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Home My WebLink AboutFEMA Application 1999-6-2 ... FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEV A liON CERTIFICATE Important Read the instructIons on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION buiLDING OWNER S NAME ~e:. ~ V\L,<, ~G~ BUILDING STREET ADDRESS (Including Apt, Unrt, SUIte and/or Bldg No) OR P 0 ROUTE AND BOX NO <O%jG.. "'S1Y\€Q,~ ~~. CITY 5ptQ~~f'"\6...D sor~ PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Nu~ber, Legal Description, etc ) L o"T OS 'l.. Le" 1 L~QI~ C. 'Z. ';:L f'\OD'114"-' BUILDING USEle j , Residential, Non-reSIdential, Addition, Accessory, etc Use Comments section If necessary ) ~C' ~loE"",1iA~ LATITUDE/LONGITUDE (OPTIONAL) ,,-,,,, HORIZONTAL nATUM SOURCE I_I GPS (Type) ( ##0 _ ##' _ ## ##" or ## #####0) IANAD 1927 ~l NAD 1983 U USGS Quad Map ~B6<=t.~\ o M B No 3067-0077 Expires July 31, 2002 For Insurance Company Use Pelley Number Company NArC Number ZIP CODE 9, +., e Ll Other SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1 NFIP COMMUNITY NAME & L;UMMUNII Y NUMBER 82 COUNTY NAME B3 STA'r~ ~ SPR,,,,t::;RE\.O +1~S~'t.. LAt.le 0"'-_ B4 MAP AND PANEL B5 SUFFIX B6 FIRM INDEX B7 FIRM PANEL B8 FLOOD NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) + lo~" C \ \., F .Ju~ 2..) 1'9"\~ .)oJ~ '2.. \9""~ f\E 810 Indicate the source of the Base Flood Elevation (8FE) data or base flood depth entered In 89 I_I FIS Profile U FIRM I1J..Communlty Determined LI Other (Descnbe) 811 Indicate the elevation datum used for the 8FE In 89 ug.NGVD 1929 LI NAVD 1988 LI Other (DeSCribe) 812 Is the bUilding located In a Coastal 8arner Resources System (C8RS) area or Otherwise Protected Area (OPA)? DeSignation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Jlldmg elevations are based on LIConstructlon Drawlngs* '_IBUlldlng Under Constructlon* ~Flnlshed Construction * A new Elevation Certificate Will be reqUIred when construction of the bUilding IS complete C2 BUilding Diagram Number 8 (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 bUlldmg, prOVide a sketch or photograph) C3 Elevations - Zones A1-A30, AE. AH, A (With 8FE), VE, V1-V30, V (With BFE), AR, ARIA, ARlAE. ARlA1-A30, ARlAH, ARlAO 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 D or Section G. as appropriate, to document the datum conversion Datum Conversion/Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? LI Yes ~ No o a) Top of bottom floor (including basement or enclosure) '5 \4- 'Z.. ft (m) n; '" o b) Top of next higher floor S \ 1 ..L.- ft (m) ~ I' ~-.....) E:,vU0;;i ,:7 .owes! horizontal structurallll~;';j~~; \". LUIlt;~ u.dy) _ ft (m) ~"* o d) Attached garage (top of slab) ":> I";) 4- ft (m) ~ ~ o e) Lowest elevation of machinery and/or equipment ~ ; servicing the bUIlding NJ~ _ ft (m) ~ ~ o f) Lowest adjacent grade (LAG) ?\ ~ ~ ft (m) ~.Q, ::. ",(I) o g) Highest adjacent grade (HAG) 5\ OS _ ft (m) ~ o h) No of permanent openings (flood vents) Within 1 ft above adjacent grade \~ ~ o I) Total area of all permanent openings (flood vents) In C3h \ C;) 1'2. sq In (sq em) ( B9 BASE FLOOD ELEVATION(S) (Zone AO, use depth of flooding) 13\'"2. ~ LI Yes ~I No ~ REGISTERED PROFESSIONAL ~~'~~~ ; "\j- OREGON' . , l FEB 19, 1999 ; JAMES W. COLTON ' \, " ~~~?~~ ,,# ',- ; SECTION 0 - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION &:?\~~ \2./ ~I( 03> 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 In Sections A. B, 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 or Impnsonment under 18 U S Code, SectIOn 1001 r ....TIFIER'S NAME \./ C LICENSE NUMBER .III!. , J~t::~ V'4, ~ \... "Tht-1 tC:.Q.... L";). ~ '5 ~ -, oJ'- I"L.E ~ "S-.)(2..\lC'(6'- COMPANY~c> -ND'"::o-fl\~~C:>€NDClL ADDRES~ .~. !!,b}( 7.'2.1 ~"S CITYe:u"et"~ S~~E. ZIP ~~E4-4"L SIGNATURE ~ t QL ! DATE I I TELEPHONE ~ A -- - \ 1. ~ ~"2...- ~..,.\. ~4-. \8'S'L FEMA Form 81- ,AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT In these spaces, copy the correspondmg mfonnatlOn from Section A BUILDING STREET ADDRESS (Including Apt, Unit, SUite, and/or Bldg No) OR PO ROUTE AND BOX NO bSil.:. ~\V\a~ .D.F.. For Insurance Company -;)se. " POlicy Number .:' -' CITY "'Sf' {2..ltoJ " Y1 t::t.? STATE ~. ZIP CODE ~ '141~ Company NAIC Number I 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 I_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 E3 If the ElevatIOn CertIficate IS mtended for use as supporong mformatlon 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 bUild 109 IS I I I ft (m) I I IIn (em) LI 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? I_I Yes I_I No I_I Unknown The local offiaal 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, and E for Zone A (Without a FEMA-Issued or communitY-Issued BFE) or Zone AO must sIgn here PROPERTY OWNER'S OR OWNfR'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE rfLfPHONE ZIP CODE SIGNATURE DATE COMMENTS I_I Check here If attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) fhe local offiCial who IS authonzed by law or o~::hnance to adminIster the community's floodplam management ordlnar. .e can complete Sections A, B, C (or E), and G of thiS Elevation Certificate Complete the applicable Item(s) and sign below G1 U The information 10 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 elevalion data In the Comments area below) G2 LI 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 U The follOWing information (Items G4-G9) IS prOVided for community floodplain management purposes G4 PERMIT NUMBER . G5 DATE PERMIT ISSUED G6 DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7 ThIS permit has been Issued for U New Construction U SubstantJallmprovement G8 Elevation of as-bUilt lowest floor (lncludmg basement) of the bUilding IS G9 BFE or (In Zone AO) depth of floodmg at the bUIlding sIte IS LOCAL OFFICIAL'S NAME TITLE _ ft (m) Datum _ ft (m) Datum COMMUNITY NAME SIGNATURE TELEPHONE DATE COMMENTS :EMA Form 81-31, AUG 99 I_I Check here If attachments . REPLACES ALL PREVIOUS EDITIONS