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HomeMy WebLinkAbout34-2112-035-00201 FEDERAL. EMERGENCY MANAGEMENT AGENCY e9M MiAfilti-DADS NATIONAL FLOOD INSURANCE PROGRAM O.M:B. No- 3067-01077 f Expires Jury 31, 2flt32 ELEVATION CERTIFICATE PROCESS # v f~ 9 ~Z 24 12 FINAL-EEC R+ev. .JAN 01 moo ~ Important: Read the instructions on pages 1 - 7. ,w.,,..a,, OCL M9 SECTION A - PROPERTY OWNER INFORMATION $IIILDING CWNSrS NNE Par Insuranm-- Cacr:pany Use; Panty Number BUILDING STREET ADDRESS (Including Apt., Urn, SWN and" Bldg. No.) OR P.O. ROUTEAND BOX NO. Company NAIC Nc n*w 17800 N. W. 2ND AVENUE ~t . CITY STATE ZIP CODE MIAMI FL PROPERTY DESCRIFMON (Lot and Block Numbees, Tax Parcel Number, Legal ikon, etc.) PORTION OF N. W.1/4, SECTION 12-52-41, MIAMI-DADE COUNTY BUILDING USE (e g., Reside db* Non-tegicixrtlai. AddEm Arrcesso y, mac,. Use Ccmme t sedn if necessaxy.) NON-RESIDENTIAL (MOBILE. HOME)_ LATTTUDEILONGff UDE (OPTIONAL) HORIZONTAL QATUM SOURCE ❑ GAS (Type): ( #r - #V - ##jr or ~ Q NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map fl Other: SECTION 8 - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NFIP COMWNITY NAME & COMMUNITY NUMBER 82. COUNTY NAME - 83. STATE UNINCORPORATED 120635 MIAMI-DADE FL 84. MAP AND PANEL sK SUFFix 86. mm imEx 87. F(RM PANEL OOD 89. BASE FLOOD ELEVATION(S) NUMBER DATE EFFEC TNE:IREVIS'ED DATE ' E(S) (Zone AO, use depth of flood'acg) 12025C-0080 J 7'~, 3-2-94 X N/A ..810. Indicate the source of the Bass Flood Elevation (BFE) data or base flood B9. FIS Prode (M FIRM 13Community Determitied 811, Indicate the elevation datsan used for the BFE in B9: [M NGVD 1 0 NA 1988 other (Describe): 812. Is the budding located in a Coastal Barrier Resouces System (CSRS or erwise Protected Area (OPA)? [I Yes El No Designation Date SECTION C - BUILDING ELEVA,T10N 710N (SURVEY REQUIRED) C1. Buikft eievations are based on: 0 Construction Drawings* Budding E}`nder Constru tion* Finished Construction *A new Elevation Certificate will be required when consfrudi r; is complete. - C2. Building Diagram Number (Select the building drag , scm ilw to the budding for which this Ter ificate is being completed - so pages 6 and 7. If no diagram acctwately represents the. ' e a sketch or photograph.) C3. Elevations Zones AI-A30, AE, AH, A (with BFE), - ft BFE). AR. ARIA, AN/AE, AR/A14Q0. ARIAH, AR/AO Complete Items C3a4 below according to the b rspectfied in Item C2. State the datum used. if the datum is 015arentfrom th datum used for the BFE in Section 8 conv t thew used for the BFE- Show field measurements-and datum conversion cak;ulatlon. Use the space provided or of Section D or Section G, as appropriate, to documat the datum conversion. NGVD COUNTY BENCHMARK SYSTEM _ Datum rnrersio o . Elevation reference ma=lt used D as reference mark used appear on the FIRM? D Yes Q a) Top of bottom floor QnclucbxjL osure) N A 6 ti'(n') a Q b) Top of next higher titer' l • N 7A ...ti-tm) (m) y) Q c) Bottom of lowest horizontal stru member (V zones on i N 7A ft (m) -Dade) Q d) Attached garage (flop of slab) at a Ovor (1111 _ N . 8 A • e) Lowest elevation of machinery and/or equipment servicing the building A E Q f) 'Lowest adjacent grade (LAG) 9 . 6 9 Ulm) m " ~ Q g) Highest adjacent grade (HAG) N/ . ~ ft.(m) z 2 A__ Ci h)Total area of alt permanent openings (flood vents) in C3h sq. in. (sq. cm) © 0 No. of permanent openings (flood vents) within 1 ft, above adjacent grade N /A 2 o D Highest crown of road (Mia43ade) 10 •6 iL(M) Q No 72408 A~f JANUARY. 4", 2001 ROBERT F.'JACKSON SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certififiication is to be signed and sealed by a land surveyor, engineer, or archibad authorized by law to certify elevation ihformation. i cerMy that the information in Sections A, B, and C on this myWcate represents my best elm to interpret dw data avar7able- l understand that an false statement may be punishable by fine or i risenr ent under 18 U. S. Code, Secdion 1001. C>~RTiFIER'SNAME ROBERT F. JACKSON, P.L.S. Ll( Et!N~>tABER #2408 In= PRESID NT SCHWEBKE-SHISKIN & ASSOCIATES, INC ADDRESS 4 0 0 0 E JAJ CITY MIRAMAR STATE FL 21P CODE 3 3 0 2 5 SIGNATURE DATE 1-3-2001 TaJE'HCNE 305-652-7010 " J IMPORTANT: in these spaces, copy the corresponding information from Section A. For lnmirance Company Ilse; BUILDING STREET ADDRESS (Including Apt., Unit, Suite, andfor Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Nurnber CITY STATE ZIP CODE' Company NAIC Number 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 REFER ORDER'NO. y i Q Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) or Zone AO and Zone A (without BFQ, complete Items El through E4. ff the Elevation Cettilrcate is intended for use as sLgxvft nfarrnadw for a LOAM or LOUR-F, Section C trust be completed. 2-1. Budding Diagram Number _(Select the building diagram most similar to the budding for which this certificate is being completed - see pages 6 and 7. • If no diagram accurately represents the building, provide a sketch or photograph.) =2. The top of the bottom floor (Including basement or enclosure) of the building is IL(m) .._.,-i . ) above or ❑ below (check one) the highest adjacent grade. =3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated : e on b) of the building is ft. (m) in.(cm) above the highest adjacent grade. ;4. For Zone AO only. If no flood depth number is available, is the top of the bottom flood, ' in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local oflia!- ceffy this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S, P~ E T'IVE) CERTIFICATION . The property owner or owner's authorized representative who completes community4ssued BFQ or Zone AO must sign here. and E for Zone A (without a FEMA-issued or ADDRESS STATE TELEPHONE Check here if afchments SECTTIMI G 0 NITY INFORMATION (OPTIONAL) the local offic'sai who is authorized by law or ordin a8t4ister the community's floodplain management ordinance can complete Sections A, B. C (or E), and G of this Elevation -Complete the applicable item(s) and sign below. 311. The information in Section C was taken 'documentation that has been signed and-embossed by a licensed surveyor, engineer, or architect who is autho ' b state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments 32. ❑ A caimmunit.official cornpteted Section: E for a building located in Zone A (without a FEi1AA issued or community-issued BFE) or Zbne AO. 33. The following intbrmalion (Items G4-G9) is provided for community floodplain management purposes. G5. DATE PERMIT GS. DATE CERTIFICATE OF ISSUED 37. This permit has beer issued for. ❑ New Construction ❑ Substantial Improvement 38. Elevation of as-built lowest floor (Including basement) of the building is: ft.(m) Datum: 39. BFE or (in Zone AO) depth of flooding at the building site is: -.-f t.(m) Datum: LOCAL OFFICIAL'S NAME TrrLE C.OMMUNI TY NAME TELEPHONE SIGNATURE DATE COMMENTS ❑ Check here if attachments MA Farm 81-31, AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPlACaS ALL PREVIOUS EDMONS