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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 `-15' ALA FIP. 1 /2" x No I.D. 0. 1.1' o 1�p THE WEST 112 THE ST 1/2 '�- ON POOL L O T 22 OF LOT 23 OF L T 23 LA BLOCK 118 BLOCK 118 BLO K 118 10.0' NEW ADDITION ` 7,40' CONC FFE=11.80' I F E SLAB 41.00' N `ILL l rn RESIDENCE 391 FFE: 11.80' 0.9, 10.1' 31.30' � x LOT 24 I BLOCK 11 I AC "' . POOL PUMP aJ�O Ln d d- �o�� STEPS 17.15' 1 CONIC 89g2 y o FIP. 1 /2" FIP. 1/2" No I.D. No I.D. 5' CONC SIDEWALK 52.13' 77.19(TO P.l) CONC 19' PARKWAY RETURN 24.50' ASPHALT PAVEMENT 75' TOTAL R/W -� N. E 1 03 STREET " =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. ®' =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. •� =DENOTES CHAIN LINK FENCE o =DENOTES IRON FENCE BOUNDARY SURVEY — =DENOTES OVERHEAD LINE ASPHALT RETURN FIP. 11 /2" No 110. W Q- o� Iz I W F— z J N m � o �-LLJ �i= IQ Y U ¢ ¢ p xI ZO _ �- + U Or I �" x O N x I W Z xI I 2.3' 1 I R=25.00' li 89'41'51 L=39.14' CONC 1 CONC l ( 1 • 1j5t1I k1 HI111,r l •� , 5 - No. 54Q CL m " STATE OF 4 = rr'f, •SL1RVO4,����� 1�Ir I+rrI 1111601" 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