The URL can be used to link to this page

Home My WebLink About34-2112-035-0021BL DO Piocess # C 2 0 C) FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 FOLIO # 3 4 -2.1! 2-- 0 3S - C)021 NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005 Crown of Road 10. 80 FT NVGD ELEVATION CERTIFICATE Important: Read the instructions on pages 1- 7. SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number L r ~E BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. r mpany NAIL Number 17760 N. W. 2ND AVENUE CITY STATE ZIP CODE MIAMI FL PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) A PORTION OF TRACT "B", "CLOVERLEAF COMMERCIAL" PLAT BOOK 151, PAGE 81 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): ( ##o - or ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME COUN UNINCOR ORATED AREAS & COMMUNITY NUMBER 120635 I MIAM -0ADE NAME ~L. STATE B4. MAP AND PANEL B7. FIRM PANEL B9. BASE FLOOD ELEVATION(S) NUMBER B5. SUFFIX B6. FIRM INDEX DATE EFFECTIVElREVISED DATE B8. FLOOD ZONE(S) (Zone A0, use depth of flooding) 12025C-0080 J 7-17-95 3-2-94 X NIA B10. Indicate the source of the Base Flood Elevation (BFE) data or base tlood depth entered in By. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: ® 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* ® Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number 3 (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 COUNTY BENCH MARK SYSTEM * SEE COMMENTS Elevation reference mark used * Does the elevation reference mark used appear on the FIRM? ❑ Yes ® No o a) Top of boftom floor (including basement or enclosure) 11. 66ft.(m) o b) Top of next higher floor 22.61 ft.(m) o c) Bottom of lowest horizontal structural member (V zones only) N/A, _ft.(m) o 0 o d) Attached garage (top of slab) N/A. ft.(m) E o e) Lowest elevation of machinery and/or equipment a`) . servicing the building (Describe in a Comments area) 11 .66 ft.(m) o t) Lowest adjacent (finished) grade (LAG) 10. 2 ft.(m) z 2 o g) Highest adjacent (finished) grade (HAG) 10. 9 ft.(m) o h) No. of permanent openings (flood vents) within 1 ft: above adjacent grade N/A o i) Total area of all rmanent openings (flood vents) in` C3 h N/A sq in (sq cm) #3369 APRIL 2~,:,72004 FTi ~RRE E . CALVET ;7 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 1'n''I 1 certify that the information in Sections A, B, and Con this certificate represents my best efforts to interpret the data availabl I understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. 1I CERTIFIERS NAME PIERRE E. CALVET, P.L.S: LICENSE NUMBERIi'~ III l i ~~w... I I I I r' I I.' - I I. I .I. 'III ~ I ~ l . ' V II I I ar P II I I TITLE ASSISTANT VICE PRESIDENT COMPANY NAME SCHWEBKE-SHISKIN & ASSOCIATES; INC. i 111 I I ADDRESS CITY - STATE' ZIP CODE 3240 CORPORATE WAY MIRAMAR FL p~ 33025 DATE TELEPHONE g SIGNATURE 4-23-04 305-652-701 6, ^;11 1 11 Iii... -d ~II~I'I!~~ill I ~ 1111111. III:- I ~ I lill'lll FEMA Form 81-31, January 2003 See reverse side for continuation. III' replaces aIli'previous editions IMPOFZ-"ANT: In these spaces, copy the corresponding information from Section A. For, insurance company Use: ' BUILDING STREET ADDRESS (Induding Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. PolicyNumber 17760 N. W. 2ND AVENUE CITY STATE ZIP CODE Company NAIL 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 REFER ORDER NO. 189311 Cie IS ELEVATION OF FLOOR OF ELECTRIC ROOM ❑ 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 (seepage 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. The top of the platform of machinery and/or equipment servicing the building is _ ft.(m) _in,(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, if available). E5. 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,FEMA-issued 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 K = SECTION G - COMMUNITY INFORMATION (OPTIONAL) -he local official who is authorized bylaw or a,;tinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation certificate. Complete ;the applica6ie item s) and sign below. 31. ❑ The information in Section C'was taken «m other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to cerl[h elevation, information, Indicate the source and date of the elevation data in the Comments area below.) 32. ❑ A community official completed Sec m" E for a building located in Zone A (without a FEMA4ssued or community-issued BFE) or Zone A0. :13. ❑ The following informatior="71tems C -G9) is provided for community floodplain management purposes, r "tiv G4. PERMIT NUMBER " w "G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED '77. This permit has been"issued for: ❑ New' tConstruction ❑ Substantial Improvement ;8. Elevation of as-built lowest floor (including basement) of the building is: _ft.(m) Datum: ~9. 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 :MA Form 81-31, January 2003 Replaces all previous editions