RC-06-21-1552 ELEVEAVATION CERTIFICATE AND SURVEYU.S. DEPARTMENT OF HOMELAND SECURITY �Expiration
MB No. 1660-0008
Federal Emergency Management Agency 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:
LANCE JACKSON PAULA JACKSON
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number:
Box No.
391 NE 103 ST
City State ZIP Code
MIAMI SHORES Florida 33181
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
MIAMI SHORES SEC 5 PB 10-47 E1/2 LOT 23 & LOT 24 BLK 118
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) ADDITION
A5. Latitude/Longitude: Lat. 25.870058 Long.-80.189899 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 1 B
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) N/A sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade N/A
c) Total net area of flood openings in A8.b _ N/A sq in
d) Engineered flood openings? ❑ Yes 0 No
A9. For a building with an attached garage.
a) Square footage of attached garage _ N/A sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade N/A
c) Total net area of flood openings in A9.b N/A sq in
d) Engineered flood openings? ❑ Yes ❑x No
SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number
B2. County Name
B3. State
MIAMI SHORES 120652
MIAMI-DADE
Florida
64. Map/Panel
�Su6. FIRM Index B7. FIRM Panel
B8. Flood
Zone(s)
B9. Base Flood Elevation(s)
(Zone AO, use Base Flood Depth)
NumberDate
Effective/
Revised Date
12086CO302
L 09-11-2009 09-11-2009
X
NA
B10 Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 139'
❑ FIS Profile x❑ FIRM ❑ Community Determined ❑ Other/Source
B11. Indicate elevation datum used for BFE in Item B9: ❑x 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 ❑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:
391 NE 103 ST
City State ZIP Code
Company NAIC Number
MIAMI SHORES Florida 33181
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, 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: MIAMI-DADE COUNTY Vertical Datum: NGVD 1929
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)
11.8 ❑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)
N/A ❑ feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building
N/A feet ❑meters
(Desodbe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG)
9.7 ❑x feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG)
10.2 ❑x feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
N/A 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. 1 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
PEDRO LUIS MARTINEZ LS # 5443
Title
4ti�tir1>lrrrrrrerry�r
PROFESSIONAL SURVEYOR AND MAPPER
='��5�p.� G!E
Company Name
`-:Qja
=rNo, * 443 :.
MARTINEZ AND MARTINEZ ENTERPRISES, INC.
, UJ
a z
Address
STATE OF ;' a
= "N ' 00
7179 WEST 13 AVENUE
City Digitally sIgnedbyPEDRO L State ZIP Code
HIALEAH MARTINEZ Florida 33014
PEDRO L DN:c US,-MARTINEZ AND
_MARTINEZ EMERPRISES INC,
Signature D, cn=PEDRO L p
MARTINEZ dnQualA000AFAlD, 000001R08 Date Telephone
Ext.
MARTlAAOOOAFA7
MARTINEZ 07-15-2022 (786) 277-4851
Date: 2022 0721 0724:33-04'00'
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)
USED GARMIN GPS TO OBTAIN LAT. AND LONG.HIGHEST CROWN OF ROAD ELEVATION=10.88'.
USED MIAMI-DADE COUNTY
BENCHMARK N-566 ELEVATION=10.78'
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:
391 NE 103 ST
City State ZIP Code Company NAIC Number
MIAMI SHORES Florida 33181
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—E5. If the Certificate is intended to support a LOMA or LOMR-F request,
complete Sections A, B,and C. For Items El—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
Signature
Comments
C ity
irrta
State
Telephone
ZIP Code
❑ 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:
391 NE 103 ST
City State ZIP Code
Company NAIC Number
MIAMI SHORES Florida 33181
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 ❑ meters
of the building: 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-0. Route and Box No- Policy Number:
391 NE 103 ST
City State ZIP Code Company NAIC Number
MIAMI SHORES Florida 33181
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.
iiitr� ._ .1�'z L. - — -�
N
-JIM
Photo One Caption WEST SIDE VIEW 7-15-2022
Photo Two Caption REAR VIEW 7-15-2022
FEMA Form 086-0-33 (12/19)
Photo One
Photo Two
Replaces all previous editions.
Y . .
Clear Photo One
Clear Photo Two
Form Page 5 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30, 2022
FEMA Form 086-0-33 (12/19) Replaces all previous editions. ' """ ' uu� " "' "
BOUNDARY SURVEY
9' ASPHALT PAVEMENT
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=DENIJTt5 AIR. cn>IDITIQNrN( UNIT
GENERAL NOTES:
B.C.
=DENOTES BLOCK CORNER
B.NI.
=DENOTES BENCH MARK
LEGAL DESCRIPTION PROVIDED BY OTHERS.
EXAMINATION OF THE ABSTRACT OF THE TITLE WILL HAVE
C.13.5.
=DENOTES CONCRETE BLOCK STUCCO
TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IF ANY,
C 6 G
=DENOTES CURVE 6 GUTTER
AFFECT THI5 PROPERTY.
V.G.
=DENOTES VALLEY GUTTER
THE LANDS SHOWN HEREON WERE NOT ABSTRACTED FOR
rl
=DENOTE5 CENTERLINE
EASEMENT OR OTHER, RECORDED
I'L1
=DENOTES MONUMENT LINE
ENCUM6ERANCE5 NOT SHOWN ON THE PAT,
F. 1/2'1P
=DENOTES FOUND IRON PIPE
UNDERGROUND PORTIONS OF FOOTING, FOUNDATIONS OR OTHER
NO ID
NOT IDENTIFIED
IMPROVEMENTS WERE NOT LOCATED.
F.F.E.
=DENOTE5 FINISH FLOOR ELEVATION
ONLY VISIBLE AND ABOVE GROUND ENCROACHMENTS LOCATED.
E.M.
=DENOTES ELECTRIC METER
WALL TIES ARE THE FACE OF THE WALL.
D.H.
=DENOTES DRILL HOLE
FENCE OWNERSHIP NOT DETERMINED.
(M)
=DENOTES MEA.5URE
BEARINGS REFERENCED TO LINE NOTED AS B.R.
BOUNDARY SURVEY MEANS A DRAWING AND/OR GRAPHIC
(R)
=DENOTES RECORD
REPRESENTATION OF THE SURVEY WORK PERFORMED IN
R/W
=DENOTES RIGHT-OF-WAY
THE FIELD, COULD BE DRAWN AT A SHOWN SCALE AND/OR NOT
U.E.
=DENOTES UTILITY EASEMENT
TO SCALE.
P.B.
=DENOTES PLAT BOOK
NO IDENTIFICATION FOUND ON PROPERTY CORNERS UNLESS NOTED.
PG.
=DENOTES PAGE
NOT VALID UNLESS SEALED WITH THE SIGNINGS SURVEYORS EMBOSSED SEAL.
P.C.P.
=DENOTES PERMANENT CONTROL POINT
DIMENSIONS SHOWN ARE PLAT AND MEASURED UNLESS OTHERWISE SHOWN.
0
=DENOTES LIGHT POLE
ELEVATIONS IF SHOWN ARE BASED UPON N.G.V.D. 1929 UNLF55 OTHERWISE
X
=DENOTES EXISTING ELEVATION
NOTED.
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=DENOTES CATCH BA51N
THIS 15 A BOUNDARY SURVEY UNLESS OTHERWISE NOTED.
®
=DENOTES WATER METER
THIS BOUNDARY SURVEY HAS BEEN PREPARED FOR THE EXCLIJ51VE USE OF
—n—rr—
=DENOTES WOOD FENCE
THE ENTITIES NAME HEREON. THE CERTIFICATIONS DO NOT EXTEND TO ANY
UNNAMED PARTIES.
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=DENOTES CHAIN LINK FENCE
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=DENOTES IRON FENCE
BOUNDARY SURVEY
— =DENOTES OVERHEAD LINE
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PROPERTY ADDRESS:
gkally signed by
391 NE. 103 5T.. MIAMI SHORES, FLORIDA, 33136
OROLMAR INEZ
P E D R
DIN:
NEZ AND
LEGAL DESCRIPTION:
O MAFTIN
NWFTINIZ
ENTERPH15ES INC,
THE HALF OF LOT 23 AND ALL OF LOT 24, BLOCK 1 18. OF " AMENDED
dnQualifier—A01410
PLAT Of SECTION TO THE
D47,
MART D F6BSA
PLAT THEREOF, AS RECORDED ECORD DFI PAT BOOK 50 AT PAGE OF THE
AODaAFAIING
PUBLIC RECORDS OF MIAMI-DADF COUNTY, FLORIDA,
cn=PEDROL
WIE°' 022.o7.21
N EZ
07:2312-04.00'
CERTIFIED TO:
`
LANCE JACKSON
ALL
BEARINGS AND DISTANCES SHOWN
PAUA JACK50N
HEREON ARE RECORD AND MEASURED
UNLESS OTHERWISE NOTED -
FIELD SURVEY I 07- 15-2022 [ FLOOD ZONE] COMMUNITY: I PANEL:
BENCH MARK: I N-5GG
ELEVATION: 1 10.78'
-DENOTES FOUND IRON PIPE (NO ID.)
a<!— S� 11, 41 m
0 =DENOTES FOUND NAIL AND D15C
DATE
DRAWN 5Y
SCALE
�� =DENOTES WOOD POWER POLE
SQ =DENOTES MANHOLE SANITARY
QD =DENOTES MANHOIF S'fOP.M
07- 15-2022
I.0
1 "=20'
wvv
RIM =DENOTES ASPHALT
REVISION / UPDATE OF 5URVEY
BRICY.
DATE
DESCRIPTION
1 =DENOTES CONCRETE PAD
1' X 1 120G52 1 0302 1
I ELEVATION: I DATE OF FIRM: 1 SUFFIX: 1
j N/A 1 09- 1 1 -09 I L
MARTINEZ & MARTINEZ ENTERPRISES, INC.
LICENSE BUSINESS NO, 7702
7179 WEST 13 AVENUE, HIALEAH, FL 33014
PH: (786) 277-4851 PLSPSM@GMAIL.COM
WEBSITE: MARTINEZ AND MARTINEZ-COM
14 07-1 5-21022
SIGNED FOR THE FIRM
PEDRO LU15 MARTINEZ. LS N 443.5TATE OPFLORIDA NO VMJD WITHOUT
AN AUTHENTIC ELECTRONIC 4TURE AND AUTHENTICATED ELECTRONIC SEAL
AND/OR THIS MAP 15 NOT VA WITHOUT THE AGNATUP,E AND
=DENOTES TILE
N/A I N/A