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Home My WebLink About34-2116-000-0070, dupeFEDERAL EMERGENCY MANAGEMENT AGENCY _MIAMI-DADE 00 NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077 Q ELEVATION CERTIFICATE Expires July 31, 2002 PR. C FINAL-;-EC 2060 Rev. iAN 01 2040 Important: Read the instructions on pages I - 7. Amended by Miami-Dade County-BERM Oct. 1999 SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NA E ~y° Policy Number , - 4 De, BUILDING STREET ADDR SS (1 cludin Apt., Unit, Suite, and/or W. No.) O P.O. ROUTE-AN11 BOX NO. Company NAIC Number X00 Gt CvY ~`sS v CITY STATE ZIP COD PROPS TY DESCRIPTJ.QN ( of and Block Numbers, Tax Parcel Number (Folio Number), Legal escription, etc.) - 0000 BUILt31 ~.g., esidenti I, o -resid ntial, Addition, ccessory, etc, e Comments section if necess ) LATITUDE/LONGITUDE (OPTIONAL HORIZONTAL DATUM: SOURCE: ❑ GPS (Type): ( - - or ❑ NAD 9927 ❑ NAD 9983 ❑ USGS Quad Map ❑ Other: SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Bl. FIP OMM ITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3. STATE B4. MA D PAN L B5. SUFFIX B6.. FIRM INDEX B7. FIRM PANEL3- B8. FLOOD B9. BASE FLOOD ELEVATION(S) ,'NUMBER '17'T D EFFECTIVE/REVI DATE ZONE(S) lei r (Zone AO, use de thpf flooding) 10. Indicate the source of thee loo evation data or base fl6od depth entered in B9. } 171 FIS Profile IRM ❑ Community Dete ed ❑ Other (Describe): B11. Indicate the elevation datum used for the BFE in 139: GVD 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` Effffi'ished Construction *A new Elevation Certificate wJlll~e required when construction of the building is complete. C2. Building Diagram Number -E= e (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-V30, V (with BFE), AR, AR/A, AR/AE, AR/AI-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 01010Conversion/Com l t s EIe ion reference mark used oes the elevation reference mark used appear on the FIRM? ❑ Yes ❑ No Q a) Top of bottom floor (including basement or enclosure) (m) » b) Top of next higher floor ft.(m) ~ f El c) Bottom of lowest horizontal structural member (V zones only) ft.(m) CD W 0 d) Attached garage (top of slab) at Lowest Point (Mia-Dade) ft.(m) o CI e) Lowest elevation of machinery and/or equipment servicing the building ft.(m) -OE adjacent grade (LAG). g) Highest adjacent grade (HAG) ` ~~-ft.(m) _ El h)Total area of all permanent openings (flood vents) in C3h sq. in. (sq. cm) Z , 'm ❑ i) No. of permanent openings (flood vents) within 1 ft. above adjacent grade El j) Highest crown of road (Mia-Dade) 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. t understand that any false statement y be punishab!`e by fine or imprisonment under 18 U. S. Code, Section 1009. CERT S AENSE NUMBER TITLE 5 U r COMPANY NA MIRfti;N;C O 131,205 W_ 137TH ACV% WC ADDRESS CITY M, rL 331 r SIGNATURE~ N DATE / -00 TELEPHONE OJT Q L~ IMPORTANT: In theses aces, co the correspond p PY ing inforation from 9e on A. For lnsIrarace l!✓gmpanyUse: BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number CITY STATE ZIP CODE Corlapany NAIL Number SECTION "D - SURVEYOK,. ENGINEER, OR AR0IITECT'Ctk P CATION (CONTINUED).. . Copy both sides of this Elevation Certificate for (9) community official,` (2) insurance agent/company, and (3) budding owner. "Al COMMENTS 4 ChecC here-if attachments SECTION E - BUILDING ELEVATION INI=ORMATION'(SURVEY NOT REQUIRED) f OR ZONE AO AND ZONE"A (SIP OUT B- F0 _ r For Zone AO and Zone A (without BFE), complete items-El through E4 , If Me Elevation (Certificate is intended far use as suAAor#in . information for a LOMA or LOMR-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. 160" diagram accurately repr,'esents the building, provide a sketch or phvtograph.j E2". The top-of the bottom floor (including 'baseriment or ericlosUre) ofthe building is ft:( m~ iri:(cm) ❑ above or ' El -below (chec, lt one) the `highest adjacent grade. - rj E3. For Building Diagrams 6-g with openings (sbe page 7), the next higher floor or elevated floor (eleVation b) Vti e budding is a ft.") in:(cm) above the highest adjacent grade. E4. For Zone Ao only: It no 'flood depth number is available, 'is the top of the bottom floor elevated in accordance with the commuri ty's floodplain management ordinance?i❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Sec#ion G. SECTION F - PROPERTY OW1 ER,{OR OWN'ER'S ~REPRESEN'fATIVE)-CERTfFfPATON The property owner or owner's authorized representative who completes, Sections A, B, and E for Zone A (vvithout.a FEK4A-issued or- community-issued BFE) or Zone AO must sign here. l w PROPERTY OWNER'S OR OWNER'S AUTHORIZED. REPRESENTATIVE'S NAME ADDRESS _ CITY STATE ZIP CODE - SIGNATURE DATE :TELEPHONE COMMENTS z • : . , _ ❑ Check here ff attachments SECTION G - COMMUNITY. INFORMATION (OPTIONAL) The local official who is authorized by lain 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. a.. G1. ❑ The information in Section C was taken from other docurnenta#ion 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 G47G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G6: DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement-" G8. Elevation of as built lowest floor (inciuding basement) of the building is: ft - Datum: G9. BFE or (in Zone AO) depCof flooding at the building site is: ft:(m) Datum: . LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE • SIGNATURE DATE • COMMENTS _ - , . . -Nip FEMA Form 89-39, AUG 99X:\wIMNOR iXEI_EVCERT1EC2000FINAL.dotSEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDMONS