HomeMy WebLinkAbout34-2110-001-3420O.M.B. No. 3067-0077
Expires July 31, 2002
SECTION A -PROPERTY OWNER INFORMATION For Insurance Company Use:`':
_
BUILDING OWNER'S NAME - Policy. Number
HOWARD SIPLIN
011844
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC. Number
17320 N.W. 18TH AVE.
CITY STATE ZIP CODE
OPA-LOCKA FLORIDA 33056
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
BUILDING USE (EN IALsidentia! Non-residential, Addition, Accessoryetc Use Comments section if necessary.)
RESID"
LATITUDE/LONGITUDE (OPTIONAL) ' HORIZONTAL DATUM: SOURCE: L_i GPS (Type):
( - or I NAD 1927
l_) NAD 1983 L) USGS Quad Map L_) Other:
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2..000NTY NAME B3. STATE
120635 MIAMI-DADE FLORIDA
B4. MAP AND PANEL
B5. SUFFIX
B6. FIRM INDEX
B7. FIRM PANEL
B8. FLOOD
B9. BASE FLOOD ELEVATION(S)
NUMBER
1202500080
DATE
1
EFFECTIVE/REVISED DATE
ZONE(S)
(Zone AO, use depth of flooding)
.
J
7/
7/95
„3/2/94
X
N/A
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood'depth entered in. 139.
1_I FIS Profile' 1_:X ( FIRM 1_J Community Determined 1_1 Other (Describe):
811. Indicate the elevation datum used for.the BFE in B9: IX I NGVD'1929 1J NAVD 1988 I_j Other (Describe):
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPAL 1_1 Yes Ix J No
Designation Date:
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: Construction Drawin s* . 13uildin Under Construction" XIFinished Construction
h
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-V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO
Complete Items C3a-i below according to,the building g 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 theBFE. 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 NGVD Conversion/Comments `
Elevation reference mark used RFN(:u MARK Does the elevation reference mark used appear on the FIRM? IX I Yes Is! No
'
❑ b To p of next bottom floor (including basement or enclosure) 11 `r30 ft,(m)
P higher floor N/A fl. m
r
13 c) Bottom of lowest horizontal structural member (V zones only) N/A ft.(m) H 16
❑ d) Attached garage (top of slab) 4 `)9 00
C3 e) Lowest elevation of machinery and/or equipment x.0/22; O1
servicing the building NA ft,(m) 8
❑ 0 Lowest adjacent grade (LAG) 8 90 ft.(m) z'
❑ g) Highest adjacent grade (HAG)
~ 9 . 20 ft.(m) ~ . .
E3 h) No.of permanent openings (flood ) within _ 1 ft. above adj 9rade N S
vents adjacent /A
❑ i) Total area of all permanent openings (flood vents) in C3h N/A q. in. (sq. cm)
SECTION D ARCHITECT CERTIFICATION Ilia II . ii~ rill - S -URVEYOR 'ENGINEER OR ARCH1~~ 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 m t efforts to interpret th16 ~ ata available.
I understand that any false statement may be Punishable by fine or imprisonment under 18 U.S: Code, section 1061
CERTIFIER'S NAME LICENSE NUMBER
ADIS N. NUNEZ 5924
TITLE COMPANY NAME
.REGISTERED LAND SURVEYOR BLANCO SURVEYORS. INC.
ADDRESS r\ CITY STATE ZIP CODE
IN . s Kt; ux. MIMI-BEACH FT,QRTDA , ; I'll 39
SIGNATURE , DATE 10/22/01
(35 TEL PHONE
5 865-1200
FEMA Form 81-31`.TUL 00
SEE REVERSE SIDE FOR CONTINUATION
REPLACES ALL PREVIOUS EDITIONS