HomeMy WebLinkAbout34-2117-004-0841.
9 CO o - m.
e o ID
-n D M ~C o
M ~ at w.~
C c m~
x Z' 0 0 =o.:m~a~ o 0 o
W n
m cn cz
CD N, n.N m
>v CD 0 v
-n M M m o,QC~ m ao m o NN aN o 0 0
z .Z 0
CL m co m 3 3 3 3
C- Q
v
r O a-
(n M
N N
C) Z cn m
°w v m CO
C D' cn a
< ~ N
: :3' y 0
D M Z
ZO arz av
CD Cr
0 CD
a v
o v N
a
m any
& ~ ° m Cr CD CD 2r, -s- 3 M =3
M CI)
m m sc 0
OF N < v
~ ~X CD -
M CD ~a° Z
CD m 01 =r U)
3 0
v p~
M , m~ Z
m m
O D v 0 fD m
w -4 T> :q CD
z z
m ::3 M~ CO ;a
D
C Z in
I I > 3 3
X
rn 0 3:
z N r' CD CD m M.
c 0 n
Cl) zz oo I o -i
M O
z m "m m
M z- y a
C C 0 o Cr _I
-i -n M fn Z K o <<
D -1 mCD -v 0
--0 m o ;U CD .
0 n 0
m ~
' Z
M-
z°o ""sm-Z
-o. m
G7
m= CI)
D v m
N Z
v <
0 -z
m v n -3
M
OC)
-=0 = v
M °
-i
Z
W N
O::Q~1~ OCl,~0~m0v Co v CDro CrO
cn~ cvpQA~v<cca3vma3a.;U a~
Z m ~
oI'3mompmm
? O 0 0
< ;c i Q v ~ m
D 6, N m tT N v C N 3 N J CO
tD~o nN =hZ U)
° ~ v'~ m ~ m o ° 0
m'o c o.~ MM ~m {gym ~v D0 c 0v
O 3. 3, 3 m 0 3 a m O' a 3 m
~~c~ a.o h?-, o < M MM Dv m ° a-
v N o. 0-1 ° c N m m 0 O v I~ CD N
3 3 m m v 0 p 0 n O.-a D 3 a
=i °~rn: aa\o N0 my 0
v, D cot) 3 m v n
0 DOnm~-- ~v,omrt°Dc~M CT
m~
3 2L -o' m
m Q o a
~•Q CD rt N O~ 0 30 Dm m~ 0
rOn 3 Q C m o a
3 ~0 ~?'Q Q ~I
°3~ 3 rnI>Q < m w0 0I
a' j 3 m D ~-mM q~
oi~ ~ a m3
m "o m m m C: <c 3 ~c0
n~ m v 3 v <Q° 51 ca
0
3
Z~ ° n ln~cn ~(a m 0
3
Q n ico J~ 1(0 Z Z Z i~ 0' C: ~ - < - m 00
Cn
3 ~~NA (D ID ID~~ vQ Q. Wm ° C.a
IO I cn O p 3-n v M
CO CD Cr CO C:
CD =r a
m3Da-•,•3
nm a
3 2 3 3 a ~0 da m
SID rnNDo( O o "
G)
(n M
;p ~ - 0
m =r - 0 N
00M 1o mrt
CD
CL M -0 0
33cD~rn
License Number, Embossed Seal, M. m 3
Signature iantl Date ❑ m c ~ D
w p, m D 0 -r1
a m a
N ° 3 W 3;
+i ra i~v r
m (D. p m O w
r :3 Fn =r
_ M CL M.
CL 0
ac? 3
3 C'
D 0
UY, a c vi 3 c
N
r. 3 a n
a = ~9 rcn D
o O
3 0 m m
0 =3 Q.
:3 Cn
<
N •ti m
N O
m + _Q a
N m @ ~1 0
6M
o 3
3 ~•m °-h0
vc°rnmo
a7 CD
IM 0 u<i w 0
rt o
M
Zm°
D rL 0
o r4-
~J pp
n 3 ~ v
v a, m
Q -n
O O.
s❑m
M M M
rM0<
Mm3o
c 3.3~
C
% CO 3 00
M cp~
(n < m
cn®vCL
mz~v
v
C < 3
3 °
O3a
nom N
a
N m
(0 =b
o
N ❑❑Q
Z0m
n =r
0< m
rt N m
mmm
Nao-o
M a
3
~❑M ao
o
M
a S
Q m
nM
M u)
O n
0 07
.D
J
M
Cn
z
0
OU
oZD
003z
CO
o~D
z
m
r
v
01
C
c
m
m
X
W
0)
J -n
~v
4
Cmz
v
M
x
M
m
m
M
0 Ca
Wm-
Nm~
ADD
M
M z
0 m
r
D
M
NCO
O *n
xm0
~0
03
N~
~D
D cn
Om
~r
0
CD 0
Z CL
Dm
~m
0
o m
<
0 -D{
a0
F3, z
v cn
N(33
C)Z
wZ
~ TI
C~
z0
ZO
n~
0C
~C
0~
0M
D go
An
C
z_
z
C
03
M
~W
v•
30
b0
c
CD -Zi
-n W
.W
N
D
M
Z^
D
0
Z
v
N
v
D
v
OD
w
❑
C
Cn
m
a
v
0
M
ID
;U CU --i
i C::1
)F M
p0Z
m20
0
DC=
m
M00
CD
~0
m=
(A
m0
3C
ai =
Z
0 o
y0
a~
m =
'
v m
~
M
acnI
0 C)
DW
0
No
CD 0
n -I
C
Cn
m
0
0
3
m
N
N
CD
0
m
m
N
0
N
Ms
c
Cn {
Ms
v;
rDVi
0;
M
z
m
D
Z
A
v
M
z
G?
W
W
w
J
D
0
0
M
0
O
r
03
WC
KC 03
o -n -y
0 0
" 0
-C
~r
90 F
00
0
ZZ
~z
0 0 N
D
0
~c)
A C/)
~0
M O
o
X
P
rn z
N
cn
z
A
Drn
rm
CL
< ~
0 ;q
u
M
co
ITIZ
-4
FO 8
m
;UD
(A
W
ca
n
_ m
Z
,
M O
00
^
3
CD
0
-
~
D
v
=3
CO)
0
~
,3o Drn
CD
v
Z
D
p m ~m
Ox
0-
r
.
rn Z>
D
n
X
~m
M 'n rn
M
c
Z
M
a~0;
o
-
0 C1 M.
m
r
0
0
5.
`N Z Z
m
o
e m C3
o
;U
o ;U DZ
M
"
y nm
D
z
9
m m
-0
n
N
v
D
> 0Z
°
o
y -I G
0
z
m D Z
M
w
W
0
Ot
A
0
0
0'
X 0
z
G
N
C:
z
D
3
m
m
N
0
0
C 0
z
C:
0
3
m0:,-'
w
a
3
cn
m
C
n
(
m
'
3 O
Nv
O
O
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
16311 NW. 41ST AVENUE
CITY STATE ZIP CODE Company NAIC Number
MIAMI GARDENS 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
❑ 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.
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.
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. 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 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
community-issued BFE) or Zone AO must sign here.
09 Z.4 OJ --0 0
PROPS TY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP CODE
9 0Jr 78oo -X46 °-0&6-:;
SIGNATURE _ / l ' [SATE TELE
COMMENTS
❑ Check here if attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local official who is ai:tliorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E),
6 '
and G of this Elevation Certificate. Complete the applicable item(s) and sign below.
G1. ❑ The information"in Sectiofi C-was taken from other documentation that. has been signed and embossed by a licensed surveyor, engineer, or architect who
is authorized by stata or iocaf law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
G2. ❑ A C61m nity official ca;npl~c d section E for a building located in Zone A (without aFEMA-issued or community-issu ed BFE) or Zone AO.
G3. ❑ The folloing mformatinh (Items rvG4-G9) is provided for community floodplain management purposes.
G4. PERMIT NUMBED= G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY
411
ISSUED
7 isI has been ssued1or"L]'New Construction ❑ Substantial Improvement
14 ~
y as
k
g basement) of the building is: _ft.(m) Datum:
G8 Elevate n of a~-built Idwest floor
mcludin
~at the •
G9 BFE or (m Zone AO) depth' f
building s ite is: ft.
flooding (m)_ Datum:
oe' ,'yl;,lf
a
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE