HomeMy WebLinkAboutFEMA Application 1999-6-2
Lot 7 2
::tt 0 l - l bta
.Ji<. V\.\A.t<VC\ I ~I IOu?
FEDERAL EMERGENCY MANAGEMENT AGENCY
NA TIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
OM B No 3067-0077
ExpIres July 31, 2002
Important: Read the inStructIOns on pages 1 _ 7
SECTION A - PROPE.~TY OWNER INFORMATION
BUILDING OWNEQ S NAME (~ ,:' ~'- ,
\ ~U..uJ.. 4..; ~ ll..JUA _
BUILDING STRE=:7 ADDRESS (Including Apt Unit. Suite and10r BI<:g No) OR P 0 ROUTe: .A.~D BOX NO
L\ q 3(t/ (,,0~ PI4('e.
CITYS(J'( .f <"\d -- STOrZ..
PfOPq'HY DE~PTION 1'''' "'" Blod< N""""os. T~ p,,,,,, N......, ~ _" "oj
\.-.D;- 7'L, Lpv\ L4~ Z",/J M/i~
BUILDING USE (e 9 , Re~ldeniJa;, No'n-reslde'lllal~Jbon, Accassory, en:. Use Comments secon d necessary )
?es (d'~ *Q ~ \ _ .
LA TlTUDEtLONGITUDE (OPTiONAL) . HORIZONTAL UA IllM SOURCE. U G?S (Type)
( ##0 - ##' - ## ##!' or ## ####:f') U HAD 1927 U NAO 1983 U USGS Quad Map
Far Insurance Company Use
Pallcl Numoer
Company NAIC Numoer
ZIP CO~
c-; 2lf77
SECTIO~ B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81 N:JP COM~UNITY NAME & cur.;r.;uillriY NUM8ER 82. ~~ NAM71. t _83 STA~ ,0
C I. ~ ~ Sf''''''.:) {;e~~ ~415;;1 z., La",p LL)u",,-, '1 L.) f'....
B4 MAP AND PANEL 'B5. SUFFIX 86 FIRM INDEX 87. FIRM PANEL 1 88. FLOOD
NUMBER DATE crrcCTIVEIREVISEDDATE ZONE(S)
L\I 0 -=1qc.. \ It.o(P F:, Jlu.,\t:Z"q,'i:r~ [. L,~q X
B10 IndIcate the source of the Base Aood Bevabon \Dt'C} data or base flood depth enter.!d In B9
U FIS Profile ~IRM - . L:J ComrmiiJity Determined U Other (Desaibe)'
B11 Indicate the elevatIon datum used for the BFE In B9 Q(NGVD 1929 U NAVD 1988 U Other (DesaJbe)
812 Is the bur/ding located In a Coastal Barner Resources System (CBRS) area or OthefWise Proteded Area (OPA)? U Yes ~o
DeSignation Date
U Other_
89 BASE flOOD ELEVATION(S)
(Zone AO, use depth of flooding) IJ
.-J1 OVl. e d eo;;: l5 Vl ~ t-e ~
SECTION C - BUILDING ELEVATION INF9RMATION (SURVEY REQUIRED)
BUilding elevat,ons are based on: UConstrudJon DraWIngs. !)(JBuilding Under COns1rudJon* ..J~ . ~ .;;:, ..~'"..tetJon
,. A new ElevatIon Certificate WIll be reqUIred when .........i. ..sdJon of Bfubuilding IS complete. _ .
C2 Building DIagram Number R (Seled the building dIagram most sJlTUlar to the building for which ttus certrficate IS beIng completed _ see
pages 6 and 7 If no diagram accurately represents the bUIlding. pl'OVlde a-sketch or photograph)
C3 Elevations - Zones A 1-A30, AE, AH, A (WIth BFE). VE, V1-V30, -V (WIth BFE), AR. APJA, ARJAE, ARIA 1-A30, ARlAH, ARlAO
Complete Items C3a-, below accordrng to the buildmg dIagram speofied rn Item C2.. Slate the datum used If t."ie carum IS arrfere'1t Tram
the datum used for the BFE In Section B, conven the datum to that used for the BF::.. Show fiela measurements and datum convers.on
calculation Use the space proVided or the Comments area of Sedlon D or Section G, as aDCropnate, to oocume'1t the carum convers.on
Datum .U t:, V 0 It.4 Conversion/Comments ...-i( <;"'.e-e p'e\/ev~e.
E~atlon reference mark used N [ 'J Ql -: '1;- Does tne elevatIOn ICIC'Cnce marK used acoear on the FIRM? U Yes r::6-No
M jl)ToPOfbottomfloor(induamgbasementorendosure) ~ II ::Lit() ro ' ..... . ... I
..... b ) Top of next h'ghe, fioo, , S Jl/. ~ Il( ) ~ /. ... REm;;. &:RED '\:
E: ~) 2;.;U;.;;;; 'Jtmwc.:>~ L....a;""..~~::-...:~i m",rnc",r ('hMO<" ~,) _ ft.( ~ ~ PROfESSIONAL
a;t'd) Attached ga,age (top of slab) 5 I '3 -!i Il( ) ~ ~ I.AJlID SURVEV9fl
IJV'e) Lowest elevatIon or machinery anoJor eOClOme'1T _ _i!? ~ . ...~~. /'J/) ;/./.~ c.
servlc:ng the bulld:ng 5 , ~ 5-. it ( #/ bY (~ r-r /.
~ f) Lowest adjacent grade (tAG) ~ 13 2- ft ( ) ~ ~ OREGON _
CB"'g) HIghest adjacent grade (HAG) 5 13 !:L rt.{ .) ~::;; JULY 20, 1993
;:-0/ N t l ) ;;; REXA Ot:IL.
V')) 0 or permanent Openings (flooa vents) wnhln 1 it aoove aOJacen grace -'" '-. #2.6.OR /
'(0) Total a'ea of all pennal1ent openmgs (flood ,","Is) m C3h q 2. 't sa m, (_u) L., L E.)eft I Z /3, /0'"
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFiCATION -
Tnrs certIfication IS to be Signed and sealed by a land surveyor, engmeer, or archJted authonzed by law to certJfy elevatIon InformatIon
I certIfy that the mrormatJon m Sections A, B, and C on thIS eertJ/ieate represents my best efforts to mterpret the data available
I understand that any false statement may be DUn/shahlp. by fine orlmonsonment under 18 U S Cede. SeetJOn 1001
~=::mFJER S NAM .6t . .. . LICENSE NUMBER P S
I LE e ""2-- COMPANY NAME...-:-, l.; 2&() &
S u. yV e",_. 15Y ,,4\/1. ~ I '" {' <:.,.- '^''':\ 'Kc
ADDRESS 3 \ ,ne; CI" OS 0", h e ~SfAT~ 1Z ZIP CODE q 7 V 7 7
SIGNATURE DATE ("7 T~LEPHON) ")
u. t:C)O.::> I tlf & -D (p :.; 7
FEMA Form 81-31, AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITlnNs
I For Insurance Company Use
I PohC'f Number
Ccmpany NAIC Numoer
IMPORTANT In these spaces, copy the correspondmg ,"fonnabon from Section A.
BUILDING STREET ADDRESS (Indudm~pl Umt. Surte. and/or Bldg No) OR P 0 ROUTE ANU ~OX NO
_ q31t? C:;hr"'. '~lo/e. .
CITf - - - STATE Z!P CODE
"S pr )-~~ fr-c-tt;f () 'fZ- q,1fI-;
SECTION 0 _ SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certriicate for (1) commumty orlicai. (2) Insurance age<rtJcompany, and (3) bUlldmg owner
COMMENTS f
* Oi1-'1 U C;pYVv.-j f\-e\d Be~~.h }Jav\L;.J,..,el,-,\J1 ~ C~\~e,leJ <,ellA.LiVe.. (IN<..+ \'^ ~.
..,1 r tr ~ f' r
~~1 rl~(t..- dJ" c.urb t'At ~ W\l&.f0\1. ,.",i (' ,-,yl.-;> ,C.\l.LCb.-C.1 -tkt SJ)L<. t\"'wed CO{\16V" oJ-
~7~ tw'..tJ. ~u.Y"~t(:lY\, ~ ~...v~"\!) aY\ ekva.tL6V' c.:At 51'2.-. g, C 1~\~ 0 Zl.Tl<.1N\ ~d e<d J v <~(
-10 8(~vtLntv\ z:; I~\ \ L.Q&V!)'t~ WitS u<,eJ as W- ~"SIlS d ~levAhOVl"') t,eye~vt
U 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)'~~"'r.lete ItemS E1 through E3. If the BevatJOn CertIiicale IS Intended for use as supportIng
mformatIon for a LOMA or LOMR-F. Section C must be completed. - . -. -- -. - -- -~ - --.--. -
E1 Budding Diagram Number - .----{SeIea the bUikflOQ otagraaJ .......l Similar to ~ building far ,.,: ,;.:1 '.ttus certJficate ~ being completed-
see pages 6 and 7 )f no diagram accUrately represents the building, pro.vide a ~ or pl~~:f".,ph.) - , ,
E2. The to-p o~~e ~otto~flocil:Smdiid!n9 baSeinent or encI~) O! the buildmg-is =I_~ I --, ft.{m) I =1 :- fm.(cm) 0 abOve or ~~ ~Iow"":.-
-(check one) the hlghestadjacentgrade.:: -- .:;:::: \-- -".: ---.- ~ - ~".-
E3 For Zone AO only If no flood depth number IS available, IS the ~p ~f the b;;~",,, floor ~ in accordance WIth ~e commumty's
_ floodplain managemenf on:linar1Ci?U Yes" . Q No - -O~oWri. The-IOCaI....':..:.J mUst CertIfy thiS :.t.......:;;.J:on in sedion G.~
SECTION F _ PROP~I i OWNER (OR OWNER'S REPRESENTATIVE) CERTlACATION ~: ',.-
The property owner or owner's authonzed representative who completes Sections A. B, and E for Zone A (WIthout a FEMA-lssued or
commumty-Issued BFE) or Zone AO must Slgn here.
PROPERTf OWN~k;g OR OWNbr~Ai.jlriuRIZED REPRESENTAfivcS NAME
UA~
STATE
Tt-i PPHONE
ZIP CODE
CITY
ADDRESS
SIGNATURE
.,..c.. _"!
COMMENTS
U ChecK here If attachments
SECTIONG;COMMUNITYINFORMATION(OFTIONAL)
The local offiCIal who IS authonzed by law or ordmance to adltllmster the commumty's floodclam management ordinance can complete
SectIons A. B, C (or E), and G ofthis-Elevabon cerbiicate -eompletethe appbcablertem(s) andSlgn below
G 1 U The IntormatJon In Sedlon C was taken from other documentabon that hasiJeen-stgned-and-emcossed by a hcenseo surveyor,
englneer,'or archItect wno IS authonzed by state or local law to certIfy ele.at.".. ...."....aLon. -(Imncateihe saUTCe and-date of 1he
elevatIon data In the Comments area below )
G2 U A commumty otficlai completed SedIon E for a buddIng located In Zone A (WIthout a FEMA-lssued or community-Issued BFE) or
_. Zone AO _ ,
G3 U The follOWing Informahon (Items G4-G9) IS proVIded Tor commumty floodolarn management pumoses
G4 PERMIT NUM8ER G5 DATE PERMIT ISSUED . GoDA~ (;S:=TiFICATE OF COMFLIANCEIOCCUPANC'{
ISSUEJ
G7 ThiS permit has been ISSUed for: U New Construc'Jon U Substanballmprovemem
G8 ElevatIon of as-bUilt lowest floor (Including basement) of the building IS
G9 BFE or (In Zone AO) depth of flooding at the buddlOg site IS
LOCAL OFFICIAL'S NAME TiT Lf
_ fl(m) Datum
_ fl(m) Datum
TElEPHONE
COMMUNITY NAME
SIGNATURE
DATE
COMMENTS
LJ Check here If attachments
REPLACES ALL PREVIOUS EDITIONS 2"'::
>=FMA Form 81-31. AUG 99