HomeMy WebLinkAboutMiscellaneous APPLICANT 6/11/2008
U S DEPARTMENT OF HOMELAND SECURITV
Federal Emergency Management Agency
NatIonal Flood Insurance Program
ELEVATION CERTIFICATE
UMl:S NO IODU-UUUO
EXPires Februarv 28 2009
A2 BUlldmg Street Address (mcludmg Apt, Unit SUite, and/or Bldg No) or P 0 Route and Box No
\'\1I.P Wl-A,.,O """"'1'
C,~ Sta~
-::,V t2J I-> t:.FlIdvO 0 /'- -
A3 Property Descnptlon (Lot and Block Numbers, Tax Parcel Number, Legal Descnptlon, ete)
"'3'.......es
Important Read the instructions on pagL
SECTION A - PROPERTY INFORMATION
w.:,c:Ja.I"'J.
-8
A 1 BUIlding Owner's Name
For Insurance Company Use
Policy Number
comp~any NAIC Number ~
ZIP Code
_"1.,,\'-\"'"
84 Map/Panel Number I
4ic5 ~'l ell 4 If ~
B10
A4 BUilding Use (e 9 1 ResIdential Non-Residential AdditIon, Accessory, ete) f2..a~\ DEi""ll~t.- -
AS LatItude/Longitude Lat Long HonzontalSW ~~ nftr1~ID
A6 Attach at least 2 photographs ofthe bUIlding If the Certl'ftcate IS being used to obtain flood Insura~ce n L.. V Lm:. fV L.-
A? BUilding Diagram Number~
A8 For a bUlldmg with a crawl space or enclosure(s), provide A9 For a bUlldmg with an attached garag~J p,rovlde
a) Square footage of crawl space or enciosure(s) (~'?D sq ft a) Square footage of attached gara!lJUN 11 7008 sq ft
b) No of permanent flood openings In the crawl space or 'I b) No of permanent flood opemngs m the attached garage
enclosure(s) walls WIthin 1 0 foot above adjacent grade \ walls WIthin 1 0 foot~ve adjacent grade
c) Total net area of flood openings InA8b f~z.. sqm c) TotalnetareaoffloO~~2slnA9b sqln
SECTION B _ FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1 NFIP Commumty Name & Community Number 82 County Name I 83 State
<61'l!.1k1.... fi.a. D ___ _ L,:j>. ~ Ii. 0 l1..t:;r"o,0-
B5 Suffix B6 FIRM Index B7 FIRM Panel B6 Flood B9 Base Flood Elevatlon(s) (Zone
Date Effecttve/Revlsed Date Zone(s) AO, use base flood depth)
As: 4- Af\ b
B11
B12
IndIcate the source of the Base Flood ElevatIon (BFE) data or base flood depth entered In Item B9
o FIS Profile C8J'IRM 0 Community Determined 0 Other (Describe)
Indicate elevation datum used for BFE In Item 89 ~ NGVD 1929 0 NAVD 1988 0 Other (Describe)
Is the bUlldmg located In a Coastal Barner Resources System (CBRS) area or OtherwIse Protected Area (OPA)?
Des,gnatlon Date " 0 CBRS 0 OPA
DYes
o No
SECTION C _ BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1 Building elevatIons are based on 0 ConstructIon Drawlngs* 0 BUlldmg Under Construction. rg FInished ConstructIon
*A new Elevation CertIficate will be reqUired when constructIon of the building IS complete
C2 Elevaj,ons -Zones A1-A30, AE, AH A (With BFE) VE V1-V30, V (With BFE), AR, APJA, APJAE, APJA1-A30, APJAH, APJAO Complete Items C2 a-g
below according to the bUilding diagram speCified m Item A7
Benchmark Utilized CoC.';'",1t 11'1\....." i' \<.!r'AAo..rr ,vertical Datum ~"" 'D '2.,"\
ConverSIon/Comments
a)
b)
c)
d)
e)
Top of bottom floor (Including basement, crawl space, or enclosure floor)
Top of the next higher floor
Bottom of the lowest horrzontal structural member (V Zones only)
AttaChed garage (top of slab)
Lowest elevatIon of machmery or equipment servicing the bUilding
(DeSCribe type of equipment In Comments)
Lowest adjacent (finished) grade (LAG)
HI9hest adjacent (finished) grade (HAG)
4 4-~
4-1',1..
Check the measurement used
Sf1.gJ feet 0 meters (Puerto RICO only)
J..Q....~ feet 0 meters (Puerto RICO only)
o feet 0 meters (Puerto RICO only)
=0 feet 0 melers (Puerto RICO only)
..f2-~ feet 0 meters (Puerto RICO only)
n
g)
_,P,O
4 (of>
44-'\
~[!] feet
~~feet
o meters (Puerto RICO only)
o meters (Puerto RICO only)
SECTION D . SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
ThIS certIfication IS to be Signed and sealed by a land surveyor engmeer, or archltect authortzed by law to certify elevatIon ~
informatIon J certify that the mformatlon on thIS CertIficate represents my best efforts to mterpref the data available ~<,v-t~ PHB't,r-
I understand that any false statement may be pUnIshable by fine orlmpnsonmenlunder 18 U S Code, SectIOn 1001 - <B-"" c,\ N t ~
o Check here If comments are prOVided on back of form <vt~" 'pf~..~
rN-\I:;/,~ .". 'rcIUhitwtA '54f>22. \If '~iJft ~~, <; l
Certifier s Name ' License Number \ffi..A" --. ... ~ -
t;~("I,-,~t;12.. HILL 'i n~L.ld b"'("I~ iiI? 1'1,.,(" UL. I ~ ' , ,T := .' ~
Title , Company Name n... . _ \ \ ~ OREGoN'lo/-
11'.)11:>0 nJ.. v '!>'T f>l:>1'\'1'_ C-- l=>. U'~p,,,, to /!)~ ..... ,,,,,,, ,:) "Vu .\J- ~
Address " .. Cl~- - Slate ZIP Code \ ~ '4RY i '" ~
SI9naturr~~ ,}., ~ (Plb~~etl ~~~;h:t,f3' ,nt,f..,-t 't/.,4 S "\\.\.S~ ~!~
"""A "ncm R1-~1 "phnmv 2006 See reverse Side for conllnuatlon I ~~~V,jffI!lr'ev%8Wp~;'o~