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FEMA
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
AND
INSTRUCTIONS
2015 EDITION
OMB No. 1860-0008
Expirmon Date:November 30,2018
U.S.DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICATE AND INSTRUCTIONS
Paperwork Reduction Act Notice
Public reporting burden for this data collection is estimated to average 3 75 hours par response.The burden estimate includes the
time for reviewing instructions, searching existing data sources,gathering and maintaining the data needed, and completing and
submitting this form. You aro not required to respond to this collector, 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 Collectors Management, Department of Homeland Security, Federal Emergency Management Agency,
1800 South Bell Street, Arington, VA 20598-3005, Paperwork Reduction Project (1660-0008). NOTE: Do not send your
completed form to this address,
Privacy Act Statement
Authority;Title 44 CFR§613 and 61.8.
Principal Purpose(s):This information is being collected far the primary purpose of estimating the nsk premium rates necessary
to provide flood insurance for new or substantially improved structures in designated Spedal Flood Hazard Areas.
Routine Usets):The information on this forth 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-003-National Flood Insurance Program Files System or Records Notice 73 Fed. Reg. 77747(December 19, 2008);OHS/
FEMANRPA-OMA-1 -National Flood Insurance Program(NFIP)Lefler of Map Amendment(LOMA)System of Records Notice 71
Fed.Reg.7990(February 15,2006)',and upon written request,written consent,by agreement,or as required by law.
Disclosure: The disclosure of information on this form is voluntary; however, failure to provide the information requested may
result in the 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 Cer ificete is an important administrative tool of the National Flood Insurance Program (NFIP). 1 is to be used to
provide elevation information necessary,to ensure compliance with community floodplain management ordinances, to defennir,e
the proper insurance premium cote, 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 are buildings constructed after publication
of the Flood Insurance Rate Map(FIRM), located in flood insurance Zones At-A30,AE,AH.A(with BFE), VE,VI-VW,V(with
BFE),AR,AR/A,ARAE,AR/A1-A30,AR/AH, and AR/AO.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 community,the NFIP requires the community to adopt flocoplain
management regulations that specify minimum requirements for reducing load losses.One such requirement is for the community
0 obtain the elevation of the lowest floor(including basement) of all new and substantially improved buildings, and maintain a
record of such information The Elevation Certificate provides away for a community to document compliance with the community's
floodplain management ordinance.
Use of this certificate does not provide a waiver of the flood insurance purchase requirement. Only a LOMA or LOMR-F from the
Federal Emergency Management Agency(FEW)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 food insurance even d a
LOMAAOMR-F has been issued by FEMA.The Elevation Certificate may be used to support a LOMA or LOMR-F request. Lowest
flow and lowest adjacent grade elevations certified by a surveyor or engineer will be required If the cenificate is used to support a
LOMA or LOMR-F request A LOMA or LOMR-F request must be submitted with either a completed FEMA MT-EZ or MT-1
package,whichever is appropriate.
This certificate is used only to certify building elevations.A separate cerdficete is required for floodproofing. Under the NFIP, non-
residential buildings can be floodproofed up to or above the Base Flood Elevation(BFE).A floodproofed building is a building that
has been designed and constructed to be watertight(substantially impermeable to floodwaters) below the BFE. Floodproofing of
residential buildings is not permitted under the NFIP unless FEMA has granted the community an exception for residential
floodproofed basements. The community must adopt standards for design and construction of goodprcofed basements before
FEMA will grant a basement exception. For both floodproofed non-residential buildings and residential floodproofed basements in
communities that have been granted an exception by FEMA,a floodproofing certificate is requiretl.
Additional guidance can be found in FEMA Publication 467-1, Floodplain Management Bulletin: Elevation Certificate, available on
FEMA's website at no,/Ar-' femo.agWMediaitowlaswts/domments/3539'id=172Z.
FEMA Farm 086033(Revised 7/15) Replecea all previous edition.. F-053
U.S. DEPARTMENT OF HOMELAND SECURITY MIN. 1660-0008
Federal Emergency Management Agency Expiration Date:November 30,2018
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)wmmundy official,(2)insurance age /company,and(3)building owner.
SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name Poliq Numbar:
KEVIN MARTIN
A2. Building Street Address(including Apt,Unit,Suite,and/or Bldg. No.)or P.O.Route and
Box No. Company NAIC Number
12D2 JASMINE STREET
city State ZIP Code
ATLANTIC BEACH Florida 32233
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,eta)
LOT 3,BLOCK 4,ATLANTIC BEACH SECTION H
A4. Building Use(e.g.,Residential,Non4lesidenfial,AddKion,Acoessory,eta) COMMERCIAL
A5, Latitudell.ongaude: Lat.30 20 01 N Long.8125 24 W 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 enclosures) N/A sq ft
b) Number of permanent flood openings in the aawlspace or enclosures)within 1.0 foot above adjacent grade 0
c) Told net area of flood openings in A8.b N/A sq in
d) Engineered flood openings? ❑Yes Z No
A9.For a building with an attached garage:
a) Square footage of attached garage 380.00 sq ft
b) Number of permanent flood openings in the attached garage within 1.0 fool above adjacent grade 0
c) Total net area of flood openings in A9.b N/A sq in
d) Engineered flood openings? ❑Yes Ox No
SECTION B—FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
BI.NFIP Community Name 8 Community Number i B2.County Name 83. State
CITY OF ATLANTIC BEACH 120075 DUVAL Florida
B4.Map/Panel B5.Suffix B6. FIRM Index 87.FIRM Panel 88.Flood 09.Base Flood Elevation(s)
Number Data Effective/ Zones) (Zone AO,use Base Flood Depth)
Revised Data
12031C0408H H 06-03-2013 06-03.2013 XBAE 5'
810. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 89.
F]FIS Profile Ox FIRM ❑Community Determined ❑Other/Source:
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 Qx NAVD 1988 ❑ Other/Source:
B12- Is the building located in a Coastal Banter Resources System(CBRS)area or Otherwise Protected Area(OPA)7 0 Yea Qx No
Designation Date: ❑ CBRS ❑ OPA
FEMA Form 086-0-33(7/15) Replaces all previous editions. Forrn Page 1 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date:November 3D,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
1202 JASMINE STREET
City State ZIP Cade Company NAIC Number
ATLANTIC BEACH Florida 32233
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. Building elevations are based on: Qx Construction Drawings' ❑Building Under Construction* E]Finished Construction
•A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations-Zones At-A30,AE,AH,A(with BFE),VE,V1-V30,V(with SFE),AR,ARIA,AR/AE,AR/AI-A30,AR/AH,AR/AO.
Complete Items C2.a-h below according to the building diagram specified in Item A7.In Puerto Rim only,enter meters.
Benchmark Utilized: SEE COMMENTS Vertical Datum:NAVD 1988
Indicate elevation datum used for the elevations in items a)through h)below.
❑ NGVD 1929 (]x NAVD 1988 ❑OthnadSmrm:
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) 8.50 [K 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) 8.00 0 feet meters
a) Lowest elevation of machinery or equpment servicing the building N/A feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent(finished)grade next to building(LAG) 3.90 Ox feet ❑ meters
g) Highest adjacent(finished)grade next to building(HAG) 5.50 Ex feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs,including N/A 0 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 can9y,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 One or imprisonment under 18 U.S.Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor, 0 Yes ❑No ❑Check here if attachments.
Certifiers Name License Number
HARLO G.EVERETT,JR L83287
Title
PROFESSIONAL SURVEYOR
Company LAme 161
ECK LANOSURVEYORs,INC. ' W e�
Address
1660 EMERSON STREET It
pity slate ZIPCode 11
JACKSONVILLE Florida 32207
Signature Data Telephone Ext.
1416-2018 (904)3966334
Copy all pages of tots Elevation Cer ifica nd all arta its for(1)community official,(2)insurance agenUmnpem/,and(3)budding owner
Cmsnenb(including type of equipment and location,per C2(eL if applicable)
ELEVATIONS ARE BASED ON NAVD 1988.ELEVATIONS WERE TAKEN USING A SOKKIA GCX2 GPS RECEIVER.
FEMA Form 086o-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 Mese spaces,copy the corresponding infomration from Section A. FOR INSURANCE COMPANY USE
Building Street Address(inctuding Apt,Unit,Suite,and/or Bldg.No.)or P.O.Route and Bax No. Policy Number.
1202 JASMINE 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 BEE)
For Zones AO and A(without BEE),cornplets Hems E1{5.If the Certdimte is intended to support a LOMA or LOMR-F request,
complete Sections A,Band C.For items E1-E4,use natural grace,if available.Check the measurement used.In Puerto Rico only,
enter meters.
E1. Provide elevation information for the follovdng 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 L]Let ❑meters ❑above or ❑below the HAG.
b) Top of bottom floor(including basement,
crawlspace,or enclosure)is ❑feet ❑meters ❑above or ❑below Ne 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 slab)is ❑real ❑malers ❑above or ❑below the HAG.
E4. Top of platform of machinery and/or equipment
servicing the building is ❑feet ❑meters ❑above or ❑below Me HAG.
E5. Zone AO only. If no flood depth number is available,is the top of the bottom floor elevated in accordance with the communitys
floodplain management ordinance? El Yes ❑ No ❑ Unknown. The local offidal must certify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owners authorized representative who completes Sections A,B,and E for Zone A(without a FEMA-Issued or
communityissued BEE)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 Owners Authorized Representative's Name
HARLO G.EVERETT,JR.
Address City State ZIP Code
1660 EMERSOq STREET JACKSONVILLE Florida 32207
Signature Date Telephone
10-16-2018 (904)3966831
Comments
❑Check hem H attachments.
FEMA Form 086-0-33(7/15) Replaces all previous edition$, Form Page 3 of 6
OMB No. 7660-0008
ELEVATION CERTIFICATE Expiration Date. November 30,2018
IMPORTANT:In these spaces,copy the corresponding Information from Seetlon A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt.,Unit,Suite,arid/or Bldg.No.)or P.O.Route and Box Na. Policy Number:
1202 JASMINE STREET
City State ZIP Code Company NAIC Number
ATLANTIC BEACH Flonda 32233
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The local official who is authowed 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 CerSficste.Complete the applicable items)and sign below.Check the measurement
used in Items GB-G70.In Puerto Rim only,enter meters.
GI, ❑ The mfomation in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,
engineer,or architect who is summered by law to certity elevation infrmation.(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(item 134-1310)is provided for community floodplain management purposes.
G4. Permit Number G5. Date Permit Ia med G5. Data Certificate of
Compliance/Ocapancy Issued
GT. This permit has been issued for ❑New Construction ❑ Substantial Improvement
Ga. Elevation of a"Wit lowest floor(including basement)
of the building. ❑fee ❑ meters Datum
G9. BFE or(in Zone AO)depth of flooding at the building she: ❑feet ❑ ^eters Datum
GID. Community's design flood elevation: ❑feel ❑meters Datum
Local Official's Name Tltie
Community Name Telephone
Signature Date
Comments(including type of equipment and location,per C2(e), if applicable)
Check here it 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. Expiration Date:November 30,2018
IMPORTANT:In these spaces,copy the coneaponding information from Section A FOR INSURANCE COMPANY USE
Building Street Address(including Apt, Unit,Suite,and/or Bldg.No.)or P.O.Route and Boz No. Policy Number.
1202 JASMINE 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
verds,as indicated in Section A8.If wbmiVirg more photographs than will fit on this page,use the Continuation Page.
pima.
Photo One Caption der Plato Oris
mmno
Photo Two Caption Clear PMo Two
FEMA Form 066-0-33(7/16) Replaces all previous editions. Form Page 5 of 6
BUILDING PHOTOGRAPHS OMB No. 16600008
ELEVATION CERTIFICATE Continuation Page Expiration Date'.November 30,2018
UPORTANT:In Nese spaces,copy the corresponding Information from SectionAFOR INSURANCE COMPANY USE
Building Street Address(including Apt.,Und,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number,
1202 JASMINE STREET
Cgy State LP Code Company NAIC Number
ATLANTIC BEACH Flonda 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 Yew" and "Left Side View." When applicable,
photographs must show the foundation with representative examples of the flood openings or verde,as indicated in Section AS.
rnerom..
Photo Three Caption Cher PhaW Three
nm ro+
Photo Four Caption car PhO10 Fow
FEMA Form 0811033(7115) Replaces all previous editions. Form Page 6 of 6
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FORM BOARD ELEVATION CERTIFICATE
DATE: October 16, 2018
PERMIT NUMBER:
ADDRESS: 1202 Jasmine Street
Atlantic Beach, Florida 32233
REQUIRED SLAB ELEVATION ON CITY
APPROVED SITE PLAN: 8.5
ACTUAL ELEVATION OF FORM BOARD OR
GRADE STAKE: 8.49
SURVEY COMPANY
NAME: ECK Land Surveyors, Inc.
1660 Emerson Street Jacksonville, Florida 32207
SIGNATURE OF SURVEYOR:
Harlo G.Everett,Jr. Order No.2018-417
P.L.S.No. 3297
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