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Home My WebLink About34-2117-004-1605FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077 ELEVATION CERTIFICATE 114 Expires December 31, 2005 Important: Read the instructions on pages 1 - 7. 7943 SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number Karel Del Busto BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number 16130 N.W. 39 Place CITY STATE ZIP CODE Miami FL 33054 PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Folio# 34-2117-004-1605 BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.) Residential LATITUEE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS (Type): ( - #kk" - or ® 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. MAID AND PANEL B7. FIRM PANEL B9. BASE FLOOD ELEVATION(S) NUMBER 65. SUFFIX F B6. FIRM INDEX DATE EFFECTIVEIREVISED DATE B8. FLOOD ZONE(S) (Zone A0, use depth of flooding) 12025C 0080 J 7/17/1995 3/2/1994 X N/A 1310. Indicate the source of the Base Flood Elevafion (BFE) data or base flood depth entered in B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe): B12.16 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. Elevatiois - 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- 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 a) Tcp of bottom floor (including basement or enclosure) 10.09ft.(*) Y b) Tcp of next higher floor N.Aft.(m) _ c) Bottom of lowest horizontal structural member (V zones only) h!-Aft-(m) d) At ached garage (top of slab) 9.15ft.(*) E LLJ e) Lowest elevation of machinery and/or equipment P~ s•erviang the building (Describe in a Comments area) hllc 9.95ft.(.0) 3 f) Lowest adjacent (finished) grade (LAG) 8.95ft.(*) U) g) Highest adjacent (finished) grade (HAG) 9.37ft.(cN) h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade NA i) Tolal 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 information. I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. I understE,nd that any false statement may be punishable by fine or imprisonment under 18 U. S, Code, Section 1001. CERTIFIER'S NAME: Odalys C. Bello-lznaga LICENSE NUMBER # 6169 TITLE: Professional Surveyor and Mapper COMPANY NAME Bello & Bello Land Surveying Corporation ADDRESS CITY STATE ZIP CODE 12230S.W.131s1Avenue,Suite ;49 Miami Florida 33186 SIGNATURE DA /y/O& (305) 2TELEPHONE 1- 606 FEMA Form 81-31, Januar~ See reverse side for continuatid'n. Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bld(l. No.) OR P.O. ROUTE AND BOX N0. Policy Number 16130 N.W. 39 Place CITY STATE ZIP CODE Company NAIC Number Miami FL 33054 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both s,des of this E- a[i_ I Certificate for (1 community ofidal (2) in: agent/cornpany, and (3) building owner. COMMENTS Crown of Road Eleva;ior 7' l.'~Je,L No - ❑ 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 mos; 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 platform of machinery and/or equipment servidig 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 REPRESENT.A ADDRESS SIGNATURE DATE STATE ZIP 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 itan(s) and sign below. G1. ❑ 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 E;evation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or Zone A0. G3. ❑ The following information (Items G4-G9) is provided for community floodplain management purposes. (34. PEHMI I NUMBEH G5. DATE PERMIT ISSUED DATE CERTIFICATE OF G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-built lowest floor (including basement) of the building is: - (m) Datum: _ G9. BFE or (in Zone AO) depth of flooding at the building site is: _ II Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS Check here if attachments FEMA Form 81-31, January 2003 Replaces all previous editions