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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 o M 8 No 3067-0077 Expires July 31, 2002 For Insurance Company Use PoliCY Number . DulLDING OWNER S NAME C~ucE: \oIHCc-l~i'" c..u,,=>\CI~ \-.ll)t-.t.'C~ BUILDING STREET ADDRESS (Including Apt . Unit, SUite, and/or Bldg No) OR P 0 ROUTE AND BOX NO Go 1 ~ ~ A.~q~ \..A~ e CITY _ STATE SP~IN c:::;, fh::l...o 0(2... - PROPERTY DESCRIPTION (Lot anci Block Numbers, Ta:~:srcel Number, Legal Descnptlon etc) Lc-r \()'L LO/\ ,--,\",O,"'G. Z Ape ITI6~ " BUILDING USE (e 9 , ReSidential, Non-residential, Addition, Accessory, etc Use Comments section If necessary ) ~eStD~TI~ LATITUDE/LONGITUDE (OPTIONAL) HORiZONTAL DATUM SOURCE U GPS (Type) ( ##0 _ ##' _ ## ##. or ## #####0) t1.f NAD 1927 U NAD 1983 U USGS Quad Map SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Company NAI(; Number ZIP CODE 4, 4-1~ U Other B1 NFIP COMMUNITY NAME 8. C:UMMUNII Y NUMI:kl{ B2 COUNTY NAME 'Sr~ING.~e'lD +\~Sc::n_ ~~E. - - -- - - - B4 MAP AND PANEL B5 SUfFIX 56 FIRM INDEX B7 FIRM PANEL Bll I-LUUU NUMBER DATE EFFECTIVElREVISEDDATE ZONE(S) +\()~~ c:. \\.10, F J.,toC, 2., \"9'1 j..J\..)C '2.) \T't Ae.. 810 Indicate the source of the Base Flood ElevatIOn (BFE) data or base flood depth entered In 89 U FIS Profile U FIRM ~ Community Determined U Other (Descnbe) 811 Indicate the elevation datum used for the BFE In B9 ~ NGVD 1929 U NAVD 1988 U Other (Descnbe) B12 Is the building located In a Coastal Bamer Resources System (CBRS) area or Otherwise Protected Area (OPA)? DeSignation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Jlldlng elevations are based on UConstructlon Drawlngs* LIBUlldlng Under Constructlon* ~Inlshed Construction . A new Elevation Certificate Will be reqUired when construction of the bUilding IS complete C2 BUilding Diagram Number 2$ (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) 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 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 ConverSion/Comments Elevation reference mark used Does the elevatIon reference mark used appear on the FIRM? U Yes ~o o a) Top of bottom floor 0ncludlng basement or enclosure) S \1. ?. ft (m) c;; '" o b) Top of next higher floor '4S I"':> ~ ft (m) ~ o e) Bettolll vi (~.-.;.;.~~ nOflz0AtGI Gtructufo.l.Yn.:..rIILl...1 \~. LUIIt::~ utliYJ _ ft (m) ~ '* 00 o d) Attached garage (top of slab) ~ \4- -L ft (m) ~-g o e) Lowest elevation of machinery and/or equipment ~: servicing the bUilding NI " _ ft (m) ~ ~ o f) Lowest adjacent grade (LAG) "5 \ ~ ~ ft (m) ~ ~ ",(I) o g) Highest adjacent grade (HAG) :5 \ ~ ~ ft (m) ~ o h) No of pennanent openings (flood vents) Within 1 ft above adjacent grade \ 4- ~ o I) Total area of all permanent openings (flood vents) m C3h \~~ sq In (sq em) ( B::i ::iIAII:: I C~. - - ~ - - -- - B\:l BASI:: I-LOOD ELEVATION(S) (Zone AO, use depth of flooding) OS H. '5 LI Yes -KJ No / ---- I " REGISTERED PROFESSIONAL .~LAND S~R~-9~ OREGON FEB 19, 1999 . JAMES W. COLTON " \ #58756 , SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION 6<.f"\~<:> \~ I~ lo~ ThiS certification IS to be Signed and sealed by a land surveyor, engineer, or architect authonzed by law to certify elevation mformatlOn I certIfy that the mformatlOn m 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 /mpnsonment under 18 US Code, Section 1001 (' ~IFIER'S NAME, ,/ /' L:C:~NS~ NUM8ER ft 5 "s r ..JAIoJ\~~ V" <.....0I..\,y-... 6\2.. LS. ~ I """ TI' L~ ~ <:. n d C-;::::VclL COMPANY-NAME,:=,o".-::Ln ~!) -JII~" ~ \ n(lo- N~~ -\ rl'~~e>>t:NOv- ADDREp:6. ~ 2'- 7~S _ CITY QJ<::\~c s~Tl ZIPC~~4-~t. SIGNA TU \....... _ CI2- DATE \ / ~ 1../ 0 'L TELEPHONE 54-I 3. 4- 4- \ 8 S 1- 1, 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, andlor Bldg No) OR P 0 ROU II: ANU tJUx. NO 61 ~ 'Z. "'f\p....o~ L- Pf'4 E- For Insurance Company 0Se. Policy Number ~~,NC::; na..? STATE 6<2.... CITY ZIP CODE \.;ompany NAIL: Number ~., 4-'"l~ SECTION 0 - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of thiS Elevation Certificate for (1) community offiCial, (2) Insurance a~ent/cbmpany, and (3) bUilding owner COMMENTS I_I Che~k ~ere 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 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 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 'I 1ft (m) I I 'In (em) 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 I Yes I_i No I I Unknown The local offiCIal must certify thIS Infonnatlon In Section G SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION 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 NAME ADDRESS CITY STATE T~LEPHONf. ZIP CODE SIGNATURE DATE COMMENTS I_I Check here If attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) :he local offiCial who IS authonzed by law or ordinance to administer the community's floodplain management ordinance carr complete >ectlOns A, B, C (or E), and G of thiS Elevation Certificate Complete the applicable Item(s) and sign below 31 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 information (Indicate the source and date of the elevation data In the Comments area below) 32 U A community offiCIal completed SectIon E for a bUilding located In Zone A (without a FEMA-Issued or community-Issued BFE) or Zone AO 33 U The follOWing information (Items G4-G9) IS provided for community floodplain management purposes 'IG4 PERMIT NUMBER I G5 -DATE PERMIT ISSUED G6 bAir= CE2KTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED 7 ThiS permIt has been Issued for U New Construction U Substantial Improvement 8 Elevation of as-bUilt lowest floor (lncludmg basement) of the bulldmg IS 9 BFE or (In Zone AO) depth of flooding at the bUildIng site IS ~OCAL OFFICIAL'S NAME OMMUNITY NAME IGNA TURE r::OMMENTS _ ft (m) Datum _ ft (m) Datum TITLE TELEPHONE DATE I I rMA Form 81-31, AUG 99 I_I Check here If attachments . REPLACES ALL PREVIOUS EDITIONS