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Home My WebLink About34-2115-000-0010BUILDING OWNER'S NAME JACKSON MEMORIAL HOSPtTA BUILDING STREET ADDRESS (Includ 16555 NW 25 AVE. CITY MIAMI (Lot FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Imliortant: Read the instructions on pages, l -7. SECTION A - PROPERTY OWNER INFORMATION Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. STATE FLORIDA Legal Description, O.M.B. No. 3067-007; Expires July 31, 2002 For Insurance Company Use: Policy Number - Company NAIL Number ZIP CODE BUILDING USE(e.. Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.) NON-RES IDENhAL LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: JJ GPS (Type): ( - - or ##.##Oq Lj NAD 1927 LJ NAD 1983 LJ USGS Quad Map (J Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME 0. STATE UNINCORPORATED AREA &,120635 MIAMI-DADE FLORIDA B4. MAP AND PANEL 85. SUFFIX 86. FIRM INDEX B7. FIRM PANEL 88. FLOOD B9. BASE FLOOD ELEVATIOt NUMBER DATE EFFECTNE/REVISED DATE ZONE(S) (Zone AO, use depth of floodir 12025C & 0090 J 7/17/95 7/17/95 X N/A B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. U FIS Profile LJ FIRM I X Community Determined U Other (Describe): B11. Indicate the elevation datum used for the BFE in 139: LKJ NGVD 1929 LJ NAVD 1988 " Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? LJ Yes J_J No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: "Construction Drawings' LJBuilding 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 - 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 C3a4 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 conversi~ Datum NGVD 19 29- Conversion/Comments- Elevation reference mark used N-484 (9.41) Does the elevation reference mark used appear on the FIRM? LJ Yes IXJ a (3 a) Top of bottom floor (including basement or enclosure) 1'. -qfL ft(m) E3 b) Top of next higher floor 0 c) Bottom of lowest horizontal structural member (V zones only) C3 d) Attached garage (top of slab) fL(m) Er- 13 e) Lowest elevation of machinery and/or equipment LU Ce servicing the building (3 0 Lowest adjacent grade (LAG) E 0 g) Highest adjacent grade (HAG) C3 h) No. of permanent openings (flood vents) within I ft. above adjacent grades C] Q Total area of all permanent openings (flood vents) in C3h sq. in. (sq. cm) SECTION D -SURVEYOR, ENGINEER, OR ARPHITECT CERTIFICATION This cer0cation is to be signed and sealed by a land surveyor, engiae-er, or architect authorized by law to certify elevation information. I cef* that the infOlmadon in Secdons A, B, and C on this ceffilLcate repmsenft my best effq to interpmt the daita- available. 1 understand that any false statement may be punishable by fine or imprisonment under 18 U .S. Code, Section i001 CERTIFIER'S NAME MANUEL FELIPE 4146 LICENSE NUMBER TITLE COMPANY NAME PROFESSIONAL LAND SURVEYOR & MAPPER -MANUEL FELIPE & ASSOCTATES TN(' ADDRESS 2414 SW 137 AVE. CITY MIAMI STATE FLORIDA ZIP COD53175 -~i~' 1/11/01 305-554-6592 81-31, AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITION %09% 1 A4 V I. is I u laze spaces, copy the corresponding infornnadon from Section A. For Insurance Corm;, ' BUILDING STREET ADDRESS (Induding Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy'IVumf iwi~ CITY STATE - ZIP CODE Company NAIC Nu SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) V. Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenttcompany, and (3) building owner. COMMENTS J_J Check here if SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (MTHOR agg' For Zone AO and Zone A (without BFE), complete Items El through E4. If the Elevation Certificate is intended. for use as suppor information for a LOMA orLOMR 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 con" 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 I I J fL(m) I I lin.(cm) (_,J above or (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 I.._,I ft•(m) II_jin.(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) floodplain management ordinance? ]_J Yes J _J No J _J Unknown The local official must certify this information in Section •Gi 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 j 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 a ~J Check here if attach, 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. G 1. LJ 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 thr elevation data in the Comments area below.) G2. LJ A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) of Zone AO. G3. LJ The following information (Items G4-G9) is provided for community floodplain management purposes. ISSUED G7. This permit has been issued for LJ New Construction LJ Substantial Improvement s 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 OFFICIALS NAME TITLE COMMUNITY NAME TELEPHONE SIGNA 1 URE DATE a COMMENTS J-1 Check here if attachmo FEMA Form 81-31, AUG 99 REPLACES ALL PREVIOUS EDITIO.