1852 VENETIAN POINT DR FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
NATIONAL FL•OOD INSURANCE PROGRAM Expires July 31, 2002
�,��a 2 4 2003 ELEVATION CERTIFICATE
Im ortant: Read the instructions on a es 1 -7.
�- - SECTION A-PROPERTY OWNER INFORMATION For lnsurance Company Use;
DING OWNER S NAME . _, _._ _. Policy I�umber '
� — ._.,���a 1'Z 1P1�
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company I+IAIC Number'
��
CI STATE ZIP COD�
� LEs iC1.L�,� ^ F'L— -- ��7 s �
PRQ PERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
` v': I_�r' I��L u�[_tc ,�l�„ V'�nr�r��N ����+..►T � u�:
BUILDING SE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,if necessary.)
F Syn �vTl+!�
LATITUDE/LONGITUD (OPTIONAL) HORIZONTAL DATUM: SOURCE: L�GPS(Type):
( �°-�'-�•�" o� �•�') I_I NAD 1927 �_�NAD 1983 �_�USGS Quad Map L�Other:
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME 8 COMMUNITY NUMBER 62.COUNTY NAME B3.STATE
C�E�Q�ATE R. ,�
B4.MAP AND PANEL 65.SUFFIX B6.FIRM INDEX B7.FIRM PANEL B8.FLOOD B9.BASE FLOOD ELEVATION(S)
NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use depth of flooding)
IZSoQ4-0008 � q-t8-194Z B -Iq- 9l 13,00 (¢,o�
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in 69.
�� FIS Profile ��� FIRM �J Community Determined �_� Other(Describe):
611. Indicate the elevation datum used for the BFE in 69: ��� NGVD 1929 �_� NAVD 1988 �_�Other(Describe):
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? �_�Yes �� No
Designation Date:
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
wlding elevations are based on: �_�Construction Drawings* �_�Building Under Construction" �ZC�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 accucately 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 C3.a-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 BFE.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 _, +���»�f���,� ; :
Elevation reference mark used MAp u�1'�s 1 -f°:�K 0�5A�Does the elevation reference mark used appear o.'3�te FI �9� {_J l��b,�� No
¢i a)Top of bottom floor(inGuding basement or enclosure) (v .�ft.(�+�►) �o y� r � y�. «,q��
� r '�,:� .��'' o�' ,<
❑ b)Top of next higher floor ft.(m) `� ' �; �y'a� y, . �,: =
� c) Bottom of lowest horizontal structural member(V zones only) s .�ft.(m) �o: ,��� �;►HA���, ''�'"_
� d)Attached garage(top of slab) S.�ft.(m) � �a � �`.���� �'�'`�'S -
❑ e) Lowest elevation of machinery and/or equipment W�� -�-°.� � `'�°� �- ±
�
servicing the building(Describe in a Comments area.) ft.(m) E�- �°"a , .,�' � � ° ` �
��Lowest adjacent(finished)grade(LAG) �. �a ft.(m) z'N ='� :'
� g)Highest adjacent(finished)grade(HAG) (p .�ft.(m) � ° • ,.�•�° ;�'��:�A
❑ h) No.of permanent openings(flood vents)within 1 ft.above adjacent grade O � ��,,��� ��''i,.�`�
❑ i)Total area of all permanent openings(flood vents)in C3.h�_sq. in. (sq.cm) ' i�''�o�aaoaa�ai�`'�
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 certify elevation information.
1 ceitify that fhe info�rr►afion in Sections A, 8, and C on this certificate r�presents my best efforts to interp�t the data available.
1 understand thaf any false stafement may be punishab/e by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIER'S NAME pA U L �A(�L E�.. LICENSE NUMBER �,�� 2 D/SQ
1" O
E �IV!'O���E.�L- COMPANYNAMEQ�` �� �AOcS/L� �O.f/9a[.7i.�i�i �;uG/�t/E�R.
T
ADDRESS JZBD NFiA'TIU�i� /v/�lof3 �;�/�� CITY��u�D'� STATE� ZIP CODE���9�
SIGNATURE DATE TELEPHONE
� -Z/ - 2oo3 7L�-738 - 9oZ�
FEMA Form 81-31,JUL 00 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
IMPORTANT: In these spaces,copy the corresponding information from Section A. For Insurance Company Use: ;
BUIL ING�TREET ADDRESS(Including Apt., Unit,Suite,and/or Bldg. No.)OR P.O.ROUTE AND BOX NO. Policy Number
y ;�1'"}- !�1
CI STATE ZIP GOBE Company NAIC Number '
C�.�. i - �' �� '—�
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community o�cial, (2)insurance agenUcompany, and (3)building owner.
COMMENTS
Loc��g� 51iR►uc.7u2�tt,. .aE���ri- �s t3oT9oyc or' 4" �cvdK ���1!'!'_�
I—I Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zone AO and Zone A(without BFE),complete Items E1.through E4. If the Elevation Certificate is intended for use as supporting
information for a LOMA or LOMR-F, Section C must be completed.
E1. 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.)
E2.The top of the bottom floor(including basement or enclosure)of the building is I—I—I�•(m) I_I—lin.(cm) �_�above or L�below
(check one)the highest adjacent grade. (Use natural grade, if available.)
E3. For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is
I—I—I�•�m) I_I—lin.(cm)above the highest adjacent grade. Complete Items C3.h and C3.i on front of form.
E4. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's
floodplain management ordinance?�_I Yes �_� No �_� Unknown. The local official must certify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B, C(Items C3.h and C3.i only),and E for Zone A
(without a FEMA-issued or community-issued BFE)or Zone AO must sign here. The statements in Secfions A, 8, C, and E a�correct to
the best of my knowledge.
PRO RTY OWNER'S R OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
, _
Iu�'�'r�� `t" G� r �.r'�r /A/��
ADDRES CITY STATE ZIP CODE
C '—
SIGNA DATE ELEPHONE
�—L —
COMME
�_� Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s)and sign below.
G1. �_�The information in Section C was taken from other documentation that has tleen signed and embossed by a licensed surveyor,
engineer,or architsct who is authorized by state or local law to certify elevation information. (Indicate the source and date of the
elevation data in the Comments area below.)
G2. �_�A commuhity offici�!completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or
Zone A0. �
G3. �_�The following ir.formatio�(ItEms G4-G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY
ISSUED
G7.This permit has been issued for: �_� New Construction �_�Substantial Improvement
G8. Elevation of as-built lowest floor(including basement)of the building is: _ft.(m)Datum:
G9. BFE or(in Zone AO)depth of flooding at the building site is: _ft.(m)Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
I—I Check here if attachments
FEMA Form 81-31,JUL 00 REPLACES ALL PREVIOUS EDITIONS