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HomeMy WebLinkAboutElevation CertificateOZ-70 U.S. DEPARTMENT OF HOMELAND SECURITY OMB No: 1660-008 Federal Emergency Management Agency Expiration Date: November 30, 2018 National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on Pages 1-9 rn Dn me of ttiic Nouatinn rartifiirata and all attarhments for (11 community official. (2) insurance agent/company, and (3) building owner. SECTION A —PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name(NotecNot Validtouseforanyotherpersonorenrity). Policy Number: STANDARD PACIFIC HOMES A2. Building Street Address (Including Apt., Unit, Suite, and/or Bldg. No. or P.O. Route and Company NAIC Number: Box No. 3010 NW RADCLIFFE WAY City State ZIP Code PALM CITY FL 34990 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 4; "RIVERBEND" (P.B.C.R. PB. 67 PG. 36 THROUGH 39) A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27°13'24.07"N Long.80"17'47.86' W 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:lB A8. For a building with a crawlspace of 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 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 693 sq. ft. b) N tuber of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0 c) Total net area -of fiopd openings in A9.b 0 sq. in. d) EngiLreered,flood::oper?ings? ❑ Yes ® No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION .B1. NFIP'Ccermunity,Name & Community Number B2. County Name B3. State -ST. LUCIE COUNTY;1120285 ST. LUCIE COUNTY FLORIDA 64. Map/Panel 95. Suffix B6. Firm Index B7. FIRM Panel B8. Flood Zone(s) B9. Base Flood Elevation(s) Number . Date Effective/ (Zone AO, use Base Revised Date Flood Depth) 22011C 0406 J 02/16/2012 LOMR-F 8/26/2024 X N/A 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: LOMR-F Case #14-04-5434A Bll. 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 FEMA Form 086-0-33 (7/15) Replaces all previous editions rage i or D ELEVATION CERTIFICATE OMB No: 1660-008 Expiration Date: Novemher30. 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: 3010 NW RADCLIFFE WAY City State Zip Code Company NAIC Number: PALM CITY FL 34990 SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building Elevations are Based on: ❑ Construction. Drawings* ❑ Buildiing 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 V3 — V30, V (with BFE), AR, AR/A, AR/AE, AR/Al —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: TIDAL BM ST. LUCIE COUNTY: 872 2334 TIDAL 4'. EL= 2.60 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 (including basement, crawlspace, or enclosure floor) 9.92 ® feet ❑ meters b) Top of 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) 9.A1 ® feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) 9.75 feet ❑ meters f) Lowest adjacent (finished) grade next to building (LAG) 9.40 ® feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 9.20 ®feet ❑meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including A feet El meters N. A 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 interpreCthe data available. I 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? ® Yes ❑ . No ❑, Check here if attachments: Certifier's Name: License Number: David P. Lindley, PLS L.S. 5005 Place Title:: Professional Land Surveyor' Company Name: David, P. Lindley, PLS Caulfield & Wheeler, Inc. LS. 5005, State of Florida •05/04/2018 Address: 7960 Glades Road -.Suite 100 "Not Valid without the signature and the o►iji.oal raised seal of a Florida City: State: Zip Code: Boca Raton FL .33434 Ucensed.Surveyof& Mapper" Signature: Date: Telephoner 11W , OS/04/2018 S61-392-1991 Copy all Pages of this.Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company; and'(3) building owner. Comments (including type of equipment and location, per C2(e), If applicable. Item AS) Latitude & Longitude obtained by Magellen GPS Blazer 12. Item C2.e) Refers to AC pad on right side of building. 1 FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 2 of 6 -- � OMB No: 1660-008 FLFVATICIN CERTIFICATE 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: 3010 NW RADCLIFFE WAY City State Zip Code Company NAIC Number: PALM CITY FL 34990 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 and 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 bores 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, N ❑ ❑ below the HAG ❑feet ❑meters above or crawlspace, or enclosure) is b) Top of bottom floor (including basement, N A. Elfeet ❑ meters ❑ above or [Ibelow the LAG' crawlspace, or enclosure) is 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 N/A. ❑ feet El meters El above or El below the HAG the diagrams).of the building is E3. Attached Garage (top of slab) N A. ❑ feet [].meters' . ❑ above or ❑ below the HAG E4. Top of platform of machinery and/or equipment N A. ❑ feet ❑. 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 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: Address City State Zip Code Signature Date Telephone Comments ❑ Check here if attachments FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 3 of 6 ELEVATION CERTIFICATE OMB No: 1660-008 Exairation 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: 3010 NW RADCUHE WAY City State Zip Code Company NAIC Number: PALM CITY FL 34990 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 G7. This Permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including.basement) ❑ feet ❑ meters Datum of the building: _ . G9. BFE or (Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum G10. Community's design flood elevation. ❑ feet ❑ meters Datum The property owner or owner's authorized representative who completes Sections A, % 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. Local Official's Name Title Community Name Telephone Signature Date Comments ❑ Check here if attachments FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 4 of 6 BUILDING PHOTOGRAPHS OMB No:1660-008 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 P.O. Route and Box No. I Policy Number: 3010 NW RADCLIFFE WAY City State Zip Code Company NAIC Number: PALM CITY FL 34990 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 thefoundation 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. +► * s .:5l Photo One Caption: Front View Photo Three Caption: Rear View. Photo Two Caption: Left View I Photo Four Caption: Right View FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 5 of 6 BUILDING PHOTOGRAPHS OMB No:1660-008 ELEVATION CERTIFICATE See Instructions for Item A6 Expiration Date: 'November30,2018 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: 3010 NW RADCLIFFE WAY City State Zip Code Company NAIC Number: PALM CITY FL 34990 If Submitting more photographs that 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 1n Section A8. I Photo Two Caption: I Photo Four Caption: I FEMA Form 686-0-33 (7/15) Replaces all previous editions Page 6 of 6