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BUILDING OVVNER'S NAME SECTION A,PROPERTY OWNER INFORMATION
DOUBLE'D'PROPERTIES Policy Numbnce er
BUILDING BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Policy Number
200 NW 7 AVENUE
CITY Company NAIC Number
DANIA STATE
FL ZIP CODE
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) 33004
BUILDING USE(e.g.,Residential,Non-res
RESIDENTIAL idential,Addition,Accessory,etc. Use a Comments area,if necessary.)
LATITUDElLONGITUDE(OPTIONAL)
or ## °) HORIZONTAL DATUM: SOURCE: ❑GPS❑ --
NAD 1927 ®NAD 1983 ),pe):
ElUSGS Quad Map El Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME&COMMUNITY'NUMBER
CITY OF DANIA 120034 B2.COUNTY NAME
BROWARD B3.STATE E4.MAP AND PANEL B5.SUFFIX FL. J
NUMBER B6.FIRM INDEX DATE B7•FIRM PANEL B9.BASE FLOOD ELEVATIONS) J
12011C0308 F 1WZ97 EFFECTIVE/REVISED DATE B8.FLOOD ZONE S
B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in/102 ( ) (Zone A0,use depth of flood
AE �
❑FIS Profile ®FIRM ❑Community Determined 11
811.Indicate the elevation datum used for the BFE in B9:®NGVD 1929 Other(Describe);
B12.Is the building located in a Coastal Bamer Resources System(CBRS)area or Otherwise Protected ed Area NAV 1988 El Other(Describe):
(OPA)? Yes
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)No Designation Date
C1.Building elevations are based on:❑Construction Drawings*
lding Under
*A new Elevation Certificate will be required when construction of the bbuuildinlg is Complete Construction' ®Finished Construction
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,AR/AO 9
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 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 Conversion/Comments
Elevation reference mark used Does the elevation reference mark used appear on the FIRM?
El
C) a)Top of bottom floor(including basement or enclosure) 11. 65 ft.m Yes No
b)Top of next higher floor ( )
C)
❑ c)Bottom of lowest horizontal structural member(V zones only) N.A ft.(m)
❑ d)Attached garage(top of slab) O ° ° ,yH r'
❑ e)Lowest elevation of machinery and/or equipment N A ft.(m) .a.1
E m
servicing the building(Describe in a Comments area) 00.45 ft.m
Cl f)Lowest adjacent(finished)grade(LAG) ( )
❑ g)Highest adjacent(finished)grade(HAG) y 0
❑ h)No,of permanent openings(flood vents)within 1 ft.above adjacent grade N/A
❑ i)Total area of all permanent openings(flood vents)in C3.h NA sq,in,(sq.cm)
J
SECTI
This certification is to be signed and sealed by a0land surveRorEengiRneeNorl architect
OR AuthoRC eldTbECaT�CERTIFICATION
I certify that the information in Sections A,B, and C on this certificate represents my best efforts to interpret the data available.
y to certify elevation information.
1 understand that an false statement ma be unishable b fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIER'S NAME RICHARD H.BICKHAM
LICENSE NUMBER 6066
TITLENNICEPRESIDENT
COMPANY NAME ALL COUNTY SURVEYORS,INC.
ADDRESS
5950 W,OAKLAND PARK BLVD. #108 CITY STATE
SIGNATURE LAUDERHILL ZIP CODE
FL 33313
DATE TELEPHONE
EMA Form 81-31,JUL 00 12/12/02 954-777 4747
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