HomeMy WebLinkAbout34-2116-002-0280PROCESS t c adz 6 79 Z/J~
fOLJO Ve~ i' er, 2 e e S°0 FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM O.M.B_ No. 3067-0077
C.a.R - CO CIG Expires December 31, 2005
ELEVATION CERTIFICATE
Important: Read the instrucfions on pages 1- 7
SECTION A - PROPERTY OWNER INFORMATION Forlnsurance Company Use:
BUILDING OWNER'S NAME Policy RiJimber
4OAa1. A 41p
C~r.1Tff« o~DO
BUILDING 7Ttf E AD-DRE (In~~ ng Ap,,,Unit, u~and/oorr BI. . No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number
CITY rq I STATE ZIP CODE 3
PROP TY DESCRIPTION ( of and Block Numbers, Tax Parcel Number, Legal Description, etc.)
.Z a 19 ®c.K l L: 3 Ca /eoy E
BLUILD 80 e.., Ftqside al, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.)
vc,.~1 :rl a j
LATITUDEILONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (Type):
( or ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map - [J Other.
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. NAME B3. ST TE t~
c1~l16neR~7ED -A, ER.~~, /20 iVlfnmi-r'~-irlp- n r Ir/'1
B4. MAP AND PANEL
B5. SUFFIX
FIRM INDEX DATE
B7. FIRM PANEL
B8. FLOOD ZONE(S)
B9. BASE FLOOD ELEVATION(S)
NUMBER
! 2025C090
T
1171
n
r
EFF EQ DATE
4
(Zone A0, use t
h of tboding)
40
^
- -
-
1
i
-
111 u lG bwl w ul u lu odbc nuuu Oevauui torcl Maid Of rye nwu ueptn enterea in bV. /
❑ AS Profile ® FIRM ❑ Community Determined ❑ Other (Describe):
811. Indicate the elevation datum used for the BFE in 69: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe):
1312. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)7 ❑ Yes (O 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_L (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 A1A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, ARIA, AR/AE, ARIA1 A30, ARIAH, AR/AO
Complete Items C3: a4 below according to the building diagram specified in Item C2. State the datum used. If the datum is cli ferent 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
4 C(
Sectionn pp r on G, as appropriate, to document the datum conversion.
Conversion/Comments
DatumN''
Elevation reference mark used ti Does the elevation reference mark used appear on the FIRM? ❑ Yes No
o a) Top of bottom floor (including basement or enclosure) --l== - ft.(m) CU
o b) Top of next higher floor ft.(m), .
o c) Bottom of lowest horizontal structural member (V zones only) ft.(m) 00 o d) Attached garage (top of slab) ti[ ft (m) a a
o e) Lowest elevation of machinery and/or equipment W `a
servicing the building (Describe in a Comments area) .(m)
o f) Lowest adjacent (finished) grade (LAG) .(m) z A O FL O I DA
o g) Highest adjacent (finished) grade (HAG) °~ft-(m) U'- NO. #5 01
o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 0 J
o i) Total area of all permanent openings (flood vents) in C3.h 0 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 information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available.
1 understand that an false statement ma be punishable b fine or imprisonment under 18 U. S. Code, Section 1001.
CERTIFIER'S NAME MIGUEL ESPINOSA / LICENSE NUMBER 5101
TITLE PROFESSIONAL URVEYOR & P R COMPANY NAME MIGUEL ESPINOSA LAND SURVEYING, INC.
ADDRESS 6494 . 2,6STREET CITY MIAMI STATE FL ZJP CODE 33155
SIGNATURE I I h A 0 4 AI A t/T11/07- DATE 4-11010?) TELEPHONE 305-740-3319
FEMA Form 81-31, January12003 I REPLACES ALL PREVIOUS EDITIONS
G H,YU PUA Nu.
Policy Number
CITY STATE 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 El 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 r 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 ordnance?
❑ 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 ownel'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. The statements in Sections A, B, C, and E are correct to the best of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVES 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 fioodplain management ordinance can complete Sedtioris 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.elevatiop information. (Indicate the source and date of the elevation data in the Comments area below.)
G-,. ❑ A community official completed Section E for a building located in Zone A (without a FEMA-issued or community4ssued BFE) or Zone A0.
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 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 Replaces all previous editions