20 SEAGRAPE CIR _ _ _ _ . _ �� . __ . _ __ _ _ _ T
t� � �L� � � �
,� � �' - ., .� e �� � � 1 O.M.B. No. 3Q67-0077
��� � ELEVATION CERTIFICATE �Pires July�a, 1999
FEDERAL EMERGENCY MANAGEMENT ACENCY
NATIONAL FLOOD INSURANCE PROCRAM .
. ATTENTION:Use of this certificate does not provide a waivar ot the ilood insurance purchase requirement.This torm is used only to pro-
vide elevation information necessary to ensure compliance with applicable community tloodplain management ordinances,to determine
the proper insurance premium rate,and/or to.support a request for a Letter of Map Amendment or Revision(LOMA or LOMR).You are not
required to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form.
Instructions for completing thia form can be found on the following pages.
SECTION A PROPERTY INFORMATiON FOR INSURANCE COMPANY USE
BUIIOING OWNER'S NAME POIICY NUMBER
STREET ADORESS(including Ap�,Unit,Suite and/or Btdg.Number)OR P.O.ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
2 C� �E�► �-� �. �i�c�
OTHER OESCAIPTION ot and Block Numbers,etc.)
►�1 d� `� )rv��- �d
CI7Y����t���� STATE ZIP CODE
��c=,b�a
SEC710N B FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
Provide the following trom the proper FIRM (See Instructions): —1
1.COMMUNI7Y NUMBER 2.PANEI NUMBER 3.SUFFIX 4.DATE OF FIRM INDEX 5.FIRM 20NE 6.BASE FIOOD EIEVATION
(in AO 2ones,use depth)
�Zso97 c��8 t'� 9 ��91 I'�� Ic�
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 community has established a BFE for this building site,indicate
the community's BFE:��_L.L_.�.0(eet 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 trom the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level� .
2(a).FIRM Zones A1-A30,AE,AH,and A(with BFE). 7he top oi the reference level floor from the selected diagram is at an elevation
of_���Zi2 .0 feet NGVD(or other FIRM datum—see Section B,Item 7).
(b).FIRM Zones V1-V30,VE,and V(with BFE). The bottom of the lowest horizontal structural member of the reterence Ievei from
the seiected diagram,is at an elevation of I I I I l I,U 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 � �.iJ feet above U or
below C (check one) the highest grade adjacent to the building.
(d).FIRM Zone AO. 7he floor used as the reterence level from the selected diagram is ��.�feet above� or below�(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 C Unknown
3.Indicate the elevation datum system used in determining the above reference level elevations:,�NGVD'29 C Other(describe
under Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is diflerent than that used on
the FIRM �see Section B,Item 7J,then convert the elevations to the datum system used on the FIRM and show the conversion
equat;on 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 ol construction drawings is only valid if the building does not yet have the re(e�ence leve!lloor in place,in which
case this certificate will only be valid lor the building during the course of construction. A post-consUuctron Elevation Certificate
wi!!be required once construction is complete.)
6.The elevation of the lowest grade immediately adjacent to the building is:��.� feet NGVD(or other FIRM datum-see
Section B,Item 7).
SECTION D COMMUNITY INFOAMATION
1.It the community official responsible for veritying building elevations specifles that the reference level indicated in Section C.Item 1
is not the"lowest tloor"as defined in the community's floodplain management ardinance,the elevation of the building's"lowest
tloor"as defined by the ordinance is: �J.0 feet NGVD(or other FIRM datum—see Section B,Item 7).
2.Date ot the start of construction or substantial improvement •
FEMA Form 81-31,MAR 97 REPlACES All PREVIOUS EDtT10r15 SEE REVERSE SIDE FOR COf�lINUATION
.
. , ,,, .,• _
SECTION E CERTIFICATION
� This certification is to be signed by a land surveyor,engineer,or architect who is authorized by state or local law to certify elevation
iniormation when the elevation information for 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 fioodplain management information,may also sign the
certification. In the case of Zones AO and A(without a FEMA or communiry issued BFE),a building officiai,a property owner,or an
owner's representative may also sign the certification.
Reference levei diagrams 6,7 and 8-Distinguishing Features—If the certifier is unable to certity to breakaway/non-breakaway wall,
enclosure size,location of servicing equipment,area use,wall openings,or unfinished area Feature(s),then list the Feature(s)not
included in the certification under Comments below. The diagram number,Section C,Item 1,must still be entered.
!certify that the information in Sections B and C on this ceriificate represents my best eflorts to interpret the data available.
1 understand tha[any false statemeni may be punishable by line or imprisonment under 18 U.S. Code,Section 1001.
�;c.��1 F JE�K��� �5� S7 Z�
'�CERTIFIER'S NAME / UCENSE NUMBER(or AKx Seaq
1�� ,��N�I�Q4�- 1"'���1<-�� (-nfV�i ���1� ���11`lE.���
,1Yh. E ''` f f�� �(� COMPANY NAME
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' 'b STATE Z1P
� �� �°�.. CITY
� �^ �eg�,� � 813-9�i�- Z�oo
, �-7 �. .
=c�a ;� T � st.1 ,;: DATE PHONE
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.,�~,��bp�.sho"'�,�il:'�ie,�ade ot this Certificate for.1)community otficial,2)insurance agenUcompany,and 3)building owner.
E �' ���d ry�y 4`�1�` G �r-� �oo�r E1Lv a�►o�.1 = 13.S
�'i;ot�t+��s:
h
�� ° �.1�k��2 I��ra��.sL C1E��k'�o,ti1= I5� � _
ON WITH ON PILES,
SLAB BASEMENT PIERS,OR COLUMNS
A V A A V
ZONES 20NES 20NE5 ZONES 20NES
AE�EAE�+CE qEFEAE�+CE
lEVEt
pE�EAEKE �E LEVEI
LEvc� RO00
Elcy�TqN
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�..•r::;:t :�.: BtiSE
���'1'�: AE►E?E.`CE FLO00
:a....' .... .:.,..,,-,c::.. . .........�
b�'� '�'� •.AOJACEN7�..:'; i'• ' EIEVATqN �
flE�►�OM • MEFEt1ENCE �WACEHT GRAOE ",'.�;K� lEVEt .
LEVEI GpAOE 't�;
. ;s�,',y'�.0 s#ts:;'•
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.... :_'1�.;.r:ii::'•:: , 'i)::.'.y:�:..i:�:'::
, .,.t+ :, �:..t::;:c`:=t•::;.. .:�•r:•.•:=�� •.v:�••:.
;:�;j..: .i......::i...
— :�hs 'ii.v:'.;:r.,...,.qr�t: .`•AOJACENT�::
:i1:t�::� �f1'•:�•: :=i�:� -'i:: �'•ii� GNADE
:i�':+:RS!�'���'•...�.�:!'�.. '"'ii:fp�'''�i, •
The diagrams above illustrate the points at which the efevations should be measured in A Zones and V Zones.
Elevations for alt A Zones shoutd be measured at the top of the reference level floor.
Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member.
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