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Home My WebLink About34-2115-005-14402 3~-•Z115-ooh-t94~ FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Read the instructions on pages 1- 7 O.M.B. No. 3067-0077 Expires December 31, 200E C0 SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number E & S CONSTRUCTION BUILDING STREET ADDRESS (Including Apt., Unit, Suite, ardor Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number 1970 N.W. 152ND TERRACE CITY STATE ZIP CODE FL 33054 PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 10, BLOCK 8, FIRST ADDITION TO MAGNOLIA SUBDIVISION (P.B. 44, PG. 16 D.C.R.) BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, If necessary.) RESIDENTIAL LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (Type): ( - - or ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ O #W. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2 COUNTY NAME B3. STATE UNINC. DARE-120635 MIAMI-0ADE FL B4. MAP AND PANEL B7. FIRM PANEL B9. BASE FLOOD ELEVATION(S) NUMBER B5. SUFFIX B6. FIRM INDEX DATE EFFECTURREVISED DATE B6. FLOOD ZONE(S) (Zone A0, use depth of tbodng) 1202500090 J 07-17-95 03-94 X WA B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: ® NGVD 1929 ❑ NAVD 19M ❑ Other (Describe): _ B12 Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes 0 No Designation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Constnxtiar Drawings" ❑ Building Under Calstrudion' ® Finished Construction "A new Elevation Certificate will be required when corstnclion 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 skefch or photograph.) C3. Elevations -Zones Al A30, AE, AH, A (with BFE), VE, Vi V30, V (with BFE), AR, ANA, ARIAE, ARW AW, AR(AH, ARIAO Complete hems C3.-a4 below according to the building diagram specified in hem 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 calcination. Use the space pruMed or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum NGVD Conversion/Comments WA Elevation reference mark used NGVD Does the elevation reference mark used appear on the FIRM? ❑ Yes ® No ❑ a) Top of bottom floor (including basement or enclosure) 9. 4 fL(m) ❑ b) Top of next higher floor N/A.. ft.(m) ❑ c) Bottom of lowest horizontal structural member (V zones only) NIA. ft.(m) ❑ d) Attached garage (top of slab) 8. 6 fL(m) S ❑ e) Lowest elevation of machinery ardor equipment w servicing the building (Describe in a Comments area) 15 R(m) E 4 Lk 0 Lowest adjacent (finished) grade (LAG) 8.2 ft.(m) z' 0 ❑ g) Highest ad*ent (finished) grade (HAG) 6. 5A(m) ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade WA 8 J ❑ r) Total area of all permanent openings (flood vents) in C3.h WA 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. 1 certify that the infonnation in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. 1 understand that any false statement may be ,punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME STEPHEN H. GIBBS LICENSE NUMBER 4054 TM-E PRESIDENT COMPANY NAME GIBBS LAND SURVEYORS ADDRESS CITY STATE ZIP CODE 2131 HOLLYWOODDPOULLVMD SUITE`L04 HOLLYWOOD FL 33020 SIGNATURE DATE TELEPHONE , 01-26-04 954-W3-7666 FEMA Form 81-31, January 2003 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces, copy the cortvponding Information from Section A Forhum Corrp"Llse I BUILDING STREET ADDRESS (Indt "Apt, Urit, Suite, ardor Bldg. No.) OR P.O. ROUTE AND BOX NO. Poky Number 1970 N.W. 152ND TERRACE CITY STATE ZIP CODE Company NAIL Ntmber FL 33054 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community dkial, (2) insurance agent/con-qM, and (3) building owner. COMMENTS ❑ 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. I the Elevation Certificate is intended for use as supporting infomation for a LOMA or LOMR-F, Section C must be completed. Ell. Buildng Diagram Number _(Select the bolding diagram most similar to the building fa which this oWicate is being completed - see pages 6 and 7. If no diagram accurately represents the budding, provide a sketch or photograph.) E2- The tap of the bottom floor (irdudng basement or enclosure) of the building is _ %(m) _in.(an) ❑ above or ❑ below (check one) the highest a*cent grade. (Use natural grade, I available). E3. For Building Diagrams 6.8 with openings (seepage 7), the nerd higher floor or elevated floor (elevation b) d the building is _ k(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 d machinery ardor equipment servicing the building is _ t(m) _in.(crn) ❑ above or ❑ below (check one) the highest ad)acent grade. (Use natural grade, I available). E5. For Zone AO only: h no flood depth nwnta r. available, is the tap of the bottom floor elevated in accordance with the co mmunitys; floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local dfical must certify this incarnation 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 (hems C3.h and CW only), and E for Zane A (without a FEMA-issued or community- issued BFE) orZone AO must sign here . The staterro* in SscdansA, B, C, and Eare corred to the best of my kvWe* PROPERTY OWNER'S OR OWNERS AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS ❑ Check here I attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local dkW who is aktthorizekyby law orordpanoe to administer the oomrnurgs floodplaln management ordinance can complete Sections A, B, C (or E), and G of this EkWA n Certificate Complde theapplicableitern(s}and sign below. G1. ❑ The information h►Sectioi C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state orlocat law to celOy elevation information. (hndicate the source and dated the elevation data in the Comments area below.) G2 ❑ Ammmunity dfd$ completed Secdo nl= for a building located in Zane A (without a FEMAissued or canmunt -issued BFE) or Zane A0. G3. ❑ The fdb- mng iii m'don (Items G4-G9) is provided for community floodplaln management purposes. LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE G8. Elevation of as-built lowest floor (including basement) d the building is: _k(m) Datum: _ G9. BFE or (in Zane AO) depth of flooding at the building she is: t(m) Datum: FEMA Form 81-31, January 2003 Replaces all previous editions