HomeMy WebLinkAboutFEMA Application 1999-6-2
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FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
o M B No 3067-0077
Expires July 31, 2002
Important: Read the InstructJons on pages 1 - 7
SECTION A - ROPERTY OWNER INFORMATION
BUILDING OWNER S NAME ~
_ C\ '.A ~ ~_M. 1-,.v\M
BUILDING STRE:T ADDRESS (IncludlngApt Un";t. Suite and/or Blcg No) OR P 0 ROUTE AND BOX NO
(073 '7 )t;=~r?V\ La Vl~
CITY .,- -. STAF
so'(~1l"~\d uK
PfOp~q1Y ~SCR1PTION (Lot and Block Numbers, Tax Parcel Numcer, Legal Desc:JptJon, etc.)
\.-..D, '-'jq Lpv \ l4~1d'lV\C, 'Z",d M/f ~ ~ .
BUILDING USE (e 9 , RerrloeniJai, Non-residential, AdtirtJon, Accessory, etc. Use Comments secao Il necessary )
"f?e-s l&c?-...,j-~Q t:<. \ _ _ _ "_
LA TITUDElLONGITUDE (OPTIONAL) . HORIZONTAL lJA I uM SOURCE U G?S (Type)
( ##0 - ##' - ## ##" or ## ####tf') U NAD 1927 U NAD 1983 U USGS Quad Map
For Insurance Company Use
PollC'} Numoer
Company NAIC Numoer
liP COq,s;
~ 7'177
U Other
SECTION B - FLOOD INSURANCE RATE MAP (FIRll)JNFORMAnON
81 NFIP COM~UNITY NAME & COMMUNITY NUM8ER 82. COUNTY NAM71_ l B3 STA~ to
CI.\.; od- SfY'~e~4 -4-IS;;1z" . vL,:_"': LOU'v\,'I__ _0___ Uf'...
84 MAP AND PANEL . e5 SUFFIX 86 FIRM INDEX ';j' rlRM PANEL Bll rLUUU
NUMBER DATE cl'"rI:CTlVEJREVISEDDATE ZqNj(S)
1-\\ 0 -=iq C...' \ \lot,o F -) :rLtN\t.'Zdq1~ r~ Z, t1-1'1" J<.
B10 IndIcate the source -;;f the Ba~e Flood Bevabon (BFE) data or base flood depth entered III B9
U FIS Profile ~IRM . _ U Community Detemuned U Other ([k.....~e)
811 Indicate the elevation datum used for the BFE In B9 ~NGVO 1929 U NAVD 1988 U Other (DesCflbe)
812 Is the bUilding located In a Coastal Bamer Resources System (CBRS) area or OtheJYliseProtected Area (OPA)? U Yes ~o
DeSignation Date _
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
BUlldmg elevations are based on' UConstrucbon Drawlngs* BUIlding UnderConstrucbon* UFinrshed ConstructIon
* A new ElevatIon Certrficate Will be requIred when construction of the building IS compfe!e
C2 BUlldmg Diagram Number 9? (Select the building diagram most Similar to the budding for which thIS certriicate IS beIng comoletea _ see
pages 6 and 7 If no dIagram accurately represents the building, proVloe a sketch or pbctcgraph )
C3 Elevations - Zones A 1-A30, AE, AH, A (With 8Ft:), VE, V1-V30, V (WIth 8Ft), AR, ARiA. ARiAE, ARiA 1-A30, ARiAH, ARiAO
Complete Items C3a-1 below according to the bUilding OIagram soecriied In item C2. Slae the datum used If the oatum IS ome'e'1t ITem
the datum used for the 8FE In Secbon B, convert the datum to that used for the EFE. Shmv 'field measurements and datum convers.on
calculation Use the space proVided or the Comments area Of Section 0 or Sedlon G, as aocrocnate, to oocume'lt the oatum conver-slon
Datum MbvD'zq Conversion/Comments Se.2..- 12 ell eV-5-e-
E]e~tJon reference mark used if<;ee... ~vc~oes me elevanon rere'e'lce man< used accear on the FIRM? U Yes Tt:J-No:
W'a) Top of bottom floor (indUCIng basement or enaosure) .5/ 2. !1.. it ( ) ~ I
ub) Top ofnexthlgnerflocr 515 lft.() ~ Y REGISTERED '\
o 9- Bottom of lowest honzontal structural memoer (V zones only) AJ IA _ ft. ( ~ ~ PROFESSIONAL
/1.it' CP Attached garage (top of slab) 514- .!i ft ( ) E -g LAND SURVEYOR
~) Lowest elevatIon Of machInery and/or eaUlPme'lt 5 5 i i J // /) L./ ~'
/ servlcmg the building _ I _ #r ~ {// /~
!::f J} Lowest adjacent grade (LAG) Z;/ ~ ~ i,q OREGON
I];("g) Highest aOJacent orade (HAG) 1? /4- L ft ( ) ~.r I JULY 20,1993
po(" ) - I ~ ~ I REX A tit:: I L
~ D No or permanent openings (flood vents) wlthm 1 it aoove aOJacent grace _J /":: \... .. ~R /
1tYi) Total area of all permanent openmgs (flood vents) 10 C3h ~ /y72- so lIl. (..........'n) ~ 12--/ g, I () 3
-
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
T nlS certIficatIon IS to be Signed and sealed by a L:Jnd surveyor, engineer, cr architect authcnzed by law to certrfy e/evatJon informatIon
I certify that the mrormation m Sections A, B, and C on thIS ceroticate represents my best e;rorts to mterpret the data available
I understand that anv false statement may be pUnishable by fine orlmpnsonment under 18 U S Cade, Section 1001
-qTIFIER S NAME.,-=-, f\ r.J ..L UCENSE NUMtlt:K"p
K" e '>G 1-1 ~ 1/&\ 2- L S '2/06 ((7
TiTL.:: C - LuMPANY NAM "
"' U. yV t{ 'fa I"'" -ec:.y ~"\ ~c
ADDRESS 3 \ 0 _ t=i,ft~ 'Sh-- CITf_ sOY- VY\~ h dv{ S_~j; rz ZIP CODE q 71.f 77
SIGNATURE . ~ /J. L/~ UATt: I .I Tt:L!::l-'HONf,,-)
-~b4- ~ ~U.Vle.- 2t3) 2LJo'Z r5lfl 7lf&-{)(P37
FEMA Form 81-31, AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
89. BASE FLOOD ElEVATION(S)
(Zone AOy,rse depth of flooding)
!1f J"v\R.. -It-v 7-~ X
\
\
"
IMPORTANT In these spaces, copy the corresponding InformatJon from Section A
BUILDING STREET ADDRESS.' ~C\u.dlng Apt Unal SUite, and/or Bldg No) OR P 0 Kuuif ANCBOi NU
&7?> C; 6J:? vI)\(' l_~& \1 .;P -
CITf .. STATE Z'P CODE
~ P r ,- y"\ c, fr-d J Q f2..- - - q Ilf 1 /
'4 ./ . J
! Fer Insurance Company Use
Pelic! Number
Ccmoany NAIC Numcer
SECTION 0 _ SURVEYOR, ENGINE:.~, OR ARCHITECT CERTIFICATI?N (CONTINUED)
Copy both Sides of this ElevatIon Certificate for (1) commumty omc:al (2) Insurance age'ltJcomoany, and (3) bUlldmg owner
, COMMENTS C r - ~ I; \ \ I
>Jt: "',+, (h r "':'P"'''''J )\C' I,l Be"~ ~v~ I-e'''.} c, 0.,; ,e eo( "','<:,..0 v ~ rA--c+ ''^ -t~
+r-{1 fl~(e., eN ct...orb "'At ~_ W\lJ9Ul'\.,J OJ (L.-ly!n lClu.V--n (T iw. '5/)L(.t~L0ed Cc.){\1e-~ O:r .
~7f~ CW\tR ~~~V'stoV'~ ~a\JII""~ ~'" ek\fa..t~o~ d 51'2.-.9\ C\\~ 0,1'-14."",,- o~db.dJi.<<'+::t.:(
.-to eL.~'vu.n~ ~ 19.1 \ )J&VDI2~ waS u~e.J ~llS d elev.t<.hows ~leyeOi1
U Check here If attachments
SECTION E. BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO and ZONE A (WITHOUT 8FE)
For Zone AO and Zone A (wIthout 8FE), complete Items E1 through E3. If the Bevabon Carl1ffc:ate IS Intended for use as supporlJng
mformation for a LOMA or LOMR-F, Section C must be campJeted.
E1 8uddmg DIagram Number - (Select the building diagram most Similar to the buikfmg fcrwhldl thIS certJficate IS besng completed-
see pages 6 and 7 If no diagram accLrately represents the budamg, provtde a sketch or t'~..k.~raph.)
E2. The top of the bottom floor Qndudmg basement or endosure) of the bUIlding is J I \ ~(m) I I hn.(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 I...k.... floor elevated In accordance wrth the community's
_ floodclaln management ordinance? I_I Yes L J No I J Unknown. The lccal ofliaaI must certify thIS tnformatlon In Secbon G.
SECTION F _ PROPERTY_OWNER (OR OWNER'S REPRESENTAT1VE) CERTlACATlON
The property o,:,ner or owner's authonzed representatIVe who completes Sections A, 8, and E for Zone A (wIthout a FEMA-Issued or
commumty-Issued 8FE) or Zone AO must Sign here
PRul"'cKTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE~S NAMt
ADDRESS
Cof
~AIE
ZIP CODE
SIGNATURE
UAll::
7fLEPHONE
COMMENTS
1-1 Check here If 6rtacnmems
SECTION G _ COMMUNITY INFORMATlON (01"' IluNAL)
The local offiCial who IS authonzed by law or oromance to adrmOlster the commurmy's f100aclam management orOlnance can comOle'e
Sections A, 8, C (or E), and G of thiS ElevatJon Certriicate Complete the aooncaole Item(s) and sign below
G 1 U The information In Sect10n C was taken from other documentation that has been Slgne!J ana emoossed by a hc:e'lsed survevor,
-engineer, or architect wno IS authonzed by state or local law to ceruiy e'f!valJon rrnormanon (InClC3te tne source ano Date of tr'e
elevation data In the Comments area below)
G2 U A _community offiCIal comcleted Sect10n E fer a bulldmg lecatea In Zone A (without a FEM,A-lssued or communrrv-lssueo EFq or
Zo_ne AO ,
G3 U Tne follOWing information (Items G4-G9) IS provloed lcr commUnity ficcoolatn manage'ile'1t purnoses
I G4 PERMIT NUMBER I G5 DATE PERMIT ISSUEJ I G~ UA~ l.:~:::Tif,CATc OF COMPLIANCE-OCCUPANCY
I _ I 1<: -::UC'"\
I -~
G7 Tms permIt has been Issued Tcr LJ New Constrtlc'Jon U Substannallmorove'ile'lt
G8 Elevation of as-bUilt lowest floor (lncuolng basement) of the buliomg IS
G9 BFE or (In Zone AO) depth of flooding at the buddmg site IS
LOCAL OFFICIAL S NAME
_ fi 1m) Datum
_ ft (m) Datum
lllLt
COMMUNITY NAME
lci.E0HUNE
SIGNATURE
DAfE
COMMENTS
I Check here If attachments
REPLACES ALL PREVIOUS EDITIONS
FEMA Form 81-31, AUG 99