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Home My WebLink About34-2114-012-0070FEDERAL EMERGENCY MANAGEMENT AGENCY MIAMI--DADE tar NATIONAL FLOOD INSURANCE PROGRAM O.M:B. No. 3067-0077 PROCESS it C A ~7 ELEVATION CERTIFICATE Expires July 31, 2002 RNAL-EC Rev. JAN 01 2000 Important: Read the instructions on pages 1 -7. SECTION A - PROPERTY OWNER INFORMATION For Insurance company use: BUILDING OWNER'S NAME Policy Number BUILDING STREET ADDRESS (including Apt, Unit, State; and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number 1050 N. W. 155TH LANE Rrrr~.nTNr_ i CITY MIAMI TRACT 5 GOLDEN LAKES -AW-##.#;r or STATE NAD 1927 ❑ NAD 1983 Map Q otter. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NFIP COMMUNITY NAME & COMMUNITY NUMBER 82. COUNTY NAME B3. STATE UNINCORPORATED 120635 MIAMI-DADE FL B4. MAP AND PANEL NUMBER 12025C 0090 B5. SUFFIX 86. FIRM INDEX DATE 7-17-95 B7. FIRM PANEL "e~j LOOD EFFECTIVEIREVISED DTE Zt9NE(S) 3-2-94 T%=7 LOOD ELEVA TION(S) use depth of flooding) ..810. Indicate the source of the Base Flood Elevation (BFE) data or base florN2A% B9. ❑ FIS Profile ® FIRM ❑ Community Determined -be): 811. indicate the elevation datum used for the BFE in B9: ® NGVO 192 988 ❑ O ther (Describe): B12. Is the building located in a Coasta( Barrier Resources System (CBRS erwise Protected Area (OPA)? ❑ Yes Q No Designation Date SECTION C - BUILDING ELEV&TION INFORMATION (SURVEY REQUIRED) C1, Building elevations are based on: E3 Construction Dr. *A new Elevation Certificate will be required when coi C2, Building Diagram Number I (Select the building pages B and 7. If no diagram accurately represents t C3, Elevations-Zones Al-A30, AE, AH, A (with BFE), V1 Complete Items C3a4 below according to the bud * I datum used for the BFE in Section 8, conv%t the:&ti tgs' Building Udder Construction* ® Finished Construction uction O ufld.; is complete. A9_V309PX1S!Wwdh similar to the building for which this certificate is being completed - sai vide a sketch or photograph.) BFE , AR, ARIA, ARIAE, ARIA1 A30, ARIAH, ARIAO t specified In Item c2. State the datum used. if the datum is different from th t i that used for the BFE Show field measurements and datum conversion calculation. Use the space provided or fl~e Co m t a}ea of Section D or Section G, as appropriate, to document the datum conversion. Datum NGVD Conversion/Comments COUNTY BENCH MARK SYSTEM JS a) Top of bottom floor (indudin- basem closure) 7 B 9 ft(~ * 0 e) Lowest elevation of machinery and/or equipment servicing the building 7 50 R(m) w G[ I) Lowest adjacent grade (LAG) * e) SEE COMMENTS 6 9 Moo m 4 a M g) Highest adjacent grade (HAG) 7 1 R(t Q h)Total area of all permanent openings (flood vents) in C3h sq. in. (sq. cm) m~ ❑ i) No. of permanent openings (flood vents) within 1 it, above adjacent grade IN j) Highest crown of road (Mia-Dade) 6 58 tt(rn) No #2756 APRIL 19, 2000 ROBERT 'C. MUI M if 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 information in Sections A, B, and C an this cerfficate represents my best efforts to interpret the data available. CERnFIER5 NAME ROBERT C. MULDER, P.L.S. uceN2275N65mritx ASSISTANT VICE PRESIDENT Elevation reference mark used NN A Do eva on reference mark used appear on the FIRM? ❑ Yes .$f b) Top of next higher floor 16 36 g,~ m D c) Bottom of lowest horizontal smber (V zones only) N A R(m) D d) Attached garage (top of slab) Door (Mia-Dade j N A ft.(m) o 0 y IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: BUILDING STREETADORESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number CITY - STATE ZIP CODE Company NAIC Number SECTION D -SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for fl)'community official; (2) insurance agent/company, and (3) building owner. COMMENTS REFER ORDER NO. 181476 * e) A/C Slab U 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. 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 _ tL(m) ._i . ) above or ❑ below (check one) the highest adjacent grade. E3. For Building Diagrams " with openings (see page 7), the next higher floor or elevated on b) of th e building is _ fL(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 flo ell accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local o at certifv this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S EtTIVE) CERTIFICATION. The property owner or owner's authorized representative who completes lions A, and E for Zone A (without a FEMA-issued or cpmmunity4ssued BEE) or Zone AO must sign here. attachments G 4COMUNITY INFORMATION the local official who is authorized by law or ordinances aat~nister the communitys floodpWn management ordinance can complete 3ecfions A, B, C (or E), and G of this Elevation< Ica =,-;.Complete the applicable item(s) and sign below. 31. ❑ The information in Section C was taken rtier documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authob tate or local law to certify elevation information. (indicate the source and date of the elevation data in the Comments atlo 5 32. 0 A otmmuntyoffciz( completed SectionE.for a building located in Zone A (without a FEMA4ssued or community-issued BFE) or Zone AP. ' 33: C The following information (items G4-G9) is provided for community floodplain management purposes. 37: Thls permit has be6n issued for: ❑ New Construction ❑ Substantial Improvement 38. Elevation of as-buijt lowest floor anduding basement) of the building is: ft (m). Datum: 39. BFE or (in zone AO) depth of flooding at the building site is: Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE ❑ Check here if attachments ~r =EMA Fam 81-31, AUG 93 SEE REVERSE SIDE FOR CONTINUATION REPLACES AUVREVICUS EDMONS