Loading...
HomeMy WebLinkAboutElevation Certificatef � 1. DEPARTMENT OF HOMELAND SECURITY JERAL EMERGENCY MANAGEMENT AGENCY i- National Flood Insurance Program ELEVATION CERTIFICATE OMB Control Number. 1660-0008 IMPORTANT: FOLLOW THE INSTRUCTIONS ON PAGE5 8-15 Expiration: 11/30/2018 Copy all pages of this Elevation Certificate and all attachments for (1) community official_ (21 insuranca annnrren-nu -I I'll ti..uar.,....,., . SECTION A - PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Policy Number: RUSKOSKY A2. Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number: Box No. 5230 LOGGERHEAD PLACE City FT. PIERCE State FL Zip Code 34949 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 381 OF THE "OCEAN RESORTS CO-OP" DEVELOPMENT, IN PART OF SECTION 10 & 11, T34S, R40E, ST. LUCIE CO., FL. A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) A5. Latitude/Longitude: Lat. 27°31'45.6" N Long. 80°l8'58.6" W Horizontal Datum: O 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 8 AS. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosurea) Square footage of attached garages) 1022.07 sq f# N/'°` sq ft b) Number of permanent flood openings in the b) Number of permanent flood openings crawlspace or enclosure(s) within 1.0 foot in the attached garage within 1.0 foot above adjacent grade 5 above adjacent grade 0. c) Total net area of flood openings in A8.b 291.6 sq in c) Total net area of flood openings in A9.b 0 sq in d) Engineered flood openings? 0 Yes # No d) Engineered flood openings? 0 Yes (0 No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number 132. County Name B3. State ST. LUCIE COUNTY 1120285 ST. LUCIE FL B4. Map/Panel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel Effective/ B8. Flood Zone(s) B9. Base Flood Elevation(s) Revised Date (Zone AO, use base flood depth) 12111C0089J/0089 J 2/16/12 2/16/12 AE 4.0 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: 0 FIS Profile ® FIRM 0 Community Determined 0 Other/Source: B11. Indicate elevation datum used for BFE in Item 139: 0 NGVD 1929 # NAVD 1988 0 Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 0 Yes (W No Designation Date: 0 CBRS 0 OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: 0 Construction Drawings* 0 Building Under Construction' Q 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, V1430, 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 Rico only, enter meters. Benchmark Utilized: SEE COMMENTS DEP A-35 MONUMENT Vertical Datum: NAVD 1988 Indicate elevation datum used for the elevations in items a) through h) below. 0 NGVD 1929 ® NAVD 1988 0 Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 4 09 ® feet 0 meters b) Top of the next higher floor 7 85 0 feet 0 meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A 0 feet 0 meters d) Attached garage (top of slab) N/A 0 feet 0 meters e) Lowest elevation of machinery or equipment servicing the building 6 17 o feet 0 meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 3 2 feet 0 meters g) Highest adjacent (finished) grade next to building (HAG) 3 g feet 0 meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 7 68 (0 feet 0 meters rcroiA Form ursb-u-ss (/no) Replaces all previous editions. Page 1 of'o, ELEVATION CERTIFICATE, page 2 OMB Control Number. 1660-0008 Expiration: 11 /30/2018 IMPORTANT: In these spaces, copy the corresponding information from Section A.JNo. FINSURANCE COMPANY USE Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and BoPolicy Number.5230 LOGGERHEAD PLACE FT. PIERCE State FL Zip Code 3494 Company MAIC Number.City ; - SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to gp, _ elevation information. I certify that the information on this Certificate represents my best efforts to interpret the data available. I unders(candraf;any false statement may be punishable byline or imprisonment under 18 U.S. Code, Section 1001. � Were latitude and longitude in Section A jV , 7 "cI fir f �,, ❑ Check here if attachments. provided by a licensed land surveyor? ® Yes O No la„ Certifier's Name License Number FRANKS. CUCCURESE, PSM 4765 a t` o Title Company Namev. PSM CARTER ASSOCIATES, INC. Address City State 1708 21ST STREET VERO BEACH FL 32964•. Signature Date Telephone 2/23/2017 772-562-4191 `r ,F; 1J. Copy all pages of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) CAI JOB No. 14-425S, DWG No. 19738-A, FIELD BOOK 839; PAGE 18; 845wp/20 ELEVATION SHOWN IN C2 a) IS TOP OF FINISH FLOOR. C2e = TOP OF AC UTILITY SLAB. ORIGIN BM = TOPOF DEP MONUMENT "A-35 EL. 10.85 navd'88. SITE TEMPORARY BENCHMARK No. 102 NAIL/TAB AT NORTHWEST PROPERTY CORNER OF SUBJECT PROPERTY ELEVATION 2.84 FEET NAVD 1988. Signature Date 2/23/2017 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 E1-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. El. 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, O feet Q meters ❑ above or ❑ below the HAG. or enclosure) is b) Top of bottom floor (including basement, crawlspace, O feet Q meters ❑ above or ❑ below the LAG. or enclosure) is E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see page 8 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is O feet O meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is O feet O meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and /or equipment O feet O meters ❑ above or ❑ below the HAG. servicing the building is E5. 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? O Yes O No O 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 Signature Date Telephone Comments ❑ Check here if attachments. Page 2 of �j FEMA Form 086-0-33 (7115) Replaces all previous editions. ELEVATION CERTIFICATE, page 3 OMB Control Number. 1660-0008 Expiration: 11/30/2018 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. 5230 LOGGERHEAD PLACE FT. PIERCE City State FL Zip Code ' 34949 Company NAIC Number: SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's flocdplain 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 community -issued BFE) or Zone AO. G3. The following information (Items G4-G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued -70&14 G7. This permit has been issued for. 0 New Construction 0 Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: 0 feet 0 meters Datum G9. BFE or (in Zone AO) depth of flooding at the 0 feet 0 meters Datum building site: G10. Community's design flood elevation: 0 feet 0 meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments (Including type of equipment and location, per C2(e), if applicable) El Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Page 3 ov :b, _u J BUILDING PHOTOGRAPHS ELEVATION CERTIFICATE, page 4 See instructions for Item A6. OMB Control Numon:11/3ber 012018 Expiration: 11 /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. 5230 LOGGERHEAD PLACE City FT. PIERCE State FL Zip Code 34949 Company NAIC Number. If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item AS. Identify all photographs with date taken; "Front view" and Rear view'; and, if 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 Sectior AS. If submitting more photographs than will fit on this page, use the Continuation Page. Date of Photos: 9/21/16 TYP.VENT VIEW ACCESS VIEW EMA Form'086-0-33 (7/15) Replaces all previous editions. w i BUILDING PHOTOGRAPHS ELEVATION CERTIFICATE, page 4 See instructions for Item A6. OMB Control Number. 1 Expiration: /30/30/20/2018 8 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY US Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number. 5230 LOGGERHEAD PLACE City FT. PIERCE State FL Zip Code 34949 Company NAIC Number: 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 View." 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. Date of Photos: 9/21/16 FRONT VIEW REAR VIEW I FEMA Form 086-0-33 (7/15) Replaces all previous editions.