HomeMy WebLinkAbout34-2111-026-0010FEDERAL EMERGENCY MANAGEMENT AGENCY
MIAiVII-0 ADE arm- °AR NATIONAL FLOOD INSURANCE PROGRAM C.M'
ELEVATION CERTIFICA 70 pires Juiy 31, 2002
PROCESS#
I , (
FINAL-EC Rev. JAN 09 2000 qqq
Important: Read the instructiolf/
es - 7. aedby3,ttv*oadec„„ty-o Ig„
SECTION A - PROPERTY OWNER INFORMATION Far Insurance ampany Use:
i
BUILDING OWNEi:VS NAME dj //l " Policy Number
BUILDING STREETADDRESS (inciuding Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number 1
755 N. W. 167TH STREET
CITYMIAMI STATE ZIP CODE
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, eta)
TRACT A,'CRAVERO ESTATES REPLAT 154-7
BUILDING USE (e.g., Residend4 Non-residential, Addifion, Accessory, etc. Use Comments section if necessary.)
NON-RESIDENTIAL
LATITUDEILONGiTUDE (OPTIONAL) HORIZONTAL. DATUM: SOURCE: ❑ GPS (Type):
it;#.#Ir or ##.#i ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map Q Other.
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81. NFIP COMMUNITY NAME & COMMUNITY NUMBER 82. COUNTY NAME B3. STATE
UNINCORPORATED AREA 120635 MIAMI-DARE FL
89. SASE FLOOD ELEVATION(S)
B4. MAP AND PANEL - B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL. `"B -000
NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding)
12025C-0080 J 7-17-95 3-2-94 X N/A
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood de tti . " , in B9.
C FIS Profile 0 FIRM 0 Community Determined ( be}:
B11. Indicate the elevation datum used for the BFE in B9: 91 NGVD 192? C NA 1988 Q Other (Describe):
B12. is the building located in a Coastal Barrier Resources System (CBRS a or therwise Protected Area (OPA)? Yes No
Designation Date
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings* . Building rider Construction* E Finished Construction
*A new Elevation Certificate will be required when constructions o uildir g is complete.
C2. Building Diagram Number 1 (Select the building dlagr 'M--. ost, ilar to the building for which this certificate is being completed - see
pages 6 and 7. If no diagram accurately represents the, 'ngrovide a sketch or photograph.)
C3. Elevations - Zones Al-A30; AE, AH, A (with 8FE), V (with BFE), AR, ARIA, ARIAE, ARIA1-A30, ARIAH, AR/AO
Cornpfete Items C3a4 below according to the bui€ dia 'ism specified in item C2. State the datum used. If the datum is different from the
then that used for the BFE. Show field measurements-and datum conversion
datum used for the BFE in Section B, conv
st a.,
calculation. Use the space provided or the Co. en a of Section D or Section G, as appropriate, to document the datum conversion.
Datum NGVD Conversion/Comments NTY BENCH MARK SYSTEM
Elevation reference mark used 1 Doe era on reference mark used appear on the FIRM? Yes KI No
X a) Top of bottom floor (includin base t closure)
9
52
tt,( )
N/A
❑ b) Top of next higher floor
XTA
ft-(m)
❑ c) Bottom of lowest horizontal stm member (V zones only)
N/A
(m)
fl
„
❑ d) Attached garage (top of slab) at Garage Door (Mia-Dade)
•(m)
fl
Xf e) Lowest elevation of machinery and/or equipment servicing the bu
ilding 9
52
f t. (;R)
E "_7
14 f) Lowest adjacent grade (LAG)
9 _
0
{t,(W)
10
g) Highest adjacent grade (HAG)
9
9
0 Z
❑ h)Total area of all permanent openings (flood vents) in C3h
sq. in. (sq.
cm)
43
❑ i) No. of permanent openings (flood vents) within 1 ft. above adjacent grade
❑ j) Highest crown of road (Mia-Dade)
9
15
it(m)
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 'informationm;
i cartify that the information in Sections A, B, and C on this cedificate represents my best efforts to interpret the data available.
i understand that an false statement may be punishable by fine or im risonment under 18 U.S. Code, Section 1001.
CERTIFIERS NAME LICENSE NUMBER
ROBERT C. MULDER, P.L.S. 2756
TITLE ASSISTANT VICE PRESIDENT SCHWWEBKE 5HISKIN & ASSOCIATES IN
ADDRESS 3 0 ORPORATE WAY MIRAMAR FLT 33025E
SIGNATURE DATE JULY 6, 2000 TELEPHONE 305-652-7010
IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance company use-.
BUILDING STREET ADDRESS (Incfuding Apt., Unit, Suite, and/or Bldg. No.) OR P.O_ ROUTE AND BOX NO. Policy Number
CITY STATE ZIPCODE 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) building owner.
COMMENTS REFER ORDER NO. 181981
❑ Check here if attachments
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
=or Zone AO and Zone A (without BFE), complete Items El through E4. If the Elevation Certfficate is intended for use as supporting
nformation for a LOMA or LOMB-F, Section C must be completed
.1. 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.)
=2. The top of the bottom floor (including basement or enclosure) of the building is _ ft(m) _in } ❑ above or ❑ below (check one)
the highest adjacent grade.
_3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated fl - r:.( e eta on b) of the building is
_ ft.(m) :In.(cm) above the highest adjacent grade.
.4. Fqr Zone AO only: If no flood depth number is available, is the top of the bottom floor.: cicala ed` in accordance with the community's
floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local offs. al . A certify this information in Section G.
SECTION F - PROPERTY OWNER (OR OWNER'S E EN TIVE) CERTIFICATION .
The property owner or owner's authorized representative who completes actions A, $ and E for Zone A (without a FEMA4ssued 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 DA TELEPHONE
COMMENTS
Y
` Y ❑ Check here if attachments
SECTI N G = Oft 1~1NITY INFORMATION (OPTIONAL)
the local official who is authorized by law or ordinance o atifthister the community's floodplain management ordinance can complete
sections A, B, C (or E), and G of this Elevatio' fiica ;;.Complete the applicable item(s) and sign below.
31. ❑ The information in Section C was taken fr~'6' cementation 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
elev4t Eli data in the JComments araa!m
32- ❑ Arcemmunity oflidal cotn1 pleted Section E,for a building located in Zone A (without a FEMA-issued or community-issued BFE) or
tom.. - \ i - - -
..Zone AO. "
33. []The- 611owing.14oriition (items G4-G9) is provided for community floodplain management purpose
s'
<3k PERMIT NUMBER- G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY
SSUED
I
I
37: Th `permit Ras been issue for: ❑ New Construction ❑ Substantial Improvement
38. Elevator of as-built lowest floor (including basement) of the building is: _ ft.(m) Datum:
39. BFE or (in 2.6me .AU)• depth of flooding at the building site is: i ft-(m) Datum:
LOCAL OFFICIAL'S
NAME TITLE
13
=ETNA Form 81-31, AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS