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Home My WebLink AboutELEVATION CERTIFICATEv U.S.DEPAR ENT OF HOMELAND SECURITY EVATION CERTIFICATE oMBN0.lssa000s FEDERAL E ERGENCY MANAGEMENT AGENCY National Flo Insurance Program impc�rratnt• Read the -instructions on pages 1-s. Expiration Date: July 31, 2015 j� SECTION A - PROPERTY INFORMATION ,fORINSURANCE'COMPANY uSE Al. Buildi g Owner's Name RONALD & GHISLAINE ROUSSELLE 13-037 Policy Number II A2. Buildi g Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company'N.AIC Number. 2136 NE LES BOULEVARD City J li NSEN BEACH State FL ZIP Code 34957 A3. Prope' Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) ��G•®6FI0�9�UJ PARCEL I 4502-501-0139-000-4BY A4. Buildin'I Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL St. Coda County A5. Latiturd /Longitude: Lat. 27"17'142' Long. 80"12'51.3"Horizontal Datum: ❑ NAD 1927 ® NAD 1983 A6. Attach ° t least 2 photographs of the building if the Certificate is being used to obtain flood insurance. AT Buildin ° Diagram Number 6 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) sq are footage of crawlspace or enclosure(s) 1200 sq ft a) Square footage of attached garage NA sq ft b) Nu ber of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or nclosure(s) within 1.0 foot above adjacent grade 10 within 1.0 foot above adjacent grade NA c) Tot °I net area of flood openings in A8.b 1379 sq in c) Total net area of flood openings in A9.b NA sq in ❑ Yes ® No d) Engineered flood openings? El ® No d) En ineered flood openings? III SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION i1, Bl. NFIP C'mmunity Name & Community Number B2. County Name B3. State ST LUCIE OUNTY 120285 ST LUCIE FL B4. Map/P1 °nel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone 1211 0311 J 2-16-12 Effective/Revised Date Zone(s) AO, use base flood depth) �I 2-16-2012 AE (EL6) B10. Indicat °the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. IS Profile ® FIRM ❑ Community Determined ❑Other/Source: B11. Indicat (elevation datum used for BFE in Item 139: ❑ NGVD 1929 ® NAVD 1988 ❑ Other/Source: B12. Is the b ilding located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? El Yes ® No Design tlon Date: ❑ CBRS ❑ OPA II SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building ilevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* ® Finished Construction *A new E evation Certificate will be required when construction of the building is complete. C2. Elevation - Zones Al-A30, AE, AH, A (with BFE), VE, V1 V30, V (with BFE), AR, ARIA, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a-h below ac "ording to the building diagram specified in Item AT In Puerto Rico only, enter meters. Benchm rk Utilized: AF6574 Vertical Datum: NAVD88 Indicate ,evation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 ® NAVD 1988 ❑ Other/Source: Datum ued for building elevations must be the same as that used for the BFE. 1 Check the measurement used. a) Top of ottom floor (including basement, crawlspace, or enclosure floor) 4.3 ® feet ❑ meters b) Top of he next higher floor 7.9 ❑ feet Elmeters c) Bottom of the lowest horizontal structural member (V Zones only) NA. ❑ feet ❑ meters d) Attach d garage (top of slab) NA. ❑ feet Elmeters e) Lowest 11 elevation of machinery or equipment servicing the building 6.7 ® feet ❑ meters (Descn a type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 4.3 ® feet ❑ meters g) Highesl adjacent (finished) grade next to building (HAG) 4.3 ® feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 4.0 ® feet ❑ meters yl SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certificat information. I ! understand ® Check hi ❑ Check hi is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation tify that the information on this Certificate represents my best efforts to interpret the data available. any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. if comments are provided on back of form. Were latitude and longitude in Section A provided by a Q if attachments. licensed land surveyor? ® Yes ❑ No Certfier's Na I a RICHARD A MIXON License Number LS3335 Title PRESID ii NP7 n Company Name MIXON LAND SURVEYING, INC. Addres 267 r Vf /�� ,City OKEECHOBEE State FL ZIP Code 34972 Signatu>e � //1LA_/4__B1te 10-15-13 Telephone 772-260-5302 FEMA Form 0$f-0-33 (7/12) See reverse side for continuation. Replaces all previous editions. r ELEVATI„N CERTIFICATE, page 2 IMPORT NT: In these spaces, copy the cu; "ponding information from Section A. FOR INSURANCE COMPANY USE Building St "et Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number. 2136 NETT ES BOULEVARD City JENS ;,N BEACH State FL ZIP Code 34957 Company NAIC Number. III SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) li Copy both sJdes of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments '1 C2.e I = AIR CONDITIONER Signature I Date 10-1 -13 SECTION E - BUILDINd ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones IO 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 I �i ms E1-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. E1. ProviA, 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 I'of bottom floor (including basement, crawlspace, or enclosure) is El feet El meters El above or ❑ below the HAG. b) Top �of bottom floor (including basement, crawlspace, or enclosure) is 1-1feet❑ meters El above or ❑ below the LAG. E2. For B Jding 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 (eleva ion C2.b in the diagrams) of the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. Attach d garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of �Iatform of machinery and/or equipment servicing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. Zone il0 only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinal ce? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. II 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 ° ust sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property ii is or Owner's Authorized Representative's Name Address i City State ZIP Code Signature I Date Telephone Comments Check here if attachments. II SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local officia Iwho 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 Elevatio 11 Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8�10. In Puerto Rico only; enter meters. G1. ❑ The i in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is au lformation orized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A co ill munity official completed Section E for a building located in Zone A (without a FEMA-issued or community -issued BFE) or Zone AO. G3. ❑ The f llllowing information (Items G4-GI0) is provided for community floodplain management purposes. G4. Permit N tuber G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This perm II has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation cif as -built lowest floor (including basement) of the building: El feet ❑ meters Datum G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum G10. Communi ll's design flood elevation: ❑ feet ❑ meters Datum II Local Official'sl`lName Title Community N IllIne Telephone Signature I Date Comments N ❑ Check here if attachments. FEMA Form 0 i6-0-33 (7/12) Replaces all previous editions. ELEVA ,ION CERTIFICATE, page 3 Photographs .3uilding See Instructions for Item A6. IMPORT ANT: In these spaces, copy the corresponding information from Section A. f=oR INSURANCE COMPANY USE ., Building St feet Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: 2,36 NE iLES BOULEVARD City JENS!I, N BEACH State FL ZIP Code 34957 Company NAIC Number: If using thV Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item 6. Identify all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." WI 1en applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated ill I Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. 1 €" F Ill_ 1111111� . K -- -� i- f+ V I I �V I V V I� FEMA Form 0 6-0-33 (7/12) Replaces all previous editions. I