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Home My WebLink About34-2116-004-0010FEDERAL EMERGENCY MANAGEMENT AGENCY PROCES # , NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077 3A- ~1 IDi o04 -OD10 Expires December 31; 2005 FOLIO # a _ ELEVATION CERTIFICATE CROWN & ROAD 9.67 Ft NGVD Important: Read the instructions on pages 1- 7. ORDER NO. 8=8234 SECTION A - PROPERTY OWNER INFORMATION Fpr iizsuran'l Company Use: BUILDING OWNER'S NAME Policy Number DARREL MAZYCK BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR.P.O. ROUTE AND BOX NO. Company NAIL Number 16610 NW 27th Avenue CITY - STATE.. ZIP CODE 33054 FL MIAMI PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Descnption,etc.) . BUILDING USE (e:g., Residentjal, Non-residentiat,.Addition, Accessory, etc. Use a Comments area, if necessary.).. C'(WMERCIAL SHOPPING 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. NAP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3. STATE TININMEEDRATM 120635 MIAMI DADE FLORIDA B4. MAP AND PANEL B7. FIRM PANEL B9. BASE FLOOD ELEVATION(S) NUMBER 135. SUFFIX B6. FIRM INDEX DATE EFFECTIVEiREVISED DATE B8. FLOOD ZONE(S). (Zone AO, use depth of flooding) 1202-S C 0080 J 71795 3294 X N/A 610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. ❑ FIS Profile )M FIRM ❑ Community Determined ❑ Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: IMNGVD 1929 ❑ NAVD 1988 ❑ Other (Describe): B12 Is the building located in a Coastal Barrier Resources stem CBRS) area or Otherwise Protected Area OPA ? Yes >0No Desi nation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawinge ❑ Building Under Construction* )9 Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number_lSelect 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, ARIA, AR/AE, AR/A1-A30, AR/AH, ARIAO Complete Items C3.-a- 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 NGVDConversion/Comments Elevation reference mark used N484)oes the elevation reference mark used appear on the FIRM? ❑ Yes Flo ❑ a) Top of bottom floor (including basement or enclosure) 11 .8,3 ft(m) ❑ b) Top of next higher floor N/A. rft.(m) a~i a~ r ^ 1' N7A ❑ c) Bottom of lowest horizontal structural member (V zones only), -T 70 ❑ d) Attached garage (top of slab) N -0 ~ft.(mj W I" ❑ e) Lowest elevation of machinery and/or equipment servicing the building (Describe in a Comments area) N/A. ~ft.(m) - ❑ f) Lowest adjacent (finished) grade (LAG) 11.2. rft.(m) z T- 11 ❑ g) Highest adjacent (finished)i grade (HAG) ❑ h No, of permanent o ni N~A °I • pe ngs (flood vents) within 1 ft. above adjacent grade / El i) Total area of all permanent openings (flood vents) in G3.h N Asq. in. (sq. cm) - SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATIOi ' II lI 'I ill ! gel ii This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation rnfari'nation. It Ili I certify that the information in Sections A, 8, and C on this certificate represents my best efforts to interpret the data ava)ale ' I~ 1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S., Code, Section 1001 ;ll CERTIFIER'S NAME LICE MBER NARCISO J. RAMIREZ , .I! I ~I II TITLE COMPANY N M~E LAND SURVEYOR & MAPPER ATLANTIC ~~ERVICES OF FLORIDA ADDRESS 1T41 SUNSET DR- URE CITY MIAMI DATE MAY 12, 2004 SFL. ZiE CODE TELEPHONE (305) 596-0888 ~s IS "II EMA Form 81-31, January 2003 See reverse side for continuation. Replaces all previous' editions'! I .IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company-Use.- BUILDING STREET ADDRESS (Induding Apt, Unik Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX-NO. Pofc}-Number " CITY STATE Zip CODE Company NAIL 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 Q 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.) EZ The top of the bottom. floor (including basement or enclosure) of the building is ft.(m) Min.(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 frorit of forrrt 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 ordinance? ❑ Yes ❑ No Q Unknown. The 190.,offrclal 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, Q and E are correct to'the best of my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE- ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS 0C heck here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized bylaw ortordmarice 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 lccal law to certiry elevation mforrmation. (indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A~cemmunity offidai completed Section E for a building located in Zone A (without a.FEMA4ssued or communiiy4ssued'BFE) or Zone A0. G3. The following information (items G4G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCEJOCCUPANCY ISSUED G7. This permit has been issued for. EJ New Construction ❑ Substantial Improvement G8. Elevation of as-built lowest floor (including basement) of the building is: _J(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 =EMA Form 81-31, January 2003