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS FEMA Fonn 81-31, AUG 99 ; REGISTERED PROFESSIONAL lAND SURVEYOR " ~L~d~, OREGON .M.Y25,1lm TE!> C. BAKER 2'-~ . '" ~~;L~;~~~~~E~~ ~.;~~;;;~~:;U~~~ ~~;:~~:~. .;~~~~.~~~ ~.;~~~.~~~.;;~. ~:~:.~~~~~~~~- BOX. ?O'?J'7, 1--ic.,l'bo~ ,p ---- ------ CITY C. '-I:' I J 0 STATE D ZIP CODE ;Jpr. "'y. Ie 01 r. -,7477 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) ,.....II......,.."..............'t'.....,.......... Policy Number Company NAIC Number Copy both sides ofthis Elevation Certificate for (1) community official, (2) insurance agenllcompany, and (3) building owner, COMMENTS (.;.j.~ ()f ~rl':V'1;",Ir.l Rt>nrhvnc.rk - l.h;~~Ie.cJ :"l"...",c.rP_ - 101' h....,.IL m+ rud:J @ (Ct+rJ, bc,.<;.'~'" QQFJ.-ht.1JI"<'+ ('nr"e.,. o.fi HCtrb"r- Dr;\rp. u~rJ 'I""l",~d Wc.':.:J (c;,",vp,) , Ele..\1c.+;oV\ = 4-5IJ)7 '. 0 Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AD and Zone A (without BFE), complete Items E1 through E4. If the Bevalion Certificale is intended for use as supporting Informalion for a LOMA or LOMR-F, Seelion C must be complated. E1, Building Diagram Number .8.(Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7, If no diagram accurately represents the building, provide a sketch or photograph,) E2. The tOPQfthe bottom floor (including basement or enclosure) ofthe building is _ fl.(m) _in,(cm) 0 above or 0 below (check one) the highest adjacent grade. E3, For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is _ It.(m) _in.(cm) above the highest adjacent grade. E4. For Zone AD only: It no flood depth number is available, is the top of the bottom tloor elevated in accordance with the community's floodplain management ordinance? 0 Yes 0 No 0 Unknown, The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owne(s authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or cornmunity-issued BFE) or Zone AO must sign here. ADDRESS P t" (~ "'y'i. SIGNATURE ~.z:;-~ COMMENTS / PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME 1/ + Q 1/ (0 I -1 L . '\ Kf'Vl I':C4KP,,- _ 1")(,)Y1f'r L" .~rde~,,",C1 I"1C ) CITY C' STATE n ZIP CODE 974-.1 . i:'-1'-l(nP ur 0 I DATE TELEPHONE I J - 2 - '2. 0 0 \) 345 - I I 1 "Z- 71S.') o Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate, Complete the applicable rtem(s) and sign below, G1, 0 The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, orarchrtect who is authorized by state or local law to certify elevation intormation, (Indicate the source and date ot the -.'elevation daja in the Comments area below,) , G2, 0 A_corTunU~_ily,'()fficial compleied Section E for a buildin910cated in Zone A (wrthout a FEMA-issued or community-issued BFE) or ,,_ZPneAO-_:..., " G3. 0 The following information (Items G4-G9) is provided tor community fioodplain management purposes, I G4:PERMlrNUMBER . , I GS, DATE PERMIT ISSUED I G6, DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY , ISSUED, G7. This permrt has been issued for. 0 New Construction 0 Substantial Improvement . G8, Elevation of as-built lowest floor (including basement) of the building is: _' _ft.(m) Gg, BFE or (in Zone AO) depth of flooding at the building srte is: _' _ It,(m) LOCAL OFFICIAL'S NAME TITLE Datum: Datum: COMMUNITY NAME SIGNATURE COMMENTS TELEPHONE DATE FEMA Form 81-31, AUG 99 n Check here if attachments REPLACES ALL PREVIOUS EDITIONS