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Home My WebLink About34-2115-006-1550ppDCESS g;DERAL EMERGENCY MANAGEMENT AGENCY ~ O.M.B. No. 3067-0077 P( Llo ~ NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005 C.O.P- ELEVATION CERTIFICATE 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 ADDR SS (Includin ApL, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number CITY STATE ZIP CODE PROPERTY DESCRIPT (Lot and Block Numberax Parcel Number,_L al Description,ryetc.) BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.) RESIDENTIAL LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (Type): ( W - #W - f14.W' or ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NFIP COMMUNITY NAME 8 COMMUNITY NUMBER B2. COUNTY NAME B3. STATE MIAMI -DADE FLORIDA B4. MAP AND PANEL B7. FIRM PANEL B9. BASE FLOOD ELEVATION(S) NUMBER B5. SUFFIX B6. FIRM INDEX DATE EFFECTIVE/REVISED DATE B8. FLOOD ZONE(S) (Zone AO, llse depth of flooding) 2O'LCDCou\0 J 7117/95 3/2/94 ^ 1310. Indicate the source of the base Flood Elevation p-t) data or base flood depth entered in 139. ❑ AS Profile ® FIRM ❑ Community Determined ❑ Other (Describe): 1311. Indicate the elevation datum used for the BFE in B9: M 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 M No Designation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' M Finished Construction '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, VI 430, V (with BFE), AR, AR/A, AR/AE, AR/A1 A30, AR/AH, AR/AO Complete Items C3.-a4 below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for e 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 Comm area of Section D or Section G, as appropriate, to document the datum conversion. ents Datum NGVD 1929 Conve Elevation' reference mark us the elevation reference mark used appear on the FIRM? ❑ Yes ® No :Noes a) Top of bottom floor (including basement or enclosure) Cl M ft.(m) 110- b) Top of next higher floor (m) W c) Bottom of lowest horizontal structural member (V zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery and/or equipment c w D S servicing the building (Describe in a Comments area) 1(t(m) :3 C f d LAG) ~~t L t d i d t fi h ' ) e ( owes ) gra a jacen s e ( n (m) Z.2) F ST F ODA ► g) Highest adjacent (finished) grade (HAG) Wft.(m) i I~ i. 1vI Nb Ii , 3 51 O 1 . S. 0- h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 0~ ~ ! ! '1 „ i) Total area of all permanent openings (flood vents) in C3.h 0 s' q. in. (sq. cm) ~G SECTION D - SURVEYOR, ENGINEER OR ARCHITECT CERTIFICATION I; Pr l'IIII II I This certification is lobe signed and sealed by a land surveyor, engineer r architect authorized bylaw to certify elevation informaEio1n'. 1 certify that the information in Sections A, B, and C on this certificate epresents my best efforts to interpret the data available. I understand that an false atement may be punishable b fine i risonment under 18 U.S. Code, Section 1001. CERTIFIERS NAME MIG L ESPINOSA LICENSE NUMBER 5101 TITLE PROFESSIO SURVEYOR4 MAPPER COMPANY NAME MIGUEL ESPINOSA LAND SURVEYING, INC- ADDRESz/ 94 - A STREET - CITY MIAMI / STATE FL Zip CODE 33155 SIGIVqIV 1vv111LIbf / / ZI111 + DATE J1`- / -ZC) / C) C; TELEPHONE 305-740-3319 FFnna c,,,,, a1_zi iont.nrt, -)nm I L I It lltC~CJ~dI C5, copyine corresponding information from Section A. $ HFor)nsuranGeCompanyUse: BUILDING STREET ADDRESS (including Apt, Unit, Suite, andlor Bldg. No.) OR P.O. ROUTE AND BOX NO. Polity Number . % 3 CRY ' 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 L ,s s ry_ ❑ Check here if attachments SECTION E - BUILDING ELEVATION INFORMA T ION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items El through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. El .8uilding 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. (Use natural grade, if available). E3. For Building Diagrams 6-8 with openings (seepage 7), the next higher floor or elevated floor (elevation b) of the building is _ ft.(m) ^in.(cm) above the highest adjacent grade. Complete items C3.h and C3.i on front of form. E4. The top of the platform of machinery and/or equipment servicing the building is ft.(m) ^in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, if available). E5. 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 ordnance? ❑ 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, C (Items. C3.h and C3.i only), and E for Zone A (without a FEMA-issued or community- issued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and E are correct to the best of my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS ' CITY STATE ZJP CODE SIGNATURE DATE TELEPHONE COMMENTS ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorizeed 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 infOrrri'a-0or' 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 oicial completed Section E for a building located in Zone A (without a FEMA4ssued or community4ssued BFE) or Zone A0. G3. ❑ The following information (Items G4-G9) is provided for community floodoain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIMCE/OCCUPANCY ISSUED G7. This pemnit 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 COMMENT C