Loading...
HomeMy WebLinkAboutELEVATION CERTIFICATE1i �F° iL�EIVMENT OF MANAGEMENT AGEN',r �D SECURITY -t V A I I V N C: t K 111' 1 t.A 1 OMB No. 1660-0008 .Mda alF7oodlrsurancePsogram Important: Read the instructions on pages 1-9. Expiration Date: July 31, 2015 SECTION A - PROPERTY INFORMATION ' -s .. A1. Building Owner's Name GERETY A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 10701 SOUTH OCEAN DRIVE #701 City JENSEN BEACH State FL ZIP Code 34957 QCMA)Hj A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) -' - v• LOT 102 VENTURE OUT IN AMERUCA SECTION C I Ely A4: Building Use (e.g., Residential, Non-Residential,'Addition, Accessory, etc.) 94 - �� '�` RESIDENTIAL A5. LaUtude/Longitude: Lat 27°16'05.2" N Long. 80°12'27.1" 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. A7. Building Diagram Number 8 A8. For a building with a•crawlspace ore nclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) 365 sq ft a) Square footage of attached garage 561 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 3 within 1.0 foot above adjacent grade 3 c) Total net area of flood openings in A8.b- 600 sq in c) Total net area of flood openings in A9.b 600 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 B3. State UNINCORP 120285 1 ST. LUCIE I FL B4. Map/Panel Number B5. guffnk B6. FIRM Index Date B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone 12111C 0314 J 02/16/2012 Effective/Revised Date Zone(s) AO, use base flood depth) 02/%2012 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 0 'Other/Source: B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 © NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System �BRS) area or Otherwise Protected Area (OPA)? El Yes © No Designation Date: _ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. 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 A1A30, AE, AH, A (with BFE), VE, VI-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 A7. In Puerto Rico only, enter meters. Benchmark Utilized: 94 77 A02 RM1 FLDT Vertical Datum: NAVD 88 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, crawlspace, or enclosure floor) 4.42 ® feet ❑ meters b) Top of the next higher floor 7.0 © feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) jWA.. ❑ feet ❑ meters d) Attached garage (top of slab) 4.0 0 feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 7.6 feet ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building,(LAG) 3.8 0 feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 4.0 N 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 ' .r- -� information. l cerdfy that the information on this Certificate represents my best efforts to interpret the data available. JQB# 2146-01-FINAL I understand that any false statement maybe 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 t! © Check here if attachments. licensed land surveyor? ® Yes ❑ No Certfier's Name EARLE R. STARKEY License Number 004459-- Title PROFESSIONAL LAND SURVEYOR ame ACCURIGHT LAND SURVEYING INC. 01 DECKER AVEN kY STUART State FL ' ZIP Code 34994 10/12/2015 Telephone 772-286-7694 PLS #4459 FEMA Form 086-0-33 (7/12) See reverse side for continuation. Replaces all previous editions. ELEVATION CERTIFICATE, page W IMPORTANT: In these spaces, copy th jonding information from Section A. ~ ,' �tUACECOhIiPi'f(i#SE Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 10701 SOUTH OCEAN DRIVE #701 City JENSEN BEACH State FL ZIP Code 34957Oit1i)9ettril5er SECTION D - SURVEYOR, ENGINEER,.OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate foc(1) community official, (2) insurance agent/company, and (3) building owner. Comments C-2E BOTTOM OF ELECTRIC PANEL i Signature EARLE R. ST Date 10/12/2015 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 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 1crawlspace, or enclosure) is _._ ❑ feet ❑ meters ❑ above or Elbelow the LAG. E2. For Building Diagrams 6-9. with permanent'flood openings provided in Section A Items 8 and/or 91see pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is _ _ ❑ feet El meters ❑ above or [J 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. 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: 0 feet ❑ meters Datum G10. Community's design f(66d elevation: __ ❑ feet ❑ meters Datum _ Local Official's. Name Title Community Name Telephone Signature Date Comments ❑ Check here if attachments. 111ding Photographs See Instructions for Item A6. 10701 SOUTH OCEAN DRIVE #701 FLORIDA _ 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 Viev P and "Left side View' R submitting mere photographs than will fit on this page, use the Conbri oon Page, following. FRONT 10/12/2015 REAR 10/12/2015 SIDE 10/12/2015