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Home My WebLink About34-2117-004-1630FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PR~O~WM O.M.B. No. 3067-0077 60003 j C 7,~ 16) ELEVATION CERTIFICATE Expires December 31, 2005 Important: Read the instructions on pIi6s 1 - 7. ORMATION For Insurance Company Use: 4567 SECTION A -PROPERTY OWNER IN BUILDING OWNER'S NAME Policy Number Evenor Ponce; Josefa Ponce BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number 3955 N.W. 165 St. CITY STATE ZIP CODE Miami FL 33054 PROPERTY DESCRIPTION Lot and Block Numbers, Tax Parcel Number, Legal Description, etC.) L 17- BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a omment ,area, r necessary.) Residential !i'1 LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (Type): ( - ##I- or ® NAD 1927 ❑ NAD 1983 ® USGS Quad Map ❑ Other: H SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME ;I B3. STATE Unincorporated 120635 Miami-Dade Florida B4. MAP AND PANEL BT FIRM PANEL B9. BASE FLOOD ELEVATION(S) NUMBER B5. SUFFIX B6. FIRM INDEX DATE EFFECTIVE/REVISED DATE B8. FLOOD ZONE(S) (Zone A0, use depth of flooding) 12025C 0080 J 7/17/1995 31211994 ` ' X N/A t U. indicate the source of the base r-iooa tievation (tsrt) data or base tlooa depth entered ►n By. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe): B11. Indicate the elevation datum used for the BFE' in 69: ® NGVD 1929 ❑ ll 1988 ❑ Other (Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (dPA)? ❑ Yes ® No Designation Date n/a SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: Construction Drawings* ❑ Building Under Construction* ® 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, V1 430, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO Complete Items C3.-a-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 1929 Conversion/Comments n/a eva ion re erence mar use oes e elevation re erence ma used appear on the es No o a) Top of bottom floor (including basement or enclosure) 9.65ft.(a) o b) Top of next higher floor N.A_ft o c) Bottom of lowest horizontal structural member (V zones only) N.Aft.(m) a) a) r 00 o d) Attached garage (top of slab) N,Aft. m n -0 o e) Lowest elevation of machinery and/or equipment servicin the buildin (Describe in a Comments area) 9 49ft W ED a) ;yY w E g g . .(0) w,, CID f) Lowest adjacent (finished) grade (LAG) &Llt(o) o o g) Highest adjacent (finished) grade (HAG) o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade NA o i) Total area of all permanent openings (flood vents) in C3.h NA sq. in. (sq, cm) SECTION D - SURVEYOR, ENGINEER, OR ARCH i li EC'T CERTIFICqTi01 t This certification is to be signed and sealed by a land surveyor, engineer, or architect authoriz ed by law to certify elevation info mati6 n I certify that the information in Sections A, B, and C on this certificate represents my best effo si ~l to-interpret the data 1 vailabe -uvi iu v.v. vuuu, vuuuv vv I. g' CERTIFIER 'S NAME: OctalYs C. Bello-Iznaga LICENSE NUMBER # 6169 TITLE: Professional Surveyor and Mapper COMPANY NAME ADDRESS _ CITY STATE 12230 S.W.131S'Avenue, Suite 2011 Miami Florida SIGNATURE / l / ) \ ) DATE i TELE=PHONE FEMA Form 81-31, January 2003 See reverse side for coitinua'tion. 11: : Replaces All previous editions III I lij 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 ` 3955 N.W. 165 St. CITY STATE ZIP CODE Company NAIC Number Miami FL 33054 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 Crown of Road Elevation: 7.89' ❑ 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 _ 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 ordinance? ❑ 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 owners authorized representative who completes Sections A, B, C (Items CD 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 Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The Focal official who i~ authorized by taw o 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'applicahle item(s) and sign below. G,.: ❑ The information in Section C :vas taken-from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by t w cert+ elevation rnformat~on -(Indicate the source and date of the elevation data in the Comments area below.) state cr loca"N t 1 rY x . G2. ❑ A community officiyal completed Section E for a building located in Zone A (without a FEMA-issued or community4ssued BFE) or Zone AO. I VN. We i°jMr MY gy~:.m. G3. ❑ The foliov~ng information (Items O4 v9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED ,u I i New Construction ❑ Substantial Improvement G8.'Elevation of as b It lowest floor inclu ng basement of the buildin is: ft. m Datum: _ ,ilI.I . 31 G9." BFE 1 or (in Zone AO) depth of flooding at the building site is: ft.(m) Datum: LOCAL OFFICIAL'S NAME TITLE