HomeMy WebLinkAboutFEMA Application 1999-6-2
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FEDERAL EMERGENCY MANAGEMENT AGENCY
NA TJONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
Important:' Read the Instructions on pages 1 _ 7.
SECTION A - PROPERTY OWNER INFORMATION
8UILDINGOWNEqSNAME~. ~ ~ ~
\ 1.\ \.\P _ ) ,[" ~\
BUILDING S1'"REET ADDRESS (Indudlng Apt. Unit. Suite and/or 8idg I 0') OR-P 0 ROUTE AND SOX NO
(P 7'2 \ :Ta C ob. La\1e..
CITY \ STA~..L:J
S9Y~1l'~\d .. Uf'-...
P~OPSRTY OESCRlPTIO"J (Lot and Bloc.~ NwnbefS. Tax Parcel Numoer, Legal Descnpoon. etc.)
\..-Di- It 3 Ley \ L4V1d1~~ 'Zlt\.d J\.;O/iu~'
BUilDING USE (e 9 Pe<<,dentla" (Jon-residential. AdlJrtJon.Accessory, e'e:.. Use Comments sedlon" necessary )
?e-s ld~ -fQ c:.. \ _ .. _
LA TITUDEfLONGiTUDE (OPTIONAL) HORIZONTAL DAI UM SOURCE.. U G?S (fype)
( ##0 - ##' - ## #If' or ## ####:if') U HAD 1927 U NAD 1983 U USGS Quad Map
o M 8 No 3067-0077
ExpIres July 31, 2002
I For Insurance Company Use'
Policy Number
Company NAIC Numoer
ZlP :O~ 7 ~ 7 '7
U Other
SECTION 8 - FLOOD INSURANCE RATE MAP (ARM) INFORMATION
, 81 NFIPCOM~UNITYNAME&COMMUNITY~lJMBER 82.COUt-4TYNAM~) _ L - 183 s:~~ 10
~ Cl~ oJ SfY~~f\elo{-'-415;;'7z." La"1P ~U\IV\'1 U"'-,
84 MAP AND PANEL 85~ SUFFiX 86. FIRM INDEX 87 FIRM PANEL 1 88_ FLOOD
NUMBER t · (p -, DATE crr-cC11VElREVtSEDDATE Z~~(S)
~I 0 -::jqL.--\ ~t.p :-F -: " T~:Zrl11q :r~ t~ ~'fPfq. .. .... ./\
810. Indicate the source of the BasaAood BevatJOn (BFE) data or base-flood depth entered in B9. __
U FIS Protil.e_ _ _~IRM. ~ =_ L.:l Community Detemuned U Other (Oc..o...iLe)-.
811 Indicate the elevation datum used for the BFEin 89: Qs(NGVO 1929 U NAVD 1988 U Other (Desaloe):
812 Is the bUlldlngiocated In a Coastal Bamer Resources System (CaRS) area orOthe/WlSeprotectedArea (OPA)? U Yes ~o
DeSIgnation Date
69. BASE FLOOD ELEVATlON(S)
-00 (Zone-AO. ~e depth offfoodlng)
A) ().A.e. -tv- 2t7Vt e: X
SECTION C - BUIlDING ELEVATION INFORMATION (SURVEY REQUIRED)
Burldlng elevations are based on:' UConstructJon Drawmgs" UBuilding" Under Construction" /t1RnJshed Construction
* A new Elevation Certificate Will be reqUIred wherr....... ~.JdJan of the building IS compiete...
C2 BuIldmg DIagram Number 9!f (Select the building diagram most SImIlar to the buddingforwnlch thIS certIficate IS bemg comoleted _ see
pages 6 and 7 If no dIagram accurately represents the building, prOVIde a sketch or photograph_)
C3 ElevalJons - Zones A 1-A30.-AE. AH, A (with BFE), 'IE. V1-V30, V (WIth BFE). AR. ARIA. ARJ~ ARIA 1-A30. AR/AH AR/P.O
Complete-Items C3a-1 below according to the buiidlng dl39ram soecriied In Item C2. State the catum used If the oatum IS olffere'1r TrCm
the datum used for the BFE In SectIon B~convert the datum to- that used fartne BFE. Showtield measurements and datum conversion
calculatlorr Use the space prOVIded or the Comments area of S on 0 or Sedton G. as appropnate; to document the oarum conversIon
Datum}J (?VD 'ltt Convers/OnlCDmm~nts,... ,>-ee. eVeyS e...
Elt;.Yatlon reference mark used ~ .ve.. k' e \I eySe. Does the elevaton rererence mane used appear on the ARM?
tt")'l) Top of bottom floor (indUCing basement orendosure~ S I Z. ..l.. fl'..( ) (Q
~b)Topofnexthlgherfloor Cru..ol-;potte 514- ~ft ): "":-0;=_:""- .
o c) Bottom of lowest honzontal structural memner (V zones OnlY) AJ l)\. ~ ft( ) ::
~9) Attached garage (top of slab) '5 ,:3 . Q.. ft(
Ilt" e) Lowest elevatIon of machinery anolor eqUJomenr Iii ~ I
servlc:ng the burldlng 5/ 3 .g -f
~ f) Lowest adJacent grade (LAG) J!j /3 Z ft.( ) ~ _3..
tM" g) Hlgnest ad/acent grade (HAG) 5 J 3 ;:L it( ) ~..
er )r} ..:."-Jo or oermanent openrngs (flood vents) Wlthsn 1 ft. aC"ove ~clacent grace l ~ ~ \
1li"1) " otal area of al/ permanent openrngs (flood vents) In C3h 2, 02. 3 so 10. ~ ) ... {tv
SECTION 0 - SURVEYOR, ENGINEER, OR ARCHITJ:CT C~ J IFICA TlON
Tnrs certification IS to be signed and sealed by a land sUlveyor, engsneer, or an:tlltect ~onzed by law to cerllfy elevatlon Information
I certify that the mrormatlOn m SectJons A, B, and C on thts certIficate reoresents my best efforts to mteroret the data available
I understand that any false statement may be pumsnable by fine or ImDnsonment under 18 U S CDde, Section 1001
r TIFIER S NAME..,--; f\ <J ...L LICENSE NUMBER PI.;C
- K' e~'>C /4 ~ \"")eA "2- , / 2106 (c
III LE L:UMPANY NAM ~
ev ya ~ I "" -f: G~ Y"-''''). ~c
ADDRESS h e I.{ S 'A~ r.2.. liP Co,," q 7'f 7 7
-. ? ^ '::1. TElEPHON
~ U/tJ ~ I 7lf&>-{)fo 3 7
,(lJt,
"-H
'.
F='vIA Form 81-31 AUG 99
\...-; .
SEE REVERSE SIDE
REPLACES AI' PQJ:\/Ir'1l lco en,..,.,,..,,,,..
UYes ~No.
, i
i
REGI;:) I cRED
PROFESSIONAL
LAN}) SURVEVOFi
#" . . ///) 1
r~a /*P" / -
OREGON--"
JULY 20. 1993
REXA.. tn:IL /
~RM
~ (t/~llo-:J,
MPORT ANT In these spaces, copy the correspondmg mfonnatJon from S~fion A.
~UILDING STREE:T ADDRESS (IndudJng Apt Unit SUIte, and/or Bldg No) OR P U Kuu'i~N~ij';;U^ roiJ
(t? J ~ \ :Ja.L oh l..a V1 p -
Cirt' - STATE ZlP CODE
~ pr~-Y\~-h'C(d (J,'f2.... q,1f-rl
! For Insurance Company Use
PohC'f Number
Company NAIC Numoer
..
SECTION 0 _ SURVEYOR, ENGINEER, OR ARCHITECT CER11FlCATION (CONTINUED)
Copy both sides of thIs ElevatIon Certriicate for (1) commumty offic:al. (2) Insurance agenUcompany, and (3) budding owner
COMMENTS f .
* (' \+\.-1 U C;O('^".:.. ~'t'\a B~V\~ ;AavL 'rel"'1 0.. c.~\':le,ld '::::'':::II~Ve. C'.AA'+ I"" tluL
.., I r' r -~.' (' r I -
--\-,.,~, \-2.( e. eN C,.."," b '" t -\'tw "" l J 9"'\" t ,_ r (~,.-I" ,,,,fLL r-h r, 1N SJ)lL -M... '^' e d "0 '''! "'V of
.&-7~ CVv\tJ ~('{YSt6,^, ~-.:zV\tV\~ ~Y\ ele\la.t~6'^ d 51?-.6\ CI--\-u~~R,^,,- ~dC<.dJ~<,tc..{
<to &(~Vu.ntv\ 519. \ \ )J{oVD'24 WitS u.<,e) a<;, k Q,"Su'S cJ e-Ie,j~how') ~,e.yeov,
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 E 1 throUgh E3. If the BevaiJon Ce,~~ IS Intended for use as suppOft1J1g
mfonnatJon for a LOMA or LOMR-F, Section C must be compleled. -
E 1 8ulldlng DIagram Number - {S~lect the builcfmg Ql3gr<1m most sllnJlarto the building hwhich ttllSce.lJf.....~ IS being completed-
see pages 6 and7 _ Jf no dIagram acdJrately represents the budding, pro.Y'de a s;.,..i....l. or ~~::lraph.}
E2. The top of~~e_ ~~tto~ fl?oeJllldudu1g ~as';ment or enCloSUre) of the budding is I I I fl(m) I - 1 lin.(ern) 0 above or - U below -
- (check one) the highest adjacent grade.:::: - - -
E3 For Zone AD only: If no flood depth number IS avadable, IS the top of the bottom floor el,,,,,,.,j.:..J Irr accordance wrth the community's
f100dplam manag-ement ordinance? l~ Yes- U No U Unknown. The localoffiClal must certify thIS Irtfo....cX~n III Section G.-
SECTION F _ PROPt:r\l {OWNER (OR OWNER'S REPRESENTATIVE) CERTlACAll0N
The property owner or owner's authonzed representatJvewho completes SedionsA. B, and Efor Zone A (wrthouta F'""cMA-fssued or
commumty-fssued BFE) or Zone AO must Sign here.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTAT1VCS NAMl:
SIGNATURE
crr- i
DA-j"E.
STATE.
ZIP CODE
ADDRESS
TELEPHONE
COMMel'll.:l
SECTION G _ COMMUNITY tNFORMAT10N (OPTIONAL) ......"
The local offiClal who IS authonzed by law or ordmance to admImster the communrty's iloodplaln management ordinance can como tete
Sections A, 8. C (orE). and G of thIS 8evabon Certrticate. Complete the applicable stem(s) and SIgn below.
G 1 U The InformatIon In Section C was taken from other dOClJme. .lat...n that has-been SIgned and emoossed by a licensed-surveyor,
engmeer,orarchrtectwho ls..authonzed by state or local law to certIfy elevation I":v,,,~on. (Indicate the source and date of the
elevatIon data tn the Comments area below )
G2. U A community offiCIal completed Section E for a bUlldmg located In Zone A (wrthout a FEMA-ISSUed or communrty-fssued 8Ft:) or
Zone AO _
G3. U The following information (Items G4-(9) IS prOVIded for community f100d0laln management pUrPoses.
I G4 PERMIT NUMBER I G5 6Ki~t't:r,,,,,ITISSufD Go DATCCo:."'{ll;:iC;AIEOfCOMPLlANCElOCCUPANCY
ISSUED
G7 ThIS permIt has been ISSUed to: U New Construcnon U substantJai Imorovement
G8 Elevation of as-bUIlt lowest floor 0ndudmg basement) of the building IS
G9 8FE or On Zone AO) depth of flooding at the bUilding site IS.
LOCAL OFfICIAL'S NAME
1-1 Check here If attachments
_ ft.(m) Datum'
_ ft.(m) Datum.
TIT1.E
SIGNATURE
icl.EPHOrlE
DATE
COMMUNI1i' NAME
COMMENTS
LJ CheCK here If attachments .
REPLACES ALL PREVIOUS EDITIONS
FEMA Form 81-31, AUG 99