HomeMy WebLinkAbout34-2109-004-0095CROWN ELEV..9.80'
PROC.#C2003o82435
FOLIO# 3021090040095
BUILDING OWNER'S NAME
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
nportant: Read the instructions on pages 1- 7.
SECTION A - PROPERTY OWNER INFORMATION
JOAQUIN FERNANDEZ
O.M.B. No. 3067-0077
Expires December 31, 2005
Hun 1nsu181" Can>uany Use.
Policy Number
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No) OR P.O. ROUTE AND BOX NO. Company NAIC Number
2750 NW 170 ST '
CITY MIAMI I, ESTATE ZIP CODE
F
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
PLAT BOOK 39'PAGE 83
BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.)
RESIDENTIAL
LATITUDE/1-ONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS (Type):
( - - or ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ® Other.
SECTION 8 - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP COMMUNITY NAIVE & COMMUNITY NUMBER 62. COUNTY NAME B3. STATE
UNINCORPORATED 120635 MIAMI DADE FL
--b4-.-NW AND PANEL
67, FIRM PANEL
B9. BASE FLOOD ELEVATION(S)
NUMBER
85. SUFFIX
B6. FIRM INDEX DATE
FFFFCTIVFIRFVISFn nATF
M F 7t r(q)
(7n,, Ar). ,tQP ripol ,4 4.-4iivl
1 2 0 5 C o o 8 0
J
7-17-95
3-2-94
X
NA
610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in 139.
❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe):
611. Indicate the elevation datum used for the BFE in B9: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe):
B12. Is the buildin 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, ARIA, AR/AE, 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 version.
Datum NGVD Conversion/Comments N/A - ~ 6 . ~7
Elevation reference mark used - Alevation reference mark used appear on the FIRM? ❑ Yes ® No
o a) Top of bottom floor (including basement or enclosure) ft.(m)
fl.(m) <n
o b) Top of next higher floor
o c) Bottom of lowest horizontal structural member (V zones only) j~!/~fL(m) o =
o d) Attached garage (top of slab) (m) E20-
• -
e) Lowest elevation of machinery and/or equipment w T-
serviang the building (Describe in a Comments area) Qft.(m) E
t~•4~
o 0 Lowest adjacent (finished) grade (LAG) azo ft. m)
Z
o g) Highest adjacent (finished) grade (HAG) Ou ~ft.(m)
o h) No. ofpermanent openings (flood vents) within 1 ft. above adjacent grade ° I
o i) Total area of all permanent openings (flood vents) in C3.h q. in. (sq. ) ,R 'II
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION' I
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation' inforrrnation.
I certify that the information in Sections A, 8, and C on this certiricate represents my best efforts to interpret the data availatle.
a
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIERS NAME Arturo Toirac LICENSE NUM8ER"3102
twill
TITLE Professional Land Surveyors. COMPANY NAME Vizcaya Land Surveyors Inc.
ADDRESS CITY STATE ZIP CODE
13217 SW 46 LN MIAMI FL 33175
SIGNATURE DATE TELEPHONE
• t 5 f (305)223-solo
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IMPORTANT: In these spaces, copy the corresponding information from Section A. i J :urancx; c ~n>Ek~r,y u:;L:
BUILDING STREET ADDRESS (Induding Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUT; AND BOX NO. i x~ r Jumber
2750 NW 170 ST
CITY MIAMI
FL STATE
ZIP CODE I C 'o pany NAIC Number
SECTION D - SURVEYOR, ENGINEER, OR. ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certilcate for (1) am Iniulily oliiclol, (2) in;ur, i x! , n ;t tl/~x x r If X11 ty, , n u 1(;1) i,udl, fin( I (»vt H >t
COMMENTS BM used N 484 ELEV. 9. 41 '
❑ 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 cornpleted - 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 (see page 7), the next higher floor or elevated floor (elevation b) of ft Wilding is ft.(m) in.(cxn) above the highest adjacent
grixk Comocto Itonls C3.h and C3] oil front of form,
E4. The top of the platform of machinery and/or equipment servicing the building is rl.(a)) in.(cr») ;IN-)vo or txc ow (0)('6% ()oil) Iho iu,rll,-~ I , :natural grade, if available).
E5. For Zone A0 only: If no flood depth number is available, Is the top of 'he bottom floor elevated in accordance with the community's floodplain management ordinance?
❑ Yes ❑ No E] 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 contact to the bast of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZJP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
r. ❑ Check here if attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local official who is authori ed by law or ordin,m(x) to admini%lor lho (.,()I fit r1unily'r; tl~,rN f1>lrun i m m l; )f r I H Jill f N(Gl I; u l( 41 a .111 '1111 Jig At, b, )f v. n i ~ r . i r .11, I f r u I r, a,,
Certificate. Complete the appliuible 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 cent y elevation infonmtion. (Indicate the source and date of the elevation data in the Comments area below.)
G2. ❑ A community official o6mpI661 Section n E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or Zone A0.
G3. ❑ The fafowing information Otems G4-G9) is provided for community floodplain management purposes.
G4. Pt_RMIT NUMBER I -G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF OWLIANCE/OCCUPAN,','Y ISSUED
G7. This permit has been issued for. ❑ New Construction ❑ Substantial Improveraab6
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
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