980 BAY ESPLANADE c�cv�►� iuN l:tH i7FiCATE o."'.B."°3o��•°°»
ERpires Alay 3I.I943
• � FEDERAL EMER�ENC1f MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGpqM
ATTENTION: Use of this certificate does not prov�de a waiver of the flood insurance purd�ass requirement. This torm is used anly to
provide etevation Intormation necessary tc snsure compliance v�ith appt�caWe xmmumiy floodpla�n management ordtnances,to
deterrttine the proper insu�ance premium rato,andior to suppoR a request ior a lener a1 Map Amendment or Revision{LOMA or LOMR)
• Instructionr tor con�plslinp thls to►m can be lound on tNe tolicwin0 papes.
SECTION A PROPERTV INFORMATION FOR 1NSURANCE COMPANY US6
BUIIOING OWfYEH'S NAME �L�Y�M�q
�a r-ed D �r».yn
STREET ADOAESS(Indud�ng Apt,UrNL$��N arxya gte�g,Nympor�OR PA.ROUTE ANO 80X NUMBER f�A1PANV WuC N�Ai1gEF
D c+� ,E� /�n G
OTHEH DESCRIPTtON�Lo1 and 8bde Numbers,e1e.�
LOl'! 9�.GIe�r^7� 07'��OT• �D •B�C�� Z�p�p �7/'�Oc��f �i� �JG/�4o.E �o� /�3 �OS G 2-
CITY STAT£ �T21P COOE
C�Ga r r✓c2}'6i^ �/A. .3�G�o
� SECTION 8� FLOOD.INStJRANCE R/lTE MAP(FIRM)lNFOqMAT10N
Provide the tollowfng from tha proper FIRM(See In3tryujpns):
t.CpMMUtrITY NUM6E11 2.PANEL�ABER 0.SUFFlX t. T�O�PIqM INp�( S,FIRM ZpNE 6.BASE ftOOD ELBVATION .
� .(n A0 2onu.we eaPPq
!25'09� aoo 3 "L7'' �• � A�� '� �� ,
7. Indicate the elevation datum system used on the FIRM tor Base Flood Elevatfons(BFE)� NGVD'29 C�Other(dosc►ib�vn badc) .
8. For Zones A or V,where no BFE is provided on the FlqM,and the ccmmunlry hes established a 8FE tor this building site,indicate
the communiry's BFE:L�J.0 feet NGVD(or other FIRM datum-�s Section B,Hem�,
SECTION C BUILDING ELEVATION INFORAAATION �
1. Using the Elevation CeRrficete Instructions,indicate the diegram number trom the dlagrems lound on Pa�es 5 end 8 thed best
descrlbes the subject bu�ldinO's.reference lavel I . . ,
2(a). FIRM Zones A1-A30,AE,AN,and A(with BFE), The top ot the reference Ievel fioor irom the.selected diagram is a4 an e�evat�on
o+�S.�1.�iest NGVO(cr ather FiRM datum-see Section B,Item 7� ,
•(b). FIRM Zones Vt-V30,VE,and V(w�th BFE). The bottom ot the lowest horizontal strudu�al rnember of the reference level fram
the selected diagram,ic at an elevatio�of!J I I I 1 ' �teet NGVD(or other PIRM datum-sss Section 8,ttem�.
(C). FIRM Zone A(without BFE). The flCOr ug�d as the ceference level frqm the SeleCied diegram�S 'WJ.�:�}eet abpve� o►'
below❑ (��one) the hiQhest grade adjeceM to the building.
(d). F{RM 2one AO. The iloer used as ehe rsfsrance fevel Irom the selacted diagram is W.Li fest above❑ or below�(�heqc
one)the h�phest grade adjacent to the building. If no flood tlepth number is availeble,is the bwlding'S lowest flnor(reference
level)elevated in accordar�ce w11h th�community's Noodplain managemern ordinence� (� Yes 1 No ❑ Unknown
3. Ind�cate the elevallon datum system used In dete�m�ninp the above rsfersnce levet elevations:[�^1GGYD'29 n Other(doscribe
untler CommeMs on Page 2). (NOTE: d rhe efevatlon datum used�n measurinD the elevaticr►s is diliarenf than iher used on
rhe FIRM (see SecNOn 8, Item�J,then converf rhe ebvatrons�o the dah,m system used on the FlRM dnd show the conversion
eqLation under Commems on Page 2.)
4. Elevacion raterence marK used appoa►s on FIRM: ❑ Yes �V�o (See Instrucbons on Page a�
5.The reference level elevation is based on: �qual conatruc�on ;_ : constructwn drawings
(NOTE: Use o!�ny�ruct�an drawwrngs is onfy valid/l the building does not yet have the relerence levo(f�oor in ptece, in which
case th�s ceMlicete will only be vBHd!nr�he buNdmg during the couise of cansnvction. A post-construction Elevafion CeRi/icate
wi!!be requved once construction is complete.)
6,The elevatron at the lowest grade immediatey adjacent to the Duilding is �;Yi.�feet NGvD(o►cther FIRM datum-see
Secbon 8, Item 7;
SECTION D COMMUNlTY lNFORMATION
t It the commun�ty oflidal respons�ble for venfying twilding elevations specities thet the reterence level indicated m 5ection C, Item 1
is not the"lowesi t�oor°as defined in the community's t�ootlpla�n ma�agom8ni otdinance,the elevation of the buildmg's"lowest
f�oor'as delmed by tne ordinance is� � !.;,` feet NGVD(or other FIFiM datum-sse 5ect�on 8. ltem 7}.
2. Dat@ of(he Sidrl Oi ConstruCtion or 5u�stantial imprOVement
iEMA PO�m 81•31�MA�90 Rf QLACES A�L PREviOUS ED�T�QNS SEE REVERSE S�OE FOR CONT1kU�TiON
.� ' �" q1-�`�' f�� l�
, '' ���.�ivn t t�tHTtFICqT1ON `
�-
Thrs certitication is to be signed by a�and suroayor,engmeer, or architect who is auchoriZec!by state or��1 law�o cert�fy elevation
iMOrma�ion when the eleval�on mformat�on ior Zones A�—A30, AE,qH.q(wrth BFE).V�—V30.VE,and V(with BFE)is►equired.
Commun�ty oni�fats who are authorized Dy Ioca�:aw or ordmante to p�ov�de ttoodplain mandgement intormal;on,msy also sign the
• ceRrtication. !n the case of Zenes AO and A(w;thoui a FEMA or community issueC BFE),a building ottipal.a properry owner, or an
owner's representative may atso s�gn t�e cerlification
Reference Ievei c�ragrams 6, 7 and 8-Distrngursh�ng Features—If the certifier�s unabte lo certify to breakawayinon-breakaway wall,
anefosure s¢e,locatfon ot serv;cmg equipme�t.area use,wali openings,pr unfin�shed a►ea reature(s),then list the Feature(s►not
�nGuded;r.the certitication under Commerns beiow. The aiagram number,$�l,a�C, Item t, must stil!be�entered.
1 certily thet 1he,RloimaJien in Sechons B and C on tn�s cenif;cate�p,asenis my,peu sy�to r'nterpref the data avai/abfe.
!un0erstand rAat any/a/se statement mey be pun,snable by fine or impnsonment un�r�g U.S. Cade.Section f00t.
CERTIFIER'S NAME
�" L�CENSE NUMBEA�pr�(hy Se2q
rit�E � �'/�r�o'r�. .�s • S��va. or �o.399S'
co�PaNr r�a�ue
.�U/'J�fS f-��r !H /��t r�oaeJ �/7G.
ADDFES$
3 68 ,rS A � '6// / STAT6 ZIP
SIGNATU E �'� F/e r�s4i •�¢ro65'
�� DATE PHONE
• �� � � � �
Copies shvuld be mada of thl�Csrllfl�at�for: 1)community otllcial,Z)�nsur�nc�agsnt/comp�ny,and 3)buHding owne�. ,
COMMENTS: �d ra oor o� s`1� !.e .
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ON �
�'"e� OA9EMlNf OM�IlEB,
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�� P�EAS.OR COLWb�9
ZOMES ZONES A A �
ZONES zOMES 20NF9
RPlEAENCE �EfEpENGf
IF�EL
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ROOD
ElEV�ipN ��'�
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NF�4oENCE �OJ�CEM Oh04 LEVE� Il�i 'IOOC
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The diagrg;ttg a0ove inustrate tne ooints at wnich me elevanons shouid De measured in A Zones a�d v Zores �
I
ElevaUons for an A Zones sha��be measured at tne cop ot the rete�ertce�evei floor
clevat�Or15}o�aJl V ZOnes Should O@ meaSur�gt the ooilOm ot the�oweSt honZOnta{5tru�tUfa1 member. I'
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