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Home My WebLink About34-2112-030-0030O.M.B. No. 3067-0077 Expires July 31, 2002 on~pan}~t~~e: BUILDING OWNER'S NAME hol1cy Numper BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number 17721 N. W. 7TH AVENUE CITY STATE ZIP CODE MIAMI FL PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 1, BLOCK 1, PARKWAY HOUSE 96/77 BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.) RESIDENTIAL LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (Type): ( - or . ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other: SECTION B - FLOOD INSURANCE RATE MAO (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3. STATE UNINCORPORATED 120635 MIAMI-DADE FL 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) 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 tlooa depth enterea in, try. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe): B11. Indicate the elevation datum used for the BFE in 139: ® NGVD 1929 ❑ NAVD 1'988 ❑ 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 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-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 NGVD Conversion/Comments COUNTY BENCH MARK SYSTEM r Elevation reference mark used N/A Does the elevation reference mark used appear on the FIRM? ❑ Yes ® No o a) Top of bottom floor (including basement or enclosure) 11 8 L o b To #2978 A > m Top of next higher floor N/A- ( ) CD a) APRIL 18, 2001 o c) Bottom of lowest horizontal structural member (V zones only) NIA . ft.(m) o 0 o d) Attached garage (top of slab) N/A. ft.(m) r' o e) Lowest elevation of machinery and/or equipment AI w ALFONSO C . TELLO servicing the building A/C SLAB 11 _ . 0 ~ ft.(m) E o f) Lowest adjacent grade (LAG) 11 . 2 ft.(m) Z.2) o g) Highest adjacent grade (HAG) 11. 3 ft.(m) o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade N/A o i) Total area of all permanent openings (flood vents) in C3h _sq. in. (sq. cm) i' SECTION D - SURVEYOR, ENGINEER, OR ARdHI1 ECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or archh l certify that the inforrnation in Sections A, B, and C on this certificate represents r I understand that any false statement may be punishable by fine or imprisonment. CERTIFIER'S NAME thorized by law to certify elevation information. I` efforts to interpret the data available. 18 U. S. Code, Section 1001. ALFONSO C TFLLO P L S LICENSE NUMBER 2978 TITLE SECRETARY-TREASURER COMPANY NAME SCHWEBKE-SHISKIN & ASSOCIATES, INC. ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE FEMA Form 81-31, AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/compan* and (3) building owner. _ COMMENTS REFER ORDER NO. ❑ 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. 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. 4. 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. 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) -he 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. 31. ❑ 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.) 32. ❑ A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or Zone AO. 33.! ❑ The following information (Items G4-G9) is provided for community floodplain management purposes. u4. PERMIT NUMBER G5. DATE PERMIT ISSUED. G5. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED 37. This permit has been issued for: ❑ New Construction El Substantial Improvement 38. Elevation of as-built lowest floor (including basement) of the building is: (m) Datum: 39. 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 'EMA Form 81-31, AUG 99 REPLACES ALL PREVIOUS EDITIONS