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Home My WebLink AboutFEMA Application 1999-6-2 v FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM OM B No 3067-0077 Expires July 31, 2002 ELEVATION CERTIFICATE 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 BUILDING STREET ADDRESS (Including Apt , Unit, SUite, and/or Bldg No) OR P 0 ROUTE AND BOX NO h7C:;C:; M"e"e D:>C'C' CITY - - ---- - -'-- STATE Sprlnqfle1d OR PROP~RTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc) loT?'e> LeVl Landlna 2n..d.J\dQltlo.n. Fllp IS- SlHipc: 1111?_111)1) BUILDING USE (e g , Resldenllal, Non-resldenllal, Addlllon, Accessory, etc Use a Comments area, If necessary 1 Res 1 dentJ a 1 LATITUDE/LONGITUDE (OPTIONAL) ( #If' - ##' - ## t#f' or ## #####0) I Company NAIC Number ZIP CODE 97478 Lane Cc~~~y D11t Records HORIZONTAL DATUM LI NAD 1927 LI NAD 1983 SOURCE LI GPS (Type) LI USGS Quad Map 1-1 Other SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION I B1 NFIP COMMUNITY NAME & COMMUNITY NUMBER I B2 COUNTY NAME I B3 STATE Sorlnafle1d 415SQ? I ~np Orpgon B4 MAP AND PANEL B5 SUFFIX B6 FIRM INDEX B7 FIRM PANEL B8 FLOOD B9 BASE FLOOD ELEVATION(S) NUMBER ( .1 DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding) 410 39 C 116 6 - F fd 2 / Q Q F. I? / q q 'I ? \2 - (p B 1 0 Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered In B9 I_I FIS Profile !--I FIRM I~I Community Determined I_lather (Descnbe) B 11 Indicate the elevation datum used for the BFE In B9 I~I NGVD 1929 !--I NA VD 1988 I_lather (Descnbe) B12 Is the bUilding located In a Coastal Barner Resources System (CBRS) area or Otherwise Protected Area (OPA)? I_I Yes 1)s.1 No DeSignation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1 BUilding elevations are based on !--IConstructlon DraWings> 1_IBUlldlng Under Construction> 'plnlshed Construction >A new Elevation Certificate will be reqUired when construction of the bUilding IS complete C2 BUilding Diagram Number Z. (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, ARiAO 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 appropnate, to document the datum conversion Datum LoLA-<- Conversion/Comments _A b DO.? 'TO LlJC.At.., h k'rV ilA \0 e..E..k u ,;; ~ ~A _ ~Al"cI ~ Elevation reference mark used c:? a CD WlM€l-J.T~ Does the elevation reference mark used appeGn the~lr<;M? 1-=-1 x.e~ }~I o a) Top of bottom floor (Including basement or enclosure) sl ~ l ft (m) ~ . W.i"' - ~. ~. '- o b) Top of next higher floor CS \ <0 .s.. ft (rG) ~, ..J f.t G.l Q) ...""~, o c) Bottom of lowest hOrizontal structural member (V zones only) 1-41 A - ft (m) ~ ~ A at o d) Attached garage (top of slab) S \"3 5_ ft (m) ~ -g \h ~ J _ o e) Lowest elevation of machinery and/or equipment ~ -:- --AlfI/JJ ~ servicing the building (Descnbe In a Comments area) 5l S -~- ft (.Bt) ~ ~ G'~' . ,-.. I] o f) Lowest adjacent (finished) grade (LAG) "5l 4 ~_ ft fel) i ~ . ;l" "'...; o g) Highest adjacent (finished) grade (HAG) S I S _~ ft ~ ~ JONI'\ i ftlt:~,A. Ot'\KES ' o h) No of permanent openings (flood vents) Within 1 ft above adjacent grade I \P ~ ~~~.l:"'~ _J o I) Total area of all permanent openings (flood vents) In C3 h 2..\ 0\ sq In (...; _ u) ~: ~, '3t ZO:rz., SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION ThiS certification IS to be Signed and sealed by a land surveyor, engineer, or architect authonzed by law to certify elevation information I certify that the information In Sections A, e, and C on thiS certificate represents my best efforts to Interpret the data available I understand that any false statement may be pUnishable by fine orlmpnsonment under 18 U S Code, SectIOn 1001 CERTifiER'S ~AME A 0 k LICENSE NUMBER JOnatllan . a es Oreqon L.S. #2105 r1TLE COMPANY NAME ProfesSlona1 Land Surveyor PQa~e Enalneerlna ADDRESS CITY- - - SIGNl~;Jt~:A-~W~ ~~~t~n~~~07.J &. :;JtfVPYlng_ STArE - n.o Tl::LEPHONE 54J/4RI1_Lll)nl) J[1r ZIP CODE Q7Lln? FFMA Fnrm R1_~1 1111 nn ~FF RF\/FR~F ~lnF FOR rONTINllATION RFPI ArF~ AI I PRF\/IOII~ FnITION~ ~ IMPORTANT In these spaces, copy the corresponding information from Section A BUILDING STREET ADDRESS (Including Apt, Unit SUite, and/or Bldg No) ORIP 0 ROUTE AND BOX NO 6755 Moses Pass , CITY STATE ZIP CODE Company NAIC Number Sprlngfleld OR I 97478 SECTION D - SURVEYOR, ENGINEER, OR A~CHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2~ Insurance agent/company, and (3) bUilding owner COMMENChy of Spnngfleld benchmark descnbed las a chlseled SQuare In thp tllr of thp curb~at the mldoolnt of the curb V'f'turn I?t thp ,Ollthwp,t rorl1pr of' tho lntQrS@ctlon of fi7th ;:Inri Thllrdnn Rn'lrl r,tr___r1'ltt.\1l1 S!1.2..,..a.!. F.~.M,/\, 3att:.'\I 513,1 Elevatlons shown have been converted to F.E,M,A, datum. ~__ICheckherelfattachments 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_1 ft (m) 1_1_lln (cm) I_I above or I_I 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 j-J-I ft (m) 1__I--I1n (cm) above the highest adjacent grade Complete Items C3 hand C3 Ion 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? I_I Yes I_I No '-_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, S, C, and E are correct to the best of my knowledqe PROPERTY OWNER'S OR OWNERS AUTHORIZED REPRESENTATIVE'S NAME For Insurance Company Use Policy Number "' I ADu~t="S CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS '-_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 In Section C,ltVas taken from other documentation 'that has been signed and embossed by a licensed surveyor, engineer, or architect who IS authOrized by state or local law to certify elevation information (Indicate the source and date of the ~.. I .J \. , 'elevation data In the Comments area below) G2 I~l 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 1--1 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 ~ " ISSUED G7 T-rIS ~eD'nljt has been Issued for (1_1 New Construction I_I Substantial Improvement G8 Eley"atlo,"! ,of a;?-b_u.!lllowes!.~qQr, (including basement) of the bUilding IS G9 BFE or (In Zone AO) depth of flooding at the bUilding site IS .> 't 'F' "\ LOCAL OFFICIAL'S NAME . ___ ft (m) Datum __ ft (m) Datum TITLE COMMUNITY NAME , TELEPHONE SIGNATURE , DATE COMMENTS '-_I Check here If attachments ~~MA~nrmR1_~1 1111 00 Ri=PI Ari=C:: AI I PRi=\lI()IIC:: i=nlTl()l\IC::