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Home My WebLink AboutFEMA Application 1999-6-2 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Important Read the instructIOns on pages 1 - 7 SECTION A - PROPERTY OWNER INFORMATION -BUILDING OWNER S NAME \R.N\"';) :C~IOC:.. BUILDING STREET ADDRESS (Including Api , Unrl, SUite, and/or Bldg No) OR P 0 ROUTE AND BOX NO '" G "1 (Q ~V\<2-o N L G\N C CITY STATE SPR.INc;f='16_o OR.. PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number ~gal DeSCription, etc ) l.OI 101 . l..~"\ '-1\.t-lDI~~ 1. F>-o~rT\~~ . BUILDING USE (e g , Resldenlial, Non-residential, Addition, Accessory etc Use Comments section If necessary ) R~'S'c6..\'~,- LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM SOURCE U GPS (Type) ( #=#0 - ## _ #=# ##' or #=# ####It') ~NAD 1927 U NAD 1983 U USGS Quad Map SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION ~ ~6 '9'-\ "- o M B No 3067-0077 Expires July 31,2002 l ~o~.!~~~ran.ce Company Use I. ~QIICY Numo.~r_ .. Company NAIC Number ZIP CODE ""1-, {-1~ U Other B1 NFIP COMMUNITY NAME & COMMUNITY NUMBER "S.PR'N~f'I~ 4l"S ~~ 1. B2 COUNTY NAME ~E B3 STATE O~ . B4 MAP AND PANEL B5 SUFFIX B6 FIRM INDEX B7 FIRM PANEL B8 FLOOD NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) f\e ~~ C \ \c..1 F J..Ne t" l ,..,., J u....c 2.., \ 9.,., Ae 810 Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered In B9 LI FrS Profile U FIRM ~Communlty Determined U Other (Descnbe) 811 IndIcate the elevatIon datum used for the BFE In B9 !B--NGVD 1929 U NA VD 1988 U Other (Descnbe) B12 Is the bUilding located In a Coastal Barner Resources System (CBRS) area or Otherwise Protected Area (OPA)? DeSignation Date I B9 BASE FLOOD ELEVATION(S) (Zone AO, use depth of flooding) 'S \C '7 LI Yes IL't-No SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Jlldlng elevations are based on LIConstructlon DraWings. LIBulldmg Under Construction. LIFlnlshed Construction . A new Elevation Certificate Will be reqUIred when construction of the building IS complete C2 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) C3 Elevations - Zones A1-A30, AE, AH, A (With BFE), VE, V1-V30, V (With 8FE), AR, ARIA, ARlAE, ARlA1-A30, ARlAH, ARlAO Complete Items C3a-1 below according to the building diagram specified In Item C2 State the datum used If the datum IS different from the datum used for the BFE In Section B, convert the datum to that used for the BFE Show field measurements and datum conversion calculation Use the space proVided or the Comments area of Section 0 or Section G, as appropriate, to document the datum conversion Datum Conversion/Comments Elevation reference mark used Does the elevatJon reference mark used appear on the FIRM? U Yes ~ No o a) Top of bottom floor Oncludlng basement or enclosure) ~ \ \ ~ ft (m) iU '" o b) Top of next higher floor ~ \ + .s... ft (m) ~ C "'} 3"o1:~... .:.~-I-b,...c.."){ h':'-'-I2..:vl-.lal ~~I uL7t.~lal member (V zone~ 0iilYJ _ it (m) ~"* o d) Attached garage (top of slab) '::> '1. .s... ft (m) ~ ~ o e) Lowest elevation of machinery and/or eqUipment ~ : servIcing the bUilding N I f'\ _ ft (m) ~ ~ o f) Lowest adjacent grade (LAG) ~ I t. l ft (m) ~ ~ ~ ",VJ o g) HIghest adjacent grade (HAG) 5 I ?. -L ft (m) ~ o h) No of permanent openings (flood vents) Within 1 ft above adjacent grade 9 ~ o I) Total area of all permanent openings (flood vents) In C3h \~ \ \ sq In (sq em) c [. ...... ... .... .t REGISTERED J PROFESSIONAL LAND SU I '~u .u.=c:~ I CJ.....OREG6N -........ -'f t FEB 19,1999 , JAMES W. COLTON ! # 58756 ; .,......... "'-'..". ............,.." .... .... ... Jt SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION 2.x..?\(tE~ J'2../~11 0) . ThiS certification IS to be signed and sealed by a land surveyor, engineer, or architect authonzed by law to certify elevation information I certIfy that the informatIOn In SectIOns A, 8, and C on thIS certIficate represents my best efforts to Interpret the data avaIlable I understand that any false statement may be pUnishable by fine or Impnsonment under 18 US Code, SectIOn 1001 r -WIER'S NAME C .... LICENSE NUMBER ..JAt-'\e~ W . CI..:.ON o~ . L:> .... '5~1'5~ I'll Lie: L~t> S"lZ-..J e-"'(o~ COMPANY N~9-D - Nt: "S.~ _ 'F~ ~ S~l'\Ce(t. ADDRESs.. ..,..,...,"3.. c. CITY - _ _ [)"tAIE ZIP CODE... A_-. \-'.6. ~)( 44 ,~J t:.uGC't\1c CR. 9"1l'l'- SIGNATURE l.....-.... ('. () DATE 1/2~/c1... TELEPHONE 54-I . ~~ \~Sz.. , AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT In these spaces, copy the corresponding informatIOn from Section A . '... ._- BUILDING STREET ADDRESS (Including Apt Unit SUIte ami/or Bldg No) UK P 0 ROUTE AND BOX NO b Eo '1 '" MP-cN U',,,,e.. CITY 'S?tp..IN~ nO-() For Insurance Company 0Se. Policy Number ~'J " " STATE C:I t- . ZIP CODE 4.41a Company NAIL: Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both Sides of this Elevation Certificate for (1) community official, (2) Insurance agenUcompany, and (3) bUilding owner COMMENTS I_I Check here If attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO and ZONE A (WITHOUT BFE) For Zone AO and Zone A (Without BFE), complete Items E1 through E3 If the Elevation Certificate IS mtended for use as supportmg mformatlOn for a LOMA or LOMR-F, Seclion C must be completed E1 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, prov~de a sketch or photograph) E2 The top of the bottom floor (including basement or enclosure) of the bUilding IS 'I 1ft (m) I I 'In (em) U above or U below (check one) the highest adjacent grade E3 For Zone AO only If no flood depth number IS available, IS the top of the bottom floor elevated In accordance With the community's floodplain management ordinance? I_I Yes I_I No I_I Unknown The local offiCIal must certify this mformatlon 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, and E for Zone A (Without a FEMA-Issued or community-Issued BFE) or Zone AO must sign here PROPERTY OWNER'S OR OWNER::; AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STAC,CE ZIP CODE SIGNATURE DATE TELtPHONf COMMENTS I_I Check here If attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) "he local officIal who IS authonzed by law or ordinance to administer the community's floodplain management ordmance can complete ;ectlons A, B; C (or E), and G of this Ele...atlon CertIficate Complete the applicable Item(s) and sign below ,1 U The information In Section C was taken from other documentation that has been Signed and embossed by a licensed surveyor, engineer, or architect who IS authonzed by state or focal law to certify elevation Information (Indicate the source and date of the elevatIon data In the Comments area below) ;2 U A community official completed Section E for a bUlldmg located In Zone A (Without a FEMA-Issued or community-Issued BFE) or Zone AO ;3 U The follOWing information (Items G4-G9) IS prOVided for community floodplain management purposes I IG4 PERMIT NUMBER G5 DATE PERMIT ISSUED " G6 DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED 7 This permit has been Issued for U New Construction U Substantial Improvement 8 Elevation of as-bUilt lowest floor (including basement) of the bUilding IS 9 BFE or (In Zone AD) depth of floodmg at the bUilding site IS rOCAL OFFICIAL'S NAME fOMMUNITY NAME f'GNATURE fOMMENTS I J _ ft (m) Datum _ ft (m) Datum TITLE TELEPHONE DATE I rMA Form 81-31, AUG 99 I_I Check here If attachments " REPLACES ALL PREVIOUS EDITIONS