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Home My WebLink About34-2109-012-0010PROCESS #~p~~Lja FEDERAL EMERGENCY MANAGEMENT AGENCY FOLIO #.s^'~tt•('~ NATIONAL FLOOD INSURANCE PROGRAM C.O.R.., 7.22' NGVD ELEVATION CERTIFICATE Important: Read the instructions on pages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION BUILDING OWNER'S NAME O.M.B. No. 3067-0077 Expires July 31, 2002 Amended b MDC-DERM-OCT.1999 For Insurance Company Use: Policy Number BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number 2701 NW 179th Street CITY STATE ZIP CODE Miami Florida PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 1. REVISED PLAT OF CAROL; TTY CENTER E T , PB 65-128 BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.) Residential LATITUDEILONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: L~ GPS (Type): ( - - or NAD 1927 ~1 NAD 19$3 L_i USGS Quad Map I I Other: SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3. STATE Unincorporated Area 120635 Miami-Dade County FL OD 84. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL 68 B9. BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding) 12025C 0080 J July 17,1995 March 2, 1994 AE 7,00' 810. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered, in B9. J_I FIS Profile IX I FIRM Ll Community Determined 1~ Other (Desc' nbe): 1311. Indicate the elevation datum used for the BFE in 139: fI NGVD 1929 J_I NAVD 1988 IJ Other (Describe): B12. Is the building located in a Coastal-Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? L_1 Yes 011I Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: L_JConstruction Drawings* J_JBuilding Under Construction* =Finished Construction A new Elevation Certificate will be required when construction of the building its 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 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 NGVD 1929 Conversion/Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? L_J Yes X J No ❑ a) Top of bottom floor (including basement or enclosure) 8 . 9 ft. (m) ❑ b) Top of next higher floor N/.A ft.(m) ' C3 c) Bottom of lowest horizontal structural member (V zones on N ly) ft.(m) QR ❑ d) Attached garage (top of slab) N/.~ft.(m) x I 0r-~ k ! -k e)' Loinres I o achin w ~e evation f m ery and/or equipment servicing the building 8 a i ft'(m) ~ ~ ❑ f) Lowest adjacent grade (LAG) 7 3_ ft. (m) 1 ❑ g) Highest adjacent grade (HAG) 7S ft_(m) ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade None"' tiN' -u j ❑ i Total area of all permanent openings flood vents) in C3h N/A s q in. (s q cm 3b~36 04~1002'~ ( ) q (q ) All pllt SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICA1 This certification is to be signed and sealed by a land surveyor_, engineer, or architect authorized by law It ' I certify that the information ►n Sections A, B, and C on this certificate represents my best effo►fs to inter ! understand that any false staternent inay be punishable-by fne or modsonment under 18 U. S. Code, S CERTIFIER'S NAME LICENSE NUMBER Jose F. Lopez 3086 d Surveyor & Mapper JCO~PAi PH ASSOCIATES, ;tss 55 E. 25th StreAm, Suite 21 April' 10, 2002 FEMA Fbrr (81-31, AUG SEE REVERSE SIDE FOR CONTINUATION .EPHON III' ! I,i uilll 1(305) 836-1822 REPLACE8`AhL PREVIOUS EDITIONS w'llllillill,'~ il~ ui ~ I llh HI I III 1 . 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 : - 27-GI NW 17-9th t CITY STATE ZIP CODE Company NAIC Number Miami ❑ 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. /f the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. El. 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. 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) _ln.(cm) above the highest adjacent grade. E4. 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, and E for Zone A (without a FEMA-issued or community-issued BFE) or Zone AO must sign here. ❑ 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. Gi. ❑ 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 elevad6n data i 4- n tli amrl7ents area below.) 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. Q The fa.ffowins'Informg, ton-(Items G4-G9) is provided for community floodplain management purposes. G4. PERMIT N-UMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY . ` ISSUED G7. This permit has teen I88Ued for: ❑ New Construction ❑ Substantial Improvement G8 Elevation of as built 1,,! bt Odor (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 , FF&AA =n. 04_124 Al US I,flV.11AM PIA1