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Home My WebLink AboutFEMA Application 2002-1-23 B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME SPR.I N~ rl CLc 4\ "5 '591. I....JWE 84. MAP AND PANEL 65. SUFFIX 66. FIRM INDEX 67. FIRM PANEL 68. FLOUU NUMBER _ DATE EFFECTlVElREVISEDDATE ZONE(S) f\c~c; C \ \~ 1 r J~e: ?., l"'\",\"" J \JNC 2., \~~, Ac' ' 810. Indicate the source of the Base Flqoq Elevation (BFE) data or base flood depth ~ntered in B9. U FIS Profile' , U FIRM , . ~Community Determined U Other (Desc:ribe): B11.lndicatetheelevationdatum used for the BFE in 89: !B-NGVD 1929 U NAVD 1988 UOther(Describe): 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise P~otected Area (OPA)? Designation Date: . ' Ft:lJERAL EMERGENCY MANAGEMENT AG~ .CY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE i~portant: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION BUILDING OWNER'S NAME . , . plLL'( THO M"i ~ BUILDING STREET ADDRESS (Including Apt. Unit. Suite,andlor Bldg. No.) OR P.O. ROUTE AND BOX NO. Go, 08 A f\lk.N l,..,~N C CITY STATE 5~INae=Ie..O 012... PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number\~gal Description, etc.) 'loa," \04-- L.EVl ,-""-lesl '-1 ~ '2.,.:>=- f:lr,Q~\"t\l:)~' BUILDING U.SE (e.g., Residential. Non-residential, Addition. Accessory, etc. Use Comments section it necessary.) . R~ Slof"''TI~ LA TITUDElLONGITUDE (OPTIONAL) , ')G HORIZONTAL DATUM: SOURCE: U GPS (Type): ( #If - ##' - ##.##" or ##:#####j ~NAD 1927 U NAD 1983 U USGS Quad Map SECTION 8 - FLOo.D INSURANCE RATE MAP (~IRM) INFORMATION ~2~'9. l~ a.M.B. No, 3067-0077 Expires July 31, 2002 1~i.itn'!vi~,~~~~?iIi~,~~l;~-~~t', ",',' . '" . .' '. " ..~~ ...~:~~~t, ZIP CODE 4', {-1! U Other: 63. STAY~ o~ ' , 89. BASE FLOOD ELEVATION(S) : . (Zone AO, use depth of flooding) ~\\.'Z.. . UYes IdNo SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C iilding elevations are. based on: UConstruction Drawings. L/Building Under Construction. LIFinished Construction . A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number..B- (Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations -Zones A1-A30, A.E. AH, A (with BFE), VE, V1-V30, V (with BFE), AR. ARiA. ARiAE; ARiA1-A30, ARJAH, ARiAO Complete Items C3a-i ~eJow according to the building diagram specified in" Item C2. State the datum us~d. Ifthe datum is different from the datum used for the BFE in Section B, convert the datum to that' used for the BFE. Show fj~ld' measurements and datum conversion calculation. .yse the space provided or the Comments area of Section D or SectionG, as appropriate, to document the datum conversion. Datum" Conversion/Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? U Yes [!g No o a) Top of bottom floor. Onduding basement or ~ndosure) OS \ to :., ft.(m) ~ , ' o b) Top of next higher floor "".:) IS. ~ ft.(m): ~ REGISTERED .. -8 "') :::011CiTI,,[ 1"",;.",[ 1,,,, ;..,;,,'l't<ol ,,;, ......1..., cl ,. ,,,.,.Liii (~. L.... ....." ...,.!y) . _ ft.(m) ~ ~ PROFESSIONAL o d) Attached garage (top of slab) ':>1'2;) . ~ ft.(m) i ~ ~ND SURV;ayPR o e) .Lowest elevation of machinery and/or equipment ..: m '~.,., ," . ,., servicing the building N fA. . _ ft:(m) ~ ~ ~ ""'" ~'-k- o 1) Lowest adjacent grade (LAG) '51'2;) . .5.... ft.(m) ~ ~ ~J OREGON o g) Highest adjacent grade (HAG) SI ~ . ,., ft.(m) ~ FE8. 19, 1 BOO o h) No. of pennanent openings (flood vents) within 1 ft. above adjacent grade 4 ~ JAMES W. COLTON o i) Total area of all pennanent openings (flood vent~) in C3h (0 \ \ sq. in. (sq. em) ~ , #58756 ~ SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION, Ex?\l~.e:<.> I '2./'!J1j o},' This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation infonnation. I certify that the information in Sections A, 8, and C on this certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 100,1. TFIER.S NAME , . r C L1CEN8f NUMBER ->^.....e~ 'IN . Cl\.'TON O~ . L~. ... '5~1"5~ TITLE L~!) , :s.1J(l..~ e'(o1Z. COMPANY ~\tP - N E S~ - Fll\ ~ :s &!,\oett.. ADDRESS. n..~ .,,., ..., "1. 'S CITY - _ _ ST A IE ZIP CODE... .A _.., P.6, U'"'x 4~ I.;,.) t:.~G~c C~, '-\\"r'o)<" ~:~~~~~:Encr,,,--:^~' (y u_______ _._~~~E_ ~~~.~~.~~._.. TELEPHONES+1. ~4+. \aSZ- IMPORTANT: In these spaces, copy the COI ,londing information from Section A. BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. ~ 16 a r.^P-'ON LA,"-Je CITY STATE ZIP CODE SpR,IN a PI e...'? 0 1-. <=1141~ I For Insurance'Co;np~ny -;';se.:.' '~"~': Poljcy.iN~mbE;r"" , ',' "'~:; 0:..... . .: " ,::'" ......i,'t;' ;-.:..,: -::J..;;. ,. -" ~:. ".:' .:.:': '::_':'R ~~. "', _::; :~; L~NA~t~:,j~~~;~: .. SECTION 0 - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUEQ) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenVcompany, and (3) building owner. COMMENTS 1-' Check here if attachments SECTION E. - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO and ZONE A (WITHOUT BFE) or Zone "0 and Zone A (without SFE), complete,lterns E1 through E3. If the Elevation Certificate is intended for use as supporting l(ormation (or a LOMA or LOMR-F, Section C must be completed. . 1. Building Diagram Number (Select the building diagram most similar to the building for which this certifieateis being completed _ see pages 6 and 7., If 1;10 diagram accurately represe~ts the building, prov~~e a sketch or photograph~) , . . : .', 2. The top of the bottom floor (tncll;lding basement, or enclosure) of the building is I I 'ft.(m)' I 'in.(ern) L/-aboye or U below (check one) the. hig~est adjaCent grad~.'. . 3. For Zone AO only: If no flood depth number is available, is th~ top of the bottom f1oorfelev€ltedin' accordance with the community's floodplain management ordinance? '_._' Yes 'I~ No I I Unknown. The local.official must certify this info.!!n.ation in Section G. . SECTION F - PROPERTY OWNER (OR, OWNER'S REPRESENTATIVE),,tERTIFIGATJON "he property owner or owner's authorized representative who completes Sections A. B, and E for Zone A (without a FEMA-issued or :ommunity-issued SFE) or Zone AO must sign here. . . 'ROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME DDRESS C/lY STATE ZIP CODE ::;NATURE DATE TELEPHONE OMMENTS SECTION G - COMMUNITY INFORMATION (OPT!ONAL) ~,Iocal official who,;s authorized by la~ or ordinance to administer the community's floodplain management ordinance can ,complete ;tions A.,S; C (or E). and G of this Elevation Certificate. C,omplete'the applicable item{s) and sign below. . U The information in Section C' was taken from other documentation that has been signed and embosse'd by a licensed surveyor. engineer, or ar~itect who is authorized by state or local law to certify elevation information. (Indicate the source anp date of the el~vation'data in the Comments area below.) . U A ~mmunity official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued SFE) or Zone AO. U The'following,informalion (Items G4-G9) is provided for community floodplain management purposes, . PERMIT NUMBER . G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCElOCCUP}\NCY ; ISSUED This p~rmit has peen issued for. U New Construction U Substantial Improv,ement Elevation of as-built lo.....est floor (including basement) of the building is: SFE or (in Zone AO) depth of flooding at the building site is: CAL OFFICIAL'S NAME TITLE , Checkhete if attachments , . _ ft.(m} Datum: . _ ft.(m} Datum: MMUNfTY NAME iNA TURE ~MENTS TELEPHONE DATE I Check here if attachments A r-___ "'.. "". ..,_"",.,.