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Home My WebLink AboutFEMA-ELEVATION CERTIFICATE 5-28-185 FEMA NATIONAL FLOOD 1 ELEVATION PROGRAM ERTIFICATE INSTRUCTIONS 2015 EDITION i OMB No. 1660-0008 Expiration Date: November 30, 2018 U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency lManagement Agency National Flood Insurance Program ELEVATION CERTI Paperwork Public reporting burden for this data collection is estimated to a, time for reviewing instructions, searching existing data sources submitting this form. You are not required to respond to this displayed on this form. Send comments regarding the accura burden to: Information Collections Management, Department 1800 South Bell Street, Arlington, VA 20598-3005, Paperwc completed form to this address. Privacy Ai Authority: Title 44 CFR § 61.7 and 61.8. TE AND INSTRUCTIONS Act Notice rage 3.75 hours per response. The burden estimate includes the gathering and maintaining the data needed, and completing and :ollection of information unless a valid OMB control number is y of the burden estimate and any suggestions for reducing the f Homeland Security, Federal Emergency Management Agency, k Reduction Project (1660-0008). NOTE: Do not send your Statement Principal Purpose(s): This information Is being collected for the primary purpose of estimating the risk premium rates necessary to provide flood insurance for new or substantially improved structures in designated Special Flood Hazard Areas. Routine Use(s): The information on this form may be disclosed of 1974, as amended. This includes using this information as FEMA-003 — National Flood Insurance Program Files System o FEMA/NFIP/LOMA-1 — National Flood Insurance Program (NFII Fed. Reg. 7990 (February 15, 2006); and upon written request, Disclosure: The disclosure of information on this form is v result in the inability to obtain flood insurance through the N higher premium rates for flood insurance. Information will only Purpose of the E The Elevation Certificate is an important administrative tool of provide elevation information necessary to ensure compliance the proper insurance premium rate, and to support a request f based on fill (LOMR-F). The Elevation Certificate is required in order to properly rate Po of the Flood Insurance Rate Map (FIRM), located in flood insu BFE), AR, AR/A, AR/AE, AR/A1 A30, AR/AH, and AR/AO. The the building is being rated under the optional Post -FIRM flood in is generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act ecessary and authorized by the routine uses published in DHS/ Records Notice 73 Fed. Reg. 77747 (December 19, 2008); DHS/ Letter of Map Amendment (LOMA) System of Records Notice 71 ritten consent, by agreement, or as required by law. itary; however, failure to provide the information requested may nal Flood Insurance Program or the applicant may be subject to released as permitted by law. vation Certificate e National Flood Insurance Program (NFIP). It is to be used to th community floodplain management ordinances, to determine a Letter of Map Amendment (LOMA) or Letter of Map Revision M buildings, which are buildings constructed after publication Zones Al A30, AE, AH, A (with BFE), VE, V1 V30, V (with tion Certificate is not required for Pre -FIRM buildings unless :e rules. As part of the agreement for making flood insurance available in a community, the NFIP requires the community to adopt floodplain management regulations that specify minimum requirements for reducing flood losses. One such requirement is for the community to obtain the elevation of the lowest floor (including basement) of all new and substantially improved buildings, and maintain a record of such information. The Elevation Certificate provides a way for a community to document compliance with the community's floodplain management ordinance. Use of this certificate does not provide a waiver of the flood insurance purchase requirement. Only a LOMA or LOMR-F from the Federal Emergency Management Agency (FEMA) can amend'the FIRM and remove the Federal mandate for a lending institution to require the purchase of flood insurance. However, the lending institution has the option of requiring flood insurance even if a LOMA/LOMR-F has been issued by FEMA. The Elevation Certificate may be used to support a LOMA or LOMR-F request. Lowest floor and lowest adjacent grade elevations certified by a surveyor or engineer will be required if the certificate is used to support a LOMA or LOMR-F request. A LOMA or LOMR-F request must be submitted with either a completed FEMA MT EZ or MT-1 package, whichever is appropriate. I This certificate is used only to certify building elevations. A sep residential buildings can be floodproofed up to or above the Be has been designed and constructed to be watertight (substant residential buildings is not permitted under the NFIP unless floodproofed basements. The community must adopt standari FEMA will grant a basement exception. For both floodproofed i communities that have been granted an exception by FEMA, a f Additional guidance can be found in FEMA Publication 467-1, 1 FEMA's website at httos://www.fema.onv/media-lihrorv/assets/di ate certificate is required for floodproofing. Under the NFIP, non - Flood Elevation (BFE). A floodproofed building is a building that y impermeable to floodwaters) below the BFE. Floodproofing of EMA has granted the community an exception for residential for design and construction of floodproofed basements before i-residential buildings and residential floodproofed basements in dproofing certificate is required. odplain. Management Bulletin: Elevation Certificate, available on FEMA Form 086-0-33 (Revised 7/15) Replaces all previous editions. F-053 U.S. DEPARTMENT OF HOMELAF, jECURITY U � OMB No. 1660-0008 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 Policy Number: Martin L. Riccio A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number: Box No. 2320 Oak Dr. City iState ZIP Code Fort Pierce Florida 34949 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 5, Block 28 Fort Pierce Shores A4. Building Use (e.g., Residential, Non -Residential, Addition, Ac Iessory, etc.) Residential A5. Latitude/Longitude: Lat. 27.47935 Long. 80.297,62 Horizontal Datum: ❑ NAD 1927 ❑x 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 I AB. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b sq in d) Engineered flood openings? ❑ Yes ❑ No A9. For a building with an attached garage: a) Square footage of attached garage 561 sq ft b) Number of permanent flood openings in the attached garagi within 1.0 foot above adjacent grade c) Total net area of flood openings in A9.b sq in d) Engineered flood openings? []Yes ❑ No SECTION B — FLOOD INSURANCEI RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number 132. County Name B3. State 120285 / St Lucie County St I IIIi ucie Florida 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) 121111 CO181 J 02/16/2012 02/16/2012 AE 4 1310. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 139: ❑ FIS Profile ❑x FIRM ❑ Community Determined ❑ Other/Source: 1311. Indicate elevation datum used for BFE in Item 139: ❑ NGVD 1929 ❑x NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System i(CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ❑x No Designation Date: ❑ CBRS ❑ O,PA FEMA Form 085-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 1 CLCVAIIVR UCMIIrIUAlt OMB No. 1660-0008 Expiration Date: November 30, 2U15 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. Nod) or P.O. Route and Box No. Policy Number: 2320 Oak Dr. City State ZIP Code Company NAIC Number Fort Pierce Florida 34949 SECTION C — BUILDING ELEVA C1. Building elevations are based on: ❑ Construction Drawir *A new Elevation Certificate will be required when constructi( C2. Elevations — Zones Al A30, AE, AH, A (with BFE), VE, VI—1 Complete Items C2.a—h below according to the building diagi Benchmark Utilized: NGS94 77A27 FLDT at E1.5.85 V Indicate elevation datum used for the elevations in items a) tl ❑ NGVD 1929 ❑ NAVD 1988 ❑ Other/Source:_ Datum used for building elevations must be the same as that a) Top of bottom floor (including basement, crawlspace, or e b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zon( d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) g) Highest adjacent (finished) grade next to building (HAG) h) Lowest adjacent grade at lowest elevation of deck or stain structural support SECTION D — SURVEYOR, ENGINE This certification is to be signed and sealed by a land surveyor, er I certify that the information on this Certificate represents my best statement may be punishable by fine or imprisonment under 18 U Were latitude and longitude in Section A provided by a licensed la Certifier's Name Licer Regina Kamer 4363 PSM, President Company Name kamer surveying inc 2740 sw martin downs blvd #333 City State Palm City �Florida Signature n "�� Date 1! 0�� . 1 11/2E Copy all pages of this (11al tion erGficate and all attachments for (1) Comments (including a of equipment and location, per C2(e), if INFORMATION (SURVEY REQUIRED) s* ❑x Building Under Construction* ❑ Finished Construction of the building is complete. 0, V (with BFE), AR, AR/A, AR/AE, AR/A1—A30, AR/AH, AR/AO. ,n specified in Item A7. In Puerto Rico only, enter meters. tical Datum: NAVD >ugh h) below. ,ed for the BFE. Check the measurement used. losure floor) 5.75 x❑ feet ❑ meters N/A ❑x feet ❑ meters only) NSA. Z feet ❑ meters 5 42 Z feet ❑ meters gilding NSA. ❑x feet ❑ meters 4.3 ® feet ❑ meters 5.4 ❑x feet ❑ meters including NSA ❑x feet ❑ meters 1, OR ARCHITECT CERTIFICATION leer, or architect authorized by law to certify elevation information. Drts to interpret the data available. I understand that any false Code, Section 1001. surveyor? ❑ Yes ❑x No ❑ Check here if attachments. EFRI 1 4 ZIP Code I Telephone 8 (772) 288-7206 official, (2) insurance agent/company, and (3) building owner. rcmr� rV1111 V00-V-00 t!/l0) Kepiaces an previous editions. rorm rage z or 0 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: 2320 Oak Dr. City State ZIP Code Company NAIC Number Fort Pierce Florida 34949 SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND LONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items El—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 ap ropriate 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. Property Owner or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments I i I I ❑ Check here if attachments. N=MH corm Uii6-U-33 (7/15) Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No;) or P.O. Route and Box No. Policy Number. 2320 Oak Dr. City State ZIP Code Company NAIC Number Fort Pierce Florida 34949 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 F 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 I❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) i of the building: ❑ feet ❑ meters Datum i G9. 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 Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) I ❑ Check here if attachments. FLMA Form 086-0-33 (7/16) Replaces all previous editions. Form Page 4 of 6 BUBLD NG 'PHOTO.GRAPH. OMB No. 1660'0008 ELEVATION CERtIFIQATt' See Instructions for Item'A6. Expiration: Date- November 30, 20.18. IMPORTANT:. in these,spaces, copy the:dortesponding information from: Section A: FOR INSURANCE COMPANY USE . Building SfreetAddress (including.Apt:,.Uhit, Suite; and/or Bldg.!No.) or P:O. Route and.Box N . Policy' Number:. 2320 Oak Dr. City State ZIP Code Company hIAIG Number Fort Pierce Florida 34949 If. using the. Elevation Certificate to obtain NFIP -flood : insurance, affix at :least .2. building photographs belowaccording to the instructions. for Item A6: Identify all.photographs witli.date. taken; "Front View" and ' Reat-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 submittingmore photographs than will fit on this page,, use the Continuation Page. . r 1S` r as stir 00 y" Y ..'� ,',� 1 �x•ma e- d`h to y'pt':4'. ' .. .�,L . y„-rr F� l+ � � �.is' '�• ^. tfjY i uy' 8 .r R^�x,�y "� �,}r t�.. p y w q PhotB'One ' ' .Photo One Caption Front •. • t . oto.Two.Caption. Rear - .. FEMA Form 086-0-33 (7115) .Replaces all editions. - OMB No. .1660=0008. F LFVATRO iN CER TIR icATE Continuation Page Expiration Date:,NoVember30, 2018 IMPORTANT: In these spaces, copy the co rresppriding_information from Section -A: FOR INSURANCE COMPANY USE Building. Street Address (including Apt:, Unit'.tuite, and/or Bldg. No.) or P.O. Route and Box -No. :.. Policy. Number: 2320 Oak Dr. City State; ZIP Code.. Company NAIL Number Fort Pierce Florida 34949 If submitting more photographs than will. fit on the preceding page, : affix. the additional photographs below: , Identify all .photographs with: date taken; "Front and :'Rear' View' ' and, if required,- '.'Right Side View' and "Left Side. View." •'When applicable, . .Vi6w" photographs must show the foundation with. representative: examples of the flood openings or.yents; as_ indicated in..Section A8. r v . �,. r. Y •"tom lL.: t_.}',£'@ s..Et ) _z.1 s Y'?� F'E^ z.Z'.< k :• cT'ry-Jr �jt can t z3 .. � . - 44 c i • < P fti -c 1 "t••, Y. 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