HomeMy WebLinkAboutELEVATION CERTIFICATEU.S. DEPARTMENT OF HOMELAND SE1,`_ ATY o� OMB No. 1660-0008
Federal Emergency Management Agency',,_,' o , •� �� Expiration Date: November 30, 2018
National Flood Insurance Program��0
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
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
Al. Building Owner's Name
Policy Number:
MICHIELSEN
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Company NAIC Number:
Box No.
1044 NETTLES BLVD.
City State ZIP Code
JENSEN BEACH FLORIDA 34957
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 1044, NETTLES ISLAND PROJECT SECTION 2
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. 27°17'04.1" Long. 80°13'28.4" 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 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 A8.b N/A sq in
d) Engineered flood openings? [--]Yes ®No FILE COPY
A9. For a building with an attached garage:
a) Square footage of attached garage N/A 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 afflood openings in A9.b N/A sq in
d) Engineered flood opO' pings? ❑ 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)
( Z % % `G
O��lb�1Z
Revised Date
OZ tlto`lZ
x
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�O• C�
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B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9:
❑ 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
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, and/or Bldg. No.) or P.O. Route and Box No.
Policy Number.
1044 NETTLES BLVD.
City State ZIP Code
Company NAIC Number
JENSEN BEACH FLORIDA 34957
I
SECTION C — BUILDING ELEVATION 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, 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 AT In Puerto Rico only, enter meters.
Benchmark Utilized: 94 77 A04 FLDT Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a) through h) below.
❑ NGVD 1929 ® NAVD 1988 ❑ O her/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, c wlspace, or enclosure floor) 7.0
A ® feet ❑ meters
b) Top of the next higher floor ❑feet ❑meters
c) Bottom of the lowest horizontal structural member (V Zones only) N/A ❑ feet ❑ meters
d) Attached garage (top of slab) N/A ❑ feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building N/A ❑ feet ❑ meters
(Describe type of equipment and location in 'Comments)
4.0
f) Lowest adjacent (finished) grade next to building (LAG) ® feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 4.2 ® feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A ❑ feet ❑meters
structural support
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.
/ certify that the inthfmation on this Certificate represents my best efforts to interpret the data available. / understand that any false
statement may be punishable by fine orimprisonmerlt under 18 U.S. Code, Section 1001.
Were latitude and longitude in Section A provided byl a licensed land surveyor? ® Yes ❑ No ❑ Check here if attachments.
Certifier's Name
License Number
1320-94-01 UC
EARLE R. STARKEY
004459
�✓ ,
Title
PROFESSIONAL LAND SURVEYOR
Company Name
ACCURIGHT LAND SURVEYING
INC.
Address
1501 DECKER AVENUE #419
05/30/2018
City j
State ZIP Code
ST
I FLORIDA 34994
P LS #4459
Sig
Date Telephone Ext.
05/30/2018 772-286-7694
Copy all pa is Elevation 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) '
FEMA Form 086-0-33 (7/15) eplaces all previous editions. Form rage 2 of 6