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1202 Jasmine FEMA Elevation Cert. QEPAIR_`F.� 5. T Y � o���1ND SEGJO 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 n �$ vili Fg.a€4 a� � a Eff a9$g g o s E LL rams s z" €4 w I y w � f� y i W I c y(ty W 133M153SOtl I 133M1S Altl3ll i 2 � W 133NIS 13101A lg�a1S y m �H3&0 133tl1S snostem Q I O rc I 133N1S SNOOIS I Q O H K � Q tJ 2 O g r 1 Y > 2 .1 � 133a1S 3NIWStlf Q I Q S 133815 tlIN0039 W I a W AtlM F l— z "' 133a1S 41301 W' y a 133a15 Q Q. 33aNtlt Q dllfll N W. 1 I 1�38is y \ 0. �,�lad,o , a -� � . 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 @ | , � ! / � | • | ` ~ \ . \ = Q . 101 - - ; | , - ( ! �§ � [ | till } , -------_. -- . ��_