ELEVATION CERTIFICATEBUILDING OWNER'S NAME
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
Important: Read the instructions on pallas 1- 7.
SECTION A - PROPERTY OWNER INFORMATION
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
O.M.B. No. 3067-0077
ExpiTes July 31,2002
For Insurance Comps-ny Use:
Policy Number
Company NAIC Number
CITY STATE
Boynton Beach Florida
ZIP CODE
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Lot 18, Block 3, "MELEAR, P.U.D.," P.B. 86, Pa~]es 145 through 150, Palm Beach Count7
BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.)
Residential
LATITUDE/LONGITUDE (OPTIONAL)
( ~¢° - ¢~' - ~=~.~" or ~.;,".-7.'7.%®)
HORIZONTAL DATUM:
[] NAD 1927 [] NAD 1983
SOURCE: [] GPS (Type):
[] USGS Quad Map [] Other.
SECTION B - FLOOD INSURANCE RATE MAP {FIRMI INFORMATION
I BI' NFtP COMMUNITY NAME & COMMUNITY NUMBER IB2' COUNTY NAMEN/A Palm Beach County I®Florida
NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S)
1201920190 B June 2, 1992 October 15, 1982 B
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Bg.
[] FIS Profile [] FIRM [] Community Determined [] Other (Describe): N/A
Bll. Indicate the elevation datum used for the BFE in Bg: [] NGVD 1929 [] NAVD 1988 [] Other (Describe):
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (ePA)? [] Yes
Designation Date: N/A
Bg. BASE FLOOD ELEVATION(S)
(Zone AC, use depth of flooding)
N/A
N/A
[] No
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIREDt
C1. Building elevations are based on: [] Construction Drawings* [] Building Under Construction* [] Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Building Diagram Number 1_~ (Select the building diagram most similar to the building for which this certificate is being completed - see
pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
C3. Elevations - Zones Al-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, AR/A, APJAE, APJA1-A30, AR/AH, AR/AC
Complete Items C3a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from the
datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion
calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, tb document the datum conversion.
Datum NGVD-1929 Conversion/Comments Palm Beach County Benchmark System
Elevation reference mark used NIA Does the elevation reference mark used appear on the FIRM? [] Yes [] No
+14 . 72 ff.(m)
+23 . 7 fl.(m)
NIA .__ff.(m)
+13 . 98 ff.(m)
+14 . 2 fl.(m)
+13 . 8 ff.(m)
+14 . 2 ff.(m)
NIA
a) Top of bottom floor (including basement or enclosure) ~
b) Top of next higher floor ~
c) Bottom of lowest horizontal structural member (V zones only) ~ "~
d) Attached garage (top of slab) ~
e) Lowest elevation of machinery and/or equipment
servicing the building (Air Conditioning Unit Slab) ~_~
f) Lowest adjacent grade (LAG) ~,E ,~
g) Highest adjacent grade (HAG) ~
h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade
i) Total area of all permanent openings (flood vents) in C3h N/A sq. in. (sq. cm) -~
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
License #5061
June 5,2001
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 in Sections A, B, and C on this cerbT/cate 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.
CERTIFIER'S NAME LICENSE NUMBER
Thomas R. Palbicke 5061 - State of Florida
TITLE COMPANY NAME
Vice President ,~A G£R, PALB.ICKE & ASSOCIATES. INC,
ADDRESS CITY STATE ZIP CODE
3850 N.W. Boca Raton Boulevard, Suite #3, Boca Raton, Florida 33431
1('4N'~TI I ..... DATE TELEPHONE
7/~,~ ~~ June S, 2001 (S61) 395-3600
FEMA Form 81-31, AUG 99 REPLACES ALL PREVIOUS EDITIONS
IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Compa,~y Use: ~
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number
CITY STATE ZIP CODE Company NAIC Number
Boynton Beach Florida
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2)insurance agent/company, and (3) building owner.
COMMENTS
[] Check here if attachments
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AC AND ZONE A (WITHOUT BFE)
For Zone AC and Zone A (without BFE), complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting
information for a LOMA or LOMR-F, Section C must be completed. ( NIA )
El. Building Diagram Number ~ (Select the building diagram most similar to the building for which this certificate is being completed -
see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
E2. The top of the bottom floor (including basement or enclosure) of the building is ft.(m) __ in.(cm) [] above or [] below
(check one) the highest adjacent grade.
E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is
~ ft.(m) ~ in.(cm) above the highest adjacent grade.
E4. For Zone AC 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.
( N/A )
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
[] Check here if attachments
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. ( N/A )
Gl. [] The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer,
or architect who is authorized by state or local 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-G9) is provided for community floodplain management purposes.
G4. PERMIT NUMBER I G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED
I
G7. This permit has been issued for: [] New Construction [] Substantial Improvement
G8. Elevation of as-built lowest floor (including basement) of the building is: ft.(m) Datum:
G9. BFE or (in Zone AO) depth of flooding at the building site is: ft.(m) Datum:
LOCAL OFFICIAL'S NAME
TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
[] Check here if attachments
FEMA Form 81-31, AUG 99 REPLACES ALL PREVIOUS EDITIONS