HomeMy WebLinkAboutMiscellaneous Construction Specification 2010-5-31
. ,05;{J1/Z010 MON 15,Z8 FAX 541 687 07J9 GOEBEL ENGINEERING
IjjJ 0021004
U.S, DEPARTMENT OF HOMELAND SECURITY ELEV A nON CERTIFICATE
Federal Emergency Management Agency
National Flood Insurance Program Important; Read the instructions on pages 1-9,
OMB No. 1660-0008
Expires March 31. 2012
SECTION A - PROPERTY INFORMATION For Insurance Comp;my Use:
A 1. Building Owner's Nome ROSER, VAUGHN & MARCIA Polley'Number
A2. "BuildIng Street Address (including Apt.. Unit, Suite, and/or Bldg. No.) or P,O, Route IIInd Box: No. Company NAte Number
Z601 17'" STREET
City SPRINGFlElD st.te OR ZIP Cod. 97477
A3. Property Description (lot dind Block Numbers, Tax Parcel Number, logl!l( ~rlptlon, etc.)
TAl( lOT 4300 MAP 17-0:;'2-4-31
A4. Building Use (e,g., Resldant/sl, Non~ResidentiaJ, Addition, Acce'Bofy. etc.) RESIDENTIAL
AS, Lsi~udellong~ude: Lat44-ll4-30.7 Long. 1 Z2-S9-58,S Horlzontal Datum: 0 NAD 1927 1ZJ NAD 1983
"^-6; Attadl at lent 2 photograph3. of the buJldlng Ifehe Celtlficafe is being used to obtaIn 1Iood in9ur8nce.
A7. Bui!dlng Diagram Number _
AS. For a buJldinu wTth . CI1IWrspac:e or ftncJosUre(s):
s) Square f001398 of cra.w\r.paoo or encloflure(s)
b) No. Ofpenn8!"1ent "ood openings In the Cl'QwlSlpac:e or
6nclo$Ur8(s) within 1.0 foot 8bov6adjBcent grade
c) Tofal net ilrea ofnood opening@; In AB.b
d) Engineered flood. opening.s? 0 Yes 0 No
8q ft
A9, For B hulldlng WIth an attached galllglt:
0) Square foo1llge en 0~8chod go"'go "'l ft
b) No. of permanent flood openings in the attached garage
within 1.0 foot above adJa.rent 91';lde
c) Tolal net 8mB of I'Iood o~ning.s In A9.b _ &Q in
d) Engineered flood op8nings? 0 Yes O. No
&q in
seCTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
BJ. NFIP Community Name & CommunJlY Number / B2: COllnty Name: _I 83. StOle
SPRINGFIELD 41SSn LANE OR
--
84. Map/F;'anel Number 65.SU-n-lX 86. FiRM I"ds): B7. FIRM Panel B8. Flood 69. Base Flood EIC'vation(s) (Zone
41039C1153 F Dete EffeaivelRevis&d Dare Zone(s) AO, use base fiood depth)
JUNE 2, 1999 JUNE 2, 1999 AE 448.8
810.
Indicate Irle .i:OUTCe of the 8aS9 Flood Elevation (BFE) dm or bass nODd depth entel1td in ttnm 89,
o FlS Promo, 0 FIRM 0 Community Dorenmined 181 Oth.r (Describe) CASE No, 08-10~043A
IndiC2i'te elevatIon datum used for aFE in Item B9: l8J NGVO 1Q29 0 NAVO 1988 0 Other (Describe)_
It; the Duilding located In a Coastal Borrier Re:source8 S~tem (CBRS) area or otherwise Protedad Area (OPA}7 0
Designation Oate _ ' 0 CBRS . DOPA
Y..
181 No
811,
812,
SECTION C - BUilDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building tll~\iBflo"lro are ba9ed on: 181 Con&tnlction Orawing.s.- 0 Building. Ul'1der Construdion- . 0 FiniShed Con~tT\JctIDn
"'A n8'olltl Eieiistion CertifiCJte wfll .be reqUired when construction of the building Is complete.
C2, Elevation. -Zone. Al-A30, AE. AH, A (wIth 8FE), liE, Vl-V30, V (with 8FE), AR, ARIA, ARlAE. ARlA1-A30, AR/AH, ARlAD, Comploia IMm. G:1.a-h
below B.Coortllng to the building diagram I9pedfi9d in Uetrn A7. Uge the same datum 85 the BFE.
Benchmark utillz~d SPRINGFIELD BENCHMARKVertics.1 DatulTl NGVD 192~
Conversion/CDmments _.
f)
g)
h)
a1) Top Dr bottorn floor (jndudlng bOBemenl, aawtBPace. or enclosure floor) ~..1:
b) Top of the next hiahcr floor ' ~.~
c) Bottom of the I~t horizontal structl.lnlll mer:nber CV Zones only) lW:!._
d). Anachad g....g. (top of sl.b) l'l/t,,_
a) LOwe5t elovation of machinory or equipment &ervi~ng the building ~_
(Describe type-of equipment and locaeion in CamrTu!IInfs)
lowtt&t adjacent (finishltd) grado next to building (LAG)
Highest adJQC8nt (fini3hed) gl"Bde next to buiJding (HAG)
Lowest edjacet1t "rode at IDWfl&e elevation of deck or &taj~, including
!itrudurliIl su ort
Check the me8~urement \Aed.
1ZJ ""', 0 met.", (Pu.rto Rico only)
181 ""'t 0 m...", (puerto Rico only)
o feet 0 mala", (Puorto Rico only)
o feee 0 me19rs (Puerto'Rico only)
o feet 0 meref1S. (Puerto Rico ~oly)
l'l/t,,_
l'l/t,,_
l'l/t,,_
o Ill.t 0 mete", (Puol1o'Rlco only)
o hfer 0 mete~ (Pueno Rk:o only)
o toot 0 mete", (Poena Rico only)
SECTION D - SURVEYOR, ENGINEER, OR ^RCHITECT CERTIFICATION
ThIs certification Is to be: Glgned f.lnd sealed by a land :surveyor, engineer, or archited; authorized bylaw to cen:if'y erevaHon
information. I cerr;ty thBt th6 info""stion On this CertJf1cs'rJ represents my bIJ3t efforts to intfJfTJ!TJl the dB/8 8l1lJi!Bbla.l
und6f3tand that Bny f8/S9 statom9nt may be puniShBble by fine or ;rnprl3onmenf und9r 18 U.S. COdB, Sgef/on 1001.[81
Check hel'8 if comme~ are provIded on back offorrn. Were latitude and longitude in Section A proW'ided by 8
licensed lahd &Llrveyor? l';gI Yes 0 No
PROFESSIONAL
LAND SURVEYO
Addr... 310 GARFIELD STREET
City EUGENE
State OR
ZIP Code 97402
Certifier's Name SCOTT J. GOEBEL
License Numbor 2280
TIlle PRESIDENT
Compeny Name GOEBEL ENGINEERING & SURVEYiNG, INC,
Signature
Date OS/26/10
Telephone 541/6B7wDS42
06-01-10A09:36
RCVD
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1'.11.
, ,
05/J1/2010 MaN 15:28 FAX 541 687 0739 GOEBEL ENGINEERING
I4J 003/004
IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company U:se:
Building Street Addre88 (including Apr., Unir, SuIre, andlor Bldg, No.) or P.O. Routg and Bar No. Policy Number
2501 17'" STREET ..
City SPRiNGFIELD State OR ZIP Code 974n Comp9ny NAIC Number
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenUcompany, and (3) building Owner.
Comment:> LOT is EXCAVATED AND READY TO SET FORMS; 6" FOOTING, 24' STEM WALL, 1-1/2" MUD SILL. '-1/6" SUB FLOOR, PAD ~ CRAWL
SPACE, FINISH FLOOR. PAD + 34-5/6". (446.4') .
SECTION D - SURVEYOR, ENGINEER. OR ARCHITECT CERTIFICATION (CONTINUED)
Signature
Date 05-2S-10
,
o Check here if attachments.
ON INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zones AD snd A (vvithout BFE), complete Items E1~E5. If tho Cenificate is intended to support 8 lOMA or lOMR-F request, complete SectiDns A, 8,
and C. For Itams E1-E4, use nsturn! grade. if available. Check the measurement used, In Puerto RiO) only, enter metef3.
E1. ProvIde elevation information for lhe follOWing Bnd check the appropriate boxes to show whether the ele\lation is above or below the highest adjacant
grade (HAG) and the lowet:it adja~nt grade (LAG). .
8) Top orbortorn floor (inClUding basement, crawlspace. or enclooSure) is __'_ 0 feet 0 metef3 0 above or 0 below the HAG.
b) Top ofbottam t1aar (including ba&8mOflt. crawlspaw, orencloBure) is ~'_ 0 feet 0 ma1.6tti 0 above or 0 below the LAG.
E2. For BuildIng Diagram5 6-9 with permanent flood openings provided I" Section A Items 6 and/or 9 (see pages 8-9 of InstnJctions), the next higher floor
(elevation C2.b in the diagrams) of the building is _"_ 0 feet 0 meters 0 above or" 0 belOW the HAG.
E3. Attached gor8ge (top of srab) is _'_ 0 feet 0 metsl"9 0 above or '0 below the HAG.
E4. Top ofplatfolTn of maChinery and/or equipment servicing the building is _'_ 0 klet 0 meters 0 above or 0 belaY/the HAG.
E5. Zone AO only: I' no tlood depth number is awallable, is the top of the bottom floor ele\lated in accordance with the community'6 flOodplain managemenl
ordinance? 0 Yes 0 No 0 Unknown. The local official must certify thl6 infonTIllfion in Section G.
SECTION F - PROPERTY OWNER (OR OWNER:S REPRESENTATIVE) CERTIFICATION
The property owner or owner's aUThorized representative' who completes Sections A, 8, and E for Zone A (without a FEMA-iss.ued or communifyRissued BFE)
or Zone AO mu~a sign 'here. 1116 slBtllmerlf3 in Sections A, 8, and E 8te cormct ro (f1B best of my know/edge,
Property Owner's or Owner's Authorized. Representative's Name
Address
City
State
ZIP Cooe
Sign8tUrB
Oat..
Telephone
Comments
(SECTION G - COMMUNITY INFORMATION (OPTIONAl)
The local official who is authorized by law or ordinance ~o administer the community'oS 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 us8d Inltem~ GB and G9.
G1. 0 The infonnation in Section C was laken from other documentoldon that has been signed and ~8.aJed by II licensed surveyor, enginosr..or architect who
115 authorired by law to certify elevation Information. (IndIcate the 80uroo and d~te ofthe elevation data In the Comment!; arna below.)
G2. 0 A communiTy official completed Section E fur a bUilding located In Zone A (without a FEMA-issued or community--\s.i5.ue:d BFE) or Zona AD,
G3. 0 The following informatIon (Items. G4--G9) it;. provided for community floodplain managomant purpos.es.
G4. Permit Number G5. Date Pennit Is&ued G6. Date Certificate Of Compliance/Occupancy I&f:ued
.n CheGk he~ if artachme~ts
G7. This permit ha& been issued for: 0 New Construction 0 SubstantiallrnProvement
Ga. Elevation of as-built fOWOSl floor (including basement) of the bUilding: _'_ 0 fuel 0 O1eten; (PR) Datum _
G9. BFE or (in Zone AO) depth or flooding at rhe building Site: _ _ 0 feet 0 mel$J'6 (PR) Datum _
G10, Community's design tloodelevation __ Dfeot 0 metel'& (PR) Datum _
. Local Officia.I'8 Name
Community Name
Title
Telephone
Signature
Date
Comment~
n Check here if attachments
05/Jl/2010 MON 15:29 FAX 541 687 07J9 GOEBEL ENGINEERING
IgJ 004/004
; -.
For Insurance Company Us~:
Buildin\t Street Address (including Apt., Uni!, Suite, and/or Bldg, No.) or P_O_ Route and Box No_ Policy Numbar
2601 17 STREET -
City SPRINGFIELD State OR ZIP Code 97477 Company twc Number
,
If using the Elevation Certificate to obtain NFIP fiood Insurance, affix at least two building photographs below according to
the instructions for Item A6_ Identity 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,
Building Photographs
See Instructions for Item A6
EXCA VA TED PAD - :READY TO SET FOUNDATION FORMS
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