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Process
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FEDERAL EMERGENCY MANAGEMENT AGENCY
Folio #
NATIONAL FLOOD INSURANCE PROGRAM
O.M.B. No. 3067-0077
C.O.R. 7.75
ELEVATION CERTIFICATE
Expires December 31, 2005
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4
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ons on pages
.7.
Important: Read the instruct
SECTION A - PROPERTY OWNER INFORMATION
For Insurance Company User'
BUILDING OWNER'S NAME
Policy Number
Itasca Construction Associates, Inc.
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
Company NAIC Number
16701 Park Center Blvd.
CITY STATE ZIP CODE
Miami FL
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOTS 4,5 & 6 . PARK CENTRE BUSINESS PARK (P.B. 159, PG. 49)
BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.)
Non-Residential
LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (Type):
( - - or ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other:
N/A
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER 82. COUNTY NAME B3. STATE
Unincorporated Dade 120635 Miami-Dade FLORIDA
B4. MAP AND PANEL
B5. SUFFIX
B6. FIRM INDEX DATE
B7. FIRM PANEL
B8. FLOOD ZONE(S)
B9. BASE FLOOD ELEVATION(S)
NUMBER
EFFECTIVE/REVISED DATE
(Zone A0, use depth of flooding)
12025C 0080
J
7-17-95
3-2-94
X
Outside 500 year floodplain
610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9.
❑ FIS Profile E FIRM ❑ Community Determined ❑ Other (Describe):
B11. Indicate the elevation datum used for the BFE in 69: E 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 E No Designation Date
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* E 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 N/A
Elevation reference mark used BM4#N-351 elevation reference mark used appear on the FIRM? ❑ Yes E No
#LS2261
o a) Top of bottom floor (including basement or enclosure) 9 50 ft.(m)
~
July 12, 2005
o b) Top of next higher floor 20 50_1(m)
o c) Bottom of lowest horizontal structural member (V zones only) N/A. ----A(m)
o d) Attached garage (top of slab) N/A.. ft.(m)
00
E r
o e) Lowest elevation of machinery and/or equipment
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servicing the building (Describe in a Comments area) 9 . 09 ft(m)
E cu
o f) Lowest adjacent (finished) grade (LAG) 9-. 0 ft.(m)
z
o g) Highest adjacent (finished) grade (HAG) 9 . I ft.(m)
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2
o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade N/A
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o i) Total area of all permanent openings (flood vents) in C3.h N/A 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. i k
1 certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data availatiie.
I understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001.
CERTIFIER'S NAME Patrick J. Murphy LICENSE NUMBER #LS 2261, State of Florida
TITLE Professional Surveyor & Mapper COMPANY NAME JACK MUELLER & ASSOCIATES, INC.
ADDRESS 9450 Suns Dn e - Suite200 CITY Miami STATE FL ZIP CODE 33173
SIGNATURE 1. - 11 A r U _ !l Y. . DATE 07-12-05 TELEPHONE 305-279-5555
FEMA Form 81-31, January 2003 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
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
16701 Park Centre Blvd.
CITY STATE ZIP CODE Company NAIC Number
Miami FL
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
Elevation of Lowest Machinery = A/C Slab
❑ 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 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. (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 the building is _ ft.(m) _in.(cm) above the highest adjacent
grade. Complete items C3.h and C3.i on front of form.
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, C (Items C3.h and C3.i only), and E for Zone A (without a FEMA4ssued or community-
issued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and E are correct to the best of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
❑ 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.
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 certify elevation information. (Indicate the source and date of the elevation data in the Comments 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 A0.
G3. ❑ The following information (Items G4-G9) is provided for community floodplain management purposes.
G4. PERMIT NUMBER
G5. DATE PERMIT ISSUED
G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED
G7. This permit has been issued'for: ❑ New Construction ❑ Substantial Improvement
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