HomeMy WebLinkAboutELEVATION CERTIFICATE 6-5-18U.S. DEPARTMENT OF HOMELAND S, 1RITY 5�- `U
OMB'�,Vo.1 360-0008
Federal Emergency Management Agen Expiri tioi )at November 30, 2018
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9. OWNED
BY
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/c. ,(%PQiing owner.'
SECTION A — PROPERTY INFORMATION
FOR INSURANCE COMPANY USE
Al. Building Owner's Name
Policy Number:
MR. & MRS. GRUBER
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Company NAIC Number:
Box No.
10725 SOUTH OCEAN DRIVE #490
City State ZIP Code
JENSEN BEACH FLORIDA 34957
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 18, BLOCK M, HOLIDAY OUT
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL
A5 Latitude/Longitude: Lat. 27°16'19.5" Long 80°12'21 7" 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.
AT Building Diagram Number 1 B
A8. For a building with a crawispace or enclosure(s):
a) Square footage of crawispace or enclosure(s) N/A sq ft
b) Number of permanent flood openings in the crawispace or enclosure(s) within 1.0 foot above adjacent grade N/A
c) Total net area of flood openings in A8.b N/A sq. in
d) Engineered flood openings? ❑ Yes ® No -LE
F1 -
A9. For a building with an attached garage:
Cop
a) Square footage of attached garage 416 sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade N/A
c) Total net area of flood openings in A9.b N/A 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
UNINCORP 120285•
ST. LUCIE
FLORIDA
B4. Map/Panel
B5. _Suffix. -
B6. FIRM Index
B7. FIRM Panel
B8. Flood
B9. Base Flood Elevation(s)
Number1.
Date
Effective/
Zone(s)
(Zone A0, use Base Flood Depth)
Z C' L
e�z f �tm.� t z
Revised Date
Oz1ttitooz-
AC
��t�i
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69:
❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item 139: ❑ 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
IJ
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6
ELEVATION 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 (including Apt., Unit, Suite, andior
Bldg. No.) or P.O. Route and Box No.
Policy Number.
10725 SOUTH OCEAN DRIVE #490
City State
ZIP Code
Company NAIC Number
JENSEN BEACH �LORIDA
34957
SECTION C — BUILDING gLEVATION
INFORMATION (SURVEY REQUIRED)
C1. 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, VI—V30, V (with BFE), AR, ARIA, AR/AE, AR/AlA30, 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: 94 77 A04 RM2 FDOT 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 budding 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•0 ® 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) 3.55 ® feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building N/A ❑ feet ❑ meters
(Describe type of equipment and location in Comments)
3.3
f) Lowest adjacent (finished) grade next to building (LAG) ® feet ❑ meters
g) Highest adjacent (finished) grade next to buildiril(HAG)3•5 ® feet ❑ meters_
h) Lowest adjacent grade at lowest elevation of de or stairs, including N/A
structural support ❑ feet ❑ meters
SEGT(ON D ' §URVEYOR#
ENGINEER, OR ARCHITECT CERTIFICATION
TtnsieitiflcatioA' is.to_lae.'signed:ar di,sealed by a land surveyor,
engineer, or architect authorized by law to certify elevation information.
f" 1 certify t�i& tfie inkMiatlon on f�is 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.
Were latitude and longitude in Section A provided by a licensed
land surveyor? ® Yes ❑ No ❑ Check here if attachments.
Certifier's Name
License Number
2703-01-01 UC
EARLE R. STARKEY
004459
Title
PROFESSIONAL LAND SURVEYOR
Company Name
ACCURIGHT LAND SURVEYING INC.
Address
1501 DECKER AVENUE #419
-
- G'S/30/2018
City
STUART
; tate .ZIP Code
FLORIDA 34994
PLS #4459
Sign a
Date Telephone. Ext.
05/30/2018 772-286-7694
Copy all pages evation Certificate and all attachme
I is for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments (including type of equipment and location, per'C2(e),
if applicable)
FEMA Form 086-0-33 (7/15) Repl ces all previous editions. Form Page 2 of 6