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Home My WebLink AboutMiscellaneous APPLICANT 6/25/2009 .' ELEVATION CERTIFICATE ,I OMS No, 1660-0008 , Exoires Februarv 28, 2009 " U,S, OEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program Important: Read the instructions on pages 1-8. SECTION A - PROPERTY INFORMATION ~ For Insurance Company Use: ,Policy Number A 1. Building Owner's Name Helfrich Family Revocable Trust A2. Building Street Address (including Apt., Unit. Suite, and/or Bldg. No.) or P.O. Route and Box No. 2833 20th Street Cily Slale ZIP Sp'rin~field"OR 97477 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) 17-03-24-00 - 00500 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Residenllal A5. Latitude/Longitude: Lat. 44.076293 Long, -122.9944 A6. Attach at least 2 photographs of the building Jf the Certificate is being used to obtain flood insurance. A7. Building Diagram Number ...., . '" . A8. For a building with a crawl space or enclosure(s), provide A9. For a building with an attach~ garage, provide: a) Square footage of crawl space or enclosure(s) 3600 sq 11 a) Square footage of attached garage 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 -.:JQ....... walls within 1.0 foot above adjacent grade ----1l....- c) Total net area of flood openings in A8.b ~ sq In c) Total net area of flood openings In A9.b .....!2...-- SECTION B - FLOOD INSURANCE~RATE MAP (FIRM) INFORMATION " " Horizontal Datum: NAD 1927 x NAD 1983 sqin I 81. NFIP Community Name & Community Number I 82. County Name Lane County 415591 Lane 84, Map/Panel Number B5, Suffix B6, FIRM Index Dale 06/02199 I B3, Stale OR 41039C 1153 F B7, FIRM Panel Effective/Revised Date 06102199 B8, Flood Zone(s) A B9 Base Flood Elevation(s) (Zone AO, use base flood depth) 452,1 810. Indicate the source of the Base Flood Elevatiol"! (BFE) data or base flood depth entered in Item B9. o FIS Profile x FIRM Community Determined Other (Describe) B11. Indicate elevation datum used for BFE in Item B9: X NGVD 1929 ~AVD 1988 o Other (Describe) ~ B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? Designation Dale _ 0 CBRS DOPA DYes xNo SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: 0 Construction Drawings* X Building Under Construction* 0 Finished Construction *A new Elevation Certificate will be required when construction of the building Is complete. C2, Elevations -Zones A1-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, ARIA, ARlAE, ARlA1-A30, ARlAH:' ARlAO, Complet.lIems C2,a-g below according 10 the building diagram specified in Item A7. Benchmark Utilized TRM !mike in oowemole = 453.1 Vertical Datum NGVD 1929 Conversion/Comments Check the measurement used. a) Top of bottom floor (including basement. crawl space, or enclosure f100rt b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) , Aitached garage (lop 01 slab) e) Lowest elevation of machlnery_ or equipment servicing the building (Describe type of equipment in Comments) f} Lowest adjacent (finished) grade (LAG) g) Highesl adjacenl (finished) grade (HAG) 453,16 x feet xle.t o feel x feet x feet o meters (Puerto Rico only) o meters (Puerto Rico only) o meters (Puerto Rico only) o meters (Puertb Rico only) o meters (Puerto Rico only) nla 485,73 449,3 449,3 x feet x feet o meters (Puerto Rico only) o meters (Puerto Rico only) SECTION 0 - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or l\Irchilect authorized by law 10 certify eleva1ion information. 'certify that the information on this Certificate represents my best. efforts to interpret the data available. :; , understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. o Check here if comments are provided on back of form. Certifier's Name James T. McLaughlin Tille Registered Professional Land Surveyor Address 2428 Ranch Drive Ucense Number 2583 · REGtSTl!RED" ( - -.:eROFI<SSrONAL L~t> SVRVEYOR ",-- ~ON ~~191991 , JAM~$ T~~tV'/<~\N , -t;>(PIRt;S 1,20.1/2008 Company Name City Springfield Slale OR ZIP Code 97477 Signature Date Telephone 541.729.4886 FEMA Form 81-31, February 2006 See reverse side for continuation. . . . . ~'. .; Date Received~eplaces all ~revious editions Planl'li:it:.AL o/27J!<'1 . ""1 .1, IMPORTANT: In these spaces, copy the corresponding inforrtialion from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 2833 201ll Street City Slale ZIP Code Springfield. OR 97477 ! For Insurance Company Use: Policy Number Company NAIC.Number SECTION D. SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) inslIrance agenUcompany, and (3) building owner. Comments '. ~ta" TBM spike'inpowerpole plus hi minus el 1,25 453,10 454,35 1,19 453,16 5,02 449,33 ~ 1,25 453;10 Ie> ,J~l"l Dale Ffloor 1 1/8" above floor Ch~.rG,..., Signalure le~1,' o 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 (willtoul BFE). complele Items E1-E5, Illite Certificalels tnlended 10 support a lOMA or LOMR-F tequesl. complete Sections A. B. and C. For Items E1-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only. enter meters. ' E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grada (HAG) and lite lowest adjaconl grade (LAG), a) Top of bottom floor (incfuding basement, crawl space, or enclosure) is 0 feet 0 meters 0 a:pove 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 andlor 9 (see page 8 of Instructions), the next higher floor (elevalion C2,b In lite diagrams) of lite building is 0 feel 0 melers 0 above or 0 below lite HAG, E3, AUaclted garage (lop of sl~b) is 0 feel 0 meters 0 above or 0 below tlte HAG, ' E4. Top of platform of machinery andlor equipment servicing the building is _'_ 0 feet D meters 0 above or 0 below the HAG. E5. Zone AO 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 0 Unknown. The local official must certify this informatlon In Sectlon,G. I SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, a, and E for Zone A (without a FEMA~issued or community-issued aFE) or Zone AO must sign here. The statements in Sect jansA, 8, and Ears COtT8ct to the besf of my knowledge. ' Property OWner's or Owner's Authorized Representative's Name, Address City State ZIP Code Signature Date Telepho~e Comments o Check he~ if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who Is authorized by law or ordinance to administer the community's f100qplain management ordinance can complete Sections A, a, C (or E), and G of this Elevation.Certiflca.te. Complete the applicable item(s) and sign below. Check the measurement used in Iterris G8. and Gg. G1. -0 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 elev~\jon information. (Indicate the source and date of the elevaUon data in the Comments area below.) A community official completed Section E for a building located In Zone A (without a FEMA.lssued or communlty~issued BFE) or Zone AO. The following Information (Items G4.-G9.) Is provided for community floodplain management purposes. " I G4. Permit Number' I G5. Date Permillssued I G6. Date Certtficate 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: _'_ .0 feet 0 meters (PR) Datum ~ G9. BFE or (in Zone AO) depth of floodinQ at the buildlnQ site: J:1 feel n meters (PR) Datum ~: Local Official's Name Title G2,D G3,D Community Name Telephone Signature . -' ", Dale Comments FEMA Form 81-31, February 2006 Date Received' Planner: AL 6ff~f Replaces all previous editions