HomeMy WebLinkAboutFEMA Application 1999-6-2
FRg~ '
FAY NO
Dee 18 2002 03 26PM P4
-,
~"r'"
02..- 07b;t
~~
FEDERAl EMERGENCY MANAG,EMENT A.GENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
o M B No 3067-eon
Expires JIJly 31, 2002
Imeor:ta!!!:....Readthe Instructions on paaes 1 .7.
SECllCJN A - PROPcn., l' OWNER INFORMAT10N
BUILDtNGOWNERSNM1E t'::rordtPlJ-l3re!- 8/.Aw's t M~hcrAl-~ . '/If .
BUILDING ~ ~~(IrIdudinQ~._I,.!1It.S\H.andIqtilIdg. No.)oRP.o ROVTEANDBOXNO.fItJ~~.'.~ '_ -~r:c',:-~:~.
c,,(d'ff'f h10-.sG~ yt9-<fi:> '--~.~y;-7--...:
CITY 5'.p RJ" .eel d 0 rZ- C(7 q 7 ~ STA1E ZJP COOE
?ROfEn.. . UES~~ (I.ot and B1~ Numbers.. Tel' Pan:eI Number, Legal Oe5Q'lPliCll. IIIC.)
_ l-tJf- 7(" Lev~"l.~'\I]""1 ?.)1/J ~A(iI-tJ(/\A .
6Ull.OING use:: (8 9-, ~ enljaI. ~~, 8IE:. Use a c:.,..u........ mua. it. nec..-/)
1<"e~l t?-...1-116. \ . . - .
LAlTTUOElLONGlilJOE lur IIVNALJ HORIZONTAL 0A1\JM: SOUR(;%. U t:;PS (Type)
( w. _ -##.#tf' << ##.####11') U NAD 1927 W NAD 1983 U USGS Q.Iad Map W Olh-
. SECTION B. FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
I B1 NAP COMMUNIlY ~ & COMMUNITY NUMBER I sz. COUNTY NAME + I B3. STATE.() ~
C: '+1 of '$rn",-~-ke.\d 4l55q '2-La,,,",p (3nl,.t,,,, '1 1""...
l34. MAP AN[) PANs. 85 lSIJFF\)( BS. FIRM JNor:x lIT. FIRM PANE;I.. sa fl..OOC . 89. BASE Fl.OOO aJ:VA1lON(S) ·
NUMBER DAle ~DAlE ~S) (ZoneAO.usedepttJoffloocf/ng)
lHD~C,\\(()&" F .:ru"....,t.tt1Cfi :f1.4.\I1t" f. lt1Ql'1 X. 5 \L3 *-
B1o..lndicat8'~e sOUrce of the &se Flood eeVatIon (BFE) data orbaSeftood depth 8..~.,.d In B9.~S de..:te~W"\.Y\ \!..( h::1
L-I FIS Profile 1-1 FIRM .M Community Determined 1-1 Other (Describe): C..~ r..~ S P"" "-j -h'fP.\ &.
B 11. Indicate the elevation datum used for1he BFE in B9:~GVO 1829 1-1 NAVD 1988 U Other (DesctIbe)
812 Is the building located In a Coastal Barner Resources-system (CBRS) area or Olhelwlse Protected Area (OPA)? l-I Yes tJ:,i No
Deslgnaflon Date.
. . '.',
SEcnON C. BUILDING ELEVAnoN INFORMAnoN (SURVEY REQUIRED)
C1. BUIlding elevat&on$ are based on. Llc.:.....;. .Jction Orawil\g$. ~ndlng Under Construction" LIF"lllIShed Construction
oA new Elevation CertIficate will be required when eorl$1n.~.... of the bullcflng IS complete
C2.. BuildIng Olagram Number tt;:'iJ (Select the building diagram most sundatto the building for which this certificate is bemg completed - see
pages 6 and 7. If no diagram acc:uralely repr=ents the buDdJng, provide a slcstd\ or photograph)
C3 ElevstJons - Zones A 1-A3O., -AE. AH. A (with BFE). VE, V1N30. V (wltl'1 BFE), AR. ARIA. AAJAE., ARIA 1-A30, MJIV{, AFJAO
Complete IteMS C3 a-I below a_.Jing to the building diagmrn specdied in Item C2- Slate the dal1lm used.. If the datum IS different from
the datum used for the SFE In S...~.... B. convert the datum 10 !hat used for the SFE.. Show field measurements and datum COnvefSlO1l
calculation. Use the space provided or the Comments area of Section 0 or SectIon G. as appmpnate, to document the datum eonvemton.
Datum j.l('" \w.:z~ ConversumlCOmments _ .'.
ElevatIon ref$l'9neG rnarlt used~* <"~~_ O"'Il<<<~ Does the e18\..~... reference mat1( used appear on the FIRM? Ll Yes titNo
g/~ Top of bottom floor (lOcludmQ basement or enaosure) ~J 1...!I. ft.~ -: V- "'i
9'b} Top of next nigher floor '? (~ ,.2.. ft.: REG1,;, n:nED
Q =) Bottom of lowest ho~ntal structural member 01 zones only) AI J:Jt . _ ft.( ; ! PROFESSIONAL \
~) Attached garage (top of Slab) 5 I if ..:i. ft. t ~ ~D SURveyOR
9' e} Lowest elevation of machinery and/or eqUIpment L.1 ~ ~ .t?'".. ,/;, / / ~
seNiclng 1he buildIng (Cesaibe In a Comments area.) 5/7, ..::L ft.(t) ~ ~ ,r ~"c c.~ /~L
en, Lowest adjacent (finished) gma (lAG) . ~ J.3 .:S.. ft.( ) ! j OREGON
P"S}Highe$iadJacent(finished)grade(HAG) 5/1/-_ z...ft.( ) !CI) JULY 20. 1993
l2YtJ) No. of permanent operongs (flood vents) withIn 1 fl above adjacent grade ~ ~,REX ~I L ,
P1> Total ar= of all petTmlnent openmgs (flood vents) In C3 h _4 q ~_ sq In. (sq- em) I A? . F, "'" ~ /2.("1,1<3.....
secnoN D - suRwYCR. ENGINEER, ORARCHtmCT ~J ir,CATlOM
. " -. ., , ,,-. ,,'
This cer\lfi=atlon 1$ to be sIgned and sealed by a land swveyor, engineer. or a~ authonzed by law to certify elevation Informatlon.
I certtfy that the mformatIon In SectJons A. 8, and C on this certi6eate TepnJseflis my best Bffor1.s to Interpret the data ;JVaslable
I understand that Ii'lny false .~..l,,,,...ent mav bemrn,t;hable bv fine or Jf11prisonment under 1 B U.S Code, Section 1001
Cc=llriliR"$ NAM~~ ~ A. "B~.,.t~' ucENSE NUMBER PL.. S Zf.pO Co
- TlTLE..~-- COMP/lXY NAME ~
'St..A_ve"" lAa.II\.a.e..e..,..- 13r4""~l,.. en.~/\I1Pe..1(~. J.{.;r...
AOOR!SS 3 \0 -hfji..-s Y-u.-t" ~(.)f.~h~ l~, _ srA~,4.t-Z ZIP' q7lt1'
SiGNAfURE /L /}t /~ . ~N d/ It:;, 2-0 tJ ~""'ONf:(5 (.( I) 7c/&' - 0 b 3,
!:;:UA ~tVM $l.1_~1 1111 nil ~l=~ R~R~ ~In~ ~nR ('n1lrTtNIIATtnN R;;Ql A(,I=~ All J)RAlIOI L~ ~runt'lN~-