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Home My WebLink About34-2117-004-04600,5 t G)o `4 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077 Expires December 31, 2005 ELEVATION CERTIFICATE Cd Important: Read the instructions on pages 1 - 7. 5 tol SECTION A'- PROPERTY OWNER INFORMATION a For Insurance Company Use: BUILDING OWNER'S NAME Policy Number David Rodriguez' BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR' P.O. ROUTE AND BOX NO. Company NAIC Number 4185 N.W. 161 St. CITY STATE ZIP CODE Miami FL 33054 PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Folio # 34-2117-004-0460 BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.) Residential LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (Type): ( - - or #ft.~°) ® NAD 1927 ❑ NAD 1983 ® USGS Quad Map ❑ Other: SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3. STATE Unincorporated 120635 Miami-Dade Florida 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) 12025C 0080 J 7/17/1995 312/1994 X N/A DI U. II IUIGdW 11 It JUUII;e ul U It Ddb I CIUVdLIUI I,DrrZ) udCd UI w6e IIuua ueptn enterea in bS . ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe): B11. Indicate the elevation datum used for the BFE 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 n/a 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 430, 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 1929 Conversion/Comments n/a Elevation reference mark used MCBM Does the elevation reference mark used appear on the FIRM? ❑ Yes ®No o a) Top of bottom floor (including basement or enclosure) 9.69ft.# o b) Top of next higher floor N.Aft.(m) w a) o c) Bottom of lowest horizontal structural member (V zones onl ) 1.. T ; y Q ` o d) Attached garage (top of slab) 9.06ft.(#) E - I JJJ o e) Lowest elevation of machinery and/or equipment servicing the building (Describe in a Comments area) If /mod 9 71 t( ) . r Z .2) o Lowest adjacent finished grade LAG 878ft. tlw nl I~~ . o g) Highest adjacent (finished) grade (HAG) o h No. of permanent openings flood vents within 1 ft, above adjacent grade. NA o i) Total area of all permanent openings (flood vents) in C3.h NA 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 In or and C on this certificate represents my best efforts to interpret the data available'' B rtif that the information in Sections A 1 matl 1'' I' t ' II' , , ce Y ent may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. understand that any false statement I (~'ll'' CERTIFIERS NAME: Odalys C. Bello-Iznaga LICENSE NUMBER # 61 69 TITLE: Professional Surveyor and Mapper COMPANY NAME ADDRESS 12230 S.W.131StAvenue, Suite 201 SIGNATUR idly JIAIC eu urwuE: Miami FlA~ 33186 X141. -Ii l- ATE TELEPHONE •r' 04=5 (305~ 25~-660. continua ion. ! ! Ikeplaces all previous editions ~I II~~I FEMA Form 81-31, January 2003 See reverse side 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 4185 N.W. 161 St. CITY STATE ZIP CODE Company NAIC Number Miami FL 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 Road Elevation: 8.41 ❑ 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. El. 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 platforrn 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. 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 Check here if attachments Y " 'y SECTION G. - COMMUNITY INFORMATION (OPTIONAL) The local official ,A is at ithonzed by law or'ofcA!nance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this _ w, y xw m Elevation Cert~f~c,ate' Complete the aoplicabie item(s) and sign below. G1. P, 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 orlocal law to certify elevation 446rrnat, n flndl' the source and date of the elevation data in the Comments area below.) G2 ❑ A community offcialcomplPtedss~~ion E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or Zone A0. G3 ❑ The following information ;items N-G9) is provided for community floodplain management purposes. G4. PERMIT N M5EIR x G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7 This permit h as been i ' ssued for New ; , f ; , q Construction ❑ Substantial Improvement ~ pia ~ ~ ~ riilnil G8. Elevation of as-built lowest floor (including basement) of the building is: _ft•(m) Datum: (in Zone AO) depth of g o building site is: G9. BFE or flooding fthe - ft.(m) Datum: LOCAL OFFICIAL'S NAME i; TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS . Ili it Ill I .6. i h~ lai s f i T I ~ ~;I ` ❑ Check here if attachments FEMA !Form 8,1 31 Ja~nuaryi 2003 ff ~ If Replaces all previous editions I