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Home My WebLink AboutFEMA Application 1999-6-2 Q~-078 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE o M 8 No 3067-0077 Expires July 31,2002 Important Read the instructIons on pages 1 _ 7. SECTION A - PROPERTY OWNER INFORMATION SUILDING OWNER S NAME a , (:.n;.L"71<9/1 13 r" e-t- G (/ /fvJ.s U;) L7L ld f;i SUILDING STREET ADDRESS (Indudmg Apt, Unit. SUite, and/or Sldg No) OR P 0 ROUTE AND 80X NO (" 7 2 I .AJ 11 ~~ s -:j:)asS CITY STATE ~ ("lv.? -h e ld L; PROPER qESCRI ION (Lot and Slock Numbers Tax Parcel Numcer, L~al Desa1ptJon, etc.) 1....0135 Le.VI LC<:v,d\I-1' 21<\', -n?1A.. {wUt:; 17-D2-34-1/ SUILDING USE (e 9 , Resldenval, Non.resldennal, drtJon, Accessory, etc. Use Comments S " necessary ) s , de V) 1\ a , LATITUD LONGITUDE (OPTIONAL) HORIZONTAL DATUM SOURCE. U G?S (Type) ( ##0 - ##' - ## ##" or ## #####') U NAD 1927 U NAD 1983 U USGS QUad Map U Other For Insurance Company Use Policy Numcer I I Company NAIC Number ZIP COOn 77l.f77 0., fTv\XLot 200Q SECTION B - FLOOD INSURANCE RATE MAP (ARM) INFORMATION - 81 NFIP COM~. UNITY NAME & COMMUNITY NUM8ER - 82 COUNTY NAMEC + . B3 S I,., II: 1f::J \, 'L+y at SO'f~ e.\cf IfISSq 2- Lt< e Of...<.v-. 0 "'- . .. ~ 84 MAP ANO PANEL 85 SUFFIX 86 FIRM INOEX 87 FIRM PANEL sa FLuCLi 89. BASE FLOOD ELEVATlON(S) NUMBER DATE er.."CTlVEiREVISEo DATE ~) (Z""e AOrl"" depth" _gl Lj I D 30 CJ Ie. (,. F .J"'~ e f, 11"11 J4~" f, 1')1'1 L NOVIe +ov ~ X 810 f ndlcate the Source of the 8ase Flood Elevation C8FE) data or base flood depth e, .~""...J In 89 U FIS Profile ~FIRM U CommuOIty Detennrned U Other CDesa1be). 811 IndIcate the elevation datum used for the 8FE In 89 i)4NGVD 1929 U NAVD 1988 U Other (Descnbe) B 12 Is the bwld,ng located ,n a Coastal Same, R.,ources System (CBRS) ama 0' 0_ ProtecIed A<ea (OPA)? U y., )6-No DeSIgnatIon Date SECTION C - BUILDING ELEVATION INFORMA nON (SURVEY REQUIRED) Bulldmg elevatIons are based on UConstructlon DraWIngs'" ildlOg UnderConstTUctlon'" UFimshed Construction '"A new Elevation CertIficate will be requIred when construction of the building IS complete. C2 8U1ldlng Diagram Number ?3 (Select the bulidmg dIagram most Similar to the building for whIch thIS certificate IS bemg completed _ see pages 6 and 7 If no diagram accurately represents the bUlldmg, prOVide a sketch or photograph) C3 Elevations - Zones A 1-A30, AE, AH, A (WIth BFE), VE, V1-V30, V (WIth BFE), AR, ARiA, ARiAE. ARiA 1-A30, ARiAH, ARiAO Complete Items C3a-1 below accordmg to the bUIldmg dIagram specmed m Item C2. Slate the datum used If the datum IS different from the datum used for the 8FE In SectIon 8, convert the datum to that used for the BFE. Show field measurements and datum conversion calculatIon \-Ise the space prOVided or the Comments area of Section D or SectJon G, as aopropnate, to document the datum conversIon Datum ~c, \/ 0 ( 'lq ConversIon/Comments E10/-'bon cefe'enca mack used jI: ;; ee.A< cole c S L Ooes the eJeva"on ,","",nee"",ck ""," ap"e;'''''' the FIRM? U y" IbNo" II4" Jl) Top of bottom floor (mdudmg basement or endosure) c::; / '3 . 2 It~ ~ " I ~b)Topofnexthlgherflcor 5/0 -L1t( ~ ( REGI~lcRED " ~",... 'Lln","<, '.",0""'1 '""""''''''',m,,, 0'ZQc< ~,"" "' ( i ~ .. PROFESSIONA. L Ef d) Attached garage (top of slab) ..-C; J 4 1Z It( -g -g LANJl SURveyOR o e) Lo"'es, elevabon of "",ch,ne'}' andlce equ,pmenl ~ ; ~ c:;: A.-{ servlc:ng the bUIlding !5/(P '3 ft (n) ';!.2 . . .. - =~ l OREGON o f) Lowest adjacent grade (LAG) .5 I ':3_ ~J( ) ~ ~ JULY 20, 1993 o g) Highest adjacent grade (HAG) 5 /4- E..... it ) ~ REX A 8ETZ o h)_No of permanent openings (flOOd vents) wlrhm 1 ft aoo'le aQlaCe~ graae I I. ~ ~OR / o ,) I otal acea of all pennanent ope",ngs (flood ",",sl on C2h q "- 't sq '" (S) L ,I, E y I' I 2-~ 3, /"'3 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION ~ ' ThIS certification IS to be SIgned and sealed by a land surveyor, engrneer, or archItect authonzed by law to certIfy elevation rnformatIon I certify that the mrormatIOn In SectJons A, 8, and C on thiS certJficate represents my best efforts to Interpret the data available I understand that any false statement may be pUnishable by fine or Impnsonment unde."-.!? l!_S Code, Section 1001 ""-qTIFIER S NAME T) -u -l LlLcN~t: NUM8EQ -'T') ,N / - e.X Ve..\z.-.- I LS C\OOV" ....E 0 l COMPANY NAME B \ r, -;--, ~J\...-tYVc ICH"\tl Gy (0,\t)(.~, t:;;Vj'iIYleerlV\S~ ~I1C ADDRESS ::s 10 fer to, S:--lv.eG errS",,,",, -helJ STATE oR-. ZIP<;OO"'17477 SIGNATURE f ~ DATE ,-i I I C; 2oai1:"'EPHONE S;<il 74-0 _ 0&3>7 =MA Form 81-31, AUG 99 SEE R!:VERSE SIDE FOR CONTINUATION Den. A~__ IMPORT ANT In these spaces, copy the corresponding tnformatlon from Section A. BUILDING STREET ADDRESS (Including Apt Umt, SUite, and/or Bldg No) OR P 0 ROUTE AND BOX NO G~ 72 I .\Aose S 'IJ.ct s;s - CITY C (' I 0 - STATE fl /) ZIP CODE \ Company NAIC Number --'" P" YV-.. ') T' e- \ ~\ 0 /'.... ~I 7477 For Insurance Company Use Policy Number 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) budding owner COMMENiS J- r . I,. ,- ' ( . I L. ':Ie C \ "D~' :; OJ" ""'Y ;, \ d B e ~ <-\" """',-I'- V" I V\:' "i clt I <; C ~a ~ 'j '-' ~ or e.. " IA L' ~- fI,~. io,o ~,re a rw-L" at 'M id pQ' ,,-T ",p c u ,:L> ,.-e tL< ''J./oJ fkz ~ o~ -\k v<)?$ r (' "mef oJ J h 7+h !t -n\ \A' ,;t ""~ l"tl V ,;..., 5 a V\ ",Ie v" fz ":'" "" 5 (2 - \') \ C 01'-7 1) ".t '-' "" ~"'" J . cvJJ~.2Je d. -Iv ~ \ ........ t<. -\i'""" 61 3 ,lLlJ G V 0 7'1 IJ )4 S '^ s.eJ '" S it\.<... ~s of- '21 &V '" +i v"S SkD'^"'" \., "'".. e:U'h. U~here If attachments SECTION E _ BUILDING ELEVATION INFORMATION (SURVEY NOT REaUIRED) FOR ZONE AO and ZONE A (WITHOUT 8FE) For Zone AO and Zone A (WIthout 8FE), complete Items E1 through E3. If the ElevatJon CertIficate IS mtended for use as supporong mformatJon for a LOMA or LOMR-F, Section C must be compleled. E 1 8uddlng DIagram Number (Select the builolO9 atagranl most SImilar to the building for whICh this certriicate 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 Qncludlng basement or enclosure) of the budding IS I I I ft.(m} , I lin.(an) U above or - U below (check one) the highest adjacent grade. E3 For Zone AO only If no flood depth number IS avadable. IS the top of the bottom floor elevated In a.......,Jc...ce WIth the community's floodplain management ordinance? I I Yes I J No' I J Unknown. The local official must certJfythis informabOn In Secbon G SECTION F _ PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTtACAT10N The property owner or owner's authonzed representatIVe who completes Sections A, 8, and E for Zone A (WIthout a FEMA-iSSued or commumty-Issued BFE) or Zone AO must Sign here ' . ,1,.,:"'1.P-<3 BreI Fl)AA'; G u .tar (' .. 0"d4. .0-'''''''.5 PROPER OWNER'S OR OWNER'S AunfORJlED REPRESI:I'UAIlIIE S NAM~ l /~ O? t::J 7 -~- ??~~ x ,:;L < ~.A-r' Li.. l..:l.L.~ P n(\, a If) 'ell- ':) f'l--Y\ T fl':t1tl, I<~ -( 1-:;"2 ADDRESS C. r ! cITY ) STATE ZIP CODE IA'((}: / (h ~L S' if '?-::~l/) ;;:r--. 7 tip c;,J{(J l' SIGNA E ! DA TELEPHONE COMM~N I ~ U Check here If attachments SECTION G _ CoMMUNITY INFORMATION (OPTIONAL) The local officIal who IS authonzed by law or ordinance to ;dlTl1mster the commumty's floodplain management ordtnance can complete SectIons A, B, C (or E), and G of thiS Elevation Certriicate Complete the applicable rtem(s) and SIgn below G 1 U The mformatlon 10 Section C was taken from other documentation that has been SIgned and embossed by a licensed surveyor, eng'neer, or .r<:hrtect who IS .u1hoozed by stale or [oCaI1aW 10 certtfY el....on mio...~'un. (In"-'" somce and - of the elevation data In the Comments area below) G2 U A community offiaal completed SedlOO E for. buddmg lceated ,n Zone A (wrthout a fEW,4ssued or communrty-lSSued BFE) "' Zone AO G3 U The follOWing InformatIon (Items G4-G9) IS proVided for community floodolaln management purposes \ G4 PERMiT NUMBER G5 DATE PERMIT ISSUED \ Go DATE CERTlF1CA I E OF COMPLIANCE/OCCUPANCY ISSUED G7 ThiS permit has been Issued for U New ConstrUc'Jon U Substantlallmorovement G8 Elevation of as-bUilt lowest floor Ondudlng basement) of the bUilding IS G9 BFE or (In Zone AO) depth of flooding at the bulldlOg site IS LOCAL OFi=ICiAL.:;) NAME _ ft.(m) Datum _fl(m) Datum COMMUNI I '( NAME -TJTLE - TELEPHONE uATE SIGNATURE COMMENTS - L.J Check here If attachments - - REPLACES ALL PREVIOUS cl>iTIONS