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HomeMy WebLinkAbout34-2115-008-0910FEDERAL EMERGENCY MANAGEMENT AGENCY MIAMI-DADE NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077 Expires July 31, 2002 ELEVATION CERTIFICATE„ PROCESS # FINAL-EC Rev. JAN 01 2000 Important: Read the instructions on pages 1 7. Am.na.a by Miami-Dad. County-DERM Oct _55 o f CTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: I C) Policy Number BUILDING OWNER'S NAME 2 D ^ E4aAl SIM16 L J BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number Za81 4W, 152ND 7_E z&C-e, ZIP CODE CITY STATE MI~.M1 LDTZID&. 33/512- PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Numb e , Legal Description, etc.) Lor IZ $Lock Ei.Woiz rh 9/ BUILDING E (e. g., Residential, on-residential, Addition, Accessory, etc. Use Com ents section if necessary.) tZ~St b~i ! ~ c~ LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (Type): ( - or ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other: SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNIT NUMBER B2. COUNTY NAME B3. STATE 0141 IC01VF'0 _h--cCD is z.%_::~s ) V*35 DA-'D611 'L 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) 12 0 25 c- ©o~o 3 - 2 - 9~- 7 / 7-',95 A. B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in 89. ❑ FIS Profile ❑ FIRM ❑ Community Determined ❑ Other (Describe): 1311. Indicate the elevation datum used for the BFE in 139: ❑ 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 ❑ 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 (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, V1430, 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 Conversion/Comments Yes No Elevation reference mark used \Does the elevation reference mark`used appear on the FIRM? El ❑ a) Top of bottom floor (including basement or enclosure) O .3 ft.(m) ft. m ❑ b) Top of next higher floor 4) A ( ) ~ I ❑ c) Bottom of lowest horizontal structural member (V zones only) JJ 1A, ft.(m) j'4_go,A/ Mb.1&A ❑ d) Attached garage (top of slab) at Garage Door (Mia-Dade) A ft.(m) H 00 "rGrz~ D '~Yo ❑ e) Lowest elevation of machinery and/or equipment servicing the building A1A . ft.(m, MAPPER Ah 5SO4 ❑ fl Lowest adjacent grade (LAG) Z ft.(m)r a_ m ; a - - ❑ g) Highest adjacent grade (HAG) 3 ft. (m) ❑ h)Total area of all permanent openings (flood vents) in C3h / ?409. 49> sq. in. (sq. cm) ` ❑ i) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 8 ❑ j) Highest crown of road (Mia-Dade) 7-4-ft.(m) 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. I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. CERTIFIER'S NAME _ LICENSE NUMBER TITLE tS't"~ ~t~i d OFL. 1~ PL=R- MCOMPANY NAME D-lATC~ Md &650") TZS lAIC. ADDRESS CITY STATE ZIP C? 25 /32 Nb ,~V LiV v I ''L,D rz) DA 3S9& on 0 J SIGNATURE e a,, DATE p f - 00 TELEPHONE~3or~ Z7$ r Z4-q~ vv.~v...v v..~rr. r~vv.~rvv ~...v..+v...y v...a, v~.~v, , -_-T.... CITY S I ATE ZIP CODE'' Company NAIC Number 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 _ ❑ 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 LOMB-F, Section C must be completed. El. 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. 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 floodplain management ordinance? E] 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) 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. G1. ❑ 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.) G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or Zone AO_ G3. ❑ The following information (Items G4-G9) is provided for community floodplain management purposes: G4. PERMIT NUMBER;;', G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This 0ermit has- 'Pee n issued-for: ❑ New Construction ❑ Substantial Improvement .(m) Datum: G8. Elevation of as-built lowest #loor (including basement) of the building is: _ft G9. 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 FEMA Form 81-31, AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS