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Home My WebLink AboutELEVATION CERTIFICATE 2-3-15U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 16 Federal Emergency Management Agency Expiration .lululy 31. 2015 8 1. National Flood Insurance Program Imports �t- Read the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION For Insurance Company Use: Al. Building Owners Name Mark Thyrring I Policy Number A2. Building Street Address (including Apt., Unit, Suite, and%or Bldg. No.) or P.O. Route and Box No. Company NAIC Number 10751 S. Ocean Drive #B-8 I City Jensen Beach State FL ZIP Code 34957 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Tax Parcell.D. 4511-311-0037-0004 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential A5. Latitude/Longitude: Lat. N 27.2689 Long. W 80.20871 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 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 1 1,554 sq ft a) Square footage of attached garage 444 sq ft b) No. of permanent flood openings in the crawl spaceorb) No. of permanent flood openings in the attached garage enclosure(s) walls within 1.0 foot above adjacent grade 2 walls within 1.0 foot above adjacent grade 3 c) Total net area of flood openings in A8.b 1679 Sq.,in c) Total net area of flood openings in A9.b 615 sq in d) Engineered flood openings? 0 Yes ❑ No d) Engineered flood openings? 0 Yes ❑ No SECTION B-IFLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number I B2. County Name I B3. State Unincorporated Areas 120285 St. Lucie FL B4. Map/Panel Number B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone IDate Effective/Revised Date 1 Zone(s) AO, use base flood depth) 12111 C0314 J 12/16/12 2/16/12 AE 7.0 610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile 0 FIRM ❑ Community Determined ❑ Other (Describe) Bl 1. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 0 NAVD 1988 ❑ Other (Describe) i B12. Is the building located in a Coastal Barrier Resources System CBRS) area or Otherwise Protected Area (OPA)? ❑Yes ONo Designation Date I LJ CBRS ❑ OPA SECTION C;- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. 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, ARIA, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a-g below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: _Local BM i Vertical Datum: NAVD'88 Indicate elevation datum used for the elevations in items a) through h) below. ❑NGVD 1929 ONAVD 1988 ❑Other/Source: Datum used for building elevations must be the same as that used for the 8FE. Check the measurement used. a) Top of bottom floor (including basement, crawl space, or enclosure floor)- 3.94 0 feet ❑ meters (Puerto Rico only) b) Top of the next higher floor 7.50 0 feet ❑ meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) n/a. ❑ feet ❑ meters (Puerto Rico only) d) Attached garage (top of slab) 3.94 0 feet ❑ meters (Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 7.5 0 feet ❑ meters (Puerto Rico only) ' (Describe type of equipment in Comments) 0 Lowest adjacent (finished) grade (LAG) 3_7 0 feet ❑ meters (Puerto Rico only) g) Highest adjacent (finished) grade (HAG) 3_8 0 feet ❑ meters (Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs, including 3.8 0 feet ❑ meters (Puerto Rico only) 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. 1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. 0 Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a Digitallysigned bylames ❑ Check here if attachments. licensed land surveyor? 0 Yes ❑ No James .;o A. Cesiro lF. D14; cn=lames A. Cesiro 1,, Adantic Und Design, Certifier's Name JAMES A. CESIRO, JR. License Number PSM 5543 - Cesiro J:r.'m,.= ou, ems �., 1PS543pgmail.co Title PRESIDENT Company Name ATLANTIC LAND DESIGN Date: 2015.02.04 l 6:11:16 -05'00, Address 754 Jensen Beach Blvd. City Jensen Beach State FL ZIP Code 34957 FEMA Form 086-0-33 (7/12) Replaces all previous editions. i IMPORTANT: In these spaces, copy tl x:: ajrresponding 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 #B-8 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) community official, (2) insurance agent/company, and (3) building owner. Comments Revised to reflect elevations per house plans. Revise per county comments 11/25/14 Note: - Equipment in C2e = HVAC equipment. Section A9 (b) refers to Vent Model # 816CS Date 2/3/15 ❑ Check here if attachments SECTION-E-- MILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items E1-E5. Ifithe 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. Cheek the measurement used. In Puerto Rico only, enter meters. El. 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, crawl space) or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawl space, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ 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, islthe 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 Address City State ZIP Code Signature I Date Telephone Comments SECTION - COMMUNITY INFORMATION 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 Iitem(s) 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. (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. 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 (PR) Datum G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters (PR) Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑ Check here if attachments FEMA Form 086-0-33 (7/12) Replaces all previous editions. i ELEVATION CERTIFICATE, page 3 Building Photographs See Instructions for Item A6. IMPORTANT: In these spaces, copy the corresponding information from Secthm 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 City Jensen Beach State FL ZIP Code 34957 CoaWyNAIG-14 Aber 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)1/30/1 FEMA Form 086-0-33 (7/12) Replaces all previous editions. I i ELEVATION CERTIFICATE, page 4 Building Photographs iSee Instructions for Item A6. FEMA Form 086-0-33 (7/12) Replaces all previous editions.