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347 10TH ST - FORM BOARD SURVEY & ETC.
8& B EXTERMINATING CO . , INC . 215 Osceola Street Jacksonville, Florida 32204 (904) 389-3323 • (866) 829-1913 Fax: (904) 389-9606 Builder: ` I Lot# Subdivision: Address: Time & Date: Termiticide: % Gallons: Square Ft.: Linear Ft: Type of Fill: Slab Type: Mono Floating Other: Depth of Footings: Interior: Exterior: Areas not ready for treatment: : � :' �` t •I ( '' 9556 Historic Kings Road • Suite 201 065 . % , 8 .0 '� Jacksonville, FL 32257 FIELD DENSITY TEST REPORT e'� Phone: (904)886 0766 OF JAX,INC. Email: twheeler@agesofjax.com AGES JOB NO.: -.� /7600f DATE TESTED : a-, 3 ` JOB NAME: ` Cjeot REPORT DATE: CLIENT : 9rcrt}c , t_tcli TECHNICIAN : r3C' LOCATION:= REPORT NO. Test Moisture Wet Dry Proctor Proctor Relative Cort pa tion No. Content Density Density Number Density Achieved Required Pass/Fait Test Location Elevation Test Datum (%) IPCM (P0r1 (13c0_ Mt (fit OW) a 10 0-3 . . /�,24p ,�p,,1� . r • ‹- ) 4"./M-- 11.;. • • PROCTOR INFORMATION SUMMARY: The relative compaction results are a quality control measure of the This report shall NOT be reproduced, Proctor Max. Dry Optimum adequacy of the fill and/or sub-grade compaction effort. The data shown Except in Full, without written approval of Type Number Density Moisture Soil Type herein is representative of compaction achieved at the specified test AGES OF JAX, Inc. location and depth. Passing density tests should not be construed to be a Proct (pcf) (%) "certification" of suitability of the "subsurface soil conditions" and/or an P! evaluation of the ability of the subsurface soils to adequately support the REPORTED BY: t Pl planned construction. AGES OF JAX, Inc. agrees to keep confidential any and all matters related to these test results and understands that unauthorized disclosure Remarks of these test results to anyone other than our clients, or their designated TIMOTHY R. WHEELER, P.E. representative, without the client's expressed permission, is in violation of MOD=Modified Proctor Density (ASTM D 1557) AGES OF JAX, Inc. professional ethics and company policy. Registered Fla No. 42802 U.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008 Federal Emergency Management Agency Expiration Date: November 30,2018 National Flood Insurance Program ELEVATION CERTIFICATE 1708.3983-02EC 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: MAUREEN LAMAR A2. Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Company NAIC Number Box No. 347 10TH STREET City State ZIP Code ATLANTIC BEACH FLORIDA 32233 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 24,BLOCK 13, PLAT NO 1 SUBDIVISION"A"ATLANTIC BEACH,ACCORDING TO THE PLAT THEREOF,AS RECORDED IN PLAT BOOK 5,PAGE 69,OF THE PUBLIC RECORDS OF DUVAL COUNTY,FLORIDA. A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat.30 20 06.2 Long.-081 24 01.2 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 encosure(s) sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s)within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b sq in d) Engineered flood openings? ❑ Yes ® No A9. For a building with an attached garage: a) Square footage of attached garage sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade c) Total net area of flood openings in A9.b sq in 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 THE CITY OFATLANTIC BEACH 120075 DUVAL FLORIDA B4. Map/Panel B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood Zone(s) B9. Base Flood Elevation(s) Number Date Effective/ (Zone AO, use Base Revised Date Flood Depth) 12031C-0409 H 6/3/2013 06/03/13 X B10. Indicate the source of the Base Flood Elevation (BFE)data or base flood depth entered in Item B9: ❑ FIS Profile Q FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 0 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(7/15) Replaces all previous editions. Form Page 1 of 6 OMB No. 1660-0008 ELEVATION CERTIFICATE 1708.3983-02EC 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: 347 10TH STREET 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* ❑ 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—h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: FL PERMANENT REFERENCE NETWORK; Vertical Datum: 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) 10.0 feet ❑ meters b) Top of the next higher floor ® feet ❑ meters c) Bottom of the lowest horizontal structural member(V Zones only) ® 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) 8.9 E feet ❑ meters g) Highest adjacent(finished) grade next to building(HAG) 9-.2- ® feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including x❑ feet ❑ meters structural support 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? ©Yes ❑No ❑Check here if attachments. Certifier's Name License Number C BOYD ALLEN 3932 ,.•gSYb',f�EN,. Title • PROFESSIONAL SURVEYOR AND MAPPER • p�t /�2T'• • No 3932 - Company Name EXACTA LAND SURVEYORS, INC C� • /, 409:XV------/ • • Address - E'OF • a ' • p * ; Q '•< •• _O R 10 •• .1,9•11940 FAIRWAY LAKES DRIVE SUITE 1 '•••• o• City State ZIP Code ••c•s.FFp LAND • �• FT.MYERS ,��/� FL 33913 Signature % Date Telephone 2I13/2018 2/13/2018 P:(866)735-1916 CENTERLINE ROAD ELEVATION.8.25 Copy all pages of this Elevation Certificate and all attachments for(1)community official, (2)insurance agent/company, and(3)building owner. Comments(including type of equipment and location, per C2(e), if applicable) NO SLAB AS OF THIS DATE:FORM BOARDS ONLY NOTE:THIS ELEVATION CERTIFICATE IS ONLY VALID FOR THE PERSON OR PERSONS NAMED ON THIS CERTIFICATE.THIS CERTIFICATE IS FOR FLOOD INSURANCE PURPOSES ONLY. THE INFORMATION ON THIS CERTIFICATE SHOULD NOT BE USED FOR CONSTRUCTION OR PLANNING. FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 2 of 6 OMB No. 1660-0008 ELEVATION CERTIFICATE 1708.3983-02EC 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: 347 10TH STREET 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, 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 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 stab)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 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(7/15) Replaces all previous editions. Form Page 3 of 6 OMB No. 1660-0008 ELEVATION CERTIFICATE 1708.3983-02EC 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: 347 10TH 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 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 GB—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(including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 4 of 6 BUILDING PHOTOGRAPHS OMB No. 1660-0008 ELEVATION CERTIFICATE See Instructions for Item A6- 1708 3983-02EC 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: 347 10TH STREET 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. ''•J'''e . •...,„,,_•!,t — M Y..., r .._..... .• • , , I . .. I. - A _ 11,.R OY�� nc�,. n .fir 1 _ ,: • t • 2 Front View Rear View Front View Date:2/13/2018 Rear View Date:2/13/2018 Wir? 1. a. .1 ' ... .,., ,, . ✓ y .E > y s }'F-. -0.0-771.-- - x , .� J► 15� , � ,� " z. > i:-- •i' _j • _ V t `:Y `•Tye Right Side View Left Side View Right Side View:2/13/2018 Left Side View:2/13/2018 FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 5 of 6 BUILDING PHOTOGRAPHS OMB No. 1660-0008 ELEVATION CERTIFICATE Continuation Page 1708.3983-02EC 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: 347 10TH STREET 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. Photo One Photo Two Photo Three Photo Four FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 6 of 6