HomeMy WebLinkAboutELEVATION CERTIFICATEU.�. DEPARTMENT OF HOMELAND SECURITY
� OMB No. 1660-0008
Federal Emergency Management Agency Expiration Date: November 30, 2018
National Flood Insurance Program
ELEVATION CERTIFICATE SCA Y
Important: Follow the instructions on pages 1-9. �� �a t�l��a�
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
A1. ' Building Owner's Name
Policy Number:
STEVE AND MARILYN LICAUSI
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Company NAIC Number:
Box No.
4905 RIVER PLACE
City State ZIP Code
FORT PIERCE Florida 34982
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 4 OF 'RIVER PLACE"
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. 27-22-30 N. Long. 80-20-32 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 1A
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
c) Total net area of flood openings in A8.b sq in
d) Engineered flood openings? ❑ Yes ❑ No
A9. For a building with an attached garage:
a) Square footage of attached garage 393 sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade
c) Total net area of flood openings in A9.b sq in
d) Engineered flood openings? ❑ Yes ❑ No
SECTION B — FLOOD INSURANCE RATE, MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number
B2. County Name
B3. State
UNINCORPORATED 12028SIP
ST. LUCIE
Florida
B4. Map/Panel
B5. Suffix
B6. FIRM Index
B7. FIRM Panel
B8. Flood
B9. Base Flood Elevation(s)
Number
Date
Effective/
Zone(s)
(Zone AO, use Base Flood Depth)
Revised Date
12111 CO 189
J
2/16/2012
2/16/2012
"AE"
7'
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9:
❑ FIS Profile Z FIRM ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item 139: ❑ NGVD 1929 Z 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: ❑ CBRS ❑ OPA
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6
�EL"EVATION CERTIFICATE
OMB No. 1660-0008
Expiration Date: November 30, 2018
IMPORTANT: In these spaces, copy the corresponding information from Section A.
FOR INSURANCE COMPANY USE
Building Street Address (in luding Apt., Unit S and/44or Bldg. No.) or P.O. Route and Box No.
Policy Number:
City; State ZIP Code
Company NAIC Number
SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings* N Building Under Construction*. ❑ Finished Construction
*A'riew 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: COUNTY BENCHMARK"BRIDGE" Vertical Datum: N.A.V.D: 88, ELEV.=13.61,
Indicate elevation datum used for the elevations in items a) through h) below.
❑ NGVD 1929 N 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) 8.69 N feet ❑ meters.
b) Topofthe next higher floor 9.02 N feet ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only) ❑ feet ❑ meters
d) Attached garage (top of slab) 8.69 feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building ❑ feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 8.4 Z feet ❑ meters
.g) Highest adjacent (finished) grade next to building (HAG) 8.8 feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support ❑ ❑ 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.
Were, latitude and longitude in Section A provided by a licensed land surveyor? N Yes ❑ No ❑ Check here if attachments.
Certifier's Name License Number
CLINTON .A MITCHELL LS3541
Title
REGISTERED LAND SURVEYOR AND MAPPER
Place
Company Name
C.A. MITCHELL AND ASSOCIATES, INC.
S
Address
759 S. . SOUTH MACEDO BLVD.
State ZIP Code
PO T S . L E Florida: 34983
Si nail r Date Telephone Ext.
5/10/2018 772-878-7547
opy all, ges f t ievation 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)
ELEVATIONS REFLECTED ON THIS FORM ARE TAKEN FROM THE WOODEN FORMBOARDS DURING CONSTRUCTION AND
THE GROUND ELEVATION NEXT TO THE FORMBOARDS.
FEMA Form 086-0-33 (7/15) 1 Replaces all previous editions. Form Page 2 of 6