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770 LANTANA AVE N n , • :� � . , FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM ExpirQS July 31, 2002 • . • ELEVATION CERTIFICATE Im ortant: Read the lnstructions on a es 1 -7. SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Pdicy Number BUIIDING STREET AODRESS(Ind ing Apl.,Unit,Suile,andlor BWg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number 770 Lantana Avenue N. �Clea�wat�eZ' Beach sFL ZIP CODE 33767 PR PER OES RIPTION`lot an B Numbers,Tax Parcel Number,Legai Descriplion,etc.) rAt 12 Blocac 24 r�AND�LAY BUII IN USE e.g.,Residenlial, -�es en a,Addition,Acoessory,eta Use mmenls sec6on if necessary. RBSI.C�E'Ilt.ld�. • IATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM. OUR E: PS(Type): ( ##°-H#'-1l#.�#" or ##.####11°) �)NAD 1927 ��NAD 1983 ��USGS Quad Map ��Olher.__ _ SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP COMMUNITY NAME 8 COMMUNIN NUMBER B2.COUNTY NAME B3.STATE � - Florid 84.MAP AND PANEL B5.S FFUC B6.FIRM INDEX B7. IRM PANEL B8.FLOOD B9.BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zo�e AO,use deplh of(looding) 0 D 8 9 91 8 19 91 A-E 11 0' B10.Indicate the source of lhe Base Flootl€levatfon(BFE)data or base flood depth entered in 69. �_�FIS Profiie ��FIRM �_�Community Determined �_�Other(Describe): __ B11.Indicale the elevation datum used forthe BFE in 89:�?x�NGVD 1929 �_�NAVD 1988 �__�Other(Describe):___ ` B12.Is the building located(n a Coastal Barcier Resources System(CBRS)area or Otherwise Protected Area(OPA)7 �_�Yes (tt �No Designation Date: _ . SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) _.Build�ng elevations are based on: (��Construction Drawings• �__�Building Under Construction' ��c�Finished Construction 'A new Elevation Ce�tificate will be requi�ed when construction of lhe building is complete. C2.Building Diagram Number�_(Select the building diagram most similar to the building for which this cenificate is being completed-see pages 6 and 7. If no diagram accurately represents the buflding,prov(de a sketch or photograph.) C3.Elevations—Zones A1-A30,AE,AH,A(wlth BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO Complete Items C3a-I below according to lhe building diagram specified in Item C2.State the datum used.If the datum is different from the dalum used for the BFE in Seclion B,convert the datum lo lhat used for lhe BFE.Show field measurements and datum conversion calculaUon. Use the space provided or ihe Comments area of Section D or Sectlon G,as appropriate,to document the datum conversion. Datum _ ConversioNComments Elevation reference mark used SEE C�JTS Does the elevation re(erence mark used appear on the FIRM? �_�Yes (��No ❑ a)Top of bottom floor(i�cluding basemertt or enclosure) �_, $ ft,(m) � 0 b)Top of next hlgher tloor N ,A ft.(m) `� O c)Bottom of lowest horizontal sUuctural member(V zones only) N_.A ft.(m) o o � 0 d)Attached garage(top of slab) • 4 �n•�m) E� ❑ e)Lowes t e leva t ion o f machinery and/qr equfpment W " servicing the buliding 4 .9 ft.(m) E � � 533�J 0 �Lowest adjacent grade(LAG) 4 ,7 ft.(m) i a ' O g)Hlghest adjacent grade(HAG) 4 ,9 ft.(m) � �' 0 h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade�Q� � O i)7otal area of all permanent openings(flood vents)In C3h 0 sq.in.(sq.cm) SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION This ce�tification Is to be signed and sealed by a land surveyor,engineer,or archftect authorized by law lo ceriify elevation f nformation. I certifylhaf the lntormation!n Secdons A,8,and C on fh/s cerdf�cafe represents my best efforts to interpret fhe data avallable. I undersfand(hat any false statemenf may be punlshable by llne orlmprJsonment under 18 U S Code,Section 1001 ..�.,r,r,r�r;=t—� ��n i m�n J�W1MC UCENSE NUMBER OMPANY E President �s d Sunre i Inc. ��5 60 11th Avenue N. S �;Y Petersb sT � ziP co��710 DA E ELEPHp� 347-8��0 FEMA Fortn 81-31,AUG 89 EVERSE SIDE FOR CONTINUATION REPIACES ALL PREVIOUS EDITIONS P ' , ', MPORTAN7: In these spaces,copy tho corresponding Information from Sectfon A. For Insurance Company Use: BUILDING STREET ADORESS(including Apt.,Unit,Suile,and/or Bldg.No.)OR P.O.ROUTE ANO BOX NO. Poiicy Number 77� Tantana Av�nt�n� N_ STATE ZIP COD[ Company NAIC Numbcr leaxwater Peach I'L 33767 SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copyboth sides of this Elevation Certificate for(1)community otficfal,(2)insurance agenUcompany,and(3)building owner. COMMENTS Elevati.ons Based on P.C.E.D. Benclmiark (�ural F�3) Elevation = 6.193' eva ons an . . . . �__� Check here if altachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REGIUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zone AO and Zone A(without BFE),complete Items E1 through E4. If the Elevation Ceriificate is lntended(or use as supporting In(ormatlon fo�a LOMA or LOMR-F,Sec(!on C must be completed. E1.Building Diag�am Number (Select the building diagram most similar to the building for which this ce�tificate 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 boriom floor(including basement or enclosure)of the bu(Iding is I—I—I ft.(m)(_�_�in.(cm) �__�above or �__�below (check one)the highest adjacent grade. E3.For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is I—I—I ft.(m)�_��in.(cm)above the highest adjacent grade. E4.For Zone AO only. If no fiood depth number Is available,is the top of the bottom floor elevated in accordance with the community's floodplaln management ordinance7�_�Yes �_�No �__�Unknown. The local officiai must certify this information in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owner's authorized representative who completes Sectfons A,B,and E for Zone A(without a FEMA-issued or community-issued BFE)or Zone AO must s(gn here. PROPER WNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ESS GTY STATE ZIP COOE SI NA URE DATE TELEPHONE COMMENTS �_� Check here if altachments SECTION G-COMMUNITY INFORMATION(OPTIONAL) The local o�cial who is authorized by law or ordinance to administer the community's Ooodplain management ordinance can compiete Sections A,B,C(or E),and G of this Elevation Ce�tificate. Complete the applicable item(s)and sign below. G1.�_�The information in Sectfon C was taken from other documentation that has been signed and embossed by a licensed surveyor, engfneer,or architect who is authorfzed b`y state or local law to cenify elevation in(ormation. (Indicate the source and date of the elevation data In the Comments area beiow.) G2.�_�A community officlal completed Sect(on E for a building located In Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3.�_�The following information(Items G4-G9�is provided for community floodplaln management purposes. G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7.This permit has been issued for: �_�New Construction �_�Substantial Improvement G8.Elevation of as-built lowest floor(including basement)of the building is: _ __ft.(m)Datum: G9.BFE or(fn Zone AO)depth of flooding at the building site Is: _ __ft.(m)Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DA7E COMMENTS � I__I Check here if attachments FEMA Form 81-31,AUG 99 . REPLACES ALL PREVIOUS EDITIONS