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HomeMy WebLinkAboutElevation CertificateU.S: DEPARTMENT OF HOMELANEdWRITY Federal Emergency Management AgGmr National Flood Insurance Program OMB No. 1660-0008 Expiration Date: November 30, 2018 r6.PHr1`W'/-©l(.r ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE A1. Building Owner's Name Policy Number. WINDSONG MOBILE VILLAGE A2. Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number. 3200 SOUTH 7TH. STREET City State ZIP Code FORT PIERCE Florida 34982 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 7, WINDSONG MOBILE VILLAGE A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) SINGLE FAMILY RESIDENTIAL A5. Latitude/Longitude: Let 27.406320 Long.-80.329390 Horizontal Datum: ❑ NAD 1927 ® NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood Insurance. A7. Building Diagram Number 5 A8. For a building with a crawlspace or e.nclosure(s): a) Square footage of crawispace or enclosurs(s) . 0 sq ft b) Number of permanent flood openings In the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b 0 sq In d) Engineered flood openings? ❑ Yes ® No A9. For a building with an attached garage: a) Square footage of attached garage 0 sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A9.b 0 sq In —0— d) Engineered flood openings? ❑ Yes ® No SECTION B—FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name B3. State ST. LUCIE COUNTY 120285 ST. LUCIE Florida B4. MaplPanel Number B5. Suffix 86. FIRM Index Date B7. FIRM Panel B8. Flood Zone(s) B9. Base Flood Elevation(s) Effective/ Revised Date (Zone AO, use Base Flood Depth) 12111CO187 J 02/16/2015 02/16/2012 "X" N/A B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 139: ❑ FIS Profile ❑ FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ®NAVD 1988 ❑ Other/Source: WA . B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No . Designation Date: o9/18/2019 ❑ CBRS 0 OPA ELEVATION CERTIFICATE MOMB No. 1660-0008 Expiration Date: November 30, 2018 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: 3200 SOUTH 7TH. STREET City State ZIP Code Company NAIC Number FORT PIERCE Florida 34982 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. Elevations — Zones Al A30, AE, AH, A (with BFE), VE, VIIV30, V (with BFE), AR, ARIA, AR/AE, AR/A1—A30, AR/AH, AR/AO. Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rice only, enter meters. Benchmark Utilized: CO aM Vertical Datum: NAVD 1988 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 ® NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. L Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 19. 7 ® feet ❑ meters b) Top of the next higher floor NIA, ❑ feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A. ❑ feet ❑ meters d) Attached garage (top of slab) NIA, ® feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building N/A. ® feet ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 16. 3 ® feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 16. 5 ® feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A. feat ❑ meters structural support SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification Is to be signed and seated by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by line orimprisonment under 18 U.S. Code, Section 1001. , Were latitude and longitude in Section A provided by a licensed land surveyor? ® Yes' ❑ No ❑ Check here if attachments. Certifier's Name License Number MARK W. TEEPE 4811 Title P.S.M. Company Name CORNERSTONE SURVEYING Address 325 SW SOUTH QUICK CIRCLE City State ZIP Code PORT ST. LUCIE Florida 34953 Signatur Date Telephone w 02/14/2020 7724182376 Copy all pages of this Elevation Ce ' sate and all attachments for (1) community official, (2) insurance agenticompany, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) _ A/C UNIT This residence has a proposed elevation 3.4' above crown of road CCRAA C...... nOM n OO l 14=% C..— o.._- ELEVATION CERTIFICATE f goOMB No.1660-0008 Expiration Date: November 30, 2018 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. 3200 SOUTH TTH. STREET City State ZIP Code Company NAIC Number FORT PIERCE Florida 34982 SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items El-E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B,and C. For Items E1-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or El below the HAG. b) Top of bottom floor (including basement, crawispace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 1-2 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is feet ❑ ❑ meters E] above or E] below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is E] feet ❑ meters [:]above or []below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the commun'dys 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 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. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner or Owner's Authorized Representative's Name Address City State ZIP Code Florida Signature Date Telephone Comments ❑ Check here if attachments. OGAAe C..r,n IIRRJ q9 17149% o....b....... ..0.......-'......-AW--- ,-_— n --- n _en ELEVATION CERTIFICATE MOMB No.1660-0008 Expiration Date: November 30, 2018 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: 3200 SOUTH 7TH. STREET City State ZIP Code Company NAIC Number FORT PIERCE Florida 34982 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. Check the measurement used in Items G8-G10. In Puerto Rico only, enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (indicate the source and date of the elevation data in the Comments area below.) G2 ❑ A community official completed Section E for a building located in Zone A (without a FEMA-issued or commun'dy4ssued BFE) or Zone AO. G3. ❑ The following information (Items 134-1310) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued G7. This permit has been issued for. ` ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: ❑ feet ❑ meters Datum G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum G10. Community's design flood elevation: ❑ feet ❑ meters Datum Local Official's Name Title Community Name Telephone t Signature Date Comments (Including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. ft BUILDING PHOTOGRAPHS So OMB No. 1660-0008 ELEVATION CERTIFICATE See Instructions for Item A6. Exniratlnn natty- Nnvomhar an gn1R 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. - 3200 SOUTH 7TH. STREET City State ZIP Code Company NAIC Number FORT PIERCE Florida 34982 If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side Memo When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. Photo o"e Photo One Caption 02/10/20 FRONT VIEW Pto Tx Photo Two Caption 02/10/20 FEMA Fond 08643-33 (7/15) Replaces all previous editions. Form Pane 5 of 6 BUILDING PHOTOGRAPHS OMB No. 1660-0008 ELEVATION CERTIFICATE a Continuation Page do Expiration Date: November 30, 2018 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. 3200 SOUTH 7TH. STREET City State ZIP Code Company NAIC Number FORT PIERCE T Florida 34982 1 If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and, W required, "Right Side View" and "Left Side. View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. f Photo One Photo One Caption Photo T" Photo Two Caption FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Paoe 6 of 6