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Home My WebLink AboutFEMA Application 1999-6-2 , 1 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE o M B No 3067-0077 Expires July 31, 2002 Important Read the instructions on pages 1 - 7 SECTION A - PROPERTY OWNER INFORMATION - For Insurance Company Use Policy Number BUILDING OWNER'S NAME Bruce Wlechert Custom Homes BUI!-DING STREET ADDRESS (Including Apt, Unit SUite, and/or Bldg No) OR P 0 ROUTE AND BOX NO 6116 Moses Pass Cll$pn n gfi e 1 d STAHR Company NAIC Number ZIP CQOE 97478 .....Ku.....cRTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc ) LOT <01 L~'ll Landlna 2nd AddltlQtl Flle 75. Sl1rfPc:: 11S?_11J:;J:; BUILDING USE (e g , Residential, Non-residential, Addition, Accessory etc Use a Comments area, If necessary) ReSldentlal LATITUDE/LONGITUDE (OPTIONAL) ( ##0. ##' _ ## ##" or ## #####") Lane C:ollnty Pl FIt Records HORIZONTAL DATUM 1-1 NAD 1927 1-1 NAD 1983 SOURCE 1-1 GPS (Type) 1-1 USGS Quad Map I_I Other SECTION B. FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1 NFIP COMMUNITY NAME & COMMUNITY NUMBER I B2 COUNTY NAME I B3 STATE Sp~J nqf]eJ d_ _Jl.15592_ _ ~{I.ne Oregrn B4 MAP AND PANEL B5 SUFFIX B6 FIRM INDEX B7 FIRM PANEL B8 FLOOD B9 BASE FLOOD ELEVATION(S) I NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding) 41039C1166 F 6/2/99 6/2/99 X S\1.~ ~ B10 Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered m B9 1_-1 FIS Profile 1--1 FIRM 11.1 Community Determined I_lather (DesCribe) B 11 Indicate the elevation datum used for the BFE m B9 l_ll NGVD 1929 1--1 NA VD 1988 I--l Other (DesCribe) B12 Is the bUilding located In a Coastal Barner Resources System (CBRS) area or Otherwise Protected Area (OPA)? I_I Yes 1,.61 No DeSignation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1 BUlldmg elevations are based on 1_IConstructlon Drawlngs* 1_IBUlldlng Under Constructlon* ~Flnlshed Construction *A new Elevation Certificate Will be reqUired when constructIon of the bUilding IS complete C2 BUilding 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) C3 Elevations - Zones A1-A30, AE, AH, A (With BFE), VE, V1-V30, V (With BFE), AR, ARiA, ARiAE, ARiA1-A30, ARiAH, ARJAO 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 appropriate, to document the datum conversion Datum \...lX.At., Conversion/Comments A-t> D 0"2;:.' TD LCt..A1..- DA-1 V IN\ TO \~ 1- t:: .vi, A- ' DA....il} ttI\. Elevation reference mark used ~t:.. COl'v\(v\E.gT7 Does the elevation reference mark used appearpttffie~i~r;r;.;+~~, o a) Top of bottom floor (mcludlng basement or enclosure) '3 \? ~_ ft (~~ "1 PP(~,i(.l1:-,)SlT<j.o~AL ' o b) Top of next higher floor SIlo _'Lft(:aJ) ~ '1 l.ANO ~Ufi~Vl~;-'lfOR ; o c) Bottom of lowest hOrizontal structural member (V zones only) _~Lfs._ _ ft (m) ~ ~ .L........-'_M"'~~~ ' o d) Attached garage (top of slab) SIC:> J__ft(.Bit) ~g em o e) Lowest elevation of machinery and/or eqUipment ~ ; JwJt~ v\-. servlcmg the bUlldmg (DeSCribe m a Comments area) 51 ~ _f:_ ft (<<I) ~ ~ 'f'~-~-~.;;"""":.r""'- ' ._..~ o f) Lowest adjacent (finished) grade (LAG) ~(~ _~_ ft (Ill) ~ 0 ~ ~,,~~'~ . o g) Highest adjacent (finished) grade (HAG) -::> \":? _~ ft (91) ~ ~ JONAHMN 1\. OAKES .~ o h) No of permanent openings (flood vents) Within 1 ft above adjacent grade \ b .3 ~._ l1:~ ~ 9 I) Tot?1 area of all permanent openings (flood vents) In C3 h "2-31'1 sq In ~ DE-:1... :',{ 2CQ'L- SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION' ThiS certification IS to be Signed and sealed by a land surveyor, engmeer, or architect authOrized by law to certify elevation information I certify that the mformatlon m SectIOns A, B, and C on thIS certIficate represents my best efforts to mterpret the data avaIlable I understand that any false statement may be pUnishable by fme or Impnsonment under 18 U S Code, SectIOn 1001 Ll::K I,IrIER'S(...NAMEA 0 k LICENSE NUMBERL S #2105 tJonatllan . a es uregon ,. TITLE COMEANY NAME ProfeSSlonal Land Surveyor poage tnglneerlng & SurveYlnq. Inc. ADDRESS CITY STATE ZIP CODE P,Q, Box 2527 . Euqene OR 97402 SIGNATU~~1.Cu.-. ~ C k l DATE TELEP~4f/485_4505 FFMAFnrmR1-~1 1111 00 ~FF RF\lFR~F ~lnF F()R r()NTINIIATI()N RFPI ArF~ AI I PRF\lI()II~ FnlTl()N~ IMPORTANT In these spaces, copy the correspondrng rnformatlon from Section A BUILDING STREET ADDRESS (Including Apt , Unit, SUite, and/or Bldg No) OR PO ROUTE AND BOX NO 6716 Moses Pass For Insurance Company Use Policy Number CITY STATE ZIP CODE Company NAIC Number Sprlngfleld OR 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 CIT'i crF 5>Pl2..-t l-l.{,-F'-l ~ h~l:-\ ~\AAv2.X- i)e:.~c C-t -6>E- ~ A":? A C..-'rI.'7uE---D CJ;oUM L ['j...l, n-t-E- -m0 ~ \rtE ~ A-r ~_ Ml(){)OlW-I Cf- --rrt"t. 0lX2h l2.C--t\.t<2-1-.l (j I"m:- -;;,\i......J c.....J12.+.LE...12- 0F ~ If-....l~-'';,f:L:noU or (PiTtt 4:- \lt1JYv,,;IO'r--l- ~ c..-(T'~( Dh\JM '5\""2- 'e:>\ Fe VI.A \J~ "51~ \ €.-l-t.\.lA-\IOl--tC;, ..,rtoV'I-l ~E. ~f:wc..OM\..(cl2"1f~ lD FE M,-A. DA-\1JAA '-_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 BUilding 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 (Including basement or enclosure) of the bUilding IS 1_-'_1 ft (m) 1_1_lln (cm) 1_-' above or 1__1 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_-'_-'In (cm) above the highest adjacent grade Complete Items C3 hand C3 I on front of form E4 For Zone AO only If no flood depth number IS available, IS the top of the bottom floor elevated In accordance With the community's floodplain manaqement ordinance? L_I Yes I~I No L_I Unknown The local offiCial must certify thiS information 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 CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE 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 Item(s) and sign below G1 I_I The Information tn Section C was taken from other documentation that has been Signed and embossed by a licensed surveyor, - enlillneer, or architect who IS authOrized 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 communitY-Issued BFE) or Zone AO~ G3 I_I The follOWing Information (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 c ' ISSUED G7 ThiS perrfHt has been Issued for '--' New Construction 1_-' Substantial Improvement G8 Elevation of as-bUilt lowest floor (including basement) of the bUilding IS G9 "BFE or (In Zone AO) depth of flooding at the bUilding site IS LOCAL OFFJC.lAL'S NAME __ ft (m) Datum __ ft (m) Datum TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS ~__I Check here If attachments FFMA Fnrm R1- ':\1 1111 nn RFPI ArFC:: AI I PRF\lIOIIC:: FnITIONC::