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Home My WebLink About34-2116-006-3280PROCESS # 2-001 I tQ - FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 FOLIO #30-2116-006-3280 ELEVATION CERTIFICATE C . O . R . 8.27 Important: Read the instructions on ages 1 - 7. SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number REBUILDING OUR COMMUNITY BUILDING STREET ADDRESS (including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number 2921 NW 165 ST CITY STATE ZIP CODE MIAMI FL PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 14 BLK 29 FIRST ADDITION TO PINE TREE PARK PB 46-75 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 ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ® Other: Automatic Level SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER T B2. COUNTY NAME B3. STATE ,TTWT-rMt"1n"D Dnn T mT, n T-D- T C Miami-Dade Ff. 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) 80 12025C0080 J 7-17-95 3-2-94 x NA B10. Indicate the source of the Base Flooo Lieva ion (bt-t) aaia or case wou clepi,1 ei:iereu III DZI. ❑ FIS Profile FIRM Q Community Determined ❑ Other (Describe): B11. 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 Drawinge,. ❑ 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 torthe 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 N/A Conversion/Comments N/A Elevation reference mark used Does the elevation reference mark used appear on the FIRM? ❑ Yes ® No ► a) Top of bottom floor (including basement or enclosure) 10. L5-ft-(m) m tom: ► b) Top of next higher floor N/A. fit.(m) Ill- c} Bottom of lowest horizontal structural member (V zones only) N/A. ft.(m) 01- ► d) Attached garage (top of slab) NIA. ft.(m) - 1I ► e) Lowest elevation of machinery and/or equipment m m W -T f_ servicing the building 9. 91ft.(m) Z -~7 02 f) Lowest adjacent grade (LAG) 9 . 1ff:(m) ► ► g) Highest adjacent grade (HAG) 9.'ft.(m) m - ► h) No. of permanent openings (flood vents) within 1 #t. above adjacent grade NIA 7~ ► i) Total area of all permanent openings (flood vents) in C3h N/A sq. in. (sq. cm) ~I, : j SECTION D -SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICAiO;~~~~i I Ie I sa . ie I I I I rya i I I Ir. I This certification is to be signed and sealed b a land surveyor' engineer, or architect authorized bylaw fo crtify elevation in~`ormation If the I I I- I& L I ~I I I ~ '~t I) fll~~ I I I EI'u I certify that the information in Sections A, B, and C on this certificate represents my best efforts to inter~~et the ,&ta available ~ ~I ~ ~q~i i ~ I, ! I I I D1. on b fine or rm trsonmenf under 9 8 ll. S. Code, Seal d I understand that any false statement may be punishable Y y P 11 CERTIFIER S NAME JOSE SENAS LICENSE NUMBER 6938`41141 i I II II~ III i ' I Ilk TITLE PROFESSIONAL LAND SURVEYOR AND MAPPER COMPANY NAME SUNSHINE UNITED CONSULTANTS, INC. NISI ADDRESS CITY STATE ZIP CODE 1703 MIAMI EL 33015 -TERRA E 783n W SIGNATURE n4p DATE TELEPHONE s I'3 '.Ilia k~ 4-27-02 1 3. I'.. ICI IR F(~1 FFMA. Fir-rr~ 1.-31_.± i..tG. 1✓? _ ---_RPF RFVFRS;F'RII)F FnR_ r.nNTINI IATiON RFPI ,P~C'FS A! 1 PRI=V 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. Policy Number 2921 NW 166 ST CITY STATE ZIP CODE Company NAIC Number MIAMI FL 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. ff the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-f, Section C must be completed. E1. Building Diagram dumber -(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? ❑ 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 co muni -issued BF-E) Zone AO must sign here. PR PERTY OWNER'S O OWN AU ORIZ D REPRESENTATIVE'S NA od / l#Vle 33 aeL D S CI STATE ZIP C DE 7 !>Z 3a S -loe3 tIGNATIRE ATE 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 infection C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who as-authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data n the Comments area below.) G2. ❑ 4 community official cemple ed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or r ..Zone 40. G3. ❑ The follovfing information (ltem~'s G4-G9) is provided for community floodplain management purposes. s, G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This permif h- as-been Issued`Pfor ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-built lows t floor (including basement) of the building is: (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 FFMA Fnrm R9-39 Al IC-- AA RFPI Ar`F.R AI I PRFViCnI 1q t=nlTlr)NS