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HomeMy WebLinkAboutELEVATION CERTIFICATE-DISAPPROVEDSCANNED BY IthiripCOMW COVER SHEET o,SP,Plpp,oljfiD U.S. DEPARTMENT OF HOMELAND SECURITY OMB No: 1660-008 Federal Emergency Management Agency Expiration Date: November 30, 2018 National Flood Insurance Program 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 (Note: Not Valid to use for any other person or entity). Policy Number: ROSEMARIE PALAZZOLO #4058-92 A2. Building Street Address (Including Apt., Unit, Suite, and/or Bldg. No. or P.O. Route and Company NAIC Number: Box No. 10725 S OCEAN DR.,.#117 City State ZIP Code JENSEN BEACH FL 34957 A3. Property Description. (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 25, BLOCK K, HOLIDAY OUT AT ST. LUCIE (44511-501-0322-000-2) A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude:.Lat. 27°16'8.0472"N Long.-80°12'22.392"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. A7. Building Diagram Number:8 A8. For a building with a crawlspace of enclosure(s): a) Square footage of crawlspace or enclosure(s) 818 sq. ft. b) Number of permanent flood openings; in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 6 c) Total net area of flood openings in A8i I.b 222 sq. in. d) Engineered flood openings? ® Yes J ❑ No A9. For a building with an attached garage! a) Square footage of attached garage 0 sq. ft. b) umber of p'r'�,nagent flood openings in the attached garage within 1.0 foot above adjacent grade 0 tal net: area of flood openings in A9.b 0 sq. in. n __ -. d) Engineered flood openings? ❑ Yes ® No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NFI'P Community Name &Community Number B2. County Name B3. State ST. LUCIE CTY.UNINC A'PEAS 120285 ST. LUCIE FL B4. Map/Panel B5. Suffix B6. Firm Index B7. FIRM Panel B8. Flood Zone(s) B9. Base Flood Elevation(s) Number Date Effective/ (Zone AO, use Base Revised Date Flood Depth) 12111CO314 J 02/16/12 02/16/12 AE 7.0 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 69: ❑ 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: ❑ CBRS ❑ OPA FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 1 of 6 ELEVATION CERTIFICATE OMB No: 1660-008 Exoiration 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: 10725 S OCEAN DR., #117 City State Zip Code Company NAIC Number: JENSEN BEACH FL 34957 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/Al — 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: 94 77 A 03 RM 2 FLDT ELEV. 4.08' 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 building 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) 3.98 ® feet ❑ meters b) Top of Next Higher Floor 8.53 ® 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 (Describe type of equipment and location in Comments) II 8.47 ® feet ❑ meters f) Lowest adjacent (finished) grade next to building (LAG) 3.58 ® feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 3.98 ® feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including 3.98 ® 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. 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? ® Yes ❑ No ® C < here i tachments. Certifier's Name: License Number: f Stephen J. Brown, PSM L.S. 4049 Place _ - Seal" _ Title: Professional Surveyor and Mapper ,,. Her - - Company Name: Step ' own;'PSM-• ate of Florida Stephen J. Brown, Inc. Add �EET 619ress: "NoE iti�out the signature and the raised seal ofa Florida C' State: Zip Code: TUART FL 34994 Surveyor & Mapper" Signature: Date: Telephone: Stephen J. Bro 10/23/19 (772) 288-7176 Copy all Page is Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Commen uding type of equipment and location, per C2(e), if applicable. A8 B 1-FLOOD MAP AUTOMATIC FLOOD VENT MODEL# FFNF05 (see attached) ENCL ED AREA COVERAGE 220 sq. ft., NET FREE AREA OPENING 37 sq. in. TOTAL COVERAGE OF 6 VENTS AT 220 sq. ft. PER VENT EQUALS 1320 sq. ft. A8 c TOTALCOVERAGE OF 6 VENTS AT37 sq. in. PER VENT EQUALS 222 sq. in. C2 e IS THE BOTTOM OF THE A/C UNIT FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 2 of 6 ELEVATION CERTIFICATE OMB No: 1660-008 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: 10725 S OCEAN DR., #117 City State Zip Code Company NAIC Number: JENSEN BEACH FL 34957 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 and 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, ❑ feet ❑ meters ❑ above or ❑ below the HAG crawlspace, or enclosure) is b) Top of bottom floor (including basement, ❑ feet ❑ meters ❑ above or ❑ below the LAG crawlspace, or enclosure) is 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 ❑feet ❑meters ❑above or ❑ below the HAG the diagrams) of the building is E3. Attached Garage (top of slab) ❑ feet ❑ meters ❑ above or ❑ below the HAG E4. Top of platform of machinery and/or equipment ❑ feet ❑ meters ❑ above or ❑ below the HAG servicing the building is E5. Zone AO only: If no flood depth number is available, is the top of the 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. Property Owner or Owner's Authorized Representative's Name: Address City State Zip Code Signature Date Telephone Comments ❑ Check here if attachments FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 3 of 6 ELEVATION CERTIFICATE OMB No: 1660-008 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: 10725 S OCEAN DR., #117 City State Zip Code Company NAIC Number: JENSEN BEACH FL 34957 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). G2. ❑ A community official completed Section E for;a building located in Zone A (without a FEMA-issued or community issued BFE) or Zone AD. 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 G7. This Permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) El feet ❑ meters Datum of the building: G9. BFE or (Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum G10. Community's design flood elevation: ❑ feet ❑ meters Datum 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. Local Official's Name Title Community Name Telephone Signature Date Comments ❑ Check here if attachments FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 4 of 6 BUILDING PHOTOGRAPHS OMB No: 1660-008 ELEVATION CERTIFICATE See Instructions for Item A6 Exoiration 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: 10725 S OCEAN DR., #117 City State Zip Code Company NAIC Number: JENSEN BEACH FL 34957 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. all �. / l� • yam• . r. 10103119 10103119 Photo One Caption: SIDE/FRONT VIEW Photo Three Caption: SIDE VIEW 10103119 10103119 Photo Two Caption: REAR/SIDE VIEW 1 Photo Four Caption: REAR/SIDE VIEW FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 5 of 6 BUILDING PHOTOGRAPHS OMB No: 1660-008 ELEVATION CERTIFICATE See Instructions for Item A6 Exoiration 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: 10725 S OCEAN DR., #117 City State Zip Code Company NAIC Number: JENSEN BEACH FL 34957 If Submitting more photographs that will fit on the preceding 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 representative examples of the flood openings or vents, as indicated in Section A8. i t ' 10103119 Photo One Caption: REAR/SIDE VIEW Photo Three Caption: NONE -77 10103119 Photo Two Caption: SIDE VIEW Photo Four Caption: FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 6 of 6 ESR-3560 I Most Widely Accepted and Trus(`ed specified in, those codes listed in Section 1.D Of this report, subject to the following conditions: 5.1 The Flood Flaps® automatic FVs must be installed in accordance with this report, the applicable code and the manufacturer's installation instructions. In the event of a conflict, the instructions In this report govern. 5.2 The Flood Flaps® automatic FVs must not be used in place of "breakaway walls" in coastal high hazard areas, but are permitted for use in conjunction with breakaway walls in other areas. 6.0 EVIDENCE SUBMITTED Data in accordance with the ICC-ES Acceptance Criteria for Mechanically Operated Flood Vents (AC364), dated August 2015 (editorially revised October 201 7.0 IDENTIFICATION 7.1 The Flood Flaps® models recognized in this report are identified by a label bearing the manufacturer's name, the model number, and the evaluation report number (ESR-3560). TABLE 1 MODEL MODEL NUMBER DESIGNATION FFWF12 Sealed Series FFNF12 Multi -Purpose FFWF08 Sealed Series FFNF08 Multi -Purpose FFWF05 Sealed Series FFNF05 Multi -Purpose For SI: 1 inch = 25.4 mm; 1 Pz = 0.093 m2 'For under -floor ventilation only. Paae 2 of 4 7.2 The report holder's contact information is the following: FLOOD FLAPS®; LLC POST OFFICE BOX 1003 ISLE OF PALMS; SOUTH CAROLINA 29451 (843) 881-0190 www.floodflamI6om infoPfloodflaps.com FLAP AUTOMATIC FLOOD VENT MODEL SIZES GH OPENING VENT SIZE ith X Height) (W X H X D) (inches) (inches) ENCLOSED AREA COVERAGE NET FREE AREA OPENING' (in) 16x8 151,X7/;X 22 220 NA 16x8 15/,X7/4X 22 220 37 16x8 15Isx7/4x8 220 NA 16x8 15/ax7/4x8 220 37 16x8 15/Bx7/4x5 16x8 15/8x7/4x5 220 220 NA 37 FIGURE 1 i FLOOD FLAPS® AUTOMATIC FLOOD VENT 1.