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HomeMy WebLinkAboutELEVATION CERTIFICATEr'-r% dJl!-v177 is. DEPARTMENTOFHOMELAND SECUMTY F!XVATION CERTIFICATE , .�, IFEDF-:-L EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 Natiorenl Flood Insurance Program iO;'1 ,' taflt' Read the instructions on pages 1 ^_� [Expiration Date: July 31, 2015 SECTION A - PROPERTY INFORMATION t?OR INSURANC)=;COMPANY •IJSE Al. Building Owners Name RAY & JANE OSBORN #4058-03 Policy Number A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company; 'AIG Number. 10725 SOUTH OCEAN DRIVE #417 City JENSEN BEACH State FL ZIP Code 34957 Oct e�etmemr�-a A3. Property Description (Lot and Block Numbers, I ax rarcei rvum0er, Legal Uescnp110n, MO.) wy LOT 30, BLOCK Q, HOLIDAY OUT AT ST. LUCIE SECTION B A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat 27"16'16.96"N Long. 80"12'23.421N Horizontal Datum: ® NAD 1927 ❑ 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 5 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawispace or enclosure(s) N/A sq ft a) Square footage of attached garage WA sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or encosure(s) within 1.0 foot above adjacent grade N/A within 1.0 foot above adjacent grade WA c) Total net area of flood openings in A8.b WA sq in c) Total net area of flood openings in A9.b NIA sq in d) Engineered flood openings? ❑ Yes ® No I d) Engineered flood openings? ❑ Yes ® No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number I B2. County Name I B3. State ST. LUCIE CTY UNINC. AREAS 120285 ST. LUCIE FLORIDA B4. Map/Panel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel - B8. Flood B9. Base Flood Elevation(s) (Zone 12111CO314 J I 08/19/91 I Effective/Revised Date Zones) AO, use base flood depth) 02/16/12 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 ❑ 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)? ❑ Yes ® No Designation Date: ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* ® 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 1 V (with BFE), AR, AR/A, AR/AE, AR/A1-,A30, AR/AH, AR/AO. Complete Items C2. below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: NOAA 94 77A02 Vertical Datum: NAVD 1988 , 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, crawispace, or enclosure floor) 7.21 ® feet ❑ meters b) Top of the next higher floor N/A. ❑ feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) WA. ❑ feet ❑ meters y- d) Attached garage (top of slab) WA. ❑ feet ❑ meters �. . e) Lowest elevation of machinery or equipment servicing the building 7.11 ® feet ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 3.80 ® feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 4.10 ®feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 4.1 • ® feet ❑ meters SECTION D - SURVEYOR; ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a lands eyor, engineer, or architect authorized by law to certify elevation information. I certify that the information on this Ce to represents my best efforts to interpret the data available. I understand that any false statement may be p J able by fine or imprisonment under 18 U. S. Code, Section 1001. ® Check here if com �air��e�i_p_rided o do of form. Were d and longitude in Section A provided by® Check here if a chmcensed land surveyor? ®Yes ❑ No Certifier's Nam TEPHEN J. BR" License Number 4049 Title SURV OR & MAPPER ompany Name STEPHEN J. BROWN, INC. Address 9 EAST 5TH 71E7 City STUART State FL ZIP Code 34994 Signature STEPHEN,/BRQhfN Date 02/06/14 Telephone (772) 288-7176 (7/12) See reverse side for continuation. Replaces all previous editions. U.S. DEPARTMENT OF HOMELAND SECURITY =1 EVATION CERTIFICATE "yJ FEDERAL.EMERGENCYMANAGEMENT AGENCY .OMB No.-1660-0008 - NatiaaalFloodInsurance Program Im' giant: Read:the'instructions on pages.'1—O. - - - ' Expiration Date:•July 31', 2015 SECTION A,— PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name RAY & JANE OSBORN #4058-63 Policy Number. A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No:) or P.O. Route and Box No. Company NAIL Number. 10725 SOUTH OCEAN DRIVE #417 City JENSEN BEACH State FL ZIP Code -34957 ' A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 30, BLOCK Q, HOLIDAY OUT AT ST. LUCIE SECTION B A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27'16'16.96"N Long. 80"12'23.42' W Horizontal Datum: ® NAD 1927 -❑ NAD 1983 A6. Attach at least 2 photographs of the building I the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 5 A8. For a building with,a crawlspace or enclosure(s): For a building with an attached garage:,_, a) Square footage of crawlspace or enclosure(s) WA 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 enclosures) within 1.0 foot above adjacent grade N/A i within 1.0 foot above adjacent grade, N/A c) Total net area of flood openings in A8.b N/A sq inc) 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 Community ST. LUCIE CTY. U NC. AREAS5umber I ST. LUCIE Name I FLORIDA B4. Map/Panel Number B5. Suffix B6. FIRM Index Date ! B7. FIRM Panel - B8. Flood.-. B9. Base Flood Elevations) (Zone 12111 C0314 J 08/19/91 Effective/Revised Date Zone(s) AO, use base flood depth) 11 ' 02/16/12 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 ❑ Commun'ity Determined' • '❑ Other/Sourcee: 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)? ❑ Yes ®' No Designation Date: ❑ CBRS ❑ OPA SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings' ® Building Under Construction' ❑ 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 AT In Puerto Rico only, enter meters. Benchmark Utilized: NOAA 94 77 A02 Vertical Datum: NAVD 1988 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. t Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor), 7.21 , ® feet ❑ meters b) Top of the next higher floor N/A. ❑ feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only)' �, jWA. ❑fee( ❑meters d) Attached garage (top of slab) N/A. ❑ feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building N/A. ❑ feet .' ❑ meters (Describe type of equipment and location in Comments)-, , f) Lowest adjacent (finished) grade next to building (LAG) - 3.80 ® feet ❑ meters g) Highest adjacent (finished) grade next to Building (HAG) 4.10 ® 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 byajand surveyor, engineer, or architect authorized by law to certify elevation ' information. I certify that the information on th' - r6ficate represents my best effoits to interpret the data available. I understand that any false statement may punishable by nine or imprisonment under 18 U.S. Code, Section 1001. - ❑ Check here if co nts are provi on back of form. ere latitude and longitude in Section A provided by ❑ Check her attachme s. licensed land surveyor?- ® Yes ❑ No Certifier's ame STEPHEN J. O N License Number 4049 Title S RVEYOR 8 MAPP Company Name STEPHEN-J. BROWN, INC. Addr ss 619 EAST 5T" TR City STUART State FL ZIP Code 3491 Sig ature STEPHYK J. O N Date 01/17/14 Telephone (772) 288-7176 FEMA P.MT-086-0-33 (7114 See reverse side for continuation. Replaces all previous editions. ELEVATION CERTIFICATE, page 2;. IMPORTANT: In these spaces, copy thy'%respondingwinformation 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 10725 SOUTH OCEAN DRIVE #417 ; City JENSEN BEACH _ State FL ZIP Code 34957 I ;Company NAIC Number- I SECTIOWIS- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) ' Copy bo ides of this levati certificate for (1j community official, (2) insurance. agent/company, and (3) building owner. r . BROWN Date 01/17/14 SECTION E - dUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE'A (VWTHOUT 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 Ell.-E4, use natural grade, if,available. Check the measurement used. In Puerto Rico only, enter meters. Ell. 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 -(LAP)._' a) Top of bottom floor (including basement, crawispace; orendosure).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 9 (seepages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is ❑ 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'flootf 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 Section's 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 ordinance can ordinancan 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-floodelevation: ❑ feet ❑ meters Datum Local Ofi�daYS'Nemeo .-'� ,� 4 ` 1 Title = Community Name - Telephone Signature �1y ;�� , - Date Comments:'-,..-;:� j r ` •,': ❑Check here if attachments. FEMA Form 086-0-33 (7/12) • Replaces all previous editions. ELEVATION CERTIFICATE, page 3 ; 'SUliding 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. 10725 SOUTH OCEAN DRIVE #417 City JENSEN BEACH State FL ZIP Code 34957 Company NAIC Number If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 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." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. DATE OF PHOTOGRAPHS:02/05/14 u r r x � T F l � ,.N �`'�.+b k'h sY' F < - c^P'< � ita .�: S• . AAA �x I£ R �x � '� i' "z�?ra �� �`�7s a rr�� �•a�'' , l _.{s, �� "� ..5 _ � X � Su"a7`' �i�5+ v�,•y,,,_'kZ.ty;eyli�"��' _ s x�. �r>ri�' -• rF N ti � ���+s ue+-r M +'ire f%,r%ilf '�"Nh 7. r +F•f �.N, m IT _V1 it ,�5t olt �#;ti+}: i ))�6,,JL�'�' '�.4y"jJ •. •k/ �k���,Fi.�� � � i:'� i � j f k�pp,��i'' ,/' � o- FEMA Form 086-0-33 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 4 30ding Photographs - Continuation Paae 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. 10725 SOUTH OCEAN DRIVE #41.7 City JENSEN BEACH State FL ZIP Code 34957 Company NAIC Number. If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. DATE OF PHOTOGRAPHS:02/05/14 Y o-r ji r 5, Y y . FEMA Form 086-0-33 (7/12) Replaces all previous editions. f ELEVATION CERTIFICATE, page 2 f IMPORTANT: In these spaces, copy thi j _wponding 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, - 10725 SOUTH OCEAN DRIVE #417 City JENSEN BEACH State FL ZIP Code 34957 Company NAIC Number. SECT N D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of_yi1sjElevaW Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments We IS THEfi9gUNIT Date 02/06/14 `SErsl/iON E - BfIILDING 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 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 ❑ 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 (see pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is ❑ 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? ❑ 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 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. CA. 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 fin Zone AO) 00th of flooding at the building site: ❑ feet ❑ meters Datum G10. Community's design'flood elevation: ❑ feet ❑ meters Datum Local OffiSlaPsName Title Community Name Telephone Signature Date Comments Check here if attachments. FEMA Form 086-0-33 (7/12) Replaces all previous editions.