The URL can be used to link to this page

Home My WebLink AboutELEVATION CERTIFICATEU.S. 13E i ARTMEN I OF HOMELA, SECURITY OMB No. 1660-0008 -icy LE Expiration Date: November 30, 2018 Federal Emergency Management National good Insurance Program FI ELEVATION CERTIFICATE smwwri) Important: Follow the instructions on pages 1-9. BY fr, L?��) (�yrrlf 1/ Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and, (0)"rbuilding owner. SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. B'ilding Owner's Name Policy Number: D.R. F O RTO N A2. B ilding Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number: BQx No. 8632 CiOBBLESTONE DRIVE Ci State ZIP Code F IRT PIERCE Florida 34945 A3. P Ioperty Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) 2326- 00-0069-000-0 Lot64 A4. B Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential gilding A5. L i itude/Longitude: Lat. 27°24'38.30" N. Long. 80°24'38.30" 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. BLJlIilding Diagram Number 1A A8. Ftlr a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) N/A sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b N/A sq in d) Engineered flood openings? ❑ Yes ❑x No A9. Fo a building with an attached garage: a) (Square footage of attached garage 400.00 sq ft b) (Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A9.b N/A sq in d) ngineered flood openings? ❑ Yes ❑x No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name B3. State St. Lu ile County 120285 Saint Lucie Florida B4. Mari Panel B5. Suffix B6. FIRM Index B7. FIRM Panel, B8. Flood B9. Base Flood Elevation(s) Nurpber Date Effective/ Zone(s) (Zone AO, use Base Flood Depth) Revised Date 12111 C 170 J 02-16-2012 02-16-2012 AE 16.5 B10. Indicate 11 the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: 6 FIS Profile ❑x FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ❑x NAVD 1988 ❑ Other/Source: B12. I the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes x❑ No esignation Date: ❑ CBRS ❑ OPA FEMA Fci}m 086-0-33 (7115) Replaces all previous editions. Form Page 1 of 6 ELEV TION CERTIFICATE' OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORT NT: 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: 8632 C BBLESTONE DRIVE City State ZIP Code Company NAIC Number FORT ERCE Florida 34945 SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Bi. ilding elevations are based on: ❑x 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. B nchmark Utilized: AF6653 Vertical Datum: NAVD 88 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 ❑x NAVD 1988 ❑ Other/Source: D turn 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) 18.32 x❑ 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) 17.72 ❑x 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) N/A ❑ feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) N/A ❑ feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including ❑ feet ❑ meters N/A structural support SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This c 6fication is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. / certi that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false stater' nt may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001, Were I titude and longitude in Section A provided by a licensed land surveyor? ❑x Yes ❑ No ❑ Check here if attachments. CertifiErs Name License Number Thomas P. Kiernan 6199 `�.•�PN••.. JadaP,,; - '•.,�'o :o. Title Profes ional Surveyor 4�,.oyc aca /'+ N *" a�(D Comp y Name Culpe per & Terpening. Inc. � "0 `•®, Pr 5��.`` Addre 2980 Eputh 25th Street ` %`- °j61"'k% City State ZIP Code Fort Pi rce Florida 34981 Signat re Date Telephone Ext. (772) 464-3537 206 Copy al pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comm nts (including type of equipment and location, per C2(e), if applicable) FEMA F��rm 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 OMB No. 1660-0008 • ELEV TION CERTIFICATE Expiration Date: November 30, 2018 IMPOR NT: 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: 8632 C BBLESTONE DRIVE i City State ZIP Code Company NAIC Number FORT P �ERCE Florida 34945 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 El—E4, use natural grade, if available. Check the measurement used. In Puerto Rico only; enter mt ters. E1. Prdtide 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) op of bottom floor (including basement, rawlspace, or enclosure) is ❑ feet meters ❑above or ❑below the HAG. b) ' op of bottom floor (including basement, rawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. Fo 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) 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. Zo a AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's, flo plain 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 pro erty owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or commu ity-issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Propert Owner or Owner's Authorized Representative's Name Address City State ZIP Code Signatu a Date Telephone Comme is ❑ Check here if attachments. FEMA Firm 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6 OMB No. 1660-0008 ELEVATION CERTIFICATE' Expiration Date: November 30, 2018 IMPORT NT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Otreet Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: 8632 C BBLESTONE DRIVE City State ZIP Code Company NAIC Number FORT P FRCE Florida 34945 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 Section A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in tems 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. Perit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued G7. Th s permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Ell vation of as -built lowest floor (including basement) ❑ feet ❑ meters of he building: Datum G9. B or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum G10. C munity's design flood elevation: ❑ feet ❑ meters Datum Local 01 cial's Name Title Commul ity Name Telephone Signatur Date Comme is (including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. FEMA F jm 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 ELEVAjTION CERTIFICATE'' BUILDING PHOTOGRAPH! See Instructions for Item A6. OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORT NT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE. Building 8632 C ttreet Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. �BLESTONE DRIVE Policy Number: City FORT PI State ZIP Code RCE Florida 34945 Company NAIC Number If usinc instruct "Left Si vents, E the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to- the ons for Item A6. Identify all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" -and a View." When applicable, photographs must show the foundation with representative examples of the flood openings or indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. Photo One Photo Q a Caption Front ( Clear Photo One Photo Two Photo T o Caption Back Cleaf Photo Two FEMA Flm 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 BUILDING PHOTOGRAPH, OMB No. 1660-0008 Continuation Page Expiration Date: November 30, 2018 ELEV J ION CERTIFICATE'S IMPORT INT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building' 8632 CC treet Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. BLESTONE DRIVE Policy Number: City FORT PP State ZIP Code i RCE Florida 34945 Company NAIC Number If sub m with: d photog tting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs ite taken; "Front View" and 'Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, phs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. Photo Three Photo Three Caption Right Side { Clear Photo Three Photo Four Photo F ur Caption Left Side 1-,Clear Photo Four': FEMA Fj�m 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6