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Home My WebLink AboutFEMA Application 1999-6-2 . (~, - - -O,;l-(J33 FEDERAL EMERGENCY MANAGEMENT AGENCY NA TJONAL FLOOD INSURANCE PROGRAM ELEVATION CERTJFICA TE Important Read the '"~t!u~~.n~ on pages 1 - 7 SECTION A - PROPERTY OWNER INFORMATION BUILDING OWNER S NAME . ~ ~ +h . . ___ ,~ L.- ,(f~ -BUILDING STRE::T ADDRESS~cludlOg Apt Unit. S~ and/or Bldg No) OR P 0 ROUTE AND BOX NO_ -- (0 073 :::; rvy\ €c- Y1 'U---Ic"\J e.- "- CITY r,,' STATE!? . <3f)vYv\"\.[\~td~ ~ ... O~ PROPERTY ~ESCRIPTfON (Lot and Block Numbers, Tax Parcel NumDer, Legal Descnptlon, ete.} Lot Y3 Le\h Lc;.""d\....,e-, ZvJ A?id( 111-'>"\_ I?-,-IO 1!Ap n-~Z-3'f-tt BUILDIN~E (e 9 ReSidential Non-resrCJenual, AdditIon, Accessory, ete. Use Commenls set::Jon rt necessary ) Ke5\.~~;:.( ~i-lt{. \ . ._n LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DAI uM SOURCE U GPS (Type) ( ##0 - ##' - ## ##" or ## #If:##fr) U NAD 1927 U NAD 1983 U USGS Quad Map o M B No 3067-0077 EXDlres July 31, 2002 L.~~nsurance Company Use - -. J _ P~ohC'J Number _ __ __ _ . _ . __ _ ./ v~ "\ i .Comoany ~'C Numb~: ,- ~ ZlP CODE - Cl7 If 7/ . fJh.. /' Lot 2rJOO U Other SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81 NFIP COMMl(NITY NAME & C9MMUNITY NUMBER - 82 COUNTY NAME /l L 83 STATE A 1/7 Q.I.~ tAt 5()'fi t1) hc:(tA 4-15512. Ld"lE' LOUvt.T~ UK 84 MAP AND PANEL 85 SUFFIX B6 FIRM INDEX. 1:l7 FIRM PANEL B~ i=i.uuu NUM8ER DATE EFFECTlVElREVISEDDATE ZONE(S) 4103Q C \ \~(p F .-r;U>V'l, Iqa.~vt.e. '2--,-[Q11 -..A-1:? B 10 Indicate the source of y:te Base Flood ElevatIon (8FE) data or base flood depth entered In 89 U FIS Profile "t:ttF1RM '-' Communrty Detenmned ' U Other (Descnbe) B11 Indicate the elevation datum used for the BFE In B9 U NGVD 1929 U NAVD 1988 U Other (Descnbe) B12 Is the bUlldmg located In a Coastal Barner Resources System (C8RS) area or OthelWlSe Protected Area (OPA)? U Yes ~o DeSignation Date B9 BASE FLOOD ElEVATION(S) (Zone AO, use depth of flooding) 51'/; 0 SECTION C - BUilDING ELEVATION INFORMATION (SURVEY REQUIRED) , Burldlng elevations are based on UConstructlon Drawlngs* iJdlng Under Construction * URn/shed Construction * A new Elevation CertIficate will be required when construction of the building IS complete C2 BuildIng Diagram Number A (Select the budding diagram most Similar to the buildIng for Whldl thiS certificate IS being comoleted _ see pages 6 and 7 If no diagram accurately represents the bUilding, prOVIde a sketch or photograph) C3 ElevatIons - Zones A 1-A30, AE, AH, A (WIth 8FE), VE, V1-V30, V (with BFE), AR, ARiA, ARiAE, ARiA 1-A30, ARJAH, ARJAO Complete Items C3a-1 below according to the building diagram specriied In Item C2 Slate the datum used If the oatum IS OIfferent Trem the datum used for the BFE In SectIon 8, 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 SedJon G, as aopropnate, to aocument the datum conversion Datum ,U0VO'Z?J Conversion/Comments ~ Elevation reference mark used '1i ,<:\E:?C" il..ev~vr.,L Does the elevatIon reference marl< used appear on the FiRM? U Yes 1;t:t-NO. ~ a) Top of bottom floor 0ndumng basement or endosure) '5 I 4 l ft (~~ Il:a.k. I, ?G/D~ . )!::l b) Top of next higher floor 5' I 7 ..L it (~) ~ /" REGiSTERED '\ 1/ I r\-. ::: ,,} BORef1'1 Qf lewoe:-:-,~.....~..k.J ,,[,u,-,uIClf IT..eml3or (V zone: :'11)') _ it ( ~ ~ I PROFESSIONAL ~ d) Attached garage (too or slab) 5/ 10 Q ft ( ) ~ ~ LAND SURVEYOR % e) Lowest elevatIon or macmnery and/or equipment C -t ~ : //~ /J //j- servIcing the bur/dIng ---' I , ~ ft ( ) .g ~. R L: /)/" /' /; /{./, ~ f) Lowest adjacent grade (LAG) ~) 4 Q.. ft ( ) ~.9 I OREGON" J2{ g) Hlgnest adjacent arade (HAG) 51lf~- it t) ~ Vl JULY 20,1993 N\ . - OJ REXA Ct:I~ F- h) No or permanent openrngs (f1ooa vents) Within 1 ft aoove adlacent grade / :5 \.. H2fiQ6 / "%-1) Total area of all permanentopenmgs (flooavents) In C3h JZO sq In (sQrn) Jr? I~)c~ (2/31/03 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION ThiS certification IS to be SIgned and sealed by a land surveyor, engmeer, or archltect authonzed by law to ce'1lfy elevation rnformatlon I certIfy that the mformatlon In Sections A, B, 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 lrT'pnsonment unger 18 U S Code, Section 1001 -tmFIERSNAME '1:?F'K' d~\2- ______. -i.~:;~NUM8ER PLS 2&()(o TITLE C" r CUMI-'ANY NAME'-r') _ f .---, ,H.A.vveC{ )J{U/V1C(C)e~ -:" v("G{vQ:,lvl 0;;;'h~erl'1.7 ...J..l.tc ADDRESS 310 hf~ Siv~~t- ~i~VI'\ ~ eta ~~A~~ K zIPCODFf:;7'!- 7 ') SIGNATURE OATt=~ ~ tJoZ ImPHON'(Sq() 7!I(rOt,,3"I- FEMA Form 81-31, AUG 99 cE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORT ANT In these spaces, copy the corresponding mformatlon from Section A BUILDING STREET ADDRESS (Including Apt Unit S~ and/or Bldg No) OR P 0 Koui-f. ANU tiux NO &, 67"3 S ( vYl eQ"~ J )r l\J <- - CITY (' J STATE v::::; ZlP CODE 5f(\\A'S !let en", Q7'-f7/ For Insurance Company Use Policy Number ..rl, . j Company NAIC Numcer SECTION 0 _ SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy bot!:, Sides of thiS Elevation Certificate for (1) community oTfic:al, (2) InsuJance agenUcompany, and (3) buddmg owner - CO~ENTS r C' J l \ ' I' J . ~ (i.,-t-vr e,! "S9'{"Yv\,\T\e~0 Be"'-~ ./'-" av-IL ,Vlet~j ~ C\Atse[ed ,,')"1u4v'e.... CVLTl""'-T-Lte r I 1_ u + ~- s I '" -t > fl. '"1Q.p c:J Ct.-tft"} 0. ~ (urb re.tl.{V"'" W\/jPOI:3T OJ -r~ <;DL.~ ~ u..J.?s,t COOtey c:J , J r .. fv1f'^- ~d Tt..-~V7+0V\ k4v'l"",.:'("", ("-Ievat-,~ c'-! blZ.tf\ C\. ~, 04tUVV\ LVt/l,d _f:!J)f,-,,,~d 10 F\e,/ S/3.l\ !J,{,v[i2C/ {J.Y'" us=! cs. 1ttL '/1,.$/<;' of Gl. e....J tt. +( t-V! <;. sko W'v\. heve U'V\ ' 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 BFE), complete Items E1 through E3 If the BevatIon CertIficate IS mtended for use as supportIng mfo'1T'abot'J for a LOMA or LOMR-F, SectIon C must be completed. - ' E 1 BUilding DIagram Number -- (Select the building diagram most slmiiar to the budding for ""nidi ttus certficate IS be:og complet~ - see pages 6 and 7 If no diagram accUrately represents the budding, proVide a sketch or photograph) E2. The top of the bottom floor (indudlng -basement or endosure) of the building IS 'I \ fl(m) , I ~In.(cm) 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? I....J Yes L J No ,U UnknOwn -The local offiCIal must certIfy thIS mfo...lO;;on 10 Section G SECTION F _ PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIACATION The property owner or owner's authonzed 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 OWNER'S AUTHORIZED REPRESENTATIVE S NAM~ SIGNATURE trT" OAtt: ~.IArE ZIP CODE ADDRESS ~lEPHONE COMMENTS U Check here If attachments SECTION G _ COMMUNITY INFORMATION (OPTIONAL) The local offiCial who IS authonzed by law or ordinance to adrmnlsterthe community's floodplain management ordinance can complete Sections A, 8, C (or E), and G of thiS Elevation CertIficate Complete the applicable 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 licensed surveyor, -engineer, or archlt~ct 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 U A community offiCial completed Section E for a bUIlding located In Zone A (WIthout a FEMA-lssued or communlry-Issued EFE) or , Zone AO - G3 W The followmg information (Items G4-G9) IS prOVided Tor community f100dclaln management purposes G4 PERMIT NUMBER G5 DATE PERMIT ISSUED I. Go UA~ C~::{-T'IFltATE OF COMPLJANCEiOCCUPANCY ISSUED G7 ThIS permit has been Issued for U New ConstruCJon U Substanballmprovement G8 Elevation of as-bUilt lowest floor (including basement) of the buddmg 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 Yi1'LE :j ELEPHONf COMMUNITY NAME SIGNATURE DATE COMMENTS 1.-1 Check here If attachments . REPLACES ALL PREVIOUS EDI!IONS , - FEMA Form 81-31, AUG 99