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Home My WebLink AboutElevation CertificateU.S. DEPARTMENT OF HOMELAND SECURITY _tVA I IVIV (:tK 111-IC:A 1 t `1 FEDERAL VM GENCY MANAGEMENT AGENCY OMB NO. 1660-0008. . _,Nvfional hio :.',wrance Program Important: Read the instructions on pages ti-y: Expiration Date: July 31-,2015 SECTION A -PROPERTY INFORMATION ')=3R7hJIA{MPjl+f`tJSE,. Al. Building Owner's Name FETHERLIN °P Ticy trutlb r r, sr; A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. ?tj►Y=A Nje� 1053 NETTLES BLVD.��_ City JENSEN BEACH State FL ZIP Code 34957 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 1053, NETTLES ISLAND PROJECT SECTION 2 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude:. Lat. 27°17'05.2" N Long. 80°13'30.9" W Horizontal Datum: ❑ NAD 1927 0 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) NIA sq ft a) Square footage of attached garage N/A sq It 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 0 No d) Engineered flood openings? ❑ Yes 0 No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name B3. State UNINCORP 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 12111C 0311 J 02/16/2012 Effective/Revised Date Zone(s) AO, use base flood depth) 02/16/2012 AE 7.0 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile 0 FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 0 NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (BRS) area or Otherwise Protected Area (OPA)? ElYes 0 No Designation Date: _ 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, V1 V30, 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 AT In Puerto Rico only, enter meters. Benchmark Utilized: 94 77 A04 FLDT Vertical Datum: NAVD 88 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 0 NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) g) Highest adjacent (finished) grade next to building (HAG) h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support Check the measurement used. 4.0 0 feet ❑ meters 7.8 0 feet ❑ meters NIA._ ❑ feet ❑ meters NIA., ❑ feet ❑ meters 7.1 0 feet ❑ meters 3.9 0 feet ❑ meters 4.0 0 feet ❑ meters 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. l certify that the information on this Certificate represents my best efforts to interpret the data available. l understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. 0 Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a 0 Check here if attachments. licensed land surveyor? 0 Yes ❑ No Certifier's Name EARLE R. STARKEY License Number 004459 Title I=A YOR Co y Name ACCURIGHT LAND SURVEYING INC. Address EC KER AV City STUART State FL ZIP Code 34994 Sign ARKEY Date 09/25/2015 Telephone 772-286-7694 FEMA Form 086-0-33 (7/12) See reverse side for continuation. 2317-01-01 PLACE SEAL 72015 #4459 Replaces all previous editions. ELEVATION CERTIFICATE a IMPORTANT: In these spaces, cop t . , 1>-___sponding information from Section A. FOR INSURANCE COM_ . N Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Ppiicy Number. �. 1053 NETTLES BLVD. =____ City JENSEN BEACH State FL ZIP Code 34957 I .CompanyNAIC 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. Signature EARLE R. STARK6ff_J Date 09/25/2015 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 _._ ❑ feet ❑ meters ❑ above or below the HAG. 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 9isee pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is _ _ ❑ feet El meters El above or below the HAG. E3. Attached garage (top of slab) is _ _ El feet El meters El above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is _._ ❑ feet ❑ meters ❑ above or Elbelow 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 Address City State ZIP Code Signature Date Telephone Comments 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 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 building site: _ _ ❑ feet ❑ meters Datum G10. Community's design flood elevation: ❑ feet ❑ meters Datum Local OfficiaYs. Name Title Community Name Telephone Signature-- Date Comments Check here if attachments. r Building Photographs See Instructions for Item A6. For Insurance Building Street Address (irxWing Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number 1053 NETTLES BLVD, City JENSFN BEACH state FLORIDA ZIP 4997 If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to the instructions far Item A6. Identify all photographs with: date taken; 'Front View" and 'Rear Vievf; and, if required, Tight Side View" and "Left Side View.' if submitting more photographs than will fit on this page, use the Continuation Page, folloWng. FRONT 09/25/2015 REAR 09/25/2015 SIDE 09/25/2015