HomeMy WebLinkAboutELEVATION CERTIFICATEU.S. DEPARTMENT OF HOMELAND SE( ;ITY
F'edera4 I"merppncy Management Agency'
National Flood Insurance Program
0119 1 OMB No. 1660-0008
j` Expiration Date: November 30, 2018
• ELEVATION CERTIFICATE ������®
Important: Follow the instructions on pages 1-9. By
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent JMrLP1p0nj-d i ding 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°1221.7" 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.
A7. Building Diagram Number 1 B
A8. For a building with a crawlspace or 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 N/A
c) Total net area of flood openings in AB.b N/A sq in
d) Engineered flood openings? ❑ Yes ® No
A9. For a building with an attached garage:
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 3
c) Total net area of flood openings in A9.b 600 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)
Number
Date
Effective/
Zone(s)
(Zone AO, use Base Flood Depth)
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Revised Date
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B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 139:
❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other/Source:
B11. 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. Form Page 1 of 6
duiiding Phatographs
See Insttuct'Ions for Item A6.
Far Int-j" ce Compatgi u§
Bultclitag 5tr#eeiAcfctcess (indugmgApt:, UrK Sutte, oncV c.Btcfg : a.) orP.+D,Route and:B4O*,, PoBcy:Fiumber.
:10725 SOUTH OCEAN DRIVE #490
I#y state ZIP Ciode Nmlw
JENSEN BEACH FLORIDA 34957
If usl6g the Elevation �eriifioate to obtain NFIP flood insurance, affix at feast two' wiling photographs I elow acoordtng to
the in;xtructtans for'Itern A6 IdetttfyIl phott�graplis vhth tlate taken "1=ront 1�ietii' anc! "Rear'evsi',.:and, if retquiretl,. "Right
s,de vla °'ana "L t ride View." :if _ ubm➢ktiri$ rrto�s phatagra¢tls than iii►ill it: on this page; use tie< Corr inUaon:. Page;:
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