The URL can be used to link to this page

Home My WebLink About34-1135-016-0270, dupeFEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077 ' Expires December 31, 2005 ELEVATION CERTIFICATE ~~~Read_the instructions on pag6s Impoft,a„ n JOB NO.: 03-0526 SECTION A - PROPERTY OWNER INFORMATION' For Insurance Company Use: BUILDING OWNER'S NAME - Policy Number COPELAND CONSTRUCTION BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number 1241 N.W. 207TH STREET CITY STATE ZIP CODE MIAMI FLORIDA PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) 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 B3. STATE UNINCORPORATED -120635 MIAMI-DADE FLORIDA B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding) 1202500080 J 07/17/95 REV. 03/02/94 AE B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in 139. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe): B11. Indicate the elevation datum used for the BFE in 139: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe): 1312. 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 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-V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO 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 COUNTY Does the elevation reference mark used appear on the FIRM? ❑ Yes ® No ❑ a) Top of bottom floor (including basement or enclosure) Z. 10 ft.(m) ❑ b) Top of next higher floor N/A _ft.(m) El c) Bottom of lowest horizontal structural member (V zones only) N/A. ,ft.(m) o o ❑ d) Attached garage (top of slab) 6. 29 ft.(m) a ❑ e) Lowest elevation of machinery and/or equipment servicing the building (Describe in a Comments area) 7.07 ft. (m) ~ ❑ f) Lowest adjacent (finished) grade (LAG) 6. 1 ft.(m) Z.0 a) U) C3 g) Highest adjacent (finished) grade (HAG) O ❑ h No. of permanent openings (flood vents) within 1 ft. above adjacent grade 0 - ❑ i) Total area of all permanent openings (flood vents) in C3.h 0 sq. in. (sq. cm) 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 to certify elevation' information. I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME: JASON H. PINNELL LICENSE NUMBER: 5734 TITLE: PROFESSIONAL SURVEY R & MAPPER COMPANY NAME: PINNELL SURVEY, INC. CITY STATE ZIP CODE ADDRESS - 2151 DIVE HIL BLVD., 4 06 ,DEERFIELD EAC FLORIDA 33442 is~ 8'IGNAT RE DATE TELEPHONE V CJJ (954)418-4940 orm 81-31, January 2003 See reverse side for continuation. Replaces all previous editions IMPORTANT: 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 CITY STATE ZIP CODE Company NAIC Number FLORIDA 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 ❑ 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 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.) 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 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 PINNELL SURVEY, INC. /JASON H. PINNELL, P.S.M. #5734 STATE OF FLORIDA ADDRESS CITY STATE ZIP CODE 2151 WEST HILLSBORO BLVD., #206 DEERFIELD BEACH FLORIDA 33442 SIGNATURE DATE TELEPHONE (954)418-4940 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 apiow~0 G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or Zone AO. G3. ❑ The following information (fterns G4-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: (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 FEMA Form 81-31, January 2003 Replaces all previous editions SIGNATURE DATE