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751 LANTANA AVE , .► F�DERAi.EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No.3067-0077 j��'� �,� 6� �- � � (.�.�� Expires December 31,2005 �� ELEVATION CERTIFICATE � Im ortant: Read the instructions on a es 1 -T. SECTION A-PROPERTY OWNER INFORMATION 'FQ;�:a��j��:��';:�j��'� : ;:: BUILDING OWNER'S NAME �Q��r A _ CsN� C�o�..r5 U L �Q� ' (>. BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,ancUor Bldg.No.)OR P.O.ROUTE AND BOX N0. rym ry 5 nl A A1 ° �!E J U� �.........._�.._1"N�11....._C�umber:::::-::::.::,::::::::::::-::::::: ::::::,.::::::::::::::::::::::,:-::::,.::::::::::::::::.::::::::-:,::::-::::::::::::-:::::::::: ,.:..........:.:.::...::.,,.......:-................:......._....._:......,: CITYG,L��1Z�/�I/-�`�Lm.� � STATE r�..' ZIPCODE ,��7�a PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Desc�iphon,etc.) te'1 7 �T � � �o. �/Z. �T � , l3bc.,�. ZS � MA�N1�Ia�,� �/ SJPpl�15�c�n.� BUILDINO U3E(e g,Residential,Non resldential,AddiNon,Accessory,etc. Use a Camments ar a,If necessary.) R�Sl�7�r.1T/A L LATITUDE/LONGITUDE(OPTIONAL.) HORIZONTAL DATUM: ' -- ( �t#°-##'-##.##" or ##.#l�l#°I I,�,CI NAD 1927 I`I NAp 1983 SOURCE: �-y��USG3 Quad Map�_�Other ____,_�----- lU SECTION B-FLOOD INSURANCE FtAT�MAP(FIItM)INFORMATION B1.NFIP COMMUNITY NAME&COMMUNITY NUMBER 92.COUNTY NAME B3.STATE � ��-C�l�'�i`T�K. �25a 9 I�INEC,l,AS L, 64.MAP AND PANEL B5.SUFFIX 86.FIRM INDEX B7.FIRM PANEL BS.FLOOD B9.BASE FLOOD ELEVATION(S) NUMBE DATE EFFEC IVE/REVISED DATE ZONE S ��d��u ��b7 D �_��.� �� I �( ) (Zone AO,use depth of flooding) 810.Indicate e source of the Base Flood Elevation(BFE)data or base flood depth entered in B9. • �_-�FIS Profile � (FIRM �__�Communit etennined Y �__�Other(Describe):___�_ 811.Indicate the elevation datum used for the BFE in B9:� �NGVD 1929 �__�NAVD 1988 �__�Other(Describe):______ � B12,Is the building located in a Coastal 8arrier Fiesources System(CBRS)area or Otherwise Protected Area(OPA)? �_�Yes ��No pesignation Date:_—_------------�-- SECTION C-BUILUING ELEVATION INFORMATION(3URVEY REQUIRED� C1.Building elevations are based on: �__�Construction Drawings' ��Building Und9r Construction* �__�Finished Construction "A new Elevation Certificate will be required when construction of the building is complete. C2.Building Diagram Number�(Select the bullding diagram most similar to the building for which this certificate is being completed-see pages 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.j C3. Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO Complete Items C3.a-f below according to the building diagram specified in Item C2.State the datum used.If the datum is different from the datum used for the BFE in Section B,convert the datum to that used for the BFE.Show fieid measurements and datum conversion calculation. Use the space provided or the Comments area of$ection D qr Section G,as apprapriate,to document the datum conversion. Datum�1�� Converaion/Comments 1�I QN� _ - Elevation reference mark used GI"1� � CLU.1 � - '- �` ` �___.,�_�� Does the elevation reference mark used appear on the,��l�'7` � ��Yes �J,�J No ❑ aj Top of bottom floor(inciuding basement or enclosure) _J____�, � �,�m� � , ❑ b)Top of next higher floor ��.�ft.(m) `� � "~' ' ❑ c)Bottom of lowest horizontal structural member V zones oN ^ h� `'�4 �p , ( Y) -----�`A"---•--ft.(m) ��i „L 5,�,., � �.�7�r 0 d)Attached garage(top of slab) ��Q�R�p�.l��_�ft.(m) E O e)Lowest elevation of machinery and/or equipment W� � �" � .�� --�-� •;: _. servicing the building(Describe in a Comments area.) ��.� ft.(m) � a� -------- - < _ ` ❑ fl Lowest adjacent(finished)grade(LAO) ' _a� ,� ft,�m� Z,�, ' "' r G ❑ g)Highest adjacent(finished)grade(HAG) _�. �_ft.(m) � ❑ h)No.of permanent openings(flood vents)writhin 1 ft.above adjacent grade_!?3_ '� f � ❑ i)Total area of all permanent openings(flood vents)in C3.h�-��sq,in.(sq,cm) SECTION D-SURVEYOR,ENGINEER,OR ARCHIT�CT CERTIFICATION • This ce�tification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation infortnatlon. 1 certify thaf the informatian in 5ections A,B, and C on this certificate represents my best efforts to interpret the data avallable. I undersfand fhaf any false statement may be punishable by fine or imprisonment under 18 U S Code, Seofion 1001 CERTIFI�RS NAME LICENSE NUMBER Larr L. Evans L.S. �� 2937 71TLE surveyor C MPANY NAME Evans Land Surveying, Inc. ADDRESS 1460 Beltrees St eet: Ste. 9 ��TY Dunedin, 3TATE . ZIPCODE 34698 SIGNATURE DATE EL�PHONE r �i-)�-��a (727) 734-3821 FEMA Form 81-31, anu 2003 See reverse side for continuation. Replacea all previoua editiona , ... . . °fMPORTANT: In these spaces,copy the cor�esponding information from Section A Far:tri�urana�:Gampan .:Usa... . : :: BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX N0. pr�licy Number : " 7�1 Ll4 r�?'��.1� f��r��'� C�N .- STATE ZIP CODE CCSft"f��1y Nl�IG f�u1�'tl7e�' �---�-�.,��'V��'��''_ 337fo 7 �y ;. _:..........:..:.::.::.:.:...:..:...:.::::....:..........:..:.._:::.:::::......................:::.......: SEC ION D-SURVEYOR,ENGINEER,bR ARCHITECT CERTIFICATION(CONTINUED� Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner. COMMENT8 I I Check here ff attachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NbT�EQUIRED)FOR ZON�AO AND 20NE A(WITNOUT BFE) For Zone AO and Zone A(without BFE),complete Items E1.through E5, If the Elevation CertiBcate is intended for use as supporting information for a LOMA or LOMR-F,Section C must be completed. E1.Building Diagram Number____(Select the building diagram most similar to the building for which this certificate is being completed� see pages 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.) E2.The top of the bottom floor(including basement or enclosure)of the building is �-_�_�ft,(m)I--I--.I�n.(cm)�__�above or�_�below (check one)the highest adjacent grade. (Use natural grade,if available.) E3.For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is �--�--�ft.(m)�__�__�in.(cm)above the highest adjacent grade. Complete Items C3.h and C3.i on front of fOrm. EA.The top of the platform of machinery and/or equipment servicing the building Is �--�--�ft•(m)I--I--I in.(cm)�__�above or(__�below (check one)the highest adjacent grade. (Use natural grade,if availal�le.j E5.For Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's __ floodpiain menagement ordinance7 I, I Yes I I No I I Unknawn the local o�cial must certif�this information in Section Ci ` SECtION F-PROPERTY OWNER(OR OWNER'S RLPRESENTATIVE)CERTIFICATION The property owner or owner's authorized representative who oompletes Sections A,B,C(Items C3.h and C3.i only),and E for Zone A (without a FEMA-issued or community-issued BFE)or Zone AO must sign here. The sfatements in Sectinns A,B, C,and E are correcf to the best of my knpwled e. PROPERTY OWNER'3 OR OWNER'S AUTHORIZ�D REPRES�NTATIVE'S NAME � � ' ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENtS — I �Check here if attaChmertts SECTION G-COMMUNITY INFORMATION(OPTIONAL) � The local officia!who ia authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elavation Certificate. Complete tha applicabie item{s)and sign below. G1.�__�The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, angineer,or architect who is authorized by state or local law to certify elevation Information, (Indicate the source and date of the elevation data in ihe Comments area below.) G2.�__�A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued 6FE)or Zone AO. G3.�__�The following information(Items G4-G9)is provided for cornmun;ty floodplain managerr�ent purposes. G4.PERMIT NUMBER G5. DATE PERMIT IS3UED � G8. DATE CERTIFICATE OF COMPLIANC610CCUPANCY ISSUED G7.This permit has been issued for: (__�New Construction �__� Substantial Improvement G8. Elevation of as-built lawest floor(including basemenk)of the building is: ______,_ __ft.(m) Datum: G9. BFE or(in Znne AO)depth of flooding at the building site is: _�__,___ __ft.(m) Datum: I.00AL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS I I Check here if attachments FEMA Form 81-31,January 2003 Replaces all previous editions