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Home My WebLink AboutELEVATION CERTIFICATEOMB No. 1660-0008 U.S. DEPARTMENT OFHOM .ND SECURITY,- - _ELEVATION CERTIFICATE. EXDireS February 28, 2009 Federal Emergency Management Agency National Flood insurance Program i ipol'tant:, Read the,instructidns do pages`-,-o. SECTION A - PROPERTY INFORMATION For Insurance Company Use: Al. Building Owners Name CHAD M. DALY Policy Number . A2. ,.Building.Street A dress (including Apt.';`Unit,_Suite;, and/or Bld :. N' - -or.O P: Route and:BoNo.` '' ,.' ' 9 ) , . ._ z .. .......__._. _ . ..._ _ BIRCH DRIVE Company NAIC Number City FORT PIER E -State FL ZIP Code34982 -RECEIVED A3. Property Des 'ption (Lot and Block Numbers, Tax Parcel Number, Legal -Description, etc.) LOT 17, BLOCK INDIAN RIVER ESTATES UNIT 8 AS RECORDED IN PLAT BOOK 10, MAY 3 1 70 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL _ A5- LatitudPAonnitude: Lat- Lana. Horizontal batum: 1-1 NAD 1927 171 NAD BY: _ AS; Attach at',Ieast 2 photographs of the building- if. the Certificate -is being used to obtain Aoodinsurance. - A7..Buildrng :Diagram_Nurnber' i. A8. For a building with a crawl space or enclosure(s), provide A9. For a building with an attached garage, provide: a) Square footage-of'crawl spaceor ehcbsure(s) sq ft' = a) Square footage of attached garage 374 = sq ft b) No. of permanent flood ope6ings141he crawl space or b) 'No. of permanent flood openings in the attached garage enclosure(s) walls within 1.0 foot above adjacent grade - walls within.1,.0 foot above adjacent grade c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9:b sq in SECTION-9 = FLOOD INSURANCE RATE, MAP (FIRM) -INFORMATION B1. NFIP Community Name & Community Number B2. County Name B3:•State FORT PIERCE 120285.:.. , .. sT LUCIE :.:.. .: _ : FL B4. Map/Panel Number' B5. Suffix ' B6. FIRM Indek "B7: FIRM Panel '68: Flood _ B9. Base Flood Elevatiori(s) (Zone bate "' EffectiV6/Revi6ed'Date • '°Zone(s) • • AO, use base flood depth) F12111 CO281 G 06/30/99 11 /04/92 AH 17 B10. Indicate the source of -the Base Flood:EleVatiorr(BFE).data or base flood:depth'entered in_Item 69: ❑ FIS Profile ® FIRM : ❑ Community Determined ❑ Other (Describe) Bl 1. Indicate elevation datum used for-BFE in Item`B9: ® NGVD 1929 .: ❑--NAVD 1988 ❑ Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ' []Yes []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 now 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-g below according to the building diagram specified in Item AT Benchmark Utilized.: Vartical-Datum..::.. ; .... , _ -... . Converslon/Comments. Checkthe measurement used: a) Top of bottom floor (including basement,, crawl space, or enclosure floor)_ ; 20.jt1 ® feet ❑ meters (Puerto. Rico only) T b) Top of the next higher floor,❑mpiers (Puerto Rico only) .. c) Bottom of.the lowest horizontal structural member (V Zones only) [].feet - ❑ meters (Puerto Rico only), . d) Attached garage (top of slab) 20.46 ® feet ❑ meters (Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building " ❑ feet ❑meters (Puerto Rico'only) ' (Describe type of egWoment.in Comments) - f) Lowest adjacent (finished) grade (LAG) 16.7 ®feet ❑ meters (Puerto Rico only) g) Highest adjacent (finished) grade (HAG) , 1_9.8 ® feet ❑ meters (Puerto Rico, only) 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 Certifioate:represents my best efforts to interpret the data available. 1 understand that any false statement may be punishable 6y �®r prisonment under 18 U.S. Code, Section 1001. 0=3/. ❑ Check here if comments are provided on back of form. License Number Name WILLIAM B. Title P.S.M C MpmW-Nertfe BENNETT SURVEYING + MAPPING INC; Address 439 SE PORT SAINT LUCIE BLVD City PORT SAINT LUCIE State FL ZIP Code 34984 Signature Date 05/30/2006 Telephone 772-336-4933 IMPORTANT: In these spaces, copy thi ;responding 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 BIRCH DRIVE City FORT PIERCE StateFLZIP Code 34982 I Company,NAIC Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate forl(l) community official, (2), insurance agent/company, and (3) building owner. Comments Signature Date ❑ Check here if attachments SECTION-E -BUILDING ELEVATION- INFORMATION (SURVEY -NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complel and C. For Items E1-E4, use natural grade, Et. Provide elevation information for the fc grade (HAG) and the lowest adjacent t a) Top of bottom floor (including basen b) Top of bottom floor (including basen E2. For Building Diagrams 6-8 with permai (elevation C2.b in the diagrams) of the E3. Attached garage (top of slab) is E4. Top of platform of machinery and/or ek E5. Zone AO only: If no flood depth numbs ordinance? ❑ Yes ❑ No ❑ Ui Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B, available. Check the measurement used. In Puerto Rico only, enter meters. swing and check the appropriate boxes to show whether the elevation is above or below the highest adjacent ide (LAG). nt, crawl space, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. nt, crawl space, or enclosure) is -" . ❑ feet ❑ meters ❑ above or ❑ below the LAG. nt flood openings provided in Section A Items 8 and/or 9 (see page 8 of Instructions), the next higher floor uilding is ❑ feet ❑ meters ❑ above or ❑ below the HAG. ❑ feet ❑ meters ❑ above or ❑ below the HAG. pment servicing -the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. is available, is the top of the bottom floor elevated in accordance with the community's floodplain management sown. 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 Signature Comments City State ZIP Code Date Telephone SECTION G - COMMUNITY INFORMATION (OPTIONAL) r ne local official wno is aurnonzea oy saw orlorornance to aaminister the commun¢ys riooapiain management oroinance can complete Sections A, a, t; for t), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8. and G9. Gt. ❑ 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. El 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.-G9.) is provided for community floodplain management purposes. G7. This permit has been issued for: New Construction ❑ Substantial Improvement G8. Elevation of -as -built lowestfloor (iriclu ing basement) of the building: _❑ feet ❑ meters (PR) Datum G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters (PR) Datum Local Official's. Name- I Title Community Name I Telephone Signature Date Comments Check here if attachments