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FEMA
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
AND
INSTRUCTIONS
2019 EDITION
rOMB No. 1660-0008
Expiration Date: November 30, 2022
U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICATE AND INSTRUCTIONS
Paperwork Reduction Act Notice
Public reporting burden for this data collection is estimated to average 3.75 hours per response. The burden estimate includes the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
submitting this form. You are not required to respond to this collection of information unless a valid OMB control number is
displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the
burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency,
500 C Street SW,Washington, DC 20742, Paperwork Reduction Project (1660-0008). NOTE: Do not send your completed form
to this address.
Privacy Act Statement
(
Authority:Title 44 CFR§61.7 and 61.8.
Principal Purpose(s): This information is being collected for the primary purpose of estimating the risk premium rates necessary
to provide flood insurance for new or substantially improved structures in designated Special Flood Hazard Areas.
Routine Use(s):The information on this form may be disclosed as generally permitted under 5 U.S.C. §552a(b)of the Privacy Act
of 1974, as amended. This includes using this information as necessary and authorized by the routine uses published in DHS/
FEMA-003- National Flood Insurance Program Files System or Records Notice 73 Fed. Reg. 77747 (December 19, 2008); DHS/
FEMA/NFIP/LOMA-1 -National Flood Insurance Program (NFIP)Letter of Map Amendment(LOMA)System of Records Notice 71
Fed. Reg. 7990(February 15,2006);and upon written request,written consent, by agreement,or as required by law.
Disclosure: The disclosure of information on this form is voluntary; however, failure to provide the information requested may
result in the inability to obtain flood insurance through the National Flood Insurance Program or the applicant may be subject to
higher premium rates for flood insurance. Information will only be released as permitted by law.
4 Purpose of the Elevation Certificate
1 The Elevation Certificate is an important administrative tool of the National Flood Insurance Program (NFIP). It is to be used to
provide elevation information necessary to ensure compliance with community floodplain management ordinances, to determine
the proper insurance premium rate, and to support a request for a Letter of Map Amendment (LOMA) or Letter of Map Revision
based on fill(LOMR-F).
The Elevation Certificate is required in order to properly rate Post-FIRM buildings,which are buildings constructed after publication
of the Flood Insurance Rate Map (FIRM), located in flood insurance Zones A1-A30, AE, AH, A(with BFE), VE, V1-V30, V (with
BFE),AR, AR/A, ARAE,AR/A1-A30,AR/AH, and AR/AO. The Elevation Certificate is not required for Pre-FIRM buildings unless
the building is being rated under the optional Post-FIRM flood insurance rules.
As part of the agreement for making flood insurance available in a community, the NFIP requires the community to adopt floodplain
management regulations that specify minimum requirements for reducing flood losses. One such requirement is for the community
to obtain the elevation of the lowest floor (including basement) of all new and substantially improved buildings, and maintain a
record of such information.The Elevation Certificate provides a way for a community to document compliance with the community's
floodplain management ordinance
Use of this certificate does not provide a waiver of the flood insurance purchase requirement. Only a LOMA or LOMR-F from the
Federal Emergency Management Agency (FEMA)can amend the FIRM and remove the Federal mandate for a lending institution
to require the purchase of flood insurance. However, the lending institution has the option of requiring flood insurance even if a
LOMA/LOMR-F has been issued by FEMA.The Elevation Certificate may be used to support a LOMA or LOMR-F request. Lowest
floor and lowest adjacent grade elevations certified by a surveyor or engineer will be required if the certificate is used to support a
LOMA or LOMR-F request. A LOMA or LOMR-F request must be submitted with either a completed FEMA MT-EZ or MT-1
package,whichever is appropriate.
This certificate is used only to certify building elevations. A separate certificate is required for floodproofing. Under the NFIP, non-
residential buildings can be floodproofed up to or above the Base Flood Elevation (BFE).A floodproofed building is a building that
has been designed and constructed to be watertight (substantially impermeable to floodwaters) below the BFE. Floodproofing of
residential buildings is not permitted under the NFIP unless FEMA has granted the community an exception for residential
floodproofed basements. The community must adopt standards for design and construction of floodproofed basements before
FEMA will grant a basement exception. For both floodproofed non-residential buildings and residential floodproofed basements in
Icommunities that have been granted an exception by FEMA,a floodproofing certificate is required.
Additional guidance can be found in FEMA Publication 467-1, Floodplain Management Bulletin: Elevation Certificate, available on
FEMA's website at https_Pwwinr:fefna.gpv"_/media-library/assets/documents/353`3?id=1727.
0
FEMA Form 086-0-33(12/19) Replaces all previous editions. F-053
ii
U.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008
Federal Emergency Management Agency Expiration Date: November 30,2022
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for(1)community official, (2)insurance agent/company,and(3)building owner.
SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name Policy Number:
Baptist Health Properties
A2. Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Company NAIC Number:
Box No.
1029 Atlantic Blvd.
City State ZIP Code
Atlantic Beach Florida 32233
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Part of Tax Parcel 177602 0040
A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory,etc.) Non-Residential/Hospital
A5. Latitude/Longitude: Lat. 30 19'29.17" Long. -81 24'43.49" Horizontal Datum: ❑ NAD 1927 NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 1A
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) N/A sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s)within 1.0 foot above adjacent grade N/A
c) Total net area of flood openings in A8.b N/A sq in
d) Engineered flood openings? ❑ Yes 0 No
A9. For a building with an attached garage:
a) Square footage of attached garage N/A sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade N/A
c) Total net area of flood openings in A9.b N/A sq in
d) Engineered flood openings? ❑Yes ❑x No
SECTION B—FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1. NFIP Community Name&Community Number B2.County Name B3. State
Atlantic Beach 120075 Duval Florida
B4. Map/Panel B5.Suffix 86. FIRM Index 87. FIRM Panel B8. Flood B9. Base Flood Elevation(s)
Number Date Effective/ Zone(s) (Zone AO,use Base Flood Depth)
Revised Date
1231C0408J J 11-02-2018 11-02-2018 AE 6.7'
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9:
Q FIS Profile ❑ FIRM ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 NAVD 1988 ❑ Other/Source:
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes x❑ No
Designation Date: ❑ CBRS ❑ OPA
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 1 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30,2022
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:
1029 Atlantic Blvd.
City State ZIP Code Company NAIC Number
Atlantic Beach Florida 32233
SECTION C-BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations are based on: ❑ Construction Drawings* ❑Building Under Construction* ❑x Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations-Zones A1-A30, AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,ARIAO.
Complete Items C2.a-h below according to the building diagram specified in Item AT In Puerto Rico only,enter meters.
Benchmark Utilized: GPS DERIVED Vertical Datum: NAVD 1988/BASED OFF FPRN
Indicate elevation datum used for the elevations in items a)through h)below.
❑ NGVD 1929 ❑x 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) 9.20 ❑x feet ❑ meters
b) Top of the next higher floor N/A ❑x feet 0 meters
c) Bottom of the lowest horizontal structural member(V Zones only) N/A ❑ feet ❑meters
d) Attached garage(top of slab) N/A ❑ feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building ❑ meters feet x
(Describe type of equipment and location in Comments) 9.3
f) Lowest adjacent(finished)grade next to building(LAG) 8.32 x❑ feet ❑ meters
g) Highest adjacent(finished)grade next to building(HAG) 8.62 x❑ feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
structural support N/A ❑ feet ❑ meters
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.
Were latitude and longitude in Section A provided by a licensed land surveyor? Ei Yes ❑No ❑Check here if attachments.
Certifier's Name License Number
Clayton Walley LS7209
TitleIJON
Professional Surveyor and Mapper
Company Name pta
(�'�� q�,�fl
Alliant Surveying t* z< {4j
Address 1 . f, •
10475 Fortune Parkway Suite 101 is %.
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City State ZIP Code li�ii%' roA'''r'>e.
Jacksonvill Florida 32256 � yr'-
Signat e /� Date Telephone Ext.
11-29-2021 (904)900-3507
Cop all pages o this Fleva'an Certificate and all attachments for(1)community official, (2)insurance agent/company,and(3)building owner.
Comments(' cludire of equipment and location, per C2(e), if applicable)
AC Units located on North side of building on platforms. Lowest recorded elevation=9.30'
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 2 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30,2022
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:
1029 Atlantic Blvd.
City State ZIP Code Company NAIC Number
Atlantic Beach Florida 32233
SECTION E-BUILDING ELEVATION 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, Band C. For Items E1-E4, use natural grade, if available.Check the measurement used. In Puerto Rico only,
enter meters.
El. 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,
crawtspace,or enclosure)is ❑feet ❑meters ❑above or ❑below the HAG.
b) Top of bottom floor(including basement,
crawispace,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 1-2 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 ❑feet ❑meters 0 above or 0 below the HAG.
E4. Top of platform of machinery and/or equipment
servicing the building is ❑feet ❑meters 0 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 or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
❑Check here if attachments.
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 3 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30, 2022
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:
1029 Atlantic Blvd.
City State ZIP Code Company NAIC Number
Atlantic Beach Florida 32233
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.
Gi. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,
engineer,or architect 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.
03. ❑ 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
COM M20-0032 01/26/2021 01/04/2022
G7. This permit has been issued for: XNew Construction ❑ Substantial Improvement
G8. Elevation of as-built lowest floor(including basement) feet meters
of the building: 9.2 ❑ Datum NAVD
G9. BFE or(in Zone AO)depth of flooding at the building site: 6.7 g]feet ❑ meters Datum NAVD
G10. Community's design flood elevation: 9.2 g] feet ❑ meters Datum NAVD
Local Official's Name Title
Dan Arlington Floodplain Administrator
Community Name Telephone
City of Atlantic Beach (904) 247-5813
Signature Date
devt,4 e,k‘s
Comments(including type of equipment and location,per C2(e), if applicable)
Line B4, incorrect Map/Panel Number. Correct number is 12031C0408
[I Check here if attachments.
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 4 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE See Instructions for Item A6. Expiration Date: November 30,2022
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:
1029 Atlantic Blvd.
City State ZIP Code Company NAIC Number
Atlantic Beach Florida 32233
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the
instructions for Item A6. Identify all photographs with date taken; "Front View"and"Rear View";and, if required, "Right Side View"and
"Left Side 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
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Photo One Caption FRONT/EAST VIEW Clear Photo One
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Photo Two
Photo Two Caption SOUTH VIEW Clear Photo Two
FEMA Form 086-0-33(12/19) Replaces all previous editions Form Page 5 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30, 2022
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.Q. Route and Box No. Policy Number.
1029 Atlantic Blvd.
•
City State ZIP Code Company NAIC Number
Atlantic Beach Florida 32233
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs
with: date taken; "Front View" and "Rear View"; and, if required, 'Right Side View" and "Left Side View." When applicable,
photographs must show the foundation with representative examples of the flood openings or vents,as indicated in Section A8.
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Photo 1 hree
Photo Three Caption WEST VIEW Clear Photo Three
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Photo Four Caption NORTH VIEW Clear Photo Four
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 6 of 6