ELEVATION CERTIFICATEFEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
Important: Read the instructions on pallas 1- 7.
SECTION A - PROPERTY OWNER INFORMATION
O.M.B. No. 3067-0077
Expires July 31,20.02
For Insurance Company
BUILDING OWNER'S NAME ~d....¢7'/ /.~'/-~'..'~.2-'~='~ -/ ; ~/_.~.~?~ . Policy Number
BUILDIN?~,~STREET ADDRESS (l%cluding Apt., Unit, Suite. and/or. .; Bldg. No ) OR. P.O.. -. ROUTEr_. . AND_. BOX.; NO. Company NAIC Number
CITY STATE ZIP CODE
Boynton Beach Florida
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Lot 3, Block 3, "MELEAR, P.U.D.,' P.B. 86, Pages 145 through 150, Palm Beach County
BUILDING USE (e.g., Residential, Non-residential. Addition. Accessory, etc. Use Comments section if necessary.)
Residential
LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: [] GPS (Type):
[]NAD1927 []NAD1983
[] USGS Quad Map [] Other:
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3. STATE
N/A Palm Beach County Florida
~ B4. MAP AND PANEL BS. SUFFIX B6. FIRM INDEX B7. FIRM PANEL BB. FLOOD Bg. BASE FLOOD ELEVATION(S)
NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AD, use depth of flooding)
1201920190 B June 2, 1992 October 15, 1982 B NIA
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9.
[] FIS Profile [] FIRM [] Community Determined [] Other (Describe): NIA
Bll. Indicate the elevation datum used for the BFE in.B9: [] NGVD 1929 [] NAVD 1988 [] Other (Describe): NIA
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? [] Yes
Designation Date: NIA
[] 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 I (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, AR/AE, AR/Al-A30, APJAH, AR/AD
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, to 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
Q a) Top of bottom floor (including basement or enclosure)
Q b) Top of next higher floor
Q c) Bottom of lowest horizontal structural member 0V zones only)
Q d) Attached garage (top of slab)
Q e) Lowest elevation of machinery and/or equipment
servicing the building (Air Conditioning Unit Slab)
Q f) Lowest adjacent grade (LAG)
I~ g) Highest adjacent grade (HAG)
I~1 h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade __
Q i) Total area of all permanent openings (flood vents) in C3h NIA
+14 . 83 ff.(m)
+23 . 8 fl.(m)
NIA . ft. (m)
+14 . 11 ft.(m)
+14. 3 ft.(m)
+14. 0 ft.(m)
+14. 3 fl.(m)
NIA
sq. in. (sq. cm)
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
License #5061
July 26, 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 certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprfsonment under 18 U.S. Code, Section 1001.
CERTIFIER'S NAME LICENSE NUMBER
Thomas R. Palbicke 5061 - State of Florida
TITLE COMPANY NAME
Vice President HA GER, PALB]CKE & A$SOCIATES, [NC.
ADDRESS CITY STATE ZIP CODE
3850 N.W. Boca Raton Boulevard, Suite #3~ Boca Raton~ Florida 33431
!~_.C ~~ DATE TELEPHONE
,,~,-,,.,,,,, ,lu]y 26, 2001 (561) 395-3600
FEMA Form 81-31, AUG 99 REPLACES ALL PREVIOUS EDITIONS
BUILDING PERMIT Cf
CERTIFICATION OF INSULATION INSTALLATION
PALM BEACH COUNTY
1847 MAGLIANO DRIVE
BOYNTON BEACH, FL
O / -- ,-~ 7~7-- ~ JOB ADDRESS
STATEMENT OF COMPLIANCE:
We the undersigned hereby certify that the thermal insulation has been installed in the referenced building in compliance with the
Florida Model Energy Efficiency Building Code, and the approved plans and specifications, and in accordance with good construction
practice. The insulation furnished is of the type, thickness and R value as set forth below:
MASONRY WALL INSULATION:
FIFOIL
MANUFACTURER
FOIL
TYPE
THICKNESS
R4.2
R VALUE
STUD WALL INSULATION:
OWENS/EQUAL
BATT
3 1/2"
Rll
CEILING/ROOF INSULATION:
MANUFACTURER GREEN FIBER
TYPE BLOWN CELLULOSE
THICKNESS 5.1"
R19
R VALUE
INSTALLED BY AMERICAN ALUMINUM AND INSULATION
FIREPROOFING CO., INC.
DATE 9/19/2001
INSULATION CONTRACTOR CGC-046425
BUILDER CONTINENTAL HOMES
COMPANY NAME
BUILDING CONTRACTOR CCCf
CERTIFIED ON
SUBMITTED TO
.(DATE)
OTHER INSULATION:
MANUFACTURER OWENS/EQUAL
TYPE BATT
3 1/2"
THICKNESS
Rll
R VALUE
GARAGE AND CEILING INSULATION:
MANUFACTURER OWENS/EQUAL
TYPE BATT
THICKNES 3 1/2"
R VALUE R11
AUTHORIZED CONTRACTOR'S OR
OWNERS SIGNATURE
BUILDING DEPARTMENT ON
.(DATE)
FORM 104