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Home My WebLink AboutELEVATION CERTIFICATE4 „ SCANNED S. DEPARTMENT OF HOMELAND SECURITY BY OMB No: 1660-008 kideral Emergency Management Agency St. Lude court Expiration Date: November 30, 2018 National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on Pages 1-9 Copy all Pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. 111 SECTION A —PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al Building Owner's Name (Note: Not Valid to use for any other personorentity). Policy Number: II MARK & MICHELE PALM 44058-79 AlBuilding Street Address (Including Apt., Unit, Suite, and/or Bldg. No. or P.O. Route and Company NAIC Number: Box No. 213 NETTLES BLVD. City n State ZIP Code �IENSEN BEACH FL 34957 A Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 213, NETTLES ISLAND (tf 502-501-0399-000-4) AI . Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A I5I. Latitude/Longitude: Lat. 27°17'12.7716"N Long.-80°13'29.0454" Horizontal Datum: ❑ NAD 1927 ® NAD 1983 A 6I. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. Ail. Building Diagram Number:6 A8-. For a building with a crawlspace of enclosure(s): a) Square footage of crawlspace or enclosure(s) 710 sq. ft. b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b N/A sq. in. d) Engineered flood openings? ❑ Yes ® No Al For a building with an attached garage: a) Square footage of attached garage N/A sq. ft. b) Number of permanent flood openings in the attachedgarage within 1.0 foot above adjacent grade N/A c) Total net=area of flood openings in A9.b N/A sq. in. d)Engiri66red,flo'6d6penings? ❑Yes ®No = r, SECTION B — FLOOD INSURANCEjRATE MAP (FIRM) INFORMATION `B� l NFIP Community; Nan)e-& Community Number B2. County Name B3. State -ST', LUCII=_COUNTY UNINC. AREAS 120285 ST. LUCIE FL 6�4I-.MipYP hel ' ` J5. Suffix B6. Firm Index B7. FIRM Panel B8. Flood Zone(s) B9. Base Flood Elevation(s) �N tuber Date Effective/ (Zone AO, use Base f , Revised Date Flood Depth) _ 12111C0311 J 02/16/12 02/16/12 AE 6.0 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: B1II . Indicate Elevation Datum Used for BFE in Item B9: ❑ NGVD 1929 ® NAVD 1988 ❑ Other/Source: Big . Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date: ❑ CBRS ❑ OPA FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 1 of 6 ELEVATION CERTIFICATE 01 OMB No: 1660-008 Fxniratinn r)atP- Nnvamhar in ?nl R 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: 213 NETTLES BLVD. City State Zip Code Company NAIC Number: JENSEN BEACH FL 34957 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 A1- A30, AE, AH, A (with BFE), VE V1— V30, V (with BFE), AR, AR/A, AR/AE, AR/Al — 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: 872-2312F-TIDAL 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, crawlspace, or enclosure floor) 4.05 ® feet ❑ meters b) Top of Next Higher Floor 8.07 ® feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N A. ❑ feet ❑ 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) I f) Lowest adjacent (finished) grade next to building (LAG) 3.89 ®,feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 4.05 ® feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including N A. ❑ feet ❑ meters 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. Were latitude and longitude in Section A provided by a licensed land surveyor? ® Yes ❑ No ® Check here if a achments: Certifier's Name: License Number: Stephen J. Brown, PSM L.S. 4049 Pta i Title: Professional Surveyor and Map erie; - `• , Company Name: Stephen J. Brown, Inc. Step own, PSM ; L:S ;d �; State of Flq'ricla ,- Address 619 EAS STRE t vali without thetoiature and,; a on al rdised seal of a Florida~ City: State: Zip Code: ST ARTW FL 34994 lice edSurveXor&Mappej"'" 51 nature: Date: Telephone: ,- ephen J. Brow PS 12/16/16 (772) 288-7176 opy all Pages of is E14A&n Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (iric din of equipment and location, per C2(e), if applicable. FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 2 of 6 r r ` EL VATICIN CERTIFICATE OMB No: 1660-008 Expiration Date: November 30, 2018 IM0jORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Bui ing Street Address (Including Apt., Unit, Suite, and/or Bldg. No. or P.O. Route and Box No. Policy Number: 2 3 NETTLES BLVD. cit.I'I State Zip Code Company NAIC Number: J�*N BEACH FL 34957 SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) l FOR ZONE AO AND ZONE A (WITHOUT BFE) For ones AO and A (Without BFE), complete Items E1-E5. If the Certificate is intended to support a LOMA and or LOMR-F request, Corr plete Sections A, B, and C. For Items E1-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, ent'r'meters. E1. 1 rovide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below he highest adjacent grade (HAG) and the lowest adjacent grade (LAG). Top of bottom floor (including basement, ❑ feet ❑ meters ❑ above or ❑ below the HAG crawlspace, or enclosure) is G ) Top of bottom floor (including basement, El feet El meters ❑above or C] below the LAG crawlspace, or enclosure) is E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 1-2 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) ❑ feet ❑ meters ❑ above or ❑ below the HAG E4. Top of platform of machinery and/or equipment El feet El meters Elabove or ❑below the HAG servicing the building is E5. Zone AO only: If no flood depth number is available, is the top of the 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 roperty owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or com * unity -issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. 'Pro rty Owner or Owner's Authorized Representative's Name: AddirlI ss City State Zip Code Sign ture Date Telephone Com' ents 1 ❑ Check here if attachments FEMA I rm 086-0-33 (7/15) Replaces all previous editions Page 3 of 6 ELEVATION CERTIFICATE OMB No: 1660-008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the -corresponding information from Section A. FOR INSURANCE COMPANY USE III Building Street Address (Including Apt., Unit, Suite, and/or Bldg. No. or P.O. Route and Box No. Policy Number: 213 NETTLES BLVD. I City State Zip Code Company NAIC Number: JENSEN BEACH FL 34957 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 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 •tone A (without a FEMA-issued or community issued BFE),; or Zone AD. G3. ❑ The following information (Items G4 — G10) is provided for community floodplain management purposes. I 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) ❑ feet ❑ meters Datum of the building: G9. BFE or (Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum G10. Community's design flood elevation: ❑ feet ❑ meters Datum The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or i 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. Local Official's Name Title Community Name Telephone Signature Date Comments I� ' I I I. ❑ Check here if attachments FEMA Form 086-0-33 (7/15) 1 Replaces all previous editions Page 4 of 6 ELaVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6 OMB No: 1660-008 Expiration Date: November 30, 2018 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: 2113 NETTLES BLVD. 1I1 City' State Zip Code Company NAIC Number: J�NSEN BEACH FL 34957 If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the i ".. instructions for Item A6. Identify all photographs with date taken; Front view' and Rear view";and, if required, Right Side View', an"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. d �3- ' i I F. �#W 1st � _~_� R ate, •� �2.. 12115116 12115116 Ph6to One Caption: FRONT VIEW Photo Three Caption: SIDE VIEW Al d; 44 �� r AlI[RR INN 12115116 12115116 PhO,to Two Caption: REAR/SIDE VIEW TPhoto Four Caption: SIDE VIEW FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 5 of 6