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Home My WebLink AboutElevation CertificateJOB # 20-240 U.S. DEPARTMENT OF HOMELAND �c61_IRITY OMB No. 1660-0008 Federal Emergency Management Agency Expiration Date: November 30, 2022 National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. CODV 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 Al. Building Owner's Name Policy Number: ASULINA SHLOMI A2, Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number: Box No. 3105 S. 23RD STREET City State ZIP Code FORT PIERCE Florida 34982 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 3, BLOCK 2, EDGEWOOD ACRES, AS DESCRIBED AND DEEDED BY METES AND BOUNDS IN DB 182, PG 251 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27.4103 Long.-80.3483 Horizontal Datum: ❑ NAD 1927 ❑x 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 1A A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) N/A sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b N/A sq in d) Engineered flood openings? ❑ Yes No A9. For a building with an attached garage: a) Square footage of attached garage N/A sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A9.b " N/A sq in d) Engineered flood openings? ❑ Yes ❑x 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. Map/Panel B5. Suffix B6. FIRM Index Date B7. FIRM Panel Effective/ B8. Flood Zone(s) B9. Base Flood Elevation(s) (Zone AO, use Base Flood Depth) Number Revised Date 12111C0186 F 02-16-2012 02-16-2012 X N/A B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: ❑ FIS Profile ❑x FIRM ❑ Community Determined ❑ Other/Source: Bl 1. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 ❑x NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ❑X No Designation Date: ❑ CBRS ❑ OPA FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 1 of 6 OMB No. 1660-0008 ELEVATION CERTIFICATE Expiration Date: November 30, 2022 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: 3105 S. 23RD 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* ❑x Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations — Zones A'I—A30, AE, AH, A (with BFE), VE, VI—V30, V (with BFE), AR, AR/A, AR/AE, AR/A1—A30, AR/AH, AR/AO. Complete Items C2.a—h below according to the building diagram specified in Item AT In Puerto Rico only, enter meters. Benchmark Utilized: SLC BM: BRIDGE-25 EL.=5.97' Vertical Datum: NAVD '88 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 ❑x NAVD 1988 ❑ 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) 17.4 x❑ feet ❑ meters b) Top of the next higher floor N/A ❑ feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A ❑ feet ❑ meters d) Attached garage (top of slab) N/A ❑x feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 16.9 x❑ feet ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 16.7 ❑x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 16.8 0 feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A feet meters structural support 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 certify elevation information. / certify that the information on this Certificate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. Were latitude and longitude in Section A provided by a licensed land surveyor? N Yes ❑ No ❑ Check here if attachments. Certifier's Name License Number William E. Hayhurst 4416 Title President ace Seal Company Name Hayhurst Land Surveying H.Le- .e Address 445 9th Street SW, Unit 7 - City State ZIP Code Vero Beach Florida 32962 Signature Date Telephone Ext. (772) 569-6680 1-1111 /0 4 vo Copy all pages of this Elevation Certificate and attachments for () cdinmunity official, (2) insurance agent/company, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) A5: established utilizing My NASA Data Latitude/Longitude Finder at: https:f/mynasadata.larc.nasa.gov/latitudelongitude-finder/ C2e: WELL PUMP ON CONC. BLOCK EL.=16.9' WATER EQUIPMENT ON CONC. PAVER EL.=17.3' HIGHEST CENTERLINE OF ROAD EL.=17.05' LOWEST CENTERLINE OF ROAD EL.=16.79' FEMA Form 086-0-33 (12119) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2022 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: 3105 S. 23RD 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 13FE) 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 El—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 ❑x feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑x 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 ❑x feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is ❑x feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑x 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 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 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 William E. Hayhurst Address City State ZIP Code 445 9th Street SW, Unit 7 VERO BEACH Florida 32962 Signature Date Telephone (772) 569-6680 Comments i ❑ Check here if attachments. FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 3 of 6 ELcVl T ION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2022 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USES Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: 3105 S. 23RD 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 FEIVIA-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 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. 6FE 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 Signature Date Comments (including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 4 of 6 BUILDING PHOTOGRAPHS OMB No.1660-0008 ELEVATION ION CERTIFICATE See Instructions for Item A6. Expiration Date: November 30, 2022 IIUiPORTANT: 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: 3105 S. 23RD 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 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. L `p 1 C -'^lRewsi�0 . 1� Photo One Photo One Caption FRONT 08/14/20 Clear Photo One f I tt t' h ' 7 ti ,wn ^rii o!. ,s Photo Two Photo Two Caption WATER EQUIPMENT 08/14/20 Clear Phot6 Tw6 FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page OMB No. 1660-0008 Expiration Date: November 30, 2022 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: 3105 S. 23RD STREET City State ZIP Code t Company NAIC Number FORT PIERCE Florida 34982 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, 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. .4 -s — t Photo Three Photo Three Caption WELL PUMP 08/14/20 1Clear Photo Three Photo Four Photo Four Photo Four Caption -Clear Photo Pour; FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 6 of 6