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Home My WebLink AboutFEMA Application 1999-6-2 02 - 078 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE OM B No 3067-0077 ExpIres July 31,2002 1m ortant: Read the instructions on a es 1 - 7 SECTION A - PROPERTY OWNER INFORMATION BUILDING OWNER'S ~.--.+-- , I S &ordoo f0r~ E~fTf) BUILDING STREET ADDRESS (Indutfmg Apt, Unit, SUJte, and/or B1dg No) OR P 0 ROUTE AND BOX NO (c~09( IrY'l.r. ~.p~ -rA-~S = ,\-r.; ~k (~r(' ll\lq~l ti.d 5rATE 6(.(, oftl tC ~~"""!o tf~ PROPEjUY D~:;;CRlPTION (Lot afld Block Numbers, TaxlParceI Number, Legal DesmptIon. etc.) J ---.LQT 5l.f: Le.vI ~a""&I"'~ Z'-t.;,;f A-J..J.l tr0""'- It\..y /.k.p 1/-02- 3Lf-1l . .P+11 TA.xLot 2000 BUILDING US~ (e 9 . Resid~tJaJ, Nop;e5IdehtJal, AddJbqn, ~,ete. Use a Comments area. If necessary) ; , fZ~t~ \ t1.o~ Il~ 0 - J.J'e-"-\J LATITUDElLONGITUDE (OPTIONAL) , HORlZOII(TAL DATUM SOURCE. LI GPS (Type) , ( #f/!' - ## - ## #If!' or ## #/###F) LI NAO 1927 LI NAn 1983 LI USGS Quad Map LI Other _ B1 NAP COMfwlUNIlY NAME l or '5 (1\.1 B4 MAP AND PANEL I 85 SUFFIX B6 ARM INDEX B7 FIRM PANE. 88 ~LooD NUMBER DATE crl"'cCTIVEIREVISED DATE ZONE(S) 4103QCIl0lP F =r~\i1t"2,lqqt[~w"21Iqq~ X . B 1 0 Indicate the source of }he 8ase Flood Bevatlon (BFE) data or base flood depth entered In 89 LI FIS Profile WIRM LI Community Determined L1 Other (Oescnbe) B 11 IndIcate the elevation datum used for the BFE In B9 iif-NGVD 1929 LI NA VD 1988 LI Other (Descnbe) B12 Is the budding located In a Coastal Barner ResourcesSystem (CBRS) area or Otherwise Protected Area (OPA)? DeSIgnation Date SECTION 8 - flOOD INSURANCE RATE MAP (FIRM) INFORMATION B3 STATE ot2.. B9 BASE FLOOD ELEVATION(S) (Zone AO,-use depth of flooding) k )Dvt e -my ~ x: LIYes ~o SECTION C - BUILDING ElEVATION INFORMATION (SURVEY REQUIRED) C 1 Building elevations are based on LIConstructJon DraWIngs. Ulldlng Under ConstructJon* LIFiroshed Construction . A new Elevation Certificate ~ be requued when construction of the building IS complete C2 BUilding Diagram Number Pf. (Select the bUIlding diagram most Similar to the budding for which thiS certdicate IS being completed _ see pages 6 and 7 If no diagram accurately represents the building, proVide a sketch or photograph) C3 Bevatlons - Zones A 1-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, ARIA, ARJAE, ARIA 1-A30, ARJAH, AAJAO Complete Items C3 a-I below accorchng to the budding 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 Sectron G, as appropnate, to document the datum conversion Datum AJku()' Z4 Converslon/Comm~ EI~atlon reference mark used~ "R:". t< Nf'v'S-e-ooes the elevation reference mark used appear on the FIRM? LI Yes t&l No ~ ~Top of bottom floor (including basement or enclosure) 5 J If- S fl(;1lf j . r " I!:f b) Top of next higher floor .517 Z. fl{}lf) : REGISTERED ~) BattQm Elf lewest ReflZefltal ~"""'Fel !'Remser (V zaRes BRly) _ ll~ : ~ PROfESSIONAL ~ Attached garage (top of slab) .5lto.. Oft.(ptJ ~ ~ ~D SURVEYOR e} Lowest elevation of machinery and/or equIpment SI'c; ~: ._.;;:;~ ;'//)0 A-- . /' servicing the bUIlding (Descnbe In a Comments area) 0 ~~ ~ ~ --/(~ K/~. /;?z.P\ !:f 1), Lowest adjacent (fimshed) grade (LAG) 51.3 .:L ft. (P1) ~], OREGON er'"g) Highest adjacent (fimshed) grade (HAG) SI'I- ~ ft.}P1> ~ CIl JULY 20,1993 IiitP(No of permanent openrngs (flood vents) within 1 fl above adjacent grade 7 ~ REXA. BETZ / m'ijTotal area of all pennanen! opemngo <flood venls) In C3 h E~g sq In ~ " UL ~ 2-'is, i~ 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 mformatlon In SectJons A, B, and C on thiS certJficate represents my best efforts to interpret the data avaIlable I understanrl that an false statement ma be umshable b fine or Impnsonment under 1 BUS Code, SectJon 1001 CERTIFIER'S NAME --r:> A '"/") UCENSE NUMBER PLc 2 ~e)C - DE', -Z- ..::> (00& TITLE C' '.., COMPANY NAME I ......--, . ")L!yve y; I.,GIII E~ I eeY1l1~ JI-t (' ADDRESS ."'"'? . STA y\ ZIP -,\0 (I-YI ~ v li77 SIGNATURE ,5: 2.e?OZ.)ELEPHON (54d7tj.~-O(P37 1=I=MA 1=nrm A1_~1 1111 no C::I=I= RI=VI=RC::I= C::lnl= 1=()R (,()I\ITI/lJIIA TI()/IJ RI=PI A('I=c:: All PRI=VI()IIC:: I=nITJ()I\IC:: IMPORTANT In these spaces, copy the corresponding lnfonnatJon from Section A. BU~LD~G S~ET ~pRESS (Includ~t.. Urut, SUIte, and/or BIdg No) OR P 0 ROUTE AND BOX NO (OvOo MO.<;-e<; \I-"a~b CITY r f;IA~ ./? . Z}P CODE S~YVv\7-t\e 101 0,.<, q71-f17 , - SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTlRCATlON (COtinNUED) Copy both sides of thiS Elevation CertIficate for (1) communrty OffiCIal, (2) Insurance agent/company, and (3) building owner ~~J ' ~ ( 1 ;+\' t ~0'"W\~ ~\/) ~eV\<-lr..Wl1iYk.. he'\-\1 a. r"'{s~vcl ,"?w.tly€' ~t ,"- ~ 1bp t,c c~ Luvb e:t\- -the li\lI.lAPD\....t J cuvbye1t.tyv\ cJ f~ Sw COVII\~.y J t'v"lth. 't-Tk4vsn."" ~tiv~" u"\ E.lcv'. J 512 Bl c~tvt'UtJu""" CW\J cJ,v.<;,-k., 1P Ekv 15'13,1\ J..t,VD'zq t,U-~ u~J t:<<;, 1ke 'B;~1"s JE/<"IJA-nVi-15 s\",uw'v\. '^ e"ofe 0\-\ . 1_1 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 Bevatlon CertIficate IS Intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E 1 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 Oncludlng basement or enclosure) of the bUIlding Is l-l-I ft.{m) 1-I-IIn (em) 1-1 above or 1-1 below (check one) the highest adjacent grade (Use natural grade, If available) E3. For Building DIagrams 6-8 WIth opemngs (see page 7), the next higher floor or elevated floor (elevation b) of the building Is , I 1 ft.(m) 1-I-IIn (em) above the highest adjacent grade. Complete Items C3.h and C31 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 manaRement orcltnance? I_I Yes I-I No I-I Unknown The local offiCIal must certify thIS Information In Section G SECTION F - PROPCKI (OWNER (OR OWNeR'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authonzed representative who completes Sections A, B, C (Items C3 hand C3 i only), and E for Zone A (wrthout a FEMA-lSSued or community-Issued BFE) or Zone AO must sign here The statements In SectJons A, B, C, and E are correct to the best of my know/edpe PROPER1Y OWNER'S OR OWNER'S AUTHORIZED REPRESENTAllVE'S NAME .?S$L~If1~~a!'YP~~~~~ , SIGNATURE CITY DATE STATE ZIP CODE AuU/'ICSS TElEPHONE COMMENTS LI Check here If attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local offiCIal who IS authonzed by law or ordinance to adminISter the community's floodplain management ordinance can complete Sections A. B, C (or E), and G of thIS Bevatton CertJficate _Complete the applicable Item(s) and sign below G 1 I_I The Information In Sed10n C was taken from other documentation that has been signed and embossed by a licensed surveyor, ~ engineer, or archrtect who Is authonzed by state or local law to certify elevation Information (Indicate the source and date of the elevation data In the Comments area below ) G2 1-=.1 A community offiCIal completed Secbon E for a budding located In Zone A (without a FEMA-lssued or communrty-lssued BFE) or ,Zone AO G3 I_I The follOWIng information (Items G4-G9) IS proVIded for commumty floodplain management purposes G4 PERMIT NUMBER I G5. DATE PERMIT ISSUED I G6 DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7 ThiS permit has been Issued for 1-1 New Construction 1-1 Substanttallmprovement G8, Elevation of as-built lowest floor (including basement) of the budding IS G9 BFE or (In Zone AO) depth of flooding at the budding site is LOCAL OFFICIAL'S NAME _ ft.(m) Datum _ft.(m) Datum TITLE COMMUNITY NAME SIGNATURE TELEPHONE DATE COMMENTS I_I Check here If attachments I=I=MA I=nrm R1_':l.1 \III nn RI=PI Ar;:c: AI I PRl=VlnllC: I=nlTlnNC: