HomeMy WebLinkAbout719 SW 6 St { O J— J O7(0 U FEncRAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
— .TIONAL FLOOD INSURANCE PROGRAM Expires December
31, 200�
I I a 0-1 ('0ELEVATION CERTIFICATE
(�)l a- Important: Read the instructions on pages 1-7.
SECTION A-PROPERTY OWNER INFORMATION For Insurance Company use:
BUILDING OWNER'S NAME Po6cyNumber
RGM CONSTRUCTION Com1.
NAIC Number
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. P an y
719 S.W.6'"STREET
STATE ZIP CODE
CITY
CITY FL 33004
DANIA
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
LOT 8,BLOCK 6,COLLEGE TRACT
BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,if necessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: CE: ❑GPS(Type):
SOUR
( ##0 ##'-####" or ### #� 0 NAD 1927 El NAD 1983 ClUSGS Quad Map ❑Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
7DANIA-120034
NFIP COMMUNITY NAME&COMMUNITY NUMBER �B�ROWARD
Y NAME 7FLORIDA
.STAE
B4 MAP AND PANEL 67 FIRM PANEL 139.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVE ISED DATE B8.FLOOD ZZONE(S) (Zone AO,use depth of floodirg)
12011CO308 F 102197
B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9.
❑FIS Profile ®FIRM ❑Community Determined ❑Other(Describe):
B11.Indicate the elevation datum used for the BFE in B9:®NGVD 1929 ❑NAVD 1988 ❑Other(Describe):—
612.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* ❑Building Under Construction' ®Finished Construction
'A new Elevation Certificate will be required when construction of the building's 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(wth BFE),VE,V1430,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO
Complete Items C3.-a-i below according to the budding 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 NGVD Conversion/Comments
Elevation reference mark used CROWN Does the elevation reference mark used appear on the FIRM? ❑Yes ®No
10. 09 ft m
o a)Top of bottom floor(including basement or enclosure) ( ) M
o b)Top of next higher floor N/A._ft(m) 0
o c)Bottom of lowest horizontal structural member(V zones only) N/A._ft(m) o o
o d)Attached garage(top of slab) WA. _ft(m) w
o e)Lowest elevation of machinery anddlor equipment !1!
servicing the building(Describe in a Comments area) 9.68 ft.(m) r
o f)Lowest adjacent(finished)grade(LAG) 8.45 ft.(m) z I
y� /
o g)Highest adjacent(finished)grade(HAG) 8. 9 ft.(m) ti'
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 0
o )Total area of all permanent openings(flood vents)in C3.h 0 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 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.
CERTIFIER'S NAME RICHARD A SCOTT,JR. LICENSE NUMBER 4510
TITLE REG.LAND SURVEYOR COMPANY NAME RICK SCOTT&ASSOCIATES,INC.
L1721
SS CITY STATE ZIP CODE
STATE RO MARGATE FL 33063
DATE TELEPHONE
URE , c� 11/22/O6 (954)971-0540
FEMA Form 81-31.Jan ry 2003 See reverse side for continuation. Replaces all previous editions