HomeMy WebLinkAboutMiscellaneous Field Test & Inspection Report 2011-2-2
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GANSEN CONSTRUCTION Fax 5414631001 .
Feb 2 2011 09:45am P001/003
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GANSEN CONSTRUCTION
362 Hwy. 99 N.
Eugene, OR 97402
541-463-1000
Fax 541-463-1001..
CCB #92159
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Date: Z. - 2. - I (
Pages: ,3 Including cover page
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URGENT~&~y APPROVAL REQUESTED
FYI ONLY
. Comments: nd . _ .
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GANSEN CONSTRUCTION
Fax 5414631001
Fob 2 2011 09;45am P002/003
OMS No. 1660-0008
E~pi(es March 31, 2012
u's. 'tEPA~T~",NT OF HOMELAND 5ECuRITY
. . .
Federal Emerg~r~anagement Agency
N.:I!lonal Flood Insurance Program
ELEVATION CERTIFICATE
SECTION A - PROPERTY INFORMATION For Insurance Com~any Use:
Al. 8uilding Ovvner's Name Mike. and Alisa Deller POlicy Number
.
A2. Building Street Address (including ApL, Unil, Suite, and/or Bldg. No.) or P.O. Route and Box No. company NAtC Number
2763 N 21"\ Street
Important: Read the instructions on pages 1-9.
City Springfield
State OR ZIP Code 97478
A"3. Property Description (Lo~ and Block Numbers, Tax Parcel Number, Legal DescrIption, etc.)
Lot 15, 2nd Addition to EI Bonita Gardens Map' 7-03-24-42 Lot #2728
A4. Building Use (e.g., Residential, Non-Rssidential. Addi1ion, Accessory, etc~) Residenlal
A5. LaHlude/Longitude: Lat. 44.07539 Long. ~~ Horizonlal Datum: 0 NAD 1927. 0 NAD 1983
A6. Attach allea,l 2 photographs of the building if Ihe Cenificale is being used to obtain flood insurance,
AT. t?Jullding Diagram Numb$i 2
A8. For a building with a crawlspace or enclooure{s): A9, For a building with an .olttached garage:
a) Square footage of crawle.p<Jce or enclosure{s) 1110 sq ft a) Square footage of attached garage .@dl sq f1
b) No. of permanen1 flood opSlnings in the crawlsJ'sc;;e or b) No. of permanent flood openingf> in the altached garage
enclesure(s) within 1.0 foot abo....e adjacent grade ~ within 1,0 foot above adjacent 9r:;3:de Q
c) Total net area of fiood openIngs in f,8.b m sq in c) Total net area of need openings in A9.b Q 5q in
d) Engineered flood openings? O. Yes t8l No d) Engineered flood openings? 0 Yes l:8.1 No
SECTION B _ FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B 1. NFIP Community Name & Community Number
Lane Cour.\YJ Unicorporated Areas - 415591
82. County Name
Lane>
83, Stat.
OR
1B4. Map/Panel Number I 85. Suffix B6. FIRM tndex B7, FIRM Panel 88. Flood B9. Base Flood Elevation(s) (Zone
41039C-1103 I F Date E;ffective/Revised Data Zon.(s) AO, use bi;lSI!I flood depth)
I Jon. 2,1999 Jone 2, 1999 AE 452,04
810. Indicate [he 50urce of the BaSI!! Flood Elevation (BFE) !;lata or base flood depth entered in Hem 89,
o F1S P(ofile 0 FIRM 181 Community Determined 0 Other (Pes,cribe)_
811. Indicate elevalion datum used for BFE in Item 89: I'!5l NGVD 1929 0 NAVD 1938 0 Olher (Describe)_
B12.. Is the Olli\c\n91ocatad in a Caaosta\ 6aH\e-r Resc.u,!ce'5 S'j5tem (CBRS) area or Otller.mse Ptolected Area ,OPA)? 0 'fes
Dssignalion Date _ 0 CBRS DOPA .
I'!5l No
SECTION C _ BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
cz.
Building elevations ate based on: 0 Construction Drawings" [J Building Under Construction.
~A new Elevation Certificate v,rill be rsquired when construction of the building is. complete,
Elev.lions- Zones A1.A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, ARIA, ARJAE, ARIA1-A30, AR/AH, ARJP,O.
below according to the building diagram specified In Item A7. Use the same 'datum 3S the SF!:,
Benchmark utilized See Comment Vert,lcal Datum ~
ConvQrsion/Comments ~it.... of Sodnafield Bench at 2933 Yolanda oublished bench - 459 60'
o Finished Construction
Cl.
Complete Items C2.a-h
o
g)
hi
Top of the next highBr floor
BoUom of thalowest horizontal structural member (V Zones only)
Attached garage (top of. slab)
Lowest elevation of machinery or equipment servicing the building
(Desaibe 'yp~ of equipment and localion in Comments)
Lowest adjscent (finished) grade ne;d; to building (LA.G)
Highest adj:::Jcen\ (finished) grade nex:t to building (HAG)
Lowest adjacent grade at lowest eleval10n of d~ck or stairs, including
slrucluralsuppon
ill~
n/a._
~.l
'!QQ,1
Check the measurement used.
o fo.t 0 meters (Po"no Rico only)
o feel. 0 meters (Puerto Rico only)
o felil1 0 meters (Puerto Rico only)
t8l feet 0 meters (Puerto RicO only)
(81 feel 0 m$ters (Puerto Rico orly}
Top of bottom floor (including tJasemsnt, crawlspace, or enclo5ull;l floor) 449.Z
0)
0)
c)
d)
.)
450.I
450~
450.1
[8] feel
I3l f..t
o f..1
o meters (Puer1o Rico only)
o meters (Puerto R.lco only)
o meters (Puerto Ri.::o only)
SECTION D . SURVEYOR, ENGINEER. OR ARCHITECT cERTIFICATION
ihis certification is to be sign eo .end sealed by a land surveyor. engiMer, Of architect authorized by law to certify eleva~lon
infol1Tlstion. I certify that the information 011 this Cer1ifjcat8 represents my best efforts to interpret the data available.!
understand that any f~ls8 s(at6ment may be punishable by fins or imprisonment under 18 U.S. Code, Section 1001.t8J
Check here if comments are provided on back of form. Were l:;lUlude and longitude in Section A provided by B
licensed land surveyor? 0. Yes 0 No
Address 90686 Northrop CJrive
Sjgnatu~ .....~- _~. .J
c._j.;,........J )I ( ~ ---
City Eugene
State OR
ZIP Code 97402
PROFESSIONA
LAND SURVEYO
)-/.L.Je i
OREGON
JULY 1985
DAVID H. WEL.L.
2163
Certifler's Name David Wellm(ln
License Number OR PLS 2163
Title President
Company Name O. WellmO'Jn Surveying
Data 1118/2011
Telephone 541-984-1442
RENEWAL: ':/"T,U/t?
FEMA Form 81-31, Mar 09
See reverse side for continuation.
R.eplaces all prevIOUS editions
~ In these spaces, copy the corresponding information from Section A For lr.suraf\ce Compan'i Use',
",. ~ng s!rl~~~dregS (incll,.lding Apt., Unh:, Suite. and/or Bldg. No.) or P.O. Route'snd Box No. Policy Number
. 2,.63 N 21~ B~, t:;
City SpringfieldState OR ZIP Cod. 97478 ' Company NAIC Number
GANSEN CONSTRUCTION
Fax 5414631001
Feb 2 2011 09:46am P003/003
SECTION 0 - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate far (1) community official, (2) insurance agent/company, and (3) buHding owner.
Comments AS. Determined with GPS on site. B9 - ~levGltjon received by Spriflgfield PI.,nning. .
C2 (0) & Hydraulically separate addition crawlspace elevation is 450.4 feat being higher than l'esidence crawlspace elevation. ('
C2 (b) - Hydraullcally separate addition floor level elevation is 453,5 feet being al design grade elevation.
C2 (e) - Hot water heater, furnace, and laundry On garage slab.
Note: Hydraulically separate addition area is 252 sq. ft. with 6 In5talled vents for a tolal of 604 sq. in vant area,
Signature - " _ .., I.. J j~ Dale 1/1812011 .
--4"~ n t.--I<1,E-1 r.-..__ ~ Chec;:(l; here jf aflachments
SECTION E. BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zones AQ en.d A (without BFE:), complete Items E 1-E5. If Ihe Certificata Is intended to support a LOMA or lOMR~F request., complete Sections A, B.
and C, For Items E1-E4, use natural grade. if avaliable, Check the me~suremenl used. In Puerto Rico only, enter meters.
E1. Provide elevation informatjon for (he following and check the appropriate boxes to show whether the .Iavation is above or belOw ~he Ilighest adjacent
grade: (HAG) and the lowest adjacent grade (LAG).
a) Top of bottom floor (including basement, crawlspace, or enclosure) is ~'_ 0 feet 0 meters. 0 above or D below the HAG.
b) Top of bottom fioot (including basement, crBwlspace, or 8nclosure) is _'_ 0 feel 0 meters 0 above or:D below the LAG.
E? For Building Diagrams 6-9 with permanenf flood openings provided in Secllol'1 A Items 8 and/or 9 (sse pages 8.9 of Instructions), the ne:(j higher floor
(elevation C2.b in the diagrams) of the buildIng is ....._ 0 feel 0 meters 0 above or 0 below the HAG.
E3. Attached gen~ge (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.
E.S. Zone AO only: If no flood deptll number is available, Is the top Of the bottom floor elevalE!d in accordance with the community's floodplain managemenl
ordinance? 0 Yes 0 No 0 Un~nown. The local official musl certify this information in Section G.
SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's aulhorized representative who complete5 Sections A, B, and E for Zone A (wltholJ~ a FEMA~is.sued or commul'"lity-\'&sued BFE)
or Zone AD must sign here. ThfJ ststements in Ssctiof1S A, B, and E are- cOr{(;ct to the bast of my knowledge.
Property Owner's or Owner's Authorized Representative's Name
Address
City
S1ahi
ZIP Code
Signature
Date
Telephone
Comments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local offlCI;!l Wno is authorll.od by law or ordinance to administer the community's floodplain rnanagement ordinance can complete Sections A, B, C (or E),
and G of thie Elevation Certificate, Complete the applicable item(s) and sign below. Check the measurement used in Items GB and G9.
G1. 0 The information in Section C was taken from other documentation that has been signad and sealed by a license.d surveyor, engineer, or ~rchitect who
is authoriz:ed by law to certify elevation information. (Indical81he 5.0urce and dale of the elevation da!a in the Comments, area below.)
A community official completed S~ction E for a building located in Zona A (without a FEMA-is.sUGd Or community~is3ued 8F~) or Zone AO.
The fOllowing information (Items G4-G9) is provided for comm.unity floodplaIn ma.nagement p\Jrposes.
o Chec~ here if attachments
G2.0
G3.0
G4. ~ermi! Numper
G5. Date Permit Issued
G6. Date Certificate Of Compllance/Occup~ncy Issued
G7 This permil ha.s been issued for: 0 New Con=.trl,lction 0 Sl,Jbstantiallrnprovemen1
G8, Elevation of as-bl,Jilt loWes! noar (including basement) of the building; ~'_ 0 feet 0 meters (PR) Datum
G9. BFE or (In Zune AD) depth of flooding at th6 building site: _'_ 0 feet 0 meters (PR) Datum
G1D, CommlJnity's design flood elevation __ 0 feet 0 meters (PR) Datum _
Locsl Official's Name
Hie
Communjty Name
Telephone
Signature
Date
Comments
o Check h6re if atlachments
Replaces all previous editions
FEMA Form 81-31, Mar 09