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 Wlechert Custom Homes
BUILDING STREET ADDRESS (Indudlng Apt , Unit, SUite, and/or Bldg No) OR P 0 ROUTE AND BOX NO
fih~q Mnc::pc:: Pi'lC::C::
CITY STATE
Sprlnqfleld Orecon
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Descnptlon etc)
I Ot. 14- tevl I_flnd'n~ ~nd AddlilDn ~71) Slldpc:: 11~?_11~1)
BUILDING USE (e 9 , Residential, Non-residential, Addition, Accessory, etc Use a Comments area, If necessary)
ReSldentlal
LA TITUDElLONGITUDE (OPTIONAL)
( ##0 _ ##' _ ## ##" or ## ###t#f')
o M B No 3067-0077
Expires July 31, 2002
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ZIP CODE
g747R
I ;lYl.'" r.nlJ..U.td1 P17t R",~
HORIZONTAL DATUM
LI NAD 1927 LI NAD 1983
SOURCE LI GPS (Type)
LI USGS Quad Map LI Other
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
J
B1 NFIP COMMUNITY NAME & COMMUNITY NUMBER
<; rr, n 0 fl P'- rl 415.5..9.?
B4 MAP AND PANEL B5 SUFFIX B6 FIRM INDEX
NUMBER DATE
41039C1166 F - 6/2/99
B2 COUNTY NAME
Lane
B7 FIRM PANEL
EFFECTIVE/REVISED DATE
6/2/99
B8 FLOOD
ZONE(S)
X
B3 STATE
nrpl]nn
B9 BASE FLOOD ELEVATION(S)
(Zone AO, use oeptn or fiooOlng)
511.0
B 1 0 Indicate the source of the Base F!ood E1evabcn (BFE) data or base flood depth entered In 89
I_I FIS Profile I_I FIRM }(i CommunIty Determined I_I Other (Descnbe)
B 11 Indicate the elevation datum used for the BFE In B9 I_I NGVD 1929 1_1 NA VD 1988 )(1 Other (Describe)
B12 Is the bUIlding located In a Coastal Barner Resources System (CBRS) area or Otherwise '~ected Area (OPA)?
DeSignation Date
Local A
I_I Yes ~ No
SECTION C. BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) .
C1 BUlldmg elevations are based on I-I ConstructIOn Drawmgs* 1_IBulldmg Under Constructlon* ~Flnlshed Construction
* A new Elevation Certificate Will be reqUired when construction of the bUlldmg IS complete
C2 BUilding Diagram Number '2- (Select the bUilding diagram most Similar to the bUilding for which thiS cerlificate 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 BFE), AR, ARiA, ARiAE, ARlA1-A30, ARiAH, A.R1AO
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 0 or Section G, as appropnate, to document the datum conversIOn
Datum Local Conversion/Comments A-b Do'?' 10 U?c...-A'c.- (:)A=!VM "'to ~u_i=u"F- M..A. DkiVaA
Elevation reference mark used See Co mme n ts Does the elevation reference mark used appea plh~uFJR~? I"':=J Y e-p 'K.L N~
o a) Top of bottom floor (Including basement or enclosure) "3\ 'L ? ft (c) a; l - ' . ., rf, I
- CD f '" S>'f ~"'
o b) Top of next higher floor c:::, \ S ~ ft (m) ~ I. ' 'u , l
o c) Bottom of lowest hOrizontal structural member (V zones only) N I ~ _ ft (m) ~ ~ "'"-'=" ~-"..-- .""'.....,. --- -""-O((fl"'O u~, ~ J
o d) Attached garage (top of slab) '5 I'? ~ ft (.-) ~ -g A> (J.
o e) Lowest elevation of machinery and/or equipment ~....: ~ I
servicing the bUilding (DeSCribe In a Comments area) "5 \ '-\- Q ft €m} ~ ~ ;- ;;-~-~. ~ ~ , .!~. ~ - - - -:::,- ~
o f) Lowest adjacent (finIshed) grade (LAG) "5 \ '2... ~ ft (.e) ~ ~l '.
o g) Highest adjacent (finished) grade (HAG) '"5 \"? .-::L ft (~) ~ \ J:" i I
o h) No of permanent openings (flood vents) wlthm 1 ft above adjacent grade 1 "3 ~ '~~- .Y'__ - -- ___-c. - -= - joe"-
o I) Total area of all permanent openings (flood vents) In C3 h l"''Lo sq m ~) ~,,- ~.... ::.1':> I 7e':l.J..,
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
I certify that the mformatlOn m SectIOns A, 8, and C on thiS certificate represents my best efforts to mterpret the data available
I understand that any false statement may be Dunrshable by fine or Imprisonment under 18 U S Code, Section 1001
-RTIFIER'S NAME LICENSE NUMBER
Jonatnan A. Oakes Oreqon L,S. #2105
f1TLE COMPANY NAME
Professlonal Land Survevor Poaoe Enqlneerlno & SurveVlno. Irc_
ADDRESS CITY STATE LIP CODE
P.O. Box 2527 tWL-'. Euoenf' nR q74n?-nll)?
SIGNATURE r..L II DATE - TELEPHONE
~~AA. (0 lCo- o~ 541/485-4S01)
FEMA Form 81-31, JUL 00 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
IMPORTANT In these spaces, copy the correspondmg mformatlon from Section A.
BUILDING STREET ADDRESS (Including Apt, Unit, SUite, and/or Bldg No) OR P 0 ROUTE AND BOX NO
fifi~q Mnc:pc: D;JC:C:
CITY STATE ZIP CODE
Sprlnqfield OreQon 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
Cltv of Sorlnafleld benchmark descrlbed as a chlseled sauarp In the top of the
curb at the mldpolnt of the curb return at the southwest corner of the intersectlon of
67th & Thurston Road. Elevation 512.81
'~foEI~~(fran~~~ii}gaiiYLJ~ ~ ;:~;":4,
_'p~~cy-('lU:-~be
?~tt~~~~
'-_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 mtended for use as supporting
information for a LOMA or LOMR-F, Section C must be completed
E1 Bulldmg 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)
E2 The top of the bottom floor (Includmg basement or enclosure) of the bUilding IS 1_1_1 ft (m) 1_1_lln (cm) I-I 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 bUlldmg IS
1-1-1 ft ("1) 1_1_I'n (cm) above the highest aaJacent grade Complete Items C3 hand C3 Ion front ofform
E4 For Zone AO only If no flood depth number IS available, IS the top of the bottom floor elevated In accorda'1ce With the community's
floo~pl~~n~ mana8ement 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, 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, B, C, and E are correct to
the best of my knowledqe
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE S NAME
ADDRESS
SIGNATURE
CITY
STATE
ZIP CODE
DATE
TELEPHONE
COMMENTS
I_I Check here If attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local offiCial who IS authorIZed by law or ordmance 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 Item(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 authOrized by state or local law to certify elevation mformatlon (Indicate 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 community-Issued BFE) or
Zone AO
G3 I_I The follOWing mformatlon (Items G4-G9) IS prOVided for community floodplain management purposes
G4 PERMIT NUMBER I 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
G8 Elevation of as-bUilt lowest floor (mcludlng basement) of the bUlldmg IS
G9 BFE or (In Zone AO) depth offloodmg at the buildmg site IS
LOCAL OFFICIAL S NAME
_ ft (m)Datum
_ ft.(m) Datum
TITLE
COMMUNITY NAME
TELEPHONE
SIGNATURE
DATE
COMMENTS
I_I Check here If attachments .
REPLACES ALL PREVIOUS EDITIONS
FEMA Form 81-31, JUL 00