700 GULFVIEW BLVD S _ _ _ _
' +M• SUN4.//i- S %
FEDERAL EMERGENCY MANAGEMENT AGENCY
' ' /� NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077
� S �J`�' Q�L���, Expires December 31, 2005
.� ELEVATION CERTIFICATE
G o2�3� /.��3 Im rtant: Read the instrucdons on es 1-7.
SECTION A-PROPERTY OWNER INFORMATION For Insuranoe Caripany Use:
BUILDING OWNER'S NAME Policy Number
Surf West, Inc.
BUILDING S'TREET ADDRESS(Induding Apt.,Unit,Suite,and/or Bkig.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
700 S.Gulfview Bivd.
CfTY STATE ZIP CODE
Cleanvater FL 33767
PROPERTY DESCRIPTION(Lot and Blodc Numbers,Ta�c Paroel Number,Legal Des�xiption,etc.)
Lots 11&12,Biodc C,BAYSIDE SHORES and Lot 13,61odc E,BAYSII7E SUBDMSION NO.6
BUI�DING USE(e.g.,Residential,Non-resideMial,Addilan,Aooessory,etc. Use a Comments area,if necessary.)
Non-residential
LATTTUDFJLONGITUDE(OPTIONAL) HORIZONTAL DATUM: � SOURCE: GPS(Type):
( �#°-�-�#.#�r a #�.� ❑ruw�sz� ❑ww�se3 ❑uscs Q�ad nnap ❑aner.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61.NFIP COM��IJNfiY NAME&CONA�AINRY NUA�BER 62.COUNTY NAIuE B3.STATE �
CAy of Ct�rw�aler 125096 Pinel�s Fb�ida
B4.MAP AND PANEL B7.FRM PANEL B9.BASE FLOOD ELEVA110N(S)
NUIuBER B5.Sl1FFIX 86.FRM NdDEX DATE EFFECTNElREVISED D�TE B6.FLOOD ZONE(S) Qaie A0,use depli dAoodr�)
1250960104 G 9Ci/1003 9r31'L003 AE 11.0'
810.Indicate the soun�e of the Base Flood FJevabon(BFE)data a base flood depth entered in B9.
❑=�s Prdle �F�wul ❑Canmuniry Dete►n,�r�ed ❑on»er�oesaibe�:_
811.Irxiic�rte the eleva�on dalum used fa the BFE in B9:�NGVD 1929 �NAVD 1988 ❑Olher(Describe):_
B12.Is the bui�ng located in a C�astal Bartier Reswroes System(CBRS)area a Otl�erwise Proteaed Area(OPA)? ❑Yes �No Designa6on Date_
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Bulkiing elevati�ons�e l�sed on:�Constr��tion Drawings' �Buil�ng Unde�Constn�ction' ❑Rnished Caistn�ction
'A new Eleva6m Certii'�cale will be required when oonstrud'an of the buildrg is oanplete.
C2.Buikling biagram Number 1_ (Seled the buil�ng dagram most similar to the buil�rg i�x which this certificate�being�ed-see pages 6 and 7. I(no�agram
accurately represents the buikling�Provide a sketch a photograph.)
C3.Elevations-Zones A1-A30,AE,AH,A(w�h BFE),VE,V1-V30,V(wifh BFE),AR,ARlA,AWAE,ARIA1-A30,AWAH,AR/AO
Complete Items C3.,a-i belav acoording to the building�agram spedfied in Item C2.State tlie dalum used.If fhe daham is di�erent irom the datum used fa the BFE in
Section B,convat the daturn io that used fa the BFE.Shvuu field measurerner�ts a�d daium conversion cala�la�ion. Use the spaoe pro�rid�d a the Caixnents area d
Secii�on D or Section G,as appropriate,to document the datum oonversion.
Daium NAVD 1 ConversiadCorrxr�ents_
Eleva6on refe�ce mark used Clearwater'D�3"Dces the elevaUon reference mak used appear on the FIRM? ❑Yes �No
,�,�,�a d a u
❑a)Top of bottan floa(indudng ba�rr�ent a endosure) 7. 71L(m) � ��,'�..,,,'�.`} F e��'..:n
❑b)Top af next hi�er floor 1�. 7 ft.(m) `� ,�`',:"�°o ° �
❑c)Boitan of b�west horizontal strudural mernber(V aones only) WA ft.(m) �o �, d.,� . �:�
❑ Attactied ofslab WA. ft m g� �,. � � '� ° `~ � .
� ���� � � � E c ".�° 'v^� � �� �...,:..
U e)Louue,st elevation of machinery andra equiprr�ent W; ��%^: '� `n , ° „
s9 _«>- @„D �„.
serviang the buildmg(Descnbe m a CarKnents area) ——R(m) �� '' �t'`' °� , -" ^
1-•
U fl Lc�t adiaoent(finished)9rade(LAG) �•�ft•�m) _ � '� � ..:r , ��`
z �' `' � �r., �, � � .
❑g)Higt�estadaoent(finis�i)9rade(HAG) �. 5ft.(m) �`� �i�kl`,,..�%1.7/04 �`� �~"' . ��,�.
❑h)No.c�Pertnanent openirx�s(flood vems)wilhin 1 ft abo�ne ac�aoent grade 0 � ',� ;�"`�,�;�„ . - , .-°. �::'I'.;'.
❑i)Tdal a�ea c�all pemianent openings(flood vents)in C3.h Qsq.in.(sq.an) � T : �, , �';�,'`�
SECTION D-SURYEYOR,ENGINEER,OR ARCHRECT CERTIFICATION � r�a��
This certification is to be signed and sealed by a land surveyor,engineer,or architeci aulhorized by law to certify elevation information. .
1 cerfily that the informafion in Sections A,B,and C on this certificate iepresents my best efforts fo interpret the data available.
I understand tnat any false sfafement may be punishable by firre or imprisonment under 18 U.S.Code,Section 1001.
CERTIFIER'S NAME LICENSE NUMBER
EDWARD C.ELLIOTT 3983
TITLE COMPANY NAME
PROFESSIONAL SURVEYOR&MAPPER E4GLE CONSULTANTS,INC.
AODRESS CITY STATE ZIP CODE
8514 Old County Road 54 New Port Ridiey FL 34653
SIGNATU / DATE TEIFPHONE
_ �� �'� �—� Mar�h 17,2004 (72'l)375-1101
_ _ — __ _ _
, ..
� '
IMPORTANT: In tl�ese spaces, the comesponding i�orrr�ation from Section A For tr,suranoe carpam use: ' '
BUILDING STREET ADDRESS(kidudrg Apt,Unk,Suile,and�a Bkig.No.)OR P.O.ROUTE AND BOX N0. Pofc�r Numbe� '
700 S.Guffview Blvd. .
CfTY STATE ZIP CODE Caripany NAIC Number '
Ciearwater R 33767 -
SECTION D-SURVEYOR,ENGINEER,OR ARCHfTECT CERTIFICATION(CONTINUED)
Copy boRh sides d UNS Eleva6on Certificate fa(1)ca►ununity dfiaal,(2)insurarxe agenUoorr�pany,ard(3)buildng o+rrt�.
COMMEM'S
❑Cnedc nere if anad,ments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zone AO and Zone A(v�riUiout BFE),carplete Iterr�s Et tlrough E4. If the FJeva�a�Calificate is interxfed fa use as suppaUr�g irrbom�atiai for a LOMA or LOMR-F,
Section C must be oompleted.
E1.Builduig Diagram N�miber_(Seled the buildng�iagram most similar to the building fa whid�U►is oefificate is beirig oornpleted—see pages 6 and 7. K no�iagram aocurately
�ts the build'ing�provide a sketch or phdograph.)
E2.The top d the boitan floor(induding baserrient or enciosure)of the building is _ft.(m)_in.(an)0 above or ❑below(chedc one)the highest ac�acent grade. (Use
natural grade,ii available).
E3.Fa Buil�ng Diagran�s 6-8 wilh openings(see Pa9e 7�,ihe next higher floor a elevated floor(ele�ration b)of the buildirg is _ft.(m)_in.(an)above tl�e higl�est ac�aoent
grade. Cc,rnplete it�ns C3.h and C3.i on fra�t d fam.
E4.The top of the pla�orm of machinery and�equiprrient servic�ng the building is ,_.,ft.(m)_in.(an)❑above a ❑below(c�dc one)the highest ac�acent grade. (Use
natural grade,i(avaiiable).
E5.Fa Zone AO only; If no flood depUi nurnber is ava�lable,is the top af the bottan floa elevaled in acoordar�e with the�nit�s floodplain management adinance?
❑Yes ❑No ❑Unkrur�m. The bcal offiaal must oertify this infamafiai in Sec�on G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE�CERTIFICATION
The property owner a o�ur�s aulhaized rep�ntalive who cornpletes SeGions A,B,C(Items C3.h and C3.i only),and E for Zone A(witlia�l a FEMA�ssued a oarxnunity-
issued BFE)a Zaie AO must sic�her�. The stafern�ls in Seciions A�C,and E are caied to ihe best of my lv�owledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDFt�SS CITY STATE ZJP CODE
SIGNATURE DATE T'ELEPHONE
COMMENTS
❑Chedc here iF attachments
SECTION G-COMMUNfTY INFORMATION(OPTIONAL)
The ixal olficial�M�o is autt�izsd by k.?a c�r a�inarxe to adrr�nister the oannunit�s floocfplain managemerrt adinarxe can oomplete Sedions A,B,G(or E),and G of lhis Eleva6on
�,t�?ificate. Cor�plete the app6caCle iterri(s;and sign belaw.
U?.❑Tt�e infu.��n in�.�C was hdken from otl�er documentaUon that has been signed anci ernbossed by a licensed surveya,enginser,or ardrited who is authaized by state
�x locai;a,w to oert�y el�vabon in�amatlon. (Indicate the source and date af the elevation data m the Camrients area bebw.)
G2.�7 A cc,rr�rnunity dficid oampletc�;S�ion E fa a buikiing la�ted in Zone A(withart a FEMA�ssued a oommunity�ssued BFE)or Za�e A0.
G3.[�j The ft�lbwing ir�formaUon(ItE•��s�4-(�J)is provided ftx community floodplaln manageirient purposes.
G4.F'ERluxi'NiJMBER ^ G5.DATE PERMfT ISSUED Gfi.DATE CERTIFICATE OF CONPI.IANCEJOCCUPANCY ISSl1ED
��_ ---
c7.mis pern,it nas bee�,Issued r«: ❑New ca,stnx�ion p sub�antial�mprrnrerr�ent
GS.Elev�on af as-built lowest floor(induc�ng basernent)d the buiki'mg Is: __ft.(m) Datum:
G9.BFE a(in Zaie AO)depfh d floodirg at the buikting site is: _,..__ft.(m) Datum:_
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME , TELEPHUNE
SIGNATURE DATE
CAMMENTS
❑Check here'rf attachmenfs
. _ .
• FEDERAL EMERGENCY MANAGEMENT AGENCY
� • � NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077
Expires December 31, 2005
. � ELEVATION CERTIFICATE
� Im rtarrt: R�d the instructions on 1-7.
SECTION A-PROPERTY OWNER INFORMATION F«�nsuranoe carpany use:
BUILDING OWNER'S NAME Policy Number
Surf West, Inc.
BUILDING STREET ADDRESS(Induding Apt,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
700 S.GulRriew Blvd.
CfTY STATE ZIP CODE
Cleanvater FL 33767
PROPERTY DESCRIPTION(Lot and Blodc Numbe�s,Tax Paroel Number,Legal Desaiption,etcJ
Lots 11 812,Bbdc C,BAYSIDE SHORES and Lot 13,Blodc E,BAYSIDE SUBDMSION NO.6
BUILDING USE(e.g.,Residerdial,Non-residerrtial,Addif'an,Aooessory,etc. Use a Comments area,if neoessary.)
Non-resldendal
LATfTUDFJLONGfTUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS(Type):
( #�°-�-#�.� a �#.�> ❑nuw�s2� ❑nuw�sa3 ❑USGS Quad Map ❑aner.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP CqM�l1NfTY NANE 8 COA�IUNffY NUA�6ER 62.COUNf`/NAIuE B3.STATE
CitydClearvvaler 125096 Pir�as Fbrfda
B4.MAF'AND PMIEL 97.F�iM PANEL B9.BASE FLOOD ELEVATION(S)
ra�R a5.su�rx es.�n�can� �Crn�v�o o�� ea Fl.000ZOr�ls) R.a�eno,�sed�na�1
125(1960104 G 9�/Z003 �31Z000 AE 11.0'
B10.Iridk�te the souroe af the Base Fbod Elevation(BFE)dala or base flood depih eMered in B9.
p Fis�e �FiwN ❑c«r�,►,�r oete�r,ed ❑ou,�(�):_
811.In�ate the elevaUon da6um used ftx the BFE in 89:0 NGVD 1929 �NAVD 1988 ❑Ofher(Desaibe):
612.Is the bultdng located in a Coastal Barrier R�esouroes System(CBRS)aiea a OU�wise Proteded Area(OPA)? ❑Yes �No DesignaUon Date_
SECTION C•BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Bullding elevaUons are based on:�Constrt�ction Drawings' �8uil�ng Under Construction" ❑Fnished Ca�sfi,�ctiai
'A new Elevabon Certificate wiN be required wt�en oonslnx�ion of Ihe buil�ng is canplete.
C2.Buil�ng Dia�ram Nurr�er 1_(Select the buil�ng dagram most sirrrilar io the buil�ng fa whidi this certificate is being canpleted-sce pages 6 and 7. If no d�agram
aocuratey repr�ents the buikiing,provide a sketch a photograph.)
C3.Fleva6ons—Zones A1-A30,AE,AH,A(wi�h BFE),VE,V1-V30,V(wilh BFE),AR,AWA,ARIAE,AR/A1-A30,ARIAH,ARIAO
Complete ftems C3.�below a000rding to the building d�agram spedfied in Item C2.State tlie da�um used.If the dahim is diffe�ent fran the dalum used ia the BFE in
Sec.iion B,oonvert the dahmi fio Ihat used fa 1he BFE.ShoNU field measurerr�s and datum oonversion c�laila6on. Use the space provided or the Conxnenis ar�of
Sectiai D a Sec,tion G,as approp�iate,to doaiment U�e daAum oonversion.
Datum NAW 1988 Conversioru'Comrr�ts_ -,�s°3�°��"'�„,
Flevahon re�mark used Clearwater'D,3"Does the eleva6on reFerence mak used appear on the FIRM7 ❑Yes �No �,"s .�'� ° �'
❑a)Top d bottom floa(indud�ng basernent a endosure) 7. 7 ft.(m) � � �;��.°° � N ` .<➢ .A ,
� "h �+. .;...r_ , f .
0 b)Top of next highe�tba 1�. 7 ft.(m) ,� ��� "�. �,.a.• � �c,` ,r `A.
m .., %(d.tu. ,� � �.
❑c)Bottan d bwest haiaontal strtxtural�(V aor�es only) WA ft.(m) �o ., ,�, q�; �. �
�c�Attadied 9arage(toP of slab) WA. 1t(m) g� �'�_ , ,� ..a '" , r �
❑e)Law�est elevabon of madiinety andla equiprt�ent W� ' =p� Y F"` �"� �
� r F .r ....: ��� :' �.,
servidng the bu�ding(Desaibe�a Carxr�ents area) --ft•(m) E� y" ��=` °
� i4'� '^•4 ..�,
❑�LaHest ac�acent(fi►�isFiedl 9rade(LAG) �. �ft.(m) z' p1 •'• . ,, '� .
0 9)Hi�st adlaoent(finisf�9�I��) �• �ftdm) �� �^�� �' $/9 7/d34'�r��,`���`
❑h)No.of Permanent openirgs(flood vems)vuitl�n 1 ft above aclaoent grade Q � `'a�� � ,.}+�p�(;��'.,.>'•:
0 i)Total area d all Pem�anent opemngs(flood vents)in C3.h Qsq.in.(sq.an) -a:�n a' ,„`
SECTION D-SURVEYOR,ENGINEER,OR ARCHRECT CERTIFICATION
This certifcation is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.
I cerfify that the infom►ation in Sections A,8,and C on this cerfificate represents my best e/forts to interpref the dafa available.
1 understand that any false statemenf may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001.
CERTIFIER'S NAME LICENSE NUMBER
EDWARD C.ElLIOTT 3983
TITLE COMPANY NAME
PROFESSIONAL SURVEYOR&MAPPER EAGLE CONSULTANTS,INC.
ADDRESS CITY STATE ZIP CODE
8514 Old County Roed 54 New Pat Ridiey FL 34653
SIGNATURE DATE TELEPFIONE
� ' March 17,2004
(127}375-1101
. .
IMPORTANT: In tl�ese spac�s,c;opy the comesponding inFortr�ation from Section A. For tr,surar,ce c«r�any use: ,
BUILDING STREET ADDf2ESS(�ndudrxJ Apt.UnA,Su�e,and�Or Bidg.N0.)OR P.O.ROIfTE AND BOX N0. Poi�y Numbef r
oy
700 S.Guffview Blvd. �
CfTY STATE ZIP CODE Carpany NAIC Nixriber •
C��� � 33767
SECTION D-SURVEYOR,ENGINEER,OR ARCHfTECT CERTIFICATION(COt�fTINUED)
Copy both sides of this EJevabon Cer6ficate fa(1)oorrxnunity official,(2)�suranoe agent/oorr�anY,and(3)buildmg owr�er.
COMM[NTS
❑Cr,edc hene if attacnments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIREDj FOR ZONE AO AND ZONE A(WRHOUT BFE)
For Zone AO and Zone A(wiUiart BFE),oanplete Ite�r�s E1 thra�gh E4. If 1he Eleva6ion Catificate is intended for use as suppatirg ir�arr�ftx a LOMA or LOMR-F,
Sec.tion C must be oorripleted.
E1.BuikAng Diagram Number_(Select the buildng�iagram most similar to the building ftx which Ihis oertificate is beir�g oompleted–see pages 6 and 7. It no c�ac�rarn aoa�rately
represents the buildrg�provide a sketdi a phdograph.)
E2.The top of the bottan fba('mduding bas�nent or endosure)o#the buil�ng is ,ft,(m)_indcm)�above or ❑below(d�edc one)fhe highest adjacerrt grade, (Use
natural gr�de,�available).
E3.Fa Buil�ng Diagrarr�s 6-8 with openir�s(see Page 7j,fhe next highe�floa a elevated floor(ele+raUon b)of the bui�ing is _ft(m)_in.(an)above the hi�est adjacent
c,�ade. Ccrnplete it�xns Ci.h and C3.i on front d fam.
E4.The top of the pl�a�orm af machinery andlor equiprt�ent serviang the buildmg is _ft.(m)`in.(cm)[I above a ❑bebw(diedc one)the hi�est ac�acent grade. (Use
nalural grade,if available).
E5,Fa 7_aie AO only: If no flood deah rwmber is avalable,is the top of the bottan floor elevated in accadanoe witl�the carrnunit�s floodplain managernent adinarKe?
❑Yes ❑No ❑UnknaMt. The local dficial must oertify this irrhxm�ion in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATIQN
The property owner or o�ner's authorized representative who oaripletes Sedions A,B,C(ftems C3.h and C3.i only),and E ta Zpne A(wiftia�t a FEMA-issued a corixrnmity-
issued BFE)a Zaie AO must sign he�e. Ti►e stafe�r�nts in Sediais A,Q C,and E are aonect to the best of my Ia�aMe�k,�e,
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESEt�fTATIVE'S NAME
A�� CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
.�...._.. .._.-—- ❑Chedc here iF attachmenis
SECTION G-COMMUNfTY INFORMATION(OPTIONAL)
The Icc�affiaai who is authair�d by i�.v w ordir�anoe to adrrwnister the oatmuri�s floodplain manage�r�er�t adinar�ce can oomplete Sectiais A,B,C(a E),and G af this Elevation
Cer6i�!p. Cc�iplete±he appficable ite�i�(s}and��n below.
G1.[]i he ir�:,rmatic�,ri fn Sec��C;vas t�cs�i�an otl�er doaamentabon that has been sic�ed and ernbossed by a lioensed sunreya,engineer,a ardiited who is authaized by state
ur ia�f iaut�i�uer8fy elev�ior►i���a�an. (Indic�te the souroe arxl date af the elevation data in the Camnents area bebw.)
G2.�A cemmunity official oorr�eted So�ion E for a buiklirg bcated in 7�ne A(wiUia�t a FEMA-issued a oommunity-�ssued BFE)or Za�e A0.
G3.[]The Eollarving infamation(I(ems rr1-G9)is provided ftx corrxrx�nity floodplaln managerr�ent purposes,
G4.PERNBT NUWIBER G5. DATE PEWuaT ISSIIED Gfi.DATE CERTIFICATE OF CONPLJANCFJOCCUPANCY ISSUED �
G7.This permit has been issued fa: ❑New Ca�sfix,fiai ❑Substan6al Irr�ro�rerrient
GB.Elevation af as-built la�st floor(indu�xj�t)d the buikxng Is: _._ft.(m) Da�um:
G9.BFE a(in Za�e AO)deqh of floodrg at the buiklirig site is: �_ft.(m) Datum:.,�
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME _ TELEpMpNE
SIGNATURE DATE
COMMENTS
❑Cl�edc here if attac;hments
`r,
_ � � 3 -'��s ./ •�
� �� � a
' �-�/L�V�C �c� ,�f�J
, �� �d�
O.M.B.NO.3067-0077
Expires December 31,2005
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
F-LOODPROOFING CERTIFICAYE
FOR NQN-RESIDENTIAL STRUCTURES-
� The floodproofrng of non-iesidentia!buildings may be pem►itted as an altemaSve to eleva6ng to or above H�e Base F/ood Eleva6on;horNever,a
� floodpFOOfing design certifica6on is requireci. This fam is to be used for that ceRifrcation:Floodp�oofing of a residenSa/brrilding dces not alter a
community's floodplain management eleva6on requirements or affect the insurance rating unless the community has been issued an exception by
, FEMA to allow floodproofed residen6ai basements. The permitting of a floodproofed resrden6a/basement requires a seParate certifica6on specifyrng
that the design complies with the loca/floodplain management ordinance.
� . FOR INSURANCE COMPANY USE
BUILDIN OWNER'S NAME POLICY NUMBER
�� �S�. /�G�
STREET MADDRESS(Including ApL,Unit.Suite,and/or Bldg.Number)OR P.O.ROUTE AND BOX NUMBER
7K/ �O� �-T u�'�'�I E� COMPANY NAIC NUMBER
OTHER DESCRIPTION(�ot and Blodc Numbers,etc.)
�,oTs // t t B�OGK 'G' �l �DE Sf�' �dT i3 /3W� � Bb�YS�oG v a�w�� N t�N/
CITY STATE ZIP CODE
G���u�,4�z'�2- �'� 3 3 7�7
" SEGTION I FLOOD INSURANCE RATE MAP(FIRNi)INFORMATION
Provide the following from the proper FIRM:
� COMMUNITY NUMBER PANEL NUMBER SUFFIX DATE OF FIRM INDEX FIRNI ZONE BASE FLOOD ELEVATION
(In AO Zones,Use Depth)
l Z SOq Cp i��f 9-3 -2�3 �,� ��
SECTiON II FLOODPROOFING INFORMATION(By a Registered Professional Engineer o�Architect)
Fioodproofing Design Elevation Information: O�
Buiiding is floodProofed to an elevation of .......��..................feet NGVD.(Elevation datum used must be the same as that on the FIRM.)
Height of floodproofing on the building above the lowest adjacent grade is...........�?.!.`..�.........feet.
(NOTE.-for insurance ra6ng pwposes,the building's floodpraofed design e/eva6on must be at least one foot above the Base FJood Elevation to
receive rating credit!f the building is floodproofed only to the Base Flood Elevation,then the building's insurance rating wil!resulCrn a higher
premium.)
SECTION III CERTIFICATION(By Registered Professional Engineer or Architect)
Non-Residential Floodproofed Construction Certification:
I c�rtdy that,based upon development and/or review of shuctura/design,specifications,and plans for construc6on, the design and methods of
aonstrucSon are in acxordance with accepted standarris of practice for meeting the following provisions:
The structure,togetherwith attendant utilities and sanitary facilities,is watertight to*.he ftoodproofed design elevation indicated above,with
walls that are substantially impermeabie to the passage of water.
All structu�al components are capabl�of resisting hydrostatic and hydrodynamic flooe+forees,inclu�+ing the effecs of bu��r;�arzd,;,
anticipated debris impact forces. s ' �,
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1 certify that the informa6on on this certificate represents my best elforts to interpret the data available.l understar�`'thal'any��'s�e's{at@�rr� �. ��� ,,,�,,
may be punishable by fine orimprisonment under 18 U.S.Code,Sec6on 1001. T= ; a a� �� ���� °,so ���
r',�.
CERTIFIER'S NAME � LICENSE NUMBER(orAffix Seal) a��� � �'*-"~ c e , �
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TITLE COMPANY NAME p ° �� -;
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ADDRESS CITY STATE P� D '� � � A.
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SIGNATURE � DATE PHONE - 9 ��`�. e e n* '+ ��'
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Capies should be made of this Certificate for:1)community official,2)Insurancz ageni/comoany,and 3)building owner_
Ft�A rorm S1-ob,JA{N 03 e�epiac=_s all previous edi3ions F-0�6(i/03)
FLOOD INSIBF�ANCE *
FLOODPROOFiNG CERTIFICE;Y�
FEMA F�RM 81-65
GENEI2AI�This ir.iormation is provide�pursuant to Public Law 96-51 l, (The Paper Reduction Act of �
1980, as amended j� datedJDecember 1 I;-1980�fo a11ow tlie public to participate more fully arid
meaningfuliy in the Federal paperwork review process. '
AUTH�RITY—Public Law 9b-51 I, amended; 44 U.S.C. 3507; and� CFR 1320
PE4FERVVORK BLTRDEN DISCLOSUI�NO�'IC�—The public reporting burden for this form is
estimated to be 325 hours per response. The.hurden estimates includes the tixne for reviewing
instructions, searching existing data sources, gathering and maintaining the needed data, and completing,
reviewing,�and submitting the form. You are not required to respond to this collection of inforniation
unless a valid OMl3 control number appears in the upger right corner of this form. Send comments
regarding the accuracy of the burden estimate and any suggestions for reducing this burden to:
Information Collections Management, Federal Emergency Management Agency; 500 C Street, SW,
Washingtor�, DC 204�2, Paperworl�Reduction Project (3067-OQ77).
NOTE: Ptease do nat send your co�ple#e€1 form to the above adda-es�.
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