1631 SAND KEY ESTATES CT ' FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
NATIONAL FLOOD INSURANCE PROGRAM
r .��a , '�.,�v . Ga� 30 03 Expires July 31, 2002
ELEVATION CERTIFICATE
�� Im ortant: Read the instructions on a es 1 -7. ,
� SECTION A-PROPERTY OWNER INFORMATION For lnsurance Compan�llse:��';;;�;r-.�;;y:
BUILD G OWNER':i NAME
Policy•Number � ;r.►u��+c,';
'� ` � .. . . . .. .. .o"{c
. '..'. yf�t��CM�M�
� BUIIDI G STREE7 ADDR SS(Including Apt.,Unit,Suite,and/or Bidg.No.)OR P,O.ROUTE AND BOX NO. Company NAIC Number ,, �,�
�, , '_ ' ,.�.. ' ��'
C��' � / _ /1 STATE ZIP CODE
�C.�.i°�12�P��TL—:l_ � ��L . .
PROPERTY DESCRIP�N(Lot and Block Numbers,Tax Parcel Numbel,Legal Descrip•t1on,etc.)
�.C� � `ZO. �� \'�E �C..�O\Z� ��(A�7 �F �1�.1J \ F'�C�
BUILDING USE•(e.g. Residential,Non-res�dential,Addition,Accessory,etc. Use Comments section if necessary.)
��� IC� 'NT� o'�
LATITUDE/LONGITUD (OPTIONAL) HORIZONTAL DATUM: SOURCE: �_�GPS(Type):
. ( ##°-##'-##.##" or ##.###�t#°) I_I NAD 1927 �_�NAD 1983 �_�USGS Quad Map �_�Other:
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1. NFIP COMMUNITY NAME 8 COMMUNITY NUMBER 62.COUNTY NAME B3.STATE
, f 1�l -=- � S "�=C�.
64. MAP AND PANEL 65.SUFFIX B6.FIRM INDE B7.FIRM PANEL 88.FLOOD 69. BASE FLOOD ELEVATION(S)
NUMBER _- EFFECTIVE/REVISED DATE ZONE S
— Q � ( ) (Zone AO,use depth of flooding)
0o I � � � -o �. - 4a � l �,v'
610. Indicate the source of the Base Flood Elevation (BFE)data or base flood depth entered in 69.
� �_) FIS Profile �_� FIRM �_� Communiiy Determined �_� Other(Describe):
B11. Indicate the elevation datum used for the BFE in 69: �_� NGVD 1929 �_� NAVD 1988 �_� Other(Describe): '
B12. Is the building Iocated in a Coastal Barrier Resources System (CBRS)area or Otherwise Protected Area (OPA)? �_�Yes �_� No
Designation Date:
SECTION C -BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Building elevations are based on: �__�Construction Drawings" �_�Building Under Construction" �_Finished Construction
`A new Elevation Certificate will be required when construction of the building is complete.
C2. 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.)
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 C3a-i 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 aFE. Show field measurements and datum conversion
calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate,to document the datum conversion,
Datum Conversion/Comments
Elevation reference mark used Does the elevation reference mark used appear on the FIRM? (_�Yes �_� No
. ❑ a)Top of bottom floor(including basement or enclosure) � � ,�ft.(m) �
O b)Top of next higher floor .t�ft.�m� � , �
O c) Bottom of lowest horizontal structural member(V zones only) _ft.(m) o o ' •, '
❑ d)Attached garage (top of slab) 9 •t��•(m) E� � , ' ,
O e) Lowest elevation of machinery and/or equipment w � � r+
, �' _v '�,'
i '•.setvicing the building ft.(m) �� ,'.•, � _
� O � Lowest adjacent grade (LAG) . Z ft.(m) z'.� ; �
I ❑ g) Highest adjacent grade(HAG) —�.�{�.�m� �`� '�
❑ h) No.of permanent openings (flood vents)within 1 ft. above adjace�}t grade�� � a
❑ i)Total area of all permanent openings(flood venfs)in C3h � I�I,� sq. in. (sq.cm) J f y 4 3
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer, or architect authorized by law to ce�tify elevation information.
1 certi(y.that the information in Sections A, B, and C on tl�is certificate rep�sents my best efforts to inteipret the data evailable.
1 understand that an false sta�ement ma be punishable b fne or imprisonment under 18 U.S. Code, Section 1001.
�TIFIER'S NAME M `�` {�� �� � � LICENSE NUMBER P L,S. L-�'—T"CI S
I ' I 1 r d
�E p��cJ � ���i COMPANY NAME �LO t��O A �E�.1cH M�iZK �.rlG,
ADDRESS CITY , TE ZIP CODE �� �s
� � "Z � t-�C:.t.�1 ST, G(_.�A'R l.V A�C� C=L,
SIC'iNA DATE TELE ONE .
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FEMA Form II1-31, AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS