HomeMy WebLinkAbout34-2115-004-2000FEDERAL EMERGENCY
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.MANAGEMEMAGENCY l~I i~ ;
A .LJO NATIONAL FLOOD 1NSURANC~ 'Rb f M t OMB Flo` 3C) 7-ppj~ ,
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SECTION 1.
A -PROPERTY OWNER INFORMATION For In~,rarloe
s c
B pryUZ
1
Pohcy Number
.I ,
9i l
B S(
dg. No.) OR P O. R l1TE AND BOX NO_ Com( Jny NAIC Number
it
lull"
' Fh
P S Numb
Pa be Description, etc.)
IL Ill
1 1 e'
rest enbal, etc. use a
u 1
1110n. Ac(, 1 I I Comments area, if necessary.)
~ 1 II 11 P.
REIbNT11L
LATITUO I`9 R en a on-
,~ONGITUD
E (OPTIONAL) HORIZONTAL DATUM
I SOURCE. El GPS (type)
El NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map 1 Other.
SECTION B -FLOOD INS
URANCE RATE MAO (FIRM) INFORMATION
Y 1 i11 s II q
BZ COUNN NAME 83. STATE
MM -0ADE I11
FLORIDA
B4. MAP .
AND PANT=L B7. FiRM PANEL B9
BASS
FLOOD 8F1/A7>aV(S)
B5. SUFFIX B6. FIRM INS DATE EFFECTNEIREIIM DATE B38. FL ZONE(S) d bin)
7117195 3M
M. to the source of the"Base Flood levation (BFE) data or base flood depth entered in B9.
I I5-
a FIS Profile p 1 FIRM ~
B11. OUTer (Desaibe
ndcate the elevation d~ Detean(ned
I1 alum used forlhe B E in B9: ®NGVD 1929 ❑ NAVD 19% El 01her{pescnbe):
812Is the located i n Coastal B .
aiding 1 System
~esourt~s . CBRS areaorOther~se.Prntecte~
Area()
f 1,~9 arrier ( )
OPA ? ❑ Yes O 'No atlon bate
C1 0u7dn 'elevations are ba"'ed on: El C BUILDING ELEVATION INFORM%`T(ON (SURVEY REQUIRED)
9 El Drawings El BUIft Under Consbucdon FGlished
"Anew bevation -Certificate YA be requlmdlwhen constr don of the buiding is complete.
C2 Bdldng biagram Number 1(Select the buildng diagram most similar to the building forMa This certificae is being completed -seepages 6 and 7 If no dagrarn
1e € -
aocu►atdY rePrese -b d building, pro~unde a sketch orOnlograph.)
I I IU g ! Ili l I ,a~F;
C3. Elevations - Zoriel~ A1-,A3o, AE, AH, A (with BM, VE, V1430, V (with BM, AR, ARIA, ARIAS, ARIA1~A30, AR/AH, AR/AO
Ca
19~~g1 i ~ 111.1',1 911 I li9€ I ete items c3 l below aooodng b .-6 building dagram sped6ed in Item C2 State the datum used If the datum is different Dom the datum used for the BFEin
i 1:1 91
Sec or~ , Cornrerti the ~3 m to that used for the BFE. Shaw field measurements and datum convasion cakxlabon. Use the space provided or the Comments area of
1 ~~I 6
i .
W I'
Section
or Section G a appropriate, to document the datum conversion
Dattxnal46VDI11lill imsion/Corr~rnents
6~
0 11 rlefelaxe mark
used Does*hB elevation reference mark used on ift
FIRM?
Oil a)op of bottlom floorencloser ❑ Yes ®No
j
~ n9 basemento re) e~i
b) opof 115-i" j h I. (m)
oor -
► c) Bottom of illrwed hormontai struduralmerrb%(Vzones only, m) r "
Mad
a*ttopdslab)
1. n m) ° G>► e)"est elevationof madi1nery x dlor equipment - § Y 4
J 11 I I I I EI I ~ y 9 ~ I, ~a ~ ~
SefViCNlg flTe bU~ding (Describe h8 Cffmr ent3 am
r ql II a d, i, ti 'i ft m P
'i
est
i j 'na 'i .1
add N s
► h) Nb. of 1 pe'lri~aner~ i1ope1 471
nings (floo~''~I € I I vhttin' 1 ti. atiov~e adacent fade o - NO 5101
-I. 1 f1-1I 1, ..I. I~I1 11 ~~III .,'ai le€ 1 - R €
► i) olal aria of al topernrigs ~ffood vents) in C3h 0 sq, in. (sq.
P. 11 1 1; cm) III € ~1 1~ I ~ I I1 a 1~I I I~ I h
III y li~ 14.1 , i+r~n'' Ri 114, 1 1
..i --I € D-SURVEY
N
ENGIN~EP., OR ARCS~A dN I~! 1 91 €I
i -1 a'
This cerUt~cabon >s lobe signed and sealed a land surveyor, engineer. or architect authorizeo~ .l I,Ilawl,tol 111,
• i
ail II p JI , Ille€ i~u I• II IIII,IIIII II"II''IEipF ..,1 X 11 IoI,~~tion~
a
t certrry that the 'm~ormahor finectrons A, on this certificate rePresents m best efforts o Nnt e e
~a'Ia 11 I Y p et~'E~r , e.
5- r dal 1a6~
l understand that an false statement rnay Punishable fine or imprisonment under 18 U. S. Code, Section 1001.
CERf1-R S NAME MIGUEL ESP OSA LICENSE MINER 5101
TfrLF PROFS ZONAL $URVE R ER COMPANY NAIvE MIGUEL ESPINOSA IAND SURVEYING, INC.
91 II
S.W. EC CITY MIAMI STATE FL ZIP CODE 33155
DATE TELEPHONE 305-740-3319
1 IV
FEMA Foriii"81-31, J'a`' uary ~b03
III u,U~U apa uto coQyMme cerresponcling into crn?anon from Section A. _ Forhgxance compecos
sv,C v,~t ryY, -
n P.O RWM AND BOX NO. y Numbe
j Y.
ZJP CWE NAIC Number
SEC• ION D - SURVEYOR,-ENGINEER;:OR Ai2CHfTECT CER FICATIQN (CONTtNUEb) '
~
Copy both sides of this Oevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner:
r A i }
COMMENTS ..k ' y
. w
Che*:here.if atladiments
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 Ihrough E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F,
Section c must be completed.
E1. Bulling Diagram Number _(Select the building dagrarn most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately
Wesents the bukiirig, provide a sketch or photograph.)
E2. The top of the bottom floor (Including basement or er)dosure) of ft bolding is - ft.(m) in.(crn) ❑ above or ❑ below (check one) ttie highs adlatanl grade (Usk
natural grade, if available). ry fi r T a
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 adlaoent Y
grade. •'Complete ltz C3:I► Arid C3.1 on front of form a E4. The top of the platform'.d machinery
andlor equipment servicing the bulcbng is _ ft (m) _in.(cm) ❑ above or El below (dnedc one) the highest adjacent glade: (Use °
natural grad, if"L*e
E5. For Zone AO only: If no flood depth number is avalable, is the.topof the bottom floor elevated in acoordancewith the oarmunltys floodplafn management adnarnce?
❑ Yes ❑ No ❑ Unknown. The local otfic~al mustoertify tlls information in Sedion G.
arid ~
` EforZoneA (without a FEMP►4ssued oroorrrnudt
The property avvr>eror owners authorized ~~who~ s Eere •(coned the bestof~ IrnowJand
issued BFE~ or Zone AO must sign here. Q mY . ~9~
RS OR OWNERS AUTHORIZED REPRESENTATNES NAME
PROPERTY OWNE
ADDRESS CITY STATE ZIP CODE
S1GNAA NRE _ DATE TBPHQNE
COMMENTS
I
r
4, 'A
❑ Check here tf attachmmertts
M- SECTION G COMM N" INFORMATION (OPTIO
~ `.sit i~it I' i il,,,,_
Ili ~I administer the oorrrnuru s Rood ; ~t ord eta SecffOris B C or and . G , of , this &vadm
ino is auhorized by leer or ordnance ty' ~ ~la~lr~ n agemo hanice can oompf A, (
Tt;oicca! u~iaai 'V01),
k' :l
Cam. Carnpletie Ire applicable items) and sign below.
a.
G1. ❑ The information in Section C was taken km other documentation that has been signed and embossed by a licensed surveyor, engineer, orarchileetwho fs auhoized by state
orlod lawtocertq e(Wafi*i (Indicate the source and date of the e,6 n data in the Corruments area below.)
G2. ❑ A oo ninny od daifodmple#e Section Elora buiding located in ZoneA ( a orcomrrn,r y red BFE) orZaneAO.
.QM
M. ❑ Theo6aiuNx,)iror►'(Items C4-G9} is provided for comrrnunrty floodplainnageent purposes.
G4. PERW tJl MBM
G5. DATE PEW ISSUED
G6. DATE
G7. This Mn it has been issued for ❑ New Coro-don ❑ Substartfiai Improvement
G8. flevar" of as-bult lowest floor (hAxIiing basesr>ent) of the burldng is: ft (rn) Daturrr -
G9. 3FE or (n Zone AO) depth d floc dng at the building site is: . - tt(m) , Datunx
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS #
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