4030 Island Estates DRPROCESS #
PERMIT #
FOLIO #
C.O.R.
BUILDING STREET
4030 Ic
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
on oaaes 1 - 7.
SECTION A - PROPERTY OWNER INFORMATION
Suite, and/or Bldg. No.) OR P.O. ROUTE AND
STATE
FLORIDA
O.M.B. No. 3067 -0077
Expires July 31, 2002
For Insurance Company Use:
Policy Number
Company NAIL Number
ZIP CODE
33160.
PAGE 3, MIAMI DADE COUNTY, FLORIDA.
iw we e. nesiaennai, rvon- resiaenuai, Attbaion, Accessory, etc. Use Comments section if necessary.)
SINGLE F LY HOME.
LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: 1_1 GPS (Type):
or ##.#!## °) 1_I NAD 1927 1X1 NAD 1983 _1USGSQuad Map IX10ther_AUTOMATIC LEVEL
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
L nILINIUAA IZUb.5b I MIAMI-DARE IFLORIDA.
NUMBER DATE EFFECTIVEIREVISED DATE E(S) (Zone A0, use depth of flooding)
12025C_0084 J 3/2/1994 1 7/17/1995 "AE" 9.00
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9.
L_J FIS Profile LJ FIRM J Community Determined 1_1 Other (Describe):
B11. Indicate the elevation datum used for the BFE in B9: IX I NGVD 1929 1J NAVD 1988 J Other (Describe):
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 1J Yes [X( No
Designation Date:
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: )Construction Drawings' IJBuilding Under Construction` IX1Finished Construction
"A new Elevation Certificate will be required when construction of the building is complete.
C2. Building Diagram Number 1 (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 or photograph.)
C3. 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, ARIAO
Complete Items C3a -i 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
calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion.
Datum N . G . V . D . Conversion/Comments
Elevation referen rk d - -
ce me use Does the elevation reference mark used appe
❑ a) Top of bottom floor (including basement or enclosure) 9 87 ft.(m)
❑ b) Top of next higher floor 91 .3Zft.(m)
v
W
❑ c) Bottom of lowest horizontal structural member (V zones only) N/A _ ft.(m)
1 o
❑ d) Attached garage (top of slab) 9 04 ft.(m)
E g
❑ e) Lowest elevation of machinery and /or equipment
w "
servicing the building 8 90 ft.(m)
s
❑ f) Lowest adjacent grade (LAG) 7 00 ft.(m)
z' a
❑ g) Highest adjacent grade (HAG) 7 ZS ft.(m)
y
❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacent N/A
grade
❑ 1) Total area of all permanent openings (flood vents) in C3h N/A sq. in. (sq. cm)
J
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.
l certify that the information in Sections A, 8, and C on this certificate represents my best efforts to interpret the data available.
I understand that any false statement maZ be punishable by fine or imprisonment under 18 U.S. Code Section 1001
CERTIFIERS NAME LICENSE NUMBER
ROLANDO ORTIZ. A�1�
FEMA Form 81 -31. AUG 99 i
SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIO'
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
4030 ISLAND ESTATES DRIVE,
CITY STATE ZIP CODE I Company NAIC Number
AVENTURA, FLORIDA 33160.
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUFni
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
1_1 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 E1 through E4. If the Elevation Certificate is intended for use as supporting
information fora LOMA or LOMR -F, Section C must be completed.
Et. 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 or photograph.)
E2. The top of the bottom floor (including basement or enclosure) of the building is LI_I ft.(m) I— Llin.(cm) LJ above or LJ below
(check one) the highest adjacent grade.
E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is
LL-1 ft.(m) I_L.Iin.(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
floodplain management ordinance? I I Yes I No I I Unknown The local official must certify this information in Section G.
SM. I IUN t- - PKUPERTY 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.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
�', ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
1-1 Check here if attachments
SECTION G - COMMUNITY INFORMATION (OPTIONALI
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. 1_1 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_1 A community official completed Section E for a building located in Zone A (without a FEMA- issued or community- issued BFE) or
Zone A0.
G3. 1_1 The following information (Items G4 -G9) is provided for community floodplain management purposes.
G7. This permit has been issued for: L.1 New Construction 1_1 Substantial Improvement
G8. Elevation of as -built lowest floor (including basement) of the building is: _ ft.(m) Datum:
G9. BFE or (in Zone AO) depth of flooding at the building site is: _ ft.(m) Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
Form
'UV as
Check here if attachments
REPLACES ALL PREVIOUS EDITIONS