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HomeMy WebLinkAboutELEVATION CERTIFICATEU.S. DEPARTMENT OF HOMELAND SECURITY FEDERAL EMEitr, SNCY MANAGEMENT AGENCY National Flood .insurance Progrmn reetAddreas (including Apt., BLVD, ELEVATO N CERTIFICATE important: Read the instructions on pages 1-9, t and Block Numbers, T PROJECT SECTION 2 OMB No. 1660-D(H)t3 Cxpira#ion Da#e: July 31, 2l)15 A4. Building We (e_g., Residential, Non-Resident3ol, Addition, Accessory, etc.) 0E01D1=N77AL A5. Latitudell-ongitude: Lat. all17'12.71 N Long. 86*13'23.8"YV Horizontal Datum: ❑ MAD 1927 © NAD 1983 A6. Attach at least 2 photographs of the building 9 the Certificate is being used to obtain flood Insurance. AT Building Diagram Number la A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of orawlspace or enclosure(s) N/A sq ft a) Square footage of attached garage I sq ft b) Number of permanent flood openings In the crawispace 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 NIA c) Total net area of flood openings in A8.b NIA. sq in c) Total net area of Hood openings in A9.b N/A sq in d) Engineered flood oponingg7 ❑ Yes ® No d) Engineered flood openings? ❑ Yes ® No SECTION B - FLOOD INSURANCE DATE MAP (FIRM) INFORMATION B1, NFIP Community Name & Community Number B2. County Name 133. State VNINCORP 12028$ 1 ST. Lt1C1E B4. Map/Panel Number 12111 C 0311 136_ FIRM Index Date 137, FIRM Panel 02/16/2012 EffectivelRevised Date 02/16/2012 indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 89, ❑ FIS Profile ® FIRM d Community Determined ❑ Other/source: Indicate elevation datum used for BFE in Item eq. ❑ NGVD 1929 © NAVD 1988 23 , Base Flood Elevation(s) (Zone AO, use basa flood depth) 6.0 312. Is the building located in a Coastal Barrier Resources System 09RS) area or Otherwise Proteoted Area (OPA)? © Yes ® No Designation Date: _ CSRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) %1. Building elevations are based on: ❑ Construction Drawings" ® Building Linder Construction* ❑ Finished C005tructiorr A new Elevation Cert�cate will be required when construction of the building is complete. '2. Elevations - zones Ai-A30AE, AM, A (with BFE), VE; VI-V30, V (with BFE), AR, AR/A, AR/AE, Aid/A1430. AR/AH, AR/Ao, Complete items C241-h below according to the building diagram specified in item A7, In Puerto Rico only, entar meters. .Benchmark Utilized: 94 77 A04 FI nr Indicate elevation datum us-ed f�� elevations in items a) through �bvertil DQwum: NAVD 88 Datum used for building elevations must be the same as that used for the 8FE� NGVD 1929 ®NAV0188g �] chef/.^SGUfC6; a) Top of bottom floor.(including basement, crawlspace, or enclosure floor) b) Top of the next higher floor °) 80ttom of the lowest horizontal structural member (V Zones on d) Attached garage lop of slab) ly) e) Lowest elevation Of machinery or equipment servicing {Describe type of the equipment and location in COmnleht5) buildlag f) Lowest adjacent (finished) grade next to building meets A) Wlghest adjacent (finished) grade next to building (HAq) ' h) Lowest adjacent grade at lowest arc,.n«; , _'9 J_ _,_ _ _ . 3 certification is t0 be signed and soalod by a Iand rmation. I certify that the lnrhrmaVon on this Can der5tsnd that any false statement may be purri hs r& Check here if comments are provided on hank f 6er'slName FA_RLF R, STARKFv PROFESSIONAL LAND SURl�vno FEMA Form 086-"3 (7/12) - prue for cdntin-� Chrok the measurement used. Building Street Address (including Apt„ Unit, Sulte, and/or bidg. No.) or P.O, Route and Box No. Tan Alc'r'r1 Fc qt �m City JENSEN BEACH State FL ZIP Code 34957 I :!�!! SECTION D—,$URV9Y0R, ENGINEER, OR ARCHITECT CERTIFICATION (CON , , ITINUEDl lwlll 111�'1' Copy .both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comment$, Signature F-A2LE R. STARKEY Date 03/01/2016 SECTION E -- BUILDING ELEVATION INFORMA7lON (SURVEY NOT REQUIRED) POR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete items E1--e6,j if the Certificate fa intended to eupport 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 foilowing 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 _,_ Ell feet ❑ meters ❑ above or ❑ below• the HAG. b) Top of bottom floor (including basement crawispac�e, or enclosure) is Q feet ❑ meters ❑ above or[] below the LAG. E2. Por Building Diagrams 6-9 with permanent flood open Ingo provided in section A Items 8 and/or bses pages 8-•§ of instructions), the next higher floor (elevation C2.b in the diagrams) of the building is I ❑ feet ❑ meters El at, ve .. below the HAG. E3, Attached garage (top of slab) ie El feet 11 meters Q above or ❑ below the HAG. 1;4, Top of platform of machinery and/or equipment servlcing the building is _. T © feet ❑ meters El above or Dbelow the HAG, E5, Zone AO only: if no flood depth number is available, s the top of the bottom floor elevated In accordance with the community's floodplain management ordinance? © Yes ElNo ElUnknown. The local official must cartify this Information in Section G. SECTION F — PROPERTY OWNER OR OWNEWS 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. jS, and E are correct to the best of my knowledge. , Property Owners or Owner's Authorized Representative's Name Address I City State ZIP Code Signature Date Telephone Comments Chel; k_biam. H atiachments. • ow, iy� v — vvrnp.,+i�, , ,wvnm� ,v,� Lvr , ,v,�r►-1 The local official who In authorized by law or ordinance to administer the community's floodplain management ordinance cart complete Sections A, B, C (or SE), and G of this Elevation Certificate. Complete the applicable Items) and sign below. Check the measurement used in items Gt3-G10. In Puerto Rlco 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 archltect who Is authorized by law to ca"My elevation information, (Ir+dleate the source and date of the elevation data in the Comments area below.) (32,11 A community official completed Section E for a building located in Zone A (without a FEMA-Issued or community -issued 13FE) or Zone AO. 03. ❑ The following Information (Items C4410) is provided for community floodplain management purposes. G4. Permit Number. G5. Date Permit Issued G6. Date Certificate of Complianceloompancy issued G7. This permit has been issued for. ❑ New Construction ❑ Substantial improvement G8. Elevation of as -built lowest floor (including basement) of the building, C7 feet ❑ meters Datum — G9. BFE or (in Zone AO) depth of flooding at the building, site.- ❑ feet meters Datum — G10. Coinmuni y! dtiaign flbod.alavation: ❑fact ❑ motors Datum Local Of#401's N"ib 'Mle Community ramie Telephone Signature Pate Comments_ ' Q Check here j( alWchmenfs.