HomeMy WebLinkAboutELEVATION CERTIFICATE - DISAPPROVEDAN —* YM ' 112 wfi suers
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/ RECEIVED
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Permitting Departrnant
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OMB No. 1660-0008
Expiration Date: November 30, 2018
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nce agent/company, and (3) building owner.
FOR INSURANCE COMPANY USE
Policy Number:
Company NAIC Number:
ZIP Code
JENSEN BEACH -- ,.0 34957
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
EAST 1/2 OF LOT 2, WINDMILL VILLAGE UNIT 2, PB 16, PG 31, PARCEL ID# 4511-811-0003-000-2
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A4. Building Use (e.g., Residential,. Non -Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. 27°15'55.83" N Long. 080'12'14.18" W Horizontal Datum: ❑ NAD 1927 ❑x NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 1A
A8. Fo'r a building with a crawlspace or enolosure(s):
a) 'iSquare footage of crawlspace or enclosure(s) 495 sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 3
c) Total net area of flood openings in A8.b 768 sq in
d) (Engineered flood openings? ❑x Yes ❑ No
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A9. Forla building with an attached garage:
a) Square footage of attached garage sq ft
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b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade
c) Total net area of flood openings in A9.b sq in
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d) Engineered flood openings? ❑ Yes ❑ No
SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number B2. County Name B3. State
UNINCORPORATED 120285 ST. LUCIE Florida
B4. Map/Panel B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood Zone(s) B9. Base Flood Elevation(s)
Number Date Effective/ (Zone AO, use Base
Revised Date Flood Depth)
12111 C-d314 J 02/16/2012 02/16/2012 AE 6.0'
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B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69:
❑IFIS Profile ❑x FIRM ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item 139: ❑ 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
Designation Date: ❑ CBRS ❑ OPA
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6
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ELEVATION CERTIFICATE
OMB No. 1660-0008
Expiration Date: November 30, 2018
IMPORTANT: 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:
26 AQUA RA DRIVE
City I State ZIP Code
Company NAIC Number
JENSEN BEACH Florida 34957
1 SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* ❑x Finished Construction
*AI new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations — 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 below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
BeInchmark Utilized: FDOT 94-07-C-01 Vertical Datum: NAVD 88
Indicate elevation datum used for the elevations in items a) through h) below.
❑ NGVD 1929 ❑x NAVD 1988 ❑ Other/Source:
Daltum used for building elevations must be the same as that used for the BFE.
Check the measurement used.
a) I Top of bottom floor (including basement, crawlspace, or enclosure floor) 6 0 ❑x feet ❑ meters
b) I Top of the next higher floor NSA. Z feet ❑ meters
c) !Bottom of the lowest horizontal structural member (V Zones only) NSA. 0 feet ❑ meters
d) (Attached garage (top of slab) NSA. 0 feet ❑ meters
e) ILowest elevation of machinery or equipment servicing the building 5.67 0 feet ❑ meters
(Describe type of equipment and location in Comments)
f) ILowest adjacent (finished) grade next to building (LAG) 5.6 0 feet ❑ meters
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g) (Highest adjacent (finished) grade next to building (HAG) 5.3 0 feet ❑ meters
h) ILowest adjacent grade at lowest elevation of deck or stairs, including NSA ❑x feet ❑ meters
structural support
SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to 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 Certificate represents my best efforts to interpret the data available. 1 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? Z Yes El No ❑ Check here if attachments.
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Certifier''s Name License Number
CRAIG D. WATSON 5647
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Title
PRESIDENT/ OW R
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Place
Company Name
WATSON KIL E SURVEYING AN �APPING
Seal
Here
Address
2240 NEB DIX HWY
City State ZIP Code
JENSENI B ACH Florida 34957
Signatur' Date Telephone
04/08/2019 (772) 334-0868
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments (including type of equipment and location, per C2(e), if applicable)
EXISTING A/C ON RIGHT SIDE OF HOUSE
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3 VENTSiTOTAL (2 FRONT, 1 SIDE)
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FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6
{ OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30, 2018
IMPORTANT: 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:
26 AQUA RA DRIVE
City State ZIP Code
Company NAIC Number
JENSEN BEACH Florida 34957
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 E1—E5. If the Certificate is intended to support a LOMA or LOMR-F request,
complete Sections A, B,and C. For Items El—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 lBuilding 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. AttaIched garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E4. Top of of machinery and/or equipment
platform
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
community -issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge.
Property `Owner or Owner's Authorized Representative's Name
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Address City State ZIP Code
Signature Date Telephone
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Comments
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❑ Check here if attachments.
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6
ELEVATION CERTIFICATE
OMB No. 1660-0008
Expiration Date: November 30, 2018
IMPORTANT: In these spaces, copy the corresponding information from Section A.
FOR INSURANCE COMPANY USE
Building iStreet Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
Policy Number:
26 AQUA RA DRIVE
City State ZIP Code
Company NAIC Number
JENSEN BEACH Florida 34957
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
Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable itern(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 FEMA-issued or community -issued BFE)
I or Zone AO.
❑ The following information (Items G4—G10) is provided for community floodplain management purposes.
G3.
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G4. Permit Number
G5. Date Permit Issued
G6. Date Certificate of
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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: ❑x feet ❑ meters Datum
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G9. BFE or (in Zone AO) depth of flooding at the building site: ❑x feet ❑ meters Datum
G10. Community's design flood elevation: ❑x feet ❑ meters Datum
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Local Official's Name Title
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Community Name Telephone
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Signature' Date
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Comments (including type of equipment and location; per C2(e), if applicable)
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❑ Check here if attachments.
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6
ELEVATION CERTIFICATE
BUILDING PHOTOGRAPHS`�
See Instructions for Item A6.
OMB No. 1660-0008
Expiration Date: November 30, 2018
IMPORTANT: 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:
26 AQUA RA DRIVE
City State ZIP Code
Company NAIC Number
JENSEN BEACH Florida 34957
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the
instructions 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, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page.
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Photo One
Photo One Caption FRONT VIEW 4-5-19
� Photo Two
Photo Two Caption SIDE VIEW 4-5-19
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6
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ELEVATION CERTIFICATE
BUILDING PHOTOGRAPHS
Continuation Page
OMB No. 1660-0008
Expiration Date: November 30, 2018
IMPORTANT: In these spaces, copy the corresponding information from Section A.
Policy Number:
WA I UP ..-
Company NAICNumber
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FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6