RC-01-22-142 ELEVATION CERTIFICATEU.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:
JEFFREY M CARRON AND MALACHY O CARRON
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number:
Box No.
1270 NE 102nd STREET kc- C)
City State ZIP Code
MIAMI SHORES Florida 33138
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 4, BLOCK 185 OF"BAY BREEZE SECTION - MIAMI SHORES", PB 42, PG 25
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) ADDITION
A5. Latitude/Longitude: Lat. 25°52'8.234" Long.-80'1018.940" 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 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 Z No
A9. For a building with an attached garage:
a) Square footage of attached garage 0.00 sq ft
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 0.00 sq in
d) Engineered flood openings? ❑ Yes N No
SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number
B2. County Name
B3. State
VILLAGE OF MIAMI SHORES 120652
MIAMI-DADE
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
12086CO306
L
09-11-2009
09-11-2009
X & AE
N/A & 8.0'
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: Z NGVD 1929 ❑ NAVD 1988 ❑ Other/Source
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes Z No
Designation Date: ❑ CBRS ❑ OPA
FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 1 of 6
ELEVATION CERTIFICATE
OMB No. 1660-0008
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:
1270 NE 102nd STREET
City State ZIP Code Company NAIC Number
MIAMI SHORES Florida 33138
SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings* ❑x Building Under Construction* ❑ Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations — Zones Al—A30, AE, AH, A (with BFE), VE, VI—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: MIAMI-DADE B- 26-RA, ELV 17.23' Vertical Datum: NGVD1929
Indicate elevation datum used for the elevations in items a) through h) below.
❑x 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) 10.5 ❑x feet ❑ meters
b) Top of the next higher floor 20.1 ❑x feet ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only) N/A ❑x feet ❑ meters
d) Attached garage (top of slab) N/A ❑x feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building N/A ❑x feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 9.0 ❑x feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 10.0 ❑x feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A 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 infomiation.
1 certify that the information on this Cefficate represents my best efforts to interpret the data available. l understand that any false
statement may be punishab/e by ifne or imprisonment under 18 U. S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? Z Yes ❑ No ❑x Check here if attachments.
Certifier's Name License Number
ENRIQUE H. POUSADA LS5133
Title
LAND SURVEYOR
-
Company Name
FREEDOM OF LAND CORP
.
Address
1150 NW 72nd AVENUE, SUITE 351
.
f F
City State ZIP Code
MIAMI Florida 33126
49.12 z1122
Signature Date Telephone .
07-12-2022 (305) 266-4451
Copy all po§es 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)
A5.=GPS USED; C2.a=FORM FOR ADDITION; CROWN OF ROAD 9.45 FEET NGVD 1929
FEMA Form 086-0-33 (12/19) Replaces all previous editions. rorrn rage Z or 0
ELEVATION CERTIFICATE
OMB No. 1660-0008
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:
1270 NE 102nd STREET
Company NAIC Number
City State ZIP Code
MIAMI SHORES Florida 33138
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, B,and C. For Items E1—E4, use natural grade, if available. Check the measurement used. In Puerto Rico only,
enter meters.
E1. 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
ELEVATION CERTIFICATE
OMB No. 1660-0008
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:
1270 NE 102nd STREET
City State ZIP Code
Company NAIC Number
MIAMI SHORES Florida 33138
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 G8—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)
❑feet E] meters Datum
of the building:
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:
1270 NE 102nd STREET
City State ZIP Code
Company NAIC Number
MIAMI SHORES Florida 33138
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.
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Photo One Caption FRONT VIEW 07-12-2022 Clear Photo One
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Photo Two Caption REAR VIEW 07-12-2022 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: November30, 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:
1270 NE 102nd STREET
City State ZIP Code
Company NAIC Number
MIAMI SHORES Florida 33138
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 RIGHT SIDE VIEW 07-12-2022 Clear Photo Three
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Photo Four
Photo Four Caption LEFT SIDE VIEW 07-12-2022 Clear Photo Four
FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Hage b 01 ti