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FEDERAL EMERGENCY MANAGEMENT AGENCY
r Ft)L j Q NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
• Q - - 6 . 2 FEET Important: Read the instructions on pages I - 7.
' SECTION A PROPERTY OWNER INFORMA710N
ANNIE NEA_L
ES S(
aUILDiNH 5 0E-TN t7 W ~ 1
CI i-Y
Hill.l' , I AM I
a PROPER I Y DESCRIP ION (Lot
I n T' 1 u . P i n
I IJ,I;iI
O.M.B. No. 3687-0077
Expires July 31; 200
For Insurance Company Use:
urn r
ig Apt., Unit, Suite, and/or F309. No.) OR P.U. ROII AND BOX NU. ~ Co►npai y
E30ck ii,mber's_, tax Parcel Number, Loyal
RIDA 33054
m, etc.)
c ,1 Accessory,
etc. tise a c,arnments area, 11 necessary.)
ES16ENTIAL°
LA I I I UD_/LONGI f UDE (OPTIONAL.) -I { 1ORIZON TAI- DA 111M: 90 Mc t ~s iyj ~i
or j
!l t.!!!1##IR' NAD 1027 NAU 10133 ma- CJHrar:
-
SECTION n - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
A
f5 AND ~T1l =L X35 Si1r~
-F36. RR-MI U M
FIR PA
F38. FLOOD
89. SA5E FLOOD EL 1 ION(S)
; NUMBER
DATE
EFFEC riVE/REVISED DATE
ZONi=(S)
(Zone AO, use depth of flooding)
1 I,,
_ 0 2 5 0 0 0 8 0 1__
7 -17~ 9 5---
3-2-2
"_X "
N
B-10 II Indicate the source of the Base Flood Elevation (BFE) data Or base flood depth entered in B9w
levs~tiorr dahain r1t.XN~rnined Other (Describe):
FIS tc~ tile et Msed for Ilia Br -E In Bg
-..i VD 1929 NAVD 1988 i Other (Describe):.- -
~Illndica
81 1
ast if On' 16 rln; ourcea Synt6rr (Cn119) nres o' Otherwise Protected Area (OrA)7 Yes No
812 g
Desi r~attoinciatc tod in Co X
g
SECi?ION C ,BUILDING ELEVATION INFORMATION (3t1RVEY REQUIRED)
C1 . building elevations are based ors: j-.....IConstructfon i3r swings"' I___,.,Buildino Under Construction' i IFInlshed Construction
A new Elevation Certificate will required when construction of t to building is complete.
C2. wilding Diagram Number Select the building diagram most similar to the building for which this certificate Is being completed - see
a ee accurately rthe build hI
t3 at g t 1 g' provide a s all; I or photograph
~I
C3.Ievations,d 1. If no Zones A1 iA30,AEclI, " A ,with Bf"Ej, tiE; V1-V3(i,~IIV (with bt EAR,AR/
A, All F, Afi/A1-A30, AR/AN, ~ AR/AO
Complete items C3.n-I below according to Ilia building diagram specified in Item C2. State the datum used. If the datum Indifferent from
the datum used for the BFE In Section t3; convert Ilia datu►n to that used for the BFE. Show field measurements and datum conversion
c . I,> r Comments area of Section
provide) °III, ppropriate, to document the datum conversion
alculalion. „tJseahe space the
i~ i D or Section t3 a~nv`
Deluca - Convey ivn/IC,otnrttents
VD29
Elevation' reference mars: usod _C 0 U N T Y Doeg-tiie elevation refore ri
e rriark used appear on the FIRM7--I Yes I I No
e) Top of bottom floor (including basement or enclosure ( V
Oft
I
U b To of next hi her floor
A.._. fL(in) a
U C) Bvttorn of lowest hvri~ontal's,truc,tural rrrc~rnbPr (V Tones only) N,
=
U d) Attached garage (top of slab)V / A It .(m)
MAY 31, 2002
U e) Lowest elevation of machinery and/or equipment CIO
servicing the buildin8 (Describe in a Cornrnents area.) A,, „ il. rrt) W
A
S T, ! E O F F L O R ID
adjacent (lini3li d) grade (L~1(Uy'', 61' tt.(rr"t)
I~ r) Lowest ac z' T
,
U g) flighest "adjacent (finished) grade (OAG)I 6.. 5 _ ft.(rn) P L Jn 1060
U Ir No. of permanent opening-, (flood ven(s) within 1 ft. above adjacent grade 1 u`N I -l A .
I- _ a
U i Total area of all permanent otterns9.s (flood vents) in C3.11.. sq. In. (s'.` gym)
SECTION 'tY SURVEYOR, ENGINEER, OR ARCHItobil1priCATION ~'ll
-r I I ~ IU
This certification is to be signed and sealed tb a land surveyor, engineer, or arrh'ftec(~„1III~II@utl o~~r__ized by law to certify elevation I litormation:'
y
,
B.
I c,erfiry Ella! fhe Information rn Sections A, i 4 ° nrrc~.C on ibis rerfifrt~t e~``~prssenis hi bies~tplel!6ds to interpref (Ire' data availab
! understand that airy false statement may be punishable by fine or anpnsonrrlent under 18. U.S. Code Scctron 1001.
CF-RIINER'S NAME LICENSE NUMBER
CHARLES W. CAaR 10
LELAND
SURVEYOR
city I I I ~`'I SrA~E ZIP CODE
ADDRESS
9245 S.W. ,14TH ~TREET (`MIAMI FLORIDA 33165 teZ,1~ MAY 'TS T, 2002 305-221-3416
III 1
r4thAA i_nrm 131-1`1 IT it nn Chi F r:Ntr: qF rwir r-fip f`-f1Pl'T.IN1111 i-inm P1=P1 Af'FC AT I PRFVifli ii PnITinmiR
q,lill
IMPOR I AN r : fit these spaces, copy tile corre
BUILDING STREET ADDRESS (Inrlti fin Apt Unit S
1110 Infofilia 001 11~grtr Sectfa11
1/1x nill N OR h O ROU1'E Atv
Far nsurance company U
g g. o.)
ukj^ 11411. vpluy I-qunluco
2550 N.W. 161ST. STREET
CfTY -STATE ZIP CODE Company NAIL Number
MIAMI
FLORIDA 3354
SEC-I ION D - SURVEY011, ENGINEER, OR ARCIIII-ECT CERTINCATION (CONTINUED) k,
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
CO M M -F
-N!:9---
Check het. If attachments
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT OFE)
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) 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
j-_-j---j ft.(m) above the highest adjacent grade. Complete Items C3.h and 03.1 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
flood lain management ordinance? _ Yes No Unknown. 1-he local official must cel this information in Section G.
SEC-110k F - PROPERTY OWNER (Oft OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B, C (items C3.h and C3.1 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..9, C:, and E are correct to
the best of rr► knowled e. _ _ _
PROPERTY ONER'SROWNER'S All THORIZEU R~RESENT/11IVE'S 0AME
DUR SS C IFY STATE ZIP CODE
~SINAI' RE DA1 E PIIONIR
CO NEE l S
Check hate If attachments
f
SEC ]l G'- COMMONirY'INFORMATION jomiONAL)
The local official who is authorized by taw or orctlnanc:e to administer the cornrnunity's Il`ciodpliiin rrranagi ment ordinance can complete
n(s) an and below.
Sections A, B, C (or E), arid G of this Elevation Certificate.
The. information rn Section C Was taken fro- orn late the a ~ lice a ter
~ and err b ssed`bya ilcens®d surveyor,
G1. m other orumen6ation that has been _ n sr ne
atc~ rr coral irw torertify elevation inforriiation: (iridicata the source and date of the
t P owSr)
iaon~datar ithe C rt~'i eraits thorized, by
eifl ,
G2. A community official completed Section E for a building located in Zone A (without n FEMA-issued or corninunity-issued BFE) or
Zone AO. ,
G3. The following iriforrtiatiot~ (Items G4-G9) is provided for community ftoodplain managemeint'purposes.
` 14,1131~1 71ffi IUfvlf ~f~ - -il -T 7~T1= ff=fli~(11`1 stSt=U i t -t;nT€ €i - F1 F c;U lif 17CI cct7l CY
ISSUED
G7. This permit has been Issued for: New Construction 1,_, _ISubstantial Improverr►ent
t.
) t floor (including basement) of the building is: ft.(►r)Datum:
G8. Elevation of as-buift io ~i I f
G9. SFE or-(in Zone AO es
p th of hooding at the building site is: • tt•(rn)Datum: ,
OCA OM-CIA"C s T3nM T -TL
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
. , Check here i If attachments
PPMA Fnrrn Rf i .i! 1! nn r?GPI ACI=.q At I ppr:Nn i it, ~htTIf1NC