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HomeMy WebLinkAboutELEVATION CERTIFICATEU.S. DEPARTMENT OF HOMELAND SEC4 _ OMB No. 1660-0008 Federal Emergency Management Agency 'I' Expiration Date: November 30, 2018 National Flood 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. Building Owner's Name Policy Number: DUVILLA MYRTIL AND MARIE T. MYRTIL A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number: Box INo. 2208 CORTEZ BLVD city' State ZIP Code FORT PIERCE Florida 34982 SICANNEI) A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) la IF St Lucie 2421-234-0005-000-3COunty A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27D 25 07N Long. 80D 20 50W 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. Forla building with a crawlspace or enclosure(s): a) 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 0 Total c) net area of flood openings in A8.b 0 sq in d) Engineered flood openings? ❑ Yes X❑ No Q� A9. Forla building with an attached garage: I ` a) Square footage of attached garage N/A sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0 i c) Total net area of flood openings in A9.b 0 sq in d) Engineered flood openings? ❑ Yes X❑ No I • SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Ngme & Community Number B2. County Name B3. State ST. LUCIE COUNTY 120285 ST. LUCIE Florida B4. Map/Panel Number B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood Zone(s) B9. Base Flood Elevation(s) Date Effective/ (Zone AO, use Base Revised Date Flood Depth) 12111 CO186J I J 02/16/2012 02/16/2012 AH 16.50 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: ❑I FIS Profile X❑ FIRM ❑ Community Determined ❑ Other/Source: B11. 16, dicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 X❑ NAVD 1988 ❑ Other/Source: i 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 F Irm 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 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: 2208 CORTEZ BLVD City State ZIP Code Company NAIC Number FORT PIERCE Florida 34982 1 SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) i C1. Building elevations are based on: ❑ Construction Drawings" X❑ Building Under Construction* ❑ Finished Construction *A 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/AIIA30, 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. Benchmark Utilized: SEE COMMENT SECTION Vertical Datum: N.A.V.D. OF 1988 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 F>-<] NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measureme t used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 18.6 0 feet ❑ mete rs b) Top of the next higher floor X❑ feet E]meters c) Bottom of the lowest horizontal structural member (V Zones only) X❑ feet E]meters d) Attached garage (top of slab) X❑ feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building X❑ feet ❑meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 17 6 PRO X❑ feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 17 6 PRO 0 feet ❑ met e1rs h) Lowest adjacent grade at lowest elevation of deck or stairs, including 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. I certify 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. CertiNName License Number FLORIDA LICENSE NUMBER 4945 ROLAND E. ROLLINS l f Z I � Title OWNER Place Seal Company Name ROLAND E. ROLLINS PROFESSIONAL LAND SURVEYOR Here Address 3221 SW CRUMPACKER STREET City State ZIP Code PORT ST. LUCIE Florida 34953 . Signature Date Telephone lAt'� C 1-1/06/2018 (772) 873-4700 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) FOUND BRASS DISK'IN CONCRETE STAMPED ST: LOOIE COUNTY VERTICAL CONTROL VIR 3-04 FOUND IN CONCRETE 65 FEET PLUS OR MINUS NORTH OF THE NORTH EDGE OF PAVEMENT OF VIRGINIA AVENUE AND 46 FEET EAST OF THE EAST EDGE OF PAVEMENT OF SOUTH 25TH STREET. ADJUSTED ELEVATION = 5.12 METERS AND 16.798 FEET N.A.V.D. OF 1988. THE LATITUE AND LONGITUDE ARE DISPLAYED AS DEGREES MINUTES`AND SECONDS. PRO = PROPOSED. = `~ FEMA Form 086-0-33 (7/15) Replaces all previous editions. ' "'r ' "tj 1A ELEVATION CERTIFICATE !)MB No. 1660-0008 -'expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Stieet Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: 2208 CORTEZ BLVD City State ZIP Code Company NAIC Number FORT PIERCE Florida 34982 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 El—E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. Ell. Provid,e 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, crawispace, 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 1-2 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet Elmeters Elabove or E]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. I 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 Address City' State ZIP Code Signature Date Telephone Comments i ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6 1 ELEVATION CERTIFICATE' t4• y 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: 2208 CORTEZ BLVD City State ZIP Code Company NAIC Number FORT PIERCE Florida 34982 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 item(s) and sign below. Check the measurement used in Items G8-1310. 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. 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) ❑ feet ❑ meters Datum of the building: G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum ❑feet ❑meters G10. Community's design flood elevation: Datum I Local Official's Name Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) i ❑ Check here if attal hments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. rum l i Iaqu `' "' "