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HomeMy WebLinkAboutInstallation Packet U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 National Flood insurance Program Important: Read the instructions on pages 1-9. Expiration Date: July 31,2015 SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Country Cove MHP LLC Policy Number: A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number: 4149 N US Highway One,Ft. Pierce,FL City Ft.Pierce State FL ZIP Code 34946 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Lot 4149,located in Country Cove Mobile Home Park Parcel ID 1420-141-0009-000-0 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Vacant lot-Residential A5. Latitude/Longitude:Lat.27°30'24.60" Long.80o2l'l1.42" 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 enclosure(s): A9. For a building with an attached garage: a) Square.footage of crawlspace or enclosure(s) 1088 sq ft a) Square footage of attached garage n/a sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s)within 1.0 foot above adjacent grade n/a within 1.0 foot above adjacent grade n/a c) Total net area of flood openings in A8.b n/a sq in c) Total net area of flood openings in A9.b n/a sq in d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes ® No SECTION B—FLOOD INSURANCE RATE MAP(FIRM) INFORMATION B1.NFIP Community Name&Community Number B2.County Name TFL tate St.Lucie County 120285 St.Lucie B4.Map/Panel Number B5.Suffix B6.FIRM Index Date B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone 12111C0088 J 2/16/12 Effective/Revised Date Zone(s) AO,use base flood depth) 2/16/12 A 18 B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ® NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes ® No Designation Date:n/a ❑ CBRS ❑ OPA SECTION C—BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Cl. 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,Vl—V30,V(with BFE),AR,AR/A,AR/AE,AR/Al—A30,AR/AH,AR/AO.Complete Items C2.a—h elow according to the building diagram specified in Item AT In Puerto Rico only,enter meters. Benchmark Utilized:CUP Vertical Datum: NAVD 88 Indicate elevation datum used for the elevations in items a)through h)below. ❑ NGVD 1929 M 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) 20.57 ®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 the building N/A. ®feet ❑ meters (Describe type of equipment and location in Comments) 0 Lowest adjacent(finished)grade next to building(LAG) 16.48 ®feet ❑meters g) Highest adjacent(finished)grade next to building(HAG) 16.77 ®feet ❑meters h) Lowest adjacent grade at lowest elevation of deck or stairs,including structural support N/A. ®feet ❑meters 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.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 fine or imprisonment under 18 U.S. Code, Section 1001. ❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a C ElCheck here if attachments. licensed land surveyor? ® Yes ElNo Certifier's Name Michael T.Owen License Number LS5556 HE n .IJV I Title President Company Name Geomatics Services Inc. k Address 1934 Tucker Court City Stuart State FL ZIP Code&49kf i Signature ate //- Telephone 772-419-8383 `5 FEMA Form 086-0-33(7/12) See reverse side for continuation. Replaces 911 previous editions. ELEVATION CERTIFICATE, page 2 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: �4149 N US Highway One,Ft.Pierce,FL City Ft.Pierce State FL ZIP Code 34946 Company NAIC Number: 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 Lot is currently a vacant mobile home lot. Mobile home in picture is stored on adacent lot only,not permanent. 2 � Signature Date 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 Ell—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 n/a. ❑feet ❑meters ❑above or❑below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is n/a. ❑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 8-9 of Instructions),the next higher floor (elevation C2.b in the diagrams)of the building is n/a. ❑feet ❑meters ❑above or ❑below the HAG. E3. Attached garage(top of slab)is n/a. ❑feet ❑meters ❑above or ❑below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is nn/a. ❑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's or Owner's Authorized Representative's Name n/a Address n/a City n/a State na ZIP Code n/a Signature n/a Date n/a Telephone n/a Comments n/a ❑Check here if attachments. 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 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 n/a n/a I n/a G7. This permit has been issued for: ❑New Construction ❑Substantial Improvement G8. Elevation of as-built lowest floor(including basement)of the building: n/a. ❑feet ❑meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: n/a. ❑feet ❑meters Datum G10.Community's design flood elevation: n/a. ❑feet ❑meters Datum Local Official's Name n/a Title n/a Community Name n/a Telephone n/a Signature n/a Date n/a Comments n/a ❑Check here if attachments. All FEMA Form 086-0-33(7/12) R I r bus editions. ELEVATION CERTIFICATE, page 3 Building Photographs See Instructions for Item A6. 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: 4149 N US Highway One,Ft.Pierce,FL City Ft.Pierce State FL ZIP Code 34946 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. Front of lot—taken 2.6.15 FEMA Form 086-0-33(7/12) Replaces all previo s editions. U.S.DEPARTMENT OF HOMELAND SECURITY EVATI O N CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY • OMB No. 1660-0008 National Flood Insurance Program Impo t: Read the instructions on pages 1-9. Expiration Date:July 31,2015 SECTION A-PROPERTY INFORMATIONFQ, L�VSJAa N,CE#COIUIP11r;�USE Al. Building Owners Name Country Cove MHP LLC of c % � A2. Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. qomwE IC NumbeF�� ` u" m M 4149 N US Highway One, Lot 115 .:.� _ City Ft.Pierce State FL ZIP Code 34946 A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) Lot 4149,located in Country Cove Mobile Home Park Parcel ID 1420-141-0009-000-0 A4. Building Use(e.g., Residential,Non-Residential,Addition,Accessory,etc.)Residential A5. Latitude/Longitude:Lat.27°30'24.60" Long.80*21'11.42" Horizontal Datum: ❑ NAD 1927 N 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): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) n/a sq ft a) Square footage of attached garage n/a sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s)within 1.0 foot above adjacent grade n/a within 1.0 foot above adjacent grade n/a c) Total net area of flood openings in A8.b n/a sq in c) Total net area of flood openings in A9.b n/a sq in d) Engineered flood openings? ❑ Yes N No d) Engineered flood openings? ❑ Yes N 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 I FL B4.Map/Panel Number B5.Suffix B6.FIRM Index Date B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone 12111C0088 J 2/16/12 Effective/Revised Date Zone(s) AO,use base flood depth) 2/16/12 A Undetermined B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile N FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 N NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes N No Designation Date:n/a ❑ CBRS ❑ OPA SECTION C-BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' N 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,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 A7.In Puerto Rico only,enter meters. Benchmark Utilized:CUP Vertical Datum: NAVD 88 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(including basement,crawlspace, or enclosure floor) 20.53 N feet ❑meters b)Top of the next higher floor N/A. N feet ❑meters c) Bottom of the lowest horizontal structural member(V Zones only) N/A. N feet ❑meters d)Attached garage(top of slab) N/A. N feet ❑meters e) Lowest elevation of machinery or equipment servicing the building 20.03 N feet ❑meters (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 15.8 N feet ❑meters g) Highest adjacent(finished)grade next to building(HAG) 16.5 N feet ❑meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 16.3 N feet ❑meters Ay 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.1 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. ❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ❑ Check here if attachments. licensed land surveyor? N Yes ❑ No A Certifier's Name Michael T.Owen License Number LS5556 E Title Vice President Company Name Engineering Design&Construction Address 1934 Tucker Court City Ft.Pierce State FL ZIP Code 34950 Signature Date 07 5 Telephone 772-419-8383 01 FEMA Form 086-0-33 (7/12) See reverse side for continuation. Replaces all previous editions. tLtVAIIUIY LtKI1rILAIt,page L IMPORTANT: In these spaces, copy the coqiiiiiiiiiiioonding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt., Unit,Suite,JW Bldg. No.)or P.O. Route and Box No. Policy Number: 4149 N US Highway One,FL,Lot 1154 City Ft.Pierce State FL ZIP Code 34946 Company NAIC Number: 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 AC is attached rear of mobile home. Signature Date 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 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 4.03 ®feet ❑meters ®above or❑below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is n/a. ❑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 8-9 of Instructions),the next higher floor (elevation C2.b in the diagrams)of the building is n/a. ❑feet ❑meters ❑above or ❑below the HAG. E3. Attached garage(top of slab)is n/a. ❑feet ❑meters ❑above or ❑below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is 3.53 ®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's or Owner's Authorized Representative's Name Michael T.Owen Address 1934 Tucker Court City Ft.Pierce State FL ZIP Code 34950 Signature Date Telephone 772-419-8383 Comments n/a ❑Check here if attachments. 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 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 n/a n/a n/a G7. This permit has been issued for: ❑ New Construction ❑Substantial Improvement G8. Elevation of as-built lowest floor(including basement)of the building: n/a. ❑feet ❑meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: n/a. ❑feet ❑meters Datum G10.Community's design flood elevation: n/a. ❑feet ❑meters Datum Local Official's Name n/a Title n/a Community Name n/a Telephone n/a Signature n/a Date n/a Comments n/a ❑Check here if attachments. FEMA Form 086-0-33 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE,page &i1ding Photographs • See Instructions for Item A6. IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSUR ANCE COMPANY USE Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. Policy Number: 4149 N US Highway One, Lot 115 City Ft.Pierce State FL ZIP Code 34946 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. Front View—taken 6.25.15 Right Side View—taken 6.25.15 N x t f-,4 ____ E Left Side View—taken 6.25.15 Rear View—taken 6.25.15 FEMA Form 086-0-33 (7/12) Replaces all previous editions.