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FEMA
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
AND
INSTRUCTIONS
2019 EDITION
flECEIVE
NOV 4 2020
BY:
OMB No. 1660-0008
Expiration Date: November 30, 2022
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 per 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 are not 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,
500 C Street SW, Washington, DC 20742, Paperwork Reduction Project(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(s): This information is being collected for the primary purpose of estimating the risk premium rates necessary
to provide flood insurance for new or substantially improved structures in designated Special Flood Hazard Areas.
Routine Use(s):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-003— National Flood Insurance Program Files System or Records Notice 73 Fed. Reg. 77747 (December 19, 2008); DHS/
FEMA/NFIP/LOMA-1 —National Flood Insurance Program(NFIP) Letter 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 Certificate is an important administrative tool of the National Flood Insurance Program (NFIP). It is to be used to
provide elevation information necessary to ensure compliance with community floodplain 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 properly rate Post-FIRM buildings, which are buildings constructed after publication
of the Flood Insurance Rate Map (FIRM), located in flood insurance Zones A1—A30, AE, AH, A(with BFE), VE, V1—V30, V (with
BFE), AR, AR/A, AR/AE, AR/A1—A30, AR/AH, and AR/A0. 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 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 information. The Elevation Certificate provides a way 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 (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
LOMA/LOMR-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 certified by a surveyor or engineer will be required if the certificate 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 certificate 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 floodproofed 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 required.
Additional guidance can be found in FEMA Publication 467-1, Floodplain Management Bulletin: Elevation Certificate, available on
FEMA's website at https://www.fema.gov/media-library/assets/documents/3539?id=1727.
FEMA Form 086-0-33(12/19) Replaces all previous editions. F-053
U.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008
Federal Emergency Management Agency Expiration Date: November 30, 2022
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 Owner's Name Policy Number:
HOLSTAR,LLC
A2. Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number
Box No.
630 BEGONIA STREET
City State ZIP Code
ATLANTIC BEACH Florida 32233
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 3, BLOCK 138, ATLANTIC BEACH SEC"H" 170921-0015
A4. Building Use(e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat.30 19 46 N Long.81 25 27.58 W Horizontal Datum: ❑ NAD 1927 ❑x 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 1B
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) 0.00 sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s)within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b 0.00 sq in
d) Engineered flood openings? ❑ Yes III No
A9. For a building with an attached garage:
a) Square footage of attached garage 400.00 sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 4
c) Total net area of flood openings in A9.b 510.00 sq in
d) Engineered flood openings? ❑x Yes ❑ No
SECTION B-FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name& Community Number B2. County Name B3. State
CITY OF ATLANTIC BEACH & 120075 DUVAL Florida
B4. Map/Panel B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s)
Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth)
Revised Date
12031C0408 J 11-02-2018 11-02-2018 AE 6.0 FT
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9:
❑ FIS Profile E FIRM ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ❑x 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(12/19) Replaces all previous editions. Form Page 1 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30, 2022
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:
630 BEGONIA 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* x❑ 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: FDOT CORS NETWORK Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a)through h) below.
❑ NGVD 1929 0 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) 8.5 ❑x 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) 6.5 ❑ feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 8.5 ❑x feet meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent(finished) grade next to building (LAG) 6.0 0 feet ❑ meters
g) Highest adjacent(finished)grade next to building (HAG) 6.1 ❑x feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including feet 6.3 x
structural support ❑ ❑ 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. 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 ❑x Check here if attachments.
Certifier's Name License Number ` •US Util
DARYL S BANKS PSM 6063 `�� B 1 f
Title OP ase N . �I
PRESIDENT oe
6, 63'
Company Name i �6
BANKS& BANKS CONSULTING, INC. j , •
• � •
Address •o STATE
i^ FLORIDA
co
Cit83y 19TH STREET State ZIP Code ,4j0/2a/ c• ••
ATLANTIC BEACH Florida 32233 1/1si',;,,`••%���,
Signature Date Telephone Ext.
Daryl Banks D'0'te"ywad
by�"'B��
Dale2020 m 20 07 ae 00-WOO' 10-12-2020 (904)685-2800
Daryl .
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)
1. AC UNIT MODEL CARRIER/ AC MODEL CH14NB030-A LOCATED IN THE BACK-SOUTH END OF RESIDENCE
2. AC IS NOTED AS LOWEST EQUIPMENT ON SITE.
3. PHOTOS TAKEN 10/6/2020
4. FDOT COORS GPS/CHAMPION TKO GPS
5. ENGINEERED VENTS MODEL NUMBER (ESR 4332)/250 SF OF PROTECTION
6. ATTACHED FIRMETTE
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 2 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30, 2022
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
630 BEGONIA 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 El—E5If 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,
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 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 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(12/19) Replaces all previous editions. Form Page 3 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30, 2022
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:
630 BEGONIA 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 08—G10. In Puerto Rico only, enter meters.
Gi. ❑ 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(12/19) 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, 2022
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:
630 BEGONIA 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 Vievd'; 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.
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Photo One
Photo One Caption FRONT OF HOUSE AND GARAGE Clear Photo One
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Photo Two �.._
Photo Two Caption SOUTH END OF HOUSE 10.6.2020 Clear Photo Two
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 5 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30, 2022
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
630 BEGONIA 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.
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Photo Three
Photo Three Caption BACK OF HOUSE AND AC INSTALLED 10.6.20 AC MODEL CH14NB030-A CARRIER Clear Photo Three
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Photo Four
Photo Four Caption NORTH SIDE OF HOUSE Clear Photo Four
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 6 of 6
National Flood Hazard Layer FIRMette FEMA Legend
81°25'4r '.30°20'2"N SEE FIS REPORT FOR DETAILED LEGEND AND INDEX MAP FOR FIRM PANEL LAYOUT
-F
- - Without Base Flood Elevation(BFE)
i_)ASTAL FLOODPLAIf iit p
SPECIAL FLOOD With BFE or Depth, ..0 At,AO,AH,VE,AR
COASTAL FLOODPLAIN COASTAL. Ft OODPLAI1 HAZARD AREAS Regulatory Floodway
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(EL fi Feet) 0.2%Annual Chance Flood Hazard,Areas
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4 ' l6* OTHER AREAS OF Levee.See Notes.
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COASTAL�FLOODPLAIN Digital Data AvailableN
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lr�E er+fA: No Digital Data Available
120077 (ELx7 Feet) w willMAP PANELS Unmapped
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The pin displayed on the maps an approximate
t point selected by the user and does not represent
_� + an authoritative property location.
/ � I This map complies with FEMA's standards for the use of
digital flood maps if it is not void as described below.
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The basemap shown complies with FEMA's basemap
G y accuracy standards
ill
/ ' ,, ,,.. I The flood hazard information is derived directly from the
F; °, authoritative NFHL web services provided by FEMA.This map
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was exported on 7 17 AM and does not
COASTAL FLOODPLAIF l reflect changes or amendments subsequent to this date and
�^►A� _ time.The NFHL and effective information may change or
become superseded by new data over time
- - r E Feet} A
The National Map.Oithoimagery.Data refreshed October,2020.1
This map image is void ifthe one or more of the following map
elements do not appear basemap imagery,flood zone labels,
{ T``'R` . —a w"x legend,scale bar,map creation date,community identifiers,
` y 8125':W 30°1931"N FIRM panel number,and FIRM effective date.Map images for
Feet 1:6'000 unmapped and unmodernized areas cannot be used for
0 250 500 1,000 1,500 2,000 regulatory purposes.