137 WINDWARD IS U.S.DEPAR7MENT OF HOMELAND SECURITY ELEVATION CERTIFICATE oMg rvo. �sso-000s
Federal Emergency Management Agency ExplreS March 31, 2012
Nationai Fiood insurance Proyram Important: Read the instructions on pages 1-9.
SECTION A-PROPERTY INFORMATION ��` w'I��Ur�`�S�:�Stl ���1 U���r r.°r }
A1. Building Owner's Name t �I�;�1 �� � � �� �;s� t�<,+��ix a ;
s �v v �.� C, c�-�« �,��. �, ,�� ,-�, �� ,� ��,a,��.�C� ��'�,��� �t���y����-:
A2. Building 5freet Address(including Apt.,Unit,Suite,and/or Bld No.)or P.O.Route and Box No. �"tltljiiij����!NAi�'IVt�liitl?�i`"y x�� ���6',
►� w��.� w ,�n �� � � �,�f�,��:� � ;,����,t������4 N�f:4�s ������<<
Clt r 2�,���1�,,�'!'r�'n.r,�"„rt� i,� °T�;i )tkY�:
Y G��, State �' ZIP Code ��7
_ /��z.rN,��"�.f�.. . �3
A3. Property Descriphon(Lot and BI ck Num ers,Tax Percel Number,Legai Description,etc.)
LO�" 4 I , �n1 i T �, I�(-�N.0 �sTAT�-S o� G��t��/o�i��,.
A4. Building Use(e.g.,Resider�tiaf,Non-Resid ntlal,Addition,Accessory,etc,) ��-s�U Er.1 l (.,.,
A5. LaBtu�e/�ongitude:Lat. �L7�5�cl�rN .. Long. 2..° � 3 , Horizontal Dalum: []NAD.�1927 AD 1983
A6. Attach at least 2 photograph�of'fhe'�buiiding'Ifttle��ertiflcate is being,used to obtain flood insurance, y;
A7. Building Diagram Number . � '
A8. For a building with a crawlspace or enclosure(s): A9. Fvr a huilding with an attached garago:
a) Square footage of crawispace or enclosure(s) N�� sq ft a) Square footage of aftach�d garage �3� sq ft
b) No.of permanent flood openings in the crawlspace or b) No.of permanent flood openings in the attache garage
enclosure(s)within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade
c) 7otal net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in
d) Engmeered flood openings? �Yes [�No d) Engineered flood openings7 [�Yes [] No
SECTION E�•FLOOD INSURANC��tqtL MAP(FIRM)INFO�2MA710N
B1.NFIP Community Name&Commu ity Number B2.County Name 63.S1ate
Ct_E/� W/��TF 2 62�j p PIN����S �L�
84.Map/Panel Number B5.Suffix B6.FIRM Index B7. IRM Panel 88.Flood B9.Base Flood Elevation(s)(Zone
����� � �f�� � Date Effective/Revised Date Zone s) AO,use base flood depth)
8-►g�p9 5-i7-°5 �. 11�
B10. Indicate the source of the Base Flood Elevation(BF�)data or base flood depth entered in Ifem B9.
❑F1S Profile FIRM Community Determined �O/ther(Describe)
811. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 [�]1VAVD 1988 ❑Other(Descrfbe)
812. Is the bullding located in a Coastal Barrier Resources 5ystem(CBRS)area or Otherwise Protected Area(OPA)? [�Yes o
besignation bate �CBRS �OPA
;j
:� SECTION C-BUILDING�LEVATION INFORMATION(SUF2VEY REc�UIRED)
� C1. Building elevalions are based on: ❑COnsfruction Drawings' ❑ Building Under Constructlon" Inishetl Gonstruction
'I *A new Elevation Certiflcate will be required when construction of the building is complete.
C2. Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR1AE,AR/A1-A30,AR/AW,AR/A0. Complete Items C2.a-h
below according to the bu�ing diegram s ecifled in Item A7. Use the same datum as the BFE. � ���� �N�����g`
',� Benchmark Utilized `.� � o� G�v�/R. C7 ' ���r'�' Vertfcal Datum � ��
( Conversion/Comments C1�"�/ �UBI-1 S N Ep �LEV�-('14�1J
i ---r.
Check the measurement used.
a) Top of bottom floor(including basement,crawlspace,or enclosufe floor) , %,� feet �meters(Puerto Rico only)
b) Top of the next higher floor _�_.�2,_�_ leet meters(Puerto Rico only)
� c) Bottom of the lowest horizontal stn.icfural member(V Zones only) �.��feet ❑meters(Puerto Rico only)
� �' d) Attached garage(top of slab) 2[� eel ❑meters(Puerto Rico only) �
i e) Lowest elevation of ineohlnery or equipment servicing th�building ��.�r- ,[�et []meters(Puerto Rico onlY)
(Qescribe rype of equipment and localfon in Comments)
, t� Lowest adJacent(finished)grade next to building(LAG) � �,_� feet []meters(Puerto Rico only)
, g) Highest adjacent(flnished)grade next to building(HAG) ! ,_._�+�[]'�eet []meters(Puerto Rico only)
h) lowest adjacent grade at lowest elevatlon of deck or stairs,Inclyding N fq .�[]feet �meters(Puerto Rfco only)
structural su ort
i SECTION D-SURVEYOR,EN; INEER,OR ARCHIT�CT CERTIFICATION
' This ceriification is to be signed and sealed by a land surveyor,enginee'r or architect aulhorized by law to certify elevation • ,
information. I cerfify that the information on fhis Certificate represents m best efforts to interpref the data available. •�'� a s"�: ,y,r'd g ''
I understand thaf any false statement may be punlshable by line or impri�onment under 1 S U.S. Code,Section 1001. ° ��Y��°, ° '""' .;�'�•,s"�!"°-
�heck here if eomments are provided on back of form. Were latitude and longitude in S clion A provided by a �z� °^ ''y :�iQ��,�' �''
�'{ . .�x�,y��! i;,,:,T'��N:;�.
license�land surveyor? [�]'�es ❑No �':�' G " �� �
�'-n t@)
I f �'� Ib t• �'+i���� � ,
Certifier's Name License Number ^� ' � ,� +� •��:. ;
Larry L. Evans PLS�� 2937 ,' ��> , . � :
Title Company Name ,,> �.��yt��� '�L .'�,� �, .
Land Surveyor EvanG Land Si�rve}�.i ng, Tn�. ��: ', Y ��,�iro
Address City State ZIP Code �-"'°' '�
14 Be t ' 'y" ���.�
Signature � Date a -2 �12 elephone ����� 734-3821 v��`�„ '
:;,i
FEMA Form 8 31, r 09 See reverse side for continuation. fteplaces;all previous editions
IMPORTANT: In these spaces,copy the corresponding Information from Section A,. k:', �,� �` ' '�Po`�` '� ��U� ,�b�����M�ti;
Building StPeet Address(including Apt.,Unit,Sui e,and or B d .No.)or P.O.Route end Box No. �(�i��� :`aA ��,�`�� ��'�fi'u�i���L,ry.�}�',�.�a�,�kx''�*i
1 '4J I r.�U ti./ l� �5 L . h,�� ,�t 1 k i�i't }��il��]t7f[t��f1 Uf�
Cit
y �L���1n//-��'1=� State � ZIP Code ,���f�V�f�i�y'"��JA R���4����'�����`�Y��r'�����"��
� F � ����, �•.�,,������R��� �� �� �
�
+. :�, � .� �"s, S t "�^a , 8a;
SECTION D-SURVEYOR,ENGINE�R,OR ARCHITECT CEf2TIPICATION(CQN7INUED) '
Copy both sidea of this Elevat(on Certificate for(1)communky ofticial,(2)in�urance agenUcompany,and(3)buiiding owner. •
Comments �2.�' � I� �n1 �X.7�.f2_..I a(z- � G Co J� ��.�a�O(�,,, Q 1� f� f� �:..G � �� �
�
Signatura ��""'� f;+ Date ,�,/
�..�., ,' ,.. r � ,,,. d,.��,-`_ ' , l'a.+�.-��s�(�c..e.
L�I Check here if attachments
3�CTIDN -B I INC3 EL�VA710N IN��Of�MAT10N(SURVEY IdOT REQUIR�D)FOR ZQN�AQ ANp ZON�A(WITHQUT�FE)�
For Zones AO and A(without BF�),complete Items E1-E5. If the Certiflcate(s Intended to suppqrt a LOMA or LOMF2-F request,camplete Sectfone A,B,
and C. For Items E1-E4,use natural grade,ff av8ilable. Check the measurement used. in('uerio Rico only,enter m�ters.
E1. Provlde elevation fnformaHon for the following and check the appropriate bvxea to show whether Ihe elevalion ia abave or below fhe hlghe8t adJacent
grade(HAG)and the lowest adJacent grade(LAG).
a)Top of bottom floor(including basement,crawlspace,or enclosure)is _ Qfeet ❑meters ❑above or ❑below the HAG.
b)Top of bottom floor(including basement,crawlspace,or enClosure)Is � []feet ❑meters []$bove or ❑below the IAG.
E2. For Buildfng Diagrams 6-9 with permanent flood openings provided in Secti Items 8 and/or 9(see a as 8-9 of Instructions),the next higher floor
(elevation C2.b in the dfagrams)of the building is ____0 feet�mel�rs Q above or �below the HAG.
E3. Attached garage(top of slab)is [�faet Q meters [']above or [] below the MAG.
�4. Top of platfarm of machinery and/or equipment servicing the building is �Q feet []meters []above or �]below the HAG.
E5. Zone AO only: If no flood depth number is available,is the top of the boltom floor elevated in accordance with the community's floodplain management
ordinance? [� Yes ❑ Na ❑Unknown. The local official must certify this Informailon In Section Ci.
SECTION F-PROp�R7Y OWNER(OR OWN�R'S R�PR�SENtATNE)C�RTIFIGATION
The property owner or owner's authorized representative who complefes Sections A,B,and E for Zane A(withoul a FEMA-Issued or community-issued BFE)
or Zone AO must slgn h�re. The statements in Sections A, 8,and B are correcf to the best of my knowladge.
property bwner's or Owner's Authorized Representative's Name
�
! Address City 6tate ZIP Code
� �' Signature Date Telephone
i
� Commenta - _
� ,�
SECTION C�-COMMUNITY INFORMATION(�PTIbNAL)
! The local official who is authorized by law or ordinance to adminlster th�community's floodplain management ordfnance Can complete Sectipns A,B,C(or ),
� ? and G of this Elevation Certificate. Complete the applicable item(s)and si�n below. Check the measuremenf used in Items G8 and G9.
� ' G1. � The information In Section C was taken from other documentation that has been signed and sealed by a Iicensed surveyor,engineer,or architect who
is authorized by law to certffy elevation informetion, (Indicate the source and date of the elevation data in the Commenls area below.)
� G2. ❑ A community oificial completed Section E for a building located in Zone A(without a FEMA-(ssued or community-issued BFE)or Zone AO.
; G3. ❑ The following fnformation Qtems GA-G9)fs provided for community floodplain management purposes.
G4.Permit Number G5. Date Perm�t Issued ' G8. Date Certiflcate Of Compliance/Occupancy Issued
G7, This permit has been issued for: ❑ New Construction []Substantlal Improvement
G8, Elevation of as-buill lowest floor(including basement)of the building ❑feet ❑meters(PR} [7atum .
' G9. BFE or(in Zone AO)d�pth of flooding at the building site []feet ❑meters(PR) Datum
G10.Community's design flood elcvation ❑feet ❑meters(PR) Datum
Local O�cial's Name �, 7itle
Communiry Neme Telephone
Signature Q�t�
CommeMs
���� i
� ❑Check here if etta�hments
F�MA Form 81-31, Mar 09 � Replaces all previous editions
� . .
Building �hotographs
See Instruc#ions for Item A6.
' � �`or Insur�nce Comp���y Use;
Building Street Address(including Apt., Unit, Suite, and/or Bidg. No.)or P.O. Route and Box No. Poli�y Number :
� � l,�i rJ.D I,ti,+ 2 D ;�i� �' D , � ?
C�tY , State � ��P Cade orr,p�ny PU��G N�r,ber
C.�EA�R w'fkT��2. , � , �—
If using the Elevation Certificate to obta�n NFI�' fload insiiran�P, affix at least two building pholograplas below according to
the instructions for,l r,7�� ,ntify all E�I�utuyi��phs with: clate taken; "Front View" and "Rear View"; and, if re�aired, "Right
Side Vie �. 'r�€�mitting mor�photographs than will fit on this pag�, use the Continuation'Page pn the
reverse.
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` , ' �L�1��'�'I�JN C��`i'I�ICAT� . o.�,e ������-�4�,
. F�a��'��-�i��'i1Q�Nl3Y MANAt��ME,NT AGENCY �A�',«Fr.,�y3r, t993
. .� - IJA7(U�aa1, 1-i.04n IN�UpANC� pRuu�ArA
An�N�fi�QN�Ugp OI IIlIB C6rIUICflIB(Jq@g f10t ptQV4{�g q y,�R(ygf d�111A��OOtJ(tl9tffQnCg�UfCI1Ay9 f +
`provkle efuvatfon In(orinellon ItaCgeesry(v enaure cnrnpIlenco wllh app(Icable cohirnunlly lloqdplaln rn�ns e
d�(erming 1hg propef ln4UrerlCe preinlURl tat�, anct/or td eu eq.�lrgment, 7trls lorm!s used only io
� pF��l�teque�)bt a Lelle�rof M8p�mBndmenl o Rey�ejva�{�t�MA br I.phiR),
• • In�t�uctlon�tor compittlnp Ih►�forrn a�n b• found orr It�e foltowlnd pe�pes. � . ..
S�C710N A ppOp��1-y�t�F4F�MbTl01{ �'
9UILDIM(#OWHEFi'91W,�@ PQq IN9UFWICE COMp�IY U9C
$TRE�TADOA�SS � � F'ol►CYHUU6lq ,
4k���'���►d'a p�d0,NumMr)OA P,O,(tOUTp ANU Bph NUM9Eq �
1 37 WzN4WARb rST�AND � CUMpMIy►IAIONUAlpEi1 • �
OTHEA DESCRIP71pf�(�y�g{���r�,�b.).
LO�l' 41 , UNZT 9...rSLAND �STATES �
cinr ' aF CI,�,��tWATER �
CLEAitWATER � ' st�tTE
, � � �,L r�P ctf4E
S�CTIOtJ p FLOOn INS,U�1At10E fiATl�MAp(�l�M)(�d�OHMATIUfJ �
Provlde the followlnr from ihe pro�er�I�M(See lnatrucUons}; '
1,CWIMUNIiY IlllAIBER • ?,FM�E NUMBEA �� .
3,6VFFIx �.U�1TE UF KIR�A INbEX
S.Flp�a jp�{� 0.g�9E iLOQD E��YAiKVI
125096 � 0008 ' ' t�,�ot,,,.�,,,.•d,�,�
b _�-19- "A���
7. Indfcate Ure elevatlon�datum sys.tem uaed on H�e FINh1 tur gasu �Iooc!ElevaUons B�� ; 1 � .0
6• �or Zonea A or V,whet6 no���la provldgd on llip fiIRM,and the oor»�»unily has establl�I�iad�E!�&to�Ih�g bulidinp olfe,lndleale
��thar(desG�lbe nn backj
the communlly'a 6F�;�f�,j_jJ.�(eet�lQVb(or olhar�IRM datwn�sev Secllon(l, 11er�i 7).
S�CTION C �UIL�If�Q �CEVAYIOfJ l��FOFIMAT10�1
1.Uslnp the�levallon Certiflcete fnalrucllon�,�ndlc�fe Ihe diapr�m number Irom Ihe dlaQ�ams laund on�aQes 5 and 8 th
descrlbes the`ubJect bulldlnQ'e ref�rence leve) �
2{a),�tF�M Zonet A1-A30,A�,AH�snd q(w�lh gF��, rhQ�o�af Ihs reference(evel(bar iram!he selecled dla rarn Is 81�t��`
• °� �' �� .�leet�lOVp(or olher FlFtM dalum-aee S�cUon b, ItAm 7), g e�n elevauon
(bj,FIl�M Zones Y!•Y30�VE;and V(w11h�pE), Tna boflom of tha fowest liorizonlai scruclural mem6er oi Ihe referen
ihe asiecled dlepram,le a!an�levallon of' ' ' ' ' ' ca levet from
(a►, FIF�M Zone A(wflhoul.bF�). 7he tloor used�e����Q I��q� m`���e�Stat FlF1M datu+n-s�e Sectlon B,Ilem 1).
��ow� (chevk one) the hlphee1,Qrede ncljacenl to the bulldln�. � eiee�ed dia�rarn la L1J,Lj lee!abava[,J Qr �
(d?•�IF1M Zon�qp; Tho Iloor uped�e lhe,�efqrepc$leysl from��i�eeleoled dla rarn la
one)Uis hl�heal drade adJaCenl to Ilie bUJldin , p ��u lsel ebove
� N no 11ood depth number la avaUebls,Is tf�e bulld►ng's lawe�s�t lloore(r��a Ce1e�
fevel) elavaced in acoordance wltl�Ihe community'�Iloodplafn m�napemer►t ordlnance7
3, Ind►�a�Q���Q g�eV�pon daium ey�fem useci in delermlrilnu ihe above iet�rence levai eievatlon�s;�eHdV�'2s
under Commenls an Pa e 2 � N° � Unhnown
B 1� (N4T�; !!lha eleva�Jon da1um usad!r�measuring fhe eJevalJans!s d�llerenl lha�►�haf usod orr
!he F/RM•{SSe SecUon 6, llmm)f, flien converf the elovaUons f�!he darurn sy�sfem used on I, � ��he�tdescrlbe
, squsllort bnaer Commanls on pg�e�,� , + , 1 e f1Rll1 end sl�ow�t�e converslon
4, �lev�llon relersnce mark ueed appears on FiFiMi� Yee �
B.7hs�r@ference level elevm�►nn Is b�aed on: � ectu�coneiru�c�l nn �����nslrucUans on pape 4 f �
�.Ctlh�IrUCqnr�cirAwlnQrt � � ' �
(NOT�; UQa ol c+onslrv�!!on dr�v�lnpa!s only valld N fh�!��/Idtnp do�s nof y�l h�t-s!he rele�erice levsJ Ibar In la
cese N�l��nrf�cet�wlll o»ly be 4��Ildlo�rhB buridfnp durinp�ha course o�ccr�srrucrlan, q _ ,
kyrl be r�qulred ance cons(rvctlon!s con�plerQ,) P ce,!n whl�t,
8.The 61evaUon ol�t�g�Ow�4�Qredg,ImtT1ed18lgfy$d�gCBn(fQ II18(JUlldfn �g; p05r conslrucUon�levaUon Certlllca�e
SecUon 6��Ilem y), ' � � , q (��'� '
�� , , , • .;J leel NCiVU(or olher F�F�M delum-ee� i
, � .
$�CTION p CpMMUNITY(N�QiiMATIpN �
f.N 4he communfly o1fld�J teeponalbl�Ior yerllylnp btttldlnq�IavaUone�pe�����$ih61 th •J
Is not Ihe'lowes{�lov�'�g d���ned Ir�1he cvmmunily'�lioodp�eln me�taaehteni oldlnance�!he el�veilon a1�i�b
v relerencA levsl Indicnled!n Svctfon(�,tiem 1
�' tloor'as�e11nQd by the ordlnance Is: �,.I (_,�I��f leet N(�VD{or oih�r i'IAM da�un�-sae�eclton�,Item y Ildi���bwoit
.Uste of thv�Iar!of conglrucito�or:ubelenU�!Improvement .� ' . 1 '
iEh1A Fo�r�tt• � � � � I
]1�MAY 90 • �
, � REp�,A(ES AlL PR�EVIOUS EDI'f IONS SFE A�VEFl9E BI��E Fpa��r�t�
, • .
,� .._.. �-'�fi T��� = � _ -=�1 '- ��' r��`1i �. ; �� �'��r ti�� JI", : T �a'.. :�_-'' ' .-
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� 7hte cerUfleaUon Is Ip be tiyned by a land vUiveyof,enylha9r�ot�rohllaei,w{�v Is�r�i N T
• ` tntormaUan when Ihe efevativn inlor�r�at►on tor 7.one9 AI-q3p�A�,AH,� �,�tl����j,Vt-V3o;VC,end V wi�h�FE �
t torized by etale or Iocai le�w la eerti1y elevaUc�r�
Cornmunlly ofllcl�l�wf�o arA nuUiorlxed by lobs�f tew or ardlnance ta.provl�a�Ioodp�8�n m�nAgement In(ormatton,may�also s!gn ll�e �
ceitff(c�Uon, in p►e c�se ot�n�es Ap ar�d a(wlthout R���,�A ar eomniunlly Is$ued HF�),a bulidlnq�tli lal�a p�a ��t r owunrsci.
owner's rspresenlaqyg may also slpn ihe nerilficatlon. ,:
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Hefergnce teve!dlaaranis 8�7�r�d 8-b[stlr7��lshlnq raatures-II(he Cer1111er!a unabig(o Certffy tv br�akaway/�on•brgakewa waH
et�ctosure etza�locatlon o!bervlcfnq oyUlpmeni,area usA,w�11 upat,ln�e�or ur�ffnlsfie�area�ealure(s),Ihen Ilstlhe Feaiu�e(a r�ol
Incfuded In tt�a ce�IfticaUon under Con►menl�balow. llie dlaqrem number,Sectlon C�Itgm 1�muef elli�be enterbd.' y
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r cer(�ly V��l�he lnlorni�llon fi Se�llor�s f3 erid C on fhls cerilllcafe reprvsenls my besf elfans rn tnl�rprel�l�e dala svalla6le. '
t undersfartd thaf ar�y lalse sfafen»nl m�y be punlsl�at�le by t�ne or lmprfspnrrisnl urtder 18 U.S, Cqde, Secflon 1 d01,
. CER�IFIEN'S f�AM� ' . . , •
WzLLllli�t C'." lS�h'PTN(3 ' ucFrianNiva�en�o��mrs•,9
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�EC. SURV�YOR ' ��,y,,����'�VE�VEYYNG � ..
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cv}�te� ehouid be m�de p thla Caitlficete tor;1)cQrninuiill o a���{���6"1263
' ' Y «�clel,2)tnsurence ag¢nUcornpeny�end 3j�ullJfne owner.
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