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HomeMy WebLinkAbout34-2117-004-1700FEDERAL EMERGENCY MANAGEMENT AGENCY Loo ?1/ 723( NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077 ELEVATION CERTIFICATE Expires December 31, 2005 2A - ZI 17-c-6 el -176r? Important: Read the instructions on pages 1- 7. 4568 SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number Johnny I. Barber; Kimberly I. Richardson-Barber I -I BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. r pany NAIC Number 3985 N.W. 165 St. CITY STATE ZIP CODE Miami FL 33054 PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) The East 100 feet of the West 282.50 feet of the South 1/2 of Tract 24, REVISED PLAT OF VENETIAN GARDENS BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.) Residential LATITUDEILONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS (Type): ( - - 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 FlnriAn B4. MAP AND PANEL NUMBER 12025C 0080 B5. SUFFIX J B6. FIRM INDEX DATE 7/17/1995 B7. FIRM PANEL EFFECTIVEIREASED DATE 3/2/1994 B8. FLOOD ZONE(S) X B9. BASE FLOOD ELEVATION(S) (Zone A0, use depth of Ilooding) N/A D I v. n iuiodre a ie source ur ure oase mood bevauon (ort) 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. Is the building located in a Coasted Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date nla 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, ARIA, AR/AE, AR/A1-A30, AR/AH, AR/AO Complete Items C3.-a4 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) 9.30ft.(* v o b) Top of next higher floor N.Aft.(m) Cn o c) Bottom of lowest horizontal structural member (V zones only) N.Aft.(m) N ~1tiJ 1 o d) Attached garage (top of slab) N.Aft.(m) E o e) Lowest elevation of machinery and/or equipment w 1O servicing the building (Describe in a Comments area) ~ 9.37ft.(0 E m o f) Lowest adjacent (finished) grade (LAG) 8,34(e) z' m o g) Highest adjacent (finished) grade (HAG) 8.48ft.(o) 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) r 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 ±gfounation. - - I certify that the information in Sections A, 8, and C on this certificate represents my best efforts to interpret the data availaLVe, 1 understand that any false statement maybe punishable b fine or imprisonment under 18 U. S. Code, Section 1001. CERTIFIERS NAME: Odalys C. Bello-Iznaga LICENSE NUMBER # 61"~ TITLE: Professional Surveyor and Mapper COMPANY NAME ADDRESS 12230 S.W. 131 'Avenue, Suite 201 SIGNATURE FEMA Form 81-31, January U I T STATE ZIP CODE Miami Florida 33186 n DATE TELEPHONE 0J (305) 251-9606 See reverse side for co tinu {ion. 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 BN. No.) OR P.O. ROUTE AND BOX NO. Policy Number 3985 N.W. 165 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: 7.80' ❑ 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. (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 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, Q 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 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 item(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 elevation 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 FEMA4ssued or community4ssued BFE) or Zone A0. G3. ❑ The faltowing information (Items G4-G9) is provided for community floodplain management purposes. G4. PERMIT.NUMBER - G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This petmit has- ieen-rssued for, slew Construction ❑ Substantial Improvement G8. Elevationof as-built IGvest floor (including basement) of the building is: - ft.(m) Datum: _ G9. BFE or (iA Zone AO) Depth of flooding at tha building site is: t(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS LJ Check here if attachments FEMA Form 81-31, January 2003 Replaces all previous editions