HomeMy WebLinkAboutELEVATION CERTIFICATE 10-4-18U.S. DEPAJRTMENT OF HOMELAND S�EOURITY
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Federal Emergency Management Agency SCANNED OMB No. 1 Expiration Date:ate: November 30, 2018
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National Flood Insurance Program
ELE► 0A_30tRTIFICATE
Important: Follow the instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance a4ent/comoanv. and (3) buildino owner -
SECTION A — PROPERTY INFORMATION
FOR INSURANCE COMPANY USE
Al. Building Owner's Name
Policy Number:
D.R. HORTON CT#15-141.100.031
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A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No.
Company NAIC Number:
I8629 COBBLESTONE DRIVE
City State ZIP Code
FORT PIERCE Florida 34945
A3. Property Description (Lot and Block Numbers, Tax Pardel Number, Legal Description, etc.)
2326-600-0036-000-0 '� Lot 31
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential
A5. Latitude/Longitude: Lat. 27°24'36.54" N Long.80°24'47.87" 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.
AT Building Diagram Number 1A
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 on 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 Z No
A9. For a building with an attached garage:
a) Square footage of attached garage 400.00 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 /A sq in
d) Engineered flood openings? ❑ Yes ❑x No II
SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number
B2. County Name
B3. State
St. Lucie County 120285
Saint 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
12111C0170
J
02-16-2012
02-16-2012
AE
16.5
810. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 139:
❑ FIS Profile 0 FIRM ❑ Community Determined ❑ Other/Source:
811. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ❑x NAVD 1988 ❑ Other/Source:
B12. Is the building located in a Coastal Barrier Resources System (CBRS)-area or Otherwise Protected Area (OPA)? ❑ Yes 0 No
Designation Date: ❑ CBRS ❑ OPA
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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:
8629 COBBLESTONE DRIVE
City State ZIP Code
FORT PIERCE
Company NAIC Number
Florida 34945
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Buildingelevations are based on: ❑ Constructioln Drawings* x❑ 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), YI E, 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: AF6653 Vertical Datum: NAVD 88
Indicate elevation datum used for the elevations in itelms a) through h) below.
❑ NGVD 1929 ❑x 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, 18.34
crawlspace, or enclosure floor) ❑x feet ❑ meters
b) Top of the next higher floor I 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) 17.74 ❑x feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment and location in Comments) N/A ❑ feet ❑ meters
f) Lowest adjacent (finished) grade next to building (LAGI) N/A ❑ feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) N/A ❑ feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
structural support I N/A ❑ 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? ❑x Yes ❑ No ❑ Check here if attachments.
Certifier's Name License Number
Thomas P. Kiernan 6199
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„` ense�%y�.,•�ti �I
Title
Professional Surveyor
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Company Name
Culpepper & Terpening. Inc. I
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Addressso••I°r
2980 South 25th Street
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City State ZIP Code
Fort Pierce Florida 34981
Signature Date Telephone Ext.
9 464-3537
(772) 206
Copy all pages of this Elevation Certificate and all attachments for (1) com unity official, (2) insurance agent/company, and (3) building owner.
Comments (including type of equipment and location, per C2(e), if applicable)
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:
8629 COBBLESTONE DRIVE
City State ZIP Code
Company NAIC Number
FORT PIERCE Florida 34945
SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED)
FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zones AO and A (without BFE), complete Items E1—E5. If the Certificate is intended to support a LOMA or LOMR-F request,
complete Sections A, B,and C. For Items E1—E4, use natural grade, if available. Check the measurement used. In Puerto Rico only,
enter meters.
E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below
the highest adjacent grade (HAG) and the lowest adjacent grade (LAG).
a) Top of bottom floor (including basement,
crawlspace, or enclosure) is ❑ feet [:]meters ❑ above or ❑ below the HAG.
b) Top of bottom floor (including basement,
crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 1-2 of Instructions),
the next higher floor (elevation C2.b in
the diagrams) of the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E4. Top of platform of machinery and/or equipment
servicing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's
floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G.
SECTION F — PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or
community -issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge.
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Property Owner or Owner's Authorized Representative's Name '!
Address iI City State ZIP Code
Signature !i Date Telephone
Comments
Check here if attachments.
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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:
8629 COBBLESTONE DRIVE 1I
City State ZIP Code
Company NAIC Number
FORT PIERCE Florida 34945
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. Check the measurement
used in Items G8—G10. In Puerto Rico only, enter meters
G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,
engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation
data in the Comments area below.) `I
❑ A community official completed Section E for a building located in Zone A (without a FEMA-issued or community -issued BFE)
G2
or Zone AO.
G3. ❑ The following information (Items G4—G10) is provided for community floodplain management purposes.
G4. Permit Number
G5. Date Permit Issued
G6. Date Certificate of
Compliance/Occupancy Issued
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G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement
G8. Elevation of as -built lowest floor (including basement)
of the building: ❑ feet ❑ meters Datum
09. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum
G10. Community's design flood elevation: ❑ feet ❑ meters Datum
Local Official's Name I Title
Community Name Telephone
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Signature i Date
Comments (including type of equipment and location, per C2(e), if applicable)
❑ Check here if attachments.
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ELEVATION CERTIFICATE
BUILDING PHOTOGRAPHS OMB No. lsso-000s
,See Instructions for Item A6. 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:
8629 COBBLESTONE DRIVE
City State ZIP Code
Company NAIC Number
FORT PIERCE Fllorida 34945
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If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the
instructions for Item A6. Identify all photographs with date taken; "Front View" and "Rear View'; and, if required, "Right Side View" and
"Left Side View." When applicable, photographs must ,,show the foundation with representative examples of the flood openings or
vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page.
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,Photo One
Photo One Caption Front Clear Photo One -
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Photo Two1
Photo Two Caption Back CliacPhoto�Tw�o9
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ELEVATION CERTIFICATE
BUILDING PHOTOGRAPHS OMB No. 1660-0008
Continuation Page 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.
8629 COBBLESTONE DRIVE
Policy Number:
City State ZIP Code
FORT PIERCE Florida 34945
Company NAIC Number
If submitting more photographs than will fit on the prlceding page, affix the additional photographs below. Identify all photographs
with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable,
photographs must show the foundation with representat I ive examples of the flood openings or vents, as indicated in Section A8.
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Photo Three
Photo Three Caption Right Side I Caear Photo Three
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Photo Four
Photo Four Caption Left Side I a'r Pto Four
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