731 ISLAND WAY _____ `
. ,
, , , _ , JQB N0. E4169 " . „ '"�'m;
. . _�_"..r_._.,____.____._. -- oMe aoer•�o» ��' �
��� �� � �' �-� FEDCRAL EMH7iQENCV MANAGEMENT A(3ENCY ���x�� ''? ����
,• ' ' NATIONAL FLOOD INSURANCE PROQRAM ^� �+
� � �;���,�
� ���v�-rro�v ����ri Fi�A�ri�
� � � ��
�� This lorm is!o be uaed for:t)Now/Emerpcncy Progrnm cr��trucfion in Spec�el Flootl Harerd Aroes:2)Pie••FIRM conalruction alt�r
� � �,
; • Soptember 90.7982;9)Po6t•FiRM Conslrucllon;nnd.A)pther budd�ngs ratod aa Post-F�RM rulos. rt
� � � � � �
�. y� ' p �, ��.___--'— �, �
BUILDiNG OWNER'S ADDRESS �i•�
NAME ' � � '�'
�1- MR. t MRS. PETER YEE �31 iS!AND WAY, CLEARWATER, Fl4RIDA ; , �a�
,"�`����' x' , PROPERTY LOCAT�pN(LOt and Block numben and addr�as il availabie) � `w
��.Y���t� .. . . .. . (�' Y'..
''$ +*���r�r,'� L07 22 4JNIT 8 ISLANO E5TATE5 OF CLEARK.ATER, 731 ISi.AND WAY� CLEARWATER, F A. � }r
�, '#e��' *�.F ^� � 1 certffy that the inlormalion on th{a certllicate represents my be�t atlorte to�nterpret�he date available.I underste�d thal any talse ^ j'�,
�};�t��FC``.�� f ,; statement msy be puniahable by I�ne or Impriso�mont under 18 U.S.code,Section t00L !, �*�`
`�;rro`�#�'t �4;''y,T $ECT10N I ELIQ181lITY CERTIF«ATION (Compteled by Locet Community Permit Ot(itial or a Registeted Profes��nel Enyinee�, ,,; �,��y�y�`
� �� i7 4�
�?���,�,"*`+} � �, .� <. .�.� � _ Arch�iecl,or Sur�eyor) �.� �e ,�
\ µ
�,�� ��`'{S��� OMMUNITM NC. PANEI NO SUFFIR DME O�FIRM FIRM 204f DME Ci CONSTR OASE FLOUO ELEV. OULLDIN6IS � �
� no�O Lone.u�e Oev�nl ❑N�ri£m�rq�neY t >.�
.,•drd '�f��t . 9 Pr�•FIRM
g;} �`��',�s�� 25096 9 3 L•/1/83 A-1_ 11 FEET �pp�t-fIRMn`�0.o �� `f .
yy �� .
��� �.��i�� 'a � • `YES NQ �t fs intended that tha building descnbad r�bove w�U be conatructed in compliance with the community'e 11ood pisin �� �`��'r^��
,;��,f,��`'"�W� ' � O ordinence.The certilier may iely on communrty reco�ds.The lowest floor(including Dasement)will be at an ebvation ' �°T,�sr�
F �r�� �+� ol,i���F ft.NGVO.Failur�e to co�struct ths building et this elevation may plece the building in violation ol < ,
F ,,� �. the community's flood plain management ordinence. �°� �,,'�,�``
r�, y . � �� �,z�3
�'+ fie� ;� � ' YES NO The buiiding described above has been cor�structed in compliance with the community's Ilood plain management ';' �
��� � �
�'�,���;,�,$ ❑ � o►di�ance baaed on etevation data and visual inspection or other reaso�able means. ��+
c
�' + ' ' . It NO is Chetked,ettach cc;'/ol varia�Ce issued by the tommumty. ' '�a���:
�;�,Y��*�;KC",�+� . � �.
�c�'� � i $ �
�,,� YES NO 'me mobile home Ixated a:the address desuibed above has been tied down(enchored)in complianCe r�+!h the „t �
� a �� � p ❑ comrnunity's t!ood plsin managament ordinance,or in como�iance with the NFIP Specifications. -�
yJi � � �Y�t �ri^'t
� �" MOBILE HOME MAKE MOOEL YR.OF MANUFACTUHE SERIAI.NO. DIMENSIONS
�,� r ,V i.� X ` �S�
��x�,�,a�� �a� l .
��
+yL`��n`��y+�,`w�� :�� � }:
j��Qb�c��iits't w1 . ��
,�� �•�s3���A�� . (Community Permit Official or RegisterAd Professional Enqineer,Architect,or Surveyor)
.
� ,l�� � � . . . Av-
:� � _�"'ip' NAME _ � _ ADORESS ,� r.�
� ,��, '' J� �,
a�
�. � k,
';� �7i ��>'�t�'� ' CITV uTATE 21P "�
���lt:�a . TITLE �4 +��'`°�
* f
\_ <`,�„ PHONE i;W ti n+
�IGNATiJStE DATE — xd
.'� .,<ar F .
x 14tYr'� "
,l.a„'�}�.��� HECTION U ELEYATION CERTIFICATION (Certitied by a Local Commu�ity Permit Oiliciat or a Registered Professional Engineer, �'
�;^vf y.��"st-+'' ArChiteCl.Or Surv@y0�.) �'
�,�,,, a� �,+�p,
4 ,
j;;,t�,�+'��o.�,� , . `� '���`�,�,'"i
a
1� ��s,rxc�p FIRM ZONE At-A30: 1 certlly that the buil��g itlhe property location deseribed above has the fowest floor(including baEement)
" at an elevation o1 � teet,NGVD(mean sea levei)snd the avsrape grade at ihe building site la at �'�,�t�}��
,� ' rr az.,4' an elevation of �}°t,NGVD. ~�r+ .
(6ARAGE ELE1/ATION = 9.4j FEET) a���� �,,
!,`y�� � � ��"'�
: � ";� �.� {_
FIRM ZONES V, Vt-V30: I ceAify that the building at the property location described above has the boftom o/the loerest ff0or beam f ,��
� k� ` at an elevation ol teet,NGVO(mea�sea leveq,and the average�rade at the builrJfng slte ; ,,.� :
'�,`,,��� is at an e�evation of teet,NGV0. �`�
y�:��
�� '
,
. � � r.x
�rfi�;�� FIRM ZONES A, A99, AO,AH,and EMFRGENCY PROGRAM:I certity that the bullding et the property location described above y�:r�� �gsf^
`` '� has the lowest ttcor elevntion of feet,NGYD.The elevetion of the highest adjaeent grrde next � ,,
` r r ' .,��a�.
����� y� to the buila�ng is— feet.tvGVD. ��v ��
��'�'r} :r , ,
S �r'�t��'�:
���.,c�+���4Y SECTiOk 111 FLQOOPROC' -.�lG CERTIFlCATION �C�r'itdcatien by a Registered Professiona�Engineer or Architectl `�r�g Y�
� �`����
'TM �:��;� !certify to the Wist ol my knowledge.i�fo�mation,and beliet,that the building is designed s�that thn build(ng Is wat8rtight,with c*,;�'�4,*
��'� '�'�+ walls subsWntially Impermeable to the passage of weter and struetural components havinA the capobdity oi resisting hydrosta�ic s �t��3��
and hyd:ody�amic toads anC effects ot buoyancy thai woWd be caused by ihe flood depths,pressures velxfties,impact end up itt � ,
��` foroMt associated r��th the base!�ood. �'�'�� �
4 �" N �� � YES� NO❑ In the Pvent of flooding,will this dec�ree of fioodproofiny�be achieved with human intervention? �'.��j����:
,x �xe � '[
(HUman intervention means that water wiil enter the building when floods up to the base tlood tevel Oc- .,,,,,.�
�a r cur unleas meesures are taken prior to the Nood to prevent entry of water(e.g.,bolting metal shields over �E��
doors snd windowsi• '
S YES❑ NO O Wilt the building be xcupied as a residence7 � �`
�
' I(ths enswe�t�both ques4ion�ia YFS,the 1loodproofing cannot be credited for rating purposea a�d the actual lowest floor muat be � ��
���;�Y eompbted�nd certified instea6.Complete both the elevation and floodproo}ing cenificates. ,k��` � -e°
. "���ts���:
������ `�' = FIRM ZONES A,At-A30,V1-V30,AO and AH: Certificd Floodproofed Elevation is 'eet,(NGVD). �
, � 3„; „ :
,�' �� �
THIS CEqTIFICATION IS FOR IxSECTtON 11 ❑ BOTH SEGTIONS it AND 111(Check One) '�k;,+k �,
�y',;�e
s �y+ CERTIFi`tH'.i NAME COMPANY NAME UCENSE Nt).(or AHix Seal) ��y�i r� `,
� ' „-GE�DR6�E A. SHIMP II — GEOR6E A SHI?�!P II C ASSOC_; INC_ �2i19 �`.'� r*�d�'.
cr� z b.� w �'�-
'���" �`' AODRESS 21? � �r
r���, r�, .TITLE , , , ��i,�� *."T.
��-�:� ��'� �PR�SIDEMT 3221 U.S. ALT. 19 NORTN, SUITE e ;���_ , `�}
��'� � .
' $! TURE DATE CITY STATE PHONE
��% a i y�... �.;..
;at�F �� . ,'��'� ��� 10 2 $4 P ,ra0�,� FLORI DA 813—jRt�-5496 �
�', zb�� �t :; r� s rr;. • t Nfould�MaCt1 fM alyMal eopy ol!ht corr��M1W fo►m to tM f1ooJ i.�wrenet Po�kY KJ���, , y �
a,�r,�,y �� an� >„*� r �•� � sAOUId b�tuppllW to tha � aar,�,a n+e u+ua ntM�ad tM i r�;
'}` ;'f�''. i� n� � ' ��" `� ' tn.aaM,a eopy vo►erh �ovr b�i �von+ � , �
r��r ri � #a r ,, ,- • , INSUMNCE AGiENTS klAY�£�ER TF118 FOplM SW-117 �' k��
� �a8�� �` �r �tzz �: � � � �" � "� '«=
"" =���' ����^ F RE►LACES fEMA FOAMS81-9(T)AND61-10(T►.REB80.WHICH ARE 06SOlETE. . .. � '�
�, „: EMA Fom Fi7•�3,APR IIR2 �
� ---_. _-- — -. . __.__. _.. . . ... . _ . . � � ��.�a,.
• ELEVATION CERTIFICATE O.M.B. No. 3067-0077
� FEDERAL EMERGENCY MANAGEMENT AGENCY �pires July 31, 1999
: NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of this certificate does not provide a waivar of the flood insurance purchase requirement.This form is used only to pro-
vide elevation information necessary to ensure compliance with applicable community floodplain management ordinances,to determine
proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision(LOMA or LOMR).You are not
�ired to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form.
Instructions for completing this form ean be found on the following pages.
SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE
BUILDING OWNER'S NAME POLICY NUMBER
JOHN GIBSON
STREET AODRESS(Including Apt.,Unit,Suite and/or Bldg.Number)OR P.O.ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
731 ISLAND WAY
OTHER DESCRIPTION(Lot and Bbck Numbers,etc.)
LOT 22 UNIT 8 ISLAND ESTATES OF CLEARWATER
CITY STATE ZIP CODE
CLEARWATER FL. 33767
SEC�ION B FLOOD tNSURANCE RATE MAP(FIRM)INFORMATION
Provide the following from the proper FIRM (See Instructions):
1.COMMUNITY NUMBER 2.PANEL NUMBER 3.SUFFIX 4.DATE OF FIRM INDEX 5.FIRM ZONE 6.BASE FLOOD ELEVATION
(in AO 2ones.use depthl
125096 0007 D 8-19-91 AE 11
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations(BFE): ❑NGVD'29 ❑Other(describe on back)
8. For Zones A or V,where no BFE is provided on the FIRM,and the community has established a BFE for this building site,indicate
the community's BFE:�J.0 feet NGVD(or other FIRM datum–see Section B, Item 7),
SECTION C BUILDING ELEVATION INFORMATION
1.Using the Elevation Certificate Instructions,indicate the diagram number from the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level_1— .
�). FIRM Zones A1-A30,AE,AH,and A(with BFE). The top of the reference level floor from the selected diagram is at an elevation
of��2�.�feet NGVD(or other FIRM datum–see Section B, Item 7).
(b). FIRM Zones V1-V30,VE,and V(with BFE). The bottom of the lowest horizontal structural member of the reference level from
the selected diagram,is at an elevation of�J.0 feet NGVD(or other FIRM datum–see Section B, Item 7).
(c). FIRM Zone A(without BFE). The floor used as the reference level from the selected diagram is W.0 feet above❑ or
below❑ (check one) the highest grade adjacent to the building.
(d). FIRM Zone AO. The floor used as the reference level from the selected diagram is W.0 feet above❑ or below�(check
one)the highest grade adjacent to the building. If no flood depth number is available,is the building's lowest floor(reference
level)elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown
3. Indicate the s!e�:ation dat:.�m system ussd in determining the above reference level elevations:� NGVD'29 ❑ Other(describe
under Comments on Page 2). (NOTE: If the elevafion datum used in measuring the e/evations is different than that used on
the F/RM (see Section B, Item 7J, then convert the e/evations to the datum system used on ihe FIRM and show the conversion
equation under Comments on Page 2.)
4. Elevation reference mark used appears on FIRM: ❑ Yes �No (See Instructions on Page 4)
5.The reference level elevation is based on: � actual construction ❑ construction drawings
(NOTE: Use of construction drawings is only valid il the building does not yet have the re%rence/evel floor in place,in which
case this certificate will only be va/id/or the building during the course of construction. A post-construction E/evation Certi/icate
will be required once construction is complete.) �
6.The elevation of the lowest grade immediately adjacent to the building is:���.� feet NGVD(or other FIRM datum-see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
1. Ii the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1
�s not the"lowest floor"as defined in the community's floodplain management ordinance,the elevation of the building's"lowest
floor"as defined by the ordinance is: L�U.0 feet NGVD(or other FIRM datum–see Section B, Item 7).
2. Date of the start of construction or substantial improvement .
FEMA Form 81-31, AUG 96 REPlACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR COIYTINUATION
.
SECTION E CERTIFICATION
This certification is to be signed by a land surveyor,engineer,or architect who is authorized by state or local law to certify elevation
information when the elevation information for Zones A1—A30,AE,AH,A(with BFE),V1—V30,VE,and V(with BFE)is required.
Community officials who are authorized by local law or ordinance to provide floodplain management information,may also sign the •
certification. In the case of Zones AO and A(without a FEMA or cqmmunity issued BFE),a building official,a property owner,or an
owner's representative may also sign the certification. .
Reference level diagrams 6, 7 and 8-Distinguishing Features—If the certifier is unable to certify to breakaway/non-breakaway wall,
enclosure size, location of servicing equipment,area use,wall openings,or unfinished area Feature(s),then list the Feature(s)not
included in the certification under Comments below. The diagram number,Section C, Item 1, must still be entered.
1 certify that the information in Sections 8 and C on this certilicate represents my best efforts to interpret the data available.
1 understand that any/alse statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 100 i.
CERTIFIER'S NAME LICENSE NUMBER(or Affix Seal)
GEORGE A. SHIMP II � 2512
TITLE COMPANY NAME
PRESIDENT GEORGE A. SHIMP II & ASSOC. INC.
ADDRESS Ci i Y STATE Z�p
3301 DESOTO BLVD. PALM HARBOR FL. 34683
SIG E
JOB #970554.1 1�T�L4-97 P��E5496
Copies should be made of this Certificate for:1)communtty official,2)Insurance agenUcompany,and 3)building owner.
COMMENTS:
•
.
ON yyRH
ON PILES,
SLAB BASEMENT PIERS,OR COLUMNS
A V A A V
ZONES ZONES ZONES 20NES ZONES
REFERENCE REGEFENCE
IEVEL BASE �E�E� REFERENCE
FLOOD LEVEI
;:y.
EIEVATION
,.p�;
'i!.{�;';%Pi1::�17.;i� t�.}.;�.iti t.F.''.
���.
BASE ...�.:',.,': :;:�.��`::::i:!'• :%k.
BASE
FLOOD '""' '"�" ADJACENT�'�:?;�:y� REFEHENCE F��
ELEVATION GRADE ' �+� • LEVEL
REFERENCE ADJACENT :t:rr:: ELEVAiION
IEVEL GRADE �;�}'
';�L���i:,;��;#:.y;x`.:
;':`i�;:; :C:'�:�.::::.•;:;:,:r>: �.
.;:'r::;t�i:�::`:':•:::''�C.::: � :.
.:. :.,/•:::�'.'..::j:,',::;': "� .
.'::'1:�. �i'.:i'��:�:'.i•:•• ��"�'i.':.� f��ti�
'�.r .. ' :. .� .. ���;: ..
.,..�:���::.:��:.r:�.:•:�.:::'i:.. .,-.�•
. ... ..r.:.:.:.:..:... ..��.ADJACENT:;.
.. n. •r:.•:..•r•:•r. �.. GRADE
. ..":��'�. .... .. .......���`.�•.. .
The diagrams above illustrate the points at wh'�h the elevations�hould be measured in A Zones and V Zones.
Elevations for all A Zones should be measured at the top of the reference level floor.
Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member.
Page 2
Page' of 3 r,nt valid without alI three pages
U.S. DEPARTMENT pF tiOMELAND S�CURi'i"1'
FEDERAL EMERGENCY MANAC*EMENT AGEltiL'Y
hariozeil F1aad Iaurance Pragecm
A1. Buticiing Uwner
MAFt �ARET
A2. Buiiding Street
, Unit,
ELEVA7IQl� GE�iI�iCATE
IMPOEtTRN7: failow the instruetions on pages 1-9.
SEC"ftON A - �'f2UPERTY INFGIRMATION
andJor B;d�, f�o.) or P0, Route and Bax Na,
4M8 No. 5660-0008
Expiratibn Date: July 31, 2415
FOR INSURAEVGE
PoEicY Number:
A3. PropeRy Description (lat artd Block Numbers, Tax ParCe' Number, Leg21 Descriptian, etc.j .
R ' -� ` -
A4. Building U5e (e.g., Residentia�t,� o�-Residentiai, Addiiion, A��� s� dQ {� 7K Fiarizontal Datum; ❑ R1AD 1927 � N� 1`�
A5, LatitudeJLongitude: Lat. 2� 6 i37 — ��
A6. Attach at lea5t 2 photffgraphs of the buiid�ng If the GertiP,caie is iaeing used ta obtain fSood Insurance.
A7. BuildingDiagram NumLier �Rgfl
A9. For a building with an attached garage: �7� 5� ft
A$. EOr a building with a crawEspace or enclosure(s}: �&8 s� ft a) 5quare footage of attached gara�e
a} Square faatage of crawEspaee or enclosure(s}
b} Numbec oi permaneni ftaod openings in the craw�soace bt Rumtrer of perrnanent flood apenings in th4 attached garage
withirt 1.O fooi above adjacent grade
or e�cEosurets) within 1.6 foot at�ave adja�ent grade 5�- sq in
Cj Tptai net area of flood openings in A8.b ��a sq in c) Totai net 8rea of flood opanings in AS.b 9
dj Engineered flaod openings? O Yes �j No d} �ngineered fiaod o�enings? [� Yes � No
SECTIf?N B-�7.00d ilVSURANCE RATE MAP (F1RM) IhJ�ORMATtQN B3. State
a., .��� r.,,.,Y„��nc� wame & Cammunitv Number 82. County Name
ci najna
CI7Y OF CL AFE�t 7" aa �
g4, Map/Panet ±Vumber S5. Su+`fix 86. FIRM Index Eaie ` B7. F(RM Panei EiiectiveJ �$. �aod �°��{s) $' pOsuse Dase fload
� Revised Date �
12703C-�902 G 81'.$F2009 ttqlt}31Q3 � AE 118,12
810. Indica#e the saurce vf the Base ftaod Eleva*ian (BfE3 data or base Soad depth enterers i� liem B9:
[] Fl8 Profide (yf FIRM Q Commur�ity Determined [} Other%So�rce: �AVD 1988 ❑ CSther/Source:
811. lndicate elevation da#um used for BFE in ltem 89: D�GU� �929 �Xl
812: is the building iocated ia a Coasta'ss Barris� ReSaurces 5ysCem (CBRS) area or Otherwise Protec.ed Area {OPA)? ❑ Yes �JX Na
Designatian �ate: / J I� CBRS [� 4�'A
SECTiON C- Bti1LDiN� EkEVATIOAk lNFt}RMATION {SUitVEY REi�i11i2ED)
G1. 6uiidtng elevatjvrts a{e based on: Q Gonstructio� Drewings� [] Bui3cfin� llnder Canstsuction" (d�
Finished C4nstruciion
*A new Elevation Cerk?flcate wiii be required when canstru�Uan of the auitd�ng is compkete.
C2. Elevations - Zones A1 A30. A£, AH, A(with BFE}, VE, V1-V30, V{with 8F�}, AR,ARjA, AR/AE, AR/A1-A30, ARjAH, ARJAO. Compiete items
C2.a--h below accortling ta the building diagram specified ln ite�n A7. in Vuerta Rico only, enter meters;
nnc+ ��c�nnincft! • � � �/@'fi'1Cd) �c3±171'1:� NAl1D8$
8enohmark Uiitized:
Indieate eievation daturn used #or Yhe elevailons ir� Items aj through h} below. �' t�GVa 1929 � NAVD 1988 C� OtherJSource:
Datum used for buitd;ng e(evations must be the same as that used fnrthe BFE. �neck tne measurement used.
a) Tap af bottom ilaor {ir.cluding basernerrt, crawlspace, ac enciosure flonr;
b} iop af the ne� higher floar
c} Baicom af the lowest horizontai stnfctural mernher {V Zanes oniy9
dj Aitached g8rage {top ot slab}
e) Lowest�e3evation af macF�ir�sxy �sc equipt�ent se�cing tft� buEtd7ng
(pespr�be ;ype of ec{uiprrcent an6 Iocation in �omments)
Y} Lawest adjacent {finisned} �rade next to buiidsn� {LAGj
g) Higfiest adjacent (finished} grade ne�R ta buiiding (HAG}
h) LowBSt 8djacent grade at IowesC elavation of deck or stiairs, ;nciuding
I rt
� ,43 —
�n . A�
R , 65
.��..�_ . L+6.
�_ , Fi
��_ . 'iA
6 , S1
(� feet CI meters
� ieet p r+seters
p feet D meters
� feei � meters
� fest �: meters
� fee# � meters
� feet (a meters
� fE'Et Q [YtE''C@f5
structura suppo
SEGTi�IV D- SUFtVE"YOR, ENGIIVEER, OR ARCH[7ECT GER'CIFlCA710N
This certiflcation is to be sigrs�d and 5eaied by a tantl surveyo , e�gireer, or archltect authorized by law to certify elevation
infOrmatian. ! cerTi€y #hai the infcsrm8lion Crn this CErt+flCB�� �epr25e1it� my be5t a�f¢� tS to inFer�rs[ the dat� aua8able.
1 undetsiand that any false statement rnay be punlsh�bfe by fine or imArisonment under 18 U.S. Code, Section 10t71.
� Gheck here iY comrr3ents ere provided on baek of fothl. Were i2titi1�2 BC�d fOtlgit�id8 ili SC'Cti011 A pPOVidetl by a
❑ Check here !i attachments. iicensea iand surveyar? � Yes C�`X1 No
Cicer�se Numtaer
Gert4fief5 Name � �: �r ,.,en,
Address
Signature
C�anpa� tiame . .
Gitv �-�.... . I State
3ate
ZIP
i -- __
FEMq Fnrm 088-0 33 tReviseei 7/12}
See reverse side for corrtinuation. RB�tI�CBS �i ¢fB17101J5 Bd�:lOfiS.
���w:a sr��zoTa�
P�e 2 of 3 rrot vali� wilhaut atl three pages
ELEYATION CERTtFICATE, page 2
i1NP4R7ANT: in these spaces, copy the cor,
$uikding 5treet Addres5 (inciuding APt�, Untt,
City
SE�TiON D -
�om �'.++actior� f�.
and/ar B�tig• No�) or R0. Route and 8ox No.
�iate Z1P Cnde
�� 33767
EY4F�� EPlGthiEEi�� t►E2 Aft4'FiITECI' G
Copy both sides of tnis Efevation CertiScate far {1} corni
Comments N07E: C2.E = AG UNIi PAD. NO'
fiFRT(F(('At`E "f'H�� PFRTl�IC'AT� IG F(�R �t
U5ED F'OR CONSTRU�TIQN OR PLANNING:
SPA� 7 04 FlNIS'�Fil FI tiC}R = 11 11
Signature 1/�„ �;�:
+ afficial, t2} ins�rance age
VS ELEVA710N GERTlF#CA
E��c��iRANC� Pt1RPCS�ES (
HOUSE F�N[SFiED FLC3dR
f3aie
FL1403.2589E�
EOR INSURANCE GOMPANY USE
Folicy Number:
Comparry NAIG Number:
company, ar�tl {3j building owner.
IS QNL1' VALID FOft TME PERSC}N
PERSONS NAMEO ON THIS
1 By =1D.86. ADI�ITION (DIAGRAM 8} BOTTt7M OF CRAWL
�i26�2d�� CENTERCINE ROAd ELEVATEOt�L 6.39
5ECTt(JN E- 8U#LbFIUG ELEVATtfJN {N�QRMAiIfIN {SUR�EY WdT REQUIRED} Ft}R ZdNE Afl ANQ ZaNE A(WCtnuu� �srcj
For Zones AO and A(wrthaut BFE), eomplete liems E1-E5. ;f fihe Certificate is intended to suppoR a LOMA or LOMR-� request, cnmplete Sections A, B,and G.
�or Items E.1.-E4, use naturat grade. �'� ����able. Check tise measuremert used. In Puerto Rico on(y, entsr rrteiers.
f1. Frovide elevat�on informatian for the fioiloWing and check the appropriate boxes to show whether the elevation Es above or belaw the highest adjacent
grade tHAG} and '�he towest atljacent grade (lfiG}.
feet meters Q above or [] beiow the HAG.
a) Top of bottom �oar {inctudiRg basament, crawtspace, �r enclosure} is • � �
b) Top oP bottam flaor {incfuding basement: crawtspace, or enclosu*ej is •
��eet C� meters Cl abave or Q be�ow tr�e u+G.
E2. For Bu�lciing Clisgfams 6-9 with Re�marzent flood openings provided in Seciian A IYems 8�rd%or 9{see pages 8--9 of InstructionSj,
fe�t meters [] abowe or ❑ beiow the HAG•
ihe next higher fioor (eievation C2.b in the diagramsj af the bu�idin� is • � Q
E3. Attaehed garage ttop of slabj is _. C�X) feet [� meters [i above or [� peiow the FU1G•
E4. Top of piatform of machinery and/oY equipment s�rvicir�'.he buiiding is . C�
feet d meters ❑ aboue or � i�eiow the HAG.
E5. Zone AC oniy. li na flcsod depth number is av8ilable, is the top of the bottom �oar eieuate� in accordance with the Community's Noadptain manegement
orciinance? C! Yes ❑ No � U�knawn. The loca[ offlciai rnusY eertify this intarmation in 5ectior. �.
SECTiON F- PRf1PERTY tliAlNER (t3�! OWNER'S REPRESEt�Tlt7lVEj CER71FiCA7i0N
ine property owner ar owner's auihorized representative who eompletes SectianS R, 8, ar:d E fof Zone A(witirhut a FEMA-isstted ot community-issusd BFE) or
Znne Ao must sign here. The statemanis in Sections A, B, and E ar� correci ta the best ai my kn�w�edge.
Property Owner nr Owner's Au#i�orized Representative"s Name
Acidtess
Slgnature
Comrnents
City
Date
State ZIP Code
Teiaphone
Q Check here if attaCtlmerrts.
SECTtON G - COM1"�UNITY iNFOEtMA7IQN (OPTtONAL)
The iocai offici�! who is authorized by law or orcinance to admiriiszer the cGmmuniry`s Rnadpkain management orciinance can compiete Sectians A, B, C(or E), and
G of this Elevation Certihcate- GomD�eC� the appiicabie itern(s} and sign beiow. Check the measurement used in ttems G8-G20. in Puerto Rico anly, enter meters.
Gi. Q The ]nf6rrnatiort in SeCtion G was taken irom other documentation tnat ha� been siqned and se3ted by a licensed surVeyor, engineeY, OC 8F'ChiteCt
who ts authoTized by lav+to certify e€avavan informatian. {indicate the saurce art3 date of ihe elevation daYa in the Gomtriettis 8tea beraw•)
G2. ❑ R community officiai completetf Sectian E for a bui[air:g iocated in Z�ne A(wiYnout a FEMA-issued or cotnmuniiy-issued BfE? or Zone AO.
G3. ❑ 7he fotlawing i�forrnat'son (Items G4-G'� Q} is provided Yar community flaadp�ain management purpose5.
Permit
G5. Date PPrrnlY ISSUed
bate
G7. This Aermit has bee� issued €or. 0 New Canstruction (� 5ubsta�rtial impravement
Gg, ElevaUon vf as-buiit iowest floor (including basementj of the 6uiiding: . Ci feet �..i mete�s daYUm
G9. BFE ar (in Zon� AO) depth of flooding at the building site: . ��eet C� meters �atum
G1q.Community's design flaod e#evatiors: . i� teet C�l mecers patum
loca; Officief's Name
Commun[iy Narne
Slgnature
Catnments
7it(e
?'el8phone
DaC�
❑ Check here it aitachments.
FEMA Fortn tI86-0-33 {Revised 7/12} Repiaces all previous etiit�ans.
0
. ELEVAilON GERT9FiCATE, pa�e 3 $€i�LLitNG Pk{iTOG�APNS
Page 3 of 3 not valid withcut aA thrn.� pa�es See (n�tructior�s for Item A6.
FL1409.^cS89EC
INtPORTANT: In #herse spases, cc�py the carresponding [nformat(oa ham Sectlora A.
Ft7R (NSURANCE COMPANY USE
Poiicy Numkr�r.
Builr3ing Stree`. Address {induding Apt., klnit, 5uite, ardjor Skdg- f��-? �r �- �n�� ar� sp�; �o.
731 ISLAM1ID WAY -- Company NA3C Number:
�i� �+atp ZiP Cade
CLEARVJATER Fl, 33767
���� IP usingthe Elevatlan Certi�icate to obtain NFiP flo�d insurane�, affix �t le�st 2 huildin� phc�tographs he€ow ac�ordir�g to the Instruetions
for iter� A6, 4dentify 311 phatographs wtf� date *,�ken: "�ran� Vi�w" an�f `-Rear View"': ar�d, if required, '.Right Side View" �nd °l.E�ft
Side View" When appiicable, photographs must show the fo,andatior witi� re�res�ntative �xamp�es of the f3oad apenings ar vents, as
indicat�d in Sectian A8. if submitting ancsre Ghotographs ihar� wii( fit on th�s o�age, use .3�e Gontinuation Page.
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FI�ON7 PROFERTY' €�[��"IJRE 3l2A./20�� Rc�i.`�i I�ftC?PEr TY PICTURE 3/2�J2094
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FEMA �orrr, Ot36-C,�-33 ��seuisF� 7/.2}
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LEi= . , �� �_ -'(i� .;:;� ;�F'1�ri2�1$
RepiaCes all preVious editians.
ELEYATION CERTIFiCATL, page 4 � �Uit.blKG PHOTC3�RAPNS
� C�nt�rustion Page
fENIA Forrn 0$61)-33 (Revised if 22) Repiaces ai: previous editio�rs.