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Home My WebLink AboutELEVATION CERTIFICATES 11-18-19COVER SHEET ,5(;AN(Vt:jj 11-18-19 BY StLucieftnbi SLC Building Dept Permit # 1906-0112 Re: elevation certification Added 4 vents for stairs U.S."DEPARTMENT OF HOMELAND SECURITY �y BY OMB No:1660-008 Federal Emergency Management Agency St'LueieCount, Expiration Date: November 30, 2018 National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on Pages 1-9 Conv all Paces of this Flevation 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: 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 i 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 (#4511-501-0322-000-2) A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL AS. 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 10 c) Total net area of flood openings in A8.b 370 sq. in. d) Engineered flood openings? ® Yes ❑ No A9. For a building with an attached garage: a) Square footage of attached garage 0 sq. ft. b) Number of -permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0 _ �) Total• net prea•of flood openings in A9.b 0 sq. in. d)Engineered flood -openings? ❑ Yes ® No = 3 :I -• '' �> SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61 NPIP Cpunity Name & Community Number B2. County Name B3. State ST.111.ICIE CLYUNINCAREAS 120285 ST. LUCIE FL B4t Map/Renel 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) 12111C0314 J 02/16/12 02/16/12 AE 7.0 610. 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: Bll. 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 OMB No: 1660-008 ELEVATION CERTIFICATE Expiration Date: November30, 2018 IMPORTANT: In these spaces, copy the corresponding information frorn.5ection 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 A1- 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 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) 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 ® Che ere if attac ments. Certifier's Name: License Number: Stephen J. Brown, PSM L.S. 4049 „ , $eaF Title: Professional Surveyor and Mapper �ere ' Company Name: Stepheei J r " , PSM,' L.S. 40 Florida Stephen J. qComminc. Addre 61 AST 5th STREET I ti of Id with t.thesignoture;and Ity: State: Zip Code: a original isedseal of a Florida STUART FL 34994 Licens Surveyor, & Mapper" Signature: Date: Telephone: Stephen J. Brow , M 11/19/19 (772) 288-7176 Copy all Pages s Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Commen m in g type of equipment and location, per C2(e), if applicable. A ABLE -FLOOD MAP AUTOMATIC FLOOD VENT MODEL# FFNF05 (see attached) NCLOS AREA COVERAGE 220 sq. ft., NET FREE AREA OPENING 37 sq. i n. TOTAL COVERAGE OF 10 VENTS AT 220 sq. ft. PER VENT EQUALS 2200 sq. ft. A8 c TOTAL COVERAGE OF 10 VENTS AT 37 sq. in.,PER VENT EQUALS 370 sq. in. C2 a 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 El-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 Diagram's 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 El feet El meters El above or ❑below the HAG the diagrams) of the building is E3. Attached Garage (top ofislab) ❑ 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 bylaw 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 AO. G3. ❑ The following information (Items G4.—.GLO). 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) ❑feet El 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) 1 Replaces all previous editions Page 4 of 6 BUILDING PHOTOGRAPHS OMB No: 1660-008 ELEVATION CERTIFICATE 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: 10725 S OCEAN DR., #117 City State Zip Code Company NAIC Number: JENSEN BEACH FL 34957 If using the Elevation Certificate to obtain NAP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with data 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. min, 9 1 , 4sbb 1� 1 R Rw V , S. ,�. 1 mv 07, .. 10103119 10103119 Photo One Caption: SIDE/FRONT VIEW Photo Three Caption: SIDE VIEW a� 1 � . 10103119 10103119 Photo Two Caption: REAR/SIDE VIEW Photo Four Caption: 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 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 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 11118119 11118119 Photo One Caption: FLOOD VENT Photo Three Caption: FLOOD VENT I i t 11118119 11118119 Photo Two Caption: FLOOD VENT Photo Four Caption: FLOOD VENT FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 6 of 6 U 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 Coov 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 (#4511-501-0322-000-2) '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 A8.b 1320 sq. in. d) Engineered flood openings? ® Yes ❑ No i A9. For a building with an attached garage: a) Square footage of attached garage 0 sq. ft. b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0 c) Tota!;net area of•flood openings in A9.b 0 sq. in. d)-Ergineered,flood openings? ❑ Yes ® No SECTION B—FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. i3F'I'P Corrmm.unity N`a,me'c4c:Community Number B2. County Name B3. State ST. LUCIE CTY UNINC AREAS 12028S ST. LUCIE FL B4. Map%Panel . B5. Suffix B6. Firm Index B7. FIRM Panel B8. Flood Zone(s) B9. Base Flood Elevation(s) Number' r 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 69: ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate Elevation Datum Used for BFE in Item 139: ❑ 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 A 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 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 Vl — 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 8.47 ® feet ❑ meters (Describe type of equipment and location in Comments) 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 1 3.98 ® feet ❑ meters structural support i 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 ® Ch a if attachments. Certifier's Name: License Number: Stephen J. Brown, PSM L.S. 4049 Place. , Seam , ', ' Title: Professional Surveyor and Mapper H =r6 �- Company Name: Stephen J r Nn;:Psi1ll- L.S. 4 to of Flor;da. `. Stephen J. Brown, Inc. Address: 619 ES EET ` N alid 'thout.the siynafure and the on 'Sul raised'seal of a'Florida State: Zip Code: STUART FL 34994 Li used Surveyor & Mapper" Signature: Date: Telephone: Stephen J. Brow M 10/16/19 (772) 288-7176 Copy all Pages_pWs Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comme n ing type of equipment and location, per C2(e), if applicable. TOT COVERAGE OF 6 VENTS AT 220 SQ FT PER VENT EQUALS 1320 SQ FT J_ C2 e IS E BOTTOM OF THE A/C UNIT FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 2 of 6 ELEVATION CERTIFICATE A 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 El-E5. If the Certificate is intended to support a LOMA and or LOMR-F request, complete Sections A, B, and C. For Items El-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 adjacent1grade (LAG). a) Top of bottom floor (including basement, El ❑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 El feet El meters El 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 I Comments ❑ Check here if attachments FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 3 of 6 A - 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: 1ENSEN 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 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 G7. This Permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) ❑ 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 or b u BUILDING PHOTOGRAPHS OMB No: 1660-008 C\/ATIAAI f�fC F]TI CIf`AT/' Coo Inctrnrtinnc fnr It —AC. -.^■■— "■-^■■■ ■�^I�I txplratlonUate: November 3u, zui8 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. 10103119 10103119 Photo One Caption: SIDE/FRONT VIEW Photo Three Caotion: SIDE VIEW WIT111 ;w — f "�y m, d � i 10103119 10103119 Photo Two Caption: REAR/SIDE VIEW Photo Four Caption: REAR/SIDE VIEW FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 5 of ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See lInstructions for Item A6 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 Bidg. 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. r ! 1 I � 10103119 Photo One Caption: REAR/SIDE VIEW Photo Three Caption: ` 1W I 10103119 Photo Two Caption: SIDE VIEW Photo Four Caption: FEMA Form 086-0-33 (7/15) 1 Replaces all previous editions Page 6 of 6 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 Cnnv all Pages of this Flevation 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 touseforany other person orentity). 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• (#4511-501-0322-000-2) 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 A8.b 222 sq. in. d) Engineered flood openings? ® Yes ❑ No A9. For a building with an attached garage: a) Square footage of attached garage,0 sq. ft. ,r b) Numbendf permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0 c),Total net area,of flood openings in A9.b 0 sq. in. dj Engineered flood o�znings? ❑11 Yes ® No - SECTION B —FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61..NFiP Community Name & Community Number B2. County Name B3. State ST. L•UCIE CTY UNINC AREAS' 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 1310. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69: ❑ 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 r 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 C— BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. 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 BF E.• 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 8.47 ® feet ❑ meters (Describe type of equipment and location in Comments) 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 El 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. l 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 ® eck here if ttachments. Certifier's Name: License Number: ;�• Stephen J. Brown, PSM L.S. 4049 Plac ..t �•` Se I Title: Professional Surveyor and Mapper H " " Company Name: se . Brovyn, PSM .".4 9, State of F,iorida Stephen J. n, c. Ad�EAT 6Sth STREET -' = -" Not j{ lid,with0' the,signature and th original raised seal ofn Florida ity: State: Zip Code: STUART FL 34994 Licensed Surveyor & Mapper" Signature: Date: Telephone: Stephen J. Br SM 10/23/19 (772) 288-7176 Copy all Pa is Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. i uding type of equipment and location, per C2(e), if applicable. CommAB 1-FLOOD MAP AUTOMATIC FLOOD VENT MODEL# FFNF05 (see attached) ENCLO ED AREA COVERAGE 220 sq. ft., NET FREE AREA OPENING 37 sq. i n. TOTAL COVERAGE OF 6 VENTS AT 220 sq. ft. PER VENT EQUALS 1320 sq. ft. A8 c TOTAL COVERAGE OF 6 VENTS AT 37 sq. i n. 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 El-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, El feet El meters El above or ❑ below the HAG crawlspace, or enclosure) is b) Top of bottom floor (including basement, ❑feet El meters El 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 El 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 El feet El meters El 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 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 G7. This Permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) ❑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 oT b BUILDING PHOTOGRAPHS OMB No: 1660-008 ELEVATION CERTIFICATE 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: 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. dg1YY' 10103119 10103119 Photo One Caption: SIDE/FRONT VIEW Photo Three Caption: SIDE VIEW {. 10103119 10103119 Photo Two Caption: REAR/SIDE VIEW Photo Four Caption: REAR/SIDE VIEW FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 5 of 6 a o. BUILDING PHOTOGRAPHS OMB No: 1660-008 ELEVATION CERTIFICATE 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: 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. l f \ {f 10103119 Photo One Caption: REAR/SIDE VIEW Photo Three Caption: I f 10103119 Photo Two Caption: SIDE VIEW Photo Four Caption: FFMA Form 086-0-33 (7/15) Replaces all previous editions Page 6 of 6 ESR-3560 I Most Widely Accepted and specified in, those codes listed in Section 1.0 of this report, subject to the following conditions: 5.1 The Flood Flaps® automatic FVS must be installed in accordance with this report, the appli ble 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 coast I high hazard areas, but are permitted for use in njunction with breakaway walls in other areas. 6.0 EVIDENCE SUBMITTED Data in accordance with the ICC-ES Acce tance Criteria for Mechanically Operated Flood Vents (/ C364), dated August 2015 (editorially revised October 201 { }. 7.0 IDENTIFICATION 7.1 The Flood Flaps® models recognized in this reportare identified by a label bearing the manufacturer's name, the model number, and the evaluation report number (ESR-3560). 2of4 7.2 The report holder's contact information is the following: FLOOD FLAPS®, LLC POST OFFICE BOX 1003 ISLE OF PALMS, SOUTH CAROLINA 29451 (1343) 881-0190 www.floodfiaps.com infoCcDfloodflaps.COm TABLE 1—FLOOD FLAP AUTOMATIC FLOOD VENT MODEL SIZES MODEL NUMBER MODEL ;DESIGNATION RO (W dth X Height)(W (inches) GH OPENING;15"/, VENT SIZE X H X D) (inches) ENCLOSED AREA COVERAGE W) NET FREE AREA OPENING' (ln2) FFWF12 Sealed Series I 16 x 8 /a X 7 /4 X 12 220 NA FFNF12 Multi -Purpose 16 x 8 X 7 /4 X 12 220 37 FFWF08 Sealed Series ( 16 x 8 1551, x 7 /4 x 8 220 NA FFNF08 Multi -Purpose j 16 x 8 II 15 /8 x 7 /4 x 8 220 37 FFWF05 Sealed Series 16 x 8 15 /a x 7 /4 x 5 220 NA FFNF05 =nr sl- 1 i—h a 9r, A .....,- Multi -Purpose 4 412 - n nno —2 116 x 8 I ' 15 /e x 7 /4 x 5 220 37 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: NotValidto use for any other person orentity). Policy Number: ROSEMARIE PALAZZOLO 44058-92 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 (#4511-501-0322-000-2) 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 A8.b 1320 sq. in. d) Engineered flood openings? ® Yes ❑ No A9. For a building with an attached garage: a) Square footage'of attached garage 0 sq. ft. b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0 c) Total net area•of $lbbd openings in A9.b 0 sq. in. d) Engineered flood -openings?- ❑ Yes ® No SECTION B —FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFiP CQmmunity Narrie.& Community Number B2. County Name B3. State ST. LUCIE CTY. UNINC AREAS 120285 ST. LUCIE FL B4. Map/Parcel • 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 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 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 A1- 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 0 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 ,' 8.47 ®feet El meters (Describe type of equipment and location in Comments) 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 N/A. El 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 ® Check here if att hments. Certifier's Name: License Number: Stephen J. Brown, PSM L.S. 4049 PI c I Title: Professional Surveyor and Mapp r �r.e - Company Name: _ S phe/dJ . BraV vn,-PSaVI S.'404State of Flo?ida Stephen J. Brown, Inc. Address: 619E 51h STREET 'Not Valid 'withour the signature and INot the original raised seal of a Florida Cit . State: Zip Code: UART FL 34994 Licensed Surveyor & Mapper" (ignature: Date: Telephone: tephen J own, M 10/10/19 (772) 288-7176 Co P ges of thi levation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Com nts (iricludinIftype of equipment and location, per C2(e), if applicable. C2 e IS THE BOTTOM OF THE A/C UNIT FEMA Form 086-0-33 (7/15) Replaces all previous editions i age Z of b 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 E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE A0 AND ZONE A (WITHOUT BFE) For Zones AO and A (Without BFE), complete Items El-E5. If the Certificate is intended to support a LOMA and or LOMR-F request, complete Sections A, B, and C. For Items El-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 Elabove or ❑ below the HAG crawlspace, or enclosure) is b) Top of bottom floor (including basement, El feet El meters ❑above or E] 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 El feet El meters Elabove or E] 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 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 G7. This Permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) ❑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 or 6 BUILDING PHOTOGRAPHS OMB No: 1660-008 ELEVATION CERTIFICATE 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: 10725 S OCEAN DR., #117 City State Zip Code Company NAIC Number: JENSEN BEACH FL 34957 If using the Elevation Certificate to obtain NAP 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. ro �..._.an.—.«...�.�,...__....—mow.—.�.--.-..�..ro..—.r.�ci 1 ` !_ � 10/03119 10103119 Photo One Caption: SIDE/FRONT VIEW Photo Three Caption: SIDE VIEW 10103119 10103119 Photo Two Caption: REAR/SIDE VIEW 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 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 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'Iflood openings or vents, as indicated in Section A8. �4� I i LL 10103119 Photo One Caption: REAR/SIDE VIEW Photo Three Caption: sl' 't GMro i , 10103119 Photo Two Caption: SIDE VIEW Photo Four Caption: FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 6 of 6