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Home My WebLink AboutFEMA Application 1999-6-2 FEDERAL EMERGENCY MANAGEMENT AGENCY NA TIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Important. Read the instructions on pages 1 - 7. SECTION A. PROPERTY OWNER INFORMATION 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 6799 Mos~~ Pil<:;5-. CITY STATE Spnom.eld.. .." OR PROPERTY D~SCRIPTIUN (Lot and Block Numoers, 1 ax Parcel Number, Legal Descnptlon, ere) LoTW L.f'Vl li'lnrl1n(1 ?nrl Arlrllt10n rll~ ,1,r1oc 115?-115l) BUILDING USt: (e g , ReSIdentIal, Non-residential, Addition, k'''''''''ory. ete Use Comments sectu:)n If necessary) . ReSldentlql LA, TITUDElLONGITUDE (OPTIONI-'.l) ( #If - ##' - ## ##' or ## ####if) o M B No 3067-0077 Expires July 31, 2002 FJl~ lJiSYBn~~Pa.:ny US!!- J3jt.. ~~~~Nllinoer ....:=.~ - ZIP CODe 979 78 I ;;lnp COllnty pl ~t R~ HORIZONTAL DATUM U NAD 1927 U NAD 1983 SOURCE U GPS (Type) U USGS Quad Map U Other SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1 NFIP COMMUNITY NAME & CUMMUNITY NUMBER Sprlngfleld 415592 B2 COUNTY NAME Lane B3 STATE Oreaon B9 BASE FLOOD ELEVATION(S)- (Zone AO, use depth of flooding) S\2.ot B4 MAP AND PANEL 85 :::>Ul-I-IX ' B6 FIRM INDEX B7 FIRM PANEL B8 FLOOD NUMBER DATE EFFECTIVElREVISED DATE ZONE(S) 41039Cl166 F 6/2/99 6/2/99 X 810 Indicate the source of the Base Flood Elevation (8FE) data or base flood depth entered In 89" U FIS Profile LI FIRM ~I Community DetermIned U Other (Oescnbe) 811 Indicate the elevation datum used for the BFE In B9 ~NGVD 1929 U NAVD 1988 U Other (Descnbe) 812 Is the bUilding located In a Coastal Barner Resources System (CBRS) area or Otherwise Protected Area (OPA)? DeSignatIon Date UYes ~No SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1 BUilding elevations are based on UConstructlon DraWings. L1BUlldlng Under Constructlon* IJ9FlnJshed Construction *A new Elevation Certificate Will be required when constructIon of the bUilding IS complete C2 BUlldmg Diagram Number --Z..- (Select the bUIlding diagram most Similar to the bUIlding for which thiS certIficate IS belng.completed - SE.>e pages 6 and 7 If no diagram accurately represents the bUlldmg, prOVide a sketch or photograph) C3 ElevatIons - Zones A1-A30, AE, AH, A (With BFE), VE, V1-V30, V (With BFE), AR, ARiA, ARiAE, AR/A1-A30, AR/AH, AR/AO Complete Items C3a-1 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 0 or Section G, as appropnate, to document the datum converSion Datum lOLAt... Conversion/Comments k\) b () ~ TO l.()U\L t)I'f\\)M TO Q.~k~ f='-t (o'\,^, DktvlA Elevation reference mark usedt1I7_E.. COMI\Ae.~ Does the elevatIon reference mark used appear o a) Top of bottom floor (Including basement or enclosure) 5\4 l ft (:as) m Pilot,' il'~.H4S~fAL", I o b) Top of next higher floor ? '1 S ft (rs) ~ 1 L.AND 1!jU'r~ft.YO~ o c) Bottom of lowest honzontal structural member 01 zones only) 14 I A. - ft~) ; ~ "- " A'.-- o d) Attached garage (top of slab) S \ "" ~ ft (m) ~ ~ \ L. (# h () o e) Lowest elevation of machinery and/or equipment ~;. ~ ,~ serviCIng the bUilding "5 \<a ~ ft (m) ~ ~ r OOF.G.OO -----;J. o f) Lowest adjacent grade (LAG) _ ft (m) :f ~ l JULV ~"'. H~f!.i o g) Highest adjacent grade (HAG) S llo -2.... ft (~ ~ en . JONA nh;~tA' OAKES o h) No of penn anent openings (flood vents) within 1 ft above adjacent grade l (p ~ -" ."'" o I) Total area of aU permanent openings (flood vents) In C3h '2-10 l sq In (~) ~~ -,.;.DEu _~ \ ~-z,. 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 mformatlon I r~ ~ify that the mformatlon In SectIOns A, B, and C on thIS certIfICate represents my best efforts to Interpret the data avaiable / rstand that any false statement may be pUnishable by fine or Impnsonment under 18 US Code, Section 1001 --ceRTIFIER'S NAME A 0 k LlCENSE NUMBER JOnatnan . a es OrprJon I ~ #?1 n~ TITLE CQMPANY NAME - ProfeSSlonal Surveyor _ Ppage Enqlneenng & SurvPYlnn Trr ADDRESS t;llY STATE . - - ZIP CODE P.O. Box 2527. "I:.ugene OR g740? SIGNATUR~~W.Jt 1~:-ffi~DZ- TELEPHONE 541/485-4505 ............, A"'<::'" AI I 00<::\111""111<:: l:nITI()N~ IMPORTANT In these spaces, copy the corresponding mformatlon from Section A BUILDING STREET ADDRESS (Including Apt , Unit, SUite, and/or Bldg No) OR P 0 ROUTE AND BOX NO fi7qq Mo<;.p<;. PiI<;.<;. CITY Spnnqfleld For Insurance Company Use Policy Number , ~ STATE ZIP CODE Company NAIC~Number ' OR 97402 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 Clty of Sprlnqfleld benchmark descrlbed as a chlseled square ln the too of curb at the mldoolnt of the curb return i1t the southwest cornpr oUhp lntprsprtlOn of 67th ~ Thurston Road. Clty datum 512.81 F.E.M.A diltIJillL211_1 ElevatlOns shown have been converted to F.E.~1.A. datum '-_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 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 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 (including basement or enclosure) of the bUilding IS 1_1_1 ft (m) 1_1_11n (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 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 manaQement ordinance? L_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, 8, 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, 8, C, and E are correct to the best of my knowledqe Pr\ul""l:RTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS L_I 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, 8, 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 was 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 elevation data In the Comments area below) G2 I_I 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 I_I The follOWing mformatlon (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 ThiS permit has been Issued for I_I New Construction I_I Substantial Improvement G8 Elevation of as-built lowest floor (including basement) of the bUilding IS G9 8FE or (In Zone AO) depth of flooding at the bUlldmg site IS LOCAL OFFICIAL'S NAME __ ft (m)Datum _ ft (m) Datum TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS L-I Check here If attachments, ~I=MA ~nrm R1_~1 1111 nn RI=PI Arl=~ AI I PRI=\II()II~ I=nlT1nN~