HomeMy WebLinkAboutFEMA Application 1999-6-2
" 10/08/01
li:29
~54l 682 5593 'ElrG PERMIT&I~FO
. FEDE- EMERGENCY MANAGEMENT AGENe
NA~NAL. FLOOD INSURANCE PROGRAM .
ELEVATION CERTIFICATE
Important: Read the Instructions on paiies1 .7.
SECTION A. P~OPERTY OWNER INFORMATION
iQ 001/002
O,M.B. N.... 3067.Q0'/7
Expires July31. 2002
~ \'.J
For Insurance Company Usa:
Policy Number
BUILDING OWNER'S NAME
.5#"'/./" IZO R",,er<.
8UI~DING STREET ADDRESS '(\~c1ud~g Apl. Unit. Suita. andlor BIdg, No,) OR P.O, ROUTE AND BOX NO.
ZIfA} ,1((1!/p~A/ ,;;'~j.r?tJ!r;, PR.
Company NAiC Number
STATE
$P~/NG-;:/e'_7:> DR.
PROPERTY CESCRIPTION 1~olim~ at""" Numbers. Tax Parcel Ncmber, ~egal DesCflpoon. etc.) .
ZIP CODE
974-77
em'
. IlUILDING USE le,g.. ResiCentia!. Non-resr:lential. Addition, AccesSe/'f. ete. use a Comments area. rt necessa/'f,)
Ri!: <, ;:>IO"/O/'",PI.' .
LATlTUDEilONGITUOE iOPTiONA~) HOillZONTAL DATUM:
( 1I#'.#If. ##,#i(' or ##.1I#I#IIf) U NAD 1927 U NAD 1963
SOURCi::: LJ c..iPS (TYPO):
U USGS Quad Map
u othOr
SECTION B _ FLOOD INSURANCE RATE MAP,(!'IRM) 'NFO~MATION
Bl. NFIP COMMUNITY NAME & COMMUNIT'i NUMBER ., 62, COUNTY NAME I 63, STATE
UN"'lrp''''1!l2ArF:')-1~ij_( . t..I1Nc o/l..
64. MAP AND PANEL 65. SUFFIX 66, FIRM INDEX 7, M P . ~ B9. BAS F 00 ATI Nt ),
NUMBER DATE EFFECTlVElREVlSED DATE . ZONE(S) (Zone AO. usa depth o/flooding)
4-1os~c -/1':>3 F _ .0.1~/99 (j,/~/'t9 d f:S,:s.'?
110. Indicate the source ofl~.e Base floo~ t:levatlon (BFE) data or base floo:! depth entered In B9.
L! FtS Proflle l.!::::l FIRM LI Community Determined 1-1 Other (Describe):
111. Indicate the eleVation datum used for the BFE in B9: \.!1'NGVD 1929 U NAVD,1988 U Other (Describe),
\12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)'! U Yes ~o
Designation Date:
SECTION C . !lUILDING ELEVATION INFORMATION (SURVEY REQUI~ED)
~L Building elevations are based on: UConstruc!ion Drawings' UBuilding Under. Construction" ~inished Construction
'A new Elevation Certificate will be required when construction ofthe building Is complete.
~2. Building Diagram Number 1- (Select the building diegram most slmiler to the building for which this ce:tiflcate is being completed - see
peges 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) . . .
~3. Elevations.. Zones A1-A30. AE. AH. to. (with BFE). VE. V1-V30, V (witt. BFE). AR. ARiA. AAJAE. ARIA l-A30. ARlAH. ARl."O
Complete Items C3,a-i beloW acccrdlng to the building diagram specified in lIem C2. Stale the datum used. If the datum Is different from
the datum used for the BFE in Section S, convert the datum to thet used for the BFE. Show field measurements and dalum conversien
calculation. Use the space provided or the Comments 'area of Section D or Section G. as appropriate, to document tha datum COnversion
Datum #(711 D ',z'1 Conversion/Comments . ,
Elevation reference mark used I!. r 7" 7 CCIT'! gm)Does the elevation reference mark used appear on the FIRM7 LJ Yes ~c
o a) Top of bOttom fl~or (including basement or enclosure) 1'4-5 . ~ It.(m) i '
Q b) Top oj next higher floor' 4-5' 5 ..f:... It.(m) " REGISTERED
o c) Bottom of lowest horizontal structural member 01 zones only) 1lI/" . _ It.(m) ) ~ PROFESSIONAL
o d) Attached garage (lop of slab) .iV/A . _ It.(m) ,lj ~ LAND SURVEYOR .J
o e) Lowest elevation of machinery and/or equipmenl .':.; . /7 / '
servicing the building (Describe In a Comments area.) N/Il ' . _ It.(m) f, i ~ ~ Pt::-. .
a f) Lowest adjecent (finished) grade (LAG) 4-5 C . L It.(m) :i1:..,. .'....
o g) Highest adjaoent (finished) grade (HAG) <}-,; I ..L ft.(m) !! "'i ~~~~. l
a h) No. of permanent openings (flOOd ventS) within 1 fl above adjacent grade g i. DAVID J. COLLIER J
Cl I) Total arsa of all ~erMaMnt openings (flOOd vsnts) in C3,h sq, in. (sq. em) ~__,_ 2552 -
SECTION 0 _ SURVEYOR, ENGINEER. O~ A~CHITECT CE~TIFICATION
This certification is 10 be Signed and sealed by a land surveyor. engineer. or architect authorized by law.to certify elevation information,
I certify that the Information in Sections A. B. and C on this certificate represents my best efforts to Inferprat the date availab/e, .
I understand that any false statement mav be punlsllable by (lne or imorisonment under 18 U. S. Code. Section 1001,
CERTIFIER'S NAME ' LlCi::NSi: NUMbER
, J>A,!"C ./:',,: /, II-:,p . o,l2.l';r~~N P LoS Z !:S2.
TITLE ,- - -'-'- . _. . COMPANY NAME
'/.-/I/'Il? .5':'.liE:YO.R. .P-4c;P'!c. JU.'f::V6Y/#r.
ADORES5 CITY STATE
1". f), """. i .J.-if3J. EiAC-t3/\/E <!OK
SIGNATURE' -'./}. :;;''':'''..;;?''-,,/. DATE rE~EPHONE
~-;r,//- ./~""- S'-tJ' -ci:. ;;'>/-1. .,.". ;Z77/
/'
ZIP COOl;
97~1f-
...-......-.-.. -
....-..... .......-......,.
.....~\f'. '11""" .e" cnITlr\"
/1
.10/08/01 17:30 ~541 682 5593 EUG PERMIT&INFO ~002/002
..iMPO~TANT: In these spaces, copy the C~ndlng lnfo~'?ll!U~.!l !~m_~~cIIo!!.~ . Far Insurance Company Use: I'
BuILOlNG STREET ADORESS (Indudtng Apl. Unit, Suile, and/or Bldg. 1<0.) u" r,U. "Uu' '" "'.D BOX NO. Policy Number
Z/(.,b /-/4I1p/CN l:J2,l>(J. Die .
CTY ' . , . - . STATE .' ZIP CODE COmpa.'1)' NAlC Num.oer
St?rlINGt='IC:("P 01<.. 97f77 . [
- ,- - SECTION D. SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) .
Copy both sides 'afthis Sevellon Certificate for (1) community <:>fficial. (2) Insurance agent/company, and (3) building owner.
CoMMENTS
I I Check here if attachments
SECTION E _ BUILDING EL.EVATlON INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) .
'or Zone AO and Zone A (without BFE), complete Items E1. L'lrough E4. If the EIS'.'8l1on Certificate is intended for use as supporting
,formallon for a L.OMA or L.OMR.F. Section C must be completed.
:1. Building Diagram Number (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.) '.
:2. The top of the bottom floor (Including basement 01' enrJosura) ofthe building Is LU ft.(m) LUin.(cm) LI above or LI below
(check one) the highest adjacent grade. (Use natural grade, If available.)
:3. Fo~ Building Diagrams 6-8 with openings (see page 7); the next hlgherftoor or elevated floor (elevation b) ,of the building is
L.LJ 1I.(m) LLlln.(cm) above the highest adJacent grade. Complete Items C3.h and C3.1 on front of form.
:4. For Zone AO only. If no flood depth numbeds available, Is the top ofthe bottom floor eleVated in eccordance with the community'.
floodplain manepement ordinance? LJ Yes l_l No I. I_Unknown.. The local official must cert:fy this Information In Section G.
SECTION F. PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION .
The propertY owner or owner's authorized representative who completes Sections A. B. C (It~ms C3.h and C3,i only). and E for Zone A
(without a FEMA-issued or community-issued BFE) or Zone AO must sign here. The stataments in Sections A. B. C, and E are correct to
the best of my know/edpe.
PR~~Rl'" ""OVVloIFfl'S OR OV'oINER'S AUTHORIZED REPRESENTAnVE'~I;.' , l '
,1....... M- a..,. ~O"~ i2,Y'..~'h" ' ;,!!.-G.\(> r.l
AD SS )f" 0'- iY U
!iIG~. 12i-.
COM;b~
DAn::
, '')//!)
lJR. q 14/7
StATE ZIP CODE!
~\ 14(0 oL(~q
n,'LtPHDNE
I I Check here if attachments
SeCTION G . COMMUNITY INFORMATION (OPTIONAl.)
'he local officlal who is authorized by law or ordinance to administer the community's floodplain management ordinance ean complete .
;ectlonsA, B, C (or E). and G ofthis Elevation Certiflcaie. Complete the applicable lIem(s) and sign below.
;1. U The Information in Section C,was taken irom t.lther documentation that has been signed and embossed by a licensed surveyor,
. engineer, o~ architect who is authorized by stata or loeallaw to certify elevation Infoonation. (Indicate the source and date of the
elevation dala in the Comments area beiow,)
l2. U A community official completed Section E for a building located In Zone A (without a FEMA-Issued or cOmmunity-Issued BFE) or
Zone AO:' .
l3. U The foI1o,,",;ng Inft:""allon (Items G4-G9) Is provided for 'community floodplain management purppses.
G4. ,'ERMIT NlIMBF.:'1 I GS. DATe PER.'II1IT ISSUED I Ga. DAn: C;ERlIFIGATC OF CQMPlIANCEIOC;C;UPANC;Y
ISSUED .
l7. This permit has been issued for. U New Construction U Substantial Improvement
l8. Elevallon of as-built lowest floor Oncluding basement} of the building is: '
19. BFE or (in Zone AO) depth of flooding at the building site Is:
, lOCAL OFFICIAl'S NAME
._ft.(m)Datum:
. _f1.(m}Datum: '
nILE
COMMUNllY NAME
SIGNATURE
TELEPHONE
DATE
COMMfNTS
I Check hers if attachments
\
'-...
NT BV: SPRINGFIELDPWj
"1.1
541 7361021 j
.
OCT-a-01.:53j
PAGE 12/13
BillLDING DIAGRAMS
.-
The following eight diagrams illustrate various types ofbuildings. Compare the. features of the building being
l;Crtified with the features shown in the diagrams and select the diagram most applicable. Enter the diagram. .
number in Item C2. and the elevations in Items C3.a-C3.g. ' .
In A zones, the floor elevation is taken at the top finished surface of the floor indicated; in V zones, the floor
elevation is taken at the bottom, of the lowest horizontal s1nIctural member (see. drawing in ins1nlctions for
Section C). .
IlIAGRAM 1
AUlllab-on..grade single- and multiple-floor buildings'
(other than split-level) and high-rille buildings, either
. detached or row type (e.g., townhouses); with or
without attached gerage.
DJ.ttngut'hl"O futt.a"'" tM ~ neat LJ .t Of abcMI groUnd level
(g...da) Of; at ....t an. &ide. .
NEXT HIGHER
FLOOR
r
!
.
CQ:
GRADE \ BOTTO'" FLOOR ,
\ \'.. :
!:':'(nj;;E!l;!irr,~;fn@;:':t 1,;'1;,
,. 'cCx~5<~~~~in~~~-~~~n~'~~I' " . . ,,'.'
DIAGRAM 3
Allsplit-l"vel buildings that are alaboOn-grade, either
detached or row type (e.g.. townhOu9e9); with or '
without attached garage.
DlatlnQulablnlJ F.atun" ~ bOttOm ftOOf (elCdUdlrlg Datage) I. at or
atow gl'CWtd level (arlde) 0" 8tle:aat one .id. ,.
~ HIGHER 1f-)
~LOORS NEXT HIGHER '
GRAD\E" '" BOTIO"" FLOOR I
LOOR
. . .:~:;.. ':I'~"'-;:':':~,;~~~<,:(:':.'~.',,:,,~;~,,: ..:;:~:;":~'~:,
-... ..~. ," ,o'T-,II:.... tI'!.or.!,,~.p':...(I.I' ::;:.:. :. f'{' ........ ,.,,.. '1".
~(:N;!}~\~:.;l~~~ii@t~~:~l::;Ni;~~;~~X.~~~:'!}~~;~~;.~ ;{<;;~?~;i~~
Q:B (dlllllnnlned by exlsUng grade)
QlAGRAM 2
'Allaingle- and multlple..floor buildIngs with basement
:(other than split-level) and high-rise buildings with
'basement, either cletached or row type (e.g., .
:townholleea); with or without attached garage.
. Dlatlngullhinl ,.stu". .. Tht bottom floOr (blsemlft1 or undergRwnd.
"g8rage) 1a beIaw ground level (grlClt) 011 an tkles, BuUdtn;s conatM:t8d
'above crawf spacee that are bllow graef. on aU .;cOI .hotdd a1~ ....e this
'OIIl:1f811'\,.
.,
,.:
NEXT HIGHER
FLOOR
[0
J/
GRADE .
: \ \~ B~~;;e;~, ....,. , . ".
.. t}:,::~'L'~?~:;,:~,~::'f:.H-~rj1\~,ttf:~:-;;!J'_,J:),/;~~;'::~:
Q:B (determin&d by existing grade)
QlAGRAM 4
: All apllt-level buildings (other than alaboOnllradej,
'either detached or row type (e.g., townhouee9); with or
: without attached garage.
,.
: Dlatlntulahlng 'uturt - The bottom floar (baaemont Of loInderQ/'OUtld
. ;.r.) if ~ gl'OUr.~ It",,1 ,gradl!l) on 110 .IdB" 8uildingf cona1nlda4
. ,boW cnrwt IIpBCS6 that I'" befCW "rJOe on all tldu IInould alae un this.
. diagram. .. .
.
,
1
\;0
.. (;) . HIGHER
~ 'LOORS
GRADE \ NEXT HIGHER;
\ BOTTOM R.OOR FLOOR
. ..... .....;;,;':~.kf?;~;I:{xf:.:, ;1:::
Q:B (determined by existing grade)
· A /loor IbBl is below ground levo! (grade) on 1111 sides is considered a basCmcnl even if the floor Is used ror living purposes. or as an omce,
garage, workshop, etc.
Tnsr.rU~lions ... Pac 6