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HomeMy WebLinkAboutELEVATION CERTIFICATE 11-25-14AC-AUW-Dz�
U.S. DEPARTMENT OF HOMELAND SECURITY ELt��TS.rJ1RT�F�CATE OMB No. 1660-0008
Federal Emergency Management Agency ExDiration Juiv 31. 2015
National Flood Insurance Program Important: Read the instructions on pages 1-9.
SECTION A - PROPERTY INFORMATION For Insurance Company Use:
A2. Building Street Address (including Apt., Unit, Suite, a
10751 S. Ocean Drive #13-8
City Jensen Beach State FL ZIP Code 34957
Bldg. No.) or P.O. Route and Box No. I Company
A3. Property Description (Lot and Block Numbers, Tax Parcel iNumber, Legal Description, etc.)
Tax Parcell.D. 4511-311-0837-0004
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential
A5. Latitude/Longitude: Lat. N 27.2689 Long. W 80.2087 Horizontal Datum: ❑ NAD 1927 N 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 ji
A8. For a building with a crawl space or enclosure(s), provide A9. For a building with an attached garage, provide:
a) Square footage of crawl space or enclosure(s) 1,534 sq It a) Square footage of attached garage 444 sq it
b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage
enclosure(s) walls within 1.0 foot above adjacent grade 4 walls within 1.0 foot above adjacent grade 3
c) Total net area of flood openings in A8.b i 3,791 sq in c) Total net area of flood openings,in A9.b n/A sq in
d) Engineered flood openings? © Yes ❑ No d) Engineered flood openings? © Yes ❑ No
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number B2. County Name 133. State
Unincorporated Areas 120285 St Lucie I FL
84. Map/Panel Number
B5. Suffix
B6. FIRM Index
B7. FIRM Panel
B8. Flood
B9. Base Flood Elevation(s) (Zone
Date
I
Effective/Revised Date
Zone(s)
AO, use base flood depth)
12111CO314
J
2/16112
2/16/12
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 I ❑ Community Determined ❑ Other (Describe)
611. Indicate elevation datum used for BFE in Item B9: NGVD 1929 ® NAVD 1988 ❑ Other (Describe)
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)9 _ ❑Yes ®No
Designation Date L-I CBRS ❑ OPA ,
C-
C1. Building elevations are based on: ❑ Constnlctic
`A new Elevation Certificate will be required when cons
C2. Elevations - Zones Al-A30, AE, AH, A (with BFE), VE,
below according to the building diagram specified in Ite
Benchmark Utilized: _Local BM
Indicate elevation datum used for the elevations in items a) through t
Datum used for building elevations must be the same as that used fo
i Drawings' IN Building Under Construction* L l Finished Construction
action of the building is complete.
11430, V (with BFE), AR, ARIA, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a-g
1 A7. In Puerto'Rico only, enter meters.
Vertical Datum: NAVIY88
below. ❑NGVD 1929 ZNAVD 1988 Other/Source:
the BFE. Check the measurement used.
a) Top of bottom floor (including basement, crawl space, it enclosure floor)-
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 in Comments)
1) Lowest adjacent (finished) grade (LAG)
g) Highest adjacent (finished) grade (HAG)
h) Lowest adjacent grade at lowest elevation of deli or stairs, including
.#a f4., 1 amnnrl
-94 ® feet ❑ meters (Puerto Rico only)
7.5Q © feet ❑ meters (Puerto Rico only)
n/a. ❑ feet ❑ meters (Puerto Rico only)
33-94 © feet ❑ meters (Puerto Rico only)
7.5 © feet ❑meters (Puerto Rico only)
3.7 ® feet ❑ meters (Puerto Rico only)
3 8 ®feet ❑ meters (Puerto Rico only)
3.8 ® feet ❑ meters (Puerto Rico only)
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 fepresents my best efforts to interpret the data available.
I understand that any false statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
j Digitally signed by
® Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a James ` James A. CesiroJr.
❑ Check here if attachments. licensed land surveyor? 0 Yes ❑ No A DN: cn=James A.
A
Certifier's Name JAMES A. CESIRO, JR. License Number PSM 5543 A. cestroir.,
o=Atlantic Land
Title PRESIDENT Com an Name ATLANTIC LAND DESIGN Design,ou,
p y Ces i rO en 11=nLDssa3eg
. mall.com c=-Us
Address 754 Jensen Beach Blvd. City Jensen Beach State. FL ZIP Code 34957 Jr. Date:2014.11zs
/ i 1651:54-05'aa
FEMA Form 086-0-33 (7/12)
fi
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.
10751 S. Ocean Drive #13-8
Policy Number
City Jensen Beach State FL ZIP Code 34957
Company NAIC Number
SECTION D - SURVEYOR, ENGINEER,
OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) communityl
official, (2) insurance"agent/company, and (3) building owner.
Comments Revised to,reflect elevations per house plans. R
Note: - Equipment in C2e = HVAC equipment.
Some elevations or dimensions in Sections A8, A9 and C2 arc
lrise per county comments 11/25/14
based on Construction Drawings.
Signature t
Date 11/25/14
❑ Check here if attachments
SECTI E - BUIhDING EL A ON 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 or LOMR-F request, complete Sections A, B,
and C. For Items El-E4, use natural grade, if available. Che& the measurement used. In Puerto Rico only, enter meters.,
E1. Provide elevation information for the following and check i 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, crawl space, or enclosure) is ❑ feet Elmeters ❑ above or❑'below the HAG.
b) Top of bottom floor (including basement, crawl space, or enclosure) is Elfeet ❑ meters Elabove or El below the LAG.
E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A.Items 8 and/or 9 (see page 8 of Instructions), the next higher floor
(elevation C2.b in the diagrams) of the building is I. ❑ 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? El Yes El 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 communitrissued BFE) or
Zone AO must sign hen;. The statements in Sections A, A and E are correct to the best of my knowledge.
Property Owner's or Owner's Authorized Representative's N4. ne
Address City State ZIP Code
Signature Date Telephone
Comments
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. and G9.
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 1 (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.-G9.) is provided for community floodplain management purposes.
l G4. Permit Number I G5. Date Permit Issued I G6. Date Certficate Of Compliance/Occupancy Issued I
L
i
G7. This permit has been issued for. El New Construction ❑ Substantial Improvement
G8. Elevation of as -built lowest floor (including basement) of the building: feet ❑ meters (PR) Datum
G9. BFE or (in Zone AO) depth of flooding at the building site: El feet El meters (PR) Datum
Local Official's Name. Title
Community Name Telephone
Signature Date
FEMA Form 086-0-33 (7/12) 1 Replaces all previous editions.
ELEVATION CERTIFICATE, page 3 Building Photographs
See instructions for Item A6.
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
10751 S. Ocean Drive #13-8
City Jensen Beach State FL ZIP Code 34957 con1myNAlCNumber
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
View" and "Left Side View." If submitting more photographs than will fit on this page, use the Continuation Page:
Front View (Date Taken) NA Under Construction
F I Lh= C��Y
FEMA Form 086-0-33 (7/12) ! Replaces all previous editions.
1 � �
ELEVATION CERTIFICATE, page 4 Building Photographs
See Instructions for Item A6.
IMPORTANT: In these spaces, copy the corresponding W—ul 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
10751 S. Ocean Drive #B-8
CitV Jensen Beach State FL ZIP Code 349571 Canpany NAIC Number
If submitting more photographs than will fit on the preo
date taken; -"Front View" and "Rear View"; and, if
show the foundation with representative example
Rear View (Date Taken) NA Under Construe
le, affix the additional photographs below. Identify all photographs with:
, "Right Side View" and "Left Side View." When applicable, photographs must
good ooeninas or vents. as indicated in Section A8.
FEMA Form 086-0-33 (7/12) Replaces all previous editions.