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Home My WebLink About34-2110-002-0082PROCESS # G 1 G{ r'1 1'130 1 FEDERAL EMERGENCY MANAGEMENT AGENCY FOLIO # 30- - OZ -608;x, NATIONAL FL09D INSURANCE PROGRAM C.O.R. ,o ELEVATION CERTIFICATE fe*#-4 If *4WW%00# *W laV(0V Important: 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 BRV Construction BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number 17721 NW 27"' Avenue CITY STATE ZIP CODE Miami FL PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Folio 30-21104002-0082 Part of Tract 24 "Miami Gardens Subd of Section 16. Plat Book 2 Pa a 96 BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.) Commercial Restaurant 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 Miami-Dade County 120635 Miami-Dade County Florid B4. MAP AND PANEL B5. SUFFIX B6. FIRM INDEX 7. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding) 0080 J 17 July 95 2 March 94 AE 7.0 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 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 _ (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/A1-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 Conversion/Comments ,Q&#,ation reference mark used Does the elevation referencle mark used appear on the FIRM? ❑ Yes ®No o a) Top of bottom floor (including basement or enclosure) 8. 54 ft. (m) o o b) Top of next higher floor ft.(m) o''t) Bottom of lowest horizontal structural member (V zones only) _ft.(m) o d) Attached garage (top of slab) E o e) Lowest elevation of machinery and/or equipment W servicing the building _ft.(m) a o f) Lowest adjacent grade (LAG) 8. Ogft,(m) Z o g) Highest adjacent grade (HAG) 8. 09ft.(m) C o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade o i) Total area of all permanent openings (flood vents) in C3h _sq. in. (sq. cm) 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. 1 certify that the information in Sections A, Q and C on this certificate represents my best efforts to interpret the data ava#able. I understand that any false statement may be punishable by fine or Imprisonment under 18 U. S- Code, Section 1001. CERTIFIER'S NAME James Beadman LICENSE NUMBER 2997 TITLEProfessional Land Surveyor COMPANY NAME James Beadman $ Assoc., Inc ZIP FEMA Form 81-31, AUG-Az SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT: In these spaces, copy the cc BUILDING STREET ADDRESS (Including Apt., Unit, CITY onding information from Section A. and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. STATE I ZIP CODE For Insurance:Company Use: Policy Number Company NAIC Number 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 Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT tsrtl 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. E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is -ft.(m) _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? ❑ 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, 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 REPRESENTATNE'S NAME ADDRESS CITY STATE ZIP CODE DATE TELEPHONE SIGNATURE 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 FEMA-issued or community-issued BFE) or Zone AO. G3_ ❑ The following information (Items G4-G9) is provided for community floodplain management purposes. DA 'SUED G6. DATE CERTIFICATE OF COMPLIANt;t1u1;t.urniv0.' ISSUED ~~~~JJJI 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, AUG 99 REPLACES ALL PREVIOUS EDITIONS