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Home My WebLink AboutELEVATION CERTIFICATEr U.S. DEPARTMENT OF HOMELAND SECURIT,.. 01:: 1660-0008 Federal Emergency Management Agency piration 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 agenticompany, and (3) building owner. SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owners Name Policy Number. GENE & LYNDA NEWMAN A2. Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number. Box No. 8124 SOUTH OCEAN DRIVE City ' State ZIP Code JENSEN BEACH Florida 34957 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 27, DIAMOND SANDS PLAT NO. 2 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat 27.31790N Long.80.22561W Horizontal Datum: ❑ NAD 1927 ❑x NAD 1983 AS. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. AT Building Diagram Number 1A A8. For abuilding with a crawlspace or enclosure(s): Cje a) Square footage of crawlspace or enclosure(s) N/A sq It00, 4 b) Nui mber of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b N/A sq in d) Engineered flood openings? ❑ Yes ❑X No A9. For a building with an attached garage: a) Square footage of attached garage 1702.00 sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A9.b 0.00 sq in d) Engineered flood openings? ❑ Yes ❑x No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name B3. State ST. LUCIE COUNTY-120265 ST. LUCIE COUNTY Florida B4. Map/Panel B5. Suffix 86. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth) Revised Date 12111CO303 J 02-16-2012 02-16-2012 AE 7 810. 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 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)? ❑x Yes ❑ No Designation Date: 10-01-1983 CBRS ❑ OPA FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 FI FVATION CERTIFICATE OM `.0. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Str6et Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number. 8124 SOUTH OCEAN DRIVE City State ZIP Code Company NAIC Number JENSEN BEACH Florida 34957 SECTION C— BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction' ❑x 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, ARIAE, AR/Ai—A30, AR/AH, AR/AO. Complete Items C2.a—h below according to the building diagram specified in Item AT In Puerto Rico only, enter meters. Benchmark Utilized: PROJECT BM - ELEV = 5.27 Vertical Datum: NAVD'88 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929, ❑x NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 7.71 ❑x feet ❑ meters b) Top of the next higher floor 20.79 ❑x feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) 17.23 ❑x feet ❑ meters d) Attached garage (top of slab) 7.19 ❑x feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 7.69 ❑x feet ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 6.50 ❑x feet meters g) Highest adjacent (finished) grade next to building (HAG) 9.10 ❑x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A ❑feet El 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. l 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. Certifier'sName License Number CHARLES H. BLANCARD LS 5755 Title PRESIDENT (A4lore pp leal Company Name LAND SURVEYORS MERIDIAN Address 1717 INDIAN RIVER BLVD., STE 201 City State ZIP Code VERO BEACH, Florida 32960 Signature Date Telephone Ext. �..'��,.�� (772)794-.1213 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) PRIMARY BENCHMARK IS FLORIDA DOT MONUMENT A1A/94/08/BM12, ELEVATION = 3.51' NAVD'88. ON SITE BENCHMARK IS PK NAIL CENTERLINE ACCESS ROAD & N. PROPERTY LINE, ELEVATION= 5.02' NAVD'88. A/C PAD NORTH SIDE OF BUILDING USED TO DETERMINE'C2-E. A/C PAD SOUTH SIDE OF BUILDING ELEVATION = 7.96'NAVD88. LATTITUDE AND LONGITUDE DETERMINED USING HAND HELD GPSS DEVICE. FEMA Fomi 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 OW�-- .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 Strdet Address (including Apt, Unit, Suite; and/or Bldg. No.) or P.O. Route and Box No. Policy Number. 8124 SOUTH OCEAN DRIVE City State ZIP Code Company NAIC Number J 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 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 Rica 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 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. 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 El 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 Owners Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments. FEMA Forni 086-M3 (7115) Replaces all previous editions. Form Page 3 of 6 EL' EVATION CERTIFICATE ON' 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Str�et Address (including Apt, Unit; Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number. 8124 SOUTH OCEAN DRIVE City State ZIP Cade Company NAIL Number JENSEN BEACH Florida 34957 SECTION G — COMMUNITY INFORMATION (OPTIONAL) 111 The local otpcial 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—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. ❑ 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: Elfeet ❑ 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 Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 ELEVATION CERTIFICATE BIL aING PHOTOGRAPHS OM �,166o-a0o8 See Instructions for Item A6. 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. 8124 SOUTH OCEAN DRIVE City State ZIP Code Company NAIC Number JENSEN BEACH Florida 34957 i If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item AS. 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. 14, M11 M. 4J�YiC,• '':y Photo One Photo One Caption FRONT VIEW G;0I66FPF W.One= �^ Y -s / 17, In t C' ��}!�q •I� CC l� :" 7 i a P�Tr Y r. M - F f 6 Photo Two Photo Two Caption REAR Clear Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE Bti . )ING PHOTOGRAPHS OWr • .1660-0008 Continuation Page 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. 8124 SOUTH OCEAN DRIVE City ;, ," ' State ZIP Code Company NAIC Number JENSEN BEACH Florida 34957 If submitting more photographs than will fit on the preceding page, affix the additional photographs below. 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. ff} N f Vim. Y:Yi.. Y.RN..µ. 4 •V Mom. +�^': �y yS ryy��P �1� of TY"li � Ph.W Three Photo Three Caption RIGHT SIDE VIEW `Clear, Photo Three` yp� s s� r Pholo Four Photo Four Caption LEFT SIDE VIEW 'Clear Phofo,Four. FEMA For 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 Planning & Development Services Department Building & Code Regulations Division. 2300 Virginia Avenue Ft Pierce, FL 34982 Phone: 772- 462-2165 Fax: 772462-2522 Request for 30-Day Temporary Power Release Date: 9--Co-le Permit Number: /.S0/-0027 e Project Address: g/ a Y Ss Qceo- wn DPt ✓8 1 THE UNDERSIGNED HEREBY REQUEST RELEASE OF ELECTRICAL POWER TO THE ABOVE DESCRIBED PROPERTY, FOR A PERIOD NOT TO'EXCEED THIRTY (30) DAYS, FOR THE PURPOSE OF TESTING SYSTEMS AND EQUIPMENT IN PREPARATION FOR FINAL INSPECTION. IN CONSIDERATION OF APPROVAL OF THE REQUEST WE HEREBY ACKNOWLEDGE AND AGREE AS FOLLOWS: 1. This temporary power release is requested for the above stated purpose only, and there will be no occupancy of any type, other than that permitted by construction during this time period. 2. As witness by our signatures, we hereby agree to abide by all terms and conditions of this agreement, including Building Division Policy, which is incorporated herein by reference. 3. All conditions and requirements listed in the attached document entitled "Requirements for 30 Day Power far 4. Testing" have been fulfilled and the premise is ready for compliance inspection. 5. All requests for an extension beyond 30 days must be made in writing to the Building Official stating the reason for the request. Power may be removed from the site and/or a Stop Work Order issued if the Final Inspection has not been approved within 30days. A fee of $100.00will be required to lift the Stop Work Order. e 'vrE HEREBY RELEASE AND AGREE TO HOLD HARMLESS, ST. LUCIE COUNTY, AND THEIR EMPLOYEES FROM ALL LIABILITIES AND CLAIMS OF ANY TYPE OF NATURE WHICH MAY ARISE NOW OR IN THE FUTURE OUT OF THIS TRANSACTION, INCLUDING ANY DAMAGE WHICH MAY BE INCURRED DUE TO THE DISCONNECTION OF ELECT ALLPPOWER IN THE EVENT OF VIOLATION OF THIS AGREEMENT. SLCPDSD Revised 061142010 U.S. DEPARTMENT OF HOMELAND SI' !R1TY 15-62 00 ;L'7 Federal Emergency Management Agencl_ 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 SECTION A —PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. BuildinglOwners Name Policy Number. GENE & LYNDA NEWMAN A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number. Box No. 8124 SOUTH OCEAN DRIVE City State ZIP Code JENSEN BEACH Florida 34957 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 27, DIAMOND SANDS PLAT NO.2 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat.27.31790N Long.80.22561W 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. AT Building Diagram Number 1A A8. For a 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 N/A c) Total net area of flood openings in A8.b N/A sq in d) Engineered flood openings? ❑ Yes 9 No A9. For a building with an attached garage: a) Square footage of attached garage 1702.00 sq It b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A9.b 0.00 sq in d) Engineered flood openings? ❑ Yes ❑x No SECTION 8 — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NAP Community Name & Community Number B2. County Name B3. State ST. LUCIE COUNTY-120265 ST. LUCIE COUNTY I Florida B4. Map/Panel B5. Suffix B6. 'FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth) Revised Date 12111C0303 J 02-16-2012 02-16-2012 AE 7 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 89: ❑ FIS Profile x❑ FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ❑ 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)? ❑x Yes ❑ No Designation Date: 10-01-1983 ❑x CBRS ❑ OPA FEMA Form i86-0-33 (7116) Replaces all previous editions. Form Page i 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. 8124 SOUTH OCEAN DRIVE City State ZIP Code Company NAIC Number JENSEN BEACH Florida 34957 SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) 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, ARIA, ARIAE, 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. Benchmark Utilized: PROJECT BM - ELEV. 5.27 Vertical Datum: NAVD'88 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 ) NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 7.86 ❑X feet ❑ meters b) Top of the next higher floor 20.76 ❑x feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) 17.213 ❑x feet ❑ meters d) Attached garage (top of slab) 7.19 ❑x feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building N/❑A feet ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 620 x❑ feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 7.90 ❑x 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 certification is to be signed and seated by a land surveyor, engineer, or architect authorized by law to certify elevation information- 1 certiry 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? Yes ❑ No ❑ Check here if attachments. Certifiers Name License Number CHARLES_ H. BLANCARD LS 5755 Title PRESIDENT - Company Name MERIDIAN LAND SURVEYORS G f7;9 _./::.::,.:• ; Address 1717 INDIAN RIVER BLVD., STE 201 1iZ� 1 City State ZIP Code VERO BEACH, Florida 32960 Signatu Date Telephone Ext 11 (772) 794-1213 Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agenTlcompany, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) PRIMARY BENCHMARK IS FLORIDA DOT MONUMENT AIA/94/08/BM12, ELEVATION = 3.51' NAVD'88. ON SITE BENCHMARK IS PK NAIL CENTERLINE ACCESS ROAD & N. PROPERTY LINE, ELEVATION= 5.02' NAVD'88. NO EQUIPMENT PADS IN PLACE TO DETERMINE C2-E LATTITUDE AND LONGITUDE DETERMINED USING HAND HELD GPSS DEVICE. FEMA Farm 086-033 (7/15) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE 7M6 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. 8124 SOUTH OCEAN DRIVE I City State ZIP Code Company NAIL Number JENSEN BEACH Florida 3495-1 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 LONIA 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. El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above orbeiow 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 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. 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 communihjs floodptain management ordinance? ❑ Yes ❑ No ❑ Unknown- The local official must certify this information in Section G. SECTION F- PROPERTY OWNER (OR OWNERS REPRESENTATIVE) CERTIFICATION The property owner or ownefs authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-fssued 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 Representaflve's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments. FEMA Form 086-0-33 (7115) Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE OM@ 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: 8124 SOUTH OCEAN 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 Certficate. Complete the applicable item(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) or Zone AD. I G3. ❑ The following information (Items 134-1310) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued I G7_ This permit has been issued for., ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (ncluding basement) of the building: ❑ ❑ feet meters Datum I G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑! meters Datum G10. Communitys design flood elevation: ❑ feet ❑ meters Datum Local Official's Name Title Community Name Telephone i I Signature Date f Comments (including type of equipment and location, per C2(e), if applicable) I I i I I I ❑ Check here if attachments. FEMA Farm 086-"3 (7115) Replaces all previous editions. Form Page 4 of 6 BUILDING PHOTOGRAPHS OMB No.1660-0008 ELEVATION CERTIFICATE See Instructions for Item A6. 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: 8124 SOUTH OCEAN DRIVE City State ZIP Code Company NAIL 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 at vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. s _ r f1 r ®�r � `j r f .fi�Pi 4pl` hfrt' rv'.4f'i' 'm.Y"i YVA k '4•� .. Y _ _.,...��A5"k 2 • _ � qua.. p µ i -. o l' Ph= om Photo One Caption FRONT VIEW Clear Photo One 01, 1 �'j r 1 �_,e i • J .i: K 14 1 5 z`�n.m PhoNTwn Photo Two Caption REAR AND SOUTH SIDE > Clem Pno;oTwo' FEMA Form 08&0-33 (7/15) Replaces all previous editions. Form Page 5 of 6