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Home My WebLink AboutFEMA Application 1996-11-19 NOV-19-96 07:25 AM . ROBERTS SURVEYING INC. 5.345 3464 P.01 O.M.B. NO. 3067.0077 ELEVATION CERTIFICATE bptr..May31,1994 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ATTENtiON: Use of this certilicate does not provide a waiver of the flood insurance purchase requirement This form is used only to provide elevation information necessary to ensure compljance with applicable communily floodplain managemenl ordinances. to determine the proper Insurance premium rale. and/or 10 suppOrt a request for a Leuer of Map Amendment or Revision (LOMA or LOMR). InetrucUons for completing this torm cen be found or the following pages. SECTION A PROPERty INFORMATION I FOA; INSURANCF COM"'A~'V USE POUCV NUMBER eUILDINC OWNER'S NAME . -r"'ll.\NB_,. TRA\'\""S~ ...... STREET ADDRESS IlncludinQ Api.. Unll, Su;l. andiQ' BldQ Numb.'1 OR P,O. ROUTe AND BOX NUMSER _J!p"''' ...'rlAf'...W~ \)~ OTHER DESCRIPTION ,Lo. .na Slock Numbe". .,cl ----...... ..-.-- COMPANY ,.IC ,UIABER eUTE ZIP CODE CITY ') "E.c:..O t-J. ",' d,-.,.., SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM (See Instructions): !)PF:..t~Ic.,~1 EC~ "CO....UNITY Nu..eER 2, ~.NEL NUMBER 3, SuFFIX .. 0.1E OF FIRM INDEX 5, "RM ZONE S, e.se flOOD ELEVATION I, I, (in ,0,0 lonOl. y~,O deplh) , ""1<;6',,\ I O~/O c... l'2.-It")- e'i't A'\ +'0; ~ 7. Indicale fhe elevation datum system used on the FIRM for Bese Flood Elevations (BFE): [JNGVD '29 XOther (describe on back) B. For Zonas A or V. where no BFE is provided on the FIRM, and the community has established a BFE lor this building site, Indicate the community's BFE: U.J4l,!~"]! J.!2i feel NOVO (or other FIRM datum-see Section B, Item 7), , SECT10N C BUILDING ELEVATION INFORMATION 1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 thai best describeS the subject building's referenCe level....a.. . 2(a). FIRM Zones A 1.A30, AI:, AH, and A (with BFE), The top of the reference level floor from the selected diagram IS at an elevation ot U.J.~e. ,lgleet NOVO (or other FIRM datum':see Section 6, Item 7). (b). FIRM Zones Vt.Y30, VE, and V (with BFE): The bottom of the lowest horizontal structural member of the relerence levellrom ' the selected diagram, Is at an elevation of I I I I I j ,LJ leet NOVO (or other. FIRM datum-see Section B. Item 7). (c). FIRM Zone A (Without BFE). The floor used as the relerence level from the selected diagram is LJ_.J.U leet above [J or below U (check one) the highest grade adjacent to the buiiding, - (d). FIRM Zone AO. The floor used as the reference lavellrom the selected diagram is W. U teet above 0 or below ~ (check one) the higheSl grade aOJacent to the building, If no flood deplh number is available, Is lhe building's lowest floor (reference level) elevated in accordance with the community's floodplain management ordinance? U Yes U No U Unknown 3, Indicate Ihe elevation datum system used in determining the above reference level elevations: [] NOVO '29 ;K Other (describe under Comments on Page 2). (NOTE: /I the elevation dalum used in measurlllQ the elevations is dil/erent than fhal used'on the FIRM (see Section B, Item 7], then convert the elevations fo the datum syslem vsed on the FIRM and show the conversion equallon vnder Comments on Page 2.) .- 4. Etevalion reference mark used ~ppears on FIRM: 0 Yes ~ No (See Instructions on Page 4) 5. The reference level elevation Is based on:'O actual construction U construclion drewings (NOTE: Use 01 construcllon drawings is only valid il the building does liar yet have the relerenCe levellloor in place, in which C8se this certificate will only ba valid lor rhe building durll!{} the course 01 construction. A post.construction Elevallon Carlilieata will be required once construction is complete.) , 8. The elevation 01 the lowest grade immediately edjacentto the building is: l.ll'\i"l1?:.n! .teet NGVO (or other FIRM datum. see Section 8, Item 7). SECTION 0 COMMUNITV INFORMATION 1. If the community official responsible lor verifying building elevations speCifies thatlhe relerence level indicated in Section C, Item 1 is not the "lowest 1I00r" as delined In the community's 1I00dplain'management ordinance, the elevation of the building'. 'Iowest floor" as defined by the ordinance Is: I I I I I I.U feet NGVO (or Olher FiRM datum-see Section e, Item 7), 2, Date ot the start 01 construction or svbstantial improvement __ __.____ _.~__......._....~_..M.....,.....I , L OR,lJc/ ~+ y6..... ~ C1"y I m /I ~ .r;"'~""'" .,.:hCl '" p{~ c:.~. AJa~: l~ "', . fA Y "" .P oe..e S S l ~ ~ L{ 8' ~~~Qt.( gE..ND oJl2.:. 'l77oZ. .' , ~." . --- ---., . NOY-19-96 07:26 AM .ERTS SURYE\' I NG I t-~C_ SECTION E CERTIFICATION 5. 345 3464 P.03 ThlR cel1lf1callon I, to be signed by a land surveyor, 8nglMor, or architect who 18 authorized by state or local law 10 certify elevation Information whenfhe elevation Information for Zones A l-A30, AE, AH, A (with BFE),V1-V30,VE, and V (with BFE) is required. Community officials who are authorized by locatlaw or ordinance to provide floodplain management Informallon, may also sign the certification. In the case of Zones AO and A (wlthoul a FEMA 0' community Issued BFE), a building official, a property, owner, or an owner's representetlve may also sign the certification. Reference level diagrams 6, 7 end e . Distinguishing Features-If the Cel1llier 18 unable to certify to breakaway/non.breakaway wall, enclosure size, location 01 servicing equipment, area uso, wall openings, or unfinished area Feature(s), then list the Feature(s) not included in Ihe certification under Comments below. The diagram number, Section C, Item 1, must still be entered. ' , certify that the information In Sections Band C on (his certll/cate represents my besl efforts to Interpret the dala 'available, I understand Ihal any false stalgment may be punishable by fing or imprlsonmgnt under 18 U,$. Code, Section 100 " '- CERTIFIER'S NAME " LICENSE NUMBER 10' ~"i, S..I) LE'::> WeE.R,.-:, \,,(...,=>. 10.~1 TillE COMPANY NAME f/i:.F-:';>\P~.ljT RQf;>E.I::tS 5l.'~\)~Y\o,(L. INc... ADDRESS CITY StAtE f',O. Box liS$' d:; ~()("E./.JE. '().RI?C~ SIGNAtURE -f . ~ Ii DATE PHONE ~ \....".f'J.-fJ II-\~-"'<"'C:;'\-\' :!A5-111'Z..- ~ Cop... Ihould be mlda oflhl8 Certificate for: 1) community 0",CI81, 2) Inluranct .ganvcompeny, and 3) building owner. t R!:OI(3T~Rt:D ".PR.,",(..l=,E.LO e...1C.1-l. ".,~~-..._.. L;~~C:::;:~~~ HAf'...60P-.. O"'\',\~_A""(") :.'~' :;i' ' & ~A . 'iL D~'!'L~1 InAlZ.1<.. IS. 1..I2<~~~~/..l~. J ... I"~" v r' OREGON cuA,e......_( "~ A I ~ C.\..i1~l';,.S>._ ~VOV,T ",1'" ~. V, nvor:.n I ~ 1039 COMMENT9: t"oFloJC'l-I '!l.B..1>. \<.. U ~E'_(") FoR. ""~lc", ('E.~.."IFleA""ft2!.:L';. C.rN 01'" Lor A1'"f'=.-O Cofl.N ~P.. l'lF" AT' s..E... ~TH INLAI-l.Q !nf'..e I'!. 1- . ~ 6A<'.\l.. 0 F "'<;Jun.c:.Y__BIol_Q._. C(.J~ c:;.. t!>e;IJC!-\ <W~IC.P..."=.'n=. II 1'2, ,A PP.Pe.lli'l1 tH'lU. ~ Wtly,. <\.<.\-5" ~ 'euo>l. f'l1AI1.Io/.. , ON o....a WITIf l'uallltHT . v IONI!8 JOH!S F~ES ....- , f~1ON ',',. l""" ~;:k. ~ [i]l&i?;: iitJ '~ENT:< '~t . "!'!"!~!, OAADf ., ~:;' L(V(l - ~. :'r.i..#{",\l. I~~~~ ..." 'lOOO REIf"TJQ4 ZIP ~\ A R.oL'N r) .... DN ~lea, PIlAt, OR COlUMNS A v ZONES i!OOE5 M.~EAEIrf:' I "'''~ . ,.~ ,I"',~~~'I , .. ' \ 0.;... \1 t .... n."", Il[V",'lOtI ~ , :~ ;: :;&; ~~\... - ..Jl '..(,~ l\." ". I' I. , .~,::~..,; .'.:!:,\1.:..,~~~:,. ~' ~:i:;; ~ ::!'{>~:~i~\~~1'f~i~;;;;~; ~ ':;f.~~'~! The diagrams above illustrate the points at which the elevations should be measured In A Zones and V 'Zones. Elevations lor all A Zones Should be measured at the top of lhe reference level floor. Elevations lor all V Zones should be measured al the bottom of the lowest horizontal structural member. P.O. 2