The URL can be used to link to this page

Home My WebLink About34-2117-004-0400FEDERAL EMERGENC Y MANAGEMENT AGENCY PROCIES # NATIONAL FLOOD I NSURANCE PROGRAM O.M.B. No. 3067-0077 FOLIO ~a }00V 10 "It 0'o ELEVATIO CERTIFICATE Pines December 31, Zoos CROWN OF ROAD-6.33 Ft NGVD Important: Read the nstructions on a es 1- 7 p g . SECTION A- PROPER TY OWNER INFORMATION For Insurance Company use: camuni f -v Policy Number B IL 01TRI EET D Indud 4pt., U , u n or I . R P.O. ROUTE AND BOX NO. Company NAIC Number l t' n i IS ATIr ZIP CODE ROPF_RJY CRIPTIgN (fit a Block N ax Parcel Nu ben ~ I r D~,„ ~u al D iption, etc.) - I~D ~ ~l i USE (e. gside ' a I on-residential, Addition, A ory, etc. U e a Comments area, if necessary.) LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DAT UM: SOURCE: El GPS (Type): ( - or ##.##>YII#°) El NAD 1927 El NAq 1983 ❑ USGS Quad Map ❑ Other. SECTION B - FLOOD INSURANC E RATE MAP (FIRM) INFORMATION 1. F C U ' B2. COUNTY ME h i., j _ Dade, B3. STATE ~-i a r i da fM ' B4. MAP AND PANEL B7. FIRM P ANELL B9. BASE FLOOD ELEVATION(S) Cf~ i L 25EER B5. SUFFIX B6. Frl IND , TE EFF C IS D DATE 4 B8. FLO ZONE(S) (Zone Ao, s depth of flooding) B10. Indicate the source of the Base Flood Elevation (BFE) data o base flood depth ent ered in B . ❑ FIS Profile O FIRM ❑ Community Determined ❑ Other (Describe): B11. Indicate the elevation datum used for the BFE in B9:42 NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe): _ B12. Is the building located in a Coastal Barrier Resources System CBRS area or Oth e wise Protected Area OPA ? ❑ Yes ® No Designation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawinge ❑ Building Un r Construction" (;D Finished Construction A new Elevation Certificate will be required when construction of the building is com C2. Building Diagram Number/ (Select the building diagram most similar to the building fete. 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, VI 430, V (with BFE), AR, A, ARAAE, AR/A1-A30, AR/AH, ARIAO Complete Items C3.-a- 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 version calculation. Use the space provided or the Comments area of Section D or Section G, as appro hate, to document the datum conversion. Datum ConversionlCo _ A& Elevation reference mark used the elevation reference mark used a r c a FIRM? ❑ Yes 0 No a a) Top of bottom floor (including basement or enclosure) -rf ft(m) m I I] b) Top of next higher floor /~ft(m) co O c) Bottom of lowest horizontal structural member (V zones only) ft(m) W ` C1 d) Attached garage (top of slab) ft(m) : ❑ e) Lowest elevation of machinery and/or equipment w 1 servicing the building (Describe in a Comments area) Q 71 ft(m) E ❑ f) Lowest adjacent (finished) grade (LAG) El g) Highest adjacent (finished) grade (HAG) ft(m) z m~ ft(m) ~j 7'ntl ~O0~ ❑ h) No. of permanent openings (flood vents) within 1 ft above adjacent grade l p r - i) Total area of all permanent openings (flood vents) in C3.h __(&_sq. in. (sq. cm SECTION D - SURVEYOR, ENGINE R, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or arc itect authorized by law to certif)r elevation information. 1 certiY that the information in Sections A, A and.C on this certificate represe . , my besf,ef at to interpret the data available. - 1 understand that an false stafernentn .be. unrshable b fine on ' on Undar 18 U.S. Code; Sec ion x001. S - 11CEDISE NUMBER 10115 Pr es iana144 ors Ma er WMEY Bpi P Lan Surve 'n - Sr e Ui#e 202 , M:ilgmisTATE 3 1.14 107111 MP~ E~v DATE DATE j 2C'~/l1TELEPHONE (30' ) : 262 LQq 5 " PAS 1177. v e 11 FEMA Form 81-3 , Janua 003 See reverse side or continuation. - Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section For Insurance Company Use B I G T ET Aff S n uWt, Unit, and/ I N UTE AND BOX N0. M I LAC Policy Number CN~ pl' ~ i ~n r , ,ST i t ZIP CODE Cornpany NAIL Number- RARCHITEC SECTION D-SURVEYOR, ENGINEER, O T CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. COMMENTS ❑"Check her>' ff attachments ` SECTION_E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQ IRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) Fror Zone AO and Zone A (without BFE), complete Items E1 through E4. If the Elevation Certificate is ntended 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 ~ertificate 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 (elev, 'on b) of the building is _ fL(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 a ccordance 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 REP RESENTATIVE) 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. The statements in Sections A, B, C, and E are correct to tt, e best of my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS ❑ 6heck here if attachments SECTION G - COMMUNITY INFORMA TION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community s floodplain Manag ement ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificale. Complete the applicable item: (s) and sign below. G1. ❑ The information in Section C was taken from other documentation that has been signed and a bossed by a licensed surveyor, engineer, or architect who is authorized by sta or local law to certify elevation infcimation. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official CempleW Section E for a building located in Zone A (without a FEMA4ss jed or community4ssued BFE) or Zone A0. G3. ❑ The following information (Items G4-G( 91) is provided for community floo dplain manag"it pu poses. G4. PERMrr NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPUANCEIOCCUPANCY ISSUED G7. This permit has been issued for. ❑ New Constnxtion LU Substantial Improverrolt G8. Elevation of as-built lowest floor (including basement) of the building is: G9. BFE or (in Zone AO) depth of floods at the building site is: LOCAL OFFICIAL'S NAME fem... fMEMS Form 81-31, January 2003 -ft(m) Dahum - _ft(m) Dahrm., e Check hale if attadvelts Replaces all previous' editions i