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Home My WebLink About34-1134-013-1100r?9 FEDERAL EMERGENCY MANAGEMENT A ATIONAL FLOOD INSURANCE PROGRAM 903 O.M.B. No. 3067-0077 Expires December 31, 2005 ELEVATION CERTIFICATE " 111 " (0l, //(~~lportant Read the instructions on pages 1.7. SECTION A - PROPERTY OWNER INFORMATION 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. Company NAIC Number 1702 NW 207 ST. CITY STATE ZIP CODE MIAMI FLORIDA 33056 PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 18 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. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME J B3. 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/REMSED DATE B8. FLOOD ZONE(S) (Zone AO, use depth of Wing) 1202500080 J 07/17/95 03/02/94 AE + 7.0' B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe): B11. Indicate the elevation datum used for the BFE in 139: ® 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 ® No Designation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* ® Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number I (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, VI 430, V (with BFE), 'AR, ARIA, ARIAE, AR/A1 A30, ARIAH, ARIAO Complete Items C3: a-i 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) ❑ b) Top of next higher floor N/A ft.(m) ❑ c) Bottom of lowest horizontal structural member (V zones only) NIA :ft.(m) o in ❑ d Attached garage (top of slab) WA ft. m E RI ~~d j 011 w M ~a ❑ e) Lowest elevation of machinery and/or equipment P. , {#5034 servicing the building (Describe in a Comments area) 7.6 ft.(m) /0905 ❑ fl Lowest adjacent (finished) grade (LAG) 7.0 ft.(m) z ❑ g) Highest adjacent (finished) grade (HAG) 7.1 t(m) ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade NIA J ❑ i) Total area of all permanent openings (flood vents) in C3.h N/A sq. in. (sq• cm ) I h~ ' g ou~ !Ian ~ SECTION D - SURVEYOR ENGINEER, OR ARCHITECT CERTIFICATION ~IIII'i~lll'u~ll'dlllh Ip ~lilll ' This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation ini'ation:' I certify that the information in Sections A, 8, and C on this certificate represents my best efforts to interpret the data available /understand that any false statement maybe punishable by fine or imprisonment under 18 U. S. Code, Section 1001. ; k;11 CERTIFIERS NAME OSCAR EMILIO BAEZ-CUSIDO, P.S.M. LICENSE NUMBER 5b34 TITLE REGISTERED SURVEYOR AND MAPPER COMPANY NAME BAEZ & ASSOCIATES, INC. ADDRESS CITY STATE ZIP CODE 2000 SW 83RD CT. MIAMI FL 33155 SIGNATURE DATE TELEPHONE 03/09/05 305-265-1002 FEMA Form 81-31, January 2003 See reverse side for continuation. Replaces all previous editions AMPORTANT: 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 1702 NW 207TH ST. C111' 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 = 6.53' ❑ 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 LOMR-F, 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? ❑ 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, Q and E are co►rect 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 FEMA4ssued or community4ssued BFE) or Zone A0. G3. ❑ The fallowing information (Items G4-G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY ISSUED G7. This pemit 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 FEMA Form 81-31, January 2003 Replaces all previous editions