HomeMy WebLinkAboutMiscellaneous APPLICANT 4/19/2011
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u ~ D5PA~TMENT OF HO~ELAND SECU. ELEVATION CERTIFIC. .
F.edera! Emergency Management Agency
National Flood Insurance Program Important: Read the instructions on pages 1 :9.
OMS No. 1660-0008
Expires March 31, 2012
SECTION A - PROPERTY INFORMATION For InsurancE?: Company Use:
A1. Building Owner's Name rvtike and Alisa Deller Policy Number
A2. BUilding Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number
2763 N 21s1 Street
City Springfield
Slate OR ZIP Code 97478
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LoI1S. 2nd Addition 10 EI Bonita Gardens Map 17-03-24-42 Lot #2728
A4.
AS.
A6.
A7.
A8.
Building Use (e.g:, Residential, Non-Resider]tial, Addition, Accessory, etc.) Residental Pianner: OK
Latitude/Longitude: La!. 44.07539 Long. 122.99341 Horizontal Datum: 0 NAD 1927 0 NAD 1911:l
Attach alleast 2 photographs of the building if the Certificate is being used to obtain .flood insurance.
Building Diagram Number ~
For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s)
b) No. of permanent flood openings in the crawlspace or
enc!c5ure(~} .....\th;i"I.~.C'1oot al:.1l,ive acijacent' grade
A9.
For a building with an attached garage:
a) Square footage of attached garage 631 sq ft
b} No. ofpsrrTlJ;:ll'1en!.f!'Jqd opening::; iilthe attachc-u yc:ifags'
within 1,0 foot above adjacent grade Q
c) Total net area of flood openings inA9.b Q
d) Engineered flood openings? 0 Yes
sq in
o No
1110
sq ft
c) Total net area of flood openings in A8.b
d) Engineered flood openings? 0 Yes
o No
!2
691
sq in
81. NFIP Community Name & Community Number
Lane County, Unicorporated Areas ~ 415591
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B4. MaplPanel Number BS. Suffix 86: FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone
41039C-11S3 F Date Effective/Revised Date Zone(s) AO, use base flood depth)
June 2. 1999 June 2.1999 AE 452.44
82,_ 90unty Name
Lan~ .
B3. State
,OR
810. Indicate the source ofthe.8ase Flood Elevation (8FE) data or base flood depth entered in Item 89.
o FIS Profile 0 FIRM 0 Community Determined 0 Other (Descrlbe)_
B11. Indlcale elevation datum used for BFE In'ltem B9: 0 NGVD 1929 0 NAVD 1988 0 Other (Descrlbe)_
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 0 Yes
Designallon Dale _ G CBRS 0 OPA
o No
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C 1. Building elevations are based on: 0 Construction Drawings" 0 Building Under Construction" ~ 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. AR/A. AR/AE. AR/A1-A30, AR/AH; AR/AO. Complete Items C2.a-h
below according to the building ,diagram specified in Item. A? Use the same datu"!1 as the BFE.
Benchmark Utilized See Comment Vertical Datum 1929'
Conversion/Comments Citv of Sorinafleld Bench at 2933 Yolanda Dublished bench.~ 459.60'
Check the measurement used.
a) Top of bottom floor (including basement, crawlspace. or enclosure floor) ~,I r23J feel 0 meters (Puerto Rico only)
b) Top of the next higher floor" 451.,2 (8J feet 0 meters {Puerto 'Rico only)
c) Bottom of the lowest horizontal structural member (V Zones only) n/a._ 0 feet 0 meters (Puerto Rico only)
d) Attached garage (top of slab) 450.Z . IZI feeL 0 meters (Puerto Bieo only)
e) Lowest elevation of machinery or equipment servicing the building 450.Z IZI f~etO meters (Puerto Rieo only)
(Describe type of equipment and locatio~,in Comments)
f) Lowest adjacent (finished) g"rade .next to _~uJ~iD9~(6t.J~L ~ _ _____ 450.Z- __ ,--[8Heet-.-[J'meters'(Puerto-~ico only)
g) Highest aajacenf"(finlShed) grade next to building (HAG)' 451'.'1,~ f~e-t .0 meiers(Puerto~ico only)
h) Lowest adjacent grade at lowest-elevation of deck-otslairs, including 450,i' IZI feet 0 meters (Puerto Rico only)
structural support
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation
information. I 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,~
Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a
licensed land surveyor? IZI Yes 0 No
City Eugene
State OR
ZIP Code 97402
riL:GISTERED
PROFESSIONAL
LAND SURVEYO
WI -tJ
OREGON
JULY 1985
DAYlO H. WELL
2163
Certifier's Name David Wellman
License Number OR PLS 2163
Title President
Company Name D. Wellman Surveying
Date 3/24/2011
Telephone 541-984-1442
FEMA Form 81-31, Mar09
-.' --1,...vll~ I
See reverse side for continuation.
Replaces all previous editions
,I~~?ORTANT: In these spaces, copy t rresponding information from Section A.
Boilding Street Address {including Apt., UnIT, Suile, and/or Bldg. No.) or P.O. Route and Box No.
2763 N 21S1Street . ;,
City SpringfieldState OR liP Code 97478
Far Insurance Company Use:
POlicy Number
Company NAIC Number
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments AS - Determined wilhGPS on site. 89- Elevation received by Springfield Planning.
C2 (a) - Hydraulically separate addition crawlspace elav-aUon is 450.4 feet being higher than residence crawlspace elevation.
C2 (b) - Hydraulically separate addition floor level elevation is 453.5 feet C2(f) LAG::: 451.0 C2(g} HAG::: 451.4' each adjacent to new addition.
C2 (e) - Hot water heater, furnace, and laundry on garage slab.
Note: ~.ulicaIlY separate ~ddition area is 252 sq. ft. ,with 6 installed vents for a total of 604 sq. in vent area.
Signalure ..::b~ _ L:.J~ Date 3/24/2011
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
t8J 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 (without BFE), complete Items E1wE5: If the Certificate is intended to support a LOMA or LOMRwF'request, complete Se'ctions A, B,
and C. For Items E1wE4, use natu'i"al grade, if available. Check the measurement used. In Puerto Rico only, enter meters.
E1, Provide eleVl''1tion.infr)rrnatj0~:f0[' !he.~fc!!c'Njng'~nd'ChGckth6"CiPPJvpJia;c bu}(.-ti'::; ii,rsifow wneUfefih"e eievat]on Is'above -or bejow.the highestadja~ent
grade (HAG) and the towesl adjacenl grade (LAG).
a) Top of bottom floor (including basement, crawlspace, or enclosure) is _'_ 0 feet 0 meters 0 above or 0 below the HAG,
b) Top of.bottom floor (including basement: crawlspace, or enclosure) is _'_ 0 feet 0 meters 0 above or 0 below the LAG.
E2. For Building Diagrams 6w9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 8-9 of Instructions), the next higher floor
(elevation C2.b inJhe diagrams}'ofthe building is _'_ 0 feet 0 meters 0 above or 0 below the HAG,
E3. Attached garage (top of slab) is _'_ D feet D meters D above or D below Ihe 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.
. I __
E5. Zone AO only: If no flood depth number is available, is the top of the bottom fJoor elevated in accordance with the community's floodplain management
ordinance? 0 Yes 0 No '0 Unknown. The local 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 AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge.
Property Owner's or Owner's Authorized Representative's Name
Address
City
State
liP Code
Signature
Date
Telephone
Comments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
o Check here if attachments
G2.D
G3D
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, 8, C (or E),
and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check tlie measurement used in Items G8 and G9,
G 1. 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 elevation information. (Indicate the source and date of the elevation data in the Comments area below,)
A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or Zone AO.
The ~ollowing information (It~,ms G4~G9) is provided for community floodplain management purposes.
G4. Permit Number
G5. Date Permit Issued
G6. Date Certificate Of Compliance/Occupancy Issued
G7. This permit-has been issued for: 0 New C.onstructio~ 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 floo~ing at the building site: _ _ 0 feet 0 meters (P.R) Datum ---'---
G10. Community's design flood elevation __ 0 feet 0 meters (PR) Datum _
Local Official's Name
Tille
Community Name
Telephone
Signature
Date
Comments
o Check here-if attachments
'EMA Form 81-31, Mar 09
, Replaces all previous editions
.
.
For Insurance Company Use:
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number
2763 N 21" Street .
City Springfield State OR ZIP Code 97478. Company NAIC Number
. .
If using the Elevation Certificate to obtain NFIP ,flood insurance, affix at least two building photographs below according to
the instructions for Item AG. Identify all photographs with: date taken; "Front View" and "Rear Vieyv"; 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 I nstructionsfor Item A6
FrontView-12/10/2010
.,,'.
Rear View - 3/23/2011
.
.
Building Photographs'
:. Continuation Page .
, For Insurance Company Use;
Building Street Address (including Apt, Unit, Suite"andlor Bldg. No.) or P.O.. Route and Box No. .Policy Number
2763 N 21" Street . . .
City Sprin9.field State OR ZIP ~Code 97478 Company NAIC Number
If submitting more PhotogrClPhs than will fit on the preceding page, affix the additional photographs below. Identify all
photographs with: date taken; "Front View" and :'RearView"; and, if required, "Right Side View" and "Left Side View."
. ." '. .". '.. . . .
Additional Rear View - 3/23/2011
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