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Home My WebLink AboutMiscellaneous Miscellaneous 3/5/2009 Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL Latrtude/Longrtude: Lat. N 44"03'22.7" Long. W 122"55'435" Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. Building Diagram Number .4 For a building with a crawl space or enclosure(s), provide See Comments. AS. For a building with an attached garage, provide: a) Square footage of crawl space or enclosure(s) 360 sq ft a) Square footage of attached garage n/a sq ft b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage enclosure(s) walls within 1.0 foot above adjacent grade ! walls within 1.0 foot above adjacent grade n/a c) Total net area of flood openings in A8.b 993 sq in c) Total net area of flood openings in A9.b n/a SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number I B2. County Name Springfield City of Lane County, Unincorporated Areas Lane B4. MaplPanel Number I 85. Suffix B6. FIRM Index 87. FIRM Panel I Date Effective/Revised Date 41039C1166. F June 2,1999 June 2, 1999 ' B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. o FIS Profile I:i!l FIRM 0 Community Determined 0 Other (Describe) _ Bl1. Indicate elevation datum used for BFE in Item B9: I:i!l NGVD 1929 0 NAVD 1988 0 Other (Describe) _ B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or OtherWise Proteded Area (OPA)? DYes Designation Date 0 CBRS DOPA . :-c' '" U.S. D~PARTMENT OF HOMELAND SECURIT ,'Federal Emergency Management Agency National Flood Insurance Program ELEV A liON CERllFICA lr Important: Read the instructions on pages 1-8. SECTION A - PROPERTY INFORMATION A 1. Building Owner's Name Leland Shew A2. Building Street Address (including Apt., Unit, Suite, andlor Bldg. No.) or P.O. Route and Box No. 5700 HiQh Banks Road State Oregon ZIP Code 97478 City Springfield A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) 17-02-28-4311# 00100 A4. A5. AG. A7. A8. .- OMS No. 1660-0008 Exoires Februarv 28. 2009 For Insurance Company Use: Policy Number Company NAIC Number Im[E~[~m[~il II fll ?> ~5 -ocr I d 1 I of 3 p~ I By m Honzontal Dat - -f"""h. b" I A 161 ~..... . .....3 sqin I B3. State OreQon B8. Flood Zone(s) AE 'I' B9. Base_Flood Elevation(s) (Zone AO, use base flood depth) 495.5 feet I:i!lNo SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: D Construction Drawings. D Building Under Construction. [81 Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations - Zones Al-A30, AE, AH, A (with BFE), VE, Vl-V30, V (with BFE), AR, ARIA, ARlAE, ARlAl-A30, ARlAH, ARlAO. Complete Items C2.a-g below according to the building diagram specified in Item A7. Benchmark Utilized Lane Co. "RT 794 1970 Vertical Datum NGVD29 Conversion/Comments n/a Check the measurement used. a) Top of bottom floor (induding basement, crawl space, or enclosure floor). b) Top oflhe next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) . Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment in Comments) I) Lowest adjacent (finished) grade (LAG) g) Highest adjacent (finished) grade (HAG) 493.84. 494 03 I:i!l feet I:i!l feet. o feet D.feet I:i!l feet 494.54 493.~ 498.QjL I:i!l feet I:i!l feel , ' o meters (Puerto Rico only) o meters (Puerto Rico only) o meters (Puerto Rico only) o meters (Puerto Rico only) o meters (Puerto Rico only) o meters (Puerto Rico only) o meters (Puerto Rico only) _ I . SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or archited authorized by law to certify elevation infonnation. 'certffy that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may1be punishable by fine orimprisanment under 18 U.S. Code, Section 1001. [81 Check here if comments are provided on back of form. Certifier's Name Donn Rowe License Number LS2519 Company Name Donn Rowe LLC City Springfield State Or. ZIP Code 97478 Date March 3, 2009 Telephone 953-7778 Tnle Land Surveyor Address 90946 Sunderman Road .Si9~c r.: n r~' f1R.__~"'SIONAL - LAND'ISURVEYO' - D HER!:\) - c- r _ t, " . , . IMPORTANT: In these spaces, copy th, 'responding information from Section A, , Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No; 5700 Hiqh Banks Road City Springfield Stale Or. ZIP Code 97478 For, Insurance Company Use: Policy Number Company NAIC'Nilmt?er SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED} Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenUcompany, and (3) building owner. Comments A8- Crawl space is the "next higher floor" with access opening considered the flood openings. Equipment servicing building is a water heater in basement. Note: The new addition construction, cause for this elevation certificate, has a finished floor elevation of 499.65 feet, 4.15 feet above base flood elevation. Sign~ <""A) Date 3-5-2009 , ~,. :~:_-"f- __ [8] Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED} FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items El-E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B, andC. For Items E1-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. E 1. Provide elevation information for the follOwing and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawl space, or enclosure) is 0 feet 0 meters D above or 0 below the HAG. b) Top of bottom floor (including basement, crawl space, or enclosure) is _'_ 0 feet 0 meters 0 above or D below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9 (see page 8 of Instructions), the next higher floor (elevation C2.b in the-diagrams) of the building is 0 feet 0 meters D above or 0 below the HAG. E3. Attached garage (top of slab) is 0 feet 0 meters 0 above or 0 below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is 0 feet 0 meters 0 above or 0 below the HAG. E5. Zone AD only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? 0 Yes 0 No D Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER fOR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or community-issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments n 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 ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8. and G9. G1. D The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date Of the elevation data in the Comments area.below.) A community official completed Section E for a building located in Zone A (without a FEMA.issued'or community-issued BFE) or lone AD. The following information (Items G4.-G9.) is provided for community floodplain management purposes. G2.0 G3.0 I G4. Permit Number I G5. Date Pennit Issued I G6. 'Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: 0 New Construction 0 Substantial Improvement G8. Elevation of as-built lowest floor (including basement) of the building: D feet 0 meters (PR) Datum _ Gg. BFE or (in Zone AO) depth offfooding at the building site: 0 feet 0 meters (PR) Datum _ Local Official's Name Title Community Name Telephone Signature Date Comments n r.h~,..1t h':'r~ if J:lttJ:l"'''mpn~ " . Building Photographs See Instructions for Item A6, Building Street Address (including Apt, Unit, Sutte, and/or Bldg. No.) or P.O. Route and Box No. 5700 High Banks Road For Insurance Company Use: Policy Number I City Springfield State Or. ZIP Code 97478 I Canpany NAIC ~ If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to the instructions for Item A6. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View: If submitting more photographs than will fit on this page, use the Continuation Page, following. Rear view of house taken March 3, 2009. New addition in shown through the windows above, The floor of the addition is at 499.65 feet 4.15 feet above base flood elevation, Crawl space is shown here which is called the "next higher floor". Access is considered the flood opening, Side view taken March 3, 2009, looking east. Directly behind these blocks is a crawl space adjacent to the basement. Basement is below house behind the crawl space on the far side of the house,