Permits 5834 Fleet Landing Blvd U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660 -0008
Federal Emergency Management Agency
Expires February 28. 2009
National Flood Insurance Program Important: Read the instructions on pages 1-8.
SECTION A - PROPERTY INFORMATION For Insurance Company Use:
Al. Building Owner's Name CONTINUING NAVAL. CARE RETIREMENT FOUNDATION, 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
5834 FLEET LANDING BLVD. NORTH
City JACKSONVILLE State FL ZIP Code 32233
A3. Property Description (Lot and Biotic Numbers, Tax Parcel Number, Legal Description, etc.)
A PART OF THE ANDREW DEWEES GRANT, SECTION 37, AND SECTION 5, ALL IN TOWNSHIP 2 SOUTH, RANGE 29 EAST, DUVAL COUNTY, FL
A4. Building Use (e.g., Residential, Non - Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. 30.3568 Long. - 81.4103 Horizontal Datum: 0 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 1
A8. For a building with a crawl space or endosure(s), provide A9. For a building with an attached garage, provide:
a) Square footage of crawl space or enclosure(s) Q sq ft a) Square footage of attached garage $4 sq ft
b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage
enclosure(s) walls within 1.0 foot above adjacent grade Q walls within 1.0 foot above adjacent grade 9
c) Total net area of flood openings in A8.b 9 sq in c) Total net area of flood openings in A9.b Q sq in
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81. NFIP Community Name & Community Number I B2. County Name B3. State
JACKSONVILLE, FLORIDA, 12077 DUVAL FLORIDA
B4. Map/Panel Number 85. Suffix 86. FIRM Index 87. FIRM Panel B8. Flood 69. Base Flood Elevation(s) (Zone
Date Effective/Revised Date Zone(s) AO, use base flood depth)
0242 E 6/16/1999 8/15/1989 X, SHADED X, AE BFE = 8
AE, FW
B10. Indicate the source of ; e = : - F • • • Elevation (BFE) data or base flood depth entered in Item B9.
0 FIS Profile • FIRM ® Community Determined 0 Other (Describe)
811. Indicate elevation datum < = • • BFE in Item 69: ® NGVD 1929 0 NAVD 1988 0 Other (Describe)
B12. Is the building Ioca = • a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)7 0Yes ®No
Designation Date jv1@ 0 CBRS ❑ OPA
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: 0 Construction Drawings* 0 Building Under Construction` ® 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, AR/AO. Complete Items C2.a -g
below according to the building diagram specified in Item A7.
Benchmark Utilized SEE NOTES Vertical Datum NGVD 29
Conversion/Comments N1
Check the measurement used.
a) Top of bottom floor (including basement, crawl space, or enclosure floor)_ 19.19 ® feet 0 meters (Puerto Rico only)
b) Top of the next higher floor WA. ❑ feet 0 meters (Puerto Rico only)
c) Bottom of the lowest horizontal structural member (V Zones only) N . 0 feet 0 meters (Puerto Rico only)
d) Attached garage (top of slab) NIA ® feet 0 meters (Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building WA._ 0 feet 0 meters (Puerto Rico only)
(Describe type of equipment in Comments)
f) Lowest adjacent iflnished) grade (LAG) 1Q ® feet 0 meters (Puerto Rico only)
g) Highest adjacent (finished) grade (HAG) 14.Q ® feet 0 meters (Puerto Rico only)
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. ,
1 understand that any false statement may be punishable by tine or imprisonment under 18 U.S. Code, Section 1001. r
IR Check here if comments are provided on bad( of form.
J `
Certifier's Name ROBERT E. HOLLAND License Number 4242
Title REGISTERED LAND • URVEYOR Company Name R.E. HOLLAND & ASSOCIATES, INC. ; `+ if, -
Address 97 h (= • f •. • UITE 105 City JACKSONVILLE State FL ZIP Code 32256
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Signature ' tbli 06/24/09 Telephone (904) 260-6300 c •,
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
5834 FLEET LANDING BLVD. NORTH
City JACKSONVILLE State FL ZIP Code 32233 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 X-CUT IN CORNER OF CONCRETE TRANSFORMER PAD ELEVATION =15.53 SET BY OTHERS; THIS CERTIFICATION IS GIVEN FOR
THE SPECIFIC PU - • • E OF • INING THE AS -BUILT ELEVATION OF THE FINISHED FLOOR; NOTE ALSO THAT THE PROJECT SITE IS
UNDER ' UC ; FL • • D ZO LINES SHOWN ON THE SURVEY MAP WERE DETERMINED BY GRAPHICALLY PLOTTING THE ZONES
FROM TH 1 1 " P D u i NOT ,, RMINED FROM ACTUAL FIELD ELEVATIONS; NO UNDER FLOOR FLOOD VENTS OR CRAWL SPACES
WERE O = ' ' • = - Y - I 4-'∎ BY COJ PERSONEL; NO OUTSIDE AIR CONDITIONER PAD VISIBLE.
� _
Signature Ft • ND, PLS 142 Date 0684/09
=
® Check here if attachments
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, B,
and 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, crawl space, or enclosure) Is ❑ feet 0 meters ❑ above or ❑ below the HAG.
b) Top of bottom floor (including basement, crawl space, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2. For Building Diagrams 8-8 with permanent flood openings provided in Section A Items 8 and/or 9 (see page 8 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 ❑ above or ❑ 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 floodplaln 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
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodpiain 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. and G9.
01. ❑ 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. -G9.) is provided for community floodplain management purposes.
G4, Permit Number G5. Date Permit Issued G6. Date Certificate Of Compfiance/Occupancy Issued
G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement
08. Elevation of as -bust lowest floor (including basement) of the building: _❑ feet ❑ meters (PR) Datum
G9. BFE or (In Zone AO) depth of flooding at the building site: ❑ feet ❑ meters (PR) Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments
11 Check here if attachments
Building Photographs
See Instructions for Item A6.
For Insurance Company Use:
Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Paley Number
5834 FLEET LANDING BLVD. NORTH
City JACKSONVILLE State FL ZIP Code 32233 YNAICNumber
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two 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." If submitting more photographs than will fit on this page, use the Continuation Page,
following.
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FRONT VIEW
DATE: 06/17/09
Building Photographs
Continuation Page
For Insurance Company Use:
Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number
5834 FLEET LANDING BLVD. NORTH
City JACKSONVILLE State FL ZIP Code 32233 YNAICNtrter
If submitting more photographs than will fit on the preceding page, aMx 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."
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REAR VIEW
DATE: 06/17/09