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HomeMy WebLinkAbout1404-0377-ELEVATION CERTIFICATE 1-13-15U.S. DEP4RTMEI, T OF HOMELAND SECURITY % 'F VA 1 ICON C ER 1 If IC:A I t 'FEDERAL EME GENCY MANAGEMENT AGENCY ` �-- i OMB NO.I1660-0008 NationalFfoodl'I ranceProgram Important: Read the instructions on pages 1-9. Expiration Date: July 31, 2015 I !I SECTION A - PROPERTY INFORMATION Al. Building Ilwner's Name RIZK A2. Building reet Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.'wr `g. 1234 NE1TL S BLVD. �.� _ " Y re City JEN II EN BEACH State FL ZIP Code 34957 A3. Property Ppscription (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Z,0U�3'�� LOT 1234, NETTLES ISLAND PROJECT SECTION 2 A4. Building U e (e.g., Residential, Non -Residential, Addition, Accessory, etc.) . Il1!Lj�®� RESIDENTIAL A5. Latitude/L gitude: Lat 27.283072 N Long. 80.223986 W Horizontal Datum: ❑ NAD 1 27 ❑X NAD 1983 A6. Attach at I east 2 photographs of the building if the Certificate is being used to obtain flood insurance. AT Building Di gram Number 6 A8. For a build pg with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square ljpotage of crawlspace or enclosure(s) 280 sq ft a) Square footage of attached garage N/A sq ft b) Numbe I of permanent flood openings in the crawlspace b) Number of permanent flood opening in the attached garage or encl sure(s) within 1.0 foot above adjacent grade N/A within 1.0 foot above -adjacent grade N/A c) Total n i area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A .b N/A sq in d) Engine red flood openings? ❑Yes 0 No d) Engineered flood openings? Yes ® No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Comm nity Name & Community Number B2. County Name B3. State UNINCORP 120 85 ST. LUCIE FL B4. Map/Panel umber B5. Suffix B6. FIRM Index Date B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone 12111 C 0 1 J 02/16/2012 Effective/Revised Date Zone(s) AO, use base flood depth) 1 02/16/2012 VE I 10.0 610. Indicate the ource of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Irofile © FIRM ElCommunity Determined ❑ Other/Source: _ Bl 1. Indicate.elel tion datum used for BFE in Item 69: El NGVD 1929 ® NAVD 1988 ElOther/Source: _ B12. Is the buildin located in a Coastal Barrier Resources System �BRS) area or Otherwise Protected Area (OPA)? ElY Is © No Designation i ate: _ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building eleva ions are based on: El Construction Drawings* ❑ Building Under Construction* ❑X Finished *A new Elevati' n Certificate will be required when construction of the building is complete. C2. Elevations -Z nes Al-A30, AE, AH, A (with BFE), VE, V1 V30, V (with BFE), AR, ARIA, AR/AE, AR/A1-A30, AR/AH, AR/AO. Co below accordi g to the building diagram specified in Item AT In Puerto Rico only, enter meters. Benchmark Uti ized: 94 77 A04 FLDT Vertical Datum: NAVD 88 Indicate elevat on datum used for the elevations in items a) through h) below. ❑ NGVD 1929 © NAVD 1988 ❑ Other/Source: _ Datum used fo'' building elevations must be the same as that used for the BFE. I Check the measurers a) Top of botto floor (including basement, crawlspace, or enclosure floor) A 85 © feet ❑ b) Top of the n higher floor 11.4 © feet ❑ c) Bottom of th lowest horizontal structural member (V Zones only) 10.0 0 feet ❑ II d) Attached ga ge (top of slab) N/A-- ❑ feet ❑ T e) Lowest elev ion of machinery or equipment servicing the building 10.2 ❑X feet ❑ (Describe of equipment and location in Comments) f) Lowest adja nt (finished) grade next to building (LAG) Highest adja I� nt (finished) grade next to building (HAG) 4.4 4.9 © feet © feet Elg) ❑ h) Lowest adja . nt grade at lowest elevation of deck or stairs, including structural support N/A._ ❑ feet ❑ 1 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is tI be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. l certify that the information on this Certiricate represents my best efforts to interpret the data available. I understand that an false statement may be punishable by fine orimprisonment under 18 U.S. Code, Section 1001. ❑X Check here if c Imments are provided on back of form. Were latitude and longitude in Section A provided by a © Check here if a achments. licensed land surveyor? Yes ❑ No Certifier's Name "LE R. STARKEY License Number 004459 Title PROFESSION L LAND SURVEYOR Company Name ACCURIGHT LAND SURVEYING INC. Address 1501 DEC' ER AVENU 9 City STUART State FL ZIP Code 34994 Signature EARLE Date 01/13/2015 Telephone 772-286-7694 1 Items C2-a-h used. LACE i7'i 1I1312015 PLS 04459 FEMA Form 086-0-�,O See reverse side for continuation. Replaces all previous editions. CATE. page 2 i ATION ORTANT: inq Street) City JENSEN these spaces, copy the cd i ),nding information from Section A. Iress (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. .VD. State FL ZIP Code 34957 III SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides d this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments A8 - �� HE ENCLOSURE BELOW WAS CONtUCTED WITH BREAKAWAY WALLS. THERE IS NO STEEL OR CONCRETE FILLED CELLS. WITH 4�cn �n �naai i CM-E HOT WATFR+ EATER3,--' Signature EARLE STARKEY Date 01/13/2015 I SECTION E 41BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and,lP (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 (I-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. El. Provide elev Rion 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 boom floor (including basement, crawlspace, or enclosure) is _— ❑ feet ❑ meters ❑ above or El below the HAG. b) Top of bo om floor (including basement, crawispace, or enclosure) is _._ ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building iagrams 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 ��� in the diagrams) of the building is _ _ ❑ feet ❑ meters ❑ above or uu below the HAG. E3. Attached ga ge (top of slab) is _ _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. i E4. Top of pladol 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 lr 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 sighere. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner's or wner's Authorized Representative's Name Address City State ZIP Code Signature tl Date Telephone Comments I i i ❑ Check here if attachments. SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is ° uthorized 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 Certifi "'te. Complete the applicable item(s) and sign below. Check the measurement used in Items G8- G10. In Puerto Rico only, enter meters. G1. ❑ The informati n in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized y law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community fficial completed Section E for a building located in Zone A (without a FEMA-issued or community -issued BFE) or Zone AO. G3. ❑ The following jnformation (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 be 'lI n issued for. ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-bui t lowest floor (including basement) of the building: _ _ ❑ feet ❑ meters Datum _ G9. BFE or (in Zone A ) depth of flooding at the building site: _ _ ❑ feet ❑ meters Datum _ G10. Community's desigi i flood elevation: ❑ feet ❑ meters Datum Local Official's Name Title Community Name I Telephone Signature I'I Date Comments Check here if attachments. uilding Photographs See Instructions for Item A6. or P.O. Route and Box No. I Policy Number 1234 NETTLES BLVD, City State ZIP Code CarMW NNC Numk r JENSEN BEACH FLORIDA 34957 If using the 'Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to the instructi Ins for Item A6. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and -Left Side View." If submitting more photographs than will fit on this page, use the Continuation Page, following. 11 FRONT O1/13/2015 REAR O1/13/2015 SIDE O1/13/2015