HomeMy WebLinkAboutFEMA Application 1999-6-2
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POAGE ENGINEERING
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Apr 12 '02
Fa~ S41-4S5-5624
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FEDEAAL EMERGENCY MANAGEMENT AGENCY
NA TlbNAI.. FLOOD INSURANCE PROGRAM
I
EUEVATION CERTIFICATE
Impo!'tltnt: Read the instructJons on pages 1 r 7
. SECTION A. PROPERTY OWNER INFOR~rl0N
~ on
P j5
o M.B. No 3067.(J077
ExpIres July 31, 20C2
6Ull.DlNG OWNER'S NAME
~ '-'1. \ \2.f"'? CJ.:>'1o- \' ~llAec...
aL ILO'NG STReET AOOFl.ESS (Ineludlng Apt., unit, SUIte, ana/Or BldgNo ) OR P 0 ROuTE AND BOX NO
\01'(01"'1 Jki)e:."'i:P (...~e-
CIrf --- 5 fATE
~Q!..ljoJ.(.>.F\'U.!;>. 02... "'\14'.,.
PROPERTY oeSCRIPT10N (Lot and Block Numbet'3, TIiIJl: Parcel NumCler, Legal DellQn;ltlon, ate) -
l.Qi 1I0 l-e.\l1 (..~D~N.~ 2.~A-t>Pl1'i\ct-J ,"I:1l....16~1"..1l)e...~ l\s;.,--\\~c:. t.A+4i- (..OVJ.L'i'f' ?lA=i ~(..(lI,Z.l)~_
. eUILD1NGUSE (I'I g., Residential. NQMe5ldenhal, Mdltiiiii, ACCeSSory, etc.. JlIe ~ommen1ll $~_.....lf neeA!Ssary 1
~~l Dl!-ou'T' ~
. l.ATmJDEI1.0NGIT1.JO!(OPTIONAl.) HO~IZONTAL DATUM SOUFl.CE. U GPS (Type) .
( #1f. ## ~ ## 11#' or jill'tf#mflf) W NAC'192i' U !'lAO 19a~ W USGS Quad Map W Other_
..-..-. '.. ~
SECTION a _ FLOOO INSURANCE RATE MAP (FIRM) JNFORMATION
t .
81. ~FIP COMMUNITY Nf<.ME & COMMU...Nj,.y NUMBelR.. I a2- COUNT'!'. . NAME ---r-;;;J sf STATE
-'bP~IM64=1.e.1.~ 4L?:;T1't..- __; ... lA\Me..- ' O~qq.J_
64 MAP,ANO P,.t\NEL a5. SUFFIX 86 FIRM INOEX S1 FIRM PANEl.. B8 FLOOO S9 BAse FLOOO El..EVATiO~(Si
NUMBER. OA T'E EFFECTI\lt;iREVlseo OA n: lONE(S) (Zonfl AO, US$ depth of f100dlngi
4\o'Y\G.- t\~ ~ Cc::> 2-'14'\0\ " Z qC\ )(. CS\O:1
e 1 O. Inclcste tne SOl.lrce of the BaISe Flood ElevatiOf' (8 FE! data or base flood depth entered In 99
U FlS profile LJ FjRM ~ COlJ'\mUnlty Detemllned U Other (Descrlbe)
B11 Indicate ~he elevation datum used forthli! SFE'ln 89 l1$NGYD 1929 U NAVO 1988 U Other (DesClibe)
612 J5 l/"lfJ buildl"g located In a C02S'tsl Barner ~e$ol.m:es S;stem (CSRS) area or OtherwIse Protected Ares (CPA)? U YH lfSNo
DeSIgnatIon ::late
I b. I
SECTION C. eUllf!NG EU:-VATION INFORMATION (SURVEY REQUIREOI
BUIld,ng elevatIons Ire based on L.JConst;ru~on DraWings" ~aUlldln9 Under Conitr1Jc:tlon. UFlMlShed Construction
. A new Ellll'/atlon Cenlfic:ate will bf:' required wh.n ::.onstruc1Jon of the bUIlding IS complete
:2 BUIlding Dloagrarn NtJrnber _ 'Z... (Se!e!:1 th'O' bu~dln~ dIagram most similar to the bUilding ~r Whl:;;h thIs certificate IS being ccmpleted - see
pages 6 and 1 If nO dl1l9rarn accl.lr~tely repres,"ts the building, provide a sketch or photograph) .
;3 Elevatlons _ Zones .A.1-A30, AE. AH. A {Wltt'l 8$. \'E. V1-V30. V (With 8F'E), AR, ARiA ARJAE, ARlA1~A~O, ARJAH, ARJAO
Complete Items C3<l-1 belOW accordlns; to the bcJildlng dIagram specified In Item C2 State the datum used If ttle datum 15 different from
the datum lJ!Sed for !he 8FE In Sectlon e, Q;ln"ett the datu/il to that used for the BFE Show field mS<Ulurernents and datvm ccnvetSlon
calculation. Use tt1e space prOVided or 'the C~ents area of Section D or Section G, as i1ppropnate to dcc:ument the datum conversion
Datum 1,Ac..~ Conve~lorVComrrlenulA"t> 0.1>' "to Lt:C""- QA.-"v~ 10 ~ ~e.M..A DAi'VM '-
Elevatlo/'l /'E!fe.rence mark used~ c;~~t.....~ Ooes ttle elevatlO'1 referen..ce... mati ,",sed appea~l'nl (' .". ...."..". " 1\0
a a) Top of bottom floor (lneludlng basement Off enclosure) CSl~ ~ ft.(_) 1 ....1. PROB EU AL f'
o b) Top of ne.xt high&( f1eor _ '5,&J, i ft (r;) In l LAND UJW'EYOR;
o c) Bot1om of lowest honzomal structural member (V zones only) ~ loA _ _ fl (m) I! 'I,. . ..... .....".... ......,..,.... -., II
~ ~~=~,;~;;~~:~."'"..equ~em ::: . ~:: !l~~ I
a f) Lowest adjacent grade (l..AG) ~\ 'a.. ...J:.. ft.(.) $ j l M.\'13. SliM 0
a g) Highest adjacent grade (HAG) '5 I"'; ..:k tl(m) Jl CD JONA-THAN A.. OAKES I
o h) No of permanent openrngs (flood ven.s) wjthm 1 ft. above adjacent grade. \ Cp j '" .,. ._.,"~...,..,,",. ., .....
o 0 Tota] area of aU permanent openings (flood;vents) In C3h Z,l \ So sq In (~ ~ ..~. ~t ~.Z- I
i II. \1 ' ., ~
SECTION 0 . SUR'irevO~. ENGINEER, OR ARCHITECT CERTIFICATION
rhlS ~rtl1icatJonls to be $Igned and Geal&d by a lanP surveyor, engll'leer. or architect autl1Qnzed by law to cettJfy e1evatIon'rnformatlon
cer1Jfy that tile Illforrnaflon tn Sec:tJons A. B, and C on thIS certificate repl1lsents my best efforts to intorpret tM ch.ta 8vs18ble.
under.:tand that anJi 'alse st.afemen't ma~ be pU"'IS~a~/8 by line or Imprisonment under 18 US COOe. Secbon 1001
:ERTIFIER'S NAME \....... , A o'"'\A d..l . WCENS.; NUMseR
----'V'NA.~ n.~::o OIZ (... ?,. ~os
!TUi CO~P"NY NAME
f"~~lqNM.- ~f). ~E-'(~tt- . ~....e.. ~1!J5~1J.g. ~ "j:p~&'rI~~N.C.,.o
.JRESS = em' STA' 4'10' COCE
..... 0 1bO'fuc,7...1 B.JC:.\W-E- 02- <<r1'4.00?
IONA TURE ~. I I \ I J DATE Tl::L..EPHONE ,.
41 J.Jr ~ ~ ~ v'1..- oo;A-\-~ ~
pnH(jE r::-WI.I[ER~Nr
__.,.;!. i.. ,-:J I~ 1 " FaA ::,41-4:iC,--C"4 -
~ __ _ _ , 0_ 'x. Hpt- 12 '02
~p.oRT ANT In these Spdce~, ~opy tnlt c;o:'\"t;''Spo!'Jl:ljng information from Section A.
i,J1L.DING ~ TRE.trr~O~:ess (InC1uCtn9 AQt., UM,~ulte, ,~ctlor 6ldg No) OR ? 0 ROUTe AND BOX NO
(pco1C( .,Jk:..Oe~ -~a-
;T;' - -- STAlE LIPCODE If;€.
'":;>Pc:z.l M~ \=,~ : O\lt.-~:14'im-
_ secTION 0 _ SURVEYOR, iNGINEER, Of( ARCHITeCT CERilFICATION (CONTINUED)
,O~y both sides of this ElevatIOn Cer.Jficate for (1) cornrnumty'otr.clsl. (2) Insurance l!lgen~co"l'lpany, and (3) bUlld!n~ owner
:QMMCNiS .JL.... .0. ,., ~ .......p
c::....1"N' elf ~(:>~l~;::ral.-~ e.P'~~~~ PR'~i-le.1i!..t> ~~ />or t.:.-....\?f:~ ~l,)r'<\'~ ,..... ,p- .....
, " I - .
;F ~ (.-VVI!> A<r ~ ....' O"""..-r O~ ~ ""'_ !!?J!c}...... ""f"","",?'" "'",,",""'- d'..... ,... ~.....,.;
)~ "'J"U!: ,kf~UVJ<<)>J ~ u. W ~1v<< <>, Z "'I, Pe.>\~ """"'" So'!> l \ ~..". ,""''' ."..,...... ~
_ a>-<-"~"tO 'F,e,""" PAi"'" I, I Checl< '""" IT .tlach~
Sf:CTION E _ SUILDING ELEVATION fNFOftMJ1.TION (SURVE't NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
;;L."" AO and Zone A (w<t<<Ul aFEi.'"" o:m.'''' I~' E11h",ugh E"4 If!he Elev'- eo"",,;" ~ ..t.ndvd for use .. ,QppoIf;tIg .
IformatlOn for 8 LOMA or LOtv'~F, $9CIJo" C must J:je completed
1 CSI,.uldmg Diagram Number (Select ti're bUlldng diagram most sll"111ar to the buJldmg for which t!'115 eertlficate 15 being completed-
see pages 6 and 7 If no dIagram accurately reprj3Sents the bUIlding. provide a sketch or p"ctDgraph )
2 The top of the bottorn floor (includIng basement ot aflclo$ure) of the bUIlding IS r I \ tt.(m) I 1 JiM (em) U abolle or U below
(cMeck one) the hIghest adjacent ;nlIde.
3 For BuridHl9 O'agrams 6-8 with openings (see pate 7), the next higher r.cor or elevated floor (elevatlOr'I OJ of t"e bunOll'1g IS
L I I ft em) LLJlrl.(Cn'l) above \tis highest aOJ/leent grade.
4 F"or Zone AO only If ilO flood oeptJ'l nl.lmber IS t\\'tllllllble, 1$ the top of the bottom floor elevated In accordar;ce With the. community'S
floodplali"\ management :.J1'd!flan~? I I Yes '1' h No LJ. Unk~ow" The local OffiCl~U:;lt certlfy 1hls ,"farnatlOn In SectIOr. G
SECTION F. PROPERTY WNER (OR OWNE.R'S REI:'RESENTATfVE) CERTIFICATION
- .-' .' ",
-"'e property' OWfler .;;Ir owner's autl1onz:ed represent~tlve who complete$ SectlOl"lS A. B. and E for lone A (wrlhout a FEMA-.ssuecl er
.ornmUt'l'ty-lssued SFE) or Zone AO must :SIgn Mere
'RO~t;.Krv OWNER'S O~ OWNE;R'S AUTHORIZEORE~RESENTAT1~ NAME
C;r(
~TAre
ZIP CoDe
.ODRESS
NA T'1JRE
OMMENTS
OAn;
iEl..EPrlONE
L....l.Chec~ here 1f at"uiCh".'eflts ,
SEC;TrO~COMMUNtTY INFORMATION (OPT~ONAll
;"'ocal CffiClSI who' is auttlOnz~ by law cr ordman=4 to administer 'he com-;;:;;:;uty's floodplain mano!gement ordInance COI'n complete
::'!lons A. S, C lor E), and G of .t1I~ Bevatron Certl1iqate Complete the apPlicable ,tem($) and sIgn below
U The InformatIon In section C was taKer from pther documantatlon that has be<en signed and embossed by a licensed surv~'or.
en<:;lIneer. or;.!rP.'~e(:t who IS,,4Uthorl.:ed by i>tale or toeallaw to certIfy elevation ,nformation (Indicate the source and date of the
?revatlot:l gat'lI"!tIe Comments area below),
U A com"ll!ltJI1y offiCIal ~mpl~ SectIon E for Ii bUIldIng loea1ed In Zone A (WIthout a FEMA-IS:5Ued or cor>1mUrllty-lssUed 8FE) or
Zone ~O. ' " , , " '
. U l11e fQIIOWlrlg Information' (ItemS ~G4-GS), IS p~lde:d for coml"(lumty floodplain managemenl purposes
4. PERMrf NuMBER I G5. OJI.TE PE.RMllf ISSUFD I ~ OA TE C~T1F1CATE uF COMPUANCElOCCUPANCY
, Issuec
This perrmt has been ISSUeo tor L New ConsltructJon U substanllallmprovt:ment
E=le~atlo~ of as-bUIlt fowest ftO,or ~ncludll'lg basem~t) of the butldll1g IS -
SF c or (In Zone ;'0) dept!1,Qf flooding at the oUfI~g SIte 1$
leAl. OFFICIAL'S NAME
_ ft.vn> D:stum
_ ft.(m) Datum
TInE
)MMUNfT'V NAME
TEl.E?HONIi
DATE
:;NAru~E
)MMENTS
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_ , I Ch~lc herf! if attachments ,
~~I Ai"'~<:; All P~FlliniT<:; J;nITinN~
14 t:nl'1Tl R1...~' Al 1(.; ~Q