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Home My WebLink AboutFEMA Application 1999-6-2 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE o M B No 3067-0077 Expires July 31, 2002 Important Read the instructions on pages 1 - 7 SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use Policy Number BUILDING OWNER'S NAME -Bruce Wiechert Custom Homes BUILDING STREET ADDRESS (Including Apt, Unit SUite, and/or Bldg No) OR P 0 ROUTE AND BOX NO .n.h~1 ,lrirnh I rint:l CITY Spnngfleld OR r-Ku,...ERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Descnptlon, etc) LOT \0'1 LeYl LaY)dll'l1J ?11r1 Ll.rlrll t lOr Fll e 75, Sll des 1152-1155. BUILDING USE (e 9 , Resldenlial, Non-resldentlal,-Addllion Accessory, atc Use a Comments area, If necessary ) ReSldentlal LA TITUDElLONGITUDE (OPTIONAL) ( ##0 _ ##' _ ## ##" or ## #####0) Company NAIC Number STATE ZIP CODE 9741,8 Lane Countv Plat Records HORIZONTAL DATUM LI NAD 1927 I_I NAD 1983 SOURCE I_I GPS (Type) I_I USGS Quad Map LI Other SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION _I B1 NFIP COMMUNITY NAME & COMMUNITY NUMBER I B2 COUNTY NAME I B3 STATE Sprlngfleld 415592 Lane OreQon B4 MAP AND PANEL B5 SUFFIX B6 FIRM INDEX B7 FIRM PANEL B8 FLOOD B9 BASE FLOOD ELEVATION(S) - - - - NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding) 41039C1166 F 6/2/99 6/2/99 X 13\0,"'" B 1 0 Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered In 89 I_I FIS Profile I_I FIRM bel Community Determined I_I Other (DeSCribe) B11 Indicate the elevation datum used for the BFE In B9 I_~I NGVD 1929 I_I NA VD 1988 1_-' Other (DeSCribe) B12 Is the bUIlding located In a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? I_I Yes 1;t..1 No DeSignation Date SECTION C. BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1 BUIlding elevations are based on 1_IConstructlon Drawmgs* 1~IBUlldlng Under Constructlon* 1_IFmlshed Construction *A new ElevatIon Certificate Will be reqUIred when construction of the bUilding IS complete C2 BUIlding Diagram Number Z, (Select the bUilding diagram most Similar to the bUlldmg for which thiS certificate IS being completed - see pages 6 and 7 If no diagram accurately represents the bUilding, prOVide a sketch or photograph) C3 Elevations - Zones A1-A30, AE, AH, A (With BFE), VE, V1-V30, V (With BFE), AR, ARIA, ARlAE, ARlA1-A30, ARlAH, ARlAO Complete Items C3 a-I below according to the bUilding diagram speCified In Item C2 State the datum used If the datum IS different from the datum used for the BFE In Section B, convert the datum to that used for the BFE Show field measurements and datum conversion calculation Use the space prOVided or the Comments area of SectIon D or Section G, as appropriate, to document the datum conversion Datum LCUl<\..- Conversion/Comments A:-Dn O.? 1 \0 UX.A-1.- DA"l\.J wi.. \0 12A"-.....k..~ -r e #A />.. uA=tM'r_ Elevation reference mark used %t..c.oM.<<Al?i-I-~ Does the elevation reference mark used appe~f~~~jr.?~~ o a) Top of bottom floor (lncludmg basement or enclosure) S \0 q. ft~) Iii 1. ":~~...;"1" t....~O,;it4V'<"'_AL. f o b) Top of next higher floor 'Sl? =4-ft(wt) ~ 1 LAND !ljU~1r"~ftOR l o c) Bottom of lowest hOrizontal structural member (V zones only) t-J JA _ ft (m) * ~ L~~..c_ _....__,-------.J o d) Attached garage (top of slab) W6:JM Plk~ _ ft (m) ~ -g \..... {/I /(\ Il o e) Lowest elevation of machmery and/or eqUipment ='"1- ~; ~~.1 ~ servicing the bUlldmg (DeSCribe In a Comments area ) ~~ y _~ ft (m) E ~r--"'---'-o~-~~ o f) Lowest adjacent (finished) grade (LAG) 'S l \ 2,'_ ft ($1st) ~ ~ j ~'( 1~. ,iS4 o g) Highest adjacent (finished) grade (HAG) 51 'Z.. _ _3_ ft (m) ~ !. jONATH~~4.t OAKES o h) No of permanent openings (flood vents) wlthm 1 ft above adjacent grade .J ,~_~_ ... o I) Total area of all permanent openings (flood vents) In C3 h sq In (sq cm) ,~~~ f\~c. ...::1 7 t1'l2.::..... SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION ThiS certIfication IS to be Signed and sealed by a land surveyor, engineer, or architect authOrized by law to certify elevation information / cerllfy that the informatIon In SectIOns A, 8, and C on thIS cerllficate represents my best efforls to Interpret the data avaIlable I understand that any false statement may be pUnishable by fine or Impflsonment under 18 U S Code, SectIon 1001 CERTlFIER'S NAME A 0 k LICENSE NUMBER JOnatnan . a es Oreaon L.S _ #2105 T1TLEf>rofesslOnal Lane Surveyor <p~rrgAeNYEK"~fneennq & SurveVlnq. Inc. ADDRESS B 2527 QTY STATE ZIP CODE P.U. OX _ tuqene OR 9740? SIGNATURE !A-, _ ili 1 II J { ; DATE TEi..i;pI;iPNE , ___c~ A-i..~ ~41/485-4505 i=FMA i=nrm R1_ ':\1 1111 ()() C::FF RF\lFRC::F C::lnF i=OR rONTINllATION RFPI ArFC:: AI I PRF\lIOIIC:: FnITlDNC:: IMPORTANT In these spaces, copy the corresponding information from Section A BUILDING STREET ADDRESS (Including Apt , Unit, SUite, and/or Bldg No) OR PO ROUTE AND BOX NO 6653 Jacob Lane STATE ZIP CODE Company NAIC Number Sprlngfleld OR 97478 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of thiS Elevation Certificate for (1) community offiCial, (2) Insurance agent/company, and (3) bUilding owner COMMENTS G-n'-( OF- 0PQ...I/'.luF, EZv."" bE-Ml ~A-vUL. De-x;2..(~" A? A c-t"rt?t-L-E-b "7l{\ rA4k..- \ f.-l.. 1\."*-- 'l"W v~ /ltt. ~ A=; ~ (\Ill \')OOt MI IJ~ l)tf... c..~ Q.a 'TV~ (D --n+€... '? \..U c [)(2...I...\.EA'L- oF 1'*L \\...\~?tL-\IC\.J Of- Col"lli:. ~ I1*U12~\t:}u Q.()~ C-tT'\ /)A-TVAA. 5\'2 '0\ ~ E: MA ,')l><-ltJ'(Il\. S\~ \ E.Li:>lATIQl.t'7 "7t-\-Ox.JI-J. HA..lE...&f..;t-l Ca~'-l.~7fb 10 \="€: M.A t>f>MO~ '-_I Check here If attachments SECTION E. BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (Without BFE), complete Items E1 through E4 If the Elevation Certificate IS Intended for use as supportmg mformatlon for a LOMA or LOMR-F, Section C must be completed E1 BUilding Diagram Number (Select the bUilding diagram most Similar to the bUilding for which thiS certificate IS being completed- see pages 6 and 7 If no diagram accurately represents the bUilding, provide a sketch or photograph) E2 The top of the bottom floor (mcludmg basement or enclosure) of the bUilding IS 1--1-1 ft (m) 1__1--110 (cm) I_I above or 1--1 below (check one) the highest adjacent grade (Use natural grade, If available) E3 For BUlldmg Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the bUilding IS 1_1_/ ft (m) 1_-I_11n (cm) above the highest adjacent grade Complete Items C3 hand C3 Ion front of form E4 For Zone AO only If no flood depth number IS available, IS the top of the bottom floor elevated In accordance with the community's f1oodolaln manaf1ement ordinance? I_I Yes I_' No I_I Unknown The local offiCial must certify thiS information In Section G SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authOrized representative who completes Sections A, B, C (Items C3 hand C3 I only), and E for Zone A (Without a FEMA-Issued or communitY-Issued BFE) or Zone AO must Sign here The statements In SectIons A, 8, C, and E are correct to the best of my knowledfJe PROPERTY OWNER'S OR OWNERS AUTHORIZED REPRESENTATIVE'S NAME For Insurance Company Use Policy Number CITY ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS L_I Check here If attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local offiCial who IS authOrized by law or ordinance to administer the community's floodplain management ordmance can complete Sections A, B, C (or E), and G of thiS Elevation Certificate Complete the applicable Item(s) and sign below G1 I_I The Information In Section C was taken from other documentation that has been Signed and embossed by a licensed surveyor, ~ engmeer, or architect who IS authOrized by state or local law to certify elevation information (Indicate the source and date of the ei'evatlon data om the Comments area below) G2 I-i A community offiCial completed Section E for a bUilding located In Zone A (Without a FEMA-Issued or communitY-Issued BFE) or Zone AO G3 1_-1 The follOWing mformatlon (Items G4-G9) IS proVided for community floodplain management purposes G4 PEBMlT NUMBER I G5 DATE PERMIT ISSUED I G6 DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7 ThiS permit has been Issued for I_I New Construction 1--1 Substantial Improvement G8 Elevation of as-bUilt lowest floor (mcludlng basement) of the bUIlding IS G9 BFE or (In Zone AD) depth of flooding at the bUilding site IS LOCAL OFFICIAL'S NAME ___ ft (m)Datum ___ ft (m)Datum TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS !__I Check here If attachments FFMA Fnrm fl1_11 1111 on RFPI ArF~ AI I PRF\lI()II~ FnlTl()N~