The URL can be used to link to this page

Home My WebLink About34-2117-004-0340PROCESS # L~Mpv FOLIO # ~fl' Y~ d C.O.R. 7.57' G FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE rtant: Read the instructions on pages 1 - 7. O.M.B. No. 3067-0077 Expires July 31, 2002 06 -i~13 Lo SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number BUILDING STREET ADDRESS Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number 15921 NW 42 Ave. CITY STATE ZIP CODE Miami Florida PROPERTY DESCRIPTION ;L^t and Block Numbers, Tax Parcel Number, Legal Description, etc.) N 80' of S 200 ' less E 100' of TR 4 and less S 5' for R/W BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.) Residential LATITUDEILONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: L-I GPS'(Type): ( - - or L_I NAD 1927 L_I NAD 1983 1I USGS Quad Map I Other: SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3. STATE Unincorporated Area 120635 Miami-Dade County FL B4. MAP AND PANEL Bb. SUFFIX B6. FIRM INDEX B7. FIRM PANEL B8. FLOOD 69. BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of flooding) 12025C 0080 J July 17,1995 March 4, 1994 X B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9. J_J FIS Profile IX I FIRM 1_1 Community Determined 1_( Other (Describe): B11. Indicate the elevation datum used for the BFE in 139: Jg J NGVD 1929 J_J NAVD 1988 J_J Other (Describe): B12. Is the building located in a Coastal-Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? I_J Yes U No Designation Date: SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: J_JConstruction Drawings* L_JBuilding Under Construction* J_~TFinished 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, V1430, V (with BFE), AR, ARIA, AR/AE, AR/Al-A30, AR/AH, AR/AO Complete Items C3a-i 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 NGVD 1929 Conversion/Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? LJ Yes PIJ No Q a) Top of bottom floor (including basement or enclosure) 8 .4 ft.(m) CD b To of next hi her floor N/A ft. m • c) Bottom of lowest horizontal structural member (V Zones only) N/A ft.(m) 0 o d) Attached garage (top of slab) N/A ft.(m) -0 E c °aO e) Lowest elevation of machinery and/or equipment m servicing the building (A/C Pad ) 8 0 ft-(M) - C] f) Lowest adjacent grade (LAG) 7 4 ft,(m) z' O g) Highest adjacent grade (HAG) 7 9 ft.(m) O h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade None n , O i) Total area of all permanent openings (flood vents) in C3h N/A sq. in. (sq. cm) S 04 /dl~ SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION °i h 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 on this certificate represents my best efforts to interpret the da~aavailatile:* t understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. CERTIFIER'S NAME LICENSE NUMBER Jose F. Lopez 3086 Tl~and Surveyor & Mapper JCOPA~Jx~j~E~ ASSOCIATES, INC. a,~i ki ADDRESS CITY Lures STATE ZIP CODE„ 101 555 E. 25th Stree Suite 212 Hialeah FL „?II ILI~I I(iii~ I~lil III SIGNATURE DATE TELEPHONE April 4, 2001 (30~ 83-1822 il?~_ FEMA r 81-31, AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL,PR'EVfOUS Ftblti8wq IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number 15921 NW 42 Ave. rw CITY STATE ZIP CODE Company NAIC Number Miami Florida SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUEb) Copy both sides of this Elevation Certificate for (1) community official. (2) insurance agent/company, and (3) building owner. CCMMENTS Highest crvwn of road elevation fronting property 7.57 Fr N O 11- n 1_1 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 (withcut BFE), complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMB-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 (ncluding basement or enclosure) of the building is I-1_1 ft.(m)'_L-Jin.(cm) (_,J above or u below (check one) the highest adjacent grade. 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) LL___(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 floor elevated in accordance with the community's floodplain management ordinance? 1_1 Yes L_J No (_I 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, and E for Zone A (without a FEMA-issued or community-issued BFE) or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS J_J Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized 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. L_! The information in Secticn C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, br 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.) 11 G2. L_ JA community officio! c rr.cleted Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or Zone AO. Y G3.~ J The foiloc .ng infcm aticn[-(Items G4-G9) is provided for community floodplain management purposes. G4: PERMIT NUMBER i G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED 07.-This pe`it has been issuC-d for, U New Construction U Substantial Improvement 68 evation of as- built lowest floor (including basement) of the building is: ft.(m) Datum: G9. B ,"Oor (in Zone AO depth of t~•ooding at the building site is: ft.(m) Datum: 't'. LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE , l SIGNATURE A