The URL can be used to link to this page

Home My WebLink About34-1134-013-0890304tf3~V-D13•~ga " C2~x-Po~~~rl 2'S NAME ro FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077 Expires December 31, 2005 ELEVATION CERTIFICATE nportant: Read the instructions on pages 1- 7. SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use Policy Number Company NAIC Number ZIP CODE 33056 BUILDING STREET ADDRESS (Including Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. 20530 NW 17T" AVENUE CITY STATE MIAMI FLORIDA PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 25 BLOCK 24 OF " LAKE LUCERNE SECTION SEVEN " PLAT BOOK 157 PAGE 73 BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.) RESIDENTIAL LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (Type): ( - - or 171 NAD 1927 [1 NAD 1983 El USGS Quad Map El Other. III SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER 82. COUNTY NAME 83. STATE UNINCORPORATED AREAS 120635 MIAMI-DADE COUNTY FLORIDA B4. MAP AND PANEL B7. FIRM PANEL B9. BASE FLOOD ELEVATION(S) NUMBER B5. SUFFIX B6. FIRM INDEX DATE EFFECTIVE/REVISED DATE B8. FLOOD ZONE(S) (Zone A0, use depth of fl)oding) 1202500080 J 07/17/95 03/02/94 AE + 7.0' 610. Indicate the source of the base Flood Elevation (15FL) data or oase nooa oeptn entered in mi. ❑ FIS Profile E FIRM ❑ Community Determined ❑ Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: E NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes E No Designation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* E Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number 1(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 Al A30, AE, AH, A (with BFE), VE, V1 430, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO Complete Items C3.-a4 below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum NGVD Conversion/Comments Elevation reference marls used BM Does the elevation reference mark used appear on the FIRM? ❑ Yes E No ❑ a) Top of bottom floor (including basement or enclosure) 72 ft.(m) CIO ❑ b) Top of next higher floor N/A ft.(m) ❑ c) Bottom of lowest horizontal structural member (V zones only) N/A :ft.(m) o J~ ❑ d) Attached garage (top of slab) N/A ft.(m) ❑ e) Lowest elevation of machinery and/or equipment w 11 ' #50 servicing the building (Describe in a Comments area) 7_3 ft(m) E CIO 8f25%Q4 { ❑ f) Lowest adjacent (finished) grade (LAG) 5`7 fL(m) Z ❑ g)" Highest adjacent (finished) grade (HAG) 6.4 ft.(m) ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade N/A rt P' y ❑ i) Total area of all permanent openings (flood vents) in C3.h N/A sq. in. (sq. cm) Vii) ~I SECTION D -SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION L This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation in 01 tion. i i Sri ~ ~ I iii rl I certify that the information in Sections A B and C on this certificate represents my best efforts to interpret the data Al ilab~e understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. CERTIFIERS NAME OSCAR EMILIO BAEZ-CUSIDO, P.S.M. LICENSE NUMBER 503 1 TITLE REGISTERED SURVEYOR AND MAPPER COMPANY NAME BAEZ & ASSOCIATES, ZING. ADDRESS CITY STATE ZIP CODE 2000 SW 83RD CT. MIAMI FL 33155 SIGNATURE DATE TELEPHONE 08/25/04 305-265-1002 FEMA Form 81-31, January 2003 See reverse side for continuation. Replaces all previous editions V IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Ccmpany Use BUILDING STREET ADDRESS (Including Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number } 20530 NW 17TH AVENUE CITY - STATE ZIP CODE Company NAIC Number Miami Fl. 33056 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. COMMENTS CROWN OF ROAD ELEVATION = 6.05' ❑ Check here„if attachme SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BCE) For Zone AO and Zone A (without BFE), complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, k!, Section C must be completed. E1. Building Diagram Number _(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.) E2. The top of the bottom floor (including basement or enclosure) of the building is _ ft.(m) _in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, if available). E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is _ ft.(m) _in.(cm) above the highest adjacent grade. Complete items C3.h and C3.i on front of form. E4. The top of the platform of machinery and/or equipment servicing the building is _ ft.(m) _in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, if available). E5. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ 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, C (Items C3.h and C3.i only), 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, C, and E are correct to the best of my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS ❑ Check here if attachments SECTION G -COMMUNITY INFORMATION (OPTIONAL) The local o1 dal A64 authorized-by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate Compete the ai 6i able ,tem(s~ and sign below. G1. ❑ The inormution in Simon n vas faken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state r5 r Ilk I or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) laic r G2. ❑ A community of6c ial completed Section E for a building located in Zone A (without a FEMA-issued or community4ssued BFE) or Zone A0. G3. ❑ The following information (I6 ms'(24-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: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-built lowest floor (including basement) of the building is: _t(m) Datum: G9. BFE or (in Zone AO) depth of flooding at the building site is: _ t(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS ❑ Check here if attachments FEMA Form 81-31, January 2003 Replaces all previous editions