HomeMy WebLinkAboutFEMA Application 1999-6-2
"
\ Mr~ ~~ ~~~~~
. J .
r ~.,
\~
.I. lO~r-TI
,. V~V nt.::>::> ,. H::>::>.l:St.I'tVt.K
j
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
r-llJ l:J~~~ l:::A
~...~.,.. , r-
OM a No 3067-0077
Expires July 31, 2002
Important: Read the Instructions on pa~s 1 .. 7.
SECTION A - PROPERTY OWNER INFORMATION
, r
BUILDING OWNe,.'S NAME '"1'J zu:n ff/IU)
U\I< C '"'11-\ S, \ ~ t; g,;..v-,-__
BUILOIN,G STREEi ACDRe~S (Including Api" Unit, Suile, andlor Bldg. No ) OR P 0 ROUTe i\i~u BOX NO,
'=:.'102.. r-6~~ p~ ~~
CITY- STATe
5 pt!"INa'P,f\.Q OP...
PROPERTY c.lc\)I.<l"l.IPTION ((0' S~l;; ;;;u& ;;umOeIS, -;- ax ;:atc:ei ~lIm~r.l.t1:Ial UescripllOn, eic.)
\"0'"(' ~~ loa"\ ...""-'1)1 ~ ~ 1..we.- "Q'C:il'"T\~
BUilDING use (e,g.. Resiclential, Non-resldenll8l, Addlbon, Accessory, etc Use Commenls ~ctlon If necessary.)
~t;5.'C)e~"l~
.. - I
LAilTUDCIl..ONGITUOe (OPTIONAl) ,'.It; HORIZONTAL. DATUM SOURCE; LJ GPS (Type)
( #. #If - ## ##' or tIII,#Mff') L:;.1'NAO 1927 W HAD 1983 U USGS Quad Map
~ "'""-.........-...
WOlber
SECTION e - FLOOt> INSURANCE RATE MAP (fiRM) INFORMATION
' ,
, 61 NFl? COMMUNITY NAME & COMMUNITY NUMBER 82 COUN1Y NAME 83 STATE
-s.pR.I~R~ 4-1"S OS"; 't. __ ~e a~ .
. 84. MAP AND PAN51. .' 85 SUFFIX BSARM INDEX 87, FIRM PANEL 88, FLOOD 89. SAsE FL':;~;j ~Lt:VATION(S)
NUMBER ~ DATE EFFeCnVElREVISEDOATE ZONE(S) (ZoneAO,lIU depth off1oodlng)
+to '!>~ Q \ \6:.1 , J~ t, l~." J"~ 2.. \ ';~ AE '3 l\ . "l.
810. IndIcate the eource CJfthe Sase Flooct Elevation (SFE) data or base flood depth ~"tered in B9.
U FIS Profile U FIRM ~COmmunlty Oetemllned U Other (pescrtbe):
B 11 Indicate the erevaUQn.tdatum used for the BFE In 99: (lg,NGVD 1929 U NAVD 1988 LJ Other (Describe)'
612. Is the building locate<Hn a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? U Yes 6:::::!-No
Designallon Date~ >', ,
SeCTION C. BUILO/NG ELEVATION INFORMATION (SURVEY REQUIRED)
C1 BUilding e/evaUons are based on: UConstl\Jct.on OraWlngs- LISulldlng Under Construction. LJFinfshed Constl\Jctlon
· A new elevation Certificate will be required when constructIon of the tluilding IS complete,
BuildIng O,agram Number ~ _ (Seled Ihe budding dIagram most SImIlar to Ihe buildIng for which thiS certificate IS being compleled _ see
pages 8 and 7 If no diagram accurately represent$ the building. provIde a sketch or photograph.)
C3 Elevations - Zones A 1-A30, AE, AH, A (with BFC), ve, V1-V30. V (WILh BFe), AR, ARIA, AR/AE, ARIA 1.A30. ARlAH, Ii..RJAO
Complete Items eSs-j below according to the budding diagram speCIfied In Item 02 Stale the datum USed. If tlte datum IS different from
the datum used for the BFE in Section 8, convert the datum to V1at used forthe SFE, Show field measurements and datum conversion
calculation. Use the space provided or the Comments area of SectIon 0 or Sectlon 0, as appropriate, to document the datum conversion.
Datum' ConverslonIComments
Elevation reference mark used . Ooes the elevation referencemal1<usedappearontheFIRM?UYeSICl.No
o a) Top of bottom floo~ (inclUding basemenl or enclosure) '5 l ~ : ..t. ft.(m) .: . .
o b)~. QP of next higher tl'o<sr OS l~ , ~ ft.(m,): -# AE ~' "
~1: :1, .'" ~I I -" b ^' I ' Il' ) jjj.! GISI ~AED
o ~) ~~~;~f~O::~ ~::i~7~;'w "v.... w, j~\ ..-.-, er"\. tSRes SA 1"1 ~ (4 -: 3: ft.(:) i;, PROFESSION~L ,
Q e) Lowest elevatlono(machineryandlorequipment ~IL. ~i ~.,~~_D....SU"R.veyOR?'
servlolng the buildlMg ...fJJ.. ' _ ft.(m) Ii _ ~ """, ......J-
o t) Lowest adjacent grade (lAG) t'S I"" .~ ft.(m) ~ 9 - (; OREGON ,. '
Q g)Hlghestadjacenlgrade(HAG) S\4- ..~ft,(m) ;'" FE819.1999
Cl h) No of permanent openings (1Iood vents) within 1 ft, above adJ,cent grade a !. JAMES W. COLTON
Cl I) Totar area of all pennanent openIngs (flood venls) In C3h 8'99 sq, In. ($q em) #58758,
,
SeCTION 0 - SURVEYOR, ENGINEER, OR ARCHITe,CT CERTIFICATION ~~e,; f2./'!J'f D) .
This certification is to be SIgned and sealed by a land surveyor, engIneer. or arettitect aufhonzed by law to certify elevadon Information '
I certify that the mfommbon in Sections A. 8, and C on this cerltficate represenfl my best efforts to interpret the data available
I understand thai any false statement mav ~ ~/shab1e by fin. or ,mp"sonmenf unded 8 U.S, ~ Section 1001.
CER11FlfR'S NAME . . , C - LICENse NUMeER liCe:\. 1Ir.'-
-'^~e~ - - Q\;.ON ot . ~. -..JQ"1-,,)'Q
TI11.E \..",,",0 ~!)12.t.I e'(o1& COMPANY N~ .. Nt! '&~ _ 'FI\ ~ s e.G:....oeA..
AOORES~.~. \:Ax 7.~"~'5 CITY EL.\~~C ~~, ZIPCOD~~~7.
. ...
, ....WRE ~ 1...... l . U OAT" I /2 !>I Q.... l"EL..HQ.... S4-\ . '!. ++. ~ 51..
FEMA Fenn 8 ~ . AUG 99 "... SEE REVERSe sloe FOR CONTINUATION R1=~~t.;:.:. Al I aae,:'^, 10 e"'..,.''''.....
~
, 'MP(lRT ANT 'n th.... p..... copy the co.......ndln. Inlo""..oo ''''m "_00 A ' Fo, I......... ~n' ".~. .
k SU.""'NG SIRES' ADDRess Ilnd...~.Apt. unUWle, .....,.... No l DR .-:0 ROUT. AND 80X NO ...._"1" _ ,
,- " ,.... """" '$ ~ p" 0;. "> _ . ...t, , .. .,........... _ . " .
CITY STATE ~I;~oe C8i'lJ~y N.\r.'f1!!u!U~]"r " , ... ~
'5il'''''....~~, tl..O d-. ~1 ,. ,. """,,, ~ '"" ""'-a,.,;-~
H,r<; J.c. c.lQ\Qc.~
J. \Q~r"TI
~ VKlJ Plt:.:::>:::> ~ H:::>:::>.t:it:.NlJl:.K
NO 055 -p 3 -- - - ..
: r seCTION 0 - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICA T~ON (CONilNUEO)
~ -tJy bOlh sIdes of thIS ElevatIon Ce"r/icale (or (1) communIty offiCial. (2) Insurance agenllcompany, and (3) bur/ding owner.
-COMMENTS
~
1-1 Check here if attaChments
. sacnON a . BUILDING ElBVATlON INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AD and ZONE AlWrrHCiuT BA!)
F;,. ~ne AD and Zone A (wrthout BfE). _fete /lem. Elll11ou9h E3 If the EIoVll/ion ee_ "intendS" fIN use ."Uppottmg _
n(ormeltOn (or a LOMA or LOMR-F, Secdon C must be completed.
:;1. Budding Olagram Number (Select the building dIagram mosl similar 10 the building for whIch this cel"lltlcate Is being completed _
see pages 8 and 7. If no diagram accurately represents the bur/ding, prow~e a sketch or photograph.) ,
:2. The lOp of Ihe bottom floor (incl~d/n9 basement or enclosure) of the building Is , I I Il(m) I r Im.Can) U G~e or U below
(check one) (he highest adjacent grade. .. .
.3. For Zone AO onl)": If no flood depth number is '2Ivailable. IS th~ top 01 the bottom f10atf e/ev~l1ed in aCCOrdance with the commanity's
flood.'.,n msn..._ .~I Yes .J..J No L1llJ1known. TI1.Ios!I~I_ COI1i1'ythi. ~on In SeolJon G. _
SECTION F. PROPERTY OWNER (OR, OWNER'S REPRe8EHTAT'VE!),cERTlPIQAnOH
;:;;e prooerty ownet or....e;;;;;__ '"'__..,., ....~. Ssalons A, 8. 8M E lor Zone A Cwfthsut. Few.;..ued cr
:ammunrty-/$sued eFE:) or Zone AO must sisn here, '
'ROPERTY OWNER'S OROWNEf\'S AUTHv'~II..c:O ~RCSiNTATlVe's NAME
';:jURESS
;0;:.... TURf
CITY
~IAIt!
ZIp CODE
C. _NTS
DATE
TEl.EPHONE
-
---
I_f Checl( here if attachments
. _ ft.(m) Oatum'
-' _ ft.(m) Datum, _
MUNITY NAMe
ATURE
~~
TELEPHONE!
DATE
.-.
- ,
, .
~orm 81.31, AUG 99-
-
LI Check here If attachments ,