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Home My WebLink AboutFEMA ELEVATION CERTIFICATESCANNED Si. ILur(ga 'oiifl* FEMA py CEIVED 242018[7AUG unty, Permitting NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE AND INSTRUCTIONS 2015 EDITION OMB No. 1660-0008 Expiration Date: November 30, 2018 U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE AND INSTRUCTIONS Paperwork Reduction Act Notice Public reporting burden for this data collection is estimated to average 3.75 hours per response. The burden estimate includes the tim for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and sub itting this form. You are not required to respond to this collection of information unless a valid OMB control number is dis ayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the bur en to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street SW, Washington, DC 20742, Paperwork Reduction Project (1660-0008). NOTE: Do not send your completed form tot Jis address. Privacy Act Statement Autoority: Title 44 CFR § 61.7 and 61.8. Pri cipal Purpose(s): This information is being collected for the primary purpose of estimating the risk premium rates necessary to lq, ovide flood insurance for new or substantially improved structures in designated Special Flood Hazard Areas. RoYjtine Use(s): The information on this form may be disclosed as generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act of I , as amended. This includes using this information as necessary and authorized by the routine uses published in DHS/ FE ,l A-003 —National Flood Insurance Program Files System or Records Notice 73 Fed. Reg. 77747 (December 19, 2008); DHS/ FEI NFIP/LOMA-1 — National Flood Insurance Program (NFIP) Letter of Map Amendment (LOMA) System of Records Notice 71 Fec Reg. 7990 (February 15, 2006); and upon written request, written consent, by agreement, or as required by law. Disclosure: The disclosure of information on this form is voluntary; however, failure to provide the information requested may res.ilt in the inability to obtain flood insurance through the National Flood Insurance Program or the applicant may be subject to higl,Jer premium rates for flood insurance. Information will only be released as permitted by law. Purpose of the Elevation Certificate Th Elevation Certificate is an important administrative tool of the National Flood Insurance Program (NFIP). It is to be used to pro ide elevation information necessary to ensure compliance with community floodplain management ordinances, to determine the proper insurance premium rate, and to support a request for a Letter of Map Amendment (LOMA) or Letter of Map Revision ba don fill (LOMR-F). Th Elevation Certificate is required in order to properly rate Post -FIRM buildings, which are buildings constructed after publication of he Flood Insurance Rate Map (FIRM), located in flood insurance Zones Al—A30, AE, AH, A (with BFE), VE, VI—V30, V (with BF ), AR, AR/A, AR/AE, AR/A1—A30, AR/AH, and AR/AO. The Elevation Certificate is not required for Pre -FIRM buildings unless the building is being rated under the optional Post -FIRM flood insurance rules. As part of the agreement for making flood insurance available in a community, the NFIP requires the community to adopt floodplain mail agement regulations that specify minimum requirements for reducing flood losses. One such requirement is for the community to obtain the elevation of the lowest floor (including basement) of all new and substantially improved buildings, and maintain a re prd of such information. The Elevation Certificate provides a way for a community to document compliance with the community's flo ddplain management ordinance. Us I of this certificate does not provide a waiver of the flood insurance purchase requirement. Only a LOMA or LOMR-F from the Fei feral Emergency Management Agency (FEMA) can amend the FIRM and remove the Federal mandate for a lending institution to require the purchase of flood insurance. However, the lending institution has the option of requiring flood insurance even if a LO I A/LOMR-F has been issued by FEMA. The Elevation Certificate may be used to support a LOMA or LOMR-F request. Lowest floor and lowest adjacent grade elevations certified by a surveyor or engineer will be required if the certificate is used to support a L0 1 A or LOMR-F request. A LOMA or LOMR-F request must be submitted with either a completed FEMA MT-EZ or MT-1 pa kage, whichever is appropriate. Th certificate is used only to certify building elevations. A separate certificate is required for floodproofing. Under the NFIP, non - re dential buildings can be floodproofed up to or above the Base Flood Elevation (BFE). A floodproofed building is a building that ha been designed and constructed to be watertight (substantially impermeable to floodwaters) below the BFE. Floodproofing of re idential buildings is not permitted under the NFIP unless FEMA has granted the community an exception for residential flo , dproofed basements. The community must adopt standards for design and construction of floodproofed basements before FE A will grant a basement exception. For both floodproofed non-residential buildings and residential floodproofed basements in coi munities that have been granted an exception by FEMA, a floodproofing certificate is required. Utional guidance can be found in FEMA Publication 467-1, Floodplain Management Bulletin: Elevation Certificate, available on A's website at https://www fema gov/media-library/assets/documents/3539?id=1727. Form 086-0-33 (Revised 7/15) Replaces all previous editions. F-053 w U.S. D �ARTMENT OF HOMELAND SECURITY OMB No. 1660-0008 Federal mergency Management Agency Expiration Date: November 30, 2018 National lood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. j ilding Owner's Name Policy Number: Linda'Iland David Lloyd A2. �ilding Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number: x No. 3803 leven Mile Road 0'ty State ZIP Code F . Pierce Florida 34987 A3. Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) 2: J,,'roperty 43-0000-000-7 A4. I building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential A5. titude/Longitude: Lat. 27°23'47"N Long. 80°26'30"W Horizontal Datum: ❑ NAD 1927 ❑x NAD 1983 A6. ttach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. AT uilding Diagram Number I A8. or a building with a crawlspace or enclosure(s): Square footage of crawlspace or enclosure(s) N/A sq ft b Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade N/A Total net area of flood openings in A8.b N/A sq in Engineered flood openings? ❑ Yes Z No Ir A9. a building with an attached garage: Square footage of attached garage 416.66 sq ft Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade N/A Total net area of flood openings in A9.b sq in Engineered flood openings? ❑ Yes x❑ No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. tIP Community Name & Community Number B2. County Name B3. State St. Lie County 120285 St. Lucie Florida B4. M p/Panel B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) N mber Date Effective/ Zone(s) (Zone AO, use Base Flood Depth) Revised Date 12111 i O164 J 02-16-2012 02-16-2012 X N/A 1310. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 139: ❑ FIS Profile ❑x FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item 89: ❑ NGVD 1929 ❑x NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ❑x No j Designation Date: ❑ CBRS ❑ OPA FEMA orm 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPOR 11 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: 3803 EI ven Mile Road City State ZIP Code Company NAIC Number Ft. Pier e Florida 34987 SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: 0 Construction Drawings* ❑ Building Under Construction* ❑ Finished Construction * new Elevation Certificate will be required when construction of the building is complete. C2. 'evations — Zones Al—A30, AE, AH, A (with BFE), VE, VI—V30, V (with BFE), AR, AR/A, AR/AE, AR/A1—A30, AR/AH, AR/AO. CIomplete Items C2.a—h below according to the building diagram specified in Item AT In Puerto Rico only, enter meters. enchmark Utilized: SP4 Vertical Datum: 3.34 I Idicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 ❑x NAVD 1988 ❑ Other/Source: 6 turn used for building elevations must be the same as that used for the BFE. Check the measurement used. Top of bottom floor (including basement, crawlspace, or enclosure floor) 20.5 ❑x feet ❑ meters Top of the next higher floor N/A ❑x feet ❑ meters Bottom of the lowest horizontal structural member (V Zones only) N/A ❑X feet ❑ meters Attached garage (top of slab) 20.1 ❑X feet ❑ meters Lowest elevation of machinery or equipment servicing the building feet meters x N/A ❑ ❑ (Describe type of equipment and location in Comments) Lowest adjacent (finished) grade next to building (LAG) 17.9 ❑x feet ❑ meters Highest adjacent (finished) grade next to building (HAG) 18.5 x❑ feet ❑ meters Lowest adjacent grade at lowest elevation of deck or stairs, including N/A x feet ❑ meters structural support SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This ertification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. / certcthat the information on this Certificate represents my best efforts to interpret the data available. / understand that any false state' ent 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? 0 Yes ❑ No ❑ Check here if attachments. Certi er's Name License Number Mich el T. Owen LS5556 Title Vice resident 44 r Com any Name Engii leering, Design & Construction, Inc. " J Address 1025i1 SE Village Parkway, Suite 201 `- City State ZIP Code Port I t. Lucie Florida 34987 Sign;:'ture Date Telephone Ext. ., (772) 462-2455 120 Copy II pages of this Elevation Certificate and all attachments for (1) commu ity official, .(2) insurance agent/company, and (3) building owner. Com ents (including type of equipment and location, per C2(e), if applicable) FEMA'Form 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 IMP OR Ithese 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: 3803 El ven Mile Road City State ZIP Code Company NAIC Number Ft. Pier e Florida 34987 SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zor s AO and A (without BFE), complete Items El—E5. If the Certificate is intended to support a LOMA or LOMR-F request, comple , 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. Pr vide 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 N/A ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) op of bottom floor (including basement, crawlspace, or enclosure) is N/A ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. Fo thE Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 1-2 of Instructions), next higher floor (elevation C2.b in th '� diagrams) of the building is N/A ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. A ched garage (top of slab) is N/A ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. T of platform of machinery and/or equipment N/A se icing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. Z '�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 pr perty owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or Comm 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. Proper Owner or Owner's Authorized Representative's Name Addres City State ZIP Code Signat�re 2 Date Telephone Comm nts ❑ Check here if attachments. FEMA orm 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6 i I i ELEVA, TION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPOR ,I NT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Buildin l Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: 3803 EI ven Mile Road City State ZIP Code Company NAIC Number Ft. Pier Florida 34987 SECTION G — COMMUNITY INFORMATION (OPTIONAL) The to al official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sectior A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used ir 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 FEMA-issued or community -issued BFE) or Zone AO. G3. E The following. information (Items G4—G10) is provided for community floodplain management purposes. G4. PEImit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued N/A G7. T, is permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. E c evation of as -built lowest floor (including basement) N/A the building: ❑ feet ❑ meters Datum G9. E or (in Zone AO) depth of flooding at the building site: N/A ❑ feet ❑ meters Datum G10. ommunity's design flood elevation: N/A ❑ feet ❑ meters Datum Local fficial's Name Title N/A N/A Comm I nity Name Telephone N/A Signat re Date Comments (including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. FEMA orm 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 I ' ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS OMB No.'1660-0008 See Instructions for Item A6. Expiration Date: November 30, 2018 IMP OR NT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Build' n Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: 38,03 E'even Mile Road ii City State ZIP Code Company NAIC Number Ft. Pier e Florida 34987 If usi the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the ,g instruct,ions for Item A6. Identify all photographs with date taken; "Front View" and 'Rear View'; and, if required, 'Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents,s indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. Photo One Photo One Photo D ne Caption Clear Photo One Photo Two i Photo Two Photo j wo Caption Clear Photo Two FEMA orm 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 i ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS OMB No. 1660-0008 Continuation Page Expiration Date: November 30, 2018 IMPOR Ithese 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: 3803 EI ven Mile Road City State ZIP Code Company NAIC Number Ft. Pier e Florida 34987 If sub l itting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: ii ate taken; "Front View" and "Rear View'; and, if required, "Right Side View" and "Left Side View." When applicable, photog aphs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. I Photo ` hree i Photo Three Photo Three Caption Clear Photo Three i Photo Four i I Photo Four Photo ,Four Caption Clear Photo Four FEMA orm 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 i