HomeMy WebLinkAboutFEMA 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
Bruce Wiechert Custom Homes
BUu..DIJ:.jG STREET ADDRESS (Including Apt, Unit, SUite, and/or Bldg No) OR P 0, ROUTE AND BOX NO
Y::>Y 67th Pl ace
CITY STATE
SDrlnafleld O~fgnn
PROPERTY-DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal DescnptJon, stc)
LotB\ LeVl Landl.ng 2nd,Addltlon Flle 75. Slldes 1152-1155.
BUILDING USE (e g ~ResldentJal, Non-resloennal, Addition, Accessory, etc Use a Comments area, If necessary)
ReSldentlal '
LATITUDElLONGITUDE (OPTIONAL) HORIZONTAL DATUM SOURCE Lf GPS (Type)
( ##" _ ##' _ ## ##" or ## ####tf) LI NAD 1927 LI NAD 1983 LI USGS Quad Map
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
o M B No 3067-0077
Expires July 31, 2002
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ZIP CODE
Q7Ll7s:\
Lane COIJnty D1 FIt Rprnrds
U Other
I B1 NFIP COMMUNITY NAME & COMMUNITY NUMBER I 82 COUNTY NAME
Sorlnofle1ct 4~ I Flnp
B4 MAP AND PANEL B5 SUFFIX 86 FIRM INDEX B7 FIRM PANEL
NUMBER DATE EFFECTIVE/REVISED DATE
41039Cl~67 F 6/2/99 h/?/qq
B8 FLOOD
ZONE(S)
%;:1 rlpn X
B3 STATE
Orpgnn
B9 BASE FLOOD ELEVATION(S)
(Zone AO, use oeptn or fiooamg)
512.0
B 1 0 !ndlcate the source of the Sase Flood Elevation (BFE) data or base flood depth entered 1'1 89
I_I F1S Profile LI FIRM MCommumty Determined I_I Other (Descnbe) .
B11 Indicate the elevation datum used fortf;"e BFE In B9 I_I NGVD 1929 I_I NAVD 1988 \,d""Other (Descnbe)
812 Is the bulldmg located In a Coastal Barner Resources System (CBRS) area or Otherwise ~~tected Area (OPA)?
DeSignatIOn Date
Loca 1
1_IYes ~NO
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1 Building elevatJons are based on I-I Construction Drawlngs* l_lBulldlng Under Constructlon* ~Flmshed Construction
*A new Elevation Certificate WIll be reqUired when construction of the bUilding IS complete
C2 BUilding Diagram Number 2.. (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 Bevatlons - Zones A1-A30, AE, AH, A (wrth BFE), VE, V1-V30, V (With BFE), AR, APJA, APJAE, ARlA1-A30, ARfAH, ARlAO
Complete Items C3 a-I 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 D or Section G, as appropnate, to document the datum conversion
Datum Local Conversion/Comments .
Elevation reference mark used See Commp...[ltc; Does the elevatIon reference mark used appealtrf~~FiRM?I:""'1 Yes- l~
o a) Top of bottom floor (mcludrng basement or enclosure) <3 \ 'Z.- ~ ft (~m I :?,",:': " 'f'o.J ~'. "
o b) Top of next higher floor 5 \<5 ~ ft {;a) ~ l t :,.' ~ " .';'
o c) Bottom of lowest honzontal structural member (V zones only) W/~ _ ft (m) ~ ~ ~="t''''--~'-r'~:'-''c<"=o...d
o d) Attached garage (top of slab) 'S \ -t .k. ft (c) ~ -g ~ I (Q~
o e) Lowest elevation of machmery and/or eqUIpment ~ --:.. ~
=- , L '" ~ ....... >-I' l/. A
servlcmg the bUllolng (Descnbe In a Comments area ).J \.. .E... ft (oBI;) ~ ~ ';.. ----'.: .'. .:- =!..........-
o f) Lowest adjacent (fimshed) grade (LAG) OS \ c.\- ~ ft (m1 ~ ~i ,:..,., , '. :.::; j
o g) Highest adjacent (fimshed) grade (HAG) 5,4- -L ft (-='1 ~ "JC}:..r, ;~" ~ ( :, ',:::3 J
o h) No of permanent opemngs (flood vents) Within 1 ft above adjacent grade lO :3 ~ l. ~ ~~ ~,-/
o I) Total area of all permanent openrngs (flood vents) In C3 h IOfbO sq In (-=, -t;,-:-.' _::.::_ t\J;. r. ':Z-./ 7004)
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
ThiS certIfication IS to be Signed and sealed by a land surveyor, engineer, or architect authOrIZed by law to certIfy elevation mformatlon
/ certIfy that the informatIOn In SectIons A, B, and C on thIS certIficate represents my best efforts to Interpret the data avatlable
, understand that any false statement may be pUnishable by fine or Imorlsonment under 18 U S Code, SectIOn 1001
':RTIFIER S NAME LICENSE NUMBER
Jonathan A. Oakes Oreaon L S. #2105
TITLE CQMPANY NAME
ProfesSlonal Land Surveyor Poaqe Enolneerlnq & SurVeYlnq, Inc,
ADDRESS CITY STATE ZIP CODE
pO 80x (527 I Q_r Euoene OR 97402-0152
SIGNATURE J- -'j> ~ !J A ( f J DATE TELEPHONE
"""- _~a.....-~_ A&.t.d b t'=' O? 541/4RS-4t10i:;
FEMA Form 81-31, JUL 00 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
IMPORTANT In these spaces, copy the correspondmg Information from Section A
BUILDING STREET ADDRESS (Including Apt, Unit, SUite, and/or Bldg No) OR P 0 ROUTE AND BOX NO
959 67th Place -
CITY STATE ZIP CODE
Sprlngfleld Oregon 97478
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of thiS Elevation Certificate for (1) community official, (2) Insurance agent/company, and (3) bUilding owner
COMMENTS Clty of Sprlngfleld benchmark descrlbed as a chlseled square ln the top of the
curb at the mldpolnt of the curb return at the southwest corner of the ln~ersectlon of
67th & Thurston Road. Elevatlon 512.81
iF.:c[\=:~~lfran~-eo_@p~nY'l!~~~: i!
;>-.e~~c:ySNumbe
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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 E4 If the Elevation Certificate IS Intended for use as supporting
information for a LOMA or LOMR-F. Section C must be completed
E1 Budding Diagram Number (Select the bUlldmg 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)
E2 The top of the bottom floor (lncludmg basement or enclosure) of the bUlldmg IS - 1_1_1 ft (m) 1_1_110 (cm) 1-1 above or I-I below
(check one) the highest adjacent grade (Use natural grade. If available)
E3 For BUilding Diagrams 6-8 With openings (see page 7), the next higher floor or elevated floor (elevatIon b) of the bUilding IS
1-1-1 ft (m) I_I_1m (em) above the highest adjacent grade Complete Items C3 hand C3 Ion front of form
E4 For Zone AO only tf no flood depth number IS available, IS the top of the bottom floor elevated In accorda'1ce With the community's
floodpla!!2. m~maQement ordmance? 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 authonzed representative who completes SectIons A, B. C (Items C3 hand C3 I only). and E for Zone A
(Without a FEMA-Issued or communIty-Issued BFE) or Zone AO must sign here The statements In SectIons A, 8, C, and E are correct to
the best of my knowledge
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE S NAME
SIGNATURE
DATE
STATE
TELEPHONE
ZIP CODE
ADDRESS
CITY
COMMENTS
I_I Check here If attachments
SECTION G. COMMUNITY INFORMATION (OPTIONAL)
The local offiCIal who IS authOrized by law or ordinance to administer the community's floodplain management ordinance can complete
Sections A, B, C (or E), and G of thiS Elevation Certificate Complete the applicable ltem(s) and sign below
G1 I_I 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 local law to certify elevation information (I ndlcate the source and date of the
elevation data In the (Comments area below)
G2 I_I A community offiCIal completed Section E for a bUilding located In Zone A (Without a FEMA-Issued or commumty-Issued BFE) or
Zone AO
83 I_I The follOWing information (Items G4-G9) \$ prOVIded for commumty floodplain management purposes
G4 PERMIT NUMBER G5 DATE PERMIT ISSUED I G6 DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY
ISSUED
G7 ThiS permit has been Issued for I_I New Construction I-I Substantial Improvement
GB Elevation of as-bUilt lowest floor (mcludlng basement) of the bUlldmg IS
89 BFE or (10 Zone AO) depth of flooding at the bUilding site IS
lOCAL OFFICIAL'S NAME
_ ft.(m) Datum
_ ft (m)Datum
TITLE
COMMUNITY NAME
TELEPHONE
SIGNATURE
DATE
COMMENTS
L_I Check here If attachments.
REPLACES ALL PREVIOUS EDITIONS
FEMA Form 81-31, JUL 00