HomeMy WebLinkAbout50 SW 5 Ave ERAL EMERGENCY
i FE NATIONAL FLOOD INSURANCE ROG AM
RAM MANAGEMENT AGENC
0.M.B. No. 3067-OC�77
. ELEVATION CERTIFICATE Expires December al, 200E
1 nt Read the instructions on es 1-7.
SECTION A-PROPERTY OWNER INFORMATION
BUILDING OWNER'S NAME Insuranc NumbomparrrUse:
RICKY LEWIS Policy Number
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE
50 SW 5 AVENUE AND BOX NO. Company NAIC Number
CITY
DANIA STATE ZIP CODE
FL
33004
PROPERTY DESCRIPTION(Lot and B 9 Description,etc.)
NA
Block Numbers,Tax Parcel Number,Legal Des .—
BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,if necessary.) ---
RESIDENTIAL
LATITL E/LONGITUDE(OPTIONAL) HORIZONTAL DATUM:
( ## ##-#1f.01A or ##.#N###°) ❑NAD 1927 0 NAD 1983 SOURCE: 0 GPS(Type): —
0 USGS Quad Map 0 Othe r.
SECTION B-FLOOD INSURANCE RATE MAP IR INFORMATION
131.NFIP COMMUNfTY NAME&COMMUNITY NUMBER
CITY OF DANIA 120034 92.COUNTY NAVE
BROWARD 63.STATE
B4.MAP AND PANEL FL
NUMBER 85.SUFFIX B6.FIRM INDEX DATE EFFEC7 FTIVE�iREViSEDLDATE I39.BASE FLOOD ELEVVION(SJ
12011 C0309 F 10/1/97 FLOOD ZONE(S) (Zone A0,use depth of firming)
B10,Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in 89.P118/92 XN/A
❑FIS Profile E FIRM 0 Community Determined
B11.Indicate the elevation datum used for the BFE Ina):E NGVD 1929 Other( )'
NAVD B12 Is the buildi located in a Coastal Barrier Resources m CBRS area or Otherwise c ed Areal OPA? Other(Describe):
es
SECTION C•BUILDING ELEVATION INFORMATION(SURVEY REQUIRED�No Des' n10n Date
Cl.Buiding elevations are based on:❑Construction Drawings* 0 Building Under Construction* E Finished Construction —_
*A new Elevation Certificate will be required when construction of the buiding is complete.
C2.Building Diagram Number 1(Select the buiding diagram most simiar to the buiding 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,V1-1/30 V(with BFE),AR,AR/A,AR/AE,AR/Al-A30,AR/AH,AR/AO
Complete Items C3.-a-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 it
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 Conversion/Comments
Elevation reference mark used Does the elevation reference mark used appear on the FIRM? 0 Yes❑a)Top of bottom floor(including basement or enclosure) 12 7 ft m ®No
❑b)Top of next higher floor ( ) To
❑e)Bottom of lowest horizontal structural memberzones only) N.A ft.(m) 1
7
❑d)Attached garage(top of slab) (V N N.A ft(m) A.
N. A ft(m) 0
al
❑e)Lowest elevation of machinery and/or equipment
W
servicing the building(Describe in a Comments area) 12.3 ft m [b
❑f)Lowest adjacent(finished)grade(LAG) ( ) U
❑g)Highest adjacent11.6 ft(m) z.03
(finished)grade(HAG) 11. 9 ft(m) ci' ?/�
❑h)No.of permanent openings(flood vents)within 1 ft above adjacent grade N/A 8
❑ r)Total area of all permanent openings(flood vents)in C3.h WA 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.
I certify that the information in Sections A,B,and Con this certificate represents my best efforts to interpret the data available.
I understand that an false statement ma be unishable b fine orim risonment under 18 U.S. Code,Section 1001.
CERTIFIER'S NAME WILLIAM MICHAEL CARR
LICENSE NUMBER 5092
TITLEVICE PRESIDENT
COMPANY NAME ALL COUNTY SURVEYORS
ADDRESS
5950 W OAKLAND P K BLVD CITY STATE 7 p CODE —
SIGNATURE LAUDERHILL FL 33313
DATE TELEPHONE
9/18iO3 954-777-4747
•r - - ---, -r—..,....�.....nn.,auv,t IIV 1,Oet will Far insurance company use:
BUILDING STREETADDRESS(Including Apt,Urtt,Suit( 'x Bldg.No.)OR P.O.ROUTE AND BOX NO.
PaPgNurrter
1
CITY
STATE ZIP CODE Gerry NNC Nurber
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)buldng owner
COMMENTS
JOB#O3-16728
CENTERLINE OF ROAD=10.7
❑Check here if attachnmmts
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 El through E4. If the Elevation Certificate is intended for use as supporting nformation bra LOMA orLOMR-F,
Section C must be completed.
El.Building Diagram Number_(Select the building diagram most similar to the building for which this certificate is being completed—see pages6 and 7. If no diagram occur[fly
represents the building,provide a sketch or photograph.)
E2.The top of the bottom floor(including hacPment or enclosure)of the building is _tt(m)_in.(an)❑above or ❑below(check one)the highest adjacent grade. (UsE
natural grade,if available).
E3.For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the bukting is _it(m)_in.(an)above the highest adjacent
grade. Complete terns C3.h and C3.i on front of form.
E4.The top of the platform of machinery andlorequipment servicing the building is ft(m)_in.(an)❑above or 0 below(check one)the highest adjacent grade. (Use
natural grade,if available).
E5.ForZone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the oommunityr's floodplan management ordnance?
❑Yes ❑No 0 Unknown. The local official must certify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION _
The property owner orowners authorized representative who completes Sections A,B,C(Items C3.h and C3.i only),and E forZone A(without a FEMA-issued or oommunl y-
issued BFE)or Zone AO must sign here. The statements it Sections A,B,C,end E are'motto the best of myknowledge.
PROPERTY OWNERS OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS
CITY STATE ZIP CODE
SIGNATURE DATE TRFPHONE
COMMENTS
❑Check here if attachments
SECTION G•COMMUNITY INFORMATION(OPTIONAL) _
The local official who is authorized by law or ordinance to administer the community's floodplan management ordinance can complete Sections A,B,C(or E),and G of this Elevation
Certificate. Complete the applicable items)and sign below.
GI.❑The information in Section C was taken from other documentation that has been signed and embossed bya 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.❑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 NUW3ER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COt,?LIANCE/OCCUPANCY ISSUED
G7.This permit has been issued for.0 New Construction 0 Substantial Improvement
G8.Elevation of as-built lowest floor(including basement)of the building is: _t.(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
SIGNATURE DATE n
COMMENTS
