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Home My WebLink AboutELEVATION CERTIFICATEU.S. DEPARTMENT OF HOMELAND SECURITY , � �i t�%Aj1UN tra1Z I IC`ICA I t I� OMB.No. 1660-0008 ` SEED"R' LEMERGENCY MANAGEMENT AGENCY • . \ _ -_- �` National Flood Insaran%. Program Important: Read the instructions on pages 1-9. Expiration Date: July 31, 2016 Iv SECTION A - PROPERTY INFORMATION 1.40498f.IIsO:t 1. Building A2. Building Street Address (including Apt.,. Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. , 208 NETTLES BLVD. il 3 ',n _-755 '" +ic"`� _ ':- City JENSEN BEACH State FL ZIP Code 34957 el09/! H/Al.rQ A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) wwr.&I w, LOT 208, NETTLES ISLAND PROJECT SECTION 2 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) -�t9N-Gi1,�91��' RESIDENTIAL A5. Latitude/Longftude: Lat 27°17'12.9" N Long. 80°13'30.8" W - 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 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) N/A sq ft a) Square footage of attached garage 53 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 N/A within 1.0 foot above adjacent grade 2 c) Total net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b 9445 sq in d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes 0 No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number FB2, County Name B3. State UNINCORP 120285 LUCIE I FL B4. Map/Panel Number B5. Suffix B6. FIRM Index Date B7. 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 or base flood depth entered in Item B9. ❑ FIS Profile 0 FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 0 NAVD 1988 ❑ Other/Source: _ B12. Is the building located in a Coastal Barrier Resources System �BRS) area or Otherwise Protected Area (OPA)? ❑ Yes 0 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 A1A30, AE, AH, A (with BFE), VE, V1 V30, V (with BFE), AR, ARIA, AR/AE, AR/Ai 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 FL DT Vertical Datum: NAVD 88 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 ❑X 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) 6.12 0 feet ❑ meters b) Top of the next higher floor N/A.. ❑ feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A._ ❑ feet ❑ meters d) Attached garage (top of slab) 4.Z feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 6.55 X❑ feet ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 4.4 feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 4.6 0 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. 1320-46•-01 l understand that any false statement may be punishable by fine orimprisonment 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 PLACE 0 Check here if attachments. licensed land surveyor? 0 Yes ❑ • No SEAT: Certifier's Name EARLE R. STARKEY �� License Number 004459 <=d Title PROFESSIONAL LAND DECKER A ACCURIGHT LAND SURVEYING INC. STUART State FL ZIP Code 34994 FEMA Form 086-0-33 (7/12) Telephone 772-286-7694 See reverse side for continuation. Replaces all previous editions. ELEVATION CERTIFICATE, page IMPORTANT: In these spaces, copy � ;'rresponding information from' Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 208 NETTLES BLVD. FOR INSURANCE P4licyi Nrimlaer: �; , City JENSEN BEACH State FL ZIP Code 34957 1 _ gompany NAhC Ntk&W.. I SECTION D - SURVEYOR, ENGI R, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) co nity offi' , (2) insurance agent/company, and (3) building owner. �� Signature EARl1C-R- 'I'XRI FY Date 04/08/2014 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 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 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 — _ El 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 wee pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is — _ ❑ feet ❑ meters ❑ above or El below the HAG. E3.. Attached garage (top of slab) is _ — ❑ teet ❑ 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 communes floodpl21n 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 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. e f`� r Building Photographs See Instructions for Item A6. Far Insurance Company Use: Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number 208 NETTLES BLVD, City J E N S E N BEACH State FLORIDA ZIP Code Ca�npe WWJC NuTher 34957 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, following. FRONT 04/08/2014 f LAK 04/08/2014