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HomeMy WebLinkAboutELEVATION CERTIFICATESi UWA ( [ EF- L/ v.,,. U J--�
U-S. (DEPAR ENT OF HOMELAND SECURITY! ELEVATION CERTIFICATE
Federal Emergency Management Agency
National Flooll Insurance Program Important: Read the instructions on pages 1-8.
E
N0.1880 0008es Februar 2B. 2009 ,
' _..
SECTION A -PROPERTY INFORMATION For Insurance Oompany Use:
! Al. Building Owner's Name WILLIAM K. & FLORENCE BESSEMER
Policy Number
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC ,Number --i
1103 Tilton (toad
City P RT ST. LUCIE State FL ZIP Code
i A3. Property DesedptlOn (Lot end Blodt NURIbers, Tax Parcel Number, Legal Description, etc.)
I LEGAL DESC-LOT 4, BLOCK 3, ST. LUCIE GARDENS, PARCEL ID-3414.501-0704-000.3
A4. Bulldln Use(e.g.,Residential, Non-Residental, Addition, Accessory, RESIDENTIAL
etc.)
A5. Letitudonpitude: Let 27' 19' 45.1" Long.gq 1t'L Horizontal Datum: [3NAD 1927 ❑, NAD 1983
AS. Attach it least 2 photographs of the building If thI Certificate
Is being used to obtain flood Insurance.
! A7. Building Diagram Number-1
A8. Fore ¢uilding with a crawl space or endosura(s)i, provide A9. Foce building with attached garage, provide:
_ sq ft a) Square footage of attached garage ;),'}Q aq ft
e)- Square footage tt scowl apace or n the crawl
b) Nq. of permanent flood openings in the aawl apace or
b) No, of permanent flood openings In the attached garage
enclosure(s) walls within 1.0 foot,abbve adjacent grade _ walla within 1.0 foot above adjacent grade
c1 Tate1 net area of flood openings in A8.b sit In C) Total net area of flood openings In A9 b I sg In
i
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION -
B1. NFIP Community Name & Community Number
B2. County Name
B3. State
PSL 120287 !
ST. LUCIE
FL l
B4. Map/Panel Number
85. Sufflz I
1 3 FIRM in:
Date
B7. FIRM Panel
Bit. Flood
_J
69. Base Flood Elevation(s) (Zane!
12111CO280
F
08.30-99
Effective/Revised Date
819 91
Zone(s)
A & X
AO, use base flood depth)
NONE DETERMINED ON MAP
--Jl
B10. Indicatelthe source of the Base Flood Elevation (BF'E) data or base flood depth entered in Item Bit.
❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe)
811. Indicate elevation datum used for BFE In Item B9:1 ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe)
B12. Is the building located in a Coastal Bartiei Resources System (CBRS) Otherwise
area or Protected Area (OPA)9 ❑Yea ONO
Designation Date_ ! ❑ C13RS ❑ OPA
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
!Cl. Building elevsflons are based on:: ;❑'Constnlalon 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, V1430, V (with BFE), AR, ARIA, AR/AE, AR/Al-A30, AR/AH, AR/AO. Complecte MUM
below acdording to the building diegram;speci8ed In' Item AT
o7�B91tlOtlrn u
BenchmA U811zed Vertical Datum NGVD 1929 07 B4
Conversion/Commends BY
_
Chad(the measurement used. St-LudeCountV
I
a) Top of bottom floor (including basement,, crew! space, or enclosure floor)_ gQ.gO IR feet ❑ meters (Puerto Rico only)
b) Top of the next higher floor �¢.� ® feet ❑ meters (Puerto Rico only)
c) Sodom
od , of the lowest horizontal structural member (V Zones only) [I feet [I motors (Puerto Rico only)
it) Altaehetl garage (top of slab) I iZ,ji4 ® feet ❑ meters (Puerto Rico only)
e) Lowest elevation of machinery or equipment aervidng the building ij.:Q ®feet [3 meters (Puerto Rico only)
(Describe type of equipment In Comments)
f) Lowest adjacent (finished) grade (LAG) ]2.4 ® feet ❑ meters (Puerto Rfoo only)
High
i g) i et adjacent (finished) grade (HAG) iz-9. ® feet ❑ meters (Puerto Rico only)
i 1
SECTION - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed end sealed bye land surveyor, engineer, or architect authorized by few to certify elevation
Information. I cattily that Me infortnatlon onIM Cergficafe best Interpret
. represents my efforts to the data available.
I understand that false tie
any statement may punishable by One or Impdsonmerd under 18 U.S. Code, Section 1001.
❑ Check heire If comments are provided on beck of form.
Ir
(?
,
�R.. 3' ©_ 0q
Certinees Name WILLIAM. B. BENNErr License Number 6353
! I I
TItlePSM Company Name BENNETiSURVEYING,INC.
i
! Address 493S NOME DRf City PORT ST. LUCIE Slate FL ZIP Code 34984
i I
Signature I Date CMD-09 Telephone 772.336.4933
-IMPORTANT: btpthese spaces, copy the coneeponding Infornadon from Section A.
For Insurance Company
Use:
-9,iilding Strest.Address (including Apt., Unit. Suite, and/or Bldg. No.) or P.O. Route and Box No.
1 103 Tilton Road ; I
'Pollcy Number
C ity PSL StateFLZIP Code i I
Company NAIC Numbalr
SECTION O - SURVETOR, t:NUlH=CK, vrc rortuni r ov r k =n nrwn r wn tvvn r,n
- C upy both aides obthis Elevation Certificate for (1) community official, (2) Insurance agent/company, and (3) building owner.
C urnments LOWEST MACHINARY SERVICING BUILDING IS GENERATER PAD.
i
f IR CONDITIONER PADS ARE NEXT TO HOUSE & ARE AT ELEVATION 19.60.
0 TELL PUMP PAD'1S AT ELEVATION 17.60. I
?ignature Date09.30.09
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND
a
C
:or Zones AO and A (without BFE), complete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Section A, B.
ind C. For Items E1-E4, use natural grade, 0 available. Check the measurement used. In Puerto Rico only, entermeters. 'the etevation is above or below the highesI t adjacent?,1. Provide elevation information for the following and check the appropriate boxes to show whether
grade (HAG);and the lowest adjacent grade (LAG).
a) Top of bottom Boor (Including basement, crawl space, or enclosure) Is _._ ❑feet [3 meters ❑above or [I below the HAG.
b) Top of bottom floor (Including basement, crawl space, or enclosure) Is —_ ❑ feet ❑ meterin ❑ above or ❑ below the LAG.
12. 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 —_ [3 feet El motors ❑ above or (below the HAG.
:3. Attached garage (top of alab)1s ❑het ❑ metere ❑above or ❑.below the FfAO. ,
i1:4. Top of platform of machinery and/or equipment servicing the building is _ _ ❑ feet ❑ meters ❑ above or ❑ below the HAG:
=:5. 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. I
i
SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
.'he property owner or owner's authorized representative who completes Sections A, B. and E for Zorn A (without a FEMA-Issued or communityjlesued BFE)
. ,r Zone AO must sign here. The statements in Sections A, A and E are correct to the best of my knowhrdge.
i ioperty Owner's or Owners Authorized Representative's Name
kddress City I IStete - ZIP Code
i;ignature Date 'Telephone
i
I
omments
If aftchmente
SECTION G - COMMUNITY INFORMATION (OPMONAL) ,
ra local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sedions i
�d G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8. and G9.
1. ❑ The infa"tion In Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, o
Is authorized by law to certify elevation information. (Indicate the source and date of the elevation data Ind the Comments area below.)
I'. ❑ A community official completed Section E for a building located in Zone A (without a FEMA-Issued or community -issued BFE) or Zona
:I. ❑ The following information (Items G4.-G9.) is provided for community floodplain management �uryoaes.
I
8, C (or E), j
architect who
O.
14. Permit Number
G5. Date Permit Issued
06. Date Certificate iCompllance/Occiipancy lasuld
I
T. This permit hea been Issued for. ❑ New Construction ❑ Substantial Improvement I
11. Elevation of as -bufR lowest floor (including basement) of the building: _ _ X3 feet ❑ meters (PR) Datum
11. BFE or (In Zone AO) depth of flooding at the building site: _ _ ❑ feet ❑ meters (PR) Datum
1
Local Offlcial's'Name Tide
1ommunity Name Telephone
Bignature Date
I '
;omments
I
❑ Check h
n
U.S. DEPARTMENT OF HOMELAND SECURITY ,"ELEVATION CERTIFICATE a1
Federal Emergency Management Agency ,� r
National Flood Insurance Program Important: Read the instructions on pages 1-8. r
OMB No. 1660-0008
Exoires February 28. 2009
SECTION A - PROPERTY INFORMATION I For Insurance Company Use: I
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. r r:mmnnnv NAu _ ti,,,.,n r -
1103 Tilton Road UF/pBR C oN5%
City PORT ST. LUCIE State FL ZIP Code
A3. Property (Lot and Block Numbers, Tax ParcLEGAL DE CDLOT 4,Ion BLOCK 3, ST. LUCIE GARDENS, PARCEL DNumbe=3414-501e07n04-000--3c) APPROVED .,
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Let. 27° 19' 45.1" Long. 80° 18' 54.6" © Horizo tan I Datum: ❑ MAD 1927 ❑ NAD 91 83 _ -
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
AT Building Diagram Numbed
A8j For a building with a crawl space or enclosure(s), provide A9. 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 fit
b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage
enclosures) walls within 1.0 foot above adjacent grade _ walls within 1.0 foot above adjacent grade
c) Total net area of flood openings in AB 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 ti Community Number
82. County Name
B3. State
PSL 120287
1 ST. LUCIE
FL
B4. Map/Panel Number
85. Suffix
B6. FIRM Index
B7. FIRM Panel
B8. Flood
B9. Base Flood Elevation(s) (Zone
Data
EffectivelRevised Date
Zone(s)
AO, use base flood depth)
®NONE
12111CO280
F
06-30-99
8-19-91
A 8 X
DETERMINED ON MAP
1310. 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)9 ❑Yes ❑No
Designation Date_ ❑ CBRS ❑ OPA
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings* 0 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, AR/AE, AR/A1-A30, AR/AH, AR/AD. Complete Items C2.a-g
below according to the building diagram specified in Item AT SCANNED
Benchmark Utilized Vertical Datum NGVD 1929 �7V1"lp, NED
Conversion/Comments- b BY
Check the measurement used.St. Lude Cou
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 (top 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)
19.96 ® feet ❑ meters (Puerto Rico only)
®_ _ ❑ feet ❑ meters (Puerto Rico only)
o ❑ feet ❑ meters (Puerto Rico only)
®_ _ ❑ feet ❑ meters (Puerto Rico only)
p ❑ feet ❑ meters (Puerto Rico only)
17.4 ® feet ❑ meters (Puerto Rico only)
17.9 ® 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 eler
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.
Certifiers Name WILLIAM B. BENNETT License Number 6353
Title PSM Company Name BENNETT SURVEYING + MAPPING, INC.
IMPORTANT: In these spaces, copy, ;orresponding information from Section l' For Insurance Company use:
Building Street Address (including Apt., Unit, and/or Bldg. No.) or P.O. Route and Box No. Policy Number
1103 Tilton Road '
City PSL StateiFLZIP Code
OR ARCHITECT CERTIFICATION
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenticompany, and (3) building owner.
111. ❑ 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, Sp•,
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, 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 6 and/or 9 (see page 6 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 communitys floodplain management
ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G.
1%
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's or Owner's Authorized Representative's Name
Address City State ZIPCode
Signature Date Telephone
fl Check here If attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the communitt/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 GIL 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 bylaw 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 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: _._ _❑ feet ❑ meters (PR) Datum _
G9. BFE or (in Zone AO) depth of flooding at the building site: _ _ ❑ feet ❑ meters (PR) Datum _
Local Official's Name Title
Community Name _ Telephone
Signature - _ ' _ J Date
Comments
Check here if attachments