Loading...
18420 NE 30 AVEPROCESS # FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067 -0077 FOLIO # NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 C.O.R. f �,�r ELEVATION CERTIFICATE Important. Read the instructions on pages 1 - 7. Amended by MDC -DERM- OCT, 1999 SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number BUILDING ST ET ADDRESS (Including Api, Un' Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number ,� i / C� GCE CITY STATE / ZIP CODE PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) G� BUILDING USE (e-g., idential, Non - residential, Addition, Accessory,etc. Use Comments section if necessary.) �GD �7T`.4L LATFfUDEAANGIT UDE (OPTIONAL-) HORIZONTAL DATUM: SOURCE ❑ GPS (Type): ( tr -;W -##JW or ##.� ❑ NAD 1921 f3 AIAD 1983 ❑ USGS Quad Map ❑ Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1.VFIP C.OMMUNTTY NAME & COMMUNfLY NUMB -&� B2. COUNTY NAME >�t� l- par=kft 83. —no 64. MAP AND PANEL B5. SUFFlX BS. FIRM INDEX 67. FIRM PANEL 88. FLOOD 89. BASE FLOOD E{.EVATION(S) NUMBER i20Z5'G Do �_ DATE �'DL- EFFECTIVFJREVISED DATE - 20- .3 ZONE S) ff� (Zone ,use depfh of flooding) Indicate the source of the a Fl:,FJ evation ( $FE) data or base itond depth entered th 6:ther IS Prattle Commy ❑ Other (Dbe): ndthe elatie E in B9: M '1929 [] NAVD 1988 � (Dewlibe): 512. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ❑ NO Designation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED ).,, C1. Building elevations are based on: ❑ Construction Drawings* [] Budding Under Construction" E Fmished Construction *A new Elevation Ceriinca wtit be required when construction of the building is complete. C2. Building Diagram Ntmiberl (Select the building diagram most sirnilar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations — Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, ARIA, AR(AE, AR(A1 -A30, APJAH, ARIAO Complete items C3a4 below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion calcula ''yonr'1 Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. Dahm'rG�+vr� Comrers>oril � p y /c/� Eiev n reference mark used OV 6 the elevation reference mark usedd appear on the FIRM? ❑ Yes [] No & a) Top of bottom floor (mcludmg basement or enclosure) d O b) Top of next higher floor. _fL(m) �' m ❑ c) Bottom of lowest horizontal structural member (V zones only) .0 iL(m) ❑ d) Attached garage (top of slab) f ._r (m) m tt ❑ e) Lowest elevation of machinery and/or equipment servidmg the building /9 it(m) E. ❑ 0 Lowpest adjacent grade (LAG) t-�? 0ft(m) min 1F`M_irJt 7 ❑ g) Highest adjacent grade (HAG) f a_2fL(m) / n� ❑ h) No. of permanent openings (flood vents) within 1 ft above adj cent grade 9 O 1) Total area of all permanent openings (flood vents) in C3h _sq in. (sq. cm) 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 in Sections A, B, and C on this cedtficate represents my best efforts to interpret the data available. I understand that any false statement fnay be punishable by fine orim 'sonment under 18 U.S. Code, Section 1001. CERTIFiER'SNAMEI, 1� F !7 2 l P� nJ 3U LICENSENUI TA SURVEYORS INC TITLE � © C PANY ME' S W 137TH AVC Sa? 22S MIAML FL_"�in�ea IXM FEMA Form 81 -31, AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT: In these spaces, copy the corresponding information from Section A. I I For Insurance Company Use: CITY D - SURVEYOR, ENGINEER, OR ZIP CODE Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E through E4. If the Elevation Cedilcate is intended for use as supporting information for a LOMA or LOMB -F, Section C must be completed. E1. Building Diagram Number _ (Select the building diagram most similar to the building for which this certificate is being completed — see pages 6 and 7. if no diagram accurately represents the building, provide a sketch orphotograph.) E2. The top of the bottom floor (including basement or enclosure) of the building is I I t ft(m) I 1 lin.(cm) U above or IJ below (check one) the highest adjacent grade. E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated boor (elevation b) of the building is I—L_i ft.(m) I JJin.(cm) above the highest adjacent grade. E4. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's A... nrnin ,, nnnampnt ordinance? I I Yes I I No "I I Unknown. The local offiaalmust certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTAI Ivt) I.CK I Irn.A r DUN The property owner or owner's authorized representative who completes Sections A, B, and for Zone A (without aFEMA- issued or community- issued BFE) or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE Check here 9 attachments 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. G1. 1J The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation, data in the Comments area below.) G2.1 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. L_i The following information (Items G4 -G9) is provided for community floodplain management purposes. G7. This permit has been issued for. 1_1 New Construction LJ Substantial Improvemed G8. Elevation of as -built lowest floor (including basement) of the building is: _ IL(m) Datum: G9. BFE or (in Zone AO) depth of flooding at the building site is: _ fL(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE Check here if FEMA Form 81 -31, AUG 99 REPLACES ALL PREVIOUS EDITIONS