6840 SW 77 TERR_GREEN ELEVATION CERT ELEVATION CERTIFICATE O.M.B No. 3067-0077
FEDERAL EMERGENCY MANAGEMENT AGENCY Expires July 31, 1999
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement.This form is used only to pro-
vide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to determine
the proper insurance premium rate, and/or to_support a request for a Letter of Map Amendment or Revision (LOMA or LOMR).You are not
required to respond to-this collection of information unless a valid.OMB control number is displayed in the upper right corner of this form.
Instructions for completing this form can be found on the following pages.
SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE .
BUILDING OWNER'S NAME POLICY NUMBER
-
STREET ADDRESS(Including Apt.,Unit,Suite and/or Bldg.Number)OR P.O.ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
OTHER DESCRIPTION(Lot and Block Numbers,etc.)
14- 7 402o4h Jew I7 1A10!F 1/1--3
CIT
STATE ZIP CODE
SECTION B :FLOOD INSURANCE RATE MAP(FIRM) INFORMATION
Provide the following from the proper FIRM (See Instructions):
1.COMMUNITY NUMBER 2.PANEL NUMBER 3.SUFFIX 4.DATE OF FIRM INDEX 5.FIRM ZONE 6.BASE FLOOD ELEVATION
i
(in AO Zones,use depth) -
7. Indicate the elevation datum system used.on the FIRM fo'r Base Flood levations (BFE): ❑NGVD'29 ❑Other(describe on back)
8. For Zones A or V, where no BFE:is provided on the FIRM, and,the community has established a BFE for this building site, indicate; .
the community's BFE:1 feet NGVD (or other FIRM datum—see Section B, Item 7)_
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level
2(a). FIRM Zones Al-A30,AE,AH, and A(with BFE). The top of the reference level floor from the selected diagram is at an elevation
oft I I I I I.LJ feet NGVD (or other FIRM datum—see Section B, Item 7).
(b). FIRM.Zones V1 430, VE, and V(with BFE). The bottom of the lowest horizontal structural member of the reference level from
the selected diagram, is at an elevation:of I I I I I I.LJ feet NGVD (or other FIRM datum—see Section B, Item 7).
(c). FIRM Zone A(without BFE). -The floor---used as the reference.level from the selected diagram is �_ _I.LJ feet above❑ or
below❑ (check one) the highest grade adjacent to the building.
(d). FIRM Zone AO. The floor-.used as the reference level from the selected diagram is_LJJ.LJ feet above❑ or below❑ (check
one)the highest grade adjacent to the building. If no flood depth number is available, is the building' s lowest floor(reference
level) elevated in accordance-with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown
3. Indicate the elevation datum system used;in determining the above reference level elevations:X PIGVD'29 ❑ Other(describe
under Comments on Page 2). (NOTE: if the elevation datum used in measuring the elevations is different than that used on
the FIRM (see Section B, Item 27, then convert the elevations to the datum system used on the FIRM and show the conversion
equation under Comments on Page 2.)
4. Elevation reference mark.used appears on FIRM: ❑ Yes ® No (See Instructions on Page 4)
5. The Teference level elevation is based on: ❑.actual construction ❑ construction drawings
(NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which
case this certificate will only be valid for the building during the course of construction. A post-construction Elevation Certificate
will be required once construction is complete:)
6. The elevation of the lowest grade immediately adjacent to the building is:I I I I i -I.U feet NGVD.(or other FIRM datum-see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
1. If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1
is not the "lowest floor"as defined in the community's floodplain management ordinance,the elevation of the building's"lowest
floor"as defined by the ordinance is: I I I I I.LJ feet NGVD (or other FIRM datum—seel Section B, Item 7).
2. Date of the start of construction or substantial improvement
FEMA Form 81-31. AUG 96 REPLACES ALL PREVIOUS EDI110N5 SEE REVERSE SIDE FOR CONTINUATION
SECTION E CERTIFICATION
This certification is to be signed by a land surveyor,engineer, or architect who is authorized by state or local law to certify elevation
information when the elevation information for Zones Ai—A30,AE,AH,A(with BFE),Vl..—V30,VE, and V(with BFE) is required.
Community officials who are authorized by local law or ordinance to provide floodplain management information, may also sign the
certification. In the case of Zones AO and A(without a FEMA or community issued BFE), a building official,a property owner,or an
owner's.representative may also sign the certification.
Reference level diagrams 6, 7 and 8- Distinguishing Features—If the certifier is unable to certify to breakaway/non-breakaway wall,
enclosure size, location of servicing equipment,area use,wall openings,or unfinished area Feature(s),then list the Feature(s) not -
included in the certification under Comments below. The diagram number,Section C, Item 1, must still be entered.
I certify that the information in-Sections 8: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 J.001.
CERTIFIER'S NAME LICENSg NUMBER(or Affix Seal)
ENRIQUE H. POUSADA 5133
TITLE COMPANY NAME
REGISTERED LAND SURVEYOR FREEDOM OF LAND� CORP. SURVEYING SERVICES
ADDRESS CITY STATE ZIP
7575 WEST FLAGLER STREET. SUITE 207 MIAMI FLORIDA 33126
SIGNATURE DATE 796 266j 4451
Copies shoo be made ertificate for: 1)community official,2) insurance agent/company,and 3)building owner.
COMMENTS: �S �iG!%
ON WITH ON PILES,
SLAB ' BASEMENT PIERS,OR COLUMNS
A v -A. A v
ZONES ZONES ZONES ZONES ZONES
_ - - REFERENCE
REFERENCE BASE LEVEL REFERENCE
LEVEL FLOOD LEVEL
ELEVATION
BASE :_`:'-r.: BASE
FLOOD ADJACENT REFERENCE FLOOD
ELEVATION REFERENCE ADJACENT GRADE
LEVEL' ELEVATION
LEVEL GRADE
ADJAGENT%.
GRADE
The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones.
Elevations for all A Zones should be measured at the top of the reference level floor.
Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member.
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