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Home My WebLink AboutFEMA Miscellaneous 2009-2-28 CP,~'Yl-4 ~ I I u.s. DEPARTlI.lENT OF HOMELAND SECURITY Federal Emergency Management Agency. National Flood Insurance Program ELEVATION CERTIFICATE OMB No. 1660-0008 Exoires Februarv 28. 2009 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 Famllv Revocable Trust A2.-Suilding Street Address (including Apt., Unit. Suite, and/or Bldg. No.) or P.O. Route and Box No. 283320.,Street.--/ . City Slate ZIp. S~rinJlfield, OR 97477 A3. Property Description'(Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) 17-03-24-00 - 00500 M. .Building Use (e.g., Residential, Non~Residential, Addition, Accessory, etc.) Residential AS. Latitude/Longitude: Lot. 44076293 Long. ,122.9944 Horizontal Datum: NAD 1927 x NAD 1963 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood Insurance. A7. Building Diagram Number ..... . ".' AS. Fora building wilh a crawl space or enclosure(s), provide A9. . For a building wilh an attaChed gaj.~ge, provide: a) Square 1o0tage of crawl space or enclosure(s)' 3600 sq ft a) Square foolage of att~~hed garage sq ft. b) No. of pennanent 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 foora~ove adjacent grade ~ . c) Total net area of flood openings In A8.b ~ sq in c) Total net areaofflood.,openlngs In A9.b ~ sq in SECTION B - FLOOD INSURA"NCE~RATEMAP (FIRM) INFORMATION I B3. State :jOR B1. NFIP Community Name.& Community Number 82. County Name Lane County 415591 Lane 64, MaplPanel Number I 85. Suffix B6. FIRM Index 87. FIRMPanel Date EffedivelRevised Date 41039C 1153 F 06/02199 06102199 B10. Indicate the source of the Base Flood Elevation.'(BFE) data or base. flood depth entered in Item B9. o FIS Profile x FIRM Community Determined Other (Describe) 811. Indicate elevation d~tum used for BFE in Item B9: X NGVD 1929 o Other (Dascrlbe)_ B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? Designation Date 0 CBRS DOPA I B8. FlOOd Zone(s) A B9 BaseFJood Elevation(s) (Zone AO, use base flood depth) 452_1 NAVD 1988 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 oftha 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. .Completellems C2.a-g below according to the building diagram specified in Item A7. Benchmark Utilized TBM snikp. In Dowemole = 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) Topofthenexthigherfioor . c) Bottom oftha lowest horizontal structural member (V Zones only) d) . Allached garage (lop ot slab) e) Lowest elevation of machinery_ or equipment servicing the building (Describe type of equipment in Comments) . 1) Lowest adjacent (finished) grade (LAG) g) Highest adjacent (finished) grada (HAG) 453.16 x feel x feel o feet xfeal x feel Dmeters (Puerto Rico only) o maters (Puerto Rico only) o mete;;' (Puerto Rico only) o meters (Puerto Rico only) o meters (Puerto Rico only) o meters (Pue~o Rico only) o meters (Puerto Rico only) nla 485.73 449.3 449.3 x feel x feat SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certlficatlon'ls to be signed and sealed by a land surveyor, engineer, or architectauthorizedby.lawto certify elevation information. I cerlify that the information on this Certificate represents my bast.efforts to interpret the data available. I understand that any false statement may b9 punishable by finfl or imprisonment under 1 B U.S. Code, Section 1001. , o Check here if comments are provided on back of fonn. Certffier's Name James T. Mclaughlin Title Registered Professional Land Surveyor Address 2428 Ranch Drive License Number 2583 r R.EGISTERE!> 1 ( - ROFEssrONAL ~ () SVRYEYOR \ '--- l Q Ef70N J J, ~y 19 t99~ JAMe~ T.!o\<\.AV."'~,~ 258.3 --f;XPIRE$ i.ir)-li-z006 Company Name City Springfield State OR ZIP Code 97477 Telephone 54U29.4886 Signat.ure Date FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions .,:. ", _ .:"."J ;._ .I~ .:1 . IMPORT ANT: In lhese spaceS, copy the corresponding infonriation from Section A. Building Street Address (including Apt., Unit, Suite, -and/or Bldg. No.) or P.O. Route and Box No. 2833 20~ Street. . . City State ZtP Code , Springfield, OR 97477 For Insurance Company Use: Policy Number Company NAte Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1 )communfty official, (2) Insurance agent/company, and (3) building owner. Comments ~ta., plus hi minus el T8M spike inpowerpole, 1.25 453.10 454.35 Ffloor 1 1/8" above floor Ir 1.19 453.16 5.02 449.33 ~ 1.25 453,10 \C>.J~~ . Signature Date p Check here if aUachmenls SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AOAND ZONE A (WITHOUT BFE) For Zones AD-and A (without BFE), complete Items E1-E5. If the Certificate Is intended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For Items E1-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only. enter mi:lters. E1. Provide elevation inforrilation for tne following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacenlgrade (LAG).. . a) Top afbaUom floor (including basement, crawl space, or enclosure) is 0 feet 0 meters 0 above or o 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 O'meters D above or D,below the HAG. . E3. Attached garage (top of slab) is o reel 0 meters 0 above or 0 below the HAG: ' E4. Top of platform of machinery and/or 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 I~cal 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, and E for Zone A (without a FEMA-Issued or community-issued BFE) or Zone AOmust sign here. The statements in Sections A, B, and E are correct to the best of my know/edge. Property Owner's or Owner's Authorized Representative's Name, Address City State ZIP Code Signature Date Telephone .' Comments U Check here if attachment~ SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authori:Zed by law orordinance to admlnisterthe communlty's'flol;)c;tplain 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 It~ms Ga. and G9. . , G1..0 The Information In Section C was taken from,other documentation that has been signed and sealed bya licensed surveyor, engineer, or architect who is authorized by law to certifY eleYfl\ion Information: (Indicate the source and, date of the elevation data in the Comments area below.) G2.0 A community official completed Section E for a building 'located In Zone A (without a FEMA-Issued orcommiJ~fty~lssued BFE) or Zone AO. G3. 0 The following Information (Items G4.-G9.) is provided for community floodplaIn management purposes. I G4. Permit Number I G5. Date Permll_'ssued I G6. Date Certifl~te Of Compliance/Occupancy Issued .1 G7. This permit has been Issue9 for. 0 New Construction D Subs,tantial.lmprovement GB. Elevation of as-built lowest floor (including basement) of the building: _'~ _0 feet 0 meters (PR) Datu"! _ G9. BFE or (in Zone AO) death of fiooding at the buildlno site: p feet 0 meters (PR) Datum Local Official's Name Title Community Nam~ . Telephone Signature <......., Date Comments FEMA Fonn 81-31, February 2006 Replaces all previous editions