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HomeMy WebLinkAboutEVALUATION CERTIFICATE WITH PHOTOSIt �� - n7m� AA - ELEVATION CERTIFIC U.S. DEPARTMENT OF HOMELAND SECURITY ATE OMB No. 16 0-0008 Federal Emergency Management Agency x ilres Ma h 31. 2012 National Flood Insurance Program Important: Read the instructions on pages 1-9. A. 11 P SECTION A - PROPERTY INFORMATION or Al. Building Owner's Name St. Lucie County C&T Job No. 10-547.102 Policyy Nu A2. Building Street Address (including Apt., Unit, Suite, andlor Bldg, No.) or P.O. Route and Box No. Company NAIC Number 6805 Cassia Drive City Foil Pierce State FIL ZIP Code 34982 ax Parcel Number, Legal Description, etc.) Indian River Estates-Und 9, BlIk 78, Lot 34 Parcel 10 3402-610-0259-000-6 St. Lucie Coj inj A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential A5. LatitudelLongitude: Lat. 27,36'N Long. 80.30' Horizontal Datum: El NAID 1927 M NAD 1983 All. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. AT Building Diagram Number la As. For a building with a crawispace or enclosure(s): As. For a building with an attached garage: a) Square footage of crawispace or endosure(s) We sq ft a) Square footage of attached garage 400 sq It b) No. of permanent flood openings in the aawlspaca or b) No. of permanent flood openings in the attached garage enclosure(s) within 1.0 foot above adjacent grade We within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b n/a sq in c) Total net area of flood openings In Ag.b �la sq in d) Engineered flood openings? [] Yes C] No d) Engineered flood openings? 0 Yes 9 No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION "inc'Community Name & Community Number B2I Coundtey Name B3. State Un o'rporated Areas, 120285 Be nt Lu I FL I B4. MaplPanel Number B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Bevation(s one 12111CO281 G 1 Date I Effective/Revised Date Zone(s) AD, use base flood Z)tlhof 1 6-30-1999 11-4-1992 AH 17 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered In Item 89. 0 FIS Profile 0 FIRM 0 Community Determined [3 Other (Describe) _ all. Indicate elevation datum used for BFE in Item 89: M NGVD1929 0 NAVID 1988 0 Other (Describe) 612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 0 Yes 0 No Designation Date — 0 CBRS [] CPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: El Construction DrawIngs* 0 Building Under Construction* El 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,VI-V30, V (with BFE), AR, ARIA, ARIAE, ARIAI-A30, AR/AFI, AR/AO. Complete Items C2.a-h below according to the building diagram specified in Item AT Use the same datum as the BFE. Benchmark Utilized aLC B.M. "ROD" Vertical Datum NGVD=17.20,V Conversion/Comments Disk in Conc. is at the BE Cor. of Papaya and Cassia, converted (NAVD)l 5.73'+1.475'= (NGVD) Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 12.70 a feet E] meters (Puerto Rico only) b) Top of the next higher floor N/A._ feet meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) N/A._ feet meters (Puerto Rico only) cl) Attached garage (top of slab) N/A._ feet El meters (Puerto Rico only) a) Lowest elevation of machinery or equipment servicing the building NLA._ [I feet El meters (Puerto Rim only) (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) N/A__ El feet [I meters (Puerto Rico only) g) Highest adjacent (finished) grade next to building (RAG) NlA__ 0 feet 0 meters (Puerto Rim only) h) Lowest adjacent grade at lowest elevation of deck or stairs, including NIA._ 0 feet [3 meters (Puerto Rico only) 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 elevati information. I certffy 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. M Check here if comments; are provided on back of form. Were latitude and longitude in Section A provided by a licensed land surveyor? 0 Yes [] No Certifiers Name mas P. Kiernan, P.S.M. License Number 6199 Title Senior ProlW�Manager Company Name Culpepper & Terpening, Inc. Address 2960 S. _25th St. City Fort Pierce - State FIL ZIP Code 34981 Form 81-31, Mar 09 continualtion. editions IMPORTANT: In these spaces, COPY the corresponding Information from Section A. For Insurance Company Use: Building Street Address (including Apt., yrift, Suite. and/or Bldg. No.) or P.O. Route and Box No. Policy Number 5805 Cassia Drive . , , -, li City FortPlerce, State FIL ZIPCode 34982 Company NAIC Number . SECTION 6 -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. Comments A5. Lat./Long. coordinates obtained with handheld GPS unit. Check SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRSO) FOR ZONE AD AND ZONE A (MTHOUT BFE) For Zones AD and A (without BFE), complete Items EI-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. 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, crawispace, or enclosure) is 0 feet El meters El above or [:] below the HAG. b) Top of bottom floor (including basement, crawispace, or enclosure) is 0 feet D meters El above or 0 below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is _._ E] feet E] meters [] above or [] below the HAG. E3. Attached garage (top of slab) is _._ [] feet [I meters [] above or below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is _ feet [] meters El above or C] 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 communitys floodplain management ordinance? C] Yes [] No E] 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 AD must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Omer's or Owner's Authorized Representative's Name Address city State ZIP Code Signature The local official who is authorized by law or and G of this Elevation Cerfificate. Complet SECTION G - COMMUNITY minister the community's fl000plain management ordinance can complete z: item(s) and sign below. Check the measurement used in Items G8 and G9. Gl. E] 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. G3. The following Information (items G4-Gg) is provided for community floodplain management purposes. G4. Permit Number I G5. Date Permit Issued __F�K Date Certificate Of Compliance/Occupancy Issued G7. This permit has been Issued for: 0 New Construction 0 Substantial linprovernent G8. Elevation of as -built lowest floor (including basement) of the building: [I feet meters (PR) Datum _ G9. BFE or (in Zone AO) depth of flooding at the building site: F-1 feet meters (PR) Datum _ G10. Community's design flood elevation [I feet meters (PR) Datum _ Local Official's Name Title Community Name Telephone Signature 0 Qheck here if attachments FEMA Form 81-31, Mar 09 Replaces all previous editions 1% I U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program #110� -031-) ELEVATION CERT(FICATL Important: Read the instructions on pages 1-9. OMB No. 1660-OGOS Expires March 31, 2012 SECTION A - PROPERTY INFORMATION For insurance Company Use: Al. Buildinq Owner's Name St. Lucie County C&T Job No. 10-547.102 Policy Number A2_ Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. company NAIC Number 5805 Cassia Drive I I City Fort Pierce State Indian River Estates -Unit 9, Bik 78, Lot 34 Parcel ID 3402-610-0259-000-6 L im a MW 11 L—NE—ALL- A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential A5. LatitudelLongrude: Lat. 27.3589'N Long. 80,3005 Horizontal Datum: El NAD 1927 0 NAD 1983 As. Attach at least 2 photographs of the building I the Certificate is being used to obtain flood insurance. AT Building Diagram Number la A8. For a building with a crawlspace or endosure(s): Ag. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) nLa sot It a) Square footage of attached garage 400 sq It b) No- of permanent flood openings in the crawlspace or b) No. of permanent flood openings in the attached garage enclosure(s) within 1.0 foot above adjacent grade n/a within 1.0 foot above adjacent grade 9 c) Total net area of flood openings in A8.b n/a sq in c) Total net area offlood openings inAg.b rile sq in d) Engineered flood openings? El Yes 0 No it) Engineered flood openings? El Yes 0 No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Bl. NFIP Community Name & Community Number BI 3. State County Name B Unincorporated Areas, 120285 nt Lucie FIL B4. Map/Panel Number B5. Suffix 86. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone 12111 CO281 G Date Effective/Revised Date � Zone(s) AD, use base flood depth) 1 6-30-1999 11-4-1992 AH C-1411 r, � i � :i B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. WWI .. ". vl_� 0 FIS Profile 0 FIRM E] Community Determined [I Other (Describe) _ BY Bl 1. Indicate elevation datum used for BFIE in Item B9: N NGVD 1929 [] NAVID 1988 [] Other (Describe) St. Lucie Counq B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? Yes 0 NO Designation Date El CEIRS El OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevabons are based on: 0 Construction Drawings* El Building Under Construction* 0 Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations —Zones, AI-A30, AE. AH, A (with BFE), VE, V1430, V (with BFE), AR, ARIA, AR/AE, ARIAl-A30, AR/AH, ARIAO. Complete Items C2.a-h below according to the building diagram specified in Item AT Use the same datum as the BFIE. Benchmark Ubli7ed SLC B.M."ROD" Vertical Datum NGVD=17.204' Convension/Comments Disk in Cone. is at the SE Cor. of Papaya and Cassia. converted (NAVD)l 5.73'+l .475'= (NGVD) Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 19.0 0 feet E] meters (Puerto Rico only) b) Top of the next higher floor hm-_ El feet El meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member CV Zones only) Nf&a E] feet meters (Puerto Rico only) d) Attached garage (top of slab) a12-22 J9 feet meters (Puerto Rico, only) a) Lowest elevation of machinery or equipment servicing the building a129-11 N feet meters (Puerto Rico only) (Describe type of equipment and location in Comments) 0 Lowest adjacent (finished) grade next to building (LAG) 19.00 0 feet E] meters (Puerto Rico only) g) Highest adjacent (finished) grade next to building (RAG) a!g-�L5 0 feet C] meters (Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A._ feet [] meters (Puerto Rico only) 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 car* that the information on this Certificate represents my best efforts to interpret the data available. / understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. IM Check here if comments are provided on back of form. Were latitude and longitude in Secfion A provided by a licensed land surveyor? [D Yes [I No Cerlifier's Name Thomas P. Kiernan, P.S.M. License Number 6199 panyNanne Culpepper &Terpening, Inc. Fort Pierce State FL zip code 34981 FFMAFnrmRl-31 MarOg ZZ?F-. - */ -, �' � Spe never." side. for ReDlaces all orevious editions IMPORTANT: In these spaces, copy ft esponding Informiation from Section A. I For insurance Building Street Address (including Apt., Uni7s% fie, and/or Bldg. No.) or P.O. Route and Box No. _�Cftlmic;aNumbe umte 5805 Cassia Drive 0 City Fort Pierce State FL ZIP Code 34982 Company 01 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. Comments A5_ Lat/Long. coordinates obtained with handheld GPS unit. C2e) Concrete pad (future A/C pad) on left side of residence is shown for lowest elevation equipment servicing building. Date Check here if SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FbR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items EI-E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B, andC. For Items EI-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. Ell. 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 0 meters 0 above or 0 below the HAG. b) Top of bottom floor (including basement, crawlspare, or enclosure) is feet D meters D above or 0 Wow the LAG. F2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is _._ [] feet El meters [] above or E] below the HAG. E3. Attached garage (top of slab) is _. -at 0 fa E] meters El above or E] below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is _,_ 0 feet [] meters [] above or [] below the HAG. ES. 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? Ej Yes Ej No 0 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 AD must sign here. The statements in Sections A, B, and E are correct to the best of my knowkidge. Property Owner's or Owner's Authorized Representative's Name Address city State ZIP Code Signature Date Telephone Comments [I Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) i he iocai otriciai who is autnonzea oy taw or ordinance to administerthe community's HoGdplam management ordinance can complete Sections and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8 and G9. G1_ 0 The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architectwho is authorized by law to certify elevation information. (indicate the source and date of the elevation data in the Comments area below.) G2_ El A community official completed Section E for a building located in Zone A (without a FEMA-issued or oommunity-issued BFE) or Zone AD. G3. [I The following information (items G4-139) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of CompllancetOccupancy Lssuw- G7. This permit has been issued for. 0 New Construction [I Substantial Improvement G8. Elevation of as-buift lowest floor (incAuding basement) of the building: -at fie [I meters (PR) Datum G9. BFE or (in Zone AO) depth of flooding at the building site: feet [I meters (PR) Datum G1 0. Community's design flood elevation feet El meters (PR) Datum Local Official's Name Title Community Name Telephone Signature Date Comments FEMA Form 81-31, Mar 09 Check hem if attachments :es all previous editions Building Photographs See Instructions for Item A6. I For Insurance Company Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number 5805 Cassia Drive I Fort Pierce State FL ZIPCocle 34982 If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two 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." If submitting more photographs than will fit on this page, use the Continuation Page on the reverse. Front Back Building Photographs Continuation Paqe Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number 5805 Cassia Drive CitV Fort Pierce State FIL ZIP Code 34982 1 CompanyNAICNumbw- If submitting more photographs than will fit on the preceding page, afFrA 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." Right Side Left Side