HomeMy WebLinkAbout34-1134-013-1000/4L&AL'tIVI--KULNt;Y MANAULMLN I AULNUY
O
M
B
No
3067
0077
NATIONAL FLOOD INSURANCE PROGRAM
.
.
.
.
-
Expires December 31, 2005
ELEVATION CERTIFICATE 1-
1
Important: Read the instructions on pages 1.7.
3
/k~
SECTION A - PROPERTY OWNER INFORMATION
9
For Insurance Company Use:
BUILDING OWNER'S NAME
Policy Number
PMF BUILDERS CORP.
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
1871 NW 206TH ST.
Company NAIC Number
CITY STATE
ZIP CODE
MIAMI FLORIDA
33056
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 8 BLOCK 25 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 ❑ NAD 1927 ❑ NAD 1983
❑ USGS Quad Map ❑ Other.
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NAP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3. STATE
UNINCORPORATED AREAS 120635 MIAMI-DADE COUNTY FLORIDA
B4. MAP AND PANEL
B7. FIRM PANEL
BASE FLOOD ELEVATION(S)
NUMBER
B5. SUFFIX
B6. FIRM INDEX DATE
EFFECTIVEIREVISED DATE
B8 FLOOD ZONE(S)
AO,-6§6 depth of flooding)
tlm
1202500080
J
07/17/95
03/02/94
A~
+
indicate the source o ease o ~ Elevation ❑ Coa a or base depth flood entere in ,
B! 0. I:
❑ FIS Profile ® FIRM I mmurn Determi'
ned El Other (Describe):
BI 1, dicate the elevation datum used for the BrE in B9: NGVD 1988 i ~ y (1929) area or Otherwise Pro ed A ea OP R Other (Describe)
612. Is BRS A . ❑ Yes ®No.
the building located in a Coastal Barrier Resources S stem C ( Designation Date
SECTION C - BUILDING ELEVATI
ON INFORMATION (SURVEY REQUIRED)
61. Build'in9 elevations are based on: ❑ Construction Drawmgs* El Building Under Construction* ~ 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, ARiAE, 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 mark used BM Does the elevation reference mark used appear on the FIRM? ❑ Yes ®No
❑ a) Top of bottom floor (including basement or enclosure) 7.6 ft.(m)
Q b) Top of next higher floor NIA ft.(m)
W a)
O c Bottom of lowest horizontal structural member (V zones only)
,
Attached
0 d) garage (top of slab) 7.0 ft.(m) E
h 0 e) Lowest elevation of machinery and/or equipment
P.S. . #5034
_
a1
E servicing the building (Describein a Comments area 7.6 ft. ( m )
)
03/09/05
IJ f) Lowest adjacent (finished) grade (LAG) 7.1 ft.(m) z .2)`
❑ g) Highest adjacent (finished) grade (HAG) L2-ft (m) y
11 i, E] h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade N/A
Total area of all permanent openings (flood vents) in C3.h NIA sq. in. (sq. cm) L
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 certify eleva~fion~"information.
l certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data avaiiabi
l understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. !''I ii III
CERTIFIERS NAME OSCAR EMILIO BAEZ-CUSIDO, P.S.M. LICENSE NUMBER 6634
TITLE REGISTERED SURVEYOR AND MAPPER COMPANY NAME BAEZ & ASSOCIATES, INC.
SW 83RD CT.
CITY
MIAMI
STATE ZIP CODE
FL 33155
SIGNATURE DATE TELEPHONE
03/09/05 305-265-1002
IL
Form 81-31. Januarv 2003 See reverse side for continuntinn RAnlarac ail nrAvinim Aeiifinn-m
IMJPQRTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use:
BUILDING STREET ADDRESS (Including Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number
1871 NW 206TH ST.
CITY STATE ZIP CODE Company NAIC Number
Miami R. 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 = 5.8'
❑ Check here if attachments
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
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 LOli
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 (seepage 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?
tit I
❑ 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 FEMA4ssued 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 official who is 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. Complete the applicable item(s) and sign below.
G1. ❑ The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state
or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or Zone A0.
G3. ❑ The following information (Items G4-G9) is provided for community floodplain management purposes.
G4.
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: _ft.(m) Datum:
G9. BFE or (in Zone AO) depth of flooding at the building site is: _ ft.(m) Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
❑ Check here if attachments
r-r-it AA r-~_ nw nw