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HomeMy WebLinkAboutELEVATION CERTIFICATESU.S. DEPARTMENT OF HOMELAND SECURrr ELEVATION CERTIFICATE Z(c>�R OMB No.1660-ODO8 Federal Emergency Management Agency - C"&� I ExDlres February 28.2009 National Flood Insurance Program Important: Read the instructions on pages 1-8. SECTION A - PROPERTY INFORMATION For Insurance Company Use: Al. Building Owners Name EARL TAYLOR Policy Number A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number 5609 SUNSET BOULEVARD _ City FORT PIERCE Stale FL ZIP Code34982 - A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, a p,'By 12 LOT 21. BLOCK 64, INDIAN RIVER ESTATES UNIT 8, AS RECORDED IN PLAT BOOK 10tl. `.UCIt3 County 2006 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) A5. Latitude/Longitude: Lat. _Long. _ Horizontal Datum: ❑ NAD 1927 ❑ 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_ A8. For a building with a crawl space or endosure(s), provide As. For a building with an attached garage, provide: a) Square footage of crawl space or enclosure(s) _ sq ft a) Square footage of attached garage sq It b) No. of permanent flood openings In the crawl space or b) No. of permanent flood openings in the attached garage enclosure(s) walls within 1.0 foot above adjacent grade _ wells within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name B3. State FORT PIERCE 120285 1 ST. LUCIE FL B4. Map/Panel Number B5. Suffix B6. FIRM Index ST FIRM Panel B8. Flood 69. Base Flood Elevafion(s) (Zone Date Effective/Revised Date Zone(s) AO, use base flood depth) 12111CO281 G 06/30/99 1114/92 AH 17 B10. Indicate the source of the Base Flood Elevation (BFE) data or base Flood depth entered in Item B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe) 811. Indicate elevation datum used for BFE in Item B9: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)7 []Yes ❑No Designation Date_ ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings' ® 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, Vl-V30, V (with BFE), AR, ARIA, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a-g below according to the building diagram specified In Item AT Benchmark Utilized Vertical Datum Conversion/Comments a) Top of,bottom floor (including basement, crawl space, or enclosure floor)_ b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (lop of slab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment in Comments) 0 Lowest adjacent (finished) grade (LAG) g) Highest adjacent (finished) grade (HAG) Check the measurement used. 20..80 ® feet ❑ meters (Puerto Rico only) ❑ feet ❑ meters (Puerto Rico only) _ ❑ feet ❑ meters (Puerto Rico only) 20.47 ® feet ❑ meters (Puerto Rico only) ❑ feet ❑ meters (Puerto Rico only) :LTZ ® feet ❑ meters (Puerto Rico only) 20.8 ❑ feet ❑ meters (Puerto Rico only) 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 ele% 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. ❑ Check here if comments are provided on back of form. 3 s'3 O(o IMPORTANT: In these spaces, copy thr?aa-responding information from Section A. For Insurance Company Use: Building Street Address (including Apt., Unit, Sr. nd/or Bldg. No.) or P.O. Route and Box No. Policy Number 5609 SUNSET BOULEVARD - City FORT PIERCE StateFLZIP Code 34982 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/oompany, and (3) building owner. Comments THIS FORM WAS FILLED OUT USING FIELD DATA ALL ELEVATIONS ARE AS FIELD MEASURED. O.P.A. (FROM B-12) NOT ADDRESSED MACHINERY SERVICING BUILDING REFERS TO PROPOSED AIR CONDITIONING UNIT PAD (CONRETE) ❑ Check here if attachments 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 Et-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 or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawl space, or enclosure) is 0_5.- ® feet ❑ meters .® above or ❑ below the HAG. b) Top of bottom floor (including basement, crawl space, or enclosure) is _._ ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9 (see age 8 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is _ _ [I 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 FLOG. 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. or Signature Comments q*31I Xlk[CJl a State ZIP Code The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, U. C (or L), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8. and G9. G1. ❑ The Infornaflon 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: G9.) is provided for community floodplain management purposes. G5. Date Permit Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: _ _ _❑ feet ❑ meters (PR) Datum _ G9. BFE or (In Zone AO) depth of flooding at the building site: _ _ ❑ feet []mete rs (PR) Datum _ Local Official's Name Title + Commun)tyName Telephone Signature , . • . , i Dale I ' - Check here if attachments HE :EIVEO �(pOa-cr�clr� 'U_PARTMENTOFHOME NDS„ri,.,TtIY•j ZpLE ATION CERTIFh ,TE 0 OMB No. 1660-0008 $� Federal Emergency Managemen Agency ' $ (25 1 E)mires February 28. 2009 National Flood Insurance Prograi rhy. Important: Read the instructions on pages 1-8. SECTION A - PROPERTY INFORMATION For Insurance Company Use: Al. Building Owner's Name EARL TAYLOR Policy Number A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number 5609 SUNSET BLVD City FORT PIERCE State FL ZIP Code 3 +1 fi4 BY A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, et . t. Lucie County LOT 21, BLOCK 64, INDIAN RIVER ESTATES UNIT 8 AS RECORDED IN PLAT BOOK 10. A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL ppl A5. Latitude/Longitude: Lat. _Long. _ Horizontal Datum: ❑ NAD 1927 ❑ NA 1963JAkiprov 0 As. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. AT Building Diagram Numbert By A8. For a building with a crawl space or enclosure(s), provide A9. For a building with an attacr!W-garege: a) Square footage of crawl space or enclosure(s) _ sq ft a) Square footage of attached garage 374 sq It b) No. of permanent flood openings In the crawl space or b) No. of permanent flood openings in the attached garage enclosure(s) walls within 1.0 foot above adjacent grade _ walls within 1.0 foot above adjacent grade _ c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NFIP Community Name & Community Number B2. County Name B3. State FORT PIERCE 120285 ST. LUCIE FL B4. Map/Panel Number B5. Suffix 136. FIRM Index B7. FIRM Panel B8. Flood 89. Base Flood Elevation(s) (Zone Date Effective/Revised Date Zone(s) AO, use base flood depth) F12111CO281 G 06/30t99 11/04/92 AH 17 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe) _ all. Indicate elevation datum used for BFE in Item B9: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑Yes []No Designation Date_ ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* ® Finished Construction •A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations -Zones At-A30, AE, AH, A (with BFE), VE, VI-V30, V (with BFE), AR, ARIA, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a-g below according to the building diagram specified in Item AT Benchmark Utilized Vertical Datum Conversion/Comments Check the measurement used. a) Top of bottom floor (including basement, crawl space, or enclosure floor)_ 20.81 ® feet ❑ meters (Puerto Rico only) b) Top of the next higher floor _ _ ❑ feet ❑ meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) _ _ ❑ feet [] meters (Puerto Rico only) d) Attached garage (top of slab) 20.46 ® feet ❑ meters (Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 20.48 ® feet ❑ meters (Puerto Rico only) (Describe type of equipment in Comments) 0 Lowest adjacent (finished) grade (LAG) 18.7 ® feet ❑ meters (Puerto Rico only) g) Highest adjacent (finished) grade (HAG) 19.8 ® feet ❑ meters (Puerto Rico only) 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 ele% information. I certify that the information on this Cerfiflicate 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. ❑ Check here if comments are provided on back of form. Certifiers Name WILLIAM B. BENNETT License Number 6353 Title P.S.M Company Name BENNETT SURVEYING + MAPPING INC. Address 439 SE PORT SAINT LUCIE BLVD City PORT SAINT LUCIE State FL ZIP Code 34984 6 ( - Z-Z--U-7 0(-Z1--0-7 '7-7Z.33(,.433 IMPORTANT: In these Information from Section A. I For Insurance Company Use: Building Street Address (including. Apt., Una, Suite, .r Blag. No.) or Y.U. rcoute and BOX No. 5609 SUNSET BLVD City FORT PIERCE StateFLZIP Code 34982 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. W Signature uate 0�_ZZ_p7 X// ❑Check here if attachments SECTION E - IBUILDIIIG 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 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 or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawl space, or enclosure) is _ _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (Including basement, crawl space, or enclosure) is — _ ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9 (see page 8 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 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 owners 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 Owners or Address Representative's Name City Signature Date Telephone ZIP Code ❑ Check here if attachments 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 St and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8. and G9. 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: G9.) is provided for community floodplain management purposes. G4. Permit Number I G5. Date Permit Issued I G6. Date Certificate Of G7. This permit has been issued for. ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -bulk lowest floor (including basement) of the building: _ _ _❑ feet ❑ meters (PR) Datum _ G9. BFE or (in Zone AO) depth of flooding at the building site: _ _ ❑ feet ❑ meters (PR) Datum Local Official's Naiae Title Telephone