719 BAYVIEW AVE S i�� � �7�r� wuw ��^� �r��n n n .w��n .�w� Fi� r1i��t �.�.n 1. �� �I1n •� 1� ii
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F�U[IZ/�L �MERGGNGY MANAGEP�ENT AGENCY
NATIONAL fLOOD INSURl1NCE PROGRAUI O.M.t3. No, 3067-0077
Expires July 3�, 2002
CL�VATIO�J CERTIFICATC ---------�_
� � • linportanl: Read llie inslruclions on p�ges 1 - l.
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S -CilON /� •f'ROPERTY OWNER INfORM/1TION :�p'r: ssur.n�:e Coi'i'iai"'Usei;:::�>'::
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OUII[)Itl(; OWt1ER'S NnME _�_ _ ... ....
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UUII DII1G S1RF_i ADUHESS(Including Apl.,Unil,Suile, and/or pW� tJo.)OR P.O.ROUTE/1N0 pOX NO, ' ����������
;Company.tJAlG fJumber;:;;�:;:;;;;;;;:i.;:.:
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PROf'Ef2TY O(iSCRI('l ION(�ol and Dlock Numbers,Tax f'arcel Mumber, (_egal Uescripllon, e�c.) -
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OUIIDIIdG USE (e g Residenlial Mon-re,sldenlial,Addiifon,nccessory, elc. Use Commenls secll�n II necessary) -- -
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1A71TUU[/I.OIlGITUDE (OPIIONAI) IIORIZONT�I. p�TUM� SOURCF� �__�Gt'S(Type):__ `
� an'.na'. aa ua� or aa anuaa°� ���NAD 1927 �_�rinD ine:� �--�USGS Ouad Map �i on�er:_ ---
� SECTION [3 -FLOOO INSUR/1NCE RATE M/�f' (f'IRM) INfORMATION
F fIP C � 1 UIJITY IJhME 8 COMMUIdITY NUMUf_R [32, COUNTY N/1M D3. STl�TE �
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[34 i1 nIJD PAtJ[L �5. SUFFIX O6. FIIZM IN'U[X D7.FIRM P/iNEI E)p. !'�OOD 09. DASE flOOp E�.EVATION(5)
NUti1UElt A1 �i EFFEC7IVQ/ EVIS@ TE�����2�0�NE��S
i r ,.. " Q� �� (•) (2one l�O,use Jeplh ol flooding)
�'1` -j��---1-�'---- -- � ---- � �� °���_� �q. : �' E O. da
� y�—��I.l—___l__�_--I-- /
[310 Indicale Ihe source ol Ihe l3asa F�ood Ele aliofl(OF6)dala or tiase Ilriod de Ih enleied In 9
�_� ris Prorie �� FIRM LI COfIlf11Uf1II Oeler�nined ��Olher(Desctl!�p' ,
D 1 t. Indic.ile lhe elevaUon datum used lor tha �FE In B9: �� NGVD 1929 ��NAVD 1��� (�� Olher(Descr(be):_
(]12. Is Ihe bulldiny localed In a Coaslal Oarrler Resowces System(C�17S)area or Otherwise f�rolecled nrea (OPA)? (__� Yes ��No�
f)esignalion f)ale:
SECTION C - BUIL.DING ELEVATION INf'ORMATION(SURVEY RFQUIRED)
• C I. 13uilclin� elevallons are based on: L�Constiuclion Drawinys• �_��ullding Under Cons�ruclion' �Finished ConslrucUon
'A new[levalion Ceilificale will be required when conslrucl(on o(Ihe bulidiny Is c;ornplele.
C2. �uildiny (�iagram Nuinber / (Salecl lhe bullJing dfagram mosl slrnllar lo Ihe building lor which lhls ceilificate Is being compleled - see
payes 6 and 7. II no diayram accuralely represenls (ha building, provlde a skelch or pholograph.)
C3. Elevalions- Zones /11-A30,AE, AI I, !1(with OPE), VE, V 1-V30, V(wilh B�E), /1R, /�R/A, AR/AE, AR/A1-/130, AR//11I,ARlAO
Coniplete Ilenis C3a-I below accorJlny lo Ihe Uuildhig dlagra�n speclfled In Ilem C2. Slale lhe dalum used. U llie dalum Is diflerenl f�oin
�he dalum used lor lhe BFE In Secllon 8, conveil Ihe dalurn lo Ihot usod lor Ihe BFE. Show field ineasurenienls and dalurn conversfon
calculaUon. Use Ihe space provided or Ihe CoiYiinenls area ol Se Ilon O ur SecUon G, as approprlate, lo docuinenl Ilie dalum converslon.
Dc�lumuG�()Z°�_ Converslon/Commenls E�g'V • ��]• ��jQ -r-j�( .�. ,.lt 3��
ElevaUon referance mark used pC•gR►�399 Does Ihe elevallon reference mark used eppear on Ihe FIRM? U Yes �( No
G a)Top of UoUom Iloor(Including besemenl or enclosure) �, � n(m)
Q b)Top o!next hi�her Iloor S
/6 . 1D n.��„� �
Q c)f3oltom of lowest horizonlal slruclural mernber(V zories only) � �Qr ��R�� � -°
O d)Atlached garaye(lop ol slab) (� ,b� n.(m) �
❑ e)Lowesl elevaUon ol machinery and/or equlpmen( w
servicin��he building I Z.S�' n.(rn) � ? p �`"' � / �7
O f) Lowesl ed�acent yrade(V�G) �,L!!.(m) i Q 2 Q�/O�
C7 �)I Iighesl ad)acenl grade (i IAG) o'^
6 . n.�R,� t
O h)No. ol permanen! openlnys (flood verils)wilhln 1 f►. above ad}acenl grade_ �� �
O i) fol�l area of all pennanenl operiinys (Ilood venls In C31i ._O- � �
) sq. in. (sy. cm)
_ SECt�ION D -SURV[YOR, ENGINCER,oR nrrc►ur�cr ccRrir•icnTio��
1 his ceilificalion Is lo be slgned and sealed !�y a land stweyor, englneer, c�r arcliilecl aulhoiized by law fo ceilily elevalion Infonnalion.
l ce�fily Ihaf llio in�o�nra(ion in 5eclia�s fl, D, nnd C ort fh/s cerllfrcale lepiesenls my 6esl e!/orls fo Inforpre(Ihe defa evnilnb�a.
_1 undoral and Ihaf any/t��;o slafe�,,:�iTf ma�a��ur�;s�nL/e br Tne or Ini��onnren(undor 10 U.S. Code, Seclion 1001,
CERTIfICR'S IlAME �`" � � � UCENSE NUMBER ��;-�--;�
--- L+'�Oti— 1A'�--�.�__L..-,- ��I'�/'^�7 7
11TLE n COM('AMY PIAME
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+ n7�orsESS '2.2 �- � r -- — A u �V � �'�v�'
_sic�inru«e-- , ,. �—���-, c_-�6 _� cirv e ^ srn E �L _ zir coo � �S _
• '_ D�TE � O TELEf'{IOh1E 7Z�1 ��,7,.�7�0�'- _
� FEMn fonn 01-31,nUG 99 � , �i SEE REVERSE SIDE FOR CONTINUl1710N f�EPLl�CES ALL PREVIOUS EDITIONS
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IMPORTANT: In Ihese s aces, co� Ihe corres ondln Informallon from SecUon A. `"""' """""""""""""'""" """""""""""
P I Y � e ::For ii�s���a�G�co;�;�a��y:«s�,:::��::��l:::�
QUILDING STREET ADDRESS(Including Apl.,Unll,Suile, and/or Didg. �Jo.)OR P.O.ROUTE�ND BOX FJO. Policy Nuiii(irr ; ;
: : :
� � �t t3a�v�e�J /��e S. _ ..::.:::::::::::::::::�::::: .::..:::::::::::::::: :::::
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CITY � STATE 1_ � ZIP CO�C Gornpaiiy IJliiC IJuiiiber ,
(eh Hv��l�"e r : •
SEC710N D -SURVEYOR, ENGINEER, OR ARCIIITECT CERTIFICATION (CONTlNUCD)
i
Copy boU�sldes ol Ihls Elevalion Ce�lificale Ior(1)comrnunily olficlal, (2)Insivance ayenUcompany, and (3) building owner �
COMM[NTS � — -'-'
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_. _ � j Check here i( allachrnenis �
SECTiON E-E3UILDING ELEVATION INFORMATION (SURVEY NOT REQUIREQ) FOR ZONE AO and ZONE A (WiTIfOUT BfE�
For Zone AO and Zone/�(wilhoul �FE), cumplele Ilems E1 Ihrough E3. (f Ihe Elevnlion Ce,li�cele Is Inlended lor uso as supperirny
inlormalion loi a COtifA or IAMR-F, Sec(ion C mus! bo complofed
61. Duildiny Diagram IJumber (Select flie building dlac�ram rnosl sirnilar lo Il�e bullding lor whlch Ihls cerlificale Is beiny conipleted -
' see pages 6 end 7. II no dia�rern accuralely represenls Ihe b�ilding, provlde a sketch or pholograph.)
E2 Tlie lop of Ihe bo�lom Iloor(Including basemenl or anclosure) of(he bulldinc�Is �_�� ft(m)�_�__�in.(em) �__� abov,e or (_ � below ,
(check oi�e)U�e I�Ighesl edJacenl piaile.
C3 For Zone AO only: I/no flood deplh number Is avalla��e, Is Ilia lop ol ihe bollorn(loor elevaled In accorclance wlih Ilie coininunlly's
_ floodplain managemenl ordlna�ce7 �_� Yes �_� No �_� Unknown. The locai of(clal musi cerllfy lhfs In(onnallon in SecUon G.
SECTION f-PROFERTY OWNER (OR OWNER'S REPRESENTATIVE)CERTIFICATION
The properly owner or owners aulhorized representalive who compfeles Sedions A, D, and E (or 2one A(wilho��l a rEMA-(ssued or
comrnunily-Issued 8PE) or Zone AO rnusl sian here,
PROPERTY OWNER'S OR OWNER'S AUTIIORI2ED REPRESENTA7IVE'S NAME
AODRFSS CITY ST�TE ZIP CUDE ,r'•
SIGNATURE DATE TEIEPIIONF
COMMENTS —!
_.____ � � Check here i( aUachmen(s
j SECTION G-.COMMUNI7Y INFOftMATION(OPTIONAL)
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I he local olficial who Is euit�orized by law of ordinanoe lo adminlsler ihe corninunily's Iloodplaln'managpmenl ordinance can cornplele
SecUons A, B, C(or E), end O of thls,Elevallon Certilic�le. Compiele (he applicable Ilem(s) end sign below.
31. �_� The Inlorrnallon In Seclfon C was (aken 7rom other docurnenlalion lhal hes been slgned and embossed by a I�censed surveyor,
engineer, or erchllect who Is aulliorized by'sla'le.or local law lo ceriify elevelion Infonnalion. (Indicate Ihe souroe and dale of Ihe
elevaUon dala In Ilie Coinmenls area beloW.) �
32 L_�A communily o►ficlai compleled Seclion E (or a bulldlny localed In 2on�A(withoul a FEMA-Issued or comrT�unily-Issued E3F[)or
•i � �
Zone AO. .
�3. �_� The followlnc� inlormallon (Ilems G4-G�J)Is pt'2tvid'ed for cominunlly Iloodplain nianayemenl purposes.
G-4.PERMIT NUMdER G5. DATE P�RMIT ISSUED G6. DATE CERTIFIC�TE OF COMPI_IANCE/OCCUPANCY - l
- - - �i—__-�— I S S U E D —J
-37. This��ermil has been Issued for. �� New Conslruclion L� Subslantial hnprovemenl
�B. Elevalion of as-bullt lowesl lloor(including basemenl)af Ihe buliding Is: _ft.(m)Oalurn:
�9. OFE or(In Zone AO)deplh oI floodiny at Ihe Uuliding sile Is: __ ._Il.(m)Dalum: _
LOCAI OFfIC1AL'S NAME TITLE
COMMUNITY NAME TELEPIiONE ^
_----- � � -- •
SIGNATURE DATE
'� � ti � • ,
COMMENTS � ,i'r�' ,�'� , , , , �, - _ —
T ' Check here li aUaclimen(s . '
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EMA Form 01-31,AUG 89 REPLI�CES AU_ PRLVIOUE� EOITIONS �
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