HomeMy WebLinkAbout34-1135-016-0270~~,~c o b Cod 0 ~~`1
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077
ELEVATION CERTIFICATE Expires December 31, 2005
Im
portant: Read the instructions on paces 1 lt~ 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
6'
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 B9: ® 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 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: 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)
❑ c) Bottom of lowest horizontal structural member (V zones only)
N/A. _ft.(m)
00
❑ d) Attached garage (top of slab)
6.
29 ft.(m)
E
❑ e) Lowest elevation of machinery and/or equipment
w 6
servicing the building (Describe in a Comments area)
7.
07 ft.(m)
❑ f) Lowest adjacent (finished) grade (LAG)
6.
1 ft.(m)
z
❑ g) Highest adjacent (finished) grade (HAG)
6.
6 ft.(m)
❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent
grade 0
J
❑ 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.
/ certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available.
I 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.
ADDRESS CITY STATE ZIP CODE
2151`WE HIL BLVD., 06 DEERFIELD EAC ! FLORIDA 33442
RE kw t - DATE TELEPHONE
SIGN AT
(954)4184940
FEMA Form 81-31, January 2003 See reverse side or continuation. Replaces al previous editions