HomeMy WebLinkAboutFEMA Application 1999-6-2
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BUILDING STREET ADDRESS (InCluding Apt UOIt, SUIt , and/~r Sidg No) OR P 0 ROUTE AND BOX NO
(073 q Mn.:;es ?a5S
CITY S or\ V\VJ -F e ld.. STATE()f<..
PROPE;RTY DESCRIPTION (tOt and Slock Numoers, Tax Parcel N:Jmoer Legal Descnptlon, etc.)
Lot 8& LeVl Lav1/h~t, 2V\.Jl A-d(j\-h~ TA)C~ /7-0'2-3Lf-l\
BuiLDING "USE (e g , ResIdential, Non-reslde~i, Addition, Accessory, ete Use Comments on d necessary )
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LA TITUDElLONGITUDE (OPTIONAL)
( ##0 - ##' - ## ##" or ## ####4f)
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FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
BUILDING OWNER S NAME
Important. Read the instructIons on pages 1 _ 7.
SECTION A - PROPERTY OWNER INFORMATION
,-
HORIZONTAL uP. j UM
U NAO 1927 U NAD 1983
o M 8 No 3067-0077
Expires July 31,2002
I For Insurance Company Use
I Policy Numoer
Company NAIC Number
lIP CODE
C?7477
'?6......-t-1 dl-\. uF
,I&\.>:: Lo1 2000
,
SOURCE. U GPS (lype)
U USGS Quad Map U Other _
SECTION B - FLOOD INSURANCE RA IE MAP (FIRM) INFORMATION
81 NFIP COMMUNITY NAME & COMMUNITY NUMBER 82 CaUNTt ~E J. B3 STATE() .0
C,t. 0 'S ,~ d 41!55 Z. LaYle LoUlf\-~ 1"""'-.
84 MAP AND PANEL 85 SUFFIX 86 FIRM INDEX 87 FIRM PANEL 88 FLOOu
NUM8ER DATE EFFECTIVE!REVISEDDATE z...O~E(S)
LfI0'=3Q(.1 ~ r :SUV/~ '2)/1Q1 ~Vle Zl ~qq1' ^
B10. Indicate the source of the Base Flood BevatJon (BFE) data or base flood depth entered m B9
U FIS Profile ~ FIRM U Communrty Determined U Other (Descnbe)
B11 Indicate the elevation datum used for the BFE In B9 Pd NGVD 1929 U NA YO 1988 U Other (Descnbe)
B12 Is the bUilding located In a Coastal Barner Resources System (CBRS) area or OthelWl5e Protected Area (OPA)? U Yes ;KJ No
DeSignation Date
89 8ASE FLOOD ElEVATlON(S)
(Zone AO!, use depth of flooding)
NlMe -my Z~ X
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Budding elevatIons are based on UConstructlon DraWings. ulldmg Under Constructlon* UFimshed Construction
. A new Elevation Certificate will be reqUIred when construction of the bulldmg IS complete _
C2 BUilding Diagram Number E- (Select the budding diagram most Similar to the buddmg for wtuch thIS certificate IS being comoleted _ see
pages 6 and 7 If no diagram accurately represents the budding, proVIde a sketch or photograph)
C3 Elevations -Zones A1-A30, AE, AH, A (With BFE), VE, V1-V30, V (WIth 8FE), AR, ARiA, ARlAE, ARJA1-A30, ARJAH, ARJAO
Complete Items C3a-1 below accordmg to the bUilding diagram speCltied In Item C2 State the datum Used If the datum IS OIrferem Trom
the datum used for the BFE m Section 8, convert the datum to that used for the 8FE. Show field measurements and datum conversIon
calculation Use the space prOVided or the Comments area of Section 0 or Section G, as aporopnate, to document the datum conversion
Datum }Jb)Lo' L 4. Conversion/Comments
ElevatIOn reference mark used-j( ~ee.. ee:vev5 e.., Does the elevatIon rererence mark use!! aopear on the FIRM? U Yes l2:;j No
o a} Top of bottom floor Qncludlng basement or endosure} r:; I "3 2 ft ~ ~ J l
o b} Top of next higher floor z:; I (p 2..-ft ~ ~ / REGISTERED ;,
13- e) EeltsFl'l sf jgu'l;j€t Re~efltej "'~ .......wo! ITlcRlacr 0}'::OI,__ ::r:1::1 .Ai /--1- _ ft.(~ : ~ , PROFESSIONAL
o d) Attached garage (top of slab) 5" \ S 0 it (m) ~ ~ ~ND SURVEYOR
L w~
De) owest eleva'on of ","ohone" andlo, equ'pmenl . 1 ti // /../__(
servicing the building c:; I/.tz.... 0 IT (m) E;;; j/C Xi C(: ~
a f) Lowest adjacent grade (LAG) .5"' 3 ..!L ft.~ ~ ~ OREGON .~
513 Cd.:;:\I) JULY 20 1993
o g) Highest adjacent grade (HAG) ..Q fl(lll} a; REX A. ~t: I L-
a h) No or permanent opemngs (flood vents) wltnln 1 ft aoove aajacent grade 13 :l" Ii~ /
o I) Total area of all permanent openings (flood vents) In C3h \ 10 q '2- sq m (~ -.f:.>:,o I ye.5 I Z / 3/ /0:3 I
SECTION D - SURVEYOR, ENGINEER, OR ARC~T CERTIFICATION -
ThiS certificatIon IS to be SIgned and sealed by a land surveyor, engineer, or architect authonzed by law to certJfy elevation informatIon
I certIfy that the informatIOn In SectJons A. 8, and C on thIS certIficate represents my best efforts to mterpret the data avaIlable
I understand that any false statement may be pUnIshAble by fine or Impnsonment under 18 U S Code, SeclJon 1001
CERTIFIER S NAME +- LICENSE NUMBER
')G e\:?- FLs zroO(o
E COMPANY NAME'"D --;---,
- 5LZV-V€, MuV\.cu'JE"Y ~rU.V\Lli1 a.?Jl",e-eVI'V\~, -l-VtC~
ADDRESS 3\0 hffi 'S+r-~ CITY?tJr\V\'1:J,dd "'ATE OJQ.~ ZIPCOOEq7471
SIGNATURE /f4.-;t:J /:Ii:. /d< ~ _ DATf,{'av dI"u" ZOOE'HDNEf<;'f I) 7 Lf(P- {){;, "37
FEMA Form 81-31, AUG 99 SEE REVERSE SIDE FOR CO'iTINUATION REPLACES ALL PREVIOUS EDITIONS
For Insurance Company Use
pohC'J Number
IMPORT ANT In these spaces, copy the corresponding InfonnatIon from SectIon A.
BUILDING. STREET ADDf}E;3S (Including AptAnlt SUite and/or Bldg No) OR P 0 ROUTE AND BOX NO
~7~~ ~~~~S ~6S .
CITY S . (_D STATE ..0 q Zll' CODE
Py ~'51l e\ lA Or\, - ;Lf7t
Company NAIC Number
SECTION 0 _ SURVEYOR, ENGINEER, OR ARCHITECT CERTlFICATlON (CONTINUED)
Copy both sides of this Elevation Certificate for (1) commumty officIal, (2) Insurance agent/company, and (3) bUlldmg owner
~~'fflJ of. ~r'V)7f1-dd h'-e"",h Wl.{'i/;- reI '^j .q ck,sele,{ "1w:,y<- 0_"t h... -1\e W
.rCd~ cJ Cuy-h '"',+ -tilE.. Il\1ldP()IVd o:Li.:c/\..-.b y~j~,rV\ of fu <;'fJU~~~t r,OYi'1€r
o.t rn l~ if- T\......uvs\ov-.. ~~\l VV\(A 4~ e levtdl t'Y\ c;:j 5' 2 B I (\~ DutuW\. ~II\ d
C1cLIAc.,W.fn el~\{u+LVlA 51-311l ,U0VD\~~ u)tCs. uc;ed ~s f4e ~S \"S
{.A fJ 5"" \ -e. '" a-h ut.1.. <; -sVt~ WV1 h. eye 0Vl U 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 8FE), complete Items E1 through E3 Jf the Bevabon CertIficate IS Intended for use as supportmg
mfonnatJon for a LOMA or LOMR-F, Sec1Jon C must be completed.
E1 8uddlng Diagram Number (Select the building oJagram most S'rT',lar to \tie budding for whIch this certdicate IS betng completed-
see pages 6 and 7 If no diagram accUrately represents the buddmg, provIde a sketch or photograph.)
E2. The top of the bottom floor Oncludlng basement or enclosure) of the budding IS I I I ft.(m) I I 1m (an) U above or U below
(check one) the highest adjacent grade
E3 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? LI Yes I I No l-' Unknown The localoffioal must certJfyttus I.t.........l.on Dl Section G
SECTION F _ PROPERTY OWNER' (OR OWNER'S REPRESENTATIVE) CERT1ACATlON
The property owner or owner's authonzed representatIVe who completes Sections A, 8, and E for Zone A (WIthout a FEMA-lssued or
commumty-Issued 8FE) or Zone AO must SIgn here
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAM!::
(;(..;
~IAl-E
ZIP CODE
ADORESS
DAlt:
T8.EPHONE
SIGNATURE
COMMENTS
LJ Check here If attachments
SECTlONG_COMMUNITYINFORMATlON(OFTIONAW
The local offiCIal who IS authonzed by law or ordinance to adnuOlster the commumty's floodplain management ordinance can complete
Sections A, B, C (or E), and G of thiS Elevation Certrlicate Complete the appltcable rtem(s) and sign below
G 1 U The Information In Section C was taken from other documentation that has been sIgned and embossed by a Itcensed surveyor,
engmeer, or architect who IS authonzed by state or local law to certify elevatJon information (IndIcate the source and date of the
elevation data In the Comments area below I
G2 U A commumty offiCial completed Section E for a budding located In Zone A (WIthout a FEMA-Issued or commumty-lssued BFE) or
Zone AO
G3 U The follOWing information (Items G4-G9) IS provided for community floodplam management purposes
G4 PERMIT NUMBER G5 -DATE PERMIT ISSUED G6 UA-r~ l;~ffnFICATE OF COMPLIANCE/OCCUPANCY
ISSUED
G7 ThiS permit has been Issued for U New Constructlon U SubstantJallmprovement
G8 Elevation of as-bUIlt lowest floor (mdudmg basement) of the bulldmg IS
G9 BFE or (10 Zone AO) depth of floodmg at the bUlldtng SIte IS
LOCAL Ot=t=ii:IAL'S NAME TITLE
_ ft.(m) Datum .
_ft (m)Datum
TELEPHONE
DATE
COMMui-li I ( NAME
SIGNA1\jK~
COMM~NTS
1-' Check here If attachments
REPLACES ALL PREVIOUS EDITIONS
FEMA Form 81-31, AUG 99