HomeMy WebLinkAboutFEMA Application 1999-6-2
Important. Read the Instructions on pages 1 ~ 7
SECTION,., - PROF-E~TY OWNeR INFORMATION
2UILDJ~G OWNEr'S NAME ~. J ~ ~.,,_~
8 UILOlNG STRe;::r ACD~~55 (Jndudrna A~ lJnrc. $l.llte, iiodlOl'Sldg .N. CI ) OR P 0 ROUTE AND BOX NO
( CJ '7 CA ..::::' . ,
U l J I) ~ I ~"Y1 P c' 1rI... t r t\l '€..__.
CITY . I'""' STAJk v.:?
SO(~tr~\.J ._VI,-
p~~\ ti ~;pcrP110N ~Llilt IInd BJOI;l\ NUlTItJers. T;iX-?3ree1 Numoer, I.~:ll De&:r.pUcn, e!~l
1- 5 I . L~y \ l4V1(-(t~"d-M,fdip,...., __
SUII-CING USE; (e 9.. Re,;;iaeln~I, NOn-lTilIlClenllDl Acce~Of'y. etc. U$e Ca, ""..' ~,~ lOfil=n II neC2.S1;a1'j j
~e~~4~\~~\ .
LA TrruOElLONGiTUOE (OPTIONAL) HORIZONTAL DATUM' SOUt'l.Cli: U OPS (T~) _
( tt;#$. #I: . ##M' or !l!I\I.t......."f') U HAD 1m U NA.D 1923 U USGS OUOllf Map U I )(her
MAY-06-2003 rUE 10:57 AN
BRANCH ENGINEERING 5417460389
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTJFICATE
,-.
p, 02
r-
OM 8 Nu 3067-0077
Expires July 31 2002
Fill" l~nce Company Use
~y~
1
Com~ NAlC Nl.lmtler J
ZJPc~7ij77
SEcTIoN B. FLOOD INSURANCE RATE MAP (ARM) IN~nON
.-
81 NFIP COMI>,4UNI1Y NAME & CCMMUN/iY N..~ "j 82. COUNTY NAM~ t I in STAlE .0 I
rln., (.oJ SlO(~P:~\~ 4155>12.--1 La~p I...:l)j,.(,~ ... _ d~
, 64 ~~ AND PANB. ---:miSUFFlX I as ARM INDEX. B7 FIRM PANEL ea. R.cMJ 59 BllSl! ~OoD eu;....AnON(S) ,
NUMf!lI!R DA'Tl; EFFECTlVElREVlSEO DAn: Z~ (ZOfIe.o.o, II$e deJ;lltI of1klcdlng)
i 14\ 0 ~a C.. \ \Lole, F :fWv\l'Z" 11'1 :;JIJ.(YLi f.. I. 'fPlq X -L- _..
6iO. Indlcate the 3Qtm:e ~f~_Base Rood El2Vatlon (SFE) claIa or base ftood depth e.~"'; In 9. -'t,.)..> <'..... ~ 77;>....- '%-c~ X
U FlS Profile ~RM LI COnvnuIllty Detel1T1lned U Other (De=itle) _ _
811 l'1dlcslethe elevation datum \.Ised fcrthe 6FE m 89: ~NGVC 1929 U NAVD 1S88 U Other{Oesaibe)
612 Is the building locatet1/n a Coastal 6amer Resources System (CSRS) area Ql" Otherwise ProtedeG hea (OP~J') U Yes ~o
D'=SIQnatlon Oate
SSCTION C. BUILDING ElEVATION INFORMATION (SURVEY REQUmeo)
C1 BUIlding elevatlonG ere ba.ed an: UconSlnJdJon DtawlnSs. UBuilding' IJnder Constn.....;.... , Wmr5hed ConstnJdlon
a A new Elevallon CertJfieate win I:le ~d when construdiDn 01 the buIlding 15 complete
C2. ElLllldinS Diagram Number....fi. (Seted the building dtagram most &imilar to the building for which thls certrficatt; I.S bemg completed ~ See
pages 6 and 7 If no diagram ac::curately represents the budding. prOVIde a ~ or ~ph.)
C3. Elevations - Zones A 1-A30, AE. AH. A (with BFE). Vi:. V1.V30, V (WIth 8FE), AR. ARIA, AAJAE. ARlA1~A30, AHlArl, ARJAO
Complete Items C3a-i below SCCOrl1In9 to the buikmg magram speaiiea In Item C2. State the da1um used If the datum 1$ driferent from
the dawm uisd for the ElFE Ir1 SectIon B. ccnvert the datum to that used felr the ere. Sbowjeld measurements and datum conversIon
e:alculatlon Us~ the Space provided or the Comments area cl'SeetJcn 0 or SedJon G. as lIP,.........ate, to cloaIml!fIt the datum ccnverslon
Oatum )J I" V 0 'Z 4. ComoennonlCcmmenw
El~atlan reference matk usedC f'€.. R EV~~ Doell the elevation n:mence mark used appear 011 the IlRM? U Y H t:;6 "10 .
D'.Jl) Top of bottom flear (IIlCIuciing basement or endcsure) ~ 6 14 t2. ft.( 0;' . _ ~
tl'b)Top cfnexthlgher'tlcor ('~w\ '5(-'oIl(~ 5 \(0 lft, ! I"" AEQI":"l:i',,!D 1
Q c) B~(Jm Or lowest h... ...:.......J liltnJctl.lral memner rv zones only) 1 ) IA .. -;:;- ft. i ~ .. PROFESS.' ONA. L .
0"...d) Attached garage (tcp of slab) &5 I ~ .J2. ft ( ~ ~ ~O SUR~OR
at" e) l.oweG1 elevation or mad'lInery' MelIQr equipment I ~ ~ /tft..-4 a /~ .
/" servli:mg ti'te building {? lfl ::L ft ( ) f i .. .OREGoN-J. .....,.
e' -' Lowest adJacent grade (tAG) ~ I? 1e. ft ~ ~! JULY 20 , S93 I
~) Highest adjacent grade (HAG) E I 5 l it. ~ ) ~ REX A. BETZ r
~)1) No ef permanent opemngs (flood vents) wrtfnn 1 it aCCVEl ad]acem gr.ace Is::;.. Jd '\, . ... . ~.... tI-'
rzYi) Total are.!! of aU permanent openrngs (floodvenlsl In C.Jh II ?,,,,,O sq. III (~) L" <.. Gy,:p / 'l../), / C~ I
SEcnOh L) . SURVEYOR. ENGINEER. OR ARCHITECT CemFfCAOON
-
Trllll certrficatlO"l IS 10 be signed and :sealed by a land sUl'Veyor. engIneer, or architeCt aLJthanzed by law to eartJfy e/eval.lOl1r.formallOn
I CiJrT,fy that the mtormadon 11l SQCt1tms A, B. and C on this r:;eflIficate refJl"esents my best efforts to IIlt/3fTm1t the data ~vallt;bJe
J understiaf'l(/ that any fa/oSe staiematlt ITlflY be pum:irabJe bv tine onm"nsonmenf under 18 U.5 Code, Sac1Jon 1001
"._'<lFISl', HMt"l? e '" . 'f3....+.... lICEH.. NUMSEP PUS 2(,'0 (p
TITLE . . A . - ~ COMPANY NAME.-, ~
- 'S1,.(.........ve1 L\a.\>\ a~e,yr . t5...-alA~ ~"~.yV\.<~ Xc'
AODRESIS 3\n."f1:ttL.... 'Sh-~ cmS"("~,^~hdol~TAT~~ ZIPCCDEJ~l.f'7r
SIGNATURE /.:7:. /J. -:<..r:f--. DA.\T;F.( r /' 'A03TEW'HON~._,,,,, -- u-3 _
r(,Y"':'t1i'.I': .I ~n /tq...tZ '<1 {p) tA/ {~/"'~-Dto 7
FEMA Form 51-31, AUG 99 SEE RC'VERSE SlOe FOR COr-.rrlNUATJON R.EPLACES ALL PREVlOUS EDITIONS.
MAY-06-2003 rUE 10:58 AM
BRANCH ENGINEERING
5417460389
p, 03
IMPORTANT In trnlse epaccs, copy the cQrresPQl'ldtng mfonnatJcnfrom Section A.
. BUILOING STREeT AOORe;S.~lllcJUdln.9A?t:.UnJ>;' and/or Bldg.. No) OR PO ROUTE ANO BOX NO
(~ELi R S I \.vi f" nl""\ \V~
CITY C I JJ _. STATE ZIP coee. CGmpany riAlc Number
"'5 or iy-.,c,'n~.\a' ()fZ a ,If"'1-r ,
. I .... '. .
Faf Insur:ar,c.e COl'll~any Use
PolICY N\lmoer
SE:CTION C . SURVEYOR, ENGlNEfR, OR AR.CHITeCT C~~nF1C~ON ~C:ONT1NUED)
Copy bO~ sides of thIs Slevatlcn CertJncate for (1) CDmmuJllly ortical. (Z) Inllur.J.nce agentlcom~d (3) bU4ldIfl9 O'No-=r
C;OMM~ ) Sf',., . (" . I I.. \, ~ ~ t eJ --.
* ('> i f~ U:r r"'" f?( ........... 'J 1\ e \d B p \"\ L.h..;We V" If...,.... \-,e( 11\ 1 '" C. \.., ~ <-~{ ~(~- (I A:'J I V\ -r~ ~
:n-.~1 ~t'[,(e.. I'fi' cu.,b ...::;t ~'... \lVH~ rJ'('"-,,,..-k, ....~fLLV-'" (J ~ "/1\.<.-fuL\Jed C.c.)'(I1~ of
".cz..1.:tb tMvI"d -n,,:{~r'~t~"',h9VV\r\"3 a-V1 ~bVa.tL~ c;;1 ;;;~, CI~~ O~..h-<.~"'--.C<\V'\.d~dJ(,rd:",-{
+17 e.(e','/tl.ntv\. .z:; I~, l \ JJ& V DI2~_ \.IJh~ u ~~.d a~ ~4S~~ J el Q-JA t1tMO:; l1ey'e~lL
, U Chec:x here If attachments
se.Cil0N E. BUILDING aEVAnON INFORMATION {SUR~ NOr RE:QUIRED} FOR ZONE""O and ZONE A (WlTHOUT SFE)
For Zone AO and Zon@A (wIthout BFE). C'lImplete l1i!m$ E1 thrO\I9h 53 If t/Je Elevabon Cerl1iic81e''; miended for' 1m ;3 suppcrlJng
mfarmailcn far a LOMA or L.OMR--F, Section C mu:It be completed.
E 1 6U11dlng OISg1'Sni Number jiii? (Select the bUildirIg clk."'..... most simdar to the building tor wtudJ tius certIficrte t1 betnIJ ccmpleted -
see pages 5 and 7. If no clJagnam :acd:lrately .......""'"ent:li 1he buifdll'lg, provloe a sketdl or pj,.,Ja..",...ph.)
E.2. The top cfthe bottom flctlf fsncludIDv ba5ementor e....l....ie) aftl1e butldmg IS I I ~ ft.(m) I , Im.(cm) Ll above or U beloW
(Ghe~ one) the hIghest ild)aeent gracie ' -
e3 For Zona AO "nty: If no flood d~ n\lJooet Is avadable.15 the tap of tt\e bottOm fIaor e:..."LJ In 8CCQ1..;..,.......witl'llhe Q:'lI11murllty'~
f100dcfaln manaqement ormnanc:e? I I Yes I I No -, l-' Unknown. The!ocal oficiaI mwt certify this ~.,;\........oon 11'1 SedJOn G
S =CTlONF~ PROI"i;;k. i fOWNER (OR OWNeR'S~ REP~sanATNE) C&r.'IMCATioN .
The ~Qperty owner or owner's authol1zed representabve wilo complete$ sec:llans A. B. and e for Zone A (without 8 f EMA..JsslJed or '
community-Issued BFE) or Zone AO mutt $l9'I'I hefe.
- F'ROF'l!RTY OWN!;R S OR OVVNeR'S AIJTHCRIZSO RS'fUi;SEHTA1'J\n!S NAME.
ADDRESS
CITY
~i\<<:
;ap COOl:
SlGNAnJRa.
COMMENTS
DATE
TEw:pfiQNE
U Cher.k here if attachments
SECTION G . COMMUNITY INPORMAnON (OP11ONAL)
The IOall offiCIal who is euthorIZed by law or ol'!iinanCe to ~ the c:mnmunJty'$ ftoodplaln management on:Iina~:e ~n complete
SectlOli$ A. 6, C (or El. and G of this elevatIOn Cca~Ie. CcmpIetethe a~ic:.able dem(s) and lilgtl below
G 1 LJ The mformatJon In $_;.....1 C Willi taken frtml other documenlatlan that haJs-been STgned and emclOfJSed by a ~csm;ed survevor,
eJ'lglneer. or architect who is sufhon;Z;ec1 by siate or IcCallaw ttl....... "';1 e1ewton lnlO..."",,"w" (\rl(fleate the SO\lTce and date of the
elevation data In the COmrMnts area below)
G2 U A communrty affIc:lal completed Sadlon E tor i!I bUlldlng !Qeateclln Zone A (WIthc'-1 e FEMA-issued or _...."UJ uty-Issuad SF:) or
Zone AO
G3 U The following InformatJon (ltenr.o G4-GQ} IS provlaed fur c:ommlJnlty flocdlliam manalJement purpOStlS
I G4 Pl:;RMrT NUMseR ' ""I Gb.LlAil:;r~ITISSUEO I GS UI'\TE C!;.~T1F~-;-c I,)F c;oMPUJ\NCEiOCCUPANCY
, ISSW:!:!
G7 ThiS permit has been l$:!otJed for U New CCtlitrudion U Substantial trnprcvement
GS Elevation of 2!i-blJllt lowest 1Ioor 6ndudlng \)aSG....:..I) of the butldmg IS
G9 SFE or On Zene AO) depth of ilcod1l'1g at the bl.ldcbng site IS
l..OCAI. OFfICIAl. S NAME
_ fl(rn) I Jatum
_ ft.(m) [latum _
TlT1...E
COMMUNITY NAME
SIGNATUR.E
COMMENTS
Ta,EPHONE
OATE
F5MA Form 81.31, AUG SSl
LJ Cht'Ck here If attachment!>
R5Pl.ACES ALl. PREVIOUS EDITIONS-