HomeMy WebLinkAboutFEMA Application 1999-6-2
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FEDERAL EMERGENCY MANAGEMENT AGENCY
NA TIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTJFJCATE
o M 8 No 3067-0077
Expires July 31, 2002
Important: Read the rnstructlons on pages 1 - 7
SECTION A - PROPE~TY OWNER INFORMATION
BUILDING OWNEQ S NAME ~ -f IT L
'1 ).DJ\!\)"~ _ \M U\l1~,
BUILDING STRE:::T ADORES (Including Apt. uml SUite and/or Sldg No) OR P 0 ROlJ"TEAND BOX NO
~(p7~ 0 ~
CITY ~ Of .. f, <: \4 - ST'3rZ
P FOPE,H1Y DE~PTION (lot 'od B~c' N"",,,.,,, T '" P,w N"m',., ~ De=poon, "')
\.-D1- q J../ \..P'V \ L4I1tdIV'lC:! 'Z"'~ Mtf ~
BUILDING USE (e ~ , Re,illdenb31, Non-resldenoa( AcMltJon, Acr::.essory, ate. Use Commentss............ It necessary )
?eSCd~+Q~\ _ _. .
LATITUDE/LONGITUDE (OPTiONAL) - HORlZONTAlUAIuM SOUR~ U G?:5 (rype)
( ##Q-##, -####" or ##~ U NAD 1927 U NAD 1983 U USGS Quad Map
I Fer Insuranca Company Use
PellCj Number
Company NAIC Numoer
ZJp COD.-S
07'177
U Other
. - -.. ..
SECTION B - FLOOD INSURANCE RA l~ ~ (FiRM) INFORMATION
B1 NFIP COM1y1UNITY NAME & COMMUNITY NUMBER B2 COUNTY NAM71_ + B3 STA~ to
C I. '1 o:t S0"""~ ~d4 415 ;;12.-- . La-.,p LL>u."" '1 LJ "'"
84 MAP AND PANEL B5 SUFFIX 86 FIRM INDEX 87 ARM PANEL B8 r-LUUU 89 BASE flOOD ElEVATlON(S)
NUM8ER DATE ErrECTIVEJREVJSEDDATE Z~Nj(S) (ZoneAO, use depth of floodIng)
LI\ 0 '1qc. \ I~t.p F . JU/Y\l'Z,,'l1Q :r~ t., t1PiQ ,;x.. iJ~ ~ ~_ ><
810 Indicate the source of the Base Flood BevatJon (BFE) data or base flood depth entered 10 89
U FIS Profile ~RM . U Communrty Detemuned U Other(Desaibe)'
811 Indicate the elevation datum used for the 8FE In 89 Q( NGVD 1929 U NAVD 1988 U Other (Descnbe)
B12 Is the building located In a Coastal Barner Resources System (CBRS) area orOthenwse Protected Area (OPA)? U Yes ~o
Designation Date
. - -
SECTION C - BUILDING ELEVATION INFORMA"nOHfSURVEY REQUIRED)
Building elevations are based on. UConstructJon Drawmgs" ~uiIding Unde!"ConstructlOn" URn/shed ConstructJon
* A new Elevation Certificate WIll be required when construdJon of the buIlding IS ......~~.
C2 BUIlding Diagram Number 75 (Select the budomg diagram most slITlllar to the building for whIch thIS cernficate IS bemg comcleted _ see
pages 6 and 7 If no dIagram accurately represents the buddmg, pfOVlde a sketcn or photograch )
C3 ElevatIons - Zones A 1-A30, AE, AH, A (WIth 8FE), VE, V1-V30, V (wIth 8FE), AR, ARIA. ARJAE, ARIA 1-A30, ARJAH, ARJAO
Complete Items C3a-1 below accordmg to the buddmg OIagram soecmed In Item C2.. State the datum used If the oatum IS omere'1t Trcm
the datum used for the 8FE m SectJon B, convert the datum to that used for the 8fE.. Show field measurements and datum conversIon
calculation Use ,the space provided or the Comments area owecucn 0 or Secuon G, as acoroonate, to oocument the oatum conversion
Datum U(I7VO 24 ConversIon/Comments ~ Kev'e'v>-e.-
Ele'latl~n rererence mark used ~ Q ~I/ey, L Does the elevation re'El"E!!lCamarx useo accearon the FIRM? L! Yes ~No
if~) Top of bottom floor Qnc!uomg basement or enoosure) r::=; I Z. i. it ( ) ro
Vb) Top of next hlgner floer &S I 4- &> ft( ~ ( REGISTERED "'\
o c) Bottom or lowest honzontal structural memoer (V zones onlY) Ai /..4 _ ft ( ~ * PROFESSiONAL
!D"'d) Attacned garage (too ot slab) '::;1 "':3 ~ it ( ~ i ~D SURV~EYO
fB'" e) Lowest elevatIOn or u""...J,lnery anoior equmme'1t _~ _~ /y;,~. _ /) I:
servlc,ng the buIlding 5/5 ~ ft ~ _ 17 bY/' t' Z
~f) Lowest adjacent grade (LA.G) ~ ? c... '3 ft (. ..@ ~ l" . OREGON
ClVg) Hlgnest adjacent grade (HAG) . "') I ~ .1:. it ( ) ; 7 JULY 20, 1993
_/ }/I ~ REXA tjl:l.l.
1M h) No or permanent openIngs (flooa vents) wlthrn 1 ft aoove aaJacent graae L'+ U tfW6 /
~I) Total area of all permanent ooemngs (f1ooo vents) In C3h ~ /7 (P so_ m. (~) = _ c;op_ 12/31/ c? ~
SECTION 0 - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
T n1S certification IS to be signed and sealed by a land sUlVeyor, engrneer, or ard1Jtect authonzed by law to certIty elevatIon rnformatlOn
I certify that the mformatlOn In Sections A, B, and C on thiS certJlicate represents my best e~orts to mterpret the data available
I understand that any false statement may be pUnishable by line or ImDnsonment under 18 U S Code Section 1001
::mFJER S NAME.-rJ A r.J * UCENSE NUMBER n c
K'e'>C ~ \"")&"2-- ____ ,L::> U6 &7
TITLE ' L.UMI-'ANY NAME _
SU.yve1 UC<.II\ Cu:,ey i3'1Ult\~._~Iv-,{'(:~'YY'-'j -J.-kc
ADDRESS 3 \ () "'F" .-ft-~ c h- ~ l.,fTY S y VY\ h c lv{::' iA I ~ rz ZIP CODE I I
.. -:) f2~ --. - CJ 71.f7
SIGNATURE - /7 /A - /J.-/ ~TEZG-( -'?,...,O/} Il:LE:PHONE,..-_) . 3
,~ (,I/- ~ JL.{~e... t=1l-Vi '-- (~L(I 7lf&-{)(P 7
FEI"'A Form 81-31, AUG 99 - SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
~.....---...
I For Insurance Company Use
P~hCf Number
IMPORT ANT In these spaces, copy the correspondmg mformatlon from SectIOn A
BUILDIr-J.G STREE:T ADDRE9f3 (Inc'uding Apt Unit SUite and/or Slag No) O~ P U KUiJ I [: AND BOX NO
{t? ~7 ?, L1-t2- v tJ V7 I- U'Vl P
CITY . --- STATE Z'P CODE
~ Of)-y"\c-,fy-dJ o1Z --Y/~-;'
.. /_.
C~moany NAIC Numoe'
"\
SECTION D _ SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sIdes ot this ElevatIon Certificate for (1) community otfic.al, (2) Insurance age'ltlcomoany: and (3) bUllomg owner
COMMENTS .c n C I I \ , t \!
* C'i1-,,! Ul -:,pY\""'; ,,'e.\d BeV\0 j,-~.(LV'L. \r--,eIV\.1i c.. C\I\\)e ~~ '::;CliA.ave.. ('-<.At ,'^ tluL
~ I ( (' J r' --
~\1 ~t'~~e.. ():J CUyb -2-t -t\..tg \N\IJ90l~t ,-~I ('~LY..1n lCfu.r-r- (,1 -t~ ')I/LLtlA.~ed Cof\l(t"'v of
tL7-t~ a,,^~ ~<-<;y-:;t0"\ ~~ILJ^"'~ C7V\ ele\l~tt!o,^ c:>.\ 51"2-.6\ c.t\~ O<(.R"", CLVl,.da.dJ~<,~t:(
.-to eL~'vunt\A ~ 1:3. l \ D&VD1Zt::i \.,VtlS u..<;e) u<:) ~ ~"$uS J elev~hOV1'S ble-vec'vt .
U Check here If attachments
SECTION E _ BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO and ZONE A (WITHOUT BFE)
For Zone AD and Zone A (Without 8FE). complete Items E1 through E3. If the BevaiIon Ce,b,;...,te IS mtended for use as supportIng
mformaiIon for a LOMA or LOMR-F, SectIon C must be CDII1pJeted.
E 1 8U1ldlng Diagram Number - (Select the buildlOg diagram ...~l Similar to the building fer which this ",,;';;cate is bemg completed -
see pages 6 and 7 If no diagram accUrately represents the buildll'1g, prOVIde a sketch or photograph.)
E2. The top of the bottom floor ~nCludmg basement or enclosure) of the budding IS - I I \ ft.(m) I . I !in. (an) U above or U below
(check one) the highest adjacent grade r
E3 For Zone AO only If no flood depth number IS avadable.1S the top rof the bottom floor elevated 10 ao::ordance wrth the community's
f1oodolam management C1rrlm:'tnr,p,? 1_' Yes I ) No -1,....1 Unknown. The local offioal must certJfyttus Il,Iuo.....;,u.. In Sed10n G
- sEe-hoN j:'=PRQPI:t\J (OWNER (OR OWNER'S REPRESENTATIVE) CEf\lIrICATlON
The property o,,!ner or owner's authonzed representatIVe who completes SectIons A. 8, and E for Zone A (wrthout a FEMA-lssued or
commumty-Issued 8FE) or Zone AD must Sign here
,
PROPERTY OWN~H:~ UK LiwN~K:~ORIZED REPREsailAIIv'E S NAME
(";11 f
;IAif
ZlP CODE
ADDRESS
SIGNATURE
VAl:
I :t.!:::?HONE
COMMENTS
1-1 Ched< here If ar..achments
SECTION G _ COMMUNITY INFORMATION (OPTIONAL)
T ne local offiCial who IS authonzed by law or ordmance to administer the communIty's ffoocolam manageme'lt oramance can comoie<e
SectIons A, B, C (or E), and G of thiS Elevation Certriicate complete the apcllcaole rtemls) and Sign belOW
G 1 U Tne InfOrmation In Section C was taken from other oecumentatJon that has been slgne!l ana emnossea oy a hc:e.'1seo survevor,
engmeer, .or architect wno IS authonzed by state or lecallaw to certrfv e'evatIon lnTormanon (InOtcate the source anO oate of me
e'evation data In the Comments area below)
G2 U A community oriic:al completed Sectlon E fer a bUlldlOg ICC3te<l 10 Zore A (wlthcut a FEMA-Issued or communrrv-Issued BFa or
Zone AO
G3 U Tne follOWing mtormatlon (Items G4--G9) IS orovloea icr c::mmumrl ilcccdarn managerT'em curcoses
.,- ---_.
I G4 PEqMITNUMBEq I G5 DATEFERMITISSUEJ I Go urlJ:::Ci:=TIF,CATECFCOMFLlANCSOCCUPANCY
I 11<:<: 1~"'"
I --'-'--
G7 Tms permit has oeen Issuea ior U New ConstruC'Jon U Substanllallmorovernerr
G8 ElevatIOn of as-bUIlt lowest floor (mdudmg basement) at the bUllomg IS
G9 BFE or (In Zone AO) decth of floocmg at the bUllomg site IS
LOCAL OFFICIAL'S NAME
_ ft.(m) Datum
_ ft.(m) Datum
TITLE
COMMUNITY NAME
- -- . ~.-
I d..EDHONI::
SIGNATURE
UAIC
COMMENTS
.--1 C~_e~k here If attachments .
REPLACES ALL PREVIOUS EDITIONS
FEMA Form 81-31, AUG 99