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860 BRUCE AVE " 860 BRUCE AVE � • BCP2011-05191 /ATIUN CERTfFtCATE OMB No. 1660-0008 RTC 5127/11 Expires March 31,2012 F HENDRICKSON, DAVID � r°�-- Zoning: Low Medium Density Rf Read the instructions on pages 1-9. -.,.,�., -; � �IOM A-PROPERTY INFORMATION far insurance Company Use: . __ _ � s � Policy Nur»ber � � � ' - �� 31dg.Na.)or P.O. Route and Box No. Company;NAiC Number _..- � � � MAY 3 1 2011 � �'s' � j � dumber,�egal Descripfion,etc.) � �COUNTY,FLORIDA. � � fi `�'��-'��'"`�3 �;°� r �, Accessory,etc.) RESIDENTIAL " '�``i ; }�.s��.��- m � n � �, Horizontai Datum: ❑NAD 1927 � NAD 1983 Jt� �a��i �t�� , , - te is being used to obtain flood insurance. ,....,_.� �.� _� ` ¢:.�� ''`�f�� , A9. For a building with an attached garage: N A sq ft a) Square fooiage of attached garage ,'�4$ sq ft v� �.�,..��..�...,,....____�_ _ b) No.of perrnanent flood openings in the attached garage enciosure(s)within 1.0 foot above adjacent grade �$ within 1.d foot above adjacent grade � c) Total net area of flood openings in AS.b ly/� sq in c) Total net area of fiood openings in A9.b t�A sq in d) Engineered fiood openings? ❑ Yes ❑ Na d) Engineered flaod openings? ❑ Yes ❑ No SECTlON B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name&Community Number B2.Cqunty 1Vame B3.State CITY OF CLEARWATER 125096 PINELLAS FLORtDA B4.MapJPanel Number 85.Suffix B6.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone Date Effective/Revised Date Zone(s) AO,use base fiood depth) 12103C 0102 G 9/3/03 9/3/03 AE 14.4' 810. indicate the source of the Base Fbod Efevation{BFE)data or base fbod depth entered in Item B9. ❑FIS Profile �FIRM ❑Community Determined ❑Qther{Qescribe} B11. Indicate elevation datum used for BFE in ttem 69: ❑NGVD 1929 �fVAVD 1988 ❑Other(Describe) 812. Is the building located in a Coastal Barrier Resources System(CBRS)area or Othervvise Protected Area(OPA)? ❑Yes �No Designation Date ❑CBRS ❑OPA SECTION C-BU(LDING ELEVATlON INFORMATION(SURVEY RE(�UIRED) C1. Building elevations are based on: [�Construction Drawings' ❑Building Under Construction` �Finished Construction 'A new Elevation Certiticate wiA be required wrhen canstructian of the building is complete. C2. Elevations—Zones Ai-A30,AE,AH,A{wrth SFE},VE,V1-V30,V(with SFE),AR,ARlA,ARlAE,AR/A1-A30,AR/RH,AR/AO. Complete items C2.a-h below according to the kwilding diagram specifled in Item A7. Use the samE datum as the BFE. Benchmark Utilized GLEARWATER�NGtNEERING Vertica!Datum N VDi 29 ConversioNComments BEN�HMARK 1S PK NAIL&DISC lN POWEfi POLE IN FRONT O�833 BRUCE AVE ELEVATION OF 4 46 FEET CONVERTED TQ NAVD1988 DATUM=3.60'.EQUIPMFSNTiS A/C PAQ ON A RISER. Check the measurement used. a} Top of bottom floor(including basement,crawispace,or enclosure fborj 4 .05 �feet ❑ meters(Puerto Rico only) b) Top of the next higher Noor N�. Q feet ❑ meters(Puerto Rico only) c) Bottom of the lowest horizontal structurai member(V Zones only} N/A . ❑teet ❑meters(Puerto Rico only) d) Attached garage(top o1 slab) �_.�,_ �feet 0 meters(Puerto Rico only) e) Lowest elevation of machinery or equipmerrt servicing the buifding �_.�_ �feet �meters(Puerto Rico only) (Describe type of equipment and location in Commenis) f) Lowest adjacent(finished)grade next to buiiding(LAG) �,_,j,� �feet ❑ meters(Puerto Rico only) g) Highest adjacent(tinished)grade next to buiiding{iiAG) g_.�_ �feet � meters(Puerto Rico only} h) Lowest adjacent grade at lowest elevation of deck or stairs,including N/A . ❑feet ❑meters(Puerto Rico only) structural support SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIfICAT10N This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation inforrnation. !certify that the informadon on this Cert�cate represenfs my best eHarts to interpret the data available.1 understand that any false statement may be punishabte by fine or imprisorrmenf under i8 U,S.Code,Section i00i. �,�,�,,f#.�Q �Check here if comments are provided on badc of form. Were latifude and bngitude in Section A provided by a tCr Rlty; licensed lanct surveyor? �Yes ❑No �" r* Cert'rfier's Name License Number � �.+�N:�,�-��x'R p�, MI EL A RT p rr ,,, . � TiNe CompanyName ,C,.` rr.�rec�Ft�o�eu>n q, P M V.I.P RVEYIN fN . '�� ,�'� Address City State ZiP Code �s � 4 4 I.A REL BRAN H NE R N FL 3 17 �' �' ..!� .-� �b�Z'f�'k;Y�4 � .-- ! �f��-�s`'� �� /��'�'-� Signature �'J � Date 1/4/2011 Telephone (407)810-0838 FEMA Form 81-31,Mar 09 See reverse side for continuation. Repiaces all previous editians . � _ .d.DEPi�RTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB N0. 1660-0008 � Federai Eme�gency Managemeni Agency Expires March 31,2012 National Flood Insurance Program important: Read the instructions on pages t-9. Y2659 SECTION A-PROPERTY INFORMATlON �or insurance Company Use: Ai. Buiiding Owner's Name Policy Nurnber DAUID HENDRICKSON•DOROTHY HENDRICKSON A2. Building Street Address(including Apt.,Unit,Suite,and/or B1dg.No.)or P.O. Route and Box Na Gompany NAIC Number 860 BRUCE AVENUE City CLEARWATER BEACH State FL ZIP Code 33767 A3. Property Description(Lot and Blodc Numbers,Tax Parcei Number,�egal Description,etc.) LOT 9,SLOCK 18,MANDALAY,PB 14, PGS 32-35,PINELLAS COUNTY,FIORIDA. A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) RESIDENTIAL A5. Latitude/Longitude:Lat.27°59'47.255" Long.82°49'34.352" Horizontal Datum: ❑NAD 1927 � NAD 1983 A6. Attach at least 2 photographs of the buiiding'rf#he Cert'rficate is being used to obtain flood insurance. A7. Building Diagram Number � A8. For a building with a crawlspace w enciosure(s): A9. For a buiiding with an attached garage: a) Square footage of crawlspace or enciosure(s} � sq R a) Square toolage of attached garage �,4,$ sq ft b) No.of permanent flood openings in the crawispace or b) No.of permanent flood openings in the attached garage enclosure(s)within 1.0 foot above adjacent grade � within 1.0 foot above adjacent grade Jy(� c) Total net area of flood openings in AS.b t�jg sq in c) 7otal net area of ffoocf openings in A9.b � sq in d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes ❑ No SECTlON B-FLOOD iNSURANCE RATE MAP(FtRMj INFORMATION B1.NFlP Community Name&Community Number B2.County iVame B3.State CITY OF CLEARWATER 125096 PINELLAS FLORIOA B4.MapJPanel Number B5.Suffix B6.FIRM index B7.F(RM Panel B8.Fiood B9.Base Flood Elevation(s}(Zone Date Effective/Revised Date Zone{s) AO,use base tiood depth) 12103C 0102 G 9/3/03 9/3/03 AE 11.0' B10. indicate the source of the Base Flood Elevation(BFE)data or base fbod depth entered in Item 89. ❑FIS Profile �FIRM ❑Community Determinetf ❑Other(Oescribe} Bi t. indicate elevaiion datum used for BFE in Item 69: ❑NGVD 1929 �NAVD 1988 ❑Other{Describe) 812. Is the building located in a Coastal Barrier Resources System{CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No Designation Date ❑CBRS ❑OPA SECTiON C-BUILDtNG ELEVATION INFORMATION(SURVEY REQUIRED) Ci. 8uild+ng elevations are based on: �Construction Qrawings' ❑Building Under Construction' �Finished Construction 'A new Elevation Certificate will be required rvhen canstruction of the building is compiete. C2. Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with SFE),Aft,ARlA,ARIAE,AR/At-A30,AR/RH,AR/AO. Complete items C2.a-h below according to the building diagram specified in item A7. Use the same datum as the BFE. Benchmark Utilized CLEARWATER ENGINEERtNG Verticaf Dafum N VD1 9 ConversioNComments BENCHMARK IS PK NAIL&DISC!N POWEF POLE IN FRONT OF 833 BRUCE AVE ELEVATION OF 4 46 FEET CONVERTED TO NAVD1988 DATUM=3 60' EQUIPMENT{8 A/C PAD ON A RISER Check the measurement used. a) Top of bottom floor(inciuding basement,crawlspace,or enclosure fborj 4 .05 �feet ❑ meters(Puerto Rico onfy} b) Top of the next higher floor N�A . Q feet ❑ meters(Puerto Rico oniy) c) Bottom of the lowest horizontal structurai member(V Zones only) NJ�/ _, ❑feet ❑meters(Puerto RiCO only) d) Attached garage(top of slab) 2 . (� �feet �meters(Puerto Rico only) e) Lowest efevation of machinery or equipment servicing the buiiding �_.�_ �feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Commertts) f) Lowest adjacent(finished)grade next to building(LAG} �,_.,�Q_ �{feet ❑ meters(Puerto Rico only) g) Highest adjacent(finished)grade next to buiiding(IiAG) �_.�_, �feet ❑ meters{Puerto Rico onfy) h) Lowest adjacent grade at lowest elevation of deck or stairs,including N//1 ,. ❑feet ❑meters(Puerto Rico only) structurai_support SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor,engirteer,or architect authorized by law to certify elevation information. 1 cer6fy that fhe informatiort on ihis Certificate represenfs my best e(forts to interpret the dafa available.1 �,,�� understend thar any fatse statemenf may be punisbable by fine or imprisonment under 78 U.S.Code,Secfion t OOi. ��`��,A. (�� ❑Check here if comments are provided on back of fonn. Were latitude and bngitude in Sect+on A providad by a �G �?� 4icensed land surveyor? �Yes QNo � �� Certifier's Name License Number � i rr o..�r a w<s:n � MIGUEL A RT S r 20 tri , , .� Title CompanyName y, ' vr.�rf.c�r�r�UKU>�1. y P M V.I.P. RVEYIN fN . J; r' Address City State ZIP Code 'r',�t� ^�" 4 34 LA R L B AN H NE OR D F 17 �� R3' /,,,s �� 'b��i�r�Y(�}S� -�-' ,:, --- : �''"',�,�-Sc%�y-==' G:;� }j'�� i ,� �; � Signature •• Date 114/2011 Telephone (407}810-0838 FEMA Form 81-31,Mar 09 See reve�se side for continuation. Replaces all previous editians � � . tMPORTANT: In these spaces,copy the corresponding lnformation from Section A. For,lnsurance Company Use: Buiiding Street Address(inctuding Apt.,Unit,Suite,and/or Sldg.No.)or P.O. Route and Box No. Policy Number 860 BRUCE AVENUE Company NAIC Number City CLEARWATER BEACH State Ft ZIP Code 33767 SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFiGAT10N(CONTINUED) Copy both sides of this Elevation Certificate for{1)communiry officiai,(2)insurance agenVcompany,and(3�building owner. Comments V2fi59 iy� �!i ✓%��. j j�F/ /i��"G.O�'�lLl, �•/ /�-�'�i�U Siqnature � ' Date 1/4/2011 ❑Check here if attachments SECTION E-BUILDING ELfVATI(JN INFORMATION(SURVEY NOT REQUIRED)FOR ZUNE AO AND 20NE A(WITHOUT BFE) For Zones AO and A(without BFE),complete Items Ei-E5. If the Certiticate is intended to support a LOMA or LOMR-F request,complete Sections A,B, and C. For flems Ei-E4,use natural grade>if available. Chedc the measurement used. In Puerto Rico oniy,enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the eievation is above or below the highest adjacent grade(HAG)and the lowest adjacent grade(LAG). feet 0 meters ❑above or ❑below the HAG. a}Top of bottom floor(including basement,crawlspace,or enclosurej is � feet ❑ meters ❑above or ❑below the LAG. b)Top of bottom floor(including basement,CrawlspaCe,or enclosure)is . ❑ E2. For Building Diaqrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(ses pages 8-9 ot Instructions),the next higher floor (eievation C2.b in the diagrams)of the building is . ❑feei ❑meters�above or ❑betow the HAG. E3. Attached garage(top of siab)is . ❑feet[]meters ❑above or�below the HAG. E4. Top of platiorm of machinery and/or equipment servicing the building is . 0 feet ❑meters ❑above or ❑beiow the HAG. E5. Zone AO only: If no flood depth number is available,is the top oi the boitom floor eievated in accordance with the community's floodplain management ordinance? ❑Yes ❑No ❑Unknown. The local otficia!must ce�ily[his ir�formation in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE�CERT{FICATION The property owner or ownePs autfiorized representative who completes Sectiorfs A,8,and E for Zone A(without a FEMA-issued or community-issued BFE) or Zone AO must sign here. The sfatements in Sections A,B,and E are correct to the besi of my knowledge. Property Owner's or Ownefs Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments [;hxk here if attachments SEC710N G-COMMUNtTY 1NFORMATION(OPTIONAL) The locat officiai who is authorized by law or ordinance to administer the communitys itoodplain rnanagemerrt ardinance can compfete Sections A;B,C(or E), - and G of this Elevation Certificate. Complete the appiicabie item(s)and sign below. Check the measurement used in Items G8 and G9. Gi. The information in Section C was taken from other documentation that has been signed and seated by a iicensed surveyor,engineer;or architect who is authorized by law to certify elevation information. (indicate the source and date of the elevafion data in the Comments area below.) G2. A community official completed Section E for a building located in Zone A(without a FEMA-issued ar comrnunity-issued BFE)or Zone AO. G3. The following information{Items G4-�9)is provided for community floodplain management purposes. G4.Permit Number G5. Date Permit Issued G6. Date Cert'rficate Of Compiiartce/Occupancy Issued G7. This permik has been issued tor. New Consiruction Substantiai improvement G8. Elevation of as-built lowest fioor(includirtg basement)of the building: feet meters(PR}Datum G9. BFE or(in Zone AO)depth of flooding at the buNding sfte: feet meters(PR)Datum G10.Community's design flood elevation feet meters(PR)Datum Local Official's Name Titfe Community Name Telephone Signature Date Comments �hgck here it attachmenis FEMA Form 81-31,Mar 05 Replaces ail previous editions ' 'ci.D�=:�t�TMENT OF HOMELAND SECURITY ELEVATION CERTiFICATE OMB N0. 1660-0008 Federal�mergency Management Agency Expires March 31,2012 National Flood Insurance Program Important: Read the instructions on pages 1-9. V2659 SECTION A-PROPERTY INFC"'""""'"' Ai. Building Owne�'s Name DAVIQ HENDRICKSOM DOROTHY HENDRICKSON 860 BRUCE AVE A2. Building Street Address(including Apt.,Unit,Suite,and/or Bidg.No.)or P.O. Route and B 860 BRUCE AVENUE BCP2011-05191 City CLEARWATER BEACH State FL ZIP Code 33767 RTC 5127/11 A3. Property Description(Lot and Btock Numbers,Tau Parcel Number,legal pescription,etc. HENDRICKSON, DAVID _ LOT 9,BLOCK t8,MANDALAY,PB 14, PGS 32-35,PINELLAS COUNTY,FLORIDA. �a--- Zoning: Low Medium Density Rf ., .,,.�m.i ' �— A4. Buiiding Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) RESIDENT�A _ _, „ � �" �_` .> _ ' A5. Latitude/Longitude:Lat.27°59'47255" Long.82°49'34.352" - = J � . . .. A6. Attach at least 2 hot ra hs of the buiidi . ` � p og p ng'rf the CertHicate is being used to obtain flood :`- '_' � _. � A7. Buiiding Diagram Number � � - -- A8. For a building with a crawlspace or enclosure(s): A9. Fc � a) Square footage of crawtspace or enclosure(s) N A sq ft aa � MAY 3 1 2011 � b) No.of permanent flood openings in the crawfspace or b) � enclosure(s)within 7.0 foot above adjacent grade � c) Total net area of flood openings in AB.b � sq in c) ; C��f'°� :";,� �;s '' � d) Engineered fiood�'openings? ❑ Yes ❑ No d? , ��^i;f��}��-;�`�+;.}�p ti,��4��y^, �� SECTlON B-FLU�D INSURANCE RATE MAP(1 J � '��' �:�� :. ? , ,� � ','�� B1.NFIP Community Name&Community Number B2,Cp�nty Name �-"---�---. -•--"`°'�°"", �_ � CITY OF CLEARWATER 125096 PINELLAS � t-WHIUA B4.Map�Panel Number B5.Suffix B6.FiRM index B7.FIRM Panel 88.Fiood B9.Base Flood Elevation(s}(Zone Date Effective/Revised Date Zone(s) AO,use base flood depth) 12103C O102 G 9/3/03 9/3/03 AE 1�,p� B1�. Indicate the source of the Base Flood Elevation(BFEJ data or base fbod depth entered in Item B9. 0 FIS Profile �{FIRM ❑Community Determined ❑Other(Describe) B11. Indicate elevation datum used for BFE in Item B9: ❑NGVD 1929 �NAVD 1988 Q Other{Describe) 812. Is the building located in a Coas#a!Barrier Resources System(CBRS�area or Otherwise Protected Area(OPA)? ❑Yes �No Designation Date ❑CBRS ❑OPA SECTiON C-Bt11LDING ELEVATION INFORMATlON(SURVEY REQUIRED) C1. Build�ng elevaUons are based on. �Construct�on Drawings' ❑Building Under Construction' �Finished Construction 'A new Elevation Certificate wifl be required when canstruction of the building is�omplete. C2. Elevations-Zones Ai-A30,AE,AH,A{with 9FEj,VE,V1-V30,V{with SFE),AR,ARlA,AR/AE,AR/Ai-A30,AWAH,AR/AO. Complete Items C2.a-h betow according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized CLEARWATER ENGtNEERiNG Verticai Datum N VD1929 Conversion/Comments BENCHNtARK t5 PK NAIL&DiSC!N POWEFi POLE IN FRONT OF 833 BRUCE AVE ELEVATION OF 4 46 FEET CONVERTEU TO NAVD1988 DATUM=3 60' EQUIPMENT{S A/C PAD ON R RISER Check the measurement used. a) Top of bottom floor(including basement,crawlspace,or enclosure fbor)4 .05 �feet ❑ meters(Puerto Rico oniy) b) Top of the next higher floor N!A ❑feef ❑ meters(Puerto Rico only) c) Bottom of the lowest horizontai structural member(V Zones only} N!A . ❑feet ❑meters(Puerto Rico oniy) d) Attached garage(fop of slab) 2 .90 �feet ❑meters(Puerto Rico oniy) e) Lowest elevation of maChinery or equiprnent servicing the buiiding 5 .�_ _�feet ❑meters{Puerto Rico only} (Describe type of equipment and location in Comments) f} Lawest adjacent(finished)grade next to buiiding(I.AG) �_,jQ_ �feet ❑ meters(Puerto Rico only) g) Highest adjacent(finished)grade next to buiiding{HAG) �_,�_ �feet ❑ meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs,including N/A , ❑feet ❑meters(Puerto Rico only) structural support SECTION D-SURVEYOR,ENGtNEER,�R ARCFitTECT CERTIfICAT10N This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to ceRify e(evation ir�armation. 1 certily thaf the infomra6on on ihis Certi�cate represents my best efforts to infe�pret the data available.J �,.� urrdersfand fhat any false statement may be punishable by fine or imprisorxnent under i8 U.S.Code,Secfion t 00i. ��,,,,�,�� ❑Check here if comments are providet!on back of form. Were latitude and bngitude in Section A provided by a ��* �� licansed lartd surveyor? �Yes QNo * :f'� Certifiers Name License Number � ,rrN.�e��=�n � MIGUEL A CORTES 820 � ; ,� Title Company Name � , . ;� -- . � PSM ..� f ,t cre caF t�o�rm,i 4 V.I.P.SURVEYING INC. ,l�, Address �`�" City State ZIP Code 4034 LA REL BRANCH LANE ORLAND FL 32 17 ��P �Y �-!"�� - �� 'll��'�Y�tL �r��f=� ��' 1i;u�-'� % , Signature �• Date i/4/20i1 Telephone (407y 810-0838 FEMA Form 81-3f,Mar 09 See reverse side for continuation. Replaces all previous editions ' � �` `�� - _°� l � I _ - R IeJIPOf,1TANT: In these spaces,copy the corresp�nding tnformaUon from Section A. For cnsurance Company Use: Building Street Address(inciuding Apt.,Unit,Suite,and/or Bidg.No.)or P.O.Route arid Box No. PotieylVurnber 860 BRUCE AVENUE City CLEARWATER BEACH State Ft ZIP Code 33767 Company NAfC Number SfCT10N D-SURYEYOR,ENGlNEER,OR ARCHtTECT CERTIFIGATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)communiry official,(2)insurance agenUcompany,and{3)building owner. Comments V2659 ---i�� > ,� i�-��"-� �!e�..c:;Y/��" i� . � � Si nature ° Date 1l4/20i 1 ___ ❑Check here if aHachments SECTION E-BUILDING EI.EVATION INFORMATION(SURVEY NOT REGIUIRED}FOR ZONE AO AND 20NE 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 Ei-E4,use natural grade,if available. Check the measurement used. In Puerto Rico only,enter meters. Ei. Provide elevation information for the foliowing and check the appropriate boxes to show whether the elevation is above or below the highest adjacent gr�de(HAG}and the lowest adjacent grade(LAG). a)Top of bottom floor(including basement,crawispace,or enciasure)is ❑ feet � meters ❑above or ❑below the HAG. b)Top of bottom floor(inciuding basement,crawlspace,or enciosure)is ❑ feet ❑ meters �above or ❑below the LAG. E2. For Buiiding Diagrams 6-9 with permanent fiood openings provided in Section A Items 8 and/or 9(see pages 8-9 of instructions),the next higher floor (elevation C2.tr in the diagrams)of the buiiding is ❑feei ❑meters�abava or �belaw the HAG. E3. Attached garage(top of slab)is . ❑feet[�meters ❑above or�below the HAG. E4. Top of piatform of machinery and/or equipment servicing the building is ❑fest ❑meters �above or [�below the HAG. E5. Zone AO only: If no fiood depth number is avai�able,is the top af the boMom fioor elevated in accordance with the community's floodplain management ordinance? ❑Yes ❑No ❑Unknown. The local officiaf must certify this ir�formation in S�tian G. SECTION F-PROPERTY OWNER(OR OW�tER'S REPRESENTATIVE}CERTIFICATION The property owner or owner's authorized representative who completes Secfions A,B,and E for Zone A(wiihout a FEMA-issued or community-issued BFE) or Zone AO must sign here. The statements in Sec6ons A,B,and E are correcf to fhe besi of my knowledge. Property Owner's or Owners Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Cornments Check here if attachments SECTION G-COMMUNITY 1NFORMATfON(OPTlONAL) The loCal official who is authorized by law or ordinanCe to administerthe community's ftoodplain managemeM ordinance can comptete 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 and G9. Gi. The information in Section C was taken from other documerrtation that has been signed and sealed by a licensed sunreyor,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 officiai 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 G4G9)is provided for community floodplain management purposes. G4.Permit Number G5. Date Permit issued G6. Date CerCrficate Of Gompiiance/Occupancy Issued G7. This permit has been issued for: New Construction Substantial improvement G8. Elevation of as-buiit lowest floor(including basement)of the build+ng: feet meters(PR}Datum G9. BFE or(in Zone AO}depth of Nooding at the buiiding site: feet meters(PR}Datum G10.Community's design flood elevat+on feet meters(PR}Datum Locat Officiai's Name Ti#fe Community Name Telephone Signature Date Comments �heck here if aitachments FEMA Form 81-31,Mar 09 Replaces all previous editions � . '.' � , LEGEND gp�D�gy S��y CERTIFICATIONS �. ,�C_�� LEGJSL DE5CRIPTIDN.• LOT 9,BLOC%I8,MAND�WIY,ACCORDIIIAC 19D TXSPLAT THSREOFAS RECORDEDW PLIST BOOS 14,PRGE(5�32-39, �_�� OFTHEPUBGfCRECORpSOFPIIVEIdASCOUN7'Y,FLORmA. 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