HomeMy WebLinkAboutMiscellaneous Construction Specification 2011-5-28
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FAX 541 687 07J9 GOEBEL ENGlNEE~ING
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ELEVATION CERTIFICATE
~002/004
OS/28/2010 F~I 1J,OJ
U,S, DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood In.s-urancs Program
OMB No, 1660-0008
Expires March 31, 2012
SECTION A - PROPERTY INFORMATION For fnsurance Company Use:
A1. Building Owner's Name ROSER, VAUGHN & MARCIA Policy Number
A2. Building Street Add~&g (including Apt., Unit. Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NArc Number
2601 nTl-l STR.EET ~
Important: Read the instructions on pages '-9.
City SPRINGFIELD State OR ZIP Code 97477
A3. Proper1y OS5cription (Lot and Blode Numbers, Tax PBrcel Number, Legal De3Cl'Jption. etc.)
TAX LOT 4300 MAP 17-~2"'31
M, Building Use (c.g., Rttl!lidttntlal, Non-Residential, Addition. Ac:ceaory, &tc,) RESIDENTIAL
A5. Latitud.llong~ude= Lat, 44~30J Long. 122~1>-56,5HorlzonlBl DoIum: 0 NAO'1927 181 NAD 1963
..,AS. Artach at leasf 2 photographs of lhe building if fhe Certlflcate Is being u$8d to obtaIn floOd insurance.
A7. Building Diagram Number _
A6. For a buHdlng with e crawlspace or endO!iul1l(S)~ A9, For a building wIth an attached g3li1ge:
a) Square footage of crawlspace or 8rtclosure(9) aq 1\ a) Square tootage of :Dtached garage SQ ft
b) No. of pelTTl9nent "ood openings in the crawlspace or b) No. of pefTTTRnent nood openlng& In th& attached gamge
encl09ure(s) within 1.0 foot ..bov!! adjacent grade wit"in 1.0 foot above adjacent gmde
c) Total net area ofnood opening3 in AB.b s.q In c) Total net area afftood openings In A9.b _ sq in
d) Engineered rIood openings? 0 Yes 0 No d) Enginoered flood _nino.? 0 Yes 0 No
SECTION a - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
I B1, NFl? Community Nome & CommunitY Number , B2. COUtlty'Name 83. State
SPRINGFIELD 41~~92 LANE OR
84. Map/Panel Number 85. Suffix 66. FIRM lnde:x: 87. FIRM Panel B6, Flood 89. Base Flood Elevation(s) (Zons
41039C1153 F Date Eft'ective/Revised Date Zone(s) AO, use bas.e flood depth)
JUNE 2, 1999 JUNE 2, 1999 AE 4A8.6
Bl0,
Indicate the SOlJrce of the B8.."Ie Flood Elevation (BFE) dllta or ba68 flOOd depth entered In If em 69.
o FIS Profile 0 FIRM 0 Community Oere<mined IZI Other (Describe) CASE No, OIHO-0043A
Indleote ole.slion datum uoed lor BFE in Item 89: 181 NGVO 1929 0 NAVO 11166 0 OII1er (Describe) _
Is the building located in a Coastal Barner Resout0e3 System (CBRS) areJil or C>therwlsl! Protec:i8d Are9 (OPA)? 0
Deolgnadon Dale _ . 0 CBRS DOPA
Y..
181 No
811.
812.
C1. BUUdlng elev&tions 8re ba6ed on: ~ Con5trudlon D11Iwings" 0 Building Under Construdion" 0 Fini,hod Construction
"'A new ElevatIon Certil'icete will be reqUired wflen conSlntctfon ofthl! building 15 complete.
C2. Elevation. - Zon.. Al-A30, AE, AH, A (with BFE), VE, V1-VJO, V (with 8FE), AR, ARiA. ARlAE, ARlAl-A30, ARlAH, ARlAO, Complete IMm. C2,a-h
below accordIng to the blJilding diagl'3m &peclfied in Item PI 7. Use the same datum 8S fhe BF"E.
Benchmark Utilized SPRINGFIELD BENCHMARKVertiC.lillI Dstum NGVO 1929
ConverslonlComment:s
Sl:CTION C - BUILDING ELEVATION INFORMATIoN (SURVEY REQUIRED)
a) Top of bonom floor (indlldlng basement, Ct1IW\splJO'J, or en<:to,ure floor) ~,!
b). Top of tho next higher floor .451,~
c) Bottom of the lowest horizontal structural member N Zones only) ~'_
d} Attached gEJrage (top of slab) .w.A'_
8) LolNe&t elevation or machInery or equipment 6ervlcing the buildIng r:Jt8-_
(Dellcribe t)'pC!I or equipment and l0C3tfon,ln Comment&)
Lowest adjacent (nnl&h~) grad8 neltt fa building (LAG)
HIghest adjacent (finiShed) grade next to building (HAG)
lowest adjacent grotde at lowest elevBtlon of ded( or stairs, induding
,trudur;.tl support
Check the mea,surement used,
181 feet 0 melers (Puorto Rico only)
I2J f8ec 0 meters (Puerto Rico only)
o l'eet 0 meters. (Puerto Rico only)
o feet 0 melers (pu."" Rico only)
o feet 0 rnoto", (Puerto Rico only)
~
g)
h)
NJA._
NJA,_
NlA._
o feet 0 metel3. (Puerto RIco only)
o fe.. 0 meters (Puerto Rico only)
o feet 0 meters (Puerto Rico only)
SECTION D - SURVEYOR, ENGINEER. OR ARCHITECT CERTIFICATION
This certificatIon j3 to be signed and lIealed by a rand 8urveyor, engIneer, or 8rt:hitea authorized by !;aw to certify elevation
jnfonnatlon. / CtJrlify that rhs informstlon on thIs Certificst9 ropf'8!/J(lnts my b9St efforts to intBrpf'9t the dats avai/ab/o./
under&tsnd thst Qny 'sl~ statement may be pun;shsb/e by fine orfmprlsonment under 18 U.S. Code, Section 1001.!gI
Chffck here ff CDmments are provided on back of form. Were 18titud~ and longitude In Section A provided by a
Iloensod 100nd lSurveyor1 [gJ Ye15 0 No
PROFESSIONAL
LAND SURVEYO
SiQnature
City EUGENE
O.ta 05126/1 0
Srate OR
ZIP Code 97402
c.rtlnef. Narne SCOTT J. GOeBEL
License Number 2280
TIlle PRESIDENT
Cornpany Neme GOEBEL ENGINeERING & SURVEYING, INC.
ACldte3s 310 GARFIELD STREET
Telephone' 5411687-0542
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V;>/ "'01 .lU.lU .t'l'U IJ: UJ l"'A...!. ~41 t:HH 07 J9 GOEBEL ENGINEERING
4!J 00J/004
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IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company USft:
Building Street Address (including Apt. Unit, SuIte, <Jnd/or Bldg. No.) or P.O. Route .and BO:J" No. Polley Number
2601.1711< STREET
Cily SPRINGFIELD State OR ZIP Code 97477 Company NAIC Number
Copy both sides of this Elevation Certificate for (1) community official, (2) insu'Qn~ agent/company, and (3) building owner.
Comments LOT IS EXCAVATED AND READY TO SET FORMS; S" FOOTING, 24" STEM WALL, 1_11." MUD SILL. 1.1/S" SUB FLOOR. PAD _ CRAWL
SPACE. FINISH FLOOR = PAO + 34-5/S"= (44S.4')
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Signa.ture
Dol. 05-.8-10
For Zone5 AQ and A (without BFE), complete Items E1~E!S. If the Certificate is inrended to support a LOMA or LOMR-F request complete Sections A. B.
ilnd C. For Items El-E4, use natUf3J grade, jf .lIYaiJabJe. Cl'leck rhe mes5uroment 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 "'ig~est adjacent
grade (HA.G) and the lowest adjacent gr.lde (LAG).
8) Top of bottom floor (Including basement, crawlspace, Dr encJosure) Is _'_ 0 feet 0 meters 0 Bbolle or 0 below the HAG.
b) Top of bottom floor (including basement,. Cl1!wlspac:e, or endoslJre) IS _._ 0 feet 0 meters 0 above or 0 bglow the LAG.
E2, For Building Diagram& 8-9 wjth permanent flood openings pruvided in Sed:ion A ltem30 8 and/or 9 (see pages 6--9 of Initn.lctione), the next hIgher floor
(elevation C2,b rn the diagramG) of the building is _._ 0 feel 0 meters 0 above or 0 below the HAG.
E:3. Attached gar.age (top o( !3IBb) i3 _'_ 0 reet 0 m81ers 0 above or 0 below the HAG.
E4. Top of plllltform of machInery and/or equipmenf servicing fhe building Is ___ 0 feet 0 meteB 0 Bbove or 0 below the HAG_
E5. Zone AD only: If no tiood depth number is available, Is the fop of the bottom floor elevated In Bccordance with the community's floodplain management
ordinance? 0 Yes 0 No 0 Unknown. Ihe local official mU3t certifyth/a infonnation in Section G.
SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner'3 authorized reprefioElntative who completes Sections A, S, and E for Zone A (Without a FEMA-I6J!jued or communi!y-is&ued BFE)
or Zone AO must sign "'~re. The statements In Sections A, B, and E are COTT8ct to the be'st of my knowledge.
Propefiy Owner's or Owner's Authorized Representative's Name
o Check here if attachments
ON INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AD AND ZONE A (WITHOUT BFE)
,
Address
City
State
ZIP Code
Sign3ture
Date
Telephone
Comments
o Check here If Bttachments
G7.
GS.
Gg.
Gl0.
This permit h85 been issued for: 0 New Construction 0 Substantial Improvement
Elevation of 315-blJilt lowest floor (including basofTlerrt) 01 tne bUilding: ~__"._ 0 feet 0 meter3 (PR) Datum. _
BFE Or (in lone AO) depth of flOOding at Ihe building site: _'_ 0 feet 0 meters (PR) Datum _
Comrnunity's design flood elevation _._ 0 ~et 0 meters; CPR} Datum _
local Officia!'3 Name
Title
Community Nllme
Telephone
Sign;alure
Date
Comments
n Ched< here rt att8chmen ~
. '
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I4J 004/004
Building Photographs
See Instructions for Item A6.
EXCA VA TED PAD - READY TO SET 1I0UNDA nON FORMS
I=or InSUT'9flce Company Use:
o. Polic)' Number
C<lmpany NAlC N<.mber
'-
ing photographs below according to
"Rear View"; and, if required, "Right
s page, Use the Continuation Page,
...
BUildin~ Street Address (including Apt. Unit Suite, andlor Bldg. No.) or P.O. Route and Sox N
2601 17 STREET \
City SPRINGFIELD State OR ZIP Code 97477
If using the Elevation Certificate to obtain NFIP flood insurance. affix at least two build
the instructions for Item A6. Identify all photographs with: date taken; "Front View" and
,Side Vlew" and "Left Side View." If submitting more photographs than will fit on thi
foilowing.
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