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RC-01-22-119 Elevation Certificate 125 NE 104 StU.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: THE JAZLAZ ADVENTURE GROUP LLC A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number: Box No. 125 N.E. 104th STREET City State ZIP Code MIAMI SHORES Florida 33138 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) FOLIO:11-2136-013-0720-MIAMI SHORES PB 10-47 LOT 18 & E1/2 LOT 17 BLK 121 -RECORDS MIAMI-DADE COUNTY, FLORIDA A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential A5. Latitude/Longitude: Lat. 25° 52' 15.096" N Long. 80' 11' 42.648" 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 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 ❑x 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 MIAMISHORES VILLAGE OF: 120652 MIAMI DADE COUNTY 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 12086C/ 0302 L 09-11-2009 09-11-2009 X NONE B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: ❑ FIS Profile ❑x FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item 139: ❑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 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: 125 N.E. 104th 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, 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 AT In Puerto Rico only, enter meters. Benchmark Utilized: GPS CARLSON RTK DEVICE 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) 11.6 ❑x feet ❑ meters b) Top of the next higher floor N/A ❑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) 11.0 ❑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) 10.0 ❑x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 10.7 ❑x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including t x ee N/A ❑ f❑ 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? 0 Yes ❑ No ❑ Check here if attachments. Certifier's Name License Number ROBERTO BRIZUELA 3064 Title PROF. LAND SURVEYOR Place Sea, Company Name & ASSOCIATES ROBERTO BRIZUELA Here Address 7315 WEST FLAGLER STREET - City State ZIP Code MIAM I Florida 33244 Signature Date Telephone Ext. 01-02-2023 (305) 219-4626 Copy all pages evation Certificate and all attachments for (1) community official, (2) insurance age company, and (3) building owner. Comments (inclu dig type of equipment and location, per C2(e), if applicable) NOTE: CROWWOF ROAD: 1 0.55'(NGVD1929) C2 (e) : TYPE OF EQUIPMENT: AIR CONDITIONER: N/A NOTE: LAT/LOG AND ELEVATIONS WERE TAKEN USING GPS CARLSON RTK DEVICE (MD. BRX5) FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 2 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: 125 N.E. 104th STREET City State ZIP Code Company NAIC Number 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: 125 N.E. 104th 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) E] 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: 125 N.E. 104th 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. 4 L Photo One Photo One Caption FRONT VIEW: TAKEN ON: 02-30-2023 Clear Photo One y A r' ram.. � .• Photo Two Photo Two Caption REAR VIEW: TAKEN ON: 02-30-2023 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: 125 N.E. 104th 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. A E� 4.n Photo Three Photo Three Caption REAR VIEW: TAKEN ON: 02-30-2023 Clear Photo Three I �• .a Photo Four Photo Four Caption REAR VIEW: TAKEN ON: 02-30-2023 Clear Photo Four FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 6 of 6 AWAY o X 8.6' A0ALT FAVNENT PERTY UNE 7 A0L FND. PI3 (NOTt L ��t LL ,Z� . Qf x r {il Z DRILLHOLE 130.21' B.C. ,F.E , 11 PROPERTY LINE 75.00' DRIVEWAY 22' PARKWAY GRAPHIC SCALE �yGt. 0 750 25 50 X I I =ND. PIPE2' ( IN FEET ) �ti@�ID11 inch = 25 fi t 5' SkDEWALK'Q 1 X o NA, 104th STREET - - = 75.00' TOTAL RIGHT OF WAY 20-Y ASPHALT PAVEMENT LOCATION MAP SURVEYOR' NOTES; SCALE: N.T.S. 1) EXAMINATION OF ABSTRACT OF TITLE WILL HAVE TO BE MADE TO DETERMINE RECORDED INSTRUMENTS, IF ANY, AFFECTING THIS PROPERTY. 2) LOCATION AND IDENTIFICATION OF UTILITIES IF ANY ARE SHOWN IN ACCORDANCE WITH RECORDED PLAT. 3) OWNERSHIP IS SUBJECT TO OPINION OF TITLE. 4) TYPE OF SURVEY. "FOUNDATION SURVEY" 5) THIS SURVEY IS NOT VALID UNLESS SIGNED AND SEALED BY THE SURVEYOR OF RECORD. 6) ALL RIGHT OF WAYS SHOWN ARE PUBLIC UNLESS OTHERWAISE NOTED. 7) LANDS SURVEYED AS DESCRIBED. 8) NO UNDERGROUND INSTALLATIONS ON IMPROVEMENTS HAVE BEEN LOCATED, EXCEPT AS NOTED. 9) SOURCE ELEVATION PROVIDED BY MIAMI -DADE COUNTY SURVEY DEPARTMENT RELATIVE TO MEAN SEA LEVEL NATIONAL GEODETIC VERTICAL DATUM OF 1929 SURVEYORCERTIFICATE: I HEREBY CERTIFY: THAT THE ATTACHED "SKETCH OF SURVEY" OF THE ABOVE DESCRIBED PROPERTY IS CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF AS RECENTLY SURVEYED UNDER MY DIRECTION, AND THAT THERE ARE NO ENCROACHMENTS OTHER THAN THOSE SHOWN, AND MEETS THE INTENT OF THE APPLICABLE PROVISIONS OF THE STANDARDS OF PRACTICE FOR LAND SURVEYING SET FORTH BY THE FLORIDA BOARD OF LAND SURVEYORS IN CHAPTER 5J-17, OF FLORIDA ADMINISTRATIVE CODE, PURSUANT TO SECTION 472.027 FLORIDA STATUTES. BASE FLOOD ELEVATION Q E ° UFOUNDATIOCOMMUNITY NUMBER 120652 PANEL NUMBER 0302 SUFFIX L DATE OF FIRM INDEX 09-11-2009 FIRM ZONE X = NOTE: THIS SURVEY HAS BEEN PREPARED FOR EXCLUSIVE USE OF THE ENTITIES NAMED BASE FLOOD ELEV. NONE a HEREON. THE CERTIFICATE DOES NOT EXTEND TO ANY UNNAMED PARTY. LEGAL DESCRIPTION: LOT 18 AND EAST z OF LOT 17, BLOCK 121, OF AN AMENDED PLAT OF SECTION NO.5 OF MIAMI SHORES, ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 10, PAGE 47, OF THE PUBLIC RECORDS MIAMI DADE COUNTY, FLORIDA. FOLIO:11 -2136 - 013 - 0720 erto Brizuela Professional Sur yor and Mapper # 3064 Late of Florida V7 w J w d � w U a Q U CO z U z w 0 w } W W 0 J m T QzwZFwC"' WwW 0Q0 X0 F 0 w O W 0 0 z— u��3 w U_ WCC O V7 �j U WU_ '• ZZMz w 7 ��d'Vi IiC1 W LS 0 Z w W 2 D z W 2- a z J Wa oz UJ ¢ H0 WO niw wj 2 w b! wD W w W0d-=w W0�]QW � z�-azz�axzwo Wwn0a E oLJ,� QOMRW,-U 22r-z25z0w0w= ti IL CL z as Eeia ate_--1bd WLL:LL d E1 E,:OL. VJC mjK SHEET TITLE FOUNDATION SURVEY REVISIONS: ,.I DATE DESCRIPTION D2-16-2D231 DDALYS R.E. INDICATE JDDN' 21-04 50