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Home My WebLink About34-2116-001-0010PROCESS #S, C37 FEDERAL EMERGENCY MANAGEMENT AGENCY Q.MB. No. 3067-0077 FOLIO #'3 C, I I NATIONAL FLOOD INSURANCE PROGRAM H.C.O.R. 6.69' Expires December 3, 2005 ELEVATION CERTIFICATE Important: Read the instructions on pages 1- 7. Amended by MDC-DERM-OCT, 1999 SECTION A - PROPERTY OWNER INFORMATION For Insurance Company uses BUILDING OWNER'S NAME Polic Number Gwendolyn Chapman BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number 2901 N.W. 154 Terrace CITY STATE ZIP CODE Miami FL 33054 PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) 30-2116-001-0010 BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.) Residential LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (Type): ( - - or ##.##l#°) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other: SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B4. MAP AND PANEL B7. FIRM PANEL B9. BASE FLOOD ELEVATION(S) NUMBER B5. SUFFIX B6. FIRM INDEX DATE EFFECTIVE/REVISED DATE B8. FLOOD ZONE(S) (Zone A0, use depth of flooding) 1202500090 J 7/17/95 3/2/94 X N/A 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 BE in B9: ® 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 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 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 C3.-a-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 Elevation reference mark used BM. Does the elevation reference mark used appear on the FIRM? ❑ Yes ® No ❑ a) Top of bottom floor (including basement or enclosure) 8 .0 ft. (m) v, ❑ b) Top of next higher floor N/A ft. (m) r ❑ c) Bottom of lowest horizontal structural member N zones only) _ N/A ft. (m) 00 ❑ d) Attached garage (top of slab) N/A _ ft. (m) w M -.k _ i, ! elso ' M retla e) Lowest elevation of machinery and/or equipment ~ 464 . E 1 I- I I h E cu ,k.. Re stered Surv~eo~=& serving the building (Descn e in Comments area) 7 •2 ft. (m) fl Lowest adjacent (finished) grade (LbG) 7 3 fit. (m) z v, upper No 4iH -10 .~l FI 09724/20 ; . ~i g) Highest adjacent (fin ished) grade it A' G) 7.4 ft. (m) I i MIN h) No. of permanent opernngsflood vents) within 1 ft. above adjacent grade N/A J u ifl~ i) Total area of all peimanent openl(flood vents) in C3.h N/A sq. in. (sq. cm) ECTION 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 Infor'tnat on, t a 'o hhi a l.' I It certify that the information in Sections A, B, and Con this certificate represents my best efforts to interpret the data avaiiabje p IIa r!-- i di any Ill/" cf that fia s6 statoment A be punishable b line or imprisonment under 18 U. S. Code, Section 1001. underst' s I!'I t. si'!t II"~ ER CERTIFIER'S NAME LICENSE NUMB Nelson Mojarena 5504 TITLE COMPANY NAME President Mojarena & Associates, Inc. ADDRESS CITY STATE ZIP CODE 12925 S.W.132 Avenue Miami FL 33186 SIGN DATE TELEPHONE 06/24/2003 (305) 278-2494 01-0589 FEMA For 81-31, January03 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance company use BUILDING STREET ADDRESS (Including Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Porky Number CITY STATE 7JP CODE Company NAIL 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 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) _in.(cm) above or below (check one) the highest adjacent_grade. (Use natural grade, if available). E3. For Building Diagrams 6-8 with openings (seepage 7), the next higher floor or elevated floor (elevation b) of the building is _ ft(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 of machinery and/or equipment servicing the building is _ ft.(m) _in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, if available). E5. 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? ❑ 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, C (Items C3.h and C3.i only), and E for Zone A (without a FEMA issued or community- issued BFE) or Zone AO must sign here. 7'he statements in Sections A, B, Q and E are coned to the best of my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE' ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS Check here if attachments s~ y SECTION G -COMMUNITY INFORMATION (OPTIONAL) 'Ioc~"a} of ~l who s authorized bylaw or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation e F. r iteam Certificate.' Complete th e applicable m(s) and sign below. G1. ❑ The information in Seehon 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 k cal law to ceifify 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 A0. G3. ❑ The following information (Items G4-G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER I G5. DATE PERMIT ISSUED I 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 (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 OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS ❑ Check here if attachments FEMA Form 81-31, January 2003 See reverse side for continuation. Replaces all previous editions