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Home My WebLink AboutELEVATION CERTIFICATE 6-11-18U.S. D ARTMENT OF HOMELAND SECURITY OMB ®�� OMB No.1660-0008 Federalmergency Management Agency Expiration Date: November 30, 2018 National" food Insurance Program ELEVATION CERTIFICATE ��u�� 1��a BY Important: Follow the instructions on pages 1-9. Copy all'' agq ft ;h (V(a1@ ��8�kficate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. SECTION A = PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. B, ilding Owner's Name Policy Number: D.R: ORTON A2. B ilding Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number: Box No. 8712 OBBLESTONE DRIVE CI State ZIP Code FORT PIERCE Florida 34945 11 A3. P operty Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) 2326-1 00-0061-000-4 lot 56 A4. B ilding Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential A5. L titude/Longitude: Lat. 27°24'37.94" N. Long. 80°24'54.15" W. Horizontal Datum: ❑ NAD 1927 ❑x NAD 1983 A6. Aitach at least 2 photographs of the building if the Certificate is being used to obtain flood- insurance. A7. B' ilding Diagram Number 1A A8. F' r a building with a crawlspace or enclosure(s): a' Square footage of crawlspace or enclosure(s) N/A sq ft b)1 Number of permanent flood openings in the crawlspace or enclosure(s) within.1.0 foot above adjacent grade N/A c)j Total net area of flood openings in A8.b N/A sq in d Engineered flood openings? ❑ Yes ❑x No A9. Fc a building with an attached garage: a)I 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) Engineered flood openings? ❑ Yes ❑x No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. N IP Community Name & Community Number B2. County Name B3. State St. Lu' ie County 120285 Saint Lucie Florida B4. Ma /Panel B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) i Nu nber Date Effective/ Zone(s) (Zone AO, use Base Flood Depth) Revised Date 12111 ;I0170 J 02-16-2012 02-16-2012 AE 16.5 B10. lhdicate i the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 139: FIS Profile '0 FIRM ❑ Community Determined ❑ Other/Source: B11. 11 dicate elevation datum used for BFE in Item 139: ❑ NGVD 1929 x❑ NAVD 1988 ❑ Other/Source: B12. the building located in a Coastal BarrierResources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes j❑x No esignation Date: ❑ CBRS ❑ OPA FEMA 4rm 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 i ELEVA TION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPOR CANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Buildin Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: 8712 C BBLESTONE DRIVE City State ZIP Code Company NAIC Number FORT FillERCE Florida 34945 i SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. , ilding elevations are based on: ❑x Construction Drawings* ❑ Building Under Construction* ❑ Finished Construction * I new Elevation Certificate will be required when construction of the building is complete. C2. E 3evations — Zones Al—A30, AE, AH, A (with BFE), VE, V1—V30, V (with BFE), AR, ARM, AR/AE, AR/A1—A30, AR/AH, AR/AO. mplete Items C2.a—h below according to the building diagram specified in Item AT In Puerto Rico only, enter meters. nchmark Utilized: AF6653 Vertical Datum: NAVD 88 I Iridicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 7 NAVD 1988 ❑ Other/Source: turn used for building elevations must be the same as that used for the BFE. Check the measurement used. al Top of bottom floor (including basement, crawlspace, or enclosure floor) 18.40 ❑x feet ❑ meters It 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 �� Attached garage (top of slab) 17.80 x❑ feet ❑ meters e Lowest elevation of machinery or equipment servicing the building N/A feet meters i (Describe type of equipment and location in Comments) i 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 rtification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certi that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. Were latitude and longitude in Section A. provided by a licensed land surveyor? ❑x Yes ❑ No ❑ Check here if attachments. Ceri f se Number N � Tho s PKiernan 6199 \\\``+,:+•+ 1 V'�t (! / Title Profe ional Surveyor = ,y D- ��, Compl ny Name Culpe per & Terpening. Inc. yL 29 .0 outh 25th Street City State ZIP Code Fort P erce Florida 34981 Signa reDate ,f Telephone 206 (772) 464-3537 0 Copy 11 pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Com nts (including type of equipment and location, per C2(e), if applicable) I • I I FEMA F�rm 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 ELEV TION CERTIFICATE OMB No. 1660-0008 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: 8712 C BBLESTONE DRIVE City State ZIP Code Company NAIC Number FORT 4ERCE Florida 34945 SECTION E — BUILDING ELEVATION. INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zon s 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 m ters. E1. Pr Bride 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, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) 11op of bottom floor (including basement, rawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. Foq 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. Aft ched garage (top of slab) is [:]feet ❑ meters ❑ above or ❑ below the HAG. E4. To p of platform of machinery and/or equipment se icing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. Zor e AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's flo dplain 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 mu com 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. Prope Owner or Owner's Authorized Representative's Name AddresE City State ZIP Code Signatu a Date Telephone Comme is ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6 I ELEW TION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 'IMPOR NT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Buildin ` Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: 8712 C BBLESTONE DRIVE City State ZIP Code Company NAIC Number FORT FIIERCE 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 Sectio A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in', Items G8—G10. In Puerto Rico only, enter meters. i 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. i G3. ElThe following information (Items G4—G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate of i Compliance/Occupancy Issued G7. T i lis permit has been issued for: ❑ New Construction'❑ Substantial Improvement G8. E' vation of as -built lowest floor (including basement) o ithe building: ❑ feet ❑ meters Datum i G9. B E or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum G10. C' mmunity's design flood elevation: ❑ feet ❑ meters Datum Local O icial's Name Title i i COMML ity Name Telephone Signatu; a Date I ' Comm "' is (including type of equipment and, location, per C2(e), if applicable) I i i I it i i i I i i I ❑ Check here if attachments. i FEMA F#rm 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 / il ELEVITION BUILDING PHOTOGRAPHS OMB No. 1660-0008 CERTIFICATE See Instructions for Item A6. Expiration Date: November 30, 2018 IMPOR *NT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Buildin 8712 C 'I Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. bBBLESTONE DRIVE ii Policy Number: City FORT FJIERCE State ZIP Code Florida 34945 Company NAIC Number If usi instructions "Left vents, g the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the for Item A6. Identify all photographs with date taken; "Front View" and 'Rear View'; and, if required, 'Right Side View" and §ide View." When applicable, photographs must show the foundation with representative examples of the flood openings or 'as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. i Photo One Photo One Caption Front i Clear Phaio One I Photo Two Photo Ljwo Caption Back i' Clear Photo Two' FEMA q,orm 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 i ELEV , TION BUILDING PHOTOGRAPHS OMB No. 1660-0008 CERTIFICATE Continuation Page Expiration Date: November 30, 2018 impbR ANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Buildin 8712 C Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O.. Route and Box No. BBLESTONE DRIVE Policy Number: City FORT I State ZIP Code IERCE Florida 34945 Company NAIC Number If subii with: photo iitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs ate taken; "Front View" and "Rear View'; and, if required, 'Right Side View" and "Left Side View." When applicable, 'llraphs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. i i I i i Photo Three ' Photo I three Caption Right Side Clear Photo Three Photo Four Photo F our Caption Left Side , Cleat' PHoio-Four FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6