42 SEAGRAPE CIR �-� ,... '' r'r i v
� ' . � j l i'� '"� Y
, . ��(�` � , ,��.���s� k.
� _�
' ELEVATION CERTIFICATE O.M.B. No. 3067-00��
FEDERAL EMERGENCY MANAGEMENT AGENCY �pires July 31, 1999
� NATIONAL FLOOD INSURANCE PROGRAM
. ATTENTION:Use of this certificate does not provide a waivar oi the flood insurance purchase requirement.This form is used only to pro-
vide elevation intormation necessary to ensure compliance with applicable community floodplain management ordinances,to determine
the proper insurance premium rate,and/or to support a request for a Le.tter 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•eomer of this form.
Instructions for completing this form can be found on the following pages.
SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE
BUIIDING OWNER'S NAME POIICY NUMBER
STREET ADDRESS(Including Apl,Unit.Suite and/or Bldg.Number)OR P.O.ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
�l Z �Ew ,�-A C�' rc,l
OTHER DESCRIPTIO (Lot and BlocJc Numbers,ete.)
�t 1cl'1' � L��� `��
CITY STATE ZIP CODE
�1caA�t.��A�� FL
SECTION B FLOOD INSURANCE RATE MAP(FlRM)INFORMATION
Provide the following Erom the proper FIRM(See Instructions):
1.COMMUNITY NUMBER 2.PANEL NUMBER 3.SUFFIX 4.DATE OF FIRM INDEX 5.FIRM 20NE 6.BASE FLOOD ELEVATION
(in AO 2ones,use depth)
tzso9� �o � "� �A.,� � ►99� a� �o
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_��.0 feet NGVD(or other FIRM datum—see Section B,Item 7),
SEC710N C BUILDING ELEVATION INFORMATION
1.Using the Elevation Certificate Instructions,indicate the diagram number irom the diagrams found on Pages 5 and 6 that best
desc�ibes the subject building's reference level� .
2(a).FIRM Zones At-A30,AE,AH,and A(with BFE). The top of the reference level floor from the selected diagram is at an elevation
of_��� �� .�feet NGVD(or other FIRM datum—see Section B,Item 7).
(b).FIRM Zones V1-V30,VE,and V(with BFE). The bottom oi the lowest horizontal structural member of the reference level from
the selected diagram,is at an elevation of l I I I I I,U feet NGVD(or other FIRM datum—see Section B,Item 7).
(c). FIRM Zone A(without BFE). The floor used as the reterence level from the selected diagram is ��.�feet above t_..; or
below� (check one) the highest grade adjacent to the building.
(d). FIRM Zone AO. 7he floor used as the reference level from the selected diagram is LU.�feet above� or below�(check
one)the highest grade adjacent to the building. If no flood depth number is available,is the buitding'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 � Other(describe
under Comments on Page 2). (NOTE: 11 the elevation datum used in measuring the efevations is diHerent than tha!used on
the F/RM (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 re(erence mark used appears on FIRM: ❑ Yes k�No (See Instructions on Page 4)
5.The reference level elevation is based on: �actual construction ❑ construction drawings
(NOTE: Use o/construction drawings is only valid if the building does not yet have the�eference level floor in place,in which
case this ce�tificate will only be valid lor the building during the course of const�uction. A post-canstrucfion Elevation Certilicafe
wiN be required once const�uction 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 INFORMATION
1.If the community official responsible tor veritying building elevations speciiies that the reference level indicated in Section C,Item 1
is not the"lowest floor"as detined in the community's floodplain management ordinance,the elevation of the building's"lowest
tloor"as delined by the ordinance is: �J.0 feet NGVD(or other FIRM datum—see Section B,Item 7).
2. Date of the start ol construction or substantial improvement •
FEMA Form 81-31,MAR 97 REPLACES ALL PREVIOUS EDtilONS SEE REVERSE SIDE FOR�Ot�fTINUATION
. w
. -
SECTION E CER7IFICA710N
� This certification is to be signed by a land surveyor,engineer,or architect who is authorized by state or Ioca►law to certify elevation
information when the e�evation 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 floodplain management information,may also sign the
certification. In the case of Zones AO and A(without a FEMA or community issued BFE),a building official,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 certify to breakawayJnon-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.
1 certify that the inlormation in Sections 8 artd C on this certificate represents my best efforts to interpret the data available.
1 understand that any lalse statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001.
� L �� � .l�'i�S ��� S7Z0
����7��f��,$rNAME LICENSE NUMBER(or Atfix Seaq
,��`'� a � ��� �r�t�rr?cv�c�1 �a.�s�l�� Fr•���iv�E�S, PL-C
��,*' �'�C�n. !r, COMPANY NAME
��;, �' "j� I ,_t p' �L �3`�
°•`� `''� ' � III �•;_�• ' Li4 1V� �- �10 C.R� Z_�4 STATE ziP
'�� '� A � cirr
��� •:� .. o�^�, �13 `�(�� �80�
• a�;� :� , '. DATE PHONE
IG TURE
�.°r. '.' � ?,•"";ti��''
. i"��� '" ��+s s`
� r±Cp�t� ',,�o��hbe made oi this Certificate for:1)community official,2)insurance agenUcompany,and 3)building owner.
P.
, ,,
:.r.....-....:;.rR�stii;� .; / �
COMMENTS: " } �- �`� �I tZ �I��/►��IOrJ'
V�IA�£tZ b�E�A��- C��/'��i�-'" J D�O -
ON W1TN ON P1LE5,
SLAH BASEMENT VfERS,OR COlUMNS
A A V
� � 20NES ZONES
20NES ZONES ZONES
AE�EREt+CE qEFERENCE
LEVEI
pE�Eptr.CE �SE IEYEI
lEVEI F1000
EIE�/�?�0^�
��. T
: . v ,`•" y` .� •
.,,...c:::; � i MSE
•?..�:::.t� ..7{ REfEREVCE FL000
MSE :,-- ..'. ..AOJ�GENi�.. .:::: � EIEYAiiON
i1000 WAOE ' ::;: IEvK �
E�EVr�iO�+ NEiEAEnCE �CU�CEtiT �ti":
lFVEI G�uOE
'�5,'`�jr . '�:;t'.±:tr:��:�`�::��:•.. ... . .
: . �Y.:r.�;�.�:;:.:t.::::� ..,;, ,:4.::
i�.�.' !.• '•.•1./.•'
::i:: ':.j:.�:�r;.:i'�::t:�::;.::': :±j/iOJ�CENT-;;
. ...j:::,::Cf.(..ii:...J.%:.�.. ;•.._
='i:.r r:.:r:;•:.;..�.:�:��`� GMOE
...�"�:�..'...•.::•:..�,,..�..:
The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones.
Elevations for all A Zones should be measured at the top of the reference level tloor.
Elevations for all V Zones should be measured at the bottom of the lowest horizontal structurat member.
Page 2