HomeMy WebLinkAbout0504-0180 ELEVATION CERTIFICATEAFR 2 6 2006
t !1ERAL EMERGENCY MANAGEMENTi( X /
Val
B. No. 3067-0077
NATIONAL FLOOD INSURANCE PROGRAM es December 31, 2005
ELEVATION CERTIFICATE - NNED
Important: Read the instructions on pages 1 - 7.
SECTION A - PROPERTY OWNER INFORMATIONIgi�Aga[!Use'
BUILDIK OWNER'S NAME [policy lu
BUILDING STREET ADDRESS (Includi t., Unit, Suite, and/or Bid(,,`. No.JOR PO. ROUTE AND BOX NO. ;3eompany LAIC Nt,rfiber
3q Lrs. v ro .tea'.,.. .
CITY STATE L ZIP CODS 3 4a S7
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax I? reel.Numb'er, Legal QeseriD{ion, etc.)
L oT' !:SA O i�.l'F_'T1" L.�ES �S La i4d S FcT z
BUIL"G USE (4,g., ResWenffal„Non'-residential, Addibon, Accessory, a c. Use,a Comments area, if necessary)
LATITU E/L GITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: iJ GPS (Type):
or ##.#####°). i_J NAD 1927 U NAD 1983 U'USGS Quad Map U Other
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Bt.-NFIP-COMMUNhTY-NAME-& COMMUNITY -NUMBER 71COWNTYNAME-— - — -- - - B3-.:STATEUllI>< "' ,rep
B4. MAP AND PANEL
B5. SUFFIX
B6. FIRM INDEX
B7. FIRM PANEL
B8. FLOOD
B9. BASE FLOOD ELEVATION(S)
NUMBER
DATE
EFFECTIVE/REVISED DATE
ONES)
(Zone An, use depth of flooding)
B10. Indicate the source'ot the base mooartrevauon tbrtl aaia or vase nova aeNu1 erneicu Ill oZI.
IJ FIS Profile I t FIRM IJ Community Determined . J Other (Describe):.
B11. Indicate the elevation datum used for the BFE in 139: I v�NGVD 1929 IJ NAVD 1988 IJ Other (Describe):
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? J Yes L.d No
Desiclnation Date:
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) /
C1. Building elevations are based on: I_IConstruction Drawings* IJBuilding Under Construction*
IFinished Construction'
*A new Elevation Certificate will.be required when constni ction of the building is complete.
C2. Building Diagram_ Number (Select the building diagram most similar to the building for which this certificate is being completed - see
pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
C3. Elevations — Zones Al-A30, AE, AH, A (with BFE), VE, V? -V30, V (with BFE), AR, ARIA, AR/AE, AR/A1-A30, AR/AH, AR/AO
Complete Items'C3.a-i below according to the building diagram. specified in Item C2. State the datum used. If the datum is different from
the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion
calculation. Use the pace provided or the Comments aria of Section D or Section G, as appropriate, to document the datum conversion.
Datum Conversion/Comments
Elevation reference mark used Does the elevation. reference mark used appear on the FIRM? IJ Yes JI No
❑ a) Top of bottom floor (including basement or enclosure) . to ft.(m)
❑ b) Top of next higher floor
❑ c) Bottom of lowest horizontal structural member (V zones only) _ ft.(m) o 0
❑ d) Attached garage (top of slab) MA _ ft.(m) E
❑ e) Lowest elevation of machinery and/or equipment
servicing the building (Describe in a Comments area.) ft.(m)
❑ f) Lowest adjacent (finished) grade (LAG) S
❑ g) Highest adjacent (finished) grade (HAG) S . 5. fi`112�*
❑ h) No. of permanent openings (flood vents) within 1 ft above' adjacent grade i
❑ i) Total area of all permanent openings (flood vents) in C3.h sq. in. (sq. cm) 4 oo ` (4!;c) 0 to
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 in Sections A, B, and C 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.
CERT,,LFIER'S NAME LICENSE NUMBER
1` Ac CL(. fc. � , S'Ti cA i?. ►•C i"z `! i � oy �1 �-t S �
TITLE COMPANY NAME
PtZo t= t o e4 A-t__ Lk. N 0 � U /LV Y m IL CC V ►.Lt L-i H T' L,. vet � �u VZV DE �t t_ vti c
CITY STAT ZIP CODE
ESS CK ft 2 � A tT Lily i C(A �iL- • 3
IG-11A�J _ DATE TELEPHONE ,, Z Zg to �^edition's
a -IS-d�FE - , January 2003$ees�side for continuation. Replaces all previous
IMPORTANT: In these spaces, copy th
BUILDING STREET ADDRESS (Including Apt.; _6_',
mcling information from Section A.
,and/or Bldg. No.) OR P.O': ROUTE AND H+'_•-_ AO.
CITY jP I�d; ,
�l I;G�? •? _ it .C:
STATE
:{ SECTION D - SURVEYOR, ENGINEER, OR'ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides•of!this,Elevation Certificate for (1) community official, (2) insurance agent/company, and-(3) building owner.
COMMENTS L hA
I I Check here if attachments
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT-BFE)
For Zone AO and Zone A (without BFE),'complete Items E1. through E5. If the Elevation Certificate is intended for use as supporting
inform9tion for a LOMA or LOMR-F, Section C mustbe completed.
E1. Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed —
see pages 6 and 7. If no diagram accurately represents the building-, provide a sketch or photograph.) .
E2. The top of the bottom floo.r_(including basementlor-enclosure), of the building_ is ,I_I—I ft, _(m) LLI_ in.._(cm). I_ (above or_I_L: below
_. ch-6cicone th-e hi hest -ad acent rnde. Use natural-grade,',if'available:)- _._... __._____..._..
E3. For Building Diagrams.6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building: is
I-1J ft. (m): I —I —fin. (cm) above the highest adjacent grade. Complete Items .C3.h and 031 on front of form.
E4. The top of the platform of machinery and/or equipment servicing the building is IJJ ft. (m) IJ—I in. (cm) IJ above or IJ below
(check one) the highest adjacent grade. (Use natural grade, if available.)
E5. For Zone AO only: If no flood depth nu0ber i§ available, is the top!of the bottpm floor elevated in accordance with the community's
floodplain management ordinance? I I Yes I_I No I Unknown: The local official must certify this information in Section G.
SECTION F - PROPERTY1OWNER (OR OWNER'S REPRESENTATIVE).CERTIFICATION
The property owner or owner's authorized'represen'tative who completes Sections A, B, C (Items C3.h and C3.i only), and E for Zone A
(without a FEMA-issued or community -issued BFE)1 or Zone AO must sign here. The statements in Sections A, B, C, and E are confect to
_ the best of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS
SIGNATURE
COMMENTS
STATE ZIP CODE
DATE TELEPHONE
1 1 Check here if attachments
SECTION G - COMMUNITY INFORMATION. (OPTIONAL)
The local official who is authorized .by law or ordinance to, administer the community's floodplain management ordinance can complete
Sections A, B, C (or E), and-G of this Elevation Certificate. Complete the applicable item(s) and sign below.
G1. IJ The information'in Section C was taken f%m other documentation that.has been signed and embossed by a licensed surveyor,
engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the
elevation data in the'Comments area below.)
G2. LJ A community official completed Section E for a building located in Zone A (without a FEMA-issued or community -issued BFE) or
Zone AO.
G3. IJ The following information (Items G4-139) is provided for community floodplain management purposes.
G4. PERMIT NUMBER G5..DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY
ISSUED
G7. This permit has been issued for: ILI New Construction IJ Substantial Improvement
G8. Elevation of as -built lowest floor (including basement) of the building is: -ft. (m) Datum:
G9. BFE or (in Zone AO) depth of flooding at the building site is: _ ft. .(m) Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
I 1 Check here if attachments
FEMA Form 81-31, January 2003 Replaces all previous editions
FEDER•- 'EMERGENCY MANAGEMENT AGENC', O.M.B. No. 3067-0077
NA1 AL FLOOD INSURANCE PROGRAM k - - eern r 31, 2005
1 b� AELEVATION CERTIFICATE
Im octant: Read the instructions on pages 1 - 7. OR a
\ SECTION A - PROPERTY OWNER INFORMATION ForJnsurance Corr{pany User„
BUILDING STREL I x
CITY
PROPERTY DESCRI
�LnT 3g
N BUILMG-USE (Ela,
I
IE MI;. QER'RJ",E
ESS (Including, Unit, Suite, and/or Bldck. No.�OR PiO. ROUTE AND BOX NO.
(Lot
LATITUDE/LUNUI I WE (Ur I IUNAL)
or L1
SECTION B -
STATE , C
L
ZIP
JIF 1.•GI.I4YIIIY...1, �va�aJl Y�•+Y•'1•"',, "•"•/ /.�
ion, Accessory, a c: Use a Comments area, if necessary.)
IIZONTAL DATUM:
1927 IJ NAD 1983 SOURCE: U GPS (Ty :
L-1 USG uad Map LJ Other
-O D INSURANCE RATE MAP (FIR FORMATION'
3
-B1-NFIP-COMMUNI-TY-NAME-4COMMUNIT-Y-NUMt3trt
Ut l I td,;d f Z.D
B4. MAP AND PANEL
B5. SUFFIX
B6. FIRM INDEX
I 7. FIR ANEL
B8. FLOOD
B9. BASE FLOOD ELEVATION(S)
NUMBER
DATE
EFFEC V VISED DATE
ONE(S)
(Zone An, use depth of flooding).
6 Z c�Z13S -o
Q(b--sp 7
; r �3 o -9
�
$ . p
B10. Indicate the source of the tease tiooa ciev-C uu'C?r ) D Lt11
Vrmined "u\therwise
Describe):
FIS Profile �IFIRM �J ty
B11. Indicate the elevation datum used for the BFE in 139E NGIVD 1929AVID988 1J Other (Describe):
612. Is the building located in a Coastal Barrier Resour s System (CBRS) Protected Area (OPA)? �J Yes v_(No
Designation Date: 1
SECTION C - PIALDING ELEVATION INFORMATION (1511,IRVEY REQUIRED)
C1. Building elevations are based on: IJ nstruction Drawings* IJBuilding Under nstruction* Finished Construction
*A new Elevation Certificate will be quired when construction of the. building is complete.
C2. Building Diagram Number elect the building diagram most similar to the building for ich this certificate is being completed - see
pages 6 and 7. If no diagram ccurately represents the building, provide a sketch or photograph.
C3. Elevations —Zones A1-A3 , AE, AH, A (with BFE), VE, V1430, V (with BFE), AR, AR/A, AR/AE, A' Al-A30, AR/AH, AR/AO
Complete Items C3.a-i p low according to the building diagram specified in Item C2. State the datum ed. If the datum is different from
the datum used for t BFE in Section B, convert the datum to that used for the BFE. Show f eld measur Tents and datum conversion
calculation. Use t e space provided or the Comments alrea of Section. D or Section G; as appropriate, to do ument the datum conversion..
Datum Conversion/Comments
Elevation ref rence mark used Does the elevation reference mark used appear on the RM? 1J Yes LJ No
❑ a) Top f bottom floor (including basement or enclosure)' . to ft.(m)
❑ b) p of next higher floor S ft.(m)
❑mac Bottom of lowest horizontal structural member (V zones only) _ ft.(m) o �- - - - -- —
�❑ d) Attached garage (top of slab) A _ ft•(m) W a
❑ e) Lowest elevation of machinery and/or equipment d
servicing the building (Describe in a Comments area.)
❑ f) Lowest adjacent (finished) grade (LAG) S
❑ g) Highest adjacent (finished) grade (HAG) S
❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade
❑ i) Total area of all permanent openings (flood vents) in C3.h fit sq. in. (sq. cm) d# Pc v to
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.
l certify that the information in Sections A, B, and C on'this certificate represents my best efforts to interpret the data available.
l understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
CERT11FIER'S NAME LICENSE NUMBER
I`rktZc.Fc tZ1 S►.4 KEY ov445Z9
TITLE ANY NAME COMPv
P2o ►= < l o r l A-L_ Lta N'=t `t rl—V X Y n rZ Cc V ► -( L-1 I -I i �.� vu �u vzV u£ , I v l
ESS
CITY STAT ZIP CODE
J r,cK r�2 ��.tr 4l9 STu�rL; � 3
LGN DATE TELEPHONE .� Z ,Zg to^ -I (oq 4
o-)'-A-oi�
FE - , January 2003 .. See PeversP side for continuation. Replaces all previous editions
;FEDERAL EMERGENCY MANAGEMEI iGENCY O.M.B. No. 3067-0077
NATIONAL FLOOD INSURANCE PF'- _ .RAM Expires December 31, 2005
ELEVATION CERTIFICATE
1J NAD 1927 1J NAD 1983
1 -7.
SOURCE: 1J GPS (Type):
1-1 USGS Quad Map "Other
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
P-COMMUNrry-NAME-&COMMUNITY-NUMBER I B2. COQNTY-NAME-- - j v G 1
t: "2A I Z. D� S L
e ' B4. MAP AND PANEL
B5. SUFFIX
B6. FIRM INDEX
B7. FIRM PANEL
B8. FLOOD .
B9. BASE FLOOD ELEVATION(S)
NUMBER
DATE
EFFECTIVE/REVISED DATE
ONES)
(Zone AO. use depth of flooding)
0 Z uz$5 o3I
ac;-3 a -�►
a� ;3 =g
$ ' o
B10. Indicate the source of the Base FloodrElevatioh (BFL) data or Duse nova depth entered inrsa.
IJ FIS Profile I v- FIRM ' ' JJ Community Determined . 1J Other (Describe):
B11. Indicate the elevation'datum used for the BFE in B9: L%.,(NGVD 1929 I-1 NAVD 1988 J Other (Describe):
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? IJ Yes INo. .
Designation Date:
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: I—IConstruction Drawings• IJBuilding Under Construction" (Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Building Diagram Number __�_ (Select the building diagram most similar to the building for which this certificate is being completed -see
pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
C3. Elevations -Zones Al-A30, AE, AH, A (with BFE), VE, VI-V30, V (with BFE), AR, ARIA, AR/AE, AR/A1-A30, AR/AH, AR/AO
Complete Items C3.a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from
thedatum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion
calculation. Use the epace provided or the Comments area'of Section D or Section G,'as appropriate, to document the datum conversion.
Datum Conversion/Comments
-Elevation reference mark used Does the elevation reference mark used appear on the FIRM? J Yes LI No
❑ a) Top of bottom floor (including basement or enclosure) . to ft.(m)
❑ b) Top of next higher floor t s ft.(m)
❑ c) Bottom of lowest horizontal structural member (V zones only) o----. - - ----- -----
❑ d) Attached garage (top of slab) ri ft•(m) w
cc
❑ e) Lowest elevation of machinery and/or equipment d
servicing the building (Describe in a Comments area.) .ft.(m)
❑ f) Lowest adjacent (finished) grade (LAG)
❑ g) Highest adjacent. (finished) grade (HAG) S
❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade tJ %A� .
❑ i) Total area of all permanent openings (flood vents) in C3.h !ti X so. in. (sq. `cm) 4(4S a W- i 8 - o
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 in Sections A, B, and C 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.
vcr�rcn .a wr�w�
� A rz, rcc- TD K f Z y
TITLE COMPANY NAM
P0 lO y IU fl-V _ Y n cc EV ►2cyH T- it CJ 2V"I L I
2= L,
MSS CITY STATE
Crc ZIP CODE
rz ►G t2 A-4 cr 4 t9 S iLC A ✓�i I"� • . 3
-SIGIyATI I DATE DLl
_ Is - O TELEPHONE .� Z Z.g 10 _-I 6q
16q 4 .
FE - . January 2003 See i'e me__ide for continuation. Replaces all previous editions
FEDERAL EMERGENCY MANACrEMENT AGENCY{I
67-0077�
�j NATIONAL FLOOID iNSURANCE PROGRAli1 f _ p 'beG�31 2U0�5
l� 1 t f�`
BY ELE�ifAT10N CERTIFICATE
Important. Read the Instructions on pages 1. T. FSP01 " 81 29. li
,SECTION A - PROPERTY OWNER INFORMATION�.:'��w
BUILDING OWNER'S NA114E A
�1� {�( 'rr .,toµ^, 'r'%' �a.,�.:irsL^✓4,•-+, •.q �,.,..-
.. ,/i 2 �`.r•.•�: �.•L•ti•. :i.r.•., Y%l x•%?t.;ti •.:��i y::
BUILD[ T.IiESS fmctudl
C v ( n9 Apt, Unit, Sufte,'and/ar Bldg Na) OR P.O. ROUTE AND BOX NO. ' _,h:NrtlpgF�j�f��x„�
fiT S l'J l_ i=.�:,iic ''`r" =:i ; viC-c :i= .E✓ t';r�.
CITY STATE ZIP CODE
PROPERTY DESCRIPTION and BI Numbers, Tax Partof Number, Legal D etc.)
_ Lo-T- �CT J% Wt L-� kI i��so � 2n drtz S mac. Z
BUILDING USE (e.g .Redd ,Non-resrderdlal, AddBbr,, Accessom. eta. Else a Comnenb area, if necessary.)
IS fz c .� rig 1;4 't- t. !At_
LATITUDEILONGITUDE (OPTIONAL) HOR6i:ONTAL DATUIM SOURCE:
or- #11.� L f NAD 19Z7 " U NAD 1983 �- (fix
U USGS Quad Map . U olrr. .
�G i i.ilil: is - i-i c. r . fi Lei WGE RA G (FiiiE) iitii=viiiii�r+i i�iill
6�11I. NFTP COMMUNITY NAME/a COMMUNITY NUMBER BZ COUNTY NAME- B3. STATE
/.
tin. mew ANU FANEL ' 55. SUFM, . B6. FiRM INDEX I B7., FMM PANS - B& FLOOD B9. BASE ROOD ELEVATiON(S)
NUMBER TE EFFE ®DATE MNE(S) (Lone AO, use depUrof1kxKII ,g)
810. Indicate the souree.of the Base Flood devotion (OF fl depih'entered m B9.
L j FiS Ptofite • .. Lj:FiRM j_J Community. Determined " LJ Other (Desrxibe)c
811. Indicate the elevation datum, used for the BFE rtt B9: L✓�NGVD 19M L J NAVD 1988 L1 Other (Describe):
B 1L 'is did lnaiaQ,g iw�iexi•in a C.crnsi:si:darrinr rtnsncau�s.5lrsrern [::iiiis} artai uri: mrmm rrt,itirand r,ttia (Wit jil L j ` " ivu
DesignaSort.Date:
SECTION C - BUILDING iLEVATiON INFO TION (SURVEY• REQUIRED} .
C1. Butidrttg eleV�lttotla l hd dri:' LJCorisEtictitiri OrdV iirlor tnidNg Under CdiLedeti�, : LjFl isfied Cbrt�"t dump
'A new Elevation Cerlficate will be required when constnx on of the building is complete-
C2 Building Diagram Number ( (Select the. btaldmg diagram most similar to the buldi g for which this cea is tieing completed -see
I%IJN 6 dnd 7. If nd didtjfdtff dt:c:iffdfdfyfdOfftefL§ hie" 6ti17fiTi§. provl(id a MMM 8f p3fiob3 ifi.)
C3. Elevations -Zones AI-A30, AE, AH, A (with BEE), VE,•V1 V30, V (wfih-BFE), AR, ARIA, AR/AE, AR/A1,A30, AR/Ali, AR/AO
a
Complete Items 0 -i.below according to. the btulding diagram specified in Item C2. State the.dahan used. if the datum is drffen:nt•fivm
the datum used1hr the Bit in S9Cd6fi.B, cotivart the datiifrt to 9W used #braid BFE- Sfirnirfield rt'idai sii eirieeitg aitid tletiiimii.coiivlersiori.
calculation. Use the space provided or the Comments ared;•o[Secticn D•or$ectiorr G; as appropriate, b document the datum conversion.
Datum. Conversitm/Commenls "
Elevation referenceirtark used IDces-the elevation reference-maric usedappear•(in the•FIRM7 •j_J Yes No
a a) Top,of bottom'floor (including basement or enclosure)' ' . 6" 104
d b) Top of nand higher itoor - N
a c) Bottom of lowest horizontal structural member (V zones only) to
-❑ d) Attached garage (bop of slab) - • rtt< 6ry : _ iL(m) �' . •. �\
❑ e) Lowest elevation of machinery and/or equipment W 4
servicing the btnldin Describe in a Comments area,)
11-
❑ f) Lowest adjacent (fini hed) grade (LAG).-�-�iL(m} z �.
• g) Highest adjacent (finished) grade (HAG) R(m)
❑ h) No. of permanent openings (flood.ven1s) within 11L abbve.adjacent grade w' ti
J
❑ 0 'total area of all permanent openings (flood vents) in �C3-h ati in. (� 4:P, 00 L( t (�•c
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT Ci IMFiCATiON
This c:ertiticallon is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation Information-
/ cer* that the lnfonnaffon in Sections A, B, and C an this cerfiffcite represents my best etlorts to interpret the .data available.
I understand that any false statement may be punishable by fineorimprisonment under 19 U.S. Code. Section 1001.
C>i>zo L� � 5 � vLv ra`�° '� C_Q rz_L 6 Er•T
FEMA Form 81-31, January 2003 See reiverse side fir condnuafion, Replaces all previous editions
I
em" V,3s� ft r7
impoffrmt_ in these -spaces, copy the conwWandinj Infictinatlan from Section A.
SU14glNG STREET ADDRESS (Including ApL, UM Suite,. and/or Bldg. No.). OR P.O. ROUTE AND, E30X NO'.,'
6_1 T-17 LL rL- S \/'A- VZ_L-S.
STATE 23P
J
SECTION D - SURVEYOR, ENGINEER. OR ARCHITECTCERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent(company, and (3) building Omer.
COMMENTS
a
"'Check hale ffafta6tirrtei
SECTION E - BUILDING ELEVATION INFORMATION' (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zone AO and Zone A (without BFE),. complete Items, El. thro . ugh', . E5. W the: Elevation Certificate is Intended for use as supporting
information * a LOMA or LOMR-F, Section C must be compIG6&
.El. Building Diagram Number (Seledthe:building.diagram most similar to the building for which this certificate Is being completed -
seepages
tfnot dia—gm—m-a'c.curately.,'rep're'sen(sth-la b', 14
uffftgj:provIdea3ket iorpoptograph.)
E2. The top of the bottom floor (Including' basemerifor. enclosure) cf the btrildid below is Jn_(cm)" above or.Lj 9 _j ft. (m) r. I
(check one) the highest adfacent grade. -_(Use natural grade, if available.)
E3. For Building Diagrams 6-8 with openings (see page, 7.), the next higher floor or elevated floor (elevation b) of the building is
(m)-1 -, f n. (cm) above the highest adjacent-.0riade-' Complete Rams C3,h and C3.1 on front of form.
E4. The top of fh6 platform.dmichinei� andlar4qui'sler i0mehivi '"n,g4kebuildingis'l . 1 lt(m)l I r in. (cm) Lj above.or*LJ below
(check one) the• highest adjacent grade... (Use -natural grade. iftvailable.),.
E5. For Zone AO only: lfnoilood'dppotiuihbee'*"available; Is-thfftop; c?fthe-boftI elevated in: accordance with the community's
floodplain management ordnance? f I Yes L_j No L_ - l'UrilchbWn. The local biNeWl'in6it dertiN this irdbrinadon in Sfttloh G.''
(without a FEMA4ssued or community,49suad BFE) or Zone.AO must sign heriaL 7.he statements -in Sec9ons A 4 . _C, and Eamcorrect to
the best ofmiknowfedge.
PROPERTY OWNER'S OR OWNER'S AMORIZED REPRESENrATFVES NAM
ADDRESS' CLTY STATE 23P CODE
SIGNATURE DATE ,TELEPHONE.
.COMMENTS .
Li Checkim W attachments
SEFMWG. - BBiWWRINFORLIATION (OPTIONAL) .
The local official. who is authorized by law or ordinance to administer the community's ficadplain management ordinance can complete
Sedans A,.B', C (or E), and G of this Elevation Certificate. Complete-theapp! a (s) sign
icabl fteiii and.1gribelow.
G1. Lj 'Tie,iF46mmfion in Section Cwas.taken from other. documentation that has.been signed and embossed by a liceinsed surveyor.
engineer, or architect who is authorized by state or local law. to certify elevation. Information. (indicate the source and date of the
P
eIqvad "rll'da"o in the Comments -area below.)
.I �
G2_ Lj A carIrimunity official completed Section S for a building located in Zone A (vWthout a FEMA4ssued or community -issued BFE) or
G3. L_j The tollovArig Intormaition (Items G4•G9) is provided for community tioadplain management purposes:
[I*TEMFWrrISSUM- W. DATE CERTIFICATECERTIFICATEOF COMPLIANCIVOCCUPMCY �_PERMIT NUMBER ISSUED
G7. This permit has been issued for. L_j New Construction " Substantial Improvement
G8. Elevation of as -built lowest floor (including basement) of the building Is: IL (m) Datum:
99. SFE or (in Zone AO) depth of flooding at the building site is: ft. (m) Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
WUNA]UNh DAM
COMMENTS
-1 1 Check here Waffactiments
FEMA Form 81-31, January 2003 Replaces all previous editions
SCANNED
BY
St Lucie County
CERTIFICATE
This Certificate is issued pursuant to the requires
time of issuance this structure was in compliance
regulating building construction or use. For the f
FOCCUPANCY
; of the Florida Building Code certifying that at the
the various ordinances of St. Lucie County
3uilding Permit No.';-O-- -0180
Parcel/F61io Nbr: 4502-501-0576-000/9
Lot # Block:
Subdivision: Outdoor Resorts at Nettles Island
Occupancy: Residential - 1 & 2 family dwellings
Building Address: 390 NETTLES BLVD
Legal Description:
Permit Job CONSTRUCT SINGLE FAMILY RESIDENT= 2/2
Description
Permit Finaled: 04/26/2006
Contractor GANGI JOHN W I PREMIER CONSTRUCTION & REMODEI (561) 878-6475
9815 S OCEAN DR JENSEN BEACH, FL 34957
DENNIS M. GRIM, CBO Wednesday, April 26, 2006
Building Official Date Printed
NOTE:
This Certificate of Occupancy is issued to the above named, for building at the above named location only upon the express provision that
the applicant will abide by and comply with all the conditions of the Zoning Ordinances and all Ordinances or Building Codes of Saint
Lucie County pertaining to the erection, construction or remodeling of buildings or structures.
1
This also certifies that the electrical wiring and/or equipment, andthe plumbing work have been inspected and approved. The issuance of
this Certificate grants permission to occupy and use the property described herein only for the use indicated. Any change in use will
require a new Certificate of Occupancy.
POST IN A CONSPICUOUS PLACE
APR-18-06 12:09 PM FTD REALTY 561 878 "?540GANNP.01
-ED T
-C' ty INSULATION INSTALLATION CERTIFICATE
�^ TO: LOTQ BLOCK:- SECTION:
JOB NAME: ld
The undersigned hereby Certifies that Insulation has been Insta led tit the above described property as
follows:
A
1. Exterior CBS walls hAw en insulated with ......... ................Check one ( ) Spray on cellulose
a thickness inches o .-'I� which th s, according to the ()Fiberglass blankets
QpvYC� of r, FkFoil Aluminum Foil
ty NIA will an " R" value of V Other
x erior Frame walls have been insulated with ............................Check one ( ) Spray on cellulose
t thickness of & inches, which thickness, according to the (,/) Fiberglass blankets
PUBLIC WORKS m ufbcturer, CertalnTaod i I ( ) Aluminum Foil
ST. LUCIB COUNT`NPL enslty N/A will yield an "R" value of R-1 1 . ( ) Other
I
2. Ceilings Level have been insulated with ,,,,,,,,,,,,,,,,,,,,,,,,,Check one ( erglass blankets
to a thickness of / Q �in,lckness, according to the ( ) Fiberglass loose fill
manufacturer, �.Q�,-aG()Aluminum Foil
Density NIA will yield an "R" value of e,7Y ( ) Other,
Ceilings Cathedral p have been insulated with .........................Check one (;fibe�rglass blankets
to a thickness of / inwan.1cl.
'kness, according to the ( ) Fiberglass loose fill
manufacturer, (!y'Lt ( ) Aluminum Foil
Density N/A will yue of k-3 r/ ( ) Other
3, Interior knee walls have wInsulated with.. .......................Check on .(A Fiberglass blankets
to a thickness Inches, ickness, accordi ( ) Polyurethane
mane , CertainTeed ( )Spray on cellulose
D711 NIA yield an "R" ( ) Other
4. Garage partition walls of conditioned living areas have been
insulated with.. ........................ . .................. ...Check one V) Fiberglass blankets
to a thickness of 3.50 inches, whichl thickness, according to the () Spray on cellulose
manufacturer, CertalnTeed () Polyurethane
Density N/A will yield an"R:' value of 11 O Other
MULTI FAMILY RESIDENTIAL CONSTRUCTION ONLY: The common (party) walls separating
different tenants shall be Insulated as followsl- Frame/Metal stud walls R-1 I (Min.); CBS or Concrete walls
R-3 (Min.); by Energy Code requirements. See Energy Code Rev.1/87, paragraph 903,2(b), on page 9.17,
latest edition, These "minimums levels of insulation" are not Included In the energy Calculations, but shall
be installed In,the-field,
NOTE: Densities of sprayed on, loose fill,) or any other composed -on sit ipsulation shall be F.
(lb/ft3) average of three (3) "DRY SAMPLES" of actual Installation. 14�/�
r
LEER FIREPROOFING A INSULATION, INC.
Insulation Contractor Insulation Contractor Signature /
1 Q_ to
Insulation Contractors CC#�i %� ate o ertifioation�
r
If A —
Builder's Name • Sullder's CC# otary Public
' ,%;, JEAN S. OL,SON
MY CUMMI'S1D. d DD492232
EX4lRF.ti:Feb,unry«6•'—Of0
D-1 nt M. Co.
I •NINi•3NOTARY
I
PIP -14 0 5_�e'�'+ T
PatricI4 ExterMRnatin Inc.
3226 SE Gran Par Stuart FL 34997
(� 114,
Stuart ZZ2-286-6812° '�' q �06 Vero Beach 772-562-3700
Jupiter 561-744-2681 PUBLIC WORT s Port St Lucie 772-335-7378
ST.LU CIE COUNTY, FL
Certificate of Compliance for Termite Protection
(as required by Florida Building Code (FBC)1816.1.7)
Treatment Address: 3' 0 IVEM-c S Slav fF L,5Fri &E4C,b. FL
Builder: Permit #
❑ Footing. P Slab ❑ Driveway- ❑ Pool Deck ❑ Addition
❑ Other
I
Final Perimeter Treatment - Initial and Date for Final:, 3�as/off
Date: NOIVOG Time: /O : 3O, Square Footage
Product Used: P20?)u1 Tr_ _ Gallons: % Used: �S
Chemical Name: C-vi) a?rkArin Applicator: Sco+ (n+y
Method of Treatment: Soil Barrier
The building has received a complete treatment for the prevention of Subterranean termites.
Treatment is in accordance with rules and Ilaws established by the Florida Department of
Agriculture and Consumer Services.
Notice!to Builder
It is the responsibility of the builder to notify Patrick Exterminating .prior to the pouring of any
lab that abuts the above structure so that treatment can be completed and the` required paperworl
)r closing be submitted. Such slabs might be, but are not limited to: patios, porches, entryways,
,\C slabs, stoops, additions, bay windows, driveway additions, etc.,
Other areas that would ;require treatment would be:
1. Areas within the foundation that were disturbed after the initial treatment.
2. The foundation perimeter after final grade has been established.
Note: As per FBC 104.2.3 - If soil chemical barrier method'for termite prevention is used, final
exterior treatment shall be completed prior to final building approval.
Note: WARRANTY WILL BE ISSUED UPON COMPLETION.OF FINAL TREATMENT ONLY
MAR-31-06 12:09 PM F,TA REALTY
56:L, 878 8254 P.01
l
REQUEST FOR 30 DAY TEMPORARY POWER RELEASE
DATE; —j/
x
cap 4a ® 7 "•.�..1
tf /
ST. LUCIE COUNTY BLDG. & ZONING
2300 VIRGINIA AVE
FORT PIERCE,FL 34952.5652
Ph,
(561) 462-2165
RECEIVED AX (561) 462-1148
MAR 3 1 2006
PROPERTY DRES�: f
� w.•1
THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO
THE ABOVE DESCRIBED PROPERTY, FOR A PERIOD NOT TO EXCEED THIRTY (30)
DAYS, FOR THE PURPOSE OF i TESTING SYSTEMS AND EQUIPMENT IN
PREPARATION FOR FINAL INSPECTION. IN CONSIDERATION OF APPROVAL OF
THE REQUEST WE HEREBY ACKNOWLEDGE AND AGREE AS FOLLOWS;
1, This temporary power release in requested for the Above stated purpose only,
and there will be no occupancy, of any type, other than that permitted by
construction during this time per' iod.
2. As witness by our signatures, we hereby agree to abide by all terms and
conditions of this agreement, including Building Division Policy, which is
incorporated herein by reference.
3. All conditions and requirements listed in the attached document entitled
"Requirements for 30 Day Power for Testing" have been fulfilled and the
premises is ready for compliance inspection,
WE HEREBY RELEASE AND AGREE TO HOLD HARMLESS, ST. LUCIE COUNTY,
AND THEIR EMPLOYEES FROM ALL LIABILITIES AND CLAIMS OF ANY TYPE OF
NATURE WHICH MAY ARISE NOW OR IN THE FUTURE OUT OF TW$
TRANSACTION, INCLUDING ANY DAMAGES WHICH MAY BE INCURRED DUE TO
THE DISCONNECTION OF ELECTRICAL POWER IN THE EVENT OF VIOLATION OF
THIS AGREEMENT,,....
f !
OWNER
64W / SIGNATU
PACMICoe 610A)57;FtZ e-9tQAI
GENERAL CONTRACTOR
ELECTRICAL CONTRACTOR
0011131
SIGNA
EDWIN M. FRY, Jr., CLnu OF THE CIRCUIT COURT - SAINT LUCIE COUNTY
FILE # 2592276 OR BO 203 PAGE 715, Recorded 04/04/2005 ;� 2:41 PM
WANNED
NOTICE OF COMMENCEMENT
BY
41C'Nutf��a4P 11 �T`'1Y Tax ID# yS' 4Z-, 0/-z9576 -ODO-9
State Of adK/A4 County Of
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter
713, Florida Statutes, the following information is provided in this Notice of Commencement.
Legal Description of roperty and street address, if available ETlGE5 /SI-AAlb /Ale. A 00N� - (Sk_e7/ON.%1
PAQIt E t 3� o� �390 ZL_' t �'y ..i :ir<�/S�t/ �'N, c . ?s/9 57
General descriotion of improvements 5110',k E A-AM1k Y eE5
Owner's interest in site
Fee Simple Title holder (if other than
Address
Contractor dO/tlST, 7-IOAI/
Address 9�,C'
Surety /vie
Address
Amount of Bond S
Phone # -, 17J .
Fax # 0?,79- %5.55
Phone #
Fax #
i
Lcnder /V.4 Phone #
Address Fax #
Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by
Section 713.13 (1) (a) 7., Florida Statutes:
Name Phone #
Address Fax #
In addition to himself, owner designates of (Phone #
Fax # ) to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),.Florida Statutes.
Expiration date of notice of commencement is one year from the date of recording unlerss a ifferent`date is specified.
(Date)��.
SIGNATURE
STATE OF FLORIDA, COUNTY OF `� �` PQ�rnn',
Acknowledged before me this JO , day of —, 20 ,RY►`G , who is personally known to me or
who has produced as identification.
���. W10111 r
R\0\1\��EN T
�;Mty F9 Z
TYPE OR PRINT NAME OF NOTARY
NOTARY PUBLIC TITLE
COMMISSION NUMBER
STATE OF FLORIDA
ST, LUCIE COUNTY
THIS TO CERTIFY THAT THIS ISA
TRUE AND CORRECT COPY OFTHE
ORIGINAL,
ST. LUCIE COUNTY
CLE OF CIRC IT COURT
By;
Property Appraiser - St.Lucie,"ziI~anty, FL
Page 1 of 1
Frederick H Perrine Record: 1 of 1
Property Identification
PROPERTY RECORD CARD
<<Prev Next» Spec.Assmnt Taxes
Site Address: 390 NETTLES BvUANNE® ParcellD:
Sec/Town/Range: 02 :37S :41 E BY Account #k:
Map ID: 45/02F A Land Use:
Zoning: of LUCte CQ 9 City/Cnty:
4502-501-0576-000-9
120164
Vac Res
ST. LUCIE COUNTY
Exemptions Permits Map
���CIE CO
Rg
Ownership and Mailing j Legal Description
Owner: Frederick H Perrine Phyllis H Perrine NETTLES ISLAND INC, A CONDO -SECTION II PARCEL 390N
Address: 390 Nettles Blvd ANDPRO-RATA SHARE IN COMMON ELEMENTS (OR 284-2420
Jensen Beach FL 34957-3326 More...
Sales Information
Date Price Code Deed
2/1/1978 17500 01 CV
3/1 /1973 9000 00 CV
No Sketch
Available
Exterior Features
View:
ExtType:
Grade:
StoryHght:
Interior Features
BedRooms:
FullBath:
1 /2Bath:
%A/C:
I
Assessment Final Value Total Land and Building
Book/Page 2004 Val: 216100 Land Value: 170000 Acres: 0.05
0284 / 2420 Assessed: 216100 Building Value: 46100
0212 / 261,5 Ag.Credit: 0 Finished Area: 0 SgFt
Exempt: 0
Taxable: 216100
TotalTax: 4715.3
i
BUILDING INFORMATION
�d
RoofCover:
YearBlt:
EffYrBlt:
No.Units:
Electric:
HeatType:
HeatFuel:
%Heated:
RoofStruct:
Frame:
PrimeWall:
SecWall:
PrmintWall:
AvgHUFI:
Prm.Flors:
%Sprinkled:
Special Features and Yard Items i Land Information
Type Y/S Qty. Units Qual. Cond. YrBlt. No. Land Use Type Measure Depth
DOK2 - WOOD DOCK Y 1 348 AV AV 1977 1 0000-Vac Res CIUA-Unit 1
THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED.
THIS INFORMATION IS BELIEVED TO BE CORRECT AT THIS TIME BUT IT IS SUBJECT TO CHANGE AND IS NOT WARRANTED
l
http://www.pasle.org/PRC.asp?prclid=4502501105760009 4/4/2005
r' _ ``-,
A. M. ENGINEERING ANE =VESTING, INC.
3504 INDliSTRIAL 33RD STREET
FT. PIERCE, FLORIDA 34946 SCANNED
LOCAL OFFICE: (772) 461-7508 FAX: (772) 461-8830 BY
sttudecou*
REPORT OF FOUNDATION PAD COMPACTION
Client: Premier Construction & Remod Report Date: 8/12/05
Project No:
Report No: 6938
Site: 390 Nettles Blvd., Nettles Island Permit No: 05040180
�V
St. Lucie County, Florida ��
Foundation Pad
Density tests and Hand Cone Penetrometer (HCP) eading a made at a minimum of three locations in
the building pad. Density tests were performed in the upper one foot of fill. HCP readings were taken in
hand auger boreholes at one foot intervals from slab grade through the depth of fill. The density tests were
performed in general compliance with ASTM D 2922. The HCP test, in conjunction with information about
the soil type, is empirically correlated to the relative density of subsurface soils.
Density
Test No.
Date
Tested
Location
Elevation
(feet)
Dry Densi (cf)
Percent
Compaction
In Place
Proctor
6938
8/11/05
NE Corner
0-1
106.5
108.1
98.5
Center
0-1
106.9
108.1
98.9
SW Corner
0 - 1 -
107.5
108.1 1
99.4
* All elevations are below slab grade.
The depth of the fill was approximately three feet. The fill should extend at least five feet beyond the
building perimeter. At the time of our testing no i I nformation was available regarding the foundation pad
setbacks.
In the locations and depths that were tested, the fills has been compacted to a minimum of 95 percent of the
modified Proctor maximum dry density (ASTM D 1557). No soil borings were performed below the
recently placed fill.
Distribution: POSTEDClient — 2
SLC Bldg. Dept. — 1
Submitte&by:
A. . ENGINEERING -AND IESTING,`INC.
_y G
ebecca GrahVA coli,
Florida Registrafiori No. 517863
F.•ILITTLE LOG BOOKIHouse JobslMisc. House JobslSaint Lucie Co' 1itntylPremier(6938)390 Nettles Blvd..doc, SL
I
.1
Cn
CD
.E
t0T
+�—
a}
E
-0—+
ICU
Q�
i�
r ' . SCANNED
BY
Lucie Coc tv ,
Port St. Lucie Building Department
THIS FORM IS TO BE FILLED OUT
tiY PEST CONTROL- COMPANY
Certificate of Complianc
Minis is a partial treatment only end not a guarantee
PERMIT NUMBER: 0
LOCATION OF PROPERTY:
LEGAL DESCRIPTION:
PEST--ONMOL COhAPAtJY
RICHARD C. PATRICK
COMPANY OWNER--P''rF SE PRINT
•
SIGNATURE
OWNER
DATE i fTLE
SCIL TREATMENT COMPANY INFORMATION
PATRICK EXTERMINATING. INC.
SOIL TREATMENT COMPWY NAN E
3226 S.E.:GRAN PARK WAY, STUART
ADDRESS ,
4864
SOIL TREATMENTIDACS LICENSE #
fLJ The building has received a complete treatment for the
Prevention of subterranean termites_ Treatment is inT
Accordance with the rules and- laws established by the
Florida Department of Agriculh:,re and Consumer Services.
A second teatment was done on Patel I ; I as per
Manufactures specification. If the second treat rght is not
reau:red. a coov of theroduct label shall be inciuded with
_ This Certrficate.
w Please Note: The City of Port St.1 cie does not guarantee or war, arty the preconstmotlon soil treatment attested to
in tie above. The purpose of this document is to show that to the best of this Departments knowledge, the builder
'9 has satisfied the recuirements of the Florida Building Code for protection against termites.
c This form roust be ietumed to the Building Department
before your ifinal Inspection is scheduled.
TREATMENT' INIFORIMATION
WE OF TREATMENT
Gtr ,
CHEMICAL LWD
CONC=jN 1. rATI 0 N�/
GALLONS USED
METHM OF APPL ICAMON,7Wd" Soi Wed. EIC.1
/2f,—V
UNEAR FOO PiGE OF AEA TREATED
SECOND TREATMENT INFORMATION
DATE OF TREATMETNT
CHEMICAL USED
CONCFNT;?ATATION
GALLONS USED
METHOD OF APPLICAEON(Roddad, W M=xed, M.j
LINEAR FOOTAGE OF AREA TREATED
T-d QLE IT VO SO Li?r
��� 1�r� --
Code Compliance Division
2300 Virginia Avenue
Ft. Pierce, FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1168
Date: 04 April 2005
Address: 390 NETTLES BLVD
Received By: counselb
Paid With: CK
Building
Fee Receipt
Paid By: PREMIER CONSTRUCTION & REMODELING INC I Sign:
,SCANNED
Receipt #:
0000012717
Permit Number:
SLC- 0504-0180
Amount:
$175.00
Credit Card Number
Check Number:
13633