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HomeMy WebLinkAboutELEVATION CERTIFICATE 3-10-15_ _ _ ____ _ _ __ /yoI- 0Oe�s "UPS.•DEV TMENT OF HOMELAND SECURITY r 1_E'VA 1 ION CERTI IC:A 1 t FEDERAL EMERGENCY MANAGEMENT AGENCY I n � V �, OMB No. 1660-0008 Nadongl Flood Insurance Program Important: Read the instructions on .pages `:�:.`. Expiration Date: July 31, 2015 SECTION A - PROPERTY INFORMATION FI;M. RA 1P ll s>!'.' Al. Building Owner's Name ANTETOMASO 1 r. . A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. ti)ga " 1174 NETTLES BLVD. City JENSEN BEACH i State FL ZIP Code 349957 6@Il�lli�il A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) �� By LOT 1174, NETTLES ISLAND PROJECT SECTION 2 A4. Building Use (e.g., Residential, Nan -Residential, Addition, Accesspry, etc.) -31 will rr , RESIDENTIAL A5. Latitude/Longitude: Lat 27"1T0l" N Long. 80"13'31" W Horizontal Datum: ❑ NAD 1927 0 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 or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) 294 sq ft a) Square footage of attached garage 139 sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s) within 1.0 foot above adjacent grade .'2 within 1.0 foot above adjacent grade 2 c) Total net area of flood openings in A8.b 400 sq in c) Total net area of flood openings in A9.b 400 sq in d) Engineered flood openings? ❑X Yes ❑ No ! d) Engineered flood openings? 0 Yes ❑ No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number I B2. County Name I B3. State UNINCORP 120285 ST. LUCIE FL B4. Map/Panel Number B5. Suffix B6. FIRM Index Date B7.'FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone 12111C 0311 J 02/16/2012i Effective/Revised Date Zone(s) AO, use base flood depth) 02/16/2012 AE 6.0 1310. 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 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)? El Yes © No Designation Date: _ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* 0 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/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 A04 FLDT Vertical Datum: NAVD 88 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) 4.8 X❑ feet ❑ meters b) Top of the next higher floor 8.2 ® feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A.. ❑ feet ❑ meters d) Attached garage (top of slab) 5.2 © feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 7.5 X❑ feet ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 4.2 © feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 4.7 ® feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 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. understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ® Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ® Check here if attachments. licensed land surveyor? X❑ Yes ❑ No C Certifier's Name EARLE R. STARKEY License Number 004459 Title PROFESSIONAL LAND SURV �ompany Name ACCURIGHT LAND SURVEYING INC. ress . 1501 DECKER AWaUF�18" City S State FL ZIP Code 34994 2170-01-01 03/10/2016 PLS #4459 FEMA Form 086-0-33 (7/12) Date 03/10/2015 Telephone 772-286-7694 See reverse side for continuation. Replaces all previous editions. TION CERTI IMPORTANT: In these spaces, copy the '13ponding information from Section A. Building Street Address (including Apt., Unit, Sui`-;.__Wor Bldg. No.) or P.O. Route and Box No. City JENSEN BEACH State FL ZIP Code 34957 FOR INSURANCE COMPANY OSE I Paticy Number. •Cor�ipanpNAIC•Nuniber: r SECTION D —SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Coov both sides of this Elevation Certificate for (1) community offices(, (2) insurance agent/company, and (3) building owner. Signature EARLE R. STARKEY I Date 03/10/2015 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 Msee pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is _ ❑ feet ❑ meters ❑ above or LJ below the HAG. E3. Attached garage (top of slab) is _— ❑ feet ❑Imeters ❑ 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 oni,If no flood depth number is available, is they top of the bottom floor elevated in accordance with the community s floodplain management ordinance? LJ 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 owners 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's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments LJ Check here if attachments. SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable items) 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) of the, building: — _ ❑ feet ❑ meters Datum _ 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 ❑ Check here if attachments! r-- Building Photographs See Instrudions for Item A6. For fnwmce Company Use: lidding Street Atldress (inducting Apt., Uri Suite, arWor Bldg. No.) or P.O. Route and Box No. Mercy Number 1174 NETTLES BLVD. City State ZIP Code CMV&W Wic Number JENSEN BEACH FLORIDA 34957 If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to "Right the instructions for Item Afi. Identify all photographs with: date taken; "Front View" and 'Rear View'; and, if required, Side View" and "Left Side View.' If'submitting more photographs than will fit on this page, use the Continuation Page, following. 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