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HomeMy WebLinkAboutELEVATION CERTIFICATE 7-10-14U.S. �JEPAR ANT OF HOM.ELAN[) SECURITY R Lt VA I IVN C+CK I I I-IC.A I t PEX2Pir:afi0on:DaV 6008 FEdERAL E IRGENCY MANAGEMENT AGENCY i Insurance Program July 31, 2015 National Floo 8r important: Read the instructions on pages 1-9. lil SECTION A - PROPERTY INFORMATION FUR1�kVyySft 1>T�AYS 3 NP011'7 laltlrii[JG" Al. Buildin" Owner's Name WALLY & NANCY BURKE 1 A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.F1ex�fi 10701 SO TH OCEAN DRIVE #841 City J I NSEN BEACH State FL ZIP Code 34957 sa, g�a Aa=nunmu�, IN, A3. Prope y Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) �l�.n.� LOT 841, HPLIDAY OUT IN AMERICA SECTION D A4. Buildi Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) �sli Z'i%'I�il{l RESIDENTIAL A5. Latitu I e/Longitude: Lat. 27.271993 Long. 80.207918 Horizontal Datum: ❑ NAD 1927 0 NAD 1983 A6. Attac at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Buildi g Diagram Number 1 B A8. For a uilding with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) S Iuare footage of crawlspace or enclosures) N/A sq ft a) Square footage of attached garage 350 sq ft b Number of permanent flood openings in the attached garage b) N ' mber of permanent flood openings in the crawlspace ) within 1.0 foot above adjacent grade 7 o !enclosure(s) within 1.0 foot above adjacent grade N/A c) T 'tal net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b 350 sq in ;I d) Engineered flood openings? ElYes 0 No d) E igineered flood openings? ❑ Yes X No I!I SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B3. State B1. NFIP ommunity Name & Community Number B2. County Name FL UNINCO P 120285 ST. LUCIE B4. Map: �Panel Number 65. Suffix B6. FIRM Index Date B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone 12111 C 0314 J 02/16/2012 Effective/Revised Date Zone(s) AO, use base7.o flood depth) 02/16/2012 1310. Indi to the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. 11 FIS Profile 0 FIRM ❑ Community Determined ❑ Other/Source:._ B11. Indi to elevation datum used for BFE in Item B9: ❑ NGVD 1929 NAVD 1988 ❑ Other/Source: B12. Is t ie building located in a Coastal Barrier Resources System CBRS) area or Oth❑e OPAProtected Area (OPA). El Yes No Des gnation Date: _ CBRS SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* Finished Construction *A nw Elevation Certificate will be required when construction of the building is complete. 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 C2. Elevations belo - according to the building diagram specified in Item AT In Puerto Rico only, enter meters. Ben hmark Utilized: 94 77 A02 RM1 FLDT Vertical Datum: NAVD 88 datum used for the elevations in items a) through h) below. ❑ NGVD 1929 X❑ NAVD 1988 ❑ Other/Source: Indi Dat to elevation m used for building elevations must be the same as that used for the BFE. Check the measurement used. a) T' p of bottom floor (including basement, crawlspace, or enclosure floor) 7.9 © feet ❑ meters ❑ feet ❑ meters b) T 11 p of the next higher floor N/A.. the lowest horizontal structural member (V Zones only) N/A._ ❑ feet ❑ meters c) d) oIttom of (top of slab) 4.4 ❑X feet meters Ittached garage 'lowest of machinery or equipment servicing the building 12.6 0 feet ❑ meters e) ( elevation ' escribe type of equipment and location in Comments) N feet ❑ f) owest adjacent (finished) grade next to building (LAG) 4.0 meters adjacent (finished) grade next to building (HAG) A.1 X❑ feet ❑ meters g) h) Iighest i west adjacent grade at lowest elevation of deck or stairs, including structural support N/A._ El feet El meters SECTION D -SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This c �rtification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation Certificate my best efforts. to interpret the data available. 1320 v0-Q1 inform I unde tion. l certify that the information on this represents istand that any false statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section t001. • CIIl��Ieck here if comments are provided on back of form. Were latitude and longitude in Section A provided by a, PLACE 0 G1j�eck here if attachments. licensed land surveyor? X❑ Yes ❑ No ` =R� r.... i - .�.:_.- Certifi"r's Name EARLE R. STARKEY License Number 004459 - Title ROFESSIONAL LAND SURVEYOR mpany N e ACCURIGHT LAND SURVEYING INC. State FL ZIP Code 34994 07/ 09/2014 ECKERAVENUE Cit - 7UART PLS #4459 Add i Sign K - '' /09/2014 Telephone 772-286-7694 `. - 3 (7/12) See reverse side for continuation. Replaces all previous editions. d FEMA'JForm ELEVAT104 CERTIFICATE IMPORTANT: In theses aces, copy the , responding information from Section A. (' , FOR INSURANCE COMFnNY U5 V Building Stree; Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy.Number. 10701 SOUTH, OCEAN DRIVE#841 City JENSENIBEACH State FL ZIP Code 34957 Company NAIC Number: SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate fo ommu ' official, (2) insurance agent/company, and (3) building owner. ments 'C PEDASTAL .-•- '� Signature E/'kLE R. STARKEY Date 07/09/2014 SECTION' E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) 11 For Zones A 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 It ms E1-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. El. Provid elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade i 1AG) and the lowest adjacent grade (LAG). ❑ feet ❑ ❑ above or ❑ below the HAG. a) Top of bottom floor (including basement, crawlspace, or enclosure) is _._ meters ❑ feet ❑ ❑ above or ❑ below the LAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is — _ meters E2. For Binding 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 platform of machinery and/or equipment servicing the building is — _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. r-r ____ �I_ -_I... IC __ .__A A__&" .....v.4.... ;.......,:L,L.I�, ;� oL +nn of+hn hn++nm flnnr Plevated in accordance with the communitv's floodolain management ordina ce? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. I'I SECTION F — PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION -rti .....-4,11 n. —, n. mnracan+n+il/P whn rmmniPtPS Sections A- B. and E for Zone A (without a FEMA-issued or community -issued BFE) or Zone AO �jnust sign here The statements in Sections A B and E are correct to the best of my knowledge. Property 04er's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments. .I SECTION G—COMMUNITY INFORMATION (OPTIONAL) The local offs 'al 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 Elevati n Certificate. Complete the applicable Rem(s) and sign below. Check the measurement used in Items G8-G10. In Puerto Rico only, enter meters. G1.0. Th OI information n Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who i I uthorized by aw to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. El pmmunity official completed Section E for a building located in Zone A (without a FEMA-issued or community -issued BFE) or Zone AO. G3. ❑ Th I following information (Items G4-G10) is provided for community floodplain management purposes. G4. Permit umber G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This p it has been issued for: LJ New Construction L.I Substantial Improvement G8. Elevati n of as -built lowest floor (including basement) of the building: _ _ ❑ feet ❑ meters Datum G9. BFE o 111(in Zone AO) depth of flooding at the building site: _ _ ❑ feet ❑ meters Datum _ G10. Comm ,nity's design flood elevation: __ ❑ feet ❑ meters Datum Local Officials`Name Title - Communit Name Telephone Signature Date Check here if attachments. I Building Photographs � See Instructions for Item A6. j For Insurance Company Use: R„ariinn _ Amims rndudim ant.. Unit Suite. and/or Bldg. No.) or P.O. Route and Box No. Policy Number 10701 SOUTH OCEAN DRIVE #841 State NWNwnwr city JE SEN BEACH FLORIDA Z134957 If usin the,lElevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to the instru 'ons for Item A6. Identify all photographs with: date taken; "Front View" and Rear VieW; and, if required, "Right side view I'land "Left Side View.° If submitting more photographs than will fit on this page, use the Continuation .Page, following. I FRONT 07/09/2014 11 11 REAR 07/09/2014 _11