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Home My WebLink About34-2117-002-0731n FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. 140.4667 77 ' -07~ ~ NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005 ELEVATION CERTIFICATE VP important: Read the 1 -4471 instrucfions on pages ' 7. ' SECTION A -PROPERTY OWNER INFORMATION For Insurartoe Company Use. BUILDING OWNER'S NAME P Polley Number MARIO DAISSON BUILDING STREET ADDRESS (including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number 16000 NW 45 Avenue CITY ami STATE ZIP CODE Mi,„ Florida 33054 PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 20, BLOCK 3,VENETIAN ACRES PB:44-92,MIAMI-DADE COUNTY,FL. BUILDING USE (e.g.. Residential, Nonresidential, Addition, Accessory, etc. Use a Comments area, if necessary.) RESIDENTIAL LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: 1-1 GPS (Type): ( of - • ##.#sr or NAD 1927 NAD 1983 I-I USGS Quad Map 1__I Other SECTION B -.FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 1.14 C-011AMUNITY NAME & COMMUNITY NUMBER 82. COUNTY NAME 83. S ATE UNICORPORATED AREA - 120635 MIAMI-D.ADE 7 -FL.. 4. MAP AND ANEL B5. SUFFIX B6. FIRM INDEX 67. FIRM PANEL 88. FLOOD 89. BAS FLOO5 ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding) 1202500080 J 7-17-95 03-02-94 X N/A B10. Indicate the source of the Base Flood. Elevation (BFE) data or base flood depth entered in B9. I-I FIS Profile 1: 4 FIRM Community Determined Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: IyI NGVD 1929 1__1 NAVD 1988 1--j. other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 1__1 Yes ICI No Designation Date: _ SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: I-IConstruction Drawings' 1__1Building Under Construction' I _ 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 cgrtificate is being completed - see pages 6 and 7. If no diagram accurately represents th4'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 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 providedor the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Datum _ ~VP_-_ Conve(sion/Comments Elevation reference mark used__ BEDoes the elevation reference mark used appear on the FIRM? Yes l- a) Top of bottom floor (including basement or enclosure) 8.699 ft.(m) ft.(m) J b) Top of next higher floor 'Z) c) Bottom of lowest horizontal struc oral member (V zones only) ft.(m) J d) Attached garage (top of slab) ft -(M) E -C J e) Lowest evation of machine and/orequipment m - 8. 6 0 0 :i o-_- _ servicing the building (Describe in a Comments area.) _ a _ ft.(m) 1 0 - 2 2 - 2 Zi f) Lowest adjacent (finished) grade (LAG) 7 A 0 6 ft.(m) z _ 7. 1 ~ r ft.(m) ~ Karl F~ Kuhn J g) Highest adjacent (finished) grade (HAG) t o enin s flood vents) within 1 ft. above adjacent grade PSM# 5 9 5 3 ri'nan J h) No' of e en J i Tot p E I FI I I°d-5 e ) tai area of all ermaHne E`openings (flood vents) in C3:h sq. in. (sq. cm) SECTION D - SURVEYOR, ENGINEER ,'OR ARCHITECT CERTIFICATION This certification is to b sealed by a land surveyor, engineer, or architect authorized by law to certify elevation int~orm be signed and atlon / C"ty that the information in Sections A, B. and C on this certificate represents m best efforts to interpret the data avallab)e F ' I undorstand that an false statement may be unishable b fine or Imprisonment unde?`18 U. S. Code, Section 1001. CE IFIER'S NAME LICENSE NUMBER 5953- TITLE COMPANY NAME PI I STERED LAND SURVEYOR V . P . LAND SURVEYQRS ;IN C: ADDRffg 60 S Stream' CITY STATE ZIP OAT TELEPHONE 'I I i I ~I~I III' .t' U 10-22-2()03 , _ FEMA Form 81- 1, January 2003 See reverse side for continuation. Repla&s"all-privious ed1606Y 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 16000 NW 45 Avenue CITY STATE ZIP CODE Company NAIC Number Miami Florida 33054 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 CROWN OF THE ROAD ELEVATION: 7.65' TIE-BEAN ELEV.: 9.00' LOCATOR : . 21 4 3 NW BM## B-32-1 ELEV.: 9.14' This elevations have marked on form however slabs.have not been poured on 1st or 2nd floor. - I_I Check hero 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 E5. 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 J__j_j ft. (m) (__J__) in. (cm) j__J above or 1_1 below (check one) the highest adjacent grade. (Use natural grade, if available.) ( floor elevation Items C3 h and C3.1 l ) of the building is E3. For Bui Diagrams -8 W@ bov he enings stall acenth radet higher on front of -I _I ( ) I_ li (cm ) t h ghe 1 9 P ( in. cm above or (below i rY ant servicing " fFiebuilcfin9 ` Is E4. The toP of the latfomt of machineNand/ore4u P ~ ft. m) off I--I I - " P 1 (check one the hi9hest-ad1 jacent 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 a floodplain management ordinance? I 1-Yes J __J No 1_1 Unknown. The local official must certify this information `in Section G.__ SECTION F - PROP RTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, C (Items C3.h and Cli 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 REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS hl Cheer hem.If attactxt»tls SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorizedby 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. J__I 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. I__1 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 J__I Ths following information (Items G4-G9) is provided for community floodplain management purposes. i..~ t" PERMIT ISSUE4D 'DATE CERTIFICATE='OF'COMPLIANCE/.. F54- PERMIT NU'v1EER I` G5 DATE OCCUPANCY I! a N, li ISSN"E erm@t has been@ssUed for' P'I 1 New Con struction Substantial {mpg"o'vement ' G7. This P id -k G8. Elevation of as-built Iowes i flodr (including basement) of the )wilding is: --ft. (m) Datum G9. BFE or (in Zone AO} depth of flooding at the building site is: (m) datum . LOCAL OFFICIAL'S NAME„ ' COMMUNITY NAME TELEPHONE SIGNATURE DATE.. %Me 'll,l I ;ILA . COMMENTS