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Home My WebLink About34-2109-002-2300PROCESS #C I lie 1 2 ~,,S DERAL EMERGENCY MANAGEMENT AGENCY FOLIO # NATIONAL FLOOD INSURANCE PROGRAM C.O.R. 7 . 4 9 . ELEVATION CERTIFICATE rtant: Read the instructions on pages 1 - 7. O.M.B. No. 3067-0077 Expires July 31, 2002 SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number Mrs. Evans BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number 2761 N.W. 173rd. Terr ClTlyi am i STATE ZIP CODE FL PROPERTY DESCRIPTION (Lot and Block Numbers T x Parcel Numb r, L al Descrii n, eta,) Lot 20, BLock 11 in PB:53=~8, Dade G~ouiity, ~orida. BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.) RESIDENTIAL LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: JJ GPS (Type): C - or LJ NAD 1927 JJ NAD 1983 LJ USGS Quad Map JJ Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION r ■ B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3. STATE NINCORPORATED & 120635 DADECOUNTY FLORIDA B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding) 12025C-0080 J 07-17-95 03-02--94 "X" NONE B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. (J FIS Profile J.XJ FIRM U Community Determined JJ Other (Describe): B11. Indicate the elevation datum used for the BFE in 139: lyl NGVD 1929 JJ NAVD 1988 )J Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? LJ Yes (ZJ No Designation Date: N/A SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1 Building elevations are based on: L_JConstruction Drawings* JJBuilding Under Construction* JX jFinished 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, V1430, V (with BFE), AR, AR/A, AR/AE, AR/Al-A30, AR/AH, AR/AO Complete Items C3a-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 N V T) Conversion/Comments N/A Elevation reference mark used Nr; a 1,, ; n a d e Does the elevation reference mark used appear on the FIRM? J J Yes ~ LX J No ❑ a) Top of bottom floor (including basement or. enclosure) 8 .6 3 Nm) a ❑ b) Top of next higher floor N /.A ft.(m) C] c) Bottom of lowest horizontal structural member (V zones only) N /.A ft.(m) 00 ❑ d) Attached garage (top of slab) N /.A ft.(m) 0 ❑ e) Lowest elevation of machinery and/or equipment m servicing the building 8 . 0tft,m) ❑ f) Lowest adjacent grade (LAG) 7 .5 ~ft.(m) Z.0 ❑ g) Highest adjacent grade (HAG) 7 69 C ❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade N /A Q 6 ❑ i Total area of all permanent openings (flood vents) in C3h N A sq. in. L 0 0 2 (q. 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. l certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. l understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME LICENSE NUMBER AQberto R. Brizuela 3064 TITLE COMPANY NAME _Prnf _ T•grid Snrv ;znr an Mapper ROBERTO R BRIZUELA AND ASSOC.,INC. ADDRESS CITY STATE ZIP CODE 19'1 N_G1_ 116th Cnilrt Miami FL 33182-1957 DATE TELEPHONE -EJF,MA Form 81-31, jKUG 99 - , SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT: in these spaces, copy the corresponaing mTOrmaaon Irom *7~CGUV,I r. I . W9 ...~...a...,. (including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. 2761 N.W. 173rd. Te STATE ZIP CODE Company NAIC Number Miami FL 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 E3. 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 I I ft.(m) II_lin.(cm) (_J above or L~ below (check one) the highest adjacent grade. E3. 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? J Yes 1_1 No L1 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. 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. L_J 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. L,J A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or Zone AO. G3. L_I The following information (Items G4-G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER I G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This permit has been issued for: (_J New Construction LJ 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, AUG 99 REPLACES ALL PREVIOUS EDITIONS t