HomeMy WebLinkAboutFEMA Application 2004-9-30
BUILDING OWNER'S NAME
Don Pachkofsky
BUILDING STREET ADDRESS (Including Api.. Unil, SuilO, and/O( Bldg. No.) OR P.O. ROUTE AND BOX NO.
1810 Harbor Driv~
. CITY. j,. . STATE
. Sprin9field OR
.., PROPERTYDESCRlPTION(LoIandBIocl<Numbe..~ Tax Parcel Number. L!lllal DescripUon.otc.) F' Add to F'lbert Grove
Ta~ Lot 2900, Map No. 18-03-02-J-3 ALSO Lot 22, 8lock 3,. lrst ~
BUILDING USE (o.g.. Rosldontial, NoIHosidonlial, Addition, AecessoIy, ele. Uso a COI'nmonlS aroa, U nocessary.)
Residenti~~"" ~.' .'
LATITUDflLDNGlTUDE (OPTIONAL) HORIZONTAL DATUM:
(I/II'-II/f-/III.//II" Of /III.1llUIIIlI") UNAD1927 UNAD1983
.
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FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
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I
. Important: Read the instructions on paqes 1 ,7.
SECTION A - PROPERTY OWNER INFORMATION
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'"
Q,M.B. No. 3067-0077
Expires December 31, 2005
For InSUfaOCt1 Company U~B:
Policy Number
I Company NAJC Numoor
ZIP CODE97 4 77
SOURCE: U GPS (Type):
U USGS Quad Map U 0_
" SECnON B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Ill. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3. STATE
Lane..County Ix Incorporated Areas Lane. OR
IIW.,MAP. ANDW' EL I BS. SUFFIX" 86. FIRM INDEX I B7. FIRM PANEL I B8. FLOOD. I B9. BASE FLOOD ELEVATlON(S)
~'NUMBER ' DATE EFFECTI\IElREVISEDDATE ZONE(S) (Zone AD. uso <lopll1 oflloo<ling)
41039C11 F 6/2/1999 June 2, 1999 AE 448.3
Bl0. Indicate Ihe ~urce 0; Ihe Base Flood Elevation (BFE) data or base nood deplh entered in B9.
U'FIS Profile - . liuiI FIRM U Community Determined U Other (Describe):
Bl1. Indicate lIIe ulevation datum Used tor Ihe BFE in B9: U NGVD 1929 U NAVD 1988 U Olher(Describa):
B12.1s the building located in a Coastal Barrier ~esources System (CBRS) area or Olherwise Protected Area (OPA)? U Yes k.ld No
Designation Dale:
SECTION C. BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations ere based on: UConslNction Drawings. UBuilding Under ConslNction' I1lJgFinished ConslNction
."A new Elevation CertifICate will lie required when construction of Ihe building is complete. .
C2. ~uilding Diagram Number ~ (Selectlhe building diagram most similar to Ihe building tor which Ihis certificate is being completed _ see
pages 6 and 7. It no diagram'accUrately represenls Ihe building, provide a skelch or pholog'raph.)
C3. Elevations - Zones Al-AJO, AE, AH, A (wilh BFE), VE, Vl-V30, V (with BFE), AR, ARJA, ARJAE, ARJA1-AJO, ARJNi, ARJAO
Complete llems C3.a~ below accOrding to Ihe building diagram specified in Item C2. State the datum used. If Ihe datum is ditterenl from
1he datum used for Ihe BFE in Section B, convert Ihe datum to Ihat used for Ihe 8FE. Show field measuremenlS and datum conversion
calculation. U~ Ihe space provided Of the Co~menls area ot Section.o or Section G, as appropriate, to document the datum conversion.
Datum 1929 Converslon/Commentf1ty of Sprw9f1eld + 0.3 = NGVD 1929 .
Elevation reterence mark used Harbor-Inland N. Doeslhe elevation reference mark used appear on Ihe FIRM7 U Yes f.2J'No
o a) Top ot boltom floor (including basement or enclosure) ** 448 ,~It.(m) ... "IOIITWMO } I
o b) Top ot next higher floor , .. 452,~It.(m) ~ '''OP'ESSIONAL:
o c) Boltom otlowest horizontal slNctural member (V zones only) ._It.(m) ~~ LAND SURVEYOR
o d) Attached garage (top ot slab) NI A . _ It.(m) E 1!
O~westelevationotmachineryand/orequipmenl ~:.t"/_ /. /,~ - IJ
servicing the building (Describe in a Comments area.) 449 .::1- 1t.(m)-if;:1'~ ~'--rr-~ E
o I) LoWllSt edjacent (finished) grede (LAG) - ,,448 . L It.(m) z.., (I .~ l:: GO 0 N J
o g) Highest!ldjacenl(tinished)grade (HAG) 449.!L.tt.(m) ~1Il ..::... ..... )
o h) No. ot permanent openings (nood venlS) within 1 It. above adjacent grade 16 '.' ~ ~~1~' GUILE .'
o i) Total aree 01 aU permanent openingS (flood venlS) in C3.h 1620 sq. in. (sq. em) ~ ___, _ _ '.' " . _ . ,-
SECTION D. SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION '0/, ~ ""/ L-(A...' :;J
This certifICation is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
I cerrify /hat /he information /n Sections A, B, and C on this certiflCBte represents my besl e(fOllS 10 interpret the data available.
. / understand /hat any false statement mav be ounishable bv fine or imorisonment under 18 U.S. Code; Section 1001.
CERTIFIER'S NAME LICENSE NUMBERpLS 72 OR
Charles W. Guile 4
TITLE .. COMPANY NAME
Land Surveyor Charles W. Guile & Associates Co.
ADDRESS ." . ,; CITY STATE ZIP CODE.
52 Centenn 1al).o~.. . . ,,, Euqene OR 97401
SIGNAT~~...4.& /~ ~; DATE 9'/.32l/ZOGlq TELEPHONE(541) 343-9855
FE~ F;orm_ 81-31, January 2003 See reverse side for continuation. Replaces all previous editions