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HomeMy WebLinkAboutELEVATION CERTIFICATEt r Ties U.S. DEPARTMENT OF HOMELAND SECURITY ELE ATIO CERWICA 9 Earc �1, 7Al2Federal Emergency ManagementAgencyNational Flood Insurance Program Important Read the mstructOns on pages 1-9 SECTION A - PROPERTY INFOt?MArON A2. Bolding Street Addy (incJu rig Apt. Unit. Suite: amoof Bldg. No.) or P.O. Route and Box No. In--12S nurH •-�i D,- i, moo. ZS-7 city State ZIP Code A3. Property Description (Lot and Block Numbers, Tax Pa (,jiiIV1mlVi cal Number, Legal Description, e.c.) N1r' y • , r _ � --o (> . r:r it ij i1 ,i . i-L n l . i v� i9 4' � U "T+ aawJ AJ. Building Use (e.g., Residential. N^.^Raida^-'"=1. AddA:on. P.cwssory, etc) F._ S 1 0 r N 'i -1 A L, AS. La budarLorgdLde: Len .. Long Haraontal Datum: El If 4'9Z7""'IJ N:iO'188Y I'A6. Attach at least2 photographs ofthe building :7the Cerffiwteisbefng d usedto ohtaintloomce. suran ..a A7. Building Diagram Number I - 'A8. For a building with a crawlspace or endosure(s): As. For a budding with an attached garage: a) Square footage of crawlspace or endosure(s) sq it a) Square footage of attached garage sa R 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 within 1-0 That above adjacent grade c) Total net area of flood apa^.:ngs in AS.b sq in cj s q r-i t in $�95er�. mad uya s7 i�. Ya. []4a d, ;.r inneE'' _dEw .—y ems? -s LNo SECTION 8 - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION F` �...- - D-ate Effective/Revised Date Zones) AQ use base odepth) j2iil b3 i3 �_ Pd/3e/gyj $� 19 fq( AIL 9.� B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Rem B9. FIS Profile FIRM Community��D--ee/termined El Other (Desctib B11. Indicate elevation datum used for SFE in Item B9: LI.NGVD 1929 ❑ NAVD 1988 ❑Other (Describe) B12. Is the building located in a Coastal Banter Resources System (CBRS) area of Otherwise Protected Area (OPA)? Yes [?'No Designation Date []CERS L7 OPA on C1. Budding elevations are based on: Construction Drawings' LOOT Building Under Censbud-:on' El Finished Corstsuch J ra 'A how Elevation Certificate will be required when construction of the building is complete. CZ. Elevations -Zones A7-A30, AE,AH, A (tft BFE), VE, V1-V30, V (vw'th BFE). AR, ARIA, ARINE, ARIAI-AZO, ARfAH, AWAO. Complete Retns C2.a4a belowaccordhig to the building dagramspec3iodin Rem A7_ Use the sarne datum es the BFE Benchmark Utilized VerScai Datum C t. V. D. 14) 2 - --- Check the measurement used. a) Top of bottom floor (Including basement, crawlspace, or enclosure floor) 9 0 feet I`��j meters (Puerto Rico only) Rice b) Top of the next higherfaor c) Bottom of the lowest horizontal struchrml member (V Zones only) .J eet -_IUI--Ifeet Li meters (Puorto a*) meters (Puerto Rico only) d) Attached garage (top of slab) - ._LJ feet ❑meters (Puerto Rip only) e) Lowest e!evann of machinery or equipment servicing the budding ._Q feet meters (Puerto Rico ony) (Describe type of equipment and location in Comments) metes (Puerto Rim ony)- f) Lowest adjacent (finished) grade next to building (LAG) g) highest adjacerd (farist ed) grade next to buldmg {HAG) []meters (Fonda -co only) h) t.owestadjacent grade atbowestelevation of decker stairs, including -r- Ufeet meters (Puerto Rico, only) SECTION D -SURVEYOR, ENGINEER, OR ARCHITECT CtRTIFtCA I ION This certification is to be signed andaealad by a land ,, eyor, engineer, or architectautlwrized bylaw to wrtrfy elevation ` r information. I cerb7y that the fnfomiation on this Certidwre reprasentsmybed eNarts to friterelotthe data available. I understand that any false stommentmay be punishabieby rme,orimprisonmenf under IS U.S. Cade, Section fr^.u'7. �. Check here if comments are provided on back of forth. Were latitude and longitude in Section A.;�p-rrloIvided by a: licensediandsurveyoo ELJ yes No Name ` I`I k9 Z-b( PLACE SEAL i ERE I tit '� Zb 11 zit f FEMA Form 81-31, Mar 09 See reverse side for continuation. Replaces all previous editions p �gy �I U.S. DEPARTMENTOF HOMELAND SECURITY -ELEVATION CERTIFICATE Federal Emergency Management Agency National Flood Insurance Program Important Read the instructions On pages 1 9. SECTION A - PROPERTY INFORNMATION a0ding C;v T s Name A2. Building Stmet Addr Imcluding Ap0t. Unit. Surte; andrm Bldg. No.) Or SolH tb`tz.5 uTc-�-,�a•ti pet✓�-- city i Al SG'Al 13CA C_0 State �Z.. Expires March 31, 2D12 ZIP Code 3 L4 9 A3. Property Description (Lot and Block Numbers, Tax Paces NuahDer, Leger uascnpoon, ergo La— 3Z� Ri�OCK i� iOL.(t�/�Y UT AC. Building Use (e-g. Residential, NorrResidentlal, Addition, Accessory, eta) i e. 1 Y.) ✓' f'U 'i -i A L.- ' A5. Lat2lude/LongM•de: ! aL Z--10 1 Lo' 09 .Iv `� " Long. t O c i Z' 1 %. �) 3 " Har2ontal Datum: MAD 1927 C,-r&AD 1983 AS. Attach at least2 photographs of the building Hthe CerhTicita isbdmgusedtoobtainfloodi+rsuranna. AT Building Diagram Number -la a 'A8. For a building with a crawlspaceor endosure(s): AS. For a building with an attached garage: a) Square footage of erawispace cr encosure(s) N 4 so it a) Square footage of attached garage G i sq ft b) No, of permanent flood openings in the aawlspace or b) No. of permanent flood openings in the attached garage enclosure(s) within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade Z c) Total net area of flood openings in AS.b sq in c) Total net area of flood openings in A9b 3� sq in CD Eagloearad flood Openings? �j-as Q;10 .y :sae -ad good oamningv 0IYas []NO SECTION 8 -FLOOD INSURANCE RATE MAP (FIRM) INFORMATION St. NRP Community Name 8 Community Number B2. County Name L.L 4 G. fz- B3. State I F` i Al G' 0 2 Z 02 9$ t B4. Map/Panel Number B5- Suffa B6. FIRM Index B7. FIRM Panel to ea. Rood zone(s) 1i9. Base Rood Elevation(s) (Zone AO, use base flood depth) lzitt 03 t2 r- Date G/3o/�°1 EJIQt eiRevised B ! of Aim 9•v 310. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in dam 139 FIS Profile ffFIRM Community�D-eetermined U Other (Describe) B11. Indicate elevation datum used for BFE in Item B9: LCI NGVD 1929 ❑ NAVD 1988 []Other (Describe) B12. is the building located in a Coastal Barrier Resources System (ceRS) area or Otherwise Protected Area (OPA)7 Q Yes f No Designation Date ©CBRS Q OPA SECTION C - BUILDING rELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations ere (rased on: Z] Construction Drawings' tJ Building Under Construction' LrR�J Finished Construction •A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations -Zones Ai-A30, AE,.AH, A (wM BFE), VE, V7-V30, V (such BFE). AR, ARIA, ARIAE, ARIA?-A50, AWAH, ARIAO. Complete Items C2.a-h below according to the buldmg dragram 5pecfied in item A7- Use the same dabmr as the BFE Benchmark Ulif¢ed N Vs `1y -�`t- Aaz- R t'� 1 Ft-ar Vertical Datran C'1. V. 1'�. I 2� Conversiorecomments rct_. 3> [ (a NAVD S8 5 - S.15 wl (a.y.0. Id)29 cq Check the measurement used. a) Top of bottom floor (inciudmg basemen% orawlspace. or encosure floor) -/ (% feet Ir�I meters (Puedo Rim only) SCANNED b) Top oftho nexthigherfloor I & _feet ' 1-d motors(Puerta Rico only) rb%p c) Bottom of the layma bor¢ontal structural member NZones only) I- p -_ Jfeet - El meters (Puerto Rico o,-,f'rVtt♦ Fla d) Attached garage (top of stab) S' . 2 Folleet ❑ meters (Puerto Rico or�`r Lude Cau9tY e) Lowest elevation of machinery or equipment servicing the building 9 .7TR'feet ❑ meters (Puerto Rico only) (Describe type of equipment "and location in Comments) f) Lowest adjacent (finished) grade next to budding (LAG) Lj Q motors (Puerto Rim only) g) Highest aciacent (finished) grade next to budding (HAG) S l feet ❑ meters (Puerto Rim only) h) Lowest adjacent grade at lowest elevation at deck or stairs. including - r" Ofeet 0 meters(Puerto Rim only) structural support e�Trnxi n -ct IRVF;YOR_ ENGINEER. OR ARCHITECT CERTIFICATION This cefGfication is to be signed and sealed by a land surveyor, engineer, or atcnnea aumor¢eo gy ran information. I cerhTythat Me information on this CertrTfmfe 2Pfesents mybest efforts to tetaouetthe data avaf7azie. .-) I understand that any fake statemerltmay be punishable by fine o,impriwnment under 18 U.S. Code, Sec&m 1001. j*Ao.k here if comments are provided on back of form Were latitude and longitude in Sfiction A provided by a licensed land surveyor? Lj 1'as 0 No CeF flees Name LA(ZL_G R IiKay License Number* Ottl L4 L{ S� STtA Trite , - — Comoanv Name 11 _ r _ _ - . —1. e a6-� i iB.Z-dl PLACE. SEAL 1'1 rz lzi'zau %Ls Aliyyscl rzl2i/Zell'-T7Z-GYI(o-tcol-t FEMA Fonn 81-31, Mar 09 See reverse side for continuation. Replaces all previous editions Copy both sides of this Elevation Certificate for (1) community official, (2) insurance-agent/company, and (3) building owner. Comments C. Z C e ) A� I L t' '--? T- r- D ✓L ­4 .. 12 21 �G Ca It � Chacln hem if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) Vor Zones AO and A (without BFE). complete Items Et -ES. 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 Fuerto Rico only, entu meters - Et. Provide elevation information for the following and check the appropriate boxes to showvdetherthe 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 _ _ [3eet []meters ❑above or ❑below the LAG. E2. For Balding Diagrams "with permanent flood openings provided in Section A Items 8 andfor9 (see Was S-9 of Instructions), the nerd higher floor (elevation C2b in the dagmixa) of the building is - - ❑ feet ❑ meters []above or U belowthe HAG. E3. Attached garage (top of slab) is . _ ❑ feet b meters ❑ above or ❑ befowthe HAG. E4. Top of platform of machinery andfor 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 communitys floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OiMNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owners authorized representative who completes Sections A B, and EforZone A (without a FEMA-issued or coma mndy4sstred BFE) or Zone AO mustsign here. The sfatemerntsin SOC90MAB. and Ears WAredto thebest afmylmcwlsdga Property Owner's or Owner's Authorized Representative's Name Address Corr_marAs. City Telephone Code SECTION G -COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplein management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(*) and sign below- Check the measurement wed in items G8 and G9. G1. ❑ The infonrr�_on in Section C was taken from otherdaz"*e_ �t+�'+on tint has been signed and s_red by a licensed surveyor. engineer or aicti lectwho isauthorized bylaw to certify elovationinformation, (Indicate -the source and dateofthe elevation data in the Commentsanea below) G2. ❑ A community official completed Section E fora building located in Zone A (without a FEMA-issued or community -issued BFE) or Zone AO. G3. ❑ The follovring information (Items G449) is provided for community, floodplainmanagement purposes. G4. Permit Number I G5. Date G8. G7. This permit has been issued for ❑New Construction ❑ Substantial Improvement GS. Elevation of as -built lowest floor Onduding basement) of the building ❑ feet ❑ maters (PR) Datum G9. BFE or On Zone AO) depth of flooding at the building site Q feet ❑ meters (PR) Datum' G10. Community's design flood elevation _ . ❑ feet ❑ meters(PR) Datum Local Official's Name True Community Name Telephone Simnature Date Commnts Issued ❑ Check has ifattachrrant. FEMA Form 8131, Mar 09 Repiacas all previous editions See Instructions for Item A6, or 10725 SOUTH OCEAN DRIVE #257 FLORIDA 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 wlth: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and 'Left Side Mew.' If submitting more photographs than will fit on this page, use the Continuation Page, following. FRONT 12/21/2011 11 SIDE 12/21/2011 __ I1 Page o�wamg ouexcnawe tirsauaun� ern , Muy QUM, UMUF MXJ.1W.l a r.v. rtane a o X Irv. 10725 SOUTH OCEAN DRIVE JENSEN BEACH -�� FLORIDA 34957 I 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 Tear View'; and, if required, 'Right Side View" and "Left Side View.° REAR 12/21/2011 11 SIDE 12/21/2011 11