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HomeMy WebLinkAbout1404-0377-ELEVATION CERTIFICATEU.S. DEPARTMENT l O "90- FAELAND SECURITY L C V I 1 I I k IV V C rC I i r I koA I C FEDERAL EMERG�NCY MANAGEMENT AGENCY OMB No. 1660-0008 National Flood In!ranceProgram hi'lpurtant• Read tpe instructions on pages ;=v. Expiration Date: July 31, 2015 �! SECTION A - PROPERTY INFORMATION 'Wft"MtGQW7 :AA Al. Building 0 "her's Name RIZK „Ct1 1tib" �,r t ' �'�WOxM�An„�.y+AaY"°F'. .; A2. Building Sti et Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 'g"Coxtla � ki 1234 NETTLES BLVD. 4 City JENS iiN BEACH State FL ZIP Code 34957 uGcam' �' A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) f ' I A BY y1 LOT 1234, NETTLES ISLAND PROJECT SECTION 2 ^ A4. Building Us eJ •�Ot. (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL Igitude: A5. Latitude/Lo Lat. 27.283072 N Long. 80.223986 W Horizontal Datum: El NAD 1927 0 NAD 1983 A6. Attach at le st 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Dia'1 ram Number 6 A8. For a buildi g with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square f otage of crawlspace or enclosures) N/A sq ft a) Square footage of attached garage N/A sq ft b) Number f permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclo .ure(s) within 1.0 foot above adjacent grade N/A within 1.0 foot above adjacent grade N/A c) Total net,area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b N/A sq in d) Enginee fed flood openings? ElYes 0 No d) Engineered flood openings? ❑ Yes 0 No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Comm pity Name & Community Number B2. County Name 1 B3. State UNINCORP 12005 ST. LUCIE FL B4. Map/Panel II umber B5. Suffix B6. FIRM Index Date B7. FIRM Panel B8. Flood B9. Base Flood Elevations) (Zone 12111 C 03 11 J 02/16/2012 Effective/Revised Date Zone(s) AO, use base flood depth) 02/16/2012 VE 10.0 B10. Indicate the source of the Base Flood Elevation (BFE) data or_base flood depth entered in Item B9. ❑ FIS rofile X❑ FIRM El Community Determined ElOther/Source: B11. Indicate elev tion datum used for BFE in Item B9: El NGVD 1929 0 NAVD 1988 ❑ Other/Source: _ B12. Is the buildin located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ❑X No Designation gate: _ n CBRS ❑ OPA Ill SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building eleva ions are based on: ❑ Construction Drawings* 0 Building Under Construction* El Finished Construction *A new Elevati 11n Certificate will be required when construction of the building is complete. C2. Elevations - Z Ines 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 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 0 NAVD 1988 ❑ Other/Source: Datum used fo ibuilding elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottl floor (including basement, crawlspace, or enclosure floor) 4.85 0 feet ❑ meters b) Top of the n 11xt higher floor 11.4 0 feet ❑ meters c) Bottom of th lowest horizontal structural member (V Zones only) 10.0 0 feet ❑ meters d) Attached ga ge (top of slab) N/A., ❑feet El meters e) Lowest elev tion of machinery or equipment servicing the building (Describe ty e of equipment and locatioll Comments) N/A., ❑feet El meters f) Lowest adja ent (finished) grade next to building (LAG) 4.4 0 feet ❑ meters g) Highest adjalent (finished) grade next to building (HAG) h) Lowest adjaclent grade at lowest elevation of deck or stairs, including structural support 4.6 N/A._ 0 feet ❑ feet ❑ meters ❑ meters I,! SECTION D -SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is o be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation, information. l certi I that the information on this Certificate represents my best efforts to interpret the data available.. 1 understand that ay false statement maybe punishable by fine orimprisonment under 18 U.S. Code, Section 1001. ; ❑ Check here if omments are provided on back of form. Were latitude and longitude in Section A provided by a,, El Check here if Ilttachments. licensed land surveyor? . 0 Yes ElNo C Certifier's Name EP,rlRLE R. STARKEY License Number 004459 - -' I . Title PROFESSIO AL LAND SURVEYOR Compan*Name ACCURIGHT LAND SURVEYING INC. (- State FL ZIP Code 34994 ?nature �ARLE R. Date 08/11/2014 Telephone 772-286-7694 1 1265-45-01-UC PLACE SEAL HE �/2044- -PLS #445959 FEMA Form 086-0 � (7/12) See reverse side for continuation. Replaces all previous editions. ELEVATION CERTIFICATE, page IMPORTANT: In these spaces, copy the,.,_responding information from Section A. FOR INSURANCE CUMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. PAEicy NtltY ber, 1234 NETTLES BLVD. City JENSEN BEACH State FL ZIP Code 34957 Cornp; inI NA1G Number:: ii SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments Signature EARLE R. STARKEY Date 08/11/2014 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 E1—E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. E1. Provide 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 of bottom floor (including basement, crawlspace, or enclosure) is _._ ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is _._ ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building 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 (elevation C2.b in the diagrams) of the building is ❑ feet Elmeters Elabove 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. 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 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. I If Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone " Comments SECTION G — COMMUNITY INFORMATION (OPTIONAL) ❑ Check here if attachments 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 Rem(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 Zone A (without a FEIVIA-issued or community -issued BFE) or Zone AO. G3. ❑ The following information (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 been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: __ ❑ feet ❑ meters Datum G9. BFE or (in Zone AO),depth of flooding at the building site: _ _ ❑ feet ❑ meters Datum G10. Community's design flood elevation: ❑ feet ❑ meters Datum _ Local Official's Name Title Community Name r . " Telephone Signature '` = Date Comments " ❑ Check here if attachments.