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500 BAYSHORE BLVD N U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal Emergency Management Agency Expires March 31, 2012 National Flood Insurance Program Important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION "���IiiSUr����b'r`ri��riy U���yi � A1. Building Owner's Name �,(�� ����5��� � iP��liby NUf'h �r', � ��x���, , r�� } 5 � �� ���:�i f ln��_� � l�.�+va+'� t, Ff;��,�Y x•� . A2. Bui ding Street Addres (including Apt.,Unit Suite,and/or Bldg.No.)or P.O:Route and Box No. °b�r��5aiiy NAIf1 Nulril�2P x , � �oo No, �3/�Gl�I-��(��' �3LV� ; '�} k; ,{�;;a �{kt y���;, !�� � .,r� � City ������� � �p� State � ZIP Code ��� S� �,�ti�.,� � A3. Proper,ty Description Lot and Block N m ers,Tax Parcel Number,Legal Description,etc.) i b�),=Z9 - � �(p - Z�o.�L�,� - O o p -- bC�I l� A4. Building Use(e.g.,Residential,Non-Residentfal,Additfon,Accessory,eta) ES( DE./�.) � � A5. LatitudelLongitude:Lat.��r'.�"l� �� 4�'i � long. �Z°42-� �l•Q`� Horizontal batum: �]NAD 1927 NAD 1983 A6. Attach at least 2 phoiograph�of the building if the Certificate(s being used to oblain flood insurance. R7. Building Diagram Number A8. For a building with a crawlspace or enclosure(s): A9. Fo�a building with an attached garage: a) Square footage of crawispace or enclosure(s) �/� sq ft a) Square footage of attached garage � sq ft b) No.of permanent flood openings in the crawlspace or b) No.of p�rmanent flood openings in the attac d garage enclosure(s)within 1 A foot above adjacent grade wilhin 1.0 fook above adJacent grade c) Total net area of flood openings in A8.b sq in c) Total net ar�a of flood openings in A9.b sq in d) Engineered tlood openings? �Yes �No d) Engineered flood openings? []Yes [] No SECTIpN E3-FLOOD INSURANC�RAtE PAAP(FIRM)INFO�tMATiON B1.NFIP Community Name&Community Number B2.County Name 83.State 5A FET�( N-P�R-�o K- I 2 5 �q-,3 P a N E��.,�S .F� , B4.Map/Panel Number B5.Suffix 86.�IRM Index B7.FIRM Panel B8.Flood!' B9.Base Flood Elevation(s)(Zone Date EffectivelRevised Date Zone(s) ` AO,use base flood depth) ►21e�jc o IZ� (3 g _�g-o� �_v�-�o3 ,4 G- ', :�� . B10. Indicate lhe source of the Base Flood Elevation(BFE)date or base flood depth entered in Item B9. ❑�IS Profile �RM Community Determined [�Other(Describe) ' B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 [�IAVD 19f38 ❑Other(Describe) 812. Is the building Iocated in a Coastal Barrier Resources 5ystem(CBRS)area or Otherwise Protected Area(OPA)? � Yes No I Designalion date �CBRS �OPA � SECTION C-BUILDING�LEVATION IN�ORMA710N(SURVEY RE�IUIRED) "!� C1. Building elevations are based on: ❑Cqnstruction Drawings* ❑ Building Under Constructlon" Inished Construction ,I "A new Elevatlon Certificate will be required when,construction of ihe bullding is complete. C2. Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,ARlAE,ARIA1-A30,ARlAH,AR/A0. Complete Items C2.a-h ;; below according to the buildin diagram specified(n Item A7. Use the same datum as the 6F�. �' 2� N�UD �g� � Benchmark Utilized C�� b GLW " -I '� Vertical Datum Conversion/Commenis G� RE��-N K �-' S � Cl7eck the measurement used. a) Top of bottom floor(including basement,crawlspace,or enclosure floor) �� ,.? feet �meters(Puerto Rico onl �y b) Top of the next higher floor ' ^�/!S, .,� feet meters(Puerto Rico on c� c) Bottom of the lowest horizontal structural member(V Zones only) N/A ❑feet ❑meters(Puerto Rico on �' � ' d) Attached garage(top of slab) ��� � ��et ❑meters(Puerto Rico on � � � � e) Lowest elevation ofmachinery or equipment servicing the building r.�,.LQ•�LJ T�et [�meters(Puerto C�ico o �, (Qescribe type of equipment and location in Comments) c � +'� � t� Lowest adjacerit(finished)grade next to building(LAG) �.�[�'�t Q meters(Puerto Rfco o " � `; g) Highest adjacent(snished)grade next to building(HAG) �d,��[� eet meters(Puerto Rico o � `�� h) Lowest adJacent grade at lowest elevation of deck or stairs,including �Q,�[]'�et [�meters(Puerto Rico 0 0 structural su ort m SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION �+ This certification is to be signed and sealed by a land surveyor,enginee'r;or architect authorized by law to certify elevation information. 1 certify that the informafion on this Certificate represents rriy best efforts fo interpref the data available. Y<� ', . , • 1 understand that any false statement rttay be punishable by fine or rmpiisonment under 18 U.S. Code, Secfion 1001. �.��� �rS' Q'G�ecic here if eomments are provided on back of form. Were latitude and longitude in S ction A provided by a ,�'' �� ��,'����:�± . � ,. licensed land surveyor7 �s ❑No t � 4� �A Certifier's Name License Number ` ��"`��"�r Larry L Evans PLS�� 2937 Title Company Name - ' :�'� Land Surveyor EvanG Land S._�rv_.?�ing Tnc � ��C` Address City State ZIP Code , r ��,`" ` 14 0 Be e l" ' �' " Signature - 4� Date 3- IS- I ( elephone (727) 734-3821 .':�� „ ,a,�4, €`� , FEMA Form 8 -31, r 09 See reverse side for continuatlon. f2eplac�s aIl previous editions IPVIPORTANT: In these spaces,copy the corresponding Information from 5ectipn A. i ��f(h��St��i, ,�6f�.� y�iJ��;���h��4.,; f�I f t YI Building StPeet Address(including ApL,Unit,Suile,�ndlor Bld No.)or P.O.Route and Box Na � 4 �i�+y N� p�rr�„;���r����j,<� }�_s��=acr� � �f�� �� � ��������ri �L�✓�. ��`rk'� �wfyaif'�'i41��� ��r�s������F��� 2 �r�;�r � � �I�Y '��.-��-�.�'�—��p State �rlI.�� ZIP COde �G��t}i�Y�i�y NAI��Nlltf�lb@P �+,��, ,"'r •,I / �� � F�'��?��h 1 rlb�,UAS}�i�.{tl�i.;�� �r � ��`v �����c�. $�C710N D-SURVEYOR, ENGINEER, pR ARCHITECT CERTIFICATION(CQN7INUED) Copy both sides of this Elevatlon Cerliticate for(1)community official,(2)insurance agenUcompany,and(3)building owner. Gomments �Z� � ; ��� ��,.� ' � � � � �M G _ �-'- f��..'��UU�•� b� �� �.�=-- �,, �1.� �� , Signature Date � �+ I �M � � Cftec,k here if attachmenis � S�CTION -B fI�pIN(�ELEVATION INFORMATION(SURVEY IdOT REQUIF�ED)FQR�QN�A0 APip ZQNE A(WITHQUT�F�) For Zones AO and A(without BFE),complete Items E1-E5. If the Certificate is Int�nded to suppqrt a LOMA or LOMR-F reque9t,camplete Sections A,B, end C. For Items E1-E4,use natural grade,if av8ilable. Check the measurement used. In puerto Rico only,enter meters. E1. Provide elevation(nformation for the following and check the appropriate boxes to show whether the elevation is above or below the highe8t adjacent grade(HAG)and lhe lowest adJacent grade(LAG). a)7op of bottom floor(including basement,crawispace,or enclosure)is � ❑feet ❑meters ❑above or ❑below the HAG. b)7op of bottom floor(including basement,crawispace,or enClosure)is , [�feet ❑melers ❑above or ❑below the LAG. E2. For Buildii7g Diagrams 6-9 with permanenl flood openings provided in Secti�Items 8 an�dlor 9(see�ages 8-9 of Instructions),the next higher floor (elevation Cz.b in the dfagrams)of the building is �[]feet met�rs above or U below the WAG. E3. Attached garage(top of slab)is [�feet [I meters []above or [� below ihe MAG. E4. Top of platform of machinery and/or equipment servicing the building is _____Q feet [�metera �above or �]below the HAG. E5. Zone AO only: If no flood depth number is available,is the top of ih�bottom floor elevated in accordance with the community'8 floodpiain management ordinance? ❑ Yes ❑ No ❑ Unkn4wn. The local o�cial must certify this information In Section 0. SECTION F-PRpP�RTY OWN�R(OR OWN�R'S REPR�SENTATIVE) C�RTIFIGA710N The property owner or owner's authorized representative who completes Sections A,B,and E for Zone A(without a F�MA-issued or community-issued BFE) ' or Zone AO must sign h�re. The sfatements in Sections A, B,and E are con�ect to the best o(my knowledge. ' I'roperty bwner's or Owner's Authorized Representative's Name Address City StaYe ZIP Code Signature bate Telephane Comments . - e f ents 3ECTION(� -COMIVIUNITY IN�ORMATION(QPTIdNAL) " The local o.fficial who is authorized by law or ordinance to administer thb�ommunity's floodplaln management ordlnance can complete Sections A,B,C(or ), and G of this Elevatfon Certificale. Complete the applicable ftem(s)and gign below. Check the measurement used in Items G8 and C,9. G1. � The informatlon in 5ection C was taken from other documentat�on that has been signed and sealed by a licensed surveyor,engineer,or architect who is authorized by law to certify elevalion informatlon. (Indicate t�e snurce and date of the elevation data in the Comments area belo�v.) G2. ❑ A community o�cial completed Section E for a building Iocatec�in Zone A(without a FEMA-issued or'community-issued BFE)or Zone AO. , G3. ❑ The following in/ormation(Items GA-G9)is provided for cammunity iloodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate bf CompliancelOccupancy Issued G7, This permit has,been issued for: ❑ New Construction Q Substantial Improvement G8� Elevation oC as-built lowesi floor(inoluding basement)of the bwffding ❑feet ❑meters(PR) natum G9. BFE or(in Zone AO)depth of ilooding at the building site u feet ❑ meters(PR) Datum G10.Communily's design flood elevatlon �____ ❑feet ❑meters(PR) Datum Local Official's Name Title Community Name Telephone Signature pate Comments ❑ c if c s F�MA Form 81-31, Mar 09 Replaces all previous editions . i Building Phatographs See Instructions for Item,�6. For;lr7'sut�nce�Compa�ty,Use; � � Building Skreet Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. pd���y Number� ' 0p �1�0. ,� ��1� ��ID , ,��� ' City � �� State ZIPCode omp�r,yt�Alc �nber' '� ' j , � If using the Elevation Certificate to obtain NFIP flood irisurance, affix at least two building photograpl�s below according to the instructions for Item A6. Identify all photographs with: date taken; "Front View" and "Rear View'; ar��i�required, "Right Side View" anc�" ft Side View." If submitting more photographs than will fit on this page, use th�Con�ini�ation Page on the reverse. n�. � ��>� F r,,,� 4 R� .� �* , .. . .� r�'y .�`�,���, � � : � � � �T �` �{��qe_ �.r'��. # v � } . #R � ��^ rc�'�, � � � ^r'r /�•;! § M"� 1+ �,y � �` I �� �@ ar\��;� ^' , }� �4 L��k�.. � .,� r 'u < +�� �, \,a� /•'� P'�:'�����x�.,,1 � �. 'a.. y ! S � _ A��- �T � ,�' .. Y�.p-T , �i��R Qh�' ykS4�2'1. X �(� W �; �r ,�s � � `.i' _ � � . . h 'PF :y �v d� *x . � � J" �; '� �" '�, �oa �.;' i i�i 4 ����. 7,��, � 4,e >,. a �,� `y,"�. y�l.� � !, Q , � "��'-- � � �� "T �. �■ . .g�R4 't�``�t� - . 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R. ��r.°�'�< �.p,. �" J7 � - -� _�,�-,`� :� r .� �a.k: Buiiding Photographs �' Continuation Page For Insurance Company Use: Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O.Route and Box No. Poiicy rvumber 5� 1�,0� � � E - ��,� . Clty St8t6 ZIP de Company NAIC Number �I�� � � � ��7� 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." �+. •'� *�r: , m � b�� , a ` ., �����r ' � � , � r� , �� _. n �'``s�j '� '�� � j 1��j��i '� ' � � trt •a �1 i{ ... , . �' ��riu M1 r`�,. .. j�,.��#:j ' : . _ , qf.'� ' q y��?�,+ ...� �rcM 5��1 '�.3 � ..���r'�*�-;�°°�..;. '��°� _ � S�� � ! ,.," .. . . yF . . � � y� .� , � 1 ��4 S' �+r!'� ��g "�, ' �; � `� j.,� ���. .. �;. i. . �'�'� i�.F�.. 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