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Home My WebLink AboutFEMA Application 1999-6-2 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM OM 8 No 3067-0077 Expires July 31, 2002 ELEVATION CERTIFICATE Important Read the instructions on paf\les 1 - 7 SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use Policy Number BUILDING OWNER S NAME . l)ruce.ljrrechert Custom H6-mes BUILDING STREET ADDRESS (Including Apt, Unit, SUite, and/or Bldg No) OR P 0 ROUTE AND BOX NO 6749 Moses PelSS CITY STATE Sprlngfleld OR PROPERTY DESCRIPTION (Lot and Block Numbers Tax Parcel Number, Legal Description etc) l4>T ~ ]fYl lelr)dplO 2rd Addltlor Fll"e 75. Shelps 115?-1151) BUILDING USE (e g , ReSidential, Non-resldentlal.1>.ddltlon, Accessory, etc Use a Comments area, If necessary ) ReSldentlal LA TITUDElLONGITUDE (OPTIONAL) ( ##0 _ ##' _ ## ##" or ## #####") I Company NAIC Number ZIP CODE 97478 I rlnp rO"u..O.:t.y Pl rlt Records HORIZONTAL DATUM I_I NAD 1927 U NAD 1983 SOURCE I_I GPS (Type) I_I USGS Quad Map LI Other SECTION B. FLOOD INSURANCE RATE MAP (FIRM) INFORMATION I B1 NFIP COMMUNITY NAME & COMMUNITY NUMBER I B2 COUNTY NAME I B3 STATE SrrlnQflplrl dl~~q? Lane nrQnnn B4 MAP AND PANEL 85 SUFFIX B6 FIRM INDEX B7 FIRM PANEL B8 FLOOD B9 BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO use depth of flooding) 41039C1l66 F 6/2/99 6/2/99 X 51 '2,3 B10 Indicate the source of the Base Flood Elevation (8FE) data or base flood depth entered In 89 L-I FIS Profile L-I FIRM I~I Community Determined I_I Other (DeSCribe) 811 Indicate the elevation datum used for the BFE In 89 12LI NGVD 1929 I-I NA VD 1988 I_I Other (DeSCribe) B12 Is the bUilding located In a Coastal Barner Resources System (CBRS) area or Otherwise Protected Area (OPA)? I-I Yes I~ No DeSignation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1 BUilding elevations are based on 1__IConstructlon DraWings" 1_IBUlldlqg Under Construction" l::bIFmlshed Construction "A new Elevation Certificate Will be required when construction of the bUilding IS complete C2 BUilding Diagram Number 7... (Select the bUilding diagram most Similar to the bUlldmg 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, ARlAE, ARlA1-A30, ARlAH, ARlAO 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 l~ Conversion/Comments ~~ ()? 'TO LOLA-\..- DA=r\.JlIl-\ \"0 \'2.-e:A<,,-+-\.."":....% ,..~~ p~!~ _ Elevation reference mark used ?Ek- C.oMM.~T? Does the elevation reference mark used appe~n,":,~h,;,.~!'BJ0!~Jr:i'tl~~.lO~J o a) Top of bottom floor (including basement or enclosure) S\~ S ft (~(ij 'I.. fr... d.,,~ ;;. 1;;.......""'.. ~"'~;...... o b) Top of next higher floor - "5 \ l.c _~ ft (m) ~ I L.$%.~'lIi toO fHJ~"-EY~:H~ o c) Bottom of lowest hOrizontal structural member (V zones only) ~~ - - ft (m) ~ ~ --' "'-'~~'~m" o d) Attached garage (top of slab) '3 I '-:l sL ft (tlil) E 2! \A.. Ii l o e) Lowest elevation of machinery and/or equipment ~ : ----..E"OO'~\.l.l."'- 6: ' servicing the bUlldmg (DeSCribe In a Comments area) SI4- _?- ft (m) ~ i i' ~ 'of.;~~) ;1' o f) Lowest adjacent (finished) grade (LAG) '314 _L ft (m) :i S!' ~ .lJ!. \, ~.z, jsg..~ o g) Highest adjacent (finished) grade (HAG) SIS _Lft(m) ~ en ~ JONATHAN A OAKES . o h) No of permanent openings (flood vents) Within 1 ft above adjacent grade lea ~ ,,---~~__tli.f.l. ./ o I)Totalareaofallpermanentopenmgs(f100dvents)lnC3h Z\\S sq In (sq cm) ~....DE:G ~l zmv 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 information I certify that the mformatlOn I~ 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 orlmpnsonment under 18 U S Code, SectIon 1001 CERTIFI6R'S NAME 0 k LICENSE NUMBEFi JOna1:nan A. a es Uregon L,S, #2105 rilLE COMPAt::JY NAME profeSSlonal Land Surveyor Poage tnqlneerlnq & SurVeVlnq. Inc. ADDRESS CITY STATE ZIP CODE P.O. Box 2527 1 r<'tf1 Euaene .oR q74n? SIGNATURE,-.At~1+ ~ DAtE TELEPHO~1/485_4505 I=I=MA I=nrm R1. ':\1 1111 nn e::1=1= RF\lFRe::F e::lnF I=OR rONTINllATION RFPI ArFe:: AI I PRF\lIOI Ie:: FnITlONe:: IMPORTANT In these spaces, copy the correspondmg mformatlon from Section A BUILDING STREET ADDRESS (Including Apt, Unit, SUite, and/or Bldg No) OR PO ROUTE AND BOX NO 6749 Moses Pass 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-- _ _ _ _ _ A C-l I: 'I (JF- 0Pt?.-tl-J.L:tHe-d~ :&E:M(...nM~L t>C"-..7c-a.Ap.;>~ ~r? A C-~t'7tt.%:t> =X:rLJ~ \-k\. -,dL \OP ~"iltc- u...NIP;;> -N1 "ThtE-. t\I.tDPOt'f-lT (JP- ~ ul'af:> r2-C-l\..m-W. ~ li~'7\U C()Q.i\-l.bv2.- O{:- ~ 14Tta-'7EL<:1.~ (y- (cnm 4- ~"TO"-.l, ~. (...1,\( bA-J-UM Sl2 ~\ F-e wl.Ar- D-A-Ilh1r' -Sl~ , :evt\lA-1l01-J-S :7rru\.Uu ~E. ~l-..l C(j/..J\.lc.a ~ \0 ~-E M.;.. DfctlrW\ '-_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 E 1 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_-'_11n (cm) L-' above or L-' 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) 1_1_=-11n (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 management ordinance? L_I Yes I_I No 1__1 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 commumtY-lssued BFE) or Zone AO must sign here The statements In Sections A, e, C, and E are correct to the best of my knowledge PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME For Insurance Company Use Policy Number ADDRESS CITY STATE ZIP CODE SIGNATURE COMMENTS DATE TELEPHONE I_l 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, 1...:::...1 The information In Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, ,- , enSlneer, or architect who IS authorized by state or local law to certify elevation information (Indicate the source and date of the i -, ~evatlon data In the Comments area below) G2 I_I A community offiplal completed Section E for a bUilding located In Zone A (Without a FEMA-Issued or communitY-Issued BFE) or Zone AO G3 1_-' The follOWing information (Items G4-G9) IS proVided for community floodplain management purposes tG4 PERMIT NUMBER I G5 DATE PERMIT ISSUED I G6 DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY , ISSUED , . 87 ThiS permit has been Issued for 1_-' New Construction 1_-1 Substantial Improvement <38_ ~Jev~tlon~~f as-bUilt lowest floor (mcludlng basement) of the bUilding IS G9 BFE or (In Zone AO) depth of flooding at the bUilding site IS LOCAL OFFICIAL'S NAME ___ ft (m)Datum ___ ft (m)Datum TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS I__~ Check here If attachments FFMAFnrmR1-~11l1l()() RFPI ArF~ AI I PRF\lI()II~ FnITI()N~