601 OLD COACHMAN RD N❑
1i-5. DEPARTMENTOF Ht?MELAND SECtJRiTY EL.EV�TICd��I CERTI�I�ATE
��ederal Erner�ettcy Management Agency
Natiana( Flooti InSUtahce Program Imp�rtan#: Read the instructions on pages 1-8.
�EC71ClM A -PROPEFiTY INFORMATION
A1. Build'tng ('dwner's Name City o# Cleanvater
A2, 8tsilding Strest Addtess (including Apt., Unit, auitc, andtor Bidg. No.) or f'.O. Route ansi Bax Na.
6Q1 N. Uld Coa�cbman Rd.
CitY Cisaewaatst State FL ZIP Code 33�'85
NE t#�f`tl
TaX i�BKG$I NUtTibBf,
RD ktlV1` t}N E'FOR
t}M8 No, 1664-Oti�8
Exaires �et�rusrv 28. 20t�9
Gampany Use:
19 .X, GESS FLA I'�VR RA'4+' 8c LES.S li+W FOR 4LD Gt1:�CF�AI�.� RD U1V ��
�x �:�ss �� ww +a;v F c+�n;T as.�r�tictc:�
Ad. Building Use (�.g,, Reskiential, Nan-Resid�ntia�, Add�ivn. Accessory, efc.} ___(�itv Gov`t - Non•restder�#ial tcqrnmercial) �r�lY�
A5. L.afitudeJLongitude. Lai. 27�8-18,t2884 Long. 82,+43-56.74097 Nasizanta#'Q�tumi: [7 NAd'19�7 ��IAC} i983
A8. Attach at teast 2 phc�ogr�ptis of #hs t�uitding if the Ceri`s6cafs is being used to abtain fload inaurar�ce.
A7. Buifding D6a$ram Number ':�
A8. For a buikian� with a�rawt space or $ncEasurr:��}, provide A9. For � build�nq with an �aachad garage, Provide:
a) Squ�re footage flf craw# space �r enclosure(s} sq ft aj Squ�re faotage of atia+died garage sq ft
b) No. af pertn�nent flc�ud open�s in the crac�i space or b) Na'olpermanent floact apenings in ihe a4tached garage <
encl�scere{sj walls within 1.0 focrt above adjscent �rade walls within �f �t} f�ot above a�ar.�nt grade
�y Tbta{ �et area s�f �ood �penings in A�.b- st;' in c) Tatai net area�, of �aod openi�igs �n A9.b sq in
SEG7IQN B - �k.QC1D l
rs4. nnaprrane� r�umoer rs�. a�umx t3c3. rtF�M �naex B7. FIRM F�anel BS. Fiond B$: Base F�
Data EffectiveiFtevisec! Dat� X,�rte(sj �tO; use
4128 Cs 46It 7itI5 09J031t13 X& AE
810. lndicate t�e s�urc,� c�f the B�se Flosui Elevat�t�n {BFE� data ar:base �oi�d tlepth srrter�d �rt ltem �9;
❑ fIS Prafile � FtR�ii �] Gommunity t3etermined C� (3ther (Describe}
B1 i. Ind�cate etat+2tion t4�tum us�ti for BFE irt �tem 89: ❑ NGL►TJ 1928 I�i NF.VD i98� Q Oiher;(�l�sccibe):
812. Is the build#ng located in a`Gaastal BartEer Resaurces System ��BRSj area or Qthene+iss Prote�tetl.Area (#�RA?� (�Yes
D�signation [#ate D CBRS ❑ OPA
❑ �t�
C1. 8uitding elsvations are.based an: (] Gonstntctic�n t�r�wtn�s` ❑ B�uild�rtg Under Gortstructror�' �1 �inished G�n�irudton
'A nava Et�v�tion �erxi�cate «,v't�l be req�€red wtser� constt�ction af the truiidir�g is,ccmpiete,
�C�. Elevati4ns --�ones!#1 A34, �#E. AH, A(�n+iik� B�Ej, VE���V1-V30� �! (with�BF�); AR, ARIA, A�AE, �ARiA1:A3t}, ARfAH, ARIAb. Comp1efe Iter�s G2.a-g
below acx�ardi�� to tttie buiiding d��gr$rn s�cified in Item A7.
t3enchmark Ui'slized N.4,A. A. Tida1 Ei�A 87�8T2+�A V�ertica! Datum N.A:V.D. 1�88
ConversionfGommenfs _
aj Top of baitom �oor (ancfuciing basement, crsrr�! space, ar enclosure #toor)_
b) Top �f the next higher floflt
c} Bottom af #he tawaSt hotizo�tai s#ructura! mernbet (V Zanes only)'
d) Attached gar2ge {tr�p of slab}
e) Lo+Kest etevaiion of machinery ar equ�pment senricirtg the buitding
([?escribs #yqe of equip�ttent in �tsmments}
f} Lowest adjacent {finished} grede (LAC}
9? Highest adjec+�nt {finished) grade (HAGj
thai any
:SECTIi7N D -�URVEYC>R,
d seal� bY a kanti survevor. en�
�e rnJr�rrc��t�on ori
stste,ment mey:b
(] Check here i# cammenis are provided cn b�ck of'torm.
, or
Check the measurement usett.
23:2T � feet ❑ rrie#ers (PueRO REraa antyj
2�' .3� � feet � meters (Puerto Rico rmiy}
❑ #est ❑ meters 4PuerEo Rico anh+)
D feet ❑ met�ers (Puerto Rico at�ty)
22.43 �) teet ❑ meters (Auerto Rico onty}
2�,b2
���
o�
� i�et p rne#ets (Puertn Rico anly)'.
� Eesf ❑ meters {Puerto Rico only}
serrts my:besi efforts id inte�pr�t the data avai�
oritnprrsonmer�t under 18 U:S: Gade; Seciinn
Gsrtifier's Name ihomaa MaYr�ny License Numb�r LS 6289
7itte Geographic Tectrna�ogy RAanager Compa»y Name Giry af Giearwater
CG#AA C..�.r.. G1 ?A C..i.w.�..n.
C".�� �'...�__` _.J_ t__ _.___a.�.._t._._
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IMPQRTANT: !n
801 N. L?Id Ccac
City Ciearvvater
�s, copy the c�rresponding inform�iian from Sectian A.
Apt., Unit, Suife, an�ior 81dg. No;} or P.O. Raute and 8ax No.
AR�CNE7ECT C�RTIFl�A'C
For'tnsurance :�
Paticy i+�umt�er
Copy boih sides of 1h�s Etevation CertEficat� #or (�) cpmrnun�ty officiai, {2) insurance agenUcompany� and �3) buiicling owner.
Comments Electrical trensfarmet and Backup �enerator
E=
Ft)R 2CtNE At}
For Zones AO and A{wiihout BFE), comp��� tt�ma E1-E5. tf the Certif:Gate is intended to:suppcut a 1.f)NL4 or Lt}MR=� r�quest, comptete Sections R, S;
aad G. For ft�� E1-�4, use rzat�ara! gr�de, if svaita�ble. Ct�eck ttie measuretnent �'sed, fn Pue�to R�co only, enier rnete�,
E 1. 'Prc�vade �l�vation infom►atiars for ths folt�twiri� and check the appraprsate boxes fa shovit wh�ether the elevation S�: above ar belt�w ihe highesl adjacen€
�
�3..
E4.
E6.
grade {HAG) and ihe lowast adjacent gre�de ��AG).
a) Tap �rf baitarn �a�t (induding F�as�ment; crawl �pace, or snclvsure} i"s I❑ feet Q rneters (� abave or (� betcsr� the HAG:
l�} Top of Gotkorn fl�r (in�iuding basemeht, �rawl space, or estctosurej is _ . ❑ feet ❑ meters ;❑ �taave or (� beiow the LAG,
Fror Buittling Cliagrams �-8 innth perrr►aaent flcod open#ngs provided in SectionA Itema 8 andtor g(see age 8 af instructions), the �ext h�her #ic�or
(elevation G2.b in t#se diagcarrts} of the buildirrg is . � feet ❑ m�ters ❑ abtxre or [�below the HAG. ,
Att�cheri qarege {top af st8b} iS CI f�et ❑ meters Q at��+�r ot ❑ befow i#te NAG:
Top of plat�orm �f machinery ar�d�or ���aipment servicing the!b�ilding i� C] feet �] rneters [� above ot L7 ael�w th� HA�,
Zane Ati an1y: If ito flaod'a�pth number €s avaalable; is the tqp of the bait+am flaor �leveted i� accor�rice with fhe community's fio�dp3ain manaqerrt�nt
ardinance? [,� Yas Ll No C} �lnknov�rt. The tocal affici�! rnust:certifytfiis information in'Sect#� G,.
SECTIC}M
The praperty owner or`tywner's auihocize�# r�preser�tative wha carr�p(etes Secitans A;
or Zons A� mus# sign here. The sfatements E» Ssct'rons A. B, and � are corre�t ta lh
Property C3wner`s or Ow�r's Author'rzed RepresenCafive's'Name
C a FEM�A-issuad.ar R
Addrass �ity �fste �.lP Cocle
Signatare Date Tetep�ans
�4mmerits
G_
. , . �-,-..
an G af fhis Elevation �Ce�tificate, Complete the;eppticable item(s� and sig� l�eetow. Check tha measurement used in Rems G8; and G9:
G1, ❑ The informatian i� SeGtit�n C was taken fr4m other docume�rtation th�t has beert signed and seaied by a licensec! surveyort engrneer, trr archi#ect vvho
is authanaed by. taw to cetiify elevation infa�mation> {)ndicate the sou� and date o€�he elevation ttata in the �ommenfs area b+al�,)
G2: ❑ R community o�cia! carnpieted Section E;�Ot' a buikiing located in Tt�ne A{wittzout a FEMA-issued or cornmunitp-issued'BPE} ar Zone AO:
G3: ❑ The follow�ng infartnatie�n {Items C4.-G9.� is provided for eommuni�r flootfplain managemsnt puryxoses.
Peimit Nurr�ber
Dake Certificate Cif
G�7. This petmit has b�en'issued for< Q New Gonstructian � Substant'rat tmproverrtent
�8; Elevation of as-bui� �ow�st floo� (inGudirtg basem�nt) af the building: ,Q fee# ❑ me#er� {Pf.} Datum
G9. BFE or (in Zone AO} depCh of flooding at the building site: ❑ feet ❑ mef�rs (PR} Datum
lxaf Officiai's Name Trtle
CommuniEy Name
Signatute
Comments
Telephon�
Date
tssued:
❑ Gheck hers if attachmen
FEMA Form 61=31, Febn�an+ 2046 Reolaces ail;,orevious editior
�
� Bui�dinr� Photvgraphs
See lnstructions for ltem A6.
Building Street Addr�ss (inciuding Ap�., Llnit, Sui#e, az�dfor Bldg. Rtrs.) ar P.C3; Rc�ute ar�d Box 3Vo:
607 N. Old Coachman Rd.
Cllj� �leaewater S�at£: FL ZIP CO�f£i 33765
�r�suranee
If using the E#evaf�on Ceriifi�ate to obtain �iFIP flood insurance, �ffsx at �east iwo buiiding photc>gtaphs bePow acct�rding #o
the instruciions for ltem A6. Identify ali pho#a�raphs with: date taken; <'Front Vie�+" and "Rear V��ew"; ar��, ifi recguired, „Right
Side Viev�' and "Left Sid� View." Ifi submi�ting more photographs ttt�rt wil► fit c�n this page; use thr� C€�ntinuafi�r� P�ge,
fiol(t�wir�g.
Frant �efi View C1�te: 872212€3�2
�
Frant R�gh� Vi��+v C7ate�: 8122t�{�i2 �
Rear View [�ate: 7/1712a12 Side View with �lectrica( equipment Liate: 7117/2ti'!2
,
� Building Pha��ographs
Continuati�n P�ge
�uilding Stre�:tAddress {including Ap�, t�€�it, Suite, anc!!or Bldg. No.} ur P.Q. Raute and Box`[�o.
601 N. OId Coachman Rd.
Cl�y Gte��'wak�r St�t� FL ZIP COdB' 33765
Forinsurance
If` submitting more phnto�raphs than �riEl fit on #hs preceding page, aifix th� additic�nal photo€�raphs betow. 1c�entify ali
photngraphs with; dat� tak�n, :'�ront View" and �Re�r View", arad, if required, .:Right Side View" and "i.eft Side'�iew.:'
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� �� � � ��ti S '�. �9 � f
� � �'� �°��`�� � �
� ,� � � �A*� .�E�� � �. � �-� �� �a� � � '�ea ��! � �a �i :,� �� � •, � �,..�
Inside Left View Ciate: 812�12q12 insid� Left View Dat�; 8/22120'12