971 Paradise Circle ELEVATION 04.19.2016 U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008
Na/ioia/Flood Insurance Prograou Important: Read the Instructions on pages 1-9. Expiration Date:July31,2015
SECTION A-PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name NICK BREFFITT Policy Number., * i. .
A2. Building Street Address(including Apt.,Unit.Suite,and/or Bldg.No)or P.O.Route and Box No Company NAIC Number:
971 PARADISE CIRCLE
City ATLANTIC BEACH State FL ZIP Code 32233
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
L-7 PARADISE PRESERVE P8-57,PG-31-31C
A4. Building Use(e.g.,Residential,Non-Residential,Addition.Accessory,etc.)RESIDENCE
A5. Latitude/Longitude:Lat.N30'20'26" Long.W81°25'23"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 N/A
AB. 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 ft a) Square footage of attached garage N/A 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 NA
c) Total net area of flood openings in A8.b ILA 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
81.NFIP Community Name&Community Number B2.County Name B3.State
CITY OF ATLANTIC BEACH,120075 DUVAL FLORIDA
B4.Map/Panel Number B5.Suffix 86.FIRM Index Date 87.FIRM Panel 88.Flood 89.Base Flood Elevation(s)(Zone
12031C 0408 H 06/03/2013 Effective/Revised Date Zone(s) AO,use base flood depth)
06/03/2013 "X" - N/A
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered In Item B9.
❑ EIS 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 ® 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:PKNAIL IN ASPHALT(6.72) Vertical Datum: NAVD 1988
indicate elevation datum used for the elevations in items a)through h)below. ❑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) $. ®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) N.A ❑feet ❑meters
e)Lowest elevation of machinery or equipment servicing the building N.A ❑feet ❑meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent(finished)grade next to building(LAG) N.A ❑feet 0 meters
g)Highest adjacent(finished)grade next to building(HAG) N.A ❑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. \`��11UI1 11111//
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001. \ `°Ce DURO //,,
® Check here If comments are provided on back of form. Were latitude and longitude in Section A provided by a .'(iS �q K /
❑ Check here If attachments. licensed land surveyor? IN Yes ❑ No • r; c�'.Sp ?�
Certifiers Name H.BRUCE BURDEN dr. License Number P.L.S.#4707 ;IMRE -
Title PRESIDENT Company Name DURDEN SURVEYING AND MAPPING,INC. to ;
Address 1825-8 31'ST-EET NORTH City JACKSONVILLE BEACH State FL ZIP Code 32250 '�'kT`' ;'�_•:• ,s'.•
Signature , Date 4119 018 Telephone 904-853-6822 rr/9%rr';"%1111 i�
If.Itt
...' P A
FEMA Form I:6-0- 112) See reverse side for continuation. Replaces all previous editions.
ELEVATION CERTIFICATE, page 2
IMPORTANT:In these spaces,copy the corresponding information from Section A. FQR INS UR/Wi COMPANY USE
Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number''
971 PARADISE CIRCLE
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 A5)LATITUDE AND LONGITUDE AND ELEVATIONS OBTAINED USING SPECTRA PRECISION PROMARK 700 GPS UNIT;(SECTION C2a)
ELEVATIONS ARE TOP OF FORM BOARDS) THIS ELEVATION CERTIFICATE WAS COMPLETED AFTER THE EXPIRATION DATE OF THIS FORM,
THE FEMA WEBSITE INDICATES THAT THIS FORM IS TO BE USED THROUGH 11/30/2015,NO NEW FORM AVAILABLE AS OF 4/19/2016;
Signature Date 04/19/2016
SECTION E—BUILDING ELEVATION INFORMATIONA+•URVEY 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,crawlspace,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 BufldIng 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.
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.
G3.❑ The following information(Items G4—G10)is provided for community floodplain management purposes.
G4.Permit Number 05. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued J
G7. This permit has been issued for: ❑New Construction ❑Substantial Improvement
GB. 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 El 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 Nunter.
971 PARADISE CIRCLE
City ATLANTIC BEACH State FL ZIP Code 32233 Company t4AIC Number:
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.
LEFT VIEW(4-19-2016)
•��� ' '�` ��° .err) e .:>.,r u Y'.
RIGHT VIEW 4-19-2016
tap
�ac l � 'i94so.;��W;, : Js s �. ..
a- SJ
T 3 F s"a ice:J- •�
REAR VIEW 4-19-2016
< � 4
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 INSU FtA( COMPANY USE
Building Street Address(including Apt.,Unit,Suite,andfor Bldg.No.)or P.O.Route and Box No. Policy Number �' r
971 PARADISE CIRCLE
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.
s
it*** *****
. EMI A 11111111•1•1•111111111■1 r •■•••■• — firm
+
frr
110• 0116101 I
11E.FIrE. ,a, a ,
• _ _ *g 4 0`.•
wok
161Vik is**1o :
--' r . N PARADISE STE`
gi X:4- .*##car^_
.; 4* . 1 . m CIRCLE
+(I :: s
0** 3
• ' ¢ s PARADISE COURT
a .
FIRMETTE
FEMA Form 086-0-33(7/12) Replaces all previous editions.
LEGACY 6424AEACH BOULEVARD
INC
JACKSONVILLE, FL 32216
ENGINEERING, INC 904-721-1100 OFFICE Project No.:
904-722-1100 FAX Report No.:
Geotechnical&Materials Engineering and Testing Page of Lab No.:
Report of In-Place Density (Asphalt or$1_40/tests or Coring for Thickness (-- circle one--)
Project: `/7/ ///,',,:;,;1)) </izce
Contractor: I,4 x,c F i,ti,,>'s r%fri r - !h L-r/or n-t-o:t ', Method: 02 52z
Reported To: ti I Location by:1.� .71s-x
Location:_5 (/ Course: !~e c
Material: , /o f '/sii 7,-.,..‘ ,- 674 r/s Spec. Requirements: 24--- ''/
Date Tested: 5 -9/U,
' Pass Location Elev/ Base/LR/ Dry Max. %of Moist
Fail/ 'L)epth/ Asphalt Density Dry Max %
Retest Lift Thickness Density* Den
of Ple-10 "'2/.' 95 . ` 99. 1) `k,-7 9.
��. c. 7o
r}c tar coen:e �,t\-‘ Q�� / 91 ;
4( v LT rclr 1. r r,! F��� \ _ �t�' L/ ��' 1 /'
1 r-----,
*Source of Proctor(Project Number) / /S--/6 f/1j77F
P- Test Meets Specification Requirements F- Test Fails To Meet Specification Requirements R- Retest
_ T Be Completed In Fie
Employee Name / =-i•C7 i.i 7j/1 - ❑-Standby Time from to Total:
Billing Comments 17-Job Time from f.' to?'/ Total: .-7 3
_ Trip Charge(Job Canceled) ❑-Travel Time from to Total: (To job)
_Out of Town Mobilization ❑-Travel Time from to Total: (From Job)
City
Total Hours: ■ 7 3
white copy-office use yellow copy-field box Office use)
co '< „ fD cr v - CD "` 7 °O- to
6 - ° m 3 4t CD CD co CD ��. = D CD CD 0 co
Y Q. - o
O .. ••• 0 d r= m O _.
OD Z
0 n � Z 1:2- ° 0
7 O r O
v 1 n Q n
Coo 0 O o v v n-„ n : (D >r•
N) `� 0) 0
..7J
(D
N N O
v v v
0) 0
'< 0 CD
D (D W 7 7 N , D L C o CO N (n (D A - X,rn 73 - — >p 0 C D —A 6 co 10 7:1 co
O W N'
o Q °O 0. O 00 Z DO Cl) O
> 0 > 0 z o
0 3 n co-
Fr', m (D m cn �,
co
0 a
0 0 OD 0
v
o-n o
r„
O N O N co
m c 0 c ( m
z z —
0 v 0 v o
P
D o H o
O O
z z
o –
D 13 CD
Co Cr_
0 xi p Q '0
O O = 0
3 ..
3 o 0 fp
5
CD
c co
3
3 O 3
fv N
7 O 7
CD
C. 0 N y 7-
O (n
Z p A 7 C
(T O CD Cr (n
Q 0
Cl) CO N CD
N U
O N o
a) -0 O Q
m = 0
C Cli
Cl)
0 CD
0)
Cl) N
7
CD
0- 7
N
T CD O O N
0 > > 0 O
CO
O r. '-. 7 7
o v v CD CD
0 0 O 0 p
N 3 `. — 0
6) 3 001 c O
-.1 CD -u O O co
° = 3' CO CT D
Z ' 0 0 O )
T CD CD (3) N
J CO
A 0)
Co CO CD J
01 CT
0 O O C
CD CT
7'
O N O
N J (D
C) N
J 0)
A 0)
o J
O
n- 0
CD