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Home My WebLink AboutFEMA Application 1999-6-2 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Important Read the instructIOns on pages 1 - 7 SECTION A - PROPERTY OWNER INFORMATION ..,JILDING O~~R\JS~~\c:.c..H.etZ:\ Co...} ~'\o.N\ ~cM.E:":;) BUILDING STREET ADDRESS (Including Apt Unit SUite and/or Bldg No) OR P 0 ROUTE AND BOX NO ~""'9 \ ^AJ2..~'t.J LI\~ CITY STATE ~~aAao C~ PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Descnptlon, etc) L()"{" 4b \...6J, ~D4~<::; 'l.~ ^D.:llll~ BUILDING USE @ g , Resldentl~ Non-resIdential, Addition, Accessory, etc Use Comments section If necessary ) r<.E-~ID~ \I~ ITUDE/LONGITUDE (OPTIONAL) ,/y: HORIZONTAL DATUM SOURCE I_I GPS (Type) \ tf#o - ##' - ## ##. or ## ####if) IC10 NAD 1927 U NAD 1983 U USGS Quad Map o M B No 3067-0077 Expires July 31, 2002 I B1 NFIP COMMUNITY NAME & COMMUNITY NUMBER B2 COUNTY NAME "5PF-.t~r;e..D .4 I 'S '5 ~ 'Z.. ~N.€.. - - - - -- B4 MAP AND PANEL B5 SUFFIX 86 FIRM INDEX B7 FIRM PANEL tH! I-LUUU NUMBER DATE EFFECTIVElREVISED DATE ZONE(S) 4-'0=-9 C \\bl r .).)Ne 2, \~~ .)u\oo.,\c'J \"i AE B10 IndIcate the source of the Base Flood Elevation (BFE) data or base flood depth entered In B9 U FIS Profile U FIRM ~Communlty Determmed U Other (Descnbe) B 11 Indicate the elevation datum used for the BFE In B9 ~ NGVD 1929 U NA VD 1988 U Other (Describe) B12 Is the bUilding located In a Coastal Barner Resources System (CBRS) area or Otherwise Protected Area (OPA)? DeSignation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) ~lldln9 elevations are based on LIConstructlon Drawlngs* LIBUlldlng Under Constructlon* ~mlshed Construction "A new Elevation Certificate Will be reqUired when construction of the bUilding IS complete C2 Building Diagram Number 8 (Select the buildmg 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, ARlAE, ARlA1-A30, ARlAH, ARlAO Complete Items C3a-1 below according to the buridmg 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? U Yes ~I No o a) Top of bottom floor 0ncludmg basement or enclosure) S ,~ ..:!:... ft (m) ro ., o b) T QP of next higher floor ":> \ 'S -L ft (m) ~ Q lj) 15ul[u,l, vf luv'it:!~~ ;;U;-;Lontal structural mell UJer l v- zone:) onlY) _ ft (m) ~"* .If. 00 o d) Attached garage (top of slab) '5 \ or .::L ft (m) E 'g o e) Lowest elevation of machinery and/or equipment ~ ; servlclng the bUilding N/A. _ ft (m) ~ ~ o f) Lowest adjacent grade (LAG) S I~ <0 ft (m) ~ ~ "':L <0 ., CI) o g) Highest adjacent grade (HAG) '5 \ ~ _ 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 \ ~b ~ sq In (sq em) SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION For Insurance Company Use P{)hcy Number Company NAIl; Number ZIP CODE '14-1~ U Other ioU ~ fATE a~ ti~ BASE FLOOD ELEVATION(S) (Zone AO, use depth of flooding) S\\ '"Z- LI Yes L6l No '" .. REGISTERED PROFESSIONAL ~ND ~U~~ ~ .\.... - U OREGON FEB 19,1999 JAMES W. COLTON ~ . #58756 , SECTION 0 - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION C;<.t'IitC"> \"2./ :31/ DJ 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. 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 US Code, SectIon 1001 ('~-TIFIER'S NAME LICENSE NUMBER A-.\o-\€ ~ 'IN CO\..'\ut'\ o~ '- ~ '" -::>'a"1 '5~ 11.. C COMPANY NAME .- '-'AND ~u~\J€'(d- fbro-I'li:~'5-rl\~~&NOC<L ADDRESS ?C) ~c))< 7..1..1~'$ CITY e-:JGcr-lE ST'2l ZIP~~~?.. SIGNATURE "::: ___ L.,.. Cl2- DATE \{1..1../0'L TELEPHONE '54t ~4-4- laS'2.. FEMA Form 81- , UG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT In these spaces, copy the corresponding informatIOn from Section A . - .. - - . - . BUILDING STREET ADDRESS (Including Apt Unit ~ulle and/or Bldg No) OR I-' U RUUTE: AND BOX NO Go"" I "'''?J>N '-P\"lC CITY STATE ZIP CODE ~\~C::(fIa.O CR- 4141~ For Insurance Company -..Jse. Policy Number -....- t;ompany NAIC Number SECTION 0 - 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 attachment 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 supportmg mfonnatlOn 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 bemg 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 '" ft (m) I I 1m (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 ordmance? I_I Yes I_I No I_I Unknown The local offiCIal must certify thIS mformatlon m 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 AD must sign here PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESEN1A'nVE'S NAME ADDRESS CITY STATE TEL8PHON8 ZIP CODE .. SIGNATURE DATE COMMENTS I_I Check here If attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) rhe local offiCial who IS au1horlzed by law or ordinance to administer the community's f100dplam management ordinance can complete Sections A, B, C (or E), and G of thiS Elevation Certificate Complete the applicable Item(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 architect who IS authonzed by state or local law to certify elevation mformatlon (Indicate the source and date of the elevatron data In the Comments area below) G2 U A community offiCIal completed Section E for a bUilding located 10 Zone A (Without a FEMA-Issued or communrty-Issued BFE) or Zone AD 33 U The follOWing information (Items G4-G9) IS prOVided for community floodplam management purposes G4 PERMIT NUMBER I G5 DATE PERMIT ISSUED G6 DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED 37 ThiS permit has been Issued fOi U New Construction U Substantial Improvement 38 Elevation of as-built lowest floor (mcludmg basement) of the bUl:dlng IS 39 BFE or (m Zone AD) depth of f100dmg at the building site IS . LOCAL OFFICIAL'S NAME _ ft (m) Datum _ ft (m) Datum TITLE . COMMUNITY NAME ISIGNATURE . COMMENTS TELEPHONE DATE I I lEMA Form 81-31, AUG 99 I I_I Check here If attachments REPLACES ALL PREVIOUS EDITIONS