HomeMy WebLinkAboutFEMA Application 1999-6-2
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01-~ 278B
FEDERAL EMERGENCY MANAGEMENT AGENCY
NA TIONAl FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
OM 8 No 3067-0077
Expires July 31 2002
Important: Read the inStructiOns on pages 1 - 7
SECTION A - PROPERTf OWNER INFORMATION
BUIL~NG OWNEq S ~ME
t:f;;O!ZDo/U i5~r eV-4;uS
BUILDING STRE::T. ADDRESS (IndudIng Apt Unit. SUIte and/or Bldg No) OR P 0 ROUTE AND BOX NO
&>bq~ 0-46015 !/ffJ-'6
CITY '-7 - ( ) STA~ -.0
~ Ct ~ ~ D '- \Jf 1Iiwf-Src~ Sl'lr~GFJct.o UI,-
PF-OPErq-yy DESCRIPTION (Lot and Block Numbers, Tax Parcel Numaer ~SClpnon, etc.)
\.-D, (r.7tf Lp,\/\ ~'~~~""_~ '2l-\4 MI-l~ I~ '~'f;V14flI7-0Z-JV-/1
BUILDING USE (e 9 , Re';HdentJal, Non-reSldentJal, Ac:MltIon, Accessory, etc.. Use ~.o.:...... $.:._." n~ry )
~es ~dI~ *Q.::<- \ ---- !v-6it/ _ _
LA TITUDElLONGITUDE (OPTIONAl) HORIZONTAl uA ruM.
( ##Q - #If - ## ##' or ## ~ U NAD 1927 U NAD 1983
I~ Insurance Company Use
POhC'J Numcer
Company NAIC Numoer
ZlP COg.; -"""\ _
c.-z..L'f78
SOURCE. U G?S (Type)
U USGS Quad Map U Other
SECTION 8 - FLOOD INSURANCE RATE MAP (ARM) INFORMATION
B1 NFIP COM~UNITY NAME & COMMUNITY NUMBER ,- 82. COUNTY NAM71_ '- L 83. STATE ,0
C ~~ ~ Srr""'~ f;d,,(":::415;;1 z.., ~ -- La..,e ~ LG>UvvT'- . - d f'..,
B4 MAP AND PANEL - . 85. SUFFIX - B6 FIRM INDEX B7 ARM PANEL" - 88.. FlOOD
NUMBER DATEI::l"'r-cCTlVElREV15EODATE Z~E(S)
l..\ 10 :::3q 0 \ \Lo(P ",xF-:-.:~ :r~'Zd~1q ~~ [,- vf'1Cf -; .~
B10. IndIcate the source of the Base Aood Bevabon (BFE) Ciafa or base flood depth ~ III B9
U FIS ~rotile_ ~RM _ .:- _= _ U- CAmmunrty Detenruned U Other (Describe):
B11 Indicate the elevation datum used for the BFE In 89 Q(NGVD 1929 U NAVD 1988 U Other (DesOlbe)
812 Is the bUilding located In a CAas1aJ Barner Resources System (CBRS) area orOthefWlSe Protected Area (OPA)? U Yes ~o
DeSignation Date
- 89. BASE FlOOD ELEVATlON(S)
, (Zone AO, use depth of floodIng)
A/fOJ;r::::: ft/l Zo~~ X
-
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C 1. Budding elevations are based on: UConstrudlon Drawmgs" UBuiiding Under ConstJUdlon* ~Firushed COnstrudlon
- ..!' A new Elevation Certrficate WID be reqUired when construdlon of the building IS complete.
C2. Building Diagram Number I? (Select the buddmg diagram most suniJar to the bwlding fur wtuch thiS certriicate IS bemg comDleted _ see
pages 6 -and 7 If no dlag-rain accurately -represents the bulldmg;prowie a sketch or photograph )
C3 Bevatlons - Zones A1-A30,-AE,-AH,-A (WIth 8FE), VE, V1-V30,V (WIth BFt), AR, APJA, APJPIE. APJA1-A30, ARJPIr., APJAO
Complete Items,C3a-l below according to the budOlng olagram speciied IT1 Item C2.. SlEt.e the dc.""'tum used, If the oatum IS amere"1:TTCm
the datum used for the BFE in Sedlon B,-::convertthe.datum to thatused.fur1he BEE..-ShowfiE!'O measurementS ana datum c:mvers.cn
calculation -Use the space provtded or the Comme..l., CUl;.a of SectIon 0 or Sealon G, as aDcrocnate. to oOCJme'1tthe cawl.. ........II'ersIOn
Datum ConvefSlonlCommems .
Elev.atJon rererence mark used Does tne elevation re'erencemancuseo accearonihe RRM? I I Yes I I Nc
~) Top of bottom rloor (incluolng casement orenc::osure) ~ /! L ft.(r{{) '~ - - ]
o b) Too ofnexthlgnef"noor .:::>/:3 -2~(r) i", ( REGISII~ED):
= v) :vu;,;;.. JIlu"""'':H IIUI"'-UIILd. ~....-u"".u.'o.l-m:.wu,,"' II ...~..;';.;, ~..."~ ..::::-/2-. _ ftlll.(\~:~ i~_ D~!>DF!U5!V80~~ ':
o a) Attacneo garage (too or Slael ----' ..J ~:: _ ~ ~ n :& iT vn
De) Lowest e'evatlon or macl1Inery anaior ectllomerr \, C c ~ d. - (.'. - -....- ,- _
.1:"/1- L/ "'- It) ~ ~ 1/.. I~(,""""I L./, _.-r A ~-r- ~
servlc ng the bUllcmg j , I, ," -= _ I ~VL/~'--'...-,
:J f) Lowest adlacent grade (U\G) .5// 6 ft,( ') ~ ~ t. /' i/ OREGON -.:
'7 / L 5"'" JJ. -; :r JULY 19, 199--1 ]
o g) Mlgnest aalace'1t graoe (hPG) _ ,dlt'J ~ GARy L C",,~1"IZn ,
:J h) NO or permanent ocemngs (naoo Ve'1rSl wrrhm 1 it aoove ao!.acem grace h :: ., ,.._2(;:;;)... / I
o I) T oral area of all permanent ooemngs (tlooo vents) In C2h ::; elf SG In !sa. effl) ,!:::X!'f It::: S > i / Ji) c"S-:-'" I
SECTION D - SURVEYOR, ENGINE=.~, OR ARCHITECT CE:mRCATIC)N
Tms cemiicatIon IS to De slgneo and seajed by a Jano survevor, engIneer, (Jr arc:utec:r autnonzea by law to cemry e!evatJon Information
r certIfy that the mronnaucn m Sections A, B, and C on thiS certJficate represents TTrJ best eiforts to Interpret the data available
understand that any false statement may be ounrsnable by fine or ImDnsonment under 18 US Cede Sec!wn 1001
CEqTIFIEq S NAME.,----, f\ ~ J- ~ / /' L1 0 ~ L'CENSE Nu^,ib2~ P c
~P"J<- I:"--)~ 'C:-/,-z:;:. - 4- ~,r...JTI...r/~ L;) CL.9-&:r 265g
TITLE c . OJCc.(COMPANY NAME--,
'-- J u. (- ..; 2vl )J\t..-{III 0 C; ~ J<.1(l v-e::-'1 o~ 15)" UIA,~ ~ I ""' -(6r ~J. R~
ADDRESS 3\0 'f\ ft~ <S\y-~ cln SG-r~Y\ h c 1.~.1::;IAT~rz ZIP CODE q 74-7 7
SIGNATURE D-:.r- U;7 ./ / _ L. - GATE I -j TeLEPHONE,- _ )
___ __ _ :r)V'~1:7 (A/v7Z~--7 (~I.(/ 7lf~-{)(P 3 7
IMPORT ANT In these spaces, copy the correspondmg mfonnabon from SectIon A.
BUILDIN~ STRE~T ADDRESS (IndudlOg Apt Unit Surte and/or B!dg No) OR P 0 ROUTE AND BOX NO
(/;0qVf ......14 c C' g /..V.AC"
CITY . . - STAn: Z'P CODE C NAIC N
-"'5 p T \\'-"c,-fi-~lJ- MiA no'"' y:z =''''1 ='"
. " is: !If(vcrIG t.o
SECTION 0 _ SURVEYOR. ENGINEE.~, OR ARCHITECT CERTIACATION (CONTINUED)
Copy both sides or thiS ElevatIOn Certificate for (1) commumty offical, (2) Insurance age'ltlcomcany, and (3) bUllomg owner
COMMENTS (' -
"*- l' 1+'1 ur C;OrYv..t, ~'~_\d BeV\~ -^kv~ 'rel"'1 c.. C~ \ ~e\~( "S.c/,.A.4Ve.. ('AA..+ \'^ tlu2-
c r I ) - t r j.: r ,,-
-Th1' jZ.(e. Or cu,,-b ",t {\". w>\<tpo" ,,~(w--In <GILL"-" (,1 ~'^'- <;o,,-tltuJed ('.vi,,!""'- oJ
~7f~ CVv\tf. --n,.,.(.~v')t6Y\ ~av'v'::'\f) th1 eleva.tL6'Y' c.f 511..6\ C.L\1j 04.~~ (J/v'\dt::<JJl.<<~(
jo e-(~vlLn~ z::; I'?" \ \ D&VD'2~ Wit"; u.~ed a<;, ~ ~"S\lS d e-levAhow') ~leyeol1
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 B~, ~mplete ItemS E11tJrOU9h S. Jf the BevatJon c:=eltliicate IS Intended for use as supportIng
mformation}or a LOMA or LOMR-F, Secbon C must be ca"j.Ji:.i,..d. :. . ,-- - - - - - -. - --
E 1 Building Diagram Numbe(-- . (Select the buikflng diagr3I11 most Sllnilar to the bl.~i J, '''.: for which ttus ...:.. ;.;;cate IS L,"*':f completed .:: - -
see pages 6 and 7.)f no diagram accUrately represents the building, p~ a s~ or ph~raph.)
E2. The fclp~of}~e~~ttorlj floorJmdUd!n9.~~ei1tor~)o!the buildinglS-~l =-1-\ ft.(m) , --, ~ \in.(an) LJ abOve or ~U below --=--
-::(checkone)thehlghestac:fjacentgrade.:- :;-'-j;::S ':.-=-' -----:-;::: = .-' - --.
E3 For Zone AD only: If no flood depth number IS available, IS the tpp ~fthe ~.., ftQOr ~ in a........ Jo...... wrth the .............mrty's ~~
_ . flood"la," management "",,"anee? Cry..', . GiiiO - .u UnIinoWil." ThiIOcal-o;.;.J..... iernlv 1IUs ~{_....Loii in - G.- -'- c._ .
SECTION F _ PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERT1ACATION '
The property owner or owner's authorized representatIVe who completes Sedlons A. B, and E for Zone A (WIthout a FEMA-lssued or
commumty-Issued BFE) or Zone AO must SIgn here
I For Insurance Company Use
Pollc-/ Numcer
PROPERTY uWN~K~:; UK uvVNER'S AUTHORIZED REPRESENTAIIVt;S NAME
~jJ~IE
ZlP CODE
l.ll I
ADDRESS ,
It:LEPHONE
LJAIt;
SIGNATURE
COMMENTS
L 1 ChecK here Ii attachments
SECTION G _COMMUNITY INFORMATION (OPTIONAL)
Tne local offiCial wno IS authonzed by law or c'u....,nce to ad..II....,l.:.rthe """.......mny'SilOOODtalIl ;;;m;.;gemenr-OftllI1aI1'""'-::T1 c::mICle!e
SectIOns A, S.- C (or E), and G of thiS Bevabon Ce,u;....,re. -:..eornplete the a"........,ol.. ~...,S) and-s;gn'be'ow
G 1 U Tne IntormatJon In Secnon C was taken rrom other dca.unemanon1nar~etramre:;~:.;;:.;,ea oy-a n--=~'IOr,
e.,gmeer, or arcnrtect wno IS authonzed by state or IccaJ taw to ceruiv e'e"OUUII .. ..u...........m (Inu,-..:=;ihe-source:ana ua.::: of-me
e'evatIOn aala In the Comments area belOW )
G2 U A communIty oTfiClal comole!ed SeCllon E for a bullOlng lccate<:! In Zone A (wnnom a F3lA-1SSUe<:! or c:::mmunnv-lSsue<:! E===. cr
Zone AO
G3 U Tne TOllowlng InTCrmatJon (Items G-l-Gs) IS oroVlceo Tor c:::mmurmv i1ccoclaln rr.anat;eTe'1t our:cses
I G4 FERMITNUM6E::O, \ G5 DAIl:.PERMITISSJEJ I G;; DAI~;:;;:=-;-~~,CAT=':rC:JMFL!ANCSCCCUFANC,{
I I~SJE:
G7 Tms permit has Dee., Issuea icr U New Construc:lOn U SUDstannaJ Imcro...o-ner:
G3 Elevation or as-bUilt lowest floor (lncualng basement) of the bUIIOIng IS
G9 SFE or (10 Zone AD) deptn of flccClng at the bullolng site IS
LOCAL o~;:ii:iAL's NAME
rUm) Datum
_ fL(m) Datum
111-=
I c!.E=HONE
COMMUNITY NAME
SIGNATUK;;
DAIl::
COMMENT;
1-J CheCK here If attachments
RE?LACES ALL PREVIOUS EDITIONS