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U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008
National Flood Insurance Program Important: Read the instructions on pages 1-9. Expiration Date: July 31, 2015
SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name NAVAL CONTINUING CARE RETIREMENT FOUNDATION Policy Number:
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number:
2393 MAYPORT ROAD
City ATLANTIC BEACH State FL ZIP Code 32233
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
PT GOVT LOT 2,SEC.8,T2S,R29E, RECD O/R 16069-672,RE#169398 0100
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) RESIDENTIAL
A5. Latitude/Longitude:Lat.N30°2l'07" Long.W81°24'48" 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.
AT Building Diagram Number 1 B
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) N/A sq It a) Square footage of attached garage 000± sq ft
b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage
or enclosure(s)within 1.0 foot above adjacent grade N/A within 1.0 foot above adjacent grade N/A
c) Total net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b N/A sq in
d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes ® No
SECTION B—FLOOD INSURANCE RATE MAP(FIRM) INFORMATION
B1.NFIP Community Name&Community Number B2.County Name B3.State
CITY OF ATLANTIC BEACH#120075 DUVAL FLORIDA
B4.Map/Panel Number B5.Suffix B6.FIRM Index Date B7.FIRM Panel B8.Flood 89. Base Flood Elevation(s)(Zone
12031 C 0406 H 06/03/2013 Effective/Revised Date Zone(s) AO,use base flood depth)
06/03/2013 X,AE* 6-
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
❑ FIS Profile E FIRM ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item B9: E 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 ® No
Designation Date: ❑ CBRS ❑ OPA
SECTION C—BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations are based on: ❑ Construction Drawings* ® Building Under Construction* ❑ 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:NAIL IN WPP(13.65) Vertical Datum: NAVD 1929
Indicate elevation datum used for the elevations in items a)through h)below. E NGVD 1929 ❑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) 13.50 E 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) ®feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building ®feet ❑meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent(finished)grade next to building(LAG) E feet ❑ meters
g) Highest adjacent(finished)grade next to building(HAG) E 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.
l 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? ® Yes ❑ No
i Certifier's Name H.Bruce Durden Jr. License Number P.L.S.#4707
Title President Company Name Durden Surveying and Mapping,Inc.
Address 1825-B ` Stre orth City Jacksonville Beach State FL ZIP Code 32250
Signature Date 09/11/2013 Telephone 904.853.6822
FEMA Form 086-0-33(7/12) See reverse side for continuation. Replaces all previous editions.
ELEVA IIUN GER I IFIGA I t, page 2
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:
2393 MAYPORT ROAD
City ATLANTIC BEACH 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 SECTION C1 AND C2a-FORM BOARDS ONLY. SECTIONS B8&B9-PROPERTY LIES IN FLOOD ZONES"X,AE(6)&FLOODWAY".THE
BUILDING LIES ENTIRELY WITHIN ZONE X.
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Signature Date 09/11/2013
SECTION E-BUILDING EL ATION 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.
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 ❑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 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 attachments.
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 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.
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: ❑ 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:
2393 MAYPORT ROAD
City ATLANTIC BEACH State FL ZIP Code 32233 Company NAIC Number:
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 builtling 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.
FRONT VIEW 9/11/2013
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RIGHT VIEW 9/11/2013
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FEMA Form 086-0-33 (7/12) Replaces all previous editions.
ELEVATION CERTIFICATE, page 4 Building Photographs
Continuation Page
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:
2393 MAYPORT ROAD
City ATLANTIC BEACH State FL ZIP Code 32233 Company NAIC Number:
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.
REAR VIEW 9/11/2013
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FEMA Form 086-0-33 (7/12) Replaces all previous editions.
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Notice of I�speetion Notice of t� '
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Bede eHnspeoWn ' Date of T��tment ;
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ate of Treatment � s� D� �1 �
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Pesticide Used ; Pesticide Used
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Wood-Destroying Organism Treated i Wood-Destroying Organism Treated i
Pursuant to Chapter 482.226,Florida Statutes,this ; Pursuant to Chapter 482.226,Florida Statutes,this
notice is required to be posted.Any licensee who ; notice is required to be posted.Any licensee who ,
performs control of any wood-destroying organism ; performs control of any wood-destroying organism
shall post notice of said treatment immediately ; shall post notice of said treatment immediately
adjacent to the access to the attic or crawl area or ; adjacent to the access to the attic or crawl area or ,
other readily accessible area of property treated. ; other readily accessible area of property treated. ;
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Hom Team HomeTeam
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PEST DEFENSE° 1 PEST DEFENSE•
6694 Columbia Park Dr,Suite 3 i 6694 Columbia Park Dr,Suite 3
Jacksonville,FL 32258-2409 Jacksonville,FL 32258-2409 ;
904-730-2522 ; 904-730-2522 ;
HomeTeam Pest Defense, Inc: I IIIIII IIIII IIIII IIIIIIIIII IIIII VIII IIIII IIII IN
Columbia Park Drive, Suite 3
Jacksonville, FL 32258-2409
Bill To Address: 1848629 WORK ORDER #: 33191096
Service Address: 1988007 North FI Construction Map Code: N/A Tech: CSHARRISON
North Florida Construction Accounts Payable S/C: TP Sales: Z-SPNA
Resident Warranty Customer Po Box 2078 Pets: W/O Type: Work Order
1 Fleet Landing Blvd Callahan, FL 32011-2078 Gate/Patio: Last DS:
Atlantic Beach, FL 32233-4599 904-237-0523 Home Sqft: 7300 Target:
License#: Yard Sqft: W/O Dfso: 09/10/2013
Ph: 000-000-0000 L-Source: S-BUILDER Lot/Block: Schedule:
Alt: S-Source: Size: 7300 Time: 11:00 AM
Mobile: Sub/bevel: ONYOURLOT PO#: Range:
Builder: CUSTOM Active: Start Date:
ervice Description Amoun Directions:
Termite Pretreatment 730.00 Comments: you will have to go to 2395 Mayport Road to get to the site.tps
Sales Tax: 0.00 Taexx Install and PreConstructhon Treatment
Work Order Amount Due: 730.00
Building Sq.It:
Building In It.:
- ❑ BJNR:Reason –
®TJNR:Reason
Number of Taexx lines:
Number of pat boxes:
Nail plates installed ®>�box Winstalled,schedule trim out approximate date:
Fire caulk ®Yes ®No
Jobsite cleaned of instal ®Yes ®No
lartion matlerisl trod debris ®Yes ®No
Number of TUTS lines:
Number of port boxes: Number of slab penetrations:
❑Port box not inslelled,schedule trim out approximate date:
Construction- ❑Slab on grade
Foundation: Crawl and BeamBaserhherht 13 op-Pim ®Other
®Slab monolithic (]Slab supported Slab Roslin
Siding: ❑Lap siding Stone g ®Hollow block ®Bric"tone ®Other.
�Btitdc O Slhtcco
❑C=M to block ❑Olher
❑Complete
❑Marker
E3 Partial tremnent only,list kxxtiort(sy
dye in all areas ❑Marker dye not used
My��h wed ®Marker dye used but excluded from fisted area(s):
[additional nMerial information on the reserve side)
®Bora-care
Finished gallons applied:
Finished gallons applied:
T eat
Horizontal barrier ❑Inside foundation wall ®Mason wall
❑Footings ®O ,. Masonry voids ❑Critical sreas/bath traps ®Final gradeJvertical barrier
Outside foundation wall ®Expansion joints ®Piers ®mer:
Materials used (additional material information on the reserve side)
(]1paxx Pro ®Prevail
Premise Pre El Talstar ®Termidor SC ® Finished gallons applied:
❑Termidor wP XFinished gallons applied:,_3 J
Materials used
❑Sentricon standard ❑Sentricon Always Active Total number of stations:
0 Total number of stations:
Stations numbered ®Yes ❑No
Stations spaced <_1 Oft apart ®Yes 0 No
Graph completed and attached to paperwork
Notice of treatment sticker applied L'1 Yes ®No
All regulatory requirements me¢ es ®No
HomeTeam Pest Defense Signature:
Date:
®HomeTeam Pest Defense,Inc.20¢3
6113
HomeTeam Pest Defense, Inc: 1111111 IIIII IIID ILII IIIII IIIII IIIII IIIII IIII IIII
6694 Columbia Park Drive, Suite 3
Jacksonville, FL 32258-2409
Bill To Address: 1848629 WORK ORDER #: 33240487
Service Address: 1988007 North FI Construction Map Code: N/A Tech: CBBATTE
North Florida Construction Accounts Payable S/C: BTM Sales: Z-SPNA
Resident Warranty Customer Po Box 2078 Pets: W/O Type: Work Order
1 Fleet Landing Blvd Callahan, FL 32011-2078 Gate/Patio: Last DS:
Atlantic Beach, FL 32233-4599 904-237-0523 Home Sqft: 7300 Target:
License#: Yard Sqft: W/O Dfso: 09/13/2013
Ph: 000-000-0000 L-Source: S-BUILDER Lot/Block: Schedule:
Alt: S-Source: Size: Time: 08:00 AM
Mobile: Sub/Devel: ONYOURLOT PO#: Range:
Builder: CUSTOM Active:TWR Start Date:
TWR RD: 09/11/14 $250.00
ervice Description Amoun Directions:
RESPRAY FOOTERS 0.00 Comments:
Sales Tax: 0.00 Taexx Install and PtecOnstruetion Treatment
Work Order Amount Due: 0.00
g
Building Sq.ft: Building in ft.:
Previous Balance Due: 730.00 _
730.00
❑ BJNR:Reason
❑TJNR:Reason
Number ofTaexx lines:
Number of port boxes:
Nail plates installed ❑Port box W installed,schedule trim out approximate date:
Fire caulk ®Yes ®No
lobsite cleaned of installation ®Yes ®No
tttaterial and debris ®Yes ®No
Number of TUTS lines:
Number offport boxes: Number of slab penetratim:
❑Port box 110 iulstalled,schedule taint otic approximate date:
Constraetkiia: on grade OCrawl spaceJPief and Beam O B
asenientFoundation: monolithic ® p� ®ate
®Slab supported Slab floati ® :
Siding: ❑�siding ®Stone n8 ®Hollow bkx�t ®Btick/Stone
❑Brick ®stucco ❑Concrete block ®cher:
O Complete O Partial treatment on list
O Marker �' l (0
dye in all areas ®Marker dye not used ®Marker
Marerlals � dye used but excluded from listed area(s):
(ddMoml mucid mforem m m the were ode)
O Bora care
13 Finished gallons applied-
Finished gallons applied:
,T_t,Ya�°t
L 7A rizontai barrier ❑Inside foundation wall ❑Murry wall voids
®Footings O Critical arr�s/6ath traps ®Final grade/verticsl bartier
Outside fowldation wall - O Expansion joints ®Piers ®Other._
Materials used (amwmnl muenal mfbr�on the mmw side) /e PSP y 60 74`S
O Imaxx Pro O Prevail
Termidor SC ❑ FinishedIons
['Premise Pre gal applied:
❑Talstar ❑Termidor WP /� c Finished gallons applied:l(fid ,/
Materials used
®sentricon standard ®Sentricon Always Active Total number of stations:
0 Total number of stations:
Stations numbered O Yes O No
Stations spaced <_1 Oft apart O Yes O No
Graph completed aihd attached to paperwork O Yes o
Notice of treatment sticker applied 121es ®No
All regulatory requirements met ❑No
HomeTeam Pest Defense Signature: Date:
®HomeTeam Pest Defense,Inc.2013
6113