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HomeMy WebLinkAboutElevation CertificateU.S. DEPARTMENT OF HOMELAND SECURITY OMB No.1660-0008. Federal Emergency Management Agency Expiration Date: November 30. 2018 National Flood Insurance Program 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 Al. 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 74, WINDSONG MOBILE VILLAGE A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) SINGLE FAMILY RESIDENTIAL A5. Latitude/Longitude: Lat. 27AO6320 Long.-80.329390 Horizontal Datum: Q 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 enclosure(s): a) Square footage of crawlspace or enclosure(s) 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 g. - ge,wlthin 1 0 f64t4-bove adfacenfgrade : p: c) Total `net area of -flood openings in A9 b 0 sq.in Q'_ ;. d) Engineered flood: openings? - Q Yes SECTION B FLOOD INSURANCE RATE'MAP (FIRM) INFORMATION.' B1. NFIP CorrimupityName& �ommurnty Number fB2 CountyName B3 State ST. LUCIE COUNTY 120285: _ ST LUCIE Flop- B4. Map/Panel _ 5 Suffix B6 FIRM')ndex B7. FIRM Panel t36 FloocJ Zones) 69 8ase Flood Elevations) . Numbed Date ;: EffecWe/ = k Revised;Date ne'A , ood Dep 12111C0187 J; 02/16/2015 02J16/2012 "X" N/A use ase 1310. Indicate the source of the Base:Flood Elevation=(BFE) data or base flood depth entered tr1 Item B9 ; ' FIS Profile FIRM r - ❑ Q Q. Community Detemmed ❑Other/Source B1.1. Indicate elevation datumused;for BFE in Item B9 ❑NGVD 1929 NAVD 1988 : ❑Other/Source wp ; 912. Is`the.buildrng ocated inLLa Coastal Barrier Resources System>(CBRS) ;area orOtherwise Protected Area (OPAL? [] Yes No Designation Date 09/18/2019, ; CBRS OPA FEMA Forrit 086-0-33 (7/15) Replaces ail previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No.1660-0008 :=vriim#;nn r1.ftfn• oft dim o MPORTANT: 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 I - k,iry 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* fo 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, V1—V30, V (with BFE); AR; ARIA, ARIAE; AR/AlA30, 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: CO BM 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. Check the measurement used. a) Top. of bottom floor_(induding basement, crawlspace, or endosure-floor) 22. 5 ® 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, ® feet" ❑meters e) Lowest elevation of machinery or equipment servicing thebuilding 19,"4 feet'. ❑ meters (Describe type of equipment and location ih Comments) ` f) Lowest adjacent (finished) grade next to building (LAG) 19 1 ®,feet . ❑. motets g) Highest adjacent (finished) grade next to building -(HAG} =19 3 #eet:. 0 meters h) Lowest adjacent grade at lowest elevation of deck. or stairs, mciuding N/A f ❑feet ❑' meters structural support SECTION D ;SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to:be signed and: sealed J. y a land surveyor, engineer, or architect authonzed by law to cerktfy levatton rnforrriabori. l certify that the information on thrs Certrficate represents my bestefforts to mterprot ffre data available ! untlerstartl that;any false . statement maybe punishable *fine orimprisonment under 18 U S Code, ;Section= lOD1 Were latitude and longitude in Section A prpvided by a 6censetljland surveyor? Yes .0 No ❑.'Check here if attachments. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Exniration,Date: November 30.2018 MPORTANT. In these spaces, copy the corresponding information from Section A. rF,0R'-INTU=CE COMPANY USE Building Street Address (including Apt., Unit, Suite,and/or Bldg. No.) or P.O. Route and Box No. olicy Number. 3200 SOUTH 7TH. STREET Lary State ZIP Code Company NAIL Number FORT PIERCE Florida 34982 SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) N FOR ZONE AO AND ZONE A (WITHOUT BFE) . For Zones AO and A (without BFE), complete Items E1—E& If the Certificate is. intended to support a LOMA or LOMR-F request, complete Sections A, Band' 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, crawispace' or enclosure) is ❑ feet ❑ ❑ below the HAG. ❑ meters above or b) Top of bottom floor (including basement, crawlspace, 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 thebuilding is ❑ feet ❑ meters" ❑ above or ❑ below, the HAG. E3. Attached garage -(top of slab) is ❑feet- ❑meters 0 above or ❑.below the HAG. E4. Top of platform of machinery ,and/or equipment servicing the building is ,❑>feet ❑.meters above or Q below the HAG. E5. Zone AO only: If no flood depth number is available, the top of the bottom floor elevated in accordance with the. community.'s floodplain management ordinance? ❑ Yes ❑. No ❑ Unknown.. `The local official mus#;certify this mfp ation, in Section,G. SECTION f - PROPERTY OWNER (OR OWNER`S;REPRE$ENTATIVE)CERTIFICATION, . The property owner or owner's authorized representative who completes Se'dU6hs` -,-J and Ek%r Zone A (without a' FEMA-issued or community -issued BFE):or Zone AO must sign here :The stafementsm'Seetions�A, B, and E are correctto the best of myknowledge: F <r Property Owner or Owner'S AUthoriZed Repr6sentatn e's Name - Address City Sate ZIP Code _ Flo Signature Date }Tele hone P Comments Q;Ch - k4here, �fattachm'ents.' . FEMA Form 086-0-33 (7/15) Replaces all 'previous'eddions. Form Paae 3 of 6 ELEVATION CERTIFICATE OMB No.1660-0008 Exoiration 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 �'Iiy 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 aFEMA 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. BFE or (in Zone AO) depth of flooding at the buiiding.site: ❑ feet ❑ meters Datum G10. Community's design flood elevation: ❑ .feet - ID: met Datum rr_rvw run" uao-u-as krna) Keplaces all:previous editions. - , Form Page 4 of 6 BUILDING PHOTOGRAPHS OMB No.1660-0008 ELEVATION, CERTIFICATE See Instructions for Item A6. 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 PA. 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 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. ' 06to one BUILDING PHOTOGRAPHS OMB No.1660-0008 ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30.2018 MPORTANT: 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 NAIL Number FORT PIERCE T 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. Phofo:One.