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Home My WebLink About34-1136-011-0860FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE Important: Read the instructions on pages 1- 7. 3450 SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use:: BUILDING OWNER'S NAME Policy Number Gracia Moise BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number 125 N.E. 205th Terrace CITY STATE ZIP CODE Miami Florida 33179 PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Folio # 34-1136-011-0860 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 ® 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 120635 Unincorporated Areas - 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 88. FLOOD ZONE(S) (Zone A0, use depth of flooding) 12025CIO080 J 03102/94 07/17195 AE 6.0' B10. Indicate the source of the Base Flood Elevation (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. 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, ARIA, AR/AE, AR/A1 A30, AR/AH, ARIAO 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 ConfrhEnts area of Section D or Section G, as appropriate, to document the datum conversion. Datum 1929 Conversion/Comments n/a Elevation reference mark used MDCBM Does the elevation reference mark used appear on the FIRM? ❑ Yes ®No r - o a) Top of bottom floor (including basement or enclosure) o b) Top of next higher floor n aft.(m) W o c) Bottom of lowest horizontal structural member (V zones only) n.aft.(m) o o o d) Attached garage (top of slab) TOM* - a+ 4r GI+ `4. 4t 5- I ni F i - M?', W Lo f:.. : S ,wa.u.!» a' t71it3:sz{Xxt= o e) west elevation of machinery an ore. quipment X~I'ill j~" ~ n}i it Z~ ~ 1 N0 %TI' a ` V _ / J t'.G,15;; Vet'. d: I' n~>r fd l T39Y-.. p servicing the building (Describe in a (;omments area) r 6 92ft(PA) 4 X Y. ~ E .Tt :1,3•a "NI r = i'i'. ~ d x'. t inx o., «l to o fl: i 6fed) grade (LAG) 6.14ft.(jP) z Lowest ad acerit "finis 9) )ace ~nf: shed) grade (HAG) 6.80ft.( o Highest ad fin il~ I I I 1 j1dil r / J a v d W m A 1 cent g a e n a ove adj vents) within 1 rungs floo o h) No. of permanent ode ( 1;`4 2c ~ o I) Total area of all permanent openings (flood vents) In b3.h n1a sq. in. (sq. cm) ra l Iyyi 111 11 If 111. SSCtIdVU1~l=d SURVtYORI EIIlIGINtE' ORARdI :ltbT Id Atl hll dATION 11 li i ~ l _ jr ,I IA in+. 1 II 'III+ Illld 10- 1 II II. IIi. III This certificat ion is to be signed and-sealed by a land surveyor,` engineer, or architect authorized by I yI, Ik 'III Ili 1 III Jhpll lld el3: r- '1I III III III v l I 'il III' I certify that the information in Se'cfions and Con this certificate'represents my best efforts to iir III l understand that a 1~i false'sfafe~ieln't rn~ A1 IeI b1 A1sha1&e by fine or imprisonm ent under 18 U.S. II CERTIFIERS NAME: Odalys C. Bello-lznaga io' b6r ify elevation information. olilii I. r►~ef ihb data avail& ~~e06n ~~01. il _ H_ 1i, fl1 l~ LICENSE NUMBER # 6169 TITLE: Professional Surveyor and Mapper COMPANY NAME ADDRESS 12230 S.W.131stAvenue, Suite 201 SIGNATURE CITY STATE Miami Florida DATE / TELEF (305) 251-9606. 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 125 N.E. 205t" Terrace CITY, STATE ZIP CODE Company NAIC Number Miami Florida 33179 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: 6.20' ❑ 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 grade, g available). natural a vet h E3. For Building Dia rams 6-8 with openings (see page 7), the next higher floor or elevat ' ( ) idin is ft.(m _m. cm abo 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 Z 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 u, COMMENTS ' - Check here if attachments s u u r" SECTION G- COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by laia"or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and. G of this Elevation CertificatPd Complete the applicable item(s) and sign below. G1. ❑ The information in Secticn C w 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 FEMA-issued or community-issued BFE) or Zone A0. G3. ❑ The following information (Items G4-G9) is provided for community floodplain management purposes. 1 i I G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-built lowest floor (including basement) of the building is: ft.(m) Datum: G9. BFE or (in Zone AO) depth of flooding at the building site is: _ ft.(m) 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