HomeMy WebLinkAboutFEMA Application 1999-6-2
FEDERAL EMERGENCY MANAGEMENT AGENCY
NA TIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTJFICATE
o M 8 No 3067-0077
ExOlres July 31 2002
BuILDING OWNE" S NAME
Important: Read the instructions on pages 1 - 7
SECTION A - PROFERTY OWNE~ INFORMATION
~ Far Insurance ComDany lJse
Polle'1 NUmDef
6UILDViG ~TRE:T ADDRESS (including Apt Unrt. Suite, and/or srcg No) OR? 0 ROUTE AND SOX NO
k'fJ""'D<-J "J Ci-<:: 06 La V'\~ _ ~
ern s.OK.
~x_~f ~\4 . '._ ,
Frul"'~' t U~CR1PTION !LOI and Slock Numoer.;. Tax Parcel Nunu:er, ]:?al uesc:1plJon. e<e.)
\.-<)1- 511 \...ev \ l~~".d~'^~ 'ZL-I4 lYA ~ I ~ _
BUILDING USE (e 9 ,Re,.jl,dentz;l' Non-resldenual. Ad6rtlon,Aa:essory ate. Use Cv..~.....ntsseClCn d "--a.;zary)
'RE?O:; C,dl~ '"t""q t:<. \ _. .
LATITUDElLONGITUDE (OPTIONAL) HORlZON"IJV.. uA71JM
( ##0 - ##' . ## ##!' or ## ####:11') U HAD 1927 U NAD 1983
Ccmpany NA1C Numcer
ZIP CO~
q 7~77
SOURCE. U Gi='S (Type)
U USGS Quad Map U Other_
SECTION 6 - FLOOD INSURANCE RATE MAP (fiRM) INFORMAnON
" S1 NFIP CO~UNITY NAME & COMMUNITY NUMBER B2. COUNTY NAM~ _ t SJ. ';UJ\I ~ .0
(\ ~ of S~~'l ~el~ 4\ 5;;1 z... . La..,p \...:.oUV\, :3 U f".....
B4 MAP AND PANEL 85. SUFFIX 66. FIRM JND~ 87 FIRM PANEL 88. Fl......u f:l9.. BAsE FlOOD E1..EVATION{S)
NUMBER DATE e:FECTIVEiREV1SEDDATE ZONE(Sl./ (ZcneAO.use~offlooalng)
1410 :3q c.. \ \I.:,(p F - :r~'Zd1,q JLvvlR [, l'~ q I4Iii x. 5" 13.7
810. Jnolcate the source W Base Flood Eevabon(BFE) cfataorbase1lood depth~U1B9. J:::::- ~~ See. {<r::ve6e..
LJ FIS Frofile IRM U Community DetefTl'lU1ed U Other (Describe):
811 IndIcate the elevation datum used for the BFE In 89 Q(NGVD 1929 U NA VD 1988 U Other (Descnbe)
812 Is the bUlldmg located In a Coastal Bamer Resources System (C8RS) area or OtheNnSe Protected Area (OPA)? U Yes ~o
DeSignatIon Date.
SECTION C - BUILDING ELEVATION INFORMAnON (SURVEY REQUIRED)
";,. Building elevatIons are based on: UConstrudJon DraWIngs. USuiJding Under Cof1$'lructlon* ~Finlshed ConstructIon
* A new Elevation Certificate ~e required when construction of the bUllding IS ........,.J.;.e.
CZ. Building DIagram Number (Select the ~uddlng diagram C?ost s~ to the buuding for whld'! thiS cernncate IS hel11g comoleted _ see
pages 6 and 7 If no dIagram accurately represents the building, provtde a sketch or photograph.)
C3 Elevations - Zones A1-A30, AE, AH, A (with 8FE), VE. V1-V30. V (with 8FE), AR, ARJA, ARJAE, ARlA1-~:m. ARlAA ARlAO
Complete Items C3a-1 below ao::ordmg to the bUllcmg cragram soecfied rn Item C2. Slate the datum used If t.'ie ca'um IS cmere"'t rr::r
the datum used fer the 8FE in Sedlon 8. conven the aatum to mat used torthe SF:" Show ne10 measurements 2no caILIm C:::lnvers.cr
calculatton - LIse the space provided or the Comments area of Section 0 or SeClJon G. as aoof'Ocnate. to OCaJme'1t the cawm c::nvs-:;,c-
Datum .lY?V () 'zq Conversion/Comments
Elevation reference mark used 7 ~_";: ~\/~,~ (\{.. Does me e1evanon rerere"lca mar;c_ usee aocear en the FiRM? U Yes ~ Nc
o a) Top of bottom floor (mc:uolng case'Tle'1t or encosure) 5'/3 CJl!.(~ ~ I r _ ..\
C1 b) Top of next hloner floer C; I 5 .3 ft.!:: REGISTERED
CJ ci Bottom or IoW;St hOriZOntal struc:ural memoer (V zones Or'lYJ -.:.. ft ( ) ~ ~ I' PROFESSIONAL: I
::J c) Attacheo garaoe (toe or Slab) ~ / U -L ft (}J) "€"E 1.ANQ;SURVEYOij II
o S) Lowest elevatJ;n or macmnery anolor e!lUlOme'1f (fIr,'}; C / l-L. "3...::;....:;\-= I ~ : ; ~(-;r"'" /<: Iff-I
servlc:ng the outla:ng ./' . -..... _ ~.;in) ] ~ I OREGON---' .
:J f) Lowest adJacent grade (L4,G) ~ 'j -l:- ~..,~) ; ~ I JULY 20, 1993 I
:J g) Hlgnest aCJacent grace (HAG) .5 I, 2- r; ( ) ~ REX A. tit: l, I
:J h) No or permanent ooenJngs (flooo ve'1{s) wlthm 1 it aoove aClacem g~oe / ~) ~" ~. r
o I) T ota! area or all permanent ooensngs (flood Ve'llS) in C3h I I Cj I ) sa 111. (~) L \~, e Ie (? I 2/3 ,/ () 3 I
SECTION D - SURVEYOR, ENGiNE::R, OR ARCHITECi CERTIFICATION
Tnls certlficatlcn IS to be sIgned and sealed by a land surveyor, engrneer, or arcnnea autnonzed by law to cer.ny elevation Inr~rmallon
! cemfl that the mformatlon In SectJons A, B, and C on thIS certJlicate represents my best efforts to Interpret the data available
I understand that an." false statement may be pUnishable by fine or Imcnsonment under 1 a U S Cede, Section 1001
Cc~ IIFIE" S NAME-,--, A --:J -L UCPJSE NUMSEq"p C
K' e '>C - r:>&\ "2- L: ) '2(?() (1/
'TL= ~OMPANY NAME . _ _ _
- SL<YVej A.At<Vl ",<<e-v . tl...-u"d" ~l"<'"cn.,,~ ~L
ACORESS 3 \ 0 t'l :rtl" SlY: '" cn y_ S P" \ ""'" ;:; < Iv! srA riJlZ zip COOE q 7 'f 7-(
SIGNATURE #' DA" L fz,6e;-' /7. ZOOT lEPHONr-S-VI) 7lf&-{){p '3 7
CC:MA Fcrm 81.31 AUG SS v' SEE REvE~SE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS