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920 NARCISSUS AVE �� ; j �� oY,%..i � �� - FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 .. (VATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 SEP 07 2�� ELEVATION CERTIFICATE ,, � _ � , -� ��° ° � � Im ortant: Read the instructions on a es 1 -7. 1 r-r _. SECTION A-PROPERTY OWNER INFORMATION For Insurance,Company Use: BUILDING OWNER'S NAME Policy NUmber �-y��EE �-(-,�y D0� BUI DING STREET ADD ESS(Inclu ing Apt.,Unit,Suite,and/or Bidg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number �20 �1AiZc�ss�s �✓ENUE CITY STA7E ZIP CODE G-E-A�Qi.J TF� �-� PROPERTY DESCRIPTION Lot and lock Numbers,Tax Parcel Number,Legal Description,etc.) �oT 9 Bc.d�-I� � M�r��u sug �i��s io,J BUILD�NG US (e.g.,Residentlal,Non-re identfal,Addition,Acce sory,etc. Use Cumments section if necessary.) __�ES� �E�JT"i,�l. LATITUDElL.ONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: �_�GPS(Type): ( ##°-##'-##.##" or ##.#A�###°) �_�NAD 1927 �_�NAD 1983 �_�USGS Quad Map �_)Other: SEC710N B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 61.NFIP COMMU�JITY NAME 8 CUMMU�NITY NUMBER B2.COUNTY NAME �'u E��S B3.STATE r c�E�Rw�-rER- / �Z5 9 � T�' B4.MAP AND PANEL B5.SUFFIX 66.FIRM INDEX 87.FIRM PANEL B8.FLOOD B9.BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use depth of flooding) 1250�� o0o D 8- 18-y2 8-�9-9� � E ��, o B10. lndicate the source of the I3ase flood Elevation(BFE)data or base flood depth entered in B9. I_I�IS Profile �!!� FIRM (_�Community DetPrmined ��Other(Describe): B 11. Indir�te the elevation datum used for the BFE in B9: �✓NGVD 1929 �_� NAVD 1988 �_�Other(Describe): B12. Is the building located in a Coastal Barrier Resources System(CBRS}area or Otherwise Protected Area(OPA)? �_�Yes ��No Designation Date: � SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: ��Construction Drawings" �_�Building Under Construction* �_�Finished Construction "A new Elevation Certificate wiil be required when construction of the building is complete. C2. Building Diagram Number.0 �_(Select tl�e 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.) C3. Elevations—Zones A1-A3U,AG,AN,A{with 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 the building diagram specified in Item C2. Slate ti�e datum used. If the datum is diHerent from the datum used for the BFE in Section B,convert 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 U or Section G,as appropriate,to document the datum conversion. Datum Conversion/Comments Elevation reference mark used ��T� B M �-3 Does the elevation reference mark used appear on the FIRM? �_�Yes ��No 0 a)Top of bottom floor(including basement or enclosure) 4 . (p ft.(m) � �" °• % � O b)Top of next higher floor d- ,�ft.(m) �' l=5x:�K"Z9��' ' ❑ c) Bottom of lowest horizontal structural member(V zanes only) N�A ._ft.(m) �Q ,. '� U d)Attached garage(top of slab) Q- , I ft.(m) �� ( � 2�� O e Lowest elevalion of machine and/or e ui ment W " ' �� U _�; _ ). �Y q P d" 9. ��°�� . servicing the building * (see comments) 5 •o ft•(m) E ro " �,'�"° ��, ❑ fl Lowest adjacent grade(LAG) 4 , 2 ft.(m) z'� �r;>` ❑ g)Highest adjacent grade(HAG) Q� . 3 ft.(m) � F ❑ h) No.of permanent openings(flood vents)within 1 R.above adjacent grade u/A � ;�._F��"�a��•_ . ❑ i)Total area of all permanent openings(flood vents)in C3h N/f4 sq.in. (sq.cm) �- � SECTION D-SURVEYOR,ENGINEER, OR ARCHITECT CERTIFICATION ' This cerlification is to be signed and sealed by a land surveyor,engineer,or archiiect authorized by law to certify elevation information. I certify tliat the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available. 1 unde►stand that any false statemenf may be punishab/e by Bne or imprisonment under 18 U.S. Code, Section 1001. • CERTIFIER'S NAME LICENSE NUMBER Larry L. Evans �62937 TITLE COMPANY NAME surveyor Evans Land Surveying, Inc. ADDRESS CITY STATE ZIP CODE 1460 Bel rees Street Ste. 9 Dunedin, Fl. 34698 SIGNATUR DATE TELEPHONE -o -0 1 727) 734-3821 FEMA Form 81 31, G 9 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT: In these spaces,copy the cbrresponding information from Section A. For Insurance Company Use: BUILDING STREET ADDRESS(Including A t.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Policy Number �. Zo N�4 c.i55us VEti►�� _ CITY STATE � ZIP CODE Company NAIC Numbet '+ G��(Z W,4T�12 , SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICA710N(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official, (2)insurance agent/company,and(3)building owner. COMMENTS _ * Item C3 e) • elevation of machinerv and/or equip ment servicing this srrurrure iG haGP� nn a„ cxtarinr nspe�t��n only I_� Check here if attachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zone AO and Zone A(without BFE),complete Items E1 through E4. If the Elevation Ce�fificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. Building Diagram Number (Sefect 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)�_�_�in.(cm) L�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�•�m) I—I_I�n.(cm)above the highest adjacent grade. E4. 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 _ floodplain management ordinance? I Yes I No L�Unknown The local official 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 Sections A, B,and E for Zone A(without a FEMA-issued or commuhity-issued BFE)or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE � SIGNATURE DATE TELEPHONE COMMENTS (_� Check here if attachments SECTION G-COMMUNITY INFORMATION(OPTIONAL) The local official who is 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 Elevation Certificate. Complete the applicable 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, engineer,or architect who Is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. �_�A community official completed Section 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 floodplain 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. Etevation of as-built lowest floor(including basement)of the building is: _ft.(m)Datum: G9. BFE or(in Zone AO)depth of flooding at the building slte Is: _ft.(m)Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNIN NAME TELEPHONE SIGNATURE DA E COMMENTS � �_� Check here if attachments FEMA Form 81-31,AUG 99 REPLACES AL.L PREVIOUS EDITIONS