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FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1
Arational Flood Insurance Prograiu Important: Read the instructions on pages 1-9. Expiration Daate:te:Jullyy
31, 2015
SECTION A-PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name ALL SOUTH FLORIDA DEVELOPMENT, INC. Policy Number:
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number:
224 S.W.5 STREET
City DANIA BEACH State FL ZIP Code 33004
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A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
LOT 6, BLOCK 5, "DANIA HEIGHTS"RECORDED IN PLAT BOOK 3 PG.22, BROWARD COUNTY RECORDS
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)PROPOSED RESIDENTIAL
A5. Latitude/Longitude: Lat.26°02'36.51" Long. 80'08'47.52" Horizontal Datum: [INAD 1927 ® NAD 1383
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
AT Building Diagram Number l A
A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) 0 sq ft a) Square footage of attached garage 0 sq ft
b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attacht;d garage
or enclosure(s)within 1.0 foot above adjacent grade 0 within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b 0 sq in c) Total net area of flood openings in A9.b 0 sq it
d) Engineered flood openings? ❑ Yes N No d) Engineered flood openings? ❑ Yes N No
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1. NFIP Community Name&Community Number B2.County Name B3.State
DANIA BEACH 120034 BROWARD COUNTY FLORIDA
64.Map/Panel Number H B6.FIRM Index Date B7. FIRM Panel B8.Flood B9. Base Flood Elevations)(Zone
12011CO567 8/18/2014 Effective/Revised Date Zone(s) AO,use base flood depth)
8/18/2014 X N/A
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
❑ FIS Profile N FIRM ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item 139: ❑ NGVD 1929 N NAVD 1988 ❑ Other/Source:
812. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes ® No
Designation Date: N/A ❑ CBRS ❑ OPA
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
Cl. Building elevations are based on: ❑ Construction Drawings` ❑ Building Under Construction' N 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:SEE COMMENTS Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a)through h)below. ❑NGVD 1929 N 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) 11.59 N feet ❑meters
b)Top of the next higher floor N/A ❑feet ❑meters
c) Bottom of the lowest horizontal structural member(V Zones only) N/A ❑feet ❑meters
d)Attached garage(top of slab) 10.89 N feet ❑meters
e)Lowest elevation of machinery or equipment servicing the building 11.6 N feet ❑meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent(finished)grade next to building(LAG) N/A ❑feet ❑meters
g)Highest adjacent(finished)grade next to building(HAG) 10.8 N feet ❑meters
h)Lowest adjacent grade at lowest elevation of deck or stairs,including structural support 10.5 N feet ❑meters I�
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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.
Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a
® Check here if attachments. licensed land surveyor? N Yes ❑ No
Certifier's Name STEPHEN K.SEELEY License Number LS4574
Title PROFESIONAL SURVEYOR Company Name GIBBS LAND SURVEYORS LS#457
Address 2134OLLYWOODALVD #204 City HOLLYWOOD State FL ZIP Code 33020 4/20/2011
Signatu Date 4/20/2016 Telephone 954-923-7666
FEMA Form 086-0-33(7/12) Sap rpvprsp Girfa fnr rnntiniiatinn Ronhroc�n n�o +;+
GL.LVPII IVIV %a L-r%I IF 14M1 L-, PayC�
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPAN"USE
Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. Policy Number:
224 S.W. 5 STREET _
City DANIA BEACH — State FL ZIP Code 33004 Company NAIC Number:
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)building owner.
Comments: A5- LATITUDE&LONGITUDE ESTABLISHED FROM DIGITAL MAPPING
C2.e)- AIR CONDITIONING EQUIPMENT ON CONCRETE SLAB
BENCHMARK—BROWARD COUNTY ENGINEERING BM#1132
HIGHEST CROWN OF ROAD=9.94
Signature Date 4/20/2016
SECTION e--tiAll DING LEVATION INFORMATION(SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO and A(without BFE), complete Items E1—E5. If the Certificate is intended to support a LOMA 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,crawlspace,or enclosure)is ❑feet ❑meters ❑above or❑below the HAG.
b)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or❑ below the LAG
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions),the next higher floor
(elevation C2.b in the diagrams)of the building is ❑feet ❑meters ❑above or ❑below the HAG.
E3. Attached garage(top of slab)is El feet El meters [I above or El below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is ^_ ❑feet ❑meters ❑above or❑below the HAG.
E5. 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? ❑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's or Owner's Authorized Representative's Name —
Address— City State ZIP Code
Signature Date Telephone —
Comments
❑Check here if at':achments.
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 and sealed by a licensed surveyor,engineer,or arch test 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: I ❑New Construction ❑ Substantial Improvement
G8. Elevation of as-built lowest floor(including basement)of the building: ❑feet ❑ meters Datum
G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters Datum
G10. Community's design flood elevation: ❑feet ❑meters Datum
Local Official's Name Title
Community Name — Telephone—
Signature _-- -- Date --- --- ---- ---�--
Comments
®Check here if attachments.
FEMA Form 086-0-33(7/12) Replaces all previous editions.
ELEVATION CERTIFICATE, page 3 Building Photographs
See Instructions for Item A6.
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:
224 SW 5 STREET __ -
State ZIP Code Company NAIC Number:
City FL 33004
DANIA BEACH --- -
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instruct ons
for Item A6. Identify all photographs with date taken; "Front View" and "Rear View", and, if required, "Right Side View" and "Left ;aide
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.
4/20/16 FRONT VIEW:
4/20/16 REAR VIEW:
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Replaces all previous editions.
FEMA Form 086-0-33 (7/12)