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Home My WebLink AboutELEVATION CERTIFICATEr SCANNED BY U.S. DEPARTMENT OF HOMELAND SECURITY St. Lucie County OMB No: 1660-008 Federal Emergency Management Agency Expiration Date: November 30, 2018 National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on Pages 1-9 Copy all Pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/comoanv, and (3) building owner. SECTION A —PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name (Note: Not volidto usefor any other person orentity). Policy Number: JEFFREY & ANN HUESI NG #7346-01 A2. Building Street Address (Including Apt., Unit, Suite, and/or Bldg. No. or P.O. Route and Company NAIC Number: Box No. 1333 NETTLES BLVD. City State ZIP Code JENSEN BEACH FL 34957 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) PARCEL 1333, NETTLES ISLAND INC. A CONDO -SECTION II (#4502-501-1520-000-9) A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27'17'4.6026"N Long.-80`13'133638"W Horizontal Datum: ❑ NAD 1927 ® NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number:lA A8. For a building with a crawlspace of enclosure(s): a) Square footage of crawlspace or enclosure(s) 143 sq. ft. b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 1 c) Total net area of flood openings in A8.b SEE COMMENTS sq. in. d) Engineered flood openings? ® Yes ❑ No A9. For a building with an attached garage: a) Square footage of attached garage 170 sq. ft. b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 1 r c),Total net area of flood openings in A9.b SEE COMMENTS sq, in. ` U)Engineered flood affenings? ® Yes ❑ No SECTION B—FLOOD INSURANCE RATE MAP (FIRM) INFORMATION -B1.:.NFIP Cam munity'Nane & Community Number B2. County Name B3. State ST.'LUCIE CTY UNINC. AREAS 120285 ST. LUCIE FL B4,,,Map/Panel .- B5. Suffix B6. Firm Index B7. FIRM Panel B8. Flood Zone(s) B9. Base Flood Elevation(s) Number', ' Date Effective/ (Zone AO, use Base Revised Date Flood Depth) 12111C0311 1 02/16/12 02/16/12 AE 6.0 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: Bll. 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 " FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 1 of 6 EM ELEVATION CERTIFICATE OMB No: 1660-008 Expiration Date: November 30, 2018 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: 1333 NETTLES BLVD. City State Zip Code Company NAIC Number: JENSEN BEACH FL 34957 SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. 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 VI — V30, V (with BFE), AR, AR/A, AR/AE, AR/Al —A30, AR/AH, AR/AO. Complete Items C2.a — h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: 872 2312 G TIDAL Vertical Datum:NAVD 1988 • Indicate elevation datum used for the elevations in Items a) through h) below. ❑ NGVD 1929 ® NAVD 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 (including basement, crawlspace, or enclosure floor) 6.36 ® feet ❑ meters b) Top of Next Higher Floor , 14.36 ® feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A, ❑ feet .: ❑ meters d) Attached garage (top of slab) 5.99 ® feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 8.26 ® feet ❑ meters „ (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 5.42 ® feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 5.94 ® feet ❑ meters h) Lowest adjacent grade at lowest elevation. of deck or stairs, including N/A. ❑ feet ❑ meters 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 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. Were latitude and longitude in Section A provided by a licensed land surveyor? ® Yes ❑ No ® Check here if attachments. Certifier's Name: License Number: Stephen J. Brown, PSM L.S. 4049 - 'Plac • �e I Title: Professional Surveyor and Mapper H re - • ``� r� Company Name: Steph roi,!n; PSM _ , State of Florida!;• Stephen J. Brown, Inc. Address: 6 AST 5`h S EET / \ ;"Noalidr.'ithout the signature and original raisedsealof a Florida City: State: Zip Code: STUART FL 34994 censed5urveyor&Mapper" Signature: Date: Telephone: Stephen J. , PSM 11/05/19 (772) 288-7176 Copy aliPiVeof this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Co including type of equipment and location, per C2(e), if applicable. A8 EFER TO PRODUCT EVALUATION REPORT FOR FLOOD VENT INSULATED MODEL #1540-520 (FLOOD COVERAGE IS 200 SQ. . PER VENT) jA9c REFER TO PRODUCT EVALUATION REPORT FOR FLOOD VENT INSULATED MODEL H1540-520 (FLOOD COVERAGE IS 200 SQ. FT. PER VENT) C2e IS THE BOTTOM OF THE A/C UNIT FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 2 of 6 ELEVATION CERTIFICATE OMB No: 1660-008 Expiration Date: November 30, 2018 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: 1333 NETTLES BLVD. City State Zip Code Company NAIC Number: JENSEN BEACH FL 34957 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 and 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, ❑ feet ❑ meters ❑ above or ❑ below the HAG crawlspace, or enclosure) is b) Top of bottom floor (including basement, ❑feet ❑ meters E] above or E] below the LAG crawlspace, or enclosure) is E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 1-2 of instructions), the next higher floor (elevation C2.b in El feet meters ❑ above or ❑ below the HAG the diagrams) of the building is .❑ E3. Attached Garage (top of slab) -- ❑ feet ❑ meters ❑ above or ❑ below the HAG E4. Top of platform of machinery and/or equipment El feet El meters ❑above or ❑below the HAG servicing the building is E5. Zone AO only: If no flood depth number is available, is the top of the 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. Property Owner or Owner's Authorized Representative's Name: Address City State Zip Code Signature Date Telephone Comments RECEIVED NQV % 1 'TS ST. Lucie County, Permitting ❑ Check here if attachments FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 3 of 6 ELEVATION CERTIFICATE OMB No: 1660-008 Expiration Date: November 30, 2018 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: 1333 NETTLES BLVD. City State Zip Code Company NAIC Number: IENSEN BEACH FL 34957 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 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 G8 — G10. In Puerto Rico only, enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed andsealed 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. Efor a building located in Zone A (without a FEMA-issued or community issued BFE) or Zone AO. - - - G3. ❑ The following information (Items G4:—�G10) 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) ❑ feet ❑ meters Datum of the building: -- G9. BFE or (Zone AO) depth of flooding at the. building site: ❑ feet ❑ meters Datum G10. Community's design flood elevation: _ _ ❑ feet ❑ meters Datum 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. Local Official's Name Title Community Name Telephone Signature Date Comments ❑ Check here if attachments FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 4 of 6 BUILDING PHOTOGRAPHS OMB No: 1660-008 ELEVATION CERTIFICATE See Instructions for ItemA6 Exoiration Date: November 30. 2018 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: 1333 NETTLES BLVD. City State Zip Code Company NAIC Number: JENSEN BEACH FL 34957 If using the Elevation Certificate to obtain NFIP 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 A8. If submitting more photographs than will fit on this page, use the Continuation Page. 05106119 05106119 Photo One Caption: SIDE/FRONT VIEW Photo Three Caption: FRONT/SIDE VIEW .a I k r e IIjj r N y i f- 05106119 05106119 Photo Two Caption: REAR/SIDE VIEW I Photo Four Caption: SIDE/REAR VIEW FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 5 of 6 �A BUILDING PHOTOGRAPHS ELEVATION CERTIFICATE See Instructions for Item A6 OMB No: 08 Date: Expiration Date: November 30, 2018 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: 1333 NETTLES BLVD. City State Zip Code Company NAIC Number: JENSEN BEACH FL 34957 If Submitting more photographs that 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. P; 4' a 05106119 11104119 Photo One Caption: SIDE VIEW Photo Three Caption: VENT (E)[TERIOR VIEW) h Gaa .r pis I _ 77 yY :J .j- �Yv�,xk'�r 11104119 11104119 Photo Two Caption: VENT (INTERIOR VIEW) Photo Four Caption: GARAGE/ENCLOSED AREA (LIVING) FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 6 of 6 U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on Pages 1-9 OMB No: 1660-008 Expiration Date: November 30, 2018 Copy all Pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. SECTION A —PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name (Note: Not Valid to usefor any otherperson or entity). Policy Number: JEFFREY&ANN HUESING A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No. or P.O. Route and Company NAIC Number: Box No. 1333 NETTLES BLVD. City State ZIP Code JENSEN BEACH FL 34957 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) PARCEL 1333, NETTLES ISLAND INC. A CONDO -SECTION II (#4502-501-1520-000-9) A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL ADDITION A5. Latitude/Longitude: Lat. 27"17'4.6026"N Long: 80'13'13.3638"W Horizontal Datum: ❑ NAD 1927 ® NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number:lA A8. For a building with a crawlspace of enclosure(s): a) Square footage of crawlspace or enclosure(s) 143 sq. ft. b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 2 c) Total net area of flood openings in A8.b 256 sq. in. d) Engineered flood openings? ® Yes ❑ No SCANNtL BY A9. For a building with an attached garage: St. Lucie rnonly a)Squarefootage of attached garage 170sq. ft. b)Number of permanenlflood openings in the attached garage within 1.0 foot above adjacent grade 2 x)j'Total net area of food openings in A9.b 256 sq. in. �Ar tgin eyed flooiS'operiings? ® Yes ❑ No ^' i'•, ;-� ^+ - SECTION B—FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Bl. NFI?..Community Name & Community Number B2. County Name B3. State ST. LUCIE'CTY UNINC. AREAS 120285 1 ST. LUCIE - FL B4. Map/Panel B5. Suffix B6. Firm Index B7. FIRM Panel B8. Flood Zone(s) B9. Base Flood Elevation(s) Number Date Effective/ _ (Zone AD, use Base Revised Date Flood Depth) 12111CO311 J 02/16/12 02/16/12 AE - 6.0 810. 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: 1311. 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 FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 1 of 6 ELEVATION CERTIFICATE OMB No: 1660-008 Exoiration Date: November 30.2018 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. Polity Number: 1333 NETTLES BLVD. City State Zip Code Company NAIL Number: JENSEN BEACH FL 34957 SECTION C— BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) CS. 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, AR/AH, AR/AO. Complete Items C2.a —h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: 872 2312 G TIDAL Vertical Datum:NAVD 1988 Indicate elevation datum used for the elevations in Items a) through h) below. ❑ NGVD 1929 ® NAVD 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 (including basement, crawlspace, or enclosure floor) 6.36 ® feet ❑ meters b) Top of Next Higher Floor 14.36 ® feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A._ ❑ feet ❑ meters d) Attached garage (top of slab) 5.99 ® feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) 8.26 ® feet ❑ meters f) Lowest adjacent (finished) grade next to building (LAG) 5.42 ® feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 5.94 ® feet ❑ meters h) Lowest adjacent grade at lowest elevation of -deck or stairs, including N/A. ❑ feet ❑ meters 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 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. Were latitude and longitude in Section A provided by a licensed land surveyor? ® Yes ❑ No ®. C - ere if atta ments. Certifier's Name: License Number: Stephen J. Brown, PSM L.S. 4049 Place -Title: S@al- / A Professional Surveyor and Mapper J Here'1� Company Name: Stephen n; PSM. L.S. aofFlorida Stephen J. B - c, Address: I 619 ST Sth STREET `Not Vah ithout the signature and the ginal raised seal of a Florida Ci, !' State: Zip : COde' UART J FL 34994 1/tignature: Licensed Surveyor&Mapper" /� Date: Telephone: ow Stephen J. Br12/20/19 (772) 288-7176 Copy all Page levation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comme ncl ng type of equipment and location, per C2(e), if applicable. R 0 PRODUCT EVALUATION REPORT FOR FLOOD VENT INSULATED MODEL#1540-520 (FLOOD COVERAGE IS 200 SQ. FT �f T AND 128 SQ. IN. PER FLOOD OPENING) A8 THE GARAGE ENCLOSURE IS FOR STORAGE A9 c ER TO PRODUCT EVALUATION REPORT FOR FLOOD VENT INSULATED MODEL #1540-520 (FLOOD COVERAGE IS 200 SQ. FT. PER VENTAND 128 SQ. IN. PER FLOOD OPENING) A8b & A9b THE BOTTOM OF THE FLOOD VENT OPENING IS 6.84' C2 a IS THE BOTTOM OF THE A/C UNIT FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 2 of 6 ELEVATION CERTIFICATE OMB No: 1660-008 Expiration Date:'November30, 2018 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: 1333 NETTLES BLVD. City State Zip Code Company NAIC Number: 1ENSEN BEACH FL 34957 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 and 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. E1. 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, ❑feet El meters E]above or ❑below the HAG crawlspace, or enclosure) is -- b) Top of bottom floor (including basement, ❑feet ❑ meters ❑ above or ❑below the LAG crawlspace, or enclosure) is -- E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 1-2 of instructions), the next higher floor (elevation C2.b in ❑feet ❑ meters ❑ above or ❑ below the HAG the diagrams) of the building is -- E3. Attached Garage (top of slab) ❑ feet ❑ meters ❑ above or ❑ below the HAG E4. Top of platform of machinery and/or equipment ❑ feet ❑meters ❑above or ❑below the HAG servicing the building is -- E5. Zone AO only: If no flood depth number is available, is the top of the floor elevated in accordance with the community's floociplain 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. Property Owner or Owner's Authorized Representative's Name: Address city State Zip Code Signature Date Telephone Comments CEIVED 2 0 ? 9 [T:D County, Permittjng ❑ Check here if attachments FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 3 of 6 ELEVATION CERTIFICATE OMB No: 1660-008 Expiration Date: November 30, 2018 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: 1333 NETTLES BLVD. city State Zip Code Company NAIC Number: JENSEN BEACH FL 34957 SECTION G —COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administerthe community'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 G8—G30. In Puerto Rico only, enter meters. GS. ❑ 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—G10) 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) ❑ feet ❑ meters Datum of the building: -- G9. BFE or (Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum G30. Community's design flood elevation: ❑ feet ❑ meters Datum 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. Local Official's Name Title Community Name Telephone Signature Date Comments ❑ Check here if attachments FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 4 of 6 BUILDING PHOTOGRAPHS OMB No: 1660-008 ELEVATION CERTIFICATE See Instructions for ItemA6 Exoiration Date: November 30. 2018 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: 1333 NETTLES BLVD. City State Zip Code Company NAIL Number: JENSEN BEACH FL 34957 If using the Elevation Certificate to obtain NFIP 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 A8. If submitting more photographs than will fit on this page, use the Continuation Page. - o i L Iji y x i k i - i I# 11104119 11104119 Photo One Caption: VENT (EXTERIOR VIEW) Photo Three Caption: VENT (EXTERIOR VIEW) t n,. 9e� h Wt s 11104119 11104119 Photo Two Caption: VENT (INTERIOR VIEW) Photo Four Caption: GARAGE/ENCLOSED AREA (LIVING) FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 5 of 6 BUILDING PHOTOGRAPHS OMB No: 1660-008 ELEVATION CERTIFICATE See Instructions for ItemA6 F �n.ro-nnvnmhurZn )nlR 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: 1333 NETTLES BLVD. City State Zip Cade Company NAIC Number: JENSEN BEACH FL 34957 ' If Submitting more photographs that will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front view" and "Rearview"; 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. II� , e 8 NMI (t � 12119119 12119119 Photo One Caption: FRONT/SIDE VIEW Photo Three Caption: REAR/SIDE VIE[[[Wfir F F = 12119119 12119119 Photo Two Caption: LEFT SIDE VIEW Photo Four Caption: RIGHTSIDE VIEW FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 6 of 6