967 Camelia St elevation certificate FEMA
NATIONAL FLooDJNsu,"NcEPWoGP.4m
ELEVATION CERTIFICATE
AND
INSTRUCTIONS
2015 EDITION
OMB No. 1660-OD08
Expiration Date: November 30,2018
U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood insurance Program
ELEVATION CERTIFICATE AND INSTRUCTIONS
Papenwork 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, marching existing data sources, gathering and maintaining the data needed, and completing and
submitting this form. You are nut 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,
1800 South Bell Street, Arlington, VA 20598-3005, Paperwork Reduction Pmject (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($):This information is being collected for the primary purpose of estimating the nsk premium rates necessary
to provide flood insurance for new or substantially improved structures in designated Special Flood Hmrd Areas.
Routine Usal 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-W3—National Flood Insurance Program Files System or Records Notice 73 Fed. Reg.7T747(December 19, 2008); DHS/
FEMA/NFIP/LOMA-1 —National Flood Insurance Pmgmm NFP)Letter of Map Amendment(LOMA)System of Records Notice 71
Fed. Reg.79DO(February 15,2006);and upon written request written consent,by agreement,or as required by I".
Disclosure: The disclosure of information on this form is voluntary; however, fallure to provide the information requested may
result in ths, 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.
Purpose of the Elevation Certificate
The Elevation Certificate is an important administrative too[ of the National Flood Insurance Program (NFIP). it is to be used to
provide elevation infortimbon necessary to ensure compliance with community floodiplain 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 property rate Post-FIRM buildings,which am buildings constructed after publication
of the Flood Insurance Rate Map(FIRM), located in flood insurance Zones AI-A30,AE,AH,A(with BFIE), VE, VI-V30, V (with
BFE),AR,ARA,ARIAE,ARJA1-A30,ARIAH, and ARAD. 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 mmmunily,the NFIP requires the cornmunity,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 infornnation.The Elevation Certificate provides a way for a community to document compliance with the community's
floodiplain management ordinance.
Use of this certificate does not provide a warver 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
LOMAJLOMR-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 cartified by a surveyor or engineer will be required 0 the certificate is used to support a
LOMA or LOMR-F request. A LOMA or LOMR-F request must t>e submitted with either a completed FEMA MT-EZ or MT-1
package,whichever is appropriate.
This oertificate is used only to certify building elevations.A separate certificate is required for floodproofing. Under the NFIR non-
residential buildings can be floodiproofed up to or above the Base Flood Elevation(BFE).A floodpwofed building is a building that
has been designed and constructed to be watertight(substantially impermeable to floodwaters) below the BFE. Flwdproofing of
residential buildings is not pennifited under the NFlP unless FEMA has granted the community an exception for residential
floodiproofed basements. The community must adopt standards for design and construction of floodiprooled basements before
FEMA will grant a basement exception. For both floodiproofed non-residential buildings and residents] floodproofed basements in
communifies that have been granted an exception by FEMA,a floodproofing certificate is required.
Additional guidance can be found in FEMA Publication 467-1, Floodiplain Management Bulletin: Elevation Certificate, available on
FEMXs website at bttps!A�fama.coy](nedia:iibrarWanets/d=merdSM39?id=1727.
FEMA Form 086-0,33(Revised 7/15) Replaces all previous edlitions. F-053
U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency =AM WIninber
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 Owners Name Policy Number.
SOLAR HOME DEVELOPES, LLC
A2. Building Street Address(inducting Apt, Unit Suite,and/or Bldg. No.)or P.O.Route and Company NAIC Number.
Box No.
967 CAMELIA STREET
city State ZIP Code
ATLANTIC BEACH Florida 32233
A3. Pmperty Description(Lot and Block Numbers,Tax Pencil Number, Legal Desicsiption,etc.)
LOT 1,BLOCK 163. SECTION H ATLANTIC BEACH,PLAT BOOK 18,PAGE 34
A4. Building Use(e.g.,Residential, Non-Residential,Addition,Accessory,eti RESIDENTIAL
A5. LafitudeiLongitude: Let 30 19 56 N Long.8125 20 W Horizontal Datum: Ej NAD 1927 Z NAD 1983
A6, Attach at least 2 photographs of the building 0 the Certificate is being used to obtain flood insurance.
AT Building Diagram Number 1A
A8. Fix a building with a cravAspace or enclosimse:
a) Square footage of crawlspace or endosure(s) NIA sq It
b) Number of permanent food openings in the cravirspece or andosure(s)wmin 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b N/A sq in
d) Engineered flood openings? El Yea 9 No
Ag.For a building with an attached garage:
a) Square footage of attached garage 400.00 sq It
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A9.b N/A sq in
it) Engineered flood openings? E]Yes, F1 No
SECTION 8-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
BI.NFIP Community Name&Community Number B2. County ame B3. State
CITY OF ATLANTIC BEACH 120075 DUVAL Florida
B4. Me B5.Suffix B6. FIRM Index B7.FIRM Panel B8.Flood
N=rnel B' SU E B".Be"Flood Elevation(s)
Effective) Zone(s) (Zone AD,use Base Flood Depth)
Revised Date
12031CO408H FH 06- 06-13�2013 X
BID. Indicate the source of the Base Flood Elevation(BFE)date or base flood depth entered in Item 89:
Ej FIS Profile 21 FIRM E]Commamity,Determined E]Other/Source:
811. Indicate elevation datum used for BFIE in Item 139: E] NGVD 1929 n NAVD 1988 [:] Other/Source
B1 2. Is the building located in a Coastal Banter Resources System(CBRS)area or Otherwise Protected Area(OPA)? E]Yeis 2 No
Designation Date E] CBRS [:] OPA
I
FEMA Form 086-0-33 C71115) Replaces all previous editions. Form Page I of 6
DIMS No. 1660-0008
ELEVATION CERTIFICATE Expirabon Date: Novernber 30,2018
IMPORTANT: In these spaces,copy the correasponcling Information front Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt., Unit Suits,and/or Bldg. No,)or P.O. Route and Box No. Policy Number.
967 CAMELIA STREET
city State ZIP Code Company NAIC Number
ATLANTIC BEACH Florida 32233
SECTION C-13UILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. Building elevattons am based on: E] Construction Drawings* E]Building Under Construction* El Finished Construction
*A new Elevation Certificates will be required when construclim of the building is complete.
C2. Elevations-Zones Al-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFIE),AR,ARIA,ARAE,ARA1-A30,AR/AH,ARIAO.
Complete Items C2.a-h below according to the building diagram specified in Item AT In Puerto Rioo only,enter meters.
Benchmark Utilized SEE NOTES Vertical Datum:NAVD 1988
Indicate elevation datum used for the elevations in items a)through h)below.
E] NGVD 1929 Z NAVD 198B [-]OtherlSource:
Datum used for building situations must be the same as that used for the BFE. Check the measurement used.
a) Top of bottom flow(including basement,crawlspace, or enclosure floor) 10.55 N feet I-] meters
b) Top of the next higher floor 21.00 10 feet Ej meters
c) Bottom of the lowest horizontal structural member(V Zones only) N/A E] feet E]meters
it) Attached garage(top of slab) 10.01 [0 feet E] meters
9) Lowest elevation of machinery or equipment se,wicin the building
(Describe type of equipment and location in Commehis) 10-36 0 feet E] meters
I) Lowest adjacent(finished)grade next to building(LAG) 9.50 g feet E] meters
g) Highest adjacent(finished)grade next to building IHAG) 9.90 0 feet E] meters
h) Lowest adjacent grade at lowest elevation of dock or stairs, including
structural support N/A E] 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 inletpret the data available. I understand that any false
statement may be punishable by fine orimprisonment under 18 U.S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? ZY" []No Z Check here if attachments.
Carfifiers Name License Number
HARLO G. EVERETT,JR LS3287
Title
PROFESSIONAL SURVEYOR Place
Company Name
ECK LAND SURVEYORS,INC. Seal
Address Here
1660 EMERSON STREET
city State ZIP Code
JACKSONVILLE Florida 32207
Signature Data Telephone Ext.
04-17-2017 (904)396-6334
Copy all pages of this Elevation Certificate and all attachments for(1)community official,(2)insurance agerillomnipany,and(3)building owner
Comments(including type of equipment and location,par C2(e),if applicable)
AS LATTITUDE AND LONGITUDE EXTRAPOLATED FROM GOOGUE EARTH WES SITE
C2 BENCH MARK IS A NAIL AND DISK IN THE ASPHALT PAVEMENT IN FRONT OF THE SUBJECT LOT. ELEVATION IS 7.82 AND
REFERENCED TO NAVD 1988 DATUM.
AIR CONDITIONING UNIT IS ON A CONCRET SLAB ON THE SOUTH SIDE OF THE HOUSE.
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 2 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30,2018
IMPORTANT:In these spews,copy the corresponding Information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt,Unit Suits,and/or Bldg. No.)or P.O.Route and Box No. Policy Number.
967 CAMELIA STREET
CRY state ZIP Code Company NAIC Number
ATLANTIC BEACH Flonda 32233
SECTION E—BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)
FOR ZONE AD AND ZONE A(WITHOUT BFE)
For Zones AO and A(Without BFE),complete Items El—E5. If the Certificate is intended to support a LOMA or LOMR-F request,
complete Sections A,B,and C. For Items EI—E4, use natural grade,if available. Check the measurement used. In Puerto RIoD Wily,
enter meters.
Ell. Provide elevation information for the follovAng and check the appropriate boxes to shm whether the elevation is above or belov,
the highest adjacent grade(HAG)and the Icvest adjacent grade(LAG).
a) Top of bottom floor(including basement,
cir"Ispace,or enclosure)is feet E]matters Ej above or 0 belov,the HAG.
b) Top of bottom flow(including basement,
cravi or enclosure)is E]feet [:]matters E]above or E] belov,the LAG.
E2. For Building Diagrams 6--9 vath permanent flood openings provided in Section A Items 8 andfor 9(si pages 1-2 of Instructions),
the next higher floor(elevation C2.b in
the diagrams)of the building is E]feet E]meters Ej above or E]belw the HAG.
E3. Attached garage(top of slab)is E]feet E]matters; E]above or E]belm the HAG.
E4. Top of platform of machinery andfor equipment
servicing the building is feet [:]matters E]above or El belov;the HAG.
E& 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? E] Yes E] No F1 Unmcvm. The local official must certify this information in Section G
SECTION F—PROPERTY OWNER(OR OWNEWS REPRESENTATIVE)CERTIFICATION
The property cvvner or mnses authorized representative who completes Sections A, B,and E for Zone A(without a FEMA-issued or
community-issued BFE)or Zone AD must sign hem.The statements in Sections A, B,and E we coined to the best of my knovAedge.
Property Owner or Ovmees Aufficruted Repreaentobvers Name
HARLO G.EVERETT,JR.
Address city state ZIP Code
1600 EMERS�N STREET JACKSONVILLE Fluids 32207
Signature Data Telephone
04-17-2017 (904)396-83M
Comments
E]Check here if attachments.
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 3 of 6
OMB No. 1660,OD08
ELEVATION CERTIFICATE Expiration Date: November 30,2018
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
967 CAMELIA STREET
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 mmmunity's floodplam management ordinance can complete
Sections A,B.C(a E),and G of this Elevation Certificate.Complete the applicable itern(s)and sign balm. Check the measurement
used in Items G8-G10. In Puerto Rim only,enter metem.
(31. R The information in Section C"a taken Rom 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 rl 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,floodiplain management purposes.
G4. Permit Number 35. Date Permit Issued 06. Date Certificate of
1 7 Compfiance/Occupancy Issued
G7. This permit has been issued for: E]New Construction [] Substantial Improvement
08. Elevation of aii,built lowest floor(including basement)
of the building El feet meters Datum
G9. BFIE or(in Zone AD)depth of flooding at the building site: E]feet meters Datum
G10. Community's design flood elevation: El feet El met— Datum
Local Official's Name This
Community Name Telephone
Signature Date
Comments(including"of equipment and location, per C2(e),if applicable)
E] Check here it attachments
FEMA Form 086-0-33(7115) Replaces all previous editions. Form Page 4 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-WDB
ELEVATION CERTIFICATE Sea Instructions for Item AS. Expiration Date: November 30,2018
IMPORTANT:In thew spaces,copy the cornasporiding 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:
967 CAMELIA STREET
city state ZIP Code Company NAIC Number
ATLANTIC BEACH Florida 32233
If using the Elevation Certificate to obtain NFIP food insumirce, affix at least 2 building photographs below according to the
instructions for Item AS. Identify all photographs with date taken;"Front VieWand"Rear VwW';and. If required, "Right Side Vim"and
'Left Side Vim," When applicable, photographs must shm the Foundation with representative examples of the flood openings or
vents,as indicated in Section AB. If submitting mom photographs than Wil fit on this page,use the Continuation Page.
PhotoOneCW!on FRONT04117/2017 Clear Phot.Ore
lPhotDTWOCapbon REAR0411712017 Clear TM
FEMA Form 086-0-33(7/15) Replaces all previous aditions. Form Page 5 of 6
BUILDING PHOTOGRAPHS OMB No. 1060-0008
ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30,2018
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.
967 CAMELIA STREET
City State ZIP Code Company NAIC Number
ATLANTIC BEACH Florida 32233
It submitting mom photographs than will fit on the preceding page, affix the additional photographs below Identify all photographs
with: date taken; "Front Vim' and "Rear View"; and, if required, "Right Side View" and "Left Side Vim" Wnen applicable,
photographs must show the foundation with representative examples of the flood openings or vents,as indicated in Section AS.
Pholo Times Caption SOUTH SIDE 04/17/2017 Clear Photo Three
Photo Four
Photo Four Caption Clear Photo Four
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 6 of 6
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