1454 HILLCREST AVE S �V�
DFEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. Na. 3067-0077
NATIONAL FLOOD INSURANCE PROGRAM Expires July 31,2002
DEC 14 2001 ELEVATION CERTIFICATE �-�
� P� � Im ortant: Read the instructions on a es 1 -7. S� Z 3�
�� � SECTION A-PROPERTY OWNER INFORMATION For Insurance Comparry Use:
BUILDING OWNER'S Poliry Number
�A�,,� AND �AC El... koTSG N - .
. BUILDI(VG STREET ADDRESS(Includng Apt.,Unit,Suite,and/or Bidg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
�y 5 y Sou r�.� }���\.C.JL�.S� A�'� �V C STATE ZIP CODE
cmr ��acz.�pr� 33`�Sc.,
GLCAiZWA"'t'EZ
PROPERTY DESCRIPTION(Lot and Biodc Numbers,Tax Pa�cei Number,Legal Des��on,+tc.) �
L.�i /S B� S ��°Q��ll.l. UN�� 8 1�� (o�
BUI NG USE(e.g.,Residential,Non-residentiai,AddiGon,Aaessory,etc. Use a Comments area,if necess2r�.)
r,S�D e=N'r'1/�.�-.
LATITUDEJLONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: (_�GPS(fy;.e):
( �°-i�'-�.##' or ##.#�j0) �.—�NAD 1927 ��NAD 1983 ��USGS Q��ad!.!2? ��Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORh1A710N
t IP, TYNAME 8� ER 82.COUNTY NAME 83.STATE
Bt.NF, � _ Fl,csf�.�p�P
. r, _ 1�111E1..L.Y�S
84.MAP AND PAN L B5.SUFFIX B6.FIRM INOEX 87.FIRM PANEL B8.FLOOD 89.BASE FLOOD ELEVATION(S)
- NUM ER �� DATE�I� EFFECTIVEIREVISED DATE ZOtJ�(S) (Zone AO,use depth of flooding)
Zso9�-�/� � �l�e 9'J� -��- 9l � �E �a
B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth ntered in B9.
�_�FIS Profile �FIRM (_�Community Determined �_�Other(Describe):___
611.Indicate the elevation datum used for the BFE in B9:,(�S�NGVD 1929 ���NAVD 1988 �_�Other(Oescribe):
B12.is the buitding located in a Coastal Barrier Resources System(CBRS)area or Othenvise Protected Area(OPA)? �_�Yes �No
Designation Date:_
� SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on: �_�Construction Drawings' �_�Buitding Under Construction' �Finished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
C2.Building Diagram Number�_(Select the building diagram most similar to the buiiding 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. ElevaGons—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,ARIA.AR/AE,A�'A1-A30,AR/AH,AR/AO
Complete Items C3.a-i below according to the building diagram specified in Item C2.State the dat�m used.lf the datum is different from
the datum used for the BFE in Section B,conve�t 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 appropri�e,to document the datum conversion.
Datum ConversioNComments �I ��
Elevation reference mark used Does the elevation reference mark used appear on the FIRM? , Yes No
SYo.�ft. m �
O a)Top of bottom floor(including basement or enclosure) � ) �
Cl b)Top of next higher floor �..��ft.(m) � a � �,� Z�;',.` -+
CI c)Bottom of lowest horizontal structural member(V zones only) r'. ft:(mj £ o `� „ y,�:_
O d)Attached garage(top of slab) _ �9 .�fG(m) =z °��� .�a �
L" � � «
0 e)Lowest elevation of machinery and/or equipment z � � � ;
seNicing the building(Oescribe in a Comments area.) -3� ._Stt.(m) ; c� �� �.
� � a� �
O �Lowest adjacent(finished)grade(lAG) 3 g_ _L ft.(m) i � � � "i, �� �r;.;� ,'�
v
❑ g)Highest adjacent(finishec�grade(HAG) � . �L ft.(m) � '-M � . ,
0 h No.of ermanent o enin s flood vents within 1 ft.above a ' ent grade " �� �� �t�,� ��
) P P 9 � ) ���€�'`�
O i)Total area of aU permanent openings(800d vents)in C3.h sq.in.(sq.cm) �:° ; - s"
SECTION D-SURVEYOR,ENGI ER,OR ARCHITECT CERTIFICATION '�`'
This ce�tification is to be signed and sealed by a land surveyor,engineer,or architect authorized by la•r�to certify elevation information.
1 certify that the information In SectionsA,8,and C on this certificate represents mybest efforfs to interpret the data available.
/understand that an (alse statement ma be unishable b fine or imprisonment under 18 U.S.Code,Section 1001.
� CERTIFIER'S NAti1E LI ENSE NU BER�12� —
MATTEIEW D PICKEL —
TITLE Cp ��enrv tiannF
P S M FLA SURVEY CORP.
ADDRESS CIN STATE ZIP COD
1081 72 STRE N. E. 209 IARGO FLORIDA 33777
S� �.N DATE �l/z p a� L_PHONE 72� 5�+9 1901
. � ' •
IMPORTANT: In ihese spaces,copy the corresponding Information from Seciion A.
BUILDING STREET ADDRESS(InGuding Apt.,Unit,Suite,and/or B,de.No.)OR P.O.ROUTE AND BOX NO. ��i�u���Pany Use:
��f 5 So�7Tt{ �1�CfL�ST' V�r!V � Policy Number
CfiY .
L'L.L AR�W L�TVr jZ STATC 21P.('.ODE
�'c.o�,��d 3��S'fo CvmpanY NA1C Number
SECTlON D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATtON(CaNTINtlED)
Copy both sides of this Elevation Certificate for(1)community o�r�ciai,(2)insurance agent/company,and(3)building owner.
c n�Enirs � 3 _ e, _ A• c, r�,�.�
SECTION E-BUILDING ELEVATION INFORMA710N(SURVEY NOT REQUIREO)FOR ZONE AO AND ONE A(WITHOUT gFE�nts
For Zone AO and Zone A(without BFE),complete Items E1.through E4. If the ElevaGon Certificate is intended for use as supporting
information for a LOMA or LOMR-F,Section C must be comple!ad.
E1•Building Qiagram Number (Select the building diagram most similar to the building for which this certificate is being compieted-
see pages 6 and 7. tf no diagram accurately represents the buitding,provide a sketch ot photograph.)
E2.The top of the bottom floor Cncluding basem,ent or enclosure)of the building is ���_�,{t,���`�_�in. cm
(check one)the highest adjacent grade. (Use natura(grade,if available.) � � I_.,�ebov¢or .�_,�befow
E3.For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(etevaiion b)of the buildinq�is
�._���ft.(m)�_�_�in.(cm}above the highest adjacent grade. Complete Items C3.h and C3.i on front of form. �
E4.For Zone AO only. If no flood depth number is avaitable,is the top of the bottom floor elevated Fn accordance with the community's
flood lain mana ement ordinance? __�Yes _ No �__�Unknown. The locat official must certi this info�maUon in Sectfon G.
SECTION F-PRQPERTY OWNER(OR OWNER'S REPRESENTATlVEj CERTIFICATIOH
The property owner or owner's authorized representative who completes Sections A,8,C(ttems C3.h and C3.i only),and E for Zone A
(without a FEMA-issued or communityissued BFE)or Zone AO must sign he�e. The statements in Sections A,8, C,and E are correct to
the besf ofm knowled e.
PROP TY OWN R'S OR OWNER'S AUTHORfZED REPRESENTATIVE'S NA�AE
AO R S
CiTY S ATE - ZIP CODE
SIGNATUR
DATE TEIEPHONE
COMMENTS
SECTtON G-COMMUNITYlNFORMATiON(OPTIONAL) � Check here if attachments
The local o�cial who is authorized by law or ordinance to administer the community's 800dplain mar�agement ordinance can comptete
Sections A,B,C(or E),and G of this Elevation Certificate. Complete the appticabie item(sj and sign below.
G 1•�_(The information In Sec6on C was taken from oiher documentation that has been signed and embossed by a 6censed surveyor,
engineer,or architect who is authorized by state or local ta:�r to certify elevation informat�n. (Indicate the source and date oP the
elevation data in the Comments area below.)
G2.�_�A community official comp(eted Section E for a building tocatsd in Zone A(without a FEMA-issued or community-issued BFE)or
Zone AO.
G3.��The following information(ltems G4-G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMiT ISSUEO G6. DATE CERTIFICA COMPLIANCE/OCCUPANCY
1SSUE0
G7.This permit has been issued for: �_j Ne���ConstrucGon �__�Substantial Improvement
G8.Elevation of as-built lowest floor(inctuding basement)of the building is:
G9.8FE or(in Zone AO)depth of tlooding at the building sita is: —'—'=-'—fi•(mj datum:
LOCAL OFFICIAL'S NAME - _._ft.(m)Datum:__,
TI7 E
COMMUNITY NAME TELEPHpNE
SIGNATURE
DATE �
COMM S
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