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Home My WebLink About34-1136-011-01405EN FEDERAL EMERGENCY MANAGtmtrr i MIAMI-DADE M NATIONAL FLOOD INSURANCE PROGRA O.M.B. No. 3067-0077 Expires July 31, 2002 ' PROCESS # ELEVATION CERTIFICATE - U -cl FINAL-EC Rev. JAN 01.2000 Cl l f ~ 7 Important: Read the instructions on page 1-7. Amended by Miami-Dada County-DERM Oct 1999 1310-// , 0 V- / SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number 5&4ov* D"E'f1Q`tUS BCD C~ BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number CITY STATE ZIP CODE MIA.Mt Rl.- 331 4 PRgqPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) L01- 844 4b " &Dt I T)ol~( PS 844 P BUILDING LISE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.) RESibF,J rIAL 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 COMMUNITYNME -C MMUN-1r( NUMBER__. B2. COUNTY MAME- - - S3. STATE UN )At C.6V1P0W_&%rF_b 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) 12oZ5LOOl5o 3.2 -44 -7-1 "7- R5 Ae, Co 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): 811. Indicate the elevation datum used for the BFE in 139: 0 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 (Select the building diagram mostsimilar 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 C3a-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 Conversion/Comments _ Elevation reference mark usedQC~oes the elevation reference mark used appear on the FIRM? ❑ Yes .m2 No - ft. . ❑ a To (including basement or enclosure) Top of bottom floor g X. _ ~ . ca p w ❑ b) Top or next higher floor (m) ❑ c) Oottom of lowest horizontal structural member (V zones only) ft.(m)- 1• $ - 0 d) Attached garage (top of slab) at Garage Door (Mia=[ ade) ft;(`M) 4 e) Lowest elevation of machinery and/or equipment servicing the building E -2 U1 to O f) Lowest adjacent grade (LAG) . A_ft.(m).. C] g) Highest adjacent grade (HAG) E C h)Total area of all'permanent openings (flood vents) in C3h sq. in. (sq. cm) Z - 0 i) No. of permanent openings (flood vents) within 1 ft. move adjacent grade r h ❑ j) Highest crown of road (Mia-Dade) ~.O ft.(m) n 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 c~rtifrcate represents my best efforts to interpret the data;available. /understand that anv false statement maybe punishable by fine or imarisonment under 18 U.S. Code, Section 10011 NUMBER TITLE COMPANY NAME TiEWSTEREb LA "b WRAyok moix-RE A ASSoWA-t-ES ISO-. ADDRESS CITY STATE ZIP CODE 129as sw 1*~aa wLrmoe MIAMI u SIGNATURE MATE -IL&_:PHONE 4S90t'7W04~ 7 !Z-60 (34 `278.24?4) 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 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) Puil ing ovylter. COMMENTS - u. r~ " ; „ . ~thc6 hers if A chm*nts SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE V,)TNUWE) 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 adjacen det- ;,t,~ r3 ; •,~r , ~ 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. E4. For Zone AO only If no flood depth tit." er is available,' is the top ~of the bottom fl/Q tQ In accotdnce with the unit floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATIQN The property owner or owner's authorized representative who completes Section'sA B, and E for Zone A (without a FEMA-issued or community-issued BFE) or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEP NE COMMENTS ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local oficiel wr-,c iS authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B,~ J C (or.E),, and G of this Elevation Certificate. Complete the applicable item(s) and sign ~~Iwv G1, ❑ The information In Section C was takeQ froq ther documentation-that y. has been signed and Aoised by a licensed surveyor, er, gineef, dr architect who Is authonzel by state or local law to certify elevation information. (Indicate the source- and date of the "°a~atir~i"he,Comments area below.) G2 tomrritinity, official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or 631 j The fo owin;.Information (items G4A isWovided for community floodplain management purposes. G4. PERMIT NLJMBEF,Z G5. DA PIIIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY -Le ISSUED G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-built lowest floor (includis aserpent) of the building is: _ft.(m) Datum x.. = 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 tiCly~ .•~a" ~?;.5~ c: M A% ~ l:~. • . A i~ ' =f C1*1SM herOW atlatflMents i; FEMA Forth 81-31, AUG 99 ,t SEE REVERSE SIDE FOR CdNTINUATION "REPLACES ALL'PRVIOUS EbITIONS