223 SAND KEY ESTATES DR � ���V�7��IY C�7"17���C�TL E�Xp resMay06�-09 3
C FEDEFiA� EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANC� PROGRAM
ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to
provide elevation information necessary to ensure compliance with applicable community floodplain management ordinances,to
�etermine the proper insurance premium rate, and/or to support a request for a�etter of Map Amendment or Revision (LOMA or LOMR).
Instrucifons for completing this form can be found on the following pages.
SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE
BUILDING OWNER'S NAME POLICY NUMBER
STRE T ADDFiESS(Including Apt.,Unit,Suite and/or Bldg.Number)OR P.O.ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
Z23 �
OTHER DESCRIPTION(Lot and Block Numbers,etc.)
Lo f�9 Thc M�r�na�s OfyS.,r,.�/ K�,�
C�N -� � STATE ZIP CODE
r rive fcr..: F/oridar
SECTION B FLOOD INSURANCE RATE MAP'(FiRM) INFORMATION
Provide the following from the proper FIRM (See Instructions): , ' -
t.COMMUNITY NUMBER 2.PANEL NUMBER 3.SUFFIX 4.DATE OF FIRM INDEX 5.FIRM ZONE 6.BASE FIOOD ELEVATIOfV
/��O � QQ/4 � �u . /8 �o� �L (in AO Zones,use depth) i
9 0o Z v � � �/ '
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ❑NGVD'29 ❑Other(describe on back)
8. For Zones A or V,where no BFE is provided on the FIRM, and the communiry has estabtished a BFE for this building site, indicate
the community's BFE:� i i ! I I,�feet NGVD (or other FIRM datum—see Section B, Item 7),
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level� .
�(a). FIRM Zones A1-A30,AE,AH,and A(with BFE). The top of the reference level floor from the selected diagram is at an elevation
of I I I I N I.�,I feet NGVD (or other FIRM datum—see Section B, Item 7).
(b). F1RM Zones V1-V30, VE, and V(with BFE). The bottom of the Iowest horizontal structural member of the reference level from
the selected diagram, is at an elevation of� � I i I I.�)feet NGVD (or other FIRM datum—see Section B, Item 7).
(c). FIRM Zone A(without BFE). The floor used as the reference level from the selected diagram is U�.(�feet above❑ or
below�� (check one) the highest grade adjacent to the building.
(d). FIRM Zone AO. The floor used as the reference level from the selected diagram is w.(J feet above❑ or beiow 0(check
one)the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor(reference
level) elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown
3. Indicate the elevation datum system used in determining the above reference level elevations:� NGVD'29 ❑ Other(describe
under Comments on Page 2). (NOTE: If the elevafion datum used in measuring the elevations is differeni ihan that used on
the F1RM �see Section B, Item 7J, then convert the elevations to the datum system used on the F1RM and show the conversion
equation under Comments on Page 2.)
4. Elevation reference mark used appears on FIRM: ❑ Yes � No (See Instructions on Page 4)
5.The reference level elevation is based on: ❑ actual construction � construction drawings
(NOTE: Use of construction drawings is only valid if the building does not yet have the reference/evel floor in placa, in which
case this certificate will only be valid for the building during the course of construction. A post-consiruction Elevation Certificate
will be required once construciion is comp/ete.)
6. The elevation of the lowest grade immediately adjacent to the building is:! ! '� ' � � m-see
Section B, Item 7). D
SECTION D COMMUNITY INFORMATI
1. If the community official responsible for verifying building elevations specifies that the eferer�c I i dicate m Section , Item 1
�s not the"lowest floor"as defined in the community's floodplain management ordinan e, t �I jpn�����°lo est
floor"as defined by the ordinance is: � ' ' ' ! !.� feet NGVD (or other FIRM dat m— �1L
2. Date of the start of construction or substantial improvem e nt
1�1�'L"�:E�A�RVI�ATER
FEMA Form 81-37�MAY 90 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOfi CONTINUATlON
SECTION E CERTIFICATION
This certification is to be signed by a land surveyor, engineer, or architect wl�o is aulliorized by staie or local law to certify elevation
information when ihe elevation information tor Zones A1—A30, AE, AH, A (with BFE),V1—V30,VE, and V (with BFE) is required.
Community officials who are authorized by local law or ordinance to provide (loodplain management information, may also sign the �
certification. In the case of Zones AO and A(without a FEMA or community issued BFE), a building ofticial, a property owner, or an
owner's representative may also sign the certitication.
Re(erence level diagrams 6, 7 and 8 - Distinguishing Fealures—I(the ceriitier is unable to certify to breakaway/non-breakaway wall,
enclosure size, location of servicing equipment, area use, wall openings, or unlinished area Feature(s), lhen list the Feature(s) not
included in the certification under Comments below. The diagram number, Section C, Item 1, must still be entered.
I certify that Ihe inlormation in Secfions 8 and C on this certilicate represents nry best e(Iorts to interpret the data available.
1 undersfand that any lalse. statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIER'S NAME UCENSE NUMBER(or Aflix Seal)
_Wi %/��/� �' ,OE Lan_ _ _ __ __ _ - .. - - !�/oricda. -•SurvB _or 'y.96/6___ _
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TIT LE ,j y J�_, d � , � � COMPANY NAME
�'%�'��ia,�s�al��� .�,. __ _ _ 4'a�obye//_ GQn,sc�/}_'a_n_t� /nc._ __ _ -
ADDf��SS.' + ��., ��� ' CITY STATE ZIP
, '.��or ` � :4�t1._N.__ _ G/Ca.ryvatcr____ --_---- -�/dr��a.---_3-�760
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SIG��T Fi��" R c�'`.,� �� ��.. �' DATE PHONE
;a �;�'=�/'l. . � � � 2 3-5�73 —�✓�"B!o
Co�i�s�s;fi,pulc�#�e made�of�his Ce'rtificate or: 1)community ofiicial,2) insurance agenUcompany, and 3)building owner.
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COMM-EtVTS;���.' ±�� : � .. _ _ _ _ _ _ _
_ _ — --- __
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ON WITH ON PILES,
SLAB BASEMENT PIERS,OR COLUMNS
A V A A V
ZONES ZONES ZONES ZONES ZONES�
RFFE�7fNCE
REFERFNCF PASE LEVEL REFEFlENCF
LEVEL FLOOD _- LEJEL
FIFVAIICN
4'�'. Y �� ��_.�r.� � .
PASF-
94SF � . . .. . AD,IACENT IiFf�i_fif�lf;F Fl.npl)
, ,.,
��l()OU ` ' ELEVAiION
[IEVAfION �t GHADE ; LEVFL
RFFEf7FNCE ../�D.IACENf"' - ;:�
. -.. .. �LEVEL GRADE � ;
: � . , ;,:.i _.�.�Y. `
��� � �� no�ncenr �
. r �.� GRADE
Ly�a�.� _ ___ _—
: _:<, �:� 3
The diagrams above illustrate the p0�s��which the elevations should be measured in A Zones and V Zones.
Elev�tions for all A Zo.nes should be measured at the top of the reference level floor.
. � �
Elevatioris tor all,�V Zonesshou�d be�r�ieasured at the bottom of the lowest horizontal structural niember.
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