HomeMy WebLinkAboutPermit Miscellaneous 1991-1-19
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FEDERAL EMER3ENCY MANAGEMENT AGENl.. Y
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
Important Readthe ,"strudlonson pages 1-7
SECTIONA. PROPERTY OWNER INFORrNlTION
BUILDII'I3 OV>NER'S NAME
Robert Mentze
BUILDII'I3 STREET ADDRESS (Including Apt Unit, SUlte,and/orBldg No lOR PO ROUTE AND BOX NO
2062 Harbor Dnve
CrTY STATE
Spnngfilerd Or
PROPERTY DESCRIPTOI\I (Lot and BlockNumbers,Tax Parcel Numl:er Legal Descnpbon,etc )
1B-03.11,22 # 3500
BUILDIN3 USE (e 9 Residential Non-reSldentlalAddrtlon Accessory, etc Use a Comments area, If necessary )
Residential
OM B No 3067-0077
Expl/'6s December 31, 2005
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forlnsumn<:eCom""ryl.Jss ._.J
PolICV Number I
Comoorw NAlC Number
I
ZI P COD::
97477
LATITUDElLONGITUDE(OPTIONAL)
( I#f, ##', ####" or ## #II#I#f)
HORIZONTAL DATUM
IZI NAD 1927 0 NAD 1983
SOURCE 0 GPS (Type)_
o USGS Quad Map
o Other
SECTION B - FLOOD INSLRANCE RATE MAP (FRM) INFORMATION
I Bl NRPCOMMUNllY NAME&COMMUNITYNUMBER
Spnngfeld Crty of & 415592
B4 MAP AND PANEL
NUMBER
41039c1142F
I B2 COUNTY NAME
Lane
B7 RRM PANEL
EFFECTtVE1REVlSHDATE
&\l211ggg
B8 FLOODZONE~)
X
B9 BASEFLOODELEVATlON(S)
(ZoneAO useooph of1bo<lng)
4500
Bl0 IndICate the sour", of the Ba'" Food Elevaton (BFEldataorba", fbod depth entered ~ B9
o FIS Profile IZi FIRM 0 CommunlyDeterrmned DOther{Oes:nbel _
Bl1 IndICate the elevabon dalJm used forthe BFEIO B9 IZi NGVO 1929 0 NAVO 1988 0 Other(Oes:nbe) _
B12 Is the b~ldlng located In a Coastal BamerResourteS s,.tem (CBRSI..-eaorOtherNl:E Proleded km (OPA)? 0 Yes I8J No OestgnalJorDate_
SECTIONC - BUILDING ELEVATION INFORMATION(SURVEY REQUIRBJ)
Cl BukJ~g elevatJCI1s are based on 0 Con&rudlCl1 Orawngs" 0 BUI~IOg UrderCCI1strudion" IZi FlnSled Construdon
*A new Elevatloo Certificate wm be reqUlTedwhen cons1rudon of the bUlkllOg IS compete
C2 Buldng Dagram Nunber ~ (Select the bUilding d~gr!rn most Slmla- to tbe bUilding forwhld1 thIS certlfiOlte IS beng compleled see pages 6 and 7 If no dl"]ram
accuratelyrepr"",nt the bUlldng pro"de a sketch or photograph )
C3 Ele\Elbons-ZonesAl,A3l AE AH A (wrthBFEI VE VI V30,V (Wlfl BFE),AR ARIA AAlPE ARlAI.A30ARIAH ARlAO
Compete Items C3 -a-I below according to the buidng dagramspecfied In llem C2 State the dalum used If the datum. dtfurantfromthe datum usedfortheBFE In
SedJon S, comet the dahrn to that used for the SFE Showfiek:t mea9Jrements and dcium conWf'SlOn calaJiatcn Use the space prowed or the Conments area of
Sedlon D or Section G as appropnate, to dOQunent the dahJm comerSK:>n
Datum ConverSlOnlCorrrnents
Ele\<ltcn reference mark used tbm#303 Ooes the elevaton refer<nce ma1< used appear on the FIRM? 0 Yes IZi No
a) Top ofbott>m floor(IOctudng ba"'mentor endosural 453 75 flin)
bl Top of next higher floor _ _fi 1m}
cl Bott>moflowesthortalntalstructuralmember(Vzones only) _ _fl(m)
dlAttad1ed gar"]e (lop of slab) _ _fl(m)
eJ Lowe<l elevanon ofmachtneryandlorequpment
s.....,clngthebuld~g(Des::ribelOaComm"'tsarm) _ _fl(m)
D Lowest adJa",nt (fmshed) grade (lAG) 450 95 flin)
g) H~hest a~a"'nt(finlsbed} graa, (HAG) 450 95 ft 1m)
hi No ofpermanentop""ngs (fbod venls)wrthn 1 fl aboveadJacert grade ~
I) Total area ofalpemmentopenngs (floodvenls) ~C3 h 1080 sq In (sq em)
B5 SUFRX
B6 FIRMINDEXDATE
r\
I B3 STATE
Oregon
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+ REGISTERED 1
" ~~EfESSIONAL
I ~o-syRVEYOR
'-..~~
l EGON ' J
J AN ARY 19 1993
JAMES T MeLAUGI--fLIN
2583
EXPIRES 12/31/06
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SECTION D - SURVEYOR,ENGINEER OR ARCHfTEClCERTIFICATlON
This certlficanon IS to be signed and sealed by a land surveyor engIneer or architect authonzed by law to certIfy elevation mformatIon
I certify that the mformatlOn m SectIOns A, B, and C on this certIficate represents my best efforts to mterpret the data available
I understand/hat an~ false statement mavbe Dumshable bvfine orlmonsonment under 18 U S Code Sed/on 1001
CERTIFIER SNAME JT McLa41hll~ L1CENSENUMBER2583
TlllERegstera:! Profess"nal Lard SUIVe\<lr
COMPANY NAME
ADORESS
2428
SIGNATU
CITY
Spnng'ield
DATE
12 20 2005
,
FEMA Form 81-31, Jarluary 2003
u
See reverse Side for continuation
STATE
OR
TELEPHONE
541'729-4886
ZIP CODE
97477
Replaces all prevIous edrtlons
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,
,
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,
IMPORTANT In thesespaces, copy the correspondng ,nformatoo from SeclDn A.
BUILDINGSTREETADDRESS(lndudlngApt Und Surte and'orBIC\J No )ORPO ROUTEANDBOXNO
2062 HarborDnve
CITY
Spmngfeld
I for tnsuranCoCompary iii,- LI
PoIlCV Number I
Comoarw NAlC Number
SECTIOND - SURVEYOR,ENGINEER,ORARCHITECTCERTIFIOITION ICONTINUED_ L._.
STATE
OR
ZIP CODE
97477
I
J
CopyboltJ sides ofth~ Ele_n CertJlcatefor (1 ) communlyoffiaal (2) In"",nee ag",VoolTl'any and (3) bW~I~ owner
COMMENTS
Th~e~wtJ:>nwas based on a CrtyofSpnngle~ TBM #ilO3. Ele_n 0 445 12
[l Checkhere,fattachments
SECTlONE. BUILDING ELEVATION INFffiMATION (SURVEY NOT REQUIRED)FORZONEAO AND ZONEA (WITHOUTBFE)
For ZoneAO and ZoneA (wlttout8FEI complele llems E1 thro41h E4 If the EIevaba1 C_ ~ ,nEnded foruse as suppoilllg rrtorrratDn b- aLOMAor LDMR F
Sedion C must be compleled
El 8uking OI<'QraTl Nunber _(Select the bUlking dagra11 most smlB'1o the bUlkl~ forwtlldl th~ certJliOlIe ~ be~g compleled - see pages 6 al'd 7 If no d"lJl"m acaJratay
repre",nts the bu,l<lng proYde a sketdl or phologr'l'h )
E2 ne top of the bott"" fbor(lneludl~ basement orendosure) of the bUlldmg IS _ ft(mLln (em) 0 abo,," or 0 below (check one)the h~hest adjaCEnt graa. (Use
natural gra<il, ~ava~~)
E3 For8uld~g Diagrams6-8 wrth ope~ngs (seepage 7) the next h~erfloo:or elel.aiedfloo: (elevaba1b) ofthebUlklng ~ _ ft(m)_m (em) aho... the h~hestadJilCl'nt
gra'" Canplele rtems C3 hand C3 IOn froot alorm
E4 The top of the pla~orm of machlneryandklr equpmentselV"mg the buld~g ~ _ ft(mLln (em) 0 abo... or 0 below (check one} the h~hestadJaCEnt gram (Use
natural graa. ~avarlab~)
E5 For Zone AO only Ifno flooo deptil nurrber IS avalBble IS thetop of the bottom floor elevated In accadance wrth the commll1rty's tloodpBm managerrentordlnance?
OYes ONo OUnkoown Thelocaoffc.lmustea1fyth..,f~..~u,"nSeclonG
SECTIONF . PROPERTY OWNER (OR OWNER'SREPRESENTATIVE)CERTlFICATlON
The proreflyow,"" or ow,"" s authonzed represenlatl\e woo compleles Sedions A, B C (~a11S C311 al'd C3J only) and E for Zone A (wlt1out a FEMAiSSued or communrty.
ISSued BFE)orZone AO must s~n here. The statements rJ SedJonsA, 8, C, andE are correa to the best ofmyknowedg>
PROPERTYOWNER'SOR OWNER SAIJTHORIZEOREPRESENT ATIVE SNAME
RobertMenl2e
ADDRESS
2062 HartxJr Drr.e
SIGNATURE
CITY
Sonn!/ield
DATE
STATE
OR
TELEPHONE
ZIP CODE
971'J7
COMMENTS
[l Check here If attachments
SECTIONG - COMMUNIfY INFORMATDN (OPTDNAL)
The local offiaalwho IS authonzed by law or ordinance to admlnlsterthe community's floodplain managemertordlnance can compleE Sectons A, B C (orE) and G ofthJS Elevaton
CertrtiCEte Complele the 'l'Picab~ rlem(s) and s~n below
Gl 0 The ~Ionnalon In Seclon C was taken from other dOOJmentaton tha has been s~ned and errbossad by a licensed surve;ur e~meer or ardlrted woo ~ auttc<l2Ed by slate
orkxallawloCOllfyelewlon Infonnaton OndK:a!ethe SOUrte and d<'teofthe e~vaba1 data In the Comrrents area below)
G2 0 A commlJ1rtyoffioal compk!ted Sedion E for a bUI~'~ located In Zore A (willoiJ a FEMA;$uad or commlJ1rty.lSSuad BFE)or Zore AO
G3 0 The folbwlng IIt_(11ems G4G9) ~ pro\Oded for commlJ1rtyfbodpla~ nmagemert PlJjloses
I G4 PERMITNUMBER I G5 DATEPERMITISSUED I G6 DATECERmCATEOFCOMPUANCElOCCUPANC~SSUED
G7 Th~perrrilhasbe"'lssuedfor 0 NewConstructJon 0 Subsla1ballTl'ro...ment
G8 ElelBllon 01 as-bu,llowesl f'oor [rJdud~g basement) of the bUl~rJg IS:
G9 BFEor(ln Zone AO)depth offbod,~ atthebUlklrg s.e~
__ftp,)
__ft(m)
Datum
Datum
lOCALOFFlCIAlSNAME
TITLE
TELEPHONE
DATE
COMMUNITYNAME
SIGNAruRE
COMMENTS
~
o Check here ,f attachments
FEMA Form 81-3 1, Januar y2003
eptaces Rail prevIous
edltlons