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HomeMy WebLinkAboutELEVATION CERTIFICATEU.S. UePARTMENTOFHOMELANDSECURITY �,EVATION CERTIFICATE 11311-"1 -7 FEDEf jL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0006 NndortaJ Floodii maance Program It _ rtant: Read the instructions on pages Expiration Date: July 31, 2015 SECTION A- PROPERTY INFORMATION FOR: INSURANCE: COMPANY USE.. Al. Building Owners Name RAY & JANE OSBORN #4058-63 Policy Number. A2. Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. -•Company NA IC Number. 10725 SOUTH OCEAN DRIVE #417 - .... . ...... .. . _ __.. City JENSEN BEACH State FL ZIP Code 34957 $ GA(M(YE" ' A& Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 30, BLOCK 0, HOLIDAY OUT AT ST. LUCIE SECTION B An A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL i A5. Latitude/Longitude: Lat. 27'16'16.96"N Long. 80°12'23.42'W 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. A7. Building Diagram Number 5 AS. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage. a) Square footage of crawlspace or enclosure(s) NIA sq It a) Square footage of attached garage WA sq It b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s) within 1.0 foot above adjacent grade NIA within 1.0 That above adjacent grade WA c) Total net area of flood openings in A8.b NIA sq in c) Total net area of flood openings in A9.b WA sq in d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes ® No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name B3. State ST. LUCIE CTY LINING. AREAS 120285 ST. LUCIE FLORIDA B4. MaplPanel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel - B8. Flood B9. Base Flood Elevation(s) (Zone 12111C0314 J I 08/19/91 Effective/Revised Date Zone(s) AO, use base flood depth) 02/16/12 AE 7.0 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/Source: B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ® NAVD 1988 ❑ Other/Source: 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 Al-A30, AE, AH, A (with BFE), VE, V1 V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, ARJAH, ARJAO. Complete Items C2. below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: NOAA 94 77A02 Vertical Datum: NAVD 1988 , Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 ®NAND 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 (ncluding basement, crawlspace, or enclosure floor) 7.21 , ® feet ❑ meters b) Top of the next higher floor N/A._ ❑ feet ❑ meters C) Bottom of the lowest horizontal structural member (V Zones only) N/A. ❑ feet ❑ meters d) Attached garage (top of slab) WA._ ❑ feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 7.11 ® feet ❑ meters (Describe type of equipment and location in Comments) 0 Lowest adjacent (finished) grade next to building (LAG) 3.80 ® feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 4.10 ® feet ❑ meters h) Lowest adjacent at lowest elevation of deck or stairs, including structural support 4.1 ® feet ❑ meters LAM grade SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land s eyor, engineer, or architect authorized by law to certify elevation information. I certify that the information on this Ce to represents my best efforts to interpret the data available. - • -- - I understand that any false statement may be purl able by fine orimpdsonment under 18 U.S. Code, Section 1001. f ® Check here if com are p vided o c k of form. Vi r de nand longitude in Section A provided by a / �, a• ® Check here if a chments. ceneed land surveyor7 ® Yes El No 111 . _ Certifiers Nam TEPHEN J. BRO License Number 4049 Title SUR OR & MAPPER ompany Name STEPHEN J. BROWN, INC. Address 9 EAST 6" EET City STUART State FL ZIP Code 34994 Signature STEPHENKBR9KN I Date 02/06/14 Telephone (772) 288-7176 (7112) See reverse side for continuation. Replaces all previous editions. U.S. DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY Nariona/Flood fhnv eProgram NATION CERTIFICATE , Irnl _ . wnt: Read the instructions on pages 1 -o OMB No.1660-0008 Expiration Date: July 31, 2015 SECTION A - PROPERTY INFORMATION 1 FOR INSURANCE COMPANY USE I A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number. 10725 SOUTH OCEAN DRIVE #417 City JENSEN BEACH State FL ZIP Code 34957 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 30, BLOCK Q, HOLIDAY OUT AT ST. LUCIE SECTION B A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latdude/Long""dude: LaL 27*16'16.96'N Long. 80"12'23.42'W 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. A7. Building Diagram Number 5 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) N/A sq it - a) Square footage of attached garage N/A sq It b) Number of permanent flood openings in the crawispace b) Number of permanent flood openings in the attached garage or enclosure(s) within 1.0 foot above adjacent grade WA within 1.0 foot above adjacent grade WA c) Total net area of flood openings in A8.b WA sq in c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes N No d) Engineered flood openings? - ❑ Yes N No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name B3. State ST. LUCIE CTY. UNINC. AREAS 120285 ST. LUCIE FLORIDA B4. Map/Panel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel B8. Flood - B9. Base Flood Elevation(s) (Zone 12111 C0314 J 08/19/91 EffeclivelRevised Date Zone(s) AO, use base flood depth) 02/16/12 AE 7.0 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile N FIRM ❑ Community Determined ❑ Other/Source: _ - - BI1. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 N NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes N No Designation Date: _ ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Ct. Building elevations are based on: ❑ Construction Drawings' N 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, VI-V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-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: NOAA 94 77 A02 Vertical Datum: NAVD 1988 Indicate. -elevation datum used for the elevations in items a) through h) below. 0 NGVD 1929 0 NAVD 1988 ❑ Other/Source: _ Datum used for building elevations must be the same as that used for the BFE. ` a) Top of bottom floor (including basement, crawlspace, or enclosure floor) b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) - e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) g) Highest adjacent (finished) grade next to building (HAG) h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support Check the measurement used. 7.21 N feet ❑ meters WA- ❑ feet ❑ meters WA._ ❑ feet ❑ meters WA._ ❑ feet ❑ meters WA._ ❑ feet ❑ meters 3.80 N feet ❑ meters 4.10 N feet ❑ meters WA._ ❑ feet ❑ meters SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION / This certification is to be signed and sealed by ajand surveyor, engineer, or architect authorized by law to certify elevation information. / certify that the information on fh" rf/ficate represents my best efforts to interpret the data available. I understand that any false statement may punishable by fine orimpdsonment under f8 U.S. Code, Section foot. ❑ Check here if ce nts are prow on back of form. ere latitude and longitude in Section A provided ❑ Check her attachme licensed land surveyor? N Yes ❑ No Certifier's ameSTEPHENJ. O License Number 4049 -,,;,/ i Title S RVEYOR & MAPP Company Name STEPHEN J. BROWN, INC. Add ss 619 EAST 5' TR City STUART State FL ZIP Code 349 - Sig ature STEPH J. O Date 01/17/14 Telephone p (772) 288-7176 FEMArarrif 86-0-33 (71141 See reverse side for continuation. Replaces all previous editions. ELEVATION CERTIFICATE, page 2 IMPORTANT: In these spaces, copy th_-„_ responding information from Section A FOR INSURANCE COMPANY USE BuildingStreet Address (including Apt., Unit; Suite, and/or Bldg. No.) or P.O. Route and Box No. - Policy Number.-- - 10725 SOUTH OCEAN DRIVE #417 City JENSEN BEACH State FL ZIP Code 34957 .Company NAIC Number SECTIO" - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy be ides of thisiNlevat� ertificate for (1) community official, (2) insurance agent1company, and (3) building owner. Date 01/17/14 SECTION E - MUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For 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 El.-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. Et. 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 endosure) is ❑feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspaoe; 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 (seepages 8-9 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 -- [Ifeet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machineryand/or equipment servicing the building is _— E]feet ❑ meters ❑ above or E]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 thisinformation 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 forZbne A (without a FEMA-issued or community -issued BFE) or Zone AD must -sign here. The statements in Sections A, B, and Eare -correct to the best of my knowledge. Property Owners or Owner's Authorized Representative's Name Address . w _ --.. _ _ _ - . - - City -- State' - ZIP Code Signature Date Telephone Comments rl Check here if attachments. SECTION G - COMMUNITY INFORMATION (OPTIONAL) i ne local omual who is allthOnzed 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 appricable item(s) and sign below. Check the measurement used in items GO-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 autorizea 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 ptems G4-G10) is provided for community floodplain management purposes. •G5. Date Permit Issued 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 - Datum G9-. BFE or (ilk Zone pC)Idepth'of flooding at the building site: El feet ❑meters Datum — I. - -- G10. Communfty's:desigeflood elevation: El feet El meters Datum -- Local Of„ciaal'shame" 1. ^', ';r TNe Community Name - - Telephone , Signature^ '•r li �,npi „ , ,Date Comments i,��•r ..`.1 •''`,1i, �,,' • fl }'; \N - El Check here if attachments. FEMA Form 086-0-33 (7/12) 1 Replaces all previous editions. ELEVATION CERTIFICATE, page 3 #uilding Photographs . See Instructions for Item A6. 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. 10725 SOUTH OCEAN DRIVE #417 City JENSEN BEACH State FL ZIP Code 34957 ComDanv NAIC Number. If using the Elevation Certificate to obtain NAP 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 or vents, as indicated in Section AB. If submitting more photographs than will fit on this page, use the Continuation Page. DATE OF PHOTOGRAPHS:02105114 FEMA Form 086-0-33 (7112) Replaces all previous editions. ELEVATION CERTIFICATE, page 4 wldmg Photographs Continuation Page 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. 10725 SOUTH OCEAN DRIVE 9417 City JENSEN BEACH State FL ZIP Code 34957 Company NAIC Number. 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. DATE OF PHOTOGRAPHS:02/05M4 _ jjj - a �yn •kr�gp � I FEMA Forth 086-0-33 (7/12) Replaces all previous editions. 2 In these spaces, copy information from Section A. 1 11111i� I FOR INSURANCE COMPANY USEr Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number - 10725 SOUTH OCEAN DRIVE A417 _ City JENSEN BEACH State FL ZIP Code 34957 Company NAIC Number: SECON D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of tJy'sJEIe Certificate for (1) community official, (2) insurance ageM/oompany, and (3) building owner. Comments age Data 02/06/14 ISECPINbN E - BXIILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR 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, 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, crawlspace, or enclosure) is _ _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crewlspace, 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 8--9 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 cemmunitys 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 FEMA4ssued or community4ssued 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 Owners Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments I-7 Check here if attachments. SECTION G-COMMUNITY INFORMATION (OPTIONAL) I ne local Omclal who S autnonzac by law Or ordinance to 2dMinster the ODn of this Elevation Certificate. Complete the applicable item(s) and sign below. 7ement ordinance can complete Sections A, B, C (or E), a used in Items 138-1310. 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 FEMA4ssued or community4ssued BFE) or Zone AO G3. ❑ The following inforrimation (Items G4-G10) is provided for community floodplain management purposes. G4. Permit Number _ I G5. Date Permit Issued I G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for. ❑ New Construction ❑ Substantial Improvement 138. Elevation of as -built lowest floor (including basement) of the building: _ _ ❑ feet ❑ meters Datum G9. BFE or (in Zone AO) depth of flooding at the building site: _ _ ❑ feet ❑ meters Datum G10. Communlys desigri flood elevation: _ _ ❑ feet ❑ meters Datum LocalOftiCaal'sName - Title CommunityName Telephone Signature Date Comments Check here if attachments. FEMA Form 086-0-33 (7/12) Replaces all previous editions.