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Home My WebLink About34-2109-015-1870FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM . Expires July 31, 2002 ELEVATION CERTIFICATE Important: Read the instructions on a es 1- 7. SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number - DAVID & STE~PEHANIE TAMES BUTT y3STNW 8tDSS D~ S STuding Apt. Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number CITY - STATE ZIP CODE CAROL CITY, FL. PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etk*) RESIDENTIAL BUILDING. USE (e.g., Residential, Non-residentlW, Addition, Accessory, etc. Use Comments section if necessary.) LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: LJ GPS (Type): ( - *r - ##.#r or WAWA" U NAD 1927 L_„1 NAD 1983 1„ J USGS Quad Map LJ Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER 62. COUNTY NAME B3. STATE UNINCORP. AREAS 1 2 0 6 3 5 T)AflF TP T. B4. MAP AND PANEL 135. SUFFIX B6. FIRM INDEX B7. FIRM PANEL 88. FLOOD 139. BASE FLOOD ELEVATION(S) NUMBER TE EFFECTNE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding) 1202500080 J 7 95 Win InAlMfe Oia e,w„rr m ow tff%a Rage Clrw %A CIevml ^n In&=% o f dsw"% a."aw NA nn U FIS Profile LJ FIRM LJ Community Determined U Other (Describe): B11. Indicate the elevation datum used for the BFE in 139: x J NGVD 1929 U NAVD 1988 U Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? U Yes W No Designation Date: 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-mo, AE, AH, A (with BFE), VE, V11430, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO Complete Items C3a4 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 Conversion/Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? 0 a) Top of bottom floor (induding basement or enclosure) 8 : 5 IL(m) it Q b) Top of next higher floor ft.(m) a 0 c) Bottom of lowest horizontal structural member (V zones only) . ft.(m) c 0 d) Attached garage (top of slab) f4m) W D e) Lowest elevation of machinery and/or equipment servicing the building IL(m) 7 3 O f) Lowest adjacent grade (LAG) fL(m) . z 0 g) Highest adjacent grade (HAG) 7. 7IL(m) O h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade C1 I) Total area of all permanent openings (flood vents) in C3h sq. in. (sq. an) LJ Yes M No '~=;io 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 inl mwdon in Sections A, A and C on ibis certifeate represents my best efforts to interpret the data available. I understand that any false statement maybe punishable by** or imprisonment under 18 U. S. Code, Section 1001. TITLE - - - - - - COMPANY NAME Vi ne prEami dent All C'ot-Inty -qjvrTnn ADDRESS CITY STATE ZIP CODE FEIUA Form 81-31, AUG 99 so REVERSE SIaE FOR CONTIAILJATION REPLACES ALL PREVIOUS EMIONS IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company use. STATE ZIP CODE SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenticompany, and (3) building owner. COMMENTS 01-9006 LJ 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. !f the Elevation Certificate is intended for use as supporting information for a LOW or LOMB F, Secton C must be caomphdad. 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 L-1-_1 t(m) I_I in.(cm) L j above or U 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 I_I_.j 1(m) l _I In.(cm) above the highest adjacent grade. E4. 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? L Yes I No I Unknown. The local official must certify this information in Section G SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATNE) 'CERTIFICATION The property owner or owner's authorized representative who completes Sections A. B, and E for Zone A (without a FEMA-issued or community4ssued BFE) or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REP SENTAMVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS I_I 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. U 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 G449) is provided for community floodplain management purposes. G7. This permit has been issued for: j_j New Constriction j,_j Substantial Improvement G8. Elevation of as-built lowest floor (including basement) of the building is: . fL(m) Datum: G9. BFE or (in Zone AO) depth of flooding at the building site is: . f L(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DA COMMENTS L J Check here if attachments !FEMA Form 81-31, AUG 99 REPLACES ALL PRE MOUMS Eamo~ls