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HomeMy WebLinkAboutELEVATION CERTIFICATE 4-2-15U.S. DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY National Flood Insurance Program tVA I IVIV CERT il=iC:A I t Important: Read the instructions on pages OMB No. 1660-0008 Expiration Date: July 31, 2015 Al. Building A - PROPERTY INFORMATION A2. BuildingStreet A w�J'�t Unit, Suite, and/or Bld No. or P.O. Route and Box No. 6' 783 NETTLES BLVDM 19 )i Ms City JENSEN BEACH State FL ZIP Code 34957 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 783, NETTLES ISLAND PROJECT SECTION 2 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat 27'17'10.8" N Long. 80*13'16.7" 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) 30 5 sq ft a) Square footage of attached garage N/A 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 N/A c) Total net area of flood openings in A8.b 100 sq in c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes 0 No d) Engineered flood openings? ❑ Yes 0 No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name B3.. State UNINCORP 120285 St. LUCIE I FL B4. Map/Panel Number B5. Suffix B6. FIRM Index Date 137. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone 12111 C 0311 J 02/16/2012 Effective/Revised Date Zone(s) AO, use base flood depth) 02/16/2012 AE 6.0 B10. Indicate the source of the Base Flood Elevation (BFE) data orlbase flood depth entered in Item B9. ❑ FIS Profile 0 FIRM ❑ Community Deten lined ❑ 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 (BRS) area or Otherwise Protected Area (OPA)? ElYes 0 No Designation Date: _ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ -Construction Drav *A new Elevation Certificate will be required when construction C2. Elevations - Zones Al A30, AE, AH, A (with BFE), VE, V1=V2 below according to the building diagram specified in Item A7. li Benchmark Utilized: 94 77 A04 FLDT Indicate elevation datum used for the elevations in items a) thri Datum used for building elevations must be the same as that u ings* ❑ Building Under Construction* © Finished Construction ofthe building is complete. ), V (with BFE), AR, AR/A, AR/AE, AR/A1 A30, AR/AH, AR/AO. Complete Items C2.a-h Puerto Rico only, enter meters. Vertical Datum: NAVD 88 iugh h) below. ❑ NGVD 1929 0 NAVD 1988 ❑ Other/Source: _ ,ed for the BFE. a) Top of bottom floor (including basement, crawlspace, or enclosur b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) 0 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 stairs, iincluc Check the measurement used. floor) 4.4 0 feet ❑ meters 6.05 © feet ❑ meters N/A. ❑ feet ❑ meters WA. ❑ feet ❑ meters 6.65 © feet ❑ meters 4.0 feet ❑ meters 4.1 0 feet ❑ meters ig structural support N/A._ ❑ feet ❑ meters \ I - SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certificatiln is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. 1 certify that the information on this Certificate represerits my best efforts to interpret the data available. 1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. X❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a 0 Check here if attachments. licensed land surveyor? ' 0 Yes - -td� Certifier's Name EARLE R. STARKEY 1 License Number 004459 Title PROFESSIONAL LAND SURVEYOR-Mmpany Name ACCURIGHT LAND SURVEYING INC. 19 Ci RT , State FL ZIP Code 34994 Signature EARLE R. 5TA Y Date 04/02/2015 Telephone 772-286-7694 FEMA Form 08 /12) SeIe reverse side for continuation. 73-195-01 . UW10212015 PLS #4459 Replaces all previous editions. .EVATION CERTIFICATE page 2 IMPORTANT: In these spaces, copy of 31r •iondin information from Section A. _ °.,,F0R.IN8URANtrEC0MPANt►'a7SE Building Street Address (including Apt., Unit, Suite, r • _ :.:r Bldg. No.) or P.O. Route and Box No. 783 NETTLES BLVD. r City JENSEN BEACH State FL ZIP Code 34957'4 MIC'Nutter SECTION D—SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) co cial, (2) insurance agent/company, and (3) building owner. C - S A UTILITY R PT ING AREA THE ACTUAL LIVING AREA IS DIAGRAM 1 B C2-E A/C PEDESTAL Signature EARLE R. STARKEY Date 04/02/2015 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 CI rtificate is intended to support a LOMA 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, crawlspace, or enclosure) is ❑feet El meters El above or El 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 9see pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is _ _ I❑feet Elmeters ❑ above or LJ 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's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ 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 item(s) and sign lelow. 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 lodIated in Zone A (without a FEMA-issued or community -issued BFE) or Zone AO. G3. ❑ The following information (Items G4-GI0) is provided for community floodplain management purposes. G4. Permit Number I G5. Date Permit Issued I I 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: El feet El meters Datum Local Official's.Name Title Community Name Telephone Signature Date Comments Check here if attachments. Building Photographs See Instructions for Item A6. Far Insurance Company Use: auildina street Address (indudtrw Aot.. Unit Suite. and/orlBlda. No.) or P.O. Route and Box No. Policy Number ! 783 NETTLES BLVD, City Number JENSEN BEACH State FLORIDA - " Code I Cm"W� If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two 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 Views' and "Left Side 'View." If submitting morel photographs than will fit on this page, use the Continuation Page, following. FRONT 11/18/2014 REAR 11/18/2014 SIDE. 04/02/2015