1033 ELDORADO AVE . • ��..�VA���N �r��T�,�=ICIaI � � o.r.�.o.rvo3o67-eo�7
, �xpires Mdy 31, 194J
FEDERAL EMEFtGENCY MANAGEM�NT�AGENCY
� • � NATIONAL FLOOD INSUFiANCE PROGRAM
,'�1°fEN'f10N:Uso ol tliis cortilicato doos not nrqvido a walvor a(tlic� fload Insuranco purchase roquirc�rnont. This lorrn is used only to
{�roviclo olovalion InlorrnaUon nocessary to onsura coRipllanco with applicable community Iloodplain management ordinances,to •
�+ lorrtiine lt�o propor Insurance preinium rate,ancilor lo support a raquest lor.a Lalter ot Map Amendmant or(lovisioh(LOMA br LOMR).
• � • � � Inst�ucttons for comploling thls fonn can bo Iound on tho follovring p�ges. • •
SECTION A PRQPERTY INFORMATIOh! '� ' FORINSUAANCECOMPANYUSE
BUILUIfJQ OWN[fl'S WIME POLICY NUMBER •
ROBER'1{ I DERWENT & SUSAN T. VAN �HORN . •
STREET ADORESS(Iridud4ip/�,pt„Ur�it,Suita ancf/or OWp.Numborj Ofi P.O.f10UTE ANU D�X NUMUEII COMPIWY NAIC NUMBER �
-� 1033 ELDORADO AVENUE
OTNER UESCRIPTION(lot wx!Bbdc Numbon,otc.) • �
LOTS 8 & 9 BLOCK 68 MANDALAY
��n � STATE 21P CODE
CLEARWATER BEACH • • • � FLORIDA '
' SECTION B FIOOD 1NS,URANCE.FIAT�MAP(FIIiM) INFORMATION
Provldo the(ollowing(rom lho propor FIRM (Soo Instruclions): ,
�.C<�AMUNITY NUMUER 2.PANEI NUFd0Ef1 �9.SUFFIX �.U/1T[OF,yrJf1M INOEX 5.FIf1h1 ZONE 6.DASC FLOOD EIEVATIOt�
Q" �O�Q'. (in AO Ionos,use dopth)
12509�6 0003 D � 8��• AE 11 . 00
7. Inclicato lhe c�lovation dalurn syslorn usod on lho FIFiM for E3asU I'lond Cio��ations (BFE): �NGVD'29 ❑Other(describo on back)
�. For 7_ones A or V,wheie no BFC is provided on the FIRM,and lho communily has oslablishod a DFE (or this building sile,indicate
lho community's E1FC:�L.�.�.0 loot NGV� (or olhar FIf1M dalum-soo Section E3, Ilein 7),
. SECTION C E3UILUING �LEV�7ION INFOr1MnTIOtJ
1. Using lhe Elovatfon Cerlilicato Instruclions,Indicate lho dla�rain nurnbor(rom lho diagrams lound on Pagos 5 and 6 that best
doscribos tl�u subJoct building's rolerence lovol�_ . •
�i). FIRM Zones A1-A30,AE,AI 1,and A(wflh E�FE). The top of tho rolorunco lovol Iloor(rom lho selectod diagram is al an elavatlon
ol L_LL��,_J(eot NGVU (or olhor FIRM daturn-soo Soctlon Ij, Itom 7). .
(b). FIR�d Zones!/1-V3U,VE,and V(wilh BFE). Tho botlom of th�lownst horl2ontal slructural membar ol tho ro(oronca I�v�l froin
the sel�clod dlagram,Is al an viovation o(�.�U�,LJ(oul NC;VL) (or othor FIf1M datum-seo Sectlon E3,Item 7).
(cj. FIRI,A Zono/1(without F3FE). Tho Iloor usod as tho referonco l�vol Irom tho soloctod dla�ram is �..�.Lf foot abovo❑ or
bolutiv L] (chocic one) tho hiflhost.grade adJaconl lo llio�ulidlnq. � '
(d). FIf1M Zono AO: Tho floor usod as the.rotqronco loyol Irom U�o sulor,tod dia�ram is W.0 loot abovo 0�or bolow[](chock
ono)tlw hi�hosl grado adjacenl lo tho building. If no Ilood doplh nuinbor Is availablo,ls lho build(ng's lowest(loor(ra(oronco
lovoij olovatod In accordanco with tho commuiiily's floodE�laln rrianag�rnont o►dinanco? ❑ Yas ❑ No ❑ Unknown
3. Indicale lhv�lovalion datum systern used in delormining lhe abovo roforonce lovel ol�vations:� NGVD'29 ❑•Other(dascribo
undur Comiri�nts on Pago 2). (NOTE: ��rno a�o�arivn da(um used!n rneasuring Iho e/ev�fions is dilferenf than tha!used on
(hv F11�M fsoo Soclion B, Ifom 7J, (lion convr�rt the olevations fa th�dalum syslem used on U�a FIRM and show fhe conversion
eyualion unde�Contmenfs on Paye 2.J . ' � �
A. Elevalion rel�rence mark used appoars on FIRM: � Yes C� hlu (S�o Instruclions an Page 4)
5.Tho rularencv Ic�vol c�lovaUon Is basod on: � aclual conslructic�n ❑ cnnstruc►ion drawings
(NO'IE: Use ol construc►ion drawings is only valid il(hv buildin�doos nof yol havo(h�roloionce levol lloo�in place,in which
case tliis ceriilicale►vill only bv valid lo�Ihe building during(l�o coursQ o(construc(ion. A posl-conslrucfion Elevalion Certilicale
tivi0 be require�once cons(ruction!s compiele.J
6.The olevatioii o(Uie lowesl raiie.lmmedialol ad'acont to th�buildin is: 4• 6 0
, 9 Y J p L-�L.�.,J feet NGVD(or other FIRM dalum-see
Section B, Item 7). , . . ' .
' SECTIOP� U COMMUNI'1'Y INFORMATIQN
�� 1!th� communiry ol(iclal rosponsiblv(or veri(ylnfl buliding olovatlons spocifios that lho roforonco leval indicated In Secilon C,Item 1
is not lhe`Iowosl Ilour"as d�linod In lhe communlly's tloodplaln managE�monl ordinance,lhe olevation ol Ihe building's'lowest
Iloor'as dolinod by Uie ordinance Is: ( � I I I I.0 (oot N(aV�(or olhor FIf�P�I datum-seo Saclion B, Ilom 7).
2. Date ol th� start of construclfon or substant(ai Irnprovomont ____� � . .
. ' .-----�-
FEIAl1 Form 01-31�MAY 90 ' ' • (tF.FI.�CES nlL PItEVIUUS E01910PJS SEE REV[RSE SIO[FOR CONTWUATIOtJ
� ' • SECTION E �CERTIFICATION
_ .
Tl�is corti(icalio�i is lo bo signed by a land surveyor,onginoor,or arcl�itocl.wtio Is aull�orizod by stato or local law to certi(y elevation . �
Informatfon whon tho olevatlon informalion for Zones A1—A30,AE,/1H,A,(wilh B�E),V1—V30;VE, and V(with BFC)is requirod.
Communily o((icials who are autfiorized by local law or ordinance to:provido tloodpl��:�mana�omont In(ormatior�, may also sign the
cerlification. in U�o case of 2ones AO and A(without a�EMA or communily issued [1F�:;, a building otlicial, a property ownor,or an
owner's represontalive may aiso siyn the certification. • �
Roloroncv lovel diagrams 6,7 and A-Distlnfluishing,Fealuros—If iho certifier is unablo to cerlify to breakaway/non-breakaway wall,
onclosuro s(zo,location ot'servlcinfl equipmont,aroa use,wall oponinys,or un(inishvd area Feature(s),then list'the Faaturv(s) not �� ,
' included In tho cerlilfcatlon under Commonts bolow. The diagram nurnbar, Seclion C, Item 1, must stili be onterod. ' � �
I ! � =;c, . �? .
i 1 cortily that tho!n(orniation in Seclions E3 and C on fltis certilicafo represents my Uesf al(or(s to inlerprot the dafa avai(able. ��•
i 1 understand Ihat any false slatemonf may be punishablo by fino or imprisonmon�under i� U.S. Code, Sacfion_ i00 x. �� , .,
. 1 �
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CEI'iTIFIER'S N�ME , _ , � UCEN.4F NI IMt3EFt(or�Ilix Seal) , ' ,,, „_
. . „y .v�w. . .
WILLIIIM C�: ' KEA`1'ING ' ' #f152£3 ,�; � i;, �.,`�',' �; •�a��,;�c�•
TITLE . Y n� - ,�c �. .,� .rv 4 ` ". ..
REU. SURVEYOR � '�g,���U� �UE2VEXTNG ,,���`•;�a, ,,���, ��-,.
:.,.
ADDRESS I �` CITY 9TATE " �t��'� ;'ZIP
2124 ,5 � �v �Y hL LVD. "CLL11FtW1�'i'ER ` I'LORIDA 3'4•6-2�� �-
SIGNATURE �' � DnT F II 1.J�HONE6—1 L 6 3 ` —
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.. /�' 8./27/98 � �iti
Coplos shoulii�o'macio p thls Certllfcato for:1)community otliclal,2) Insuranco agenUcompany, and 3)buliding owner.
�COMMENTS: �
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ON WITH ON PILES,
S11�U , DASEMF.NT PIERS,OR COWMNS
A V A A V
Z01JES ZONES � 20r:ES ZONES ZONES
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