HomeMy WebLinkAboutFEMA Application 1999-6-2
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PORG'E EI~rjlh,EERlI'iG
Fn' 541-485-5624
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Apr 1.2 '02
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FEDEAA- EMERGENCY MANAGEMEN1' AGENCY
NA TII lNAL FLOOD INSURANCE PROGRAM
ELtVATION CERTIFICATE
Importaf'tt: Read .~ instructions on ~ages 1 - 7
SECTldN A _ PROPERiV OW~ER lNFORMATION
o M.B No 3067-0C77
8cplre-s July 31,2002
si.JII.-OU'IG OWNER'S NAME
i"OM ~ l~~ cp"i!::-r: ri"OMe.or~____
6UILOtNG- STREE"T ADDRESS (ll'lChJCllng Apt., Unrt, SUlte, ilIllilor Bidg, No) OR P 0 i=l:OlJiE AND 130)( NO
(j?"1Ci ->J>c.vo~;.1 L.~e-
CITY - STATE
'\7Pst.\~F'~ ... ~ _ oa-
_ PROPER-rt DaSCRtPiION (Lot inO Block Numoers T~ Pa~ N..lmbe'. Legal DssCl1ptlon, et:: )
t,.OT (\ z. LE\JL_~CH~3;.t~ .......tc>l,.\~ Pl,-'i.- '1S I ~\ tl'Z-~ \\?Z," H~1,c:1 ~ '-Ou~-n;
-SUILDING USE (c 9, RlfSldentlal, NCln~sldenl1al, Addlbpn. Al:a!Ssory, elc:. Use CQmments l;edlCI'l ff n~liry )
:oLe..;.' t:eM-n ~ . - -
-lA TmJoE1t.b";C;~De (OPTIOt-U\L)
( "~1#.II=#W Qr It#~)
~\..~ IZ-e~~
HORIZONTAl. UA ruM
U ~~ r9:;17 U NAO 196:3
SOURce LJ GPS (Typer_
U USGS Qt,lad Map W 0Ihflf" ~ --
. SECTION B .F~OOD Il'\ISURANCE')lATE ~p (FIRM) iNFORMATION __
81 NFIP COMMUNITY NAMe #. COMMuNITY NUM6e~ I'. 62 COUNTY. N..A. M~ I 83 STATE
-6f'2o..l4TJP'~\). .4\159=\2 ~~ ! 02.-1:"~QI-.l
64 MAPANO PANEL.-S5- suFFtx SS, FIRMIII'cCEX 97 FIF4"vl "'ANEL ~FLOO' 69 BASi:FLOODELE'JArlON{S)
NUM85~ bATE EFFECiIVE/ReV1SEO DATF (ZONi:(S) (Zone AD, use deolh Qt flooding)
.{.to~c.\{~ ~. (p.Z.f\~. iO'Z-ctC, -J.4~7~k)<'. '5'L\.\
610 Indicate the source of 1l1~ Base Flood E.!ft'-aUol1 (8FE) data or base 1Iood depth ent~red 'n es.
w FrS Profile LJ F1R!y1 'C::':1 Commu1'llly DetermIned U Other (Dese.'lbel
911 IndIcate 1M elevatIon datum usl'd for the SFt: ,., 89: 6-NGVD "929 U NAVe 19B8 U Other (DesG:ibe)'.
;J12 15 the bUlldlMg localed 111 a Coastal Bamer Res~urCa5 System (CaRS) area ~r OthelWl~e Protected Ares (OPA)? U'res Lt9-No
DeSlgl'1atlon Cate_
- Sc':TION C - eU'l~Ip.jG fLEYAilON iNFORMATION (SURVEYREQUIRED)
Buddin; !!'Ievatlons are ~\ased Olt' UConstrUd:pr'lOrawmgs'; lffiUlldll'l9 L-nder ConstructIon" UFlnll.hed Construdlo'1
ftA new ElevatIon Certrfica1e will be required whelrl constructlon of the bUIlding 1$ complete
:::2 BllIldlng D139l"arrl Number ..-k (Select the t:ulltimg diagram most sImilar to the bUIlding for whIch thiS certificate IS being COtnJ;leted . ~ee
pages 6 and 7 If no diagnlm accurately represents Ihe bUilding, "rcv1de a sketch or pr,otograph )
;3 Elev~tJons-Zcne$ A1-A30. AE. Arl, A (with 6Fli), VE, V1-V30, V (With 6FE), AR. ARiA. AR!AE, AR/A1.A30. ARlAH, ARJAO
Complete Items C~tH belOW aeeord'ng to 'he buBdJI"'Q' diagram apeelfled In i1em C2. State the datum used If the catum IS cllfferent from
the oatu'1l l.J$ed for the 6FE n~ Saon S, convert the datum to that used tar the SFE Show field measuremen1s and datum con'lenilon
calculation. Use tt'le space provided or tj1e Com~f\ent$ area 0' Section D or SectJon G, a5 appropnate, to document the dOltum conversion
Datum ,-,oC-1"'<",- COl"lvers1on/Ccmmllfltt ....t:>oc o_~.. \O~~ ~\VM /0 ~. ~- e.M j. ~fI\.
elevation T@ferenC<! mark lJsed ~. COIl4.~'..fl''C.7 _ Does the elevation reference mark used dppea..-- . "lo
o a) TQP of bottom floor 0ncllldlng basf!lTlent or fendOllure} S \ "1... 5l.... ft \~ '3' p ,
o b)Tcp of next higher floor ...$\~ ~ft {fa} II) i UN $UAtI"ltYO.
1.. ' n
o 1;) Bottom ofJc~st hOr'l%ot"tal stnJc:tI.Jral member (V zones only) ~f.JI"v _ __1t (m) :::! ., ......, .................... ,....,.. ....".""..., ........,
o d) Attae,.,ed garage (top of slab) oS\ ~ ..A.1t.(.) f I ~
Q e) Lowest elevatlon ot machinery and/or equfrlment ~ to' =--~ A.
~~==~b) - ~:} }~~ i' (~m~r'OAK;~ I
o h) '0 01 ._anon! oP'''''''' (nood vent.) ""In 1ft aba,..d,.""", ""de ~ - ~ . -. - ..' Ji1!1\...,., .. . -) i
o 1) Total <lrea of all permanent opening!> (flood ~Bnts) In C:Jh \ ~"S, sq In \~ aA/Ji".." I",~~ t:?9?..~
SECTION 0 - .SURV'eyO~, ENGINEER, OR ARCHITECT CERTIFICATION '
rhls certificatIOn /s (0 be sJ~ned arid $eal~ by a Jan~ surveyor, @ngrl'lPer, or archItect i!l.ltnorued by law to r.::erUfy elevatJon iofomlatloo.
certJ1Y tllBt the I17formstion m Sed10ns A. e. and C QfJ thIS t;ettfffcate (1!presents my best effofU to mtetplTlt the dats 8l1SiBble.sunderstand t+tstani!.!2ise Sf8',#If,.;.n't may
be pUnJsfl~ble by fine Qf Im/jflsonmsnt under 18 US Code, Section 10D1
'ERT1FIER'S N.AME J ~. V'\. _ _... LICENSE NUMBER
....._ Co/J~ -f\ ~ QI2. \.....," ~\ot;
e COMPANY NAME
. .f"Q.Of:~IO~AL- ~() ~a-\.te.."C"ofl- ~ ~1.,J.~G.4~ J ~e,'t'lt..lC.>.....J.""'-
""U ~ L '::':>~ . ..... _S-7~_ ~n'..-r-c:, ZIP coce
lGNATUFtE ~.A t)~ OATE.-- ..."........ ~~H'ONE
Z 1,..l O"Z- ~c:;.4(. .~..~ _
FOAGE E\liJII'>JEEF :HG F3X C:41-~"S-c - -'4
, ,'~ " _'0"; Apr 1.2 '02 (3 5S P I;>
lPQRT ft,if.-i~11'I these spa<:es, eopythe ~orrespg~dtng Informatlon from Section A. .0 'P I, 12m.
]LOING <TRElIT ",oRESS ".~,d", "'" "M, M., ,_,... "") oR e 0 .OUTE A"" .'OX N .-,,""'~
.., "'~r' ----M--1~ .. <~~
~c l ~............e-::o...... .,..-- - -ZIP cooE.i~S:9m' -..
il'( , STATE '11411 jl:j~"""
~PQ..l~"~' e..<.-b I ... oa-, - TIO'" (CO~IT1NUEO')
_ secTION 0 . SURVEYOR, lEN<:iINa;ER. OR ARCHITE:CT~IF1CA " ...
"",__ ,"es of.... e,"';;on Celtfi- for (1) col"mu"," off",al, (2) "'~"" ..entJcomp'ny, and 13) bodd,,,,, own...
~~" .",...., ~ .., !be.' -'"""""""'."'!-<'- __ "" ....., ~., ... """ """-"~ ~,,-,,- ,..., """"" "",,, OF ........
""'"" "" nTL ,"01'0'''' Dl' ~ c.<JO..ll> "i'TV'OJ-l "'" T1'f'~ -.....4- of n-\E. ,...~..~'t"I04~ .
n"*....T ... -rtWUltO'" "'" vl'N' b",,"'"' S ,.. ",' r.e "'). _-'.n' I>!'" I' (i,~" .. ,.".., ......,,'41-1
~e. ",;".... =;.. ,,~b It> ~ '" ........ OM\) '^ . _ I I Cl1eCI< here !!..tlochmonts
SECTION e . auU:'OING ELEVATION !NFORM4Tl0N (SURVEY NOT R~lJlJ!REO) FOR ZONE AO AND ZONE A (WliHOUT BFE)
;;z:Qne AO and Zone A (wIthOut BFE). complete Items E1 through E4. If the ElevatIOn' Certrficate is /l'It~nded for use as $UP,;oTtrng
formatIOn for a LOMA or LOMR.F, S6Ct1On C mU$t t>> completed.
1 Bulldu"g DIagram Number __ (Select t'1e bUlld~g diagram most Slrr\ltar to the buIlding fer wtucn thiS certl'lit:ate IS being completetl-
see pilg~ 6 and 7 If no dIagram aCCI.Ill!tely reprtsentS the !)uddtng. pro'o'lde a sketch or phOtograph)
2 The \01' of the bottom floor (Including basemert 011 Mclosure) of the bUilding IS t I ~ ft(rn) i I lln_(cm) U <!loove Of U below
(check one) the nighest adJscant grade.
3 For B\.Ildmg Diagrams 6-8 wrth openings (see pa!il" 7). the next hlQher floor or elevated f1eor (elevation b) of the bUIlding 1$
I 1 I ft (rn) L-LJln (em) above the highest adJ'cent grade.
~ For Zone AO only If no flooo depth number 15 av."able. IS the tep of the ~uttom floor elav;nO!l:lln :;l1"~rt1ance With the communIty's
lloodplclln mana~ement ordinance? 1-1 Yes I~ U Unknown The !~O'fficlal must certify thIS InfQI1"atJOn In S~Jon G
SECTION ~. PROPERTY ER lOR OWNER'S Rl::l"RESENTATIVE) CeRTIFICATION
=j;. pr~perty o"';'ner or owne~$ ilIuthoru:ed representabv, who completes sections A, e,and E for Zone ~ (WIthout ;!II FEMA*,s$u8d or
ommunrty-IS$Ued BFE) or Zcne AO must sign nere
'ROPEFl.TY OWNE~S OR ()~-V~N;;/'\'5 AUi~O~IZ!;O Fte:P~ESENTATJVES NAME
CITY
OATE
STAT!
ZIP c..ODEi
,t>ClRESS
TEI.=PHON"
~fUR.E
,Me~TS
1_' Check here If attachments
SECTION G'. COMMU~ITY INF6RMA TION (OPTIONAL.)
slocal Offi021 who 1$ aLrthonzed by faw or o~dlnance to administer the communIty's floodplain rnal"a5lement ord.manes can complete'
ctfomi A, 8. C (or E), and G ofthls elevation CertjF~1e. Complete the applicable Item(s) and sign below.
U The InformatIOn Jl'1 Section C was taken from ~/'ler docurnentallon that '!as been signed and embossed by 11 licensed surveyor,
eng1n>eer. .~ a~l~ ~h~ rs~ authorIZed by stat. or locall<lW to certify elevation InformatIon (lndlcatl:t ~he SOUfC8 and date &f the
,elevation ~a~ In tJ'le" Comments area below)
U A comrmsn~ offiCla~ CCl~'prl1!t@d ,sectIon E for III bl.lldlng JOCOlted in lone A (WIthout a FEMA~issued or CClmmunlty-rssu~ BFE) or
Zone ')\0 <
U The fOllo.....1I1glnformatlbn (ItemS' G4-G9) 1$ pr,*ded far oommunlty floodplain management PUlllOSe5
4. PERMIT NUMBER - I G5. OATEPERMlT'IS5UEO I G6 o.io.J'ECERTIFICATEOFcOMPUANCElOC:;CuPANCY
. ---1--.- ISSUEO
This permit ha:s ,been ISSUed for W New ConstftJctlon U sucstantJallmprovement
Elevation of as-built lowest floor (including basemel\lt) of the building Is
8FE ot (in _Zone AO) depth 01 flooding at the build11tl site IS
lCAL OFFICIAl. S NAME
_ ft.(m) Datum:
_ ft (m) natum
nn.!:
JMMUNITY NAI\~e
TEU:PHONE
:;NAiURE
OATE
)MMENTS
, Check here If attacnments
i=l~1 A('S:;c; Al r PRt=Vlnl J~ ~lTInN~
'A I=t'lm'l 141_'-\1 Al Jf; Q~