833 LANTANA AVEll.S. D�AARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
, National Flood Insur�nce Program
At. Building Owner's Name ��v `,� ,
� ci
A2. C+��na�g StreLe�t Add` ;e� including Apt'
T1�_! �_
yG��-� w�T�-R-�
A3. Property Description (I.ot and 61ock Nu
��_�p.�l�_r.i�_i,
A4. Building Use (e.g,, Reside
A5. Latitude/Longitude: Lat. !
A8. Attach at least Z photogra�
A7. Buildi�g Diegram Number
E�EVATION CERTIFICA�'E
Important: Read the instrvctions on pages 1-9.
SECTION A - PROPERTY INFORMATION
(`�.i�.,� SRI�EIJ
Suite, and/or Bldg. No.) or P.O. Route and 8ox No.
_���
State ��
�
nbers, Tax ParceMNumber, legal
� h�n_ �n�,n
Code 337 �
etc.)
OMB No. 1660-0008 '
Expiration Date: July 31, 2015
�on-Re dential, AddlHon, Accessor , etc. i� ES i DC.,fJ1'"� �(� ,
r� 2� b�� Long. �°•��p � Ho�izor�tel 0atum: ❑ NAD 1927 I.�d NAD 1983
the building If the Certiticate is being used to oWein flood Inaurance.
.,o. rvr a vu+�ame waa a crawispace or enclosure(s): � A9. For a building with an attaohed garage: �
a) Squa�e footage of crawiapace or enclosure(s) /f`1C sq ft a) Squa�e footage oi etteched gare8e N��c . sq ft
b) Number oi permane�t tiood openings (n the crawlapace b) Number ot pe�meneM flood openings in the ttached gerage
or enclosure(s) within 1.0 toot above adjacent grade within 1.0 foot above adjacent grade
___- ----c --�otal-r�et-area-of- _ -_- -- ----- _ _
�0°��°p°�f����. �^ ----- �-$q�n oj'�otal net area of floud openfn�s in_A9.b sq in
d) Enginee�ed flood ope�tings� -[� Yes CI No d)= Engfneered flood openings? ❑ Yes No
3ECTION 6- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81. NFIP Commu Ry Name Co munity Number 62. County Name '
c��+i��i4�i�� ►Z-�'o9(p PI�.Iki�t�f�S
- 84. Map/Panel Number 65. SutBx 66. FIRM Index Date 87. FIRM Panel 88. Flood
��i Q �. �) 0 Effective/Reviaed Date one s
3 Z. % �-10-aq �>
9-o3-r�3
810. i�dicate the source of the Base Flood Elevatlon (BFE) data or haee fiood depth entered in Item 88.
❑ FIS Pro81e �IRM ❑ Communfty Determined ❑ Other/Source: ,
811. Indicate elevation datum used tor BFE in Item B9: ❑ NOVO 1928 i,��vAVD 1988 p OthedSource:
Bt2. Is the building located fn a Coastal Barrier Resources System CBRS) area or Othervvise Protected Area (OPA)T
Designatton Date: �] CBRS ❑ OPA
C1
C2.
SECTION C- BUILDIN� ELEVATION INFORMATION
B3. State � �
69. Base Flood Elevation(s) (Zone
AO,�u$e�base flood depth)
7.
❑ Yes [H' No
Buiiding elevations are based on: ❑� Constructton Drawings" ❑ 8uilding Under Construction' Finished Construction
`A new Elevation Certiflcate will be requfred when construction of the buildfng Is aomplete.
Elevations -�ones A1-A30, AE, AH, A(with B�E), VE, V1-V30, V(+nllth BFE), AR, AR/A, AR/AE, AR/At-A30, AR/Ahl, ARlAO. Complete items C2.a-h
below according to the building diagram specitied in Item A7. In Puertb R�o only, enter �ete • �N�V D` ��►}
Benchmark Utilized: C1� Gl. ���� - C�� Vertical Oatum: Z�
Indicate elevaHon detum sed forthe elevations i� ftems a) throu8h h) below. ❑ NOVD 1929 NAVD 1988 � OtheNSource:
Datum used for bulld(ng elsvations must Fie the same as that used torthe BFE.
Check the measurement used.
a) Top of bottom floor (Inciuding basement, crawispace, or enclosure floor) �,,� �eet ❑ meters
b) Top of the next higher floor _�f�1; ❑ feet [) meters
c) Bottom of the lowest horizontal structural member (V Zones only) N/A ❑ feet ❑ mete►s
• cn Attached garage (top oi slab) N/A ❑ feet [] meters
e) Lowest elevatlon of machinery or equipment aervici�g the building _�� [�'�est ❑ meters
(Deecribe type of equlpment and location i� Comments)
� Lowest edjacent (finished) grade next to bullding (LAG) �, � 1.� t� et ❑ meters
g) Higheat adjacent (Mished) grede �ext to building (HAG) �� Q'feet ❑ meters
h) l,owest adJacent g�ade at loweat elevatlon of deck or stairs, including structural support N/� ❑ feet ❑ meters
SECTION D- SURVEYOR, ENCiINEER, OR ARCHITEC7 CERTIFICATION
Thls certification Is to be signed and sealed by a land surveyor, engineer, or archftect authorized by law to cert(ty elevatlon '
information. I cerilly that the lnformadon on fhfs Cenlficate repr�sents my besf eAiorts to lnterp�et the dsfa avellable.
! un rsfend that sny false stafement may be punishable by flne orlmprisonment under 18 U.S. Code, Secfton 1001.
�heck here if comments are provided on beck of form. Were latftude and longitude in�S�e tion A provided by a
Check here If attachments. Iicansed land surveyoi't p'Yes ❑ No
Certltler's Name LARRY L. EVANS License Numbe� PLS # 2937
Titte LAND SURVEYOR
Atldress 1460 BELTREE� ST
Signature � , , , , .r
Company Name
Cfly DUNEOIN,
EVANS LAND SURVEYINC3, INC.
State FL ZIP Code 34698
Date Q�_�7_�3 Telephone (727)7343821
''�:���l�n �
r3[.;��;;r�:
�r�rrv,Y �-,.�;v i; �n these spaces, copy the corresponding information from Sect(on A_
Address
��' uL�� /Lv�!
and/or Bldg. No.j or P.O. Route and Box No.
l.% �
�T�.�.... B���N , State �,�, Z�P �ade
„ SECTION D- SURVEYOR, ENC3INEER, OR ARCHITECT CERTIFICATION (CONTINUED)y {�Y� i'�}���1,�;a<�,� �� � 3; ;_
Copy both sides of thls Elevation CertlBcate for (1) community offtdal, (2) Insurance agenVcompany, and (3) building owner.
comments C2�L); 15 14r�1 c.xr�r��o�, ,��� e�MPR�s�o� o;�l � G,�oUNf� L�V��..,. pe��
�
Slgnature
SECTION � -
CtCVH � IVN
uate Q,.,�7_�� -
URVEY NOT REQUIR�b) FOR ZONE AO AND
ror cones AO and A(without BFE), complete Items E1-E5. if the Certificate is Intended to support a LOMA or LOMR-F request, complete Sectlons A, B,
and C, Fof Items E1-�4, use natural grade, if available. Check tfis measurement used. In Puerto Rico only. enter metets.
E1. Provkle elevatton informatlon (or the foHowing and check the appropriate boxes to show whether the elevatlon Is�bQy��Q�oW�_��aMe����,
grade (HAG) and the lowest adia�ent °rs,��AG�,_ _�.__ �_____.. �__T_�_
, . � _. __. .,,,,._�,�,��„����,,,�eeme�x, orerwspace,-w encloeure) Is_ _ _ _ . _
bj Top of bottom floor (Inciuding basement, craveispace, or enclosure) is � � fieef ❑ meters ❑ e�bove or p below the HAC3.
E2. For Butlding Olagrams 6-9 yvith p 8� • ❑ feet ❑ meters ❑ above or [] bslow the LAG.
permanent flood o enin a ovided in 3ection A Items 8 and/or 9(se�e pages 8-9 oF inshuctlons), the next higher floor
(elevatlon C2.b tn the dfagrams) of the butiding is . ❑ feet
E3. Atteched garage (top of slab) is I� meters � above or [� below the HAG.
❑ feet [] metere ❑ above or ❑ below the HAG.
E4. Top of plffiform of machinery and/or equipment serv(cing the butiding �s
E5. Zone AO only: If no flood depth number ia available, is the top of the bottom floor elevat�ed In accordanoe w� the com a ibty's flo dp aA management '
_ ordlnance? ❑ Yes ❑ No ❑ Unknow�. The local official must certify thia lnformation in 3ection O.
„ SECTION F- PROPERTY OWNER (OR OWNER'3 REPRESENTATIVE) CERTIFICATION
The property owner or owne�'s authorized repreaentative who oompletes 3ectlone A, B, and E tor Zone A(without a FEMA-issued or communfty-Issued BFE)
or Zone AO must sign here. The statements In 5ections A, B, and E are correct to the best of my k�owledge.
Property Owner�s a Owners Authorized Representative's Name
Addresa
Signature
Comments
City
Date
O - COMMUN�TY INFORMATION
State
Telephone
ZIP Code
��, i: : :-t= �i,=� -
----- -• ••-•-� ••. 4��� ��� ��� Uy,aw or orainance to administer the csomm�unfty's floodplain ma�agement ordi�ance ca� comp�ete Sectiona A, e, C(or E), and O
of thls Elevat(on Ce�tfficate. Compiete the appikable Item(e) and eign below. Cheok the measurement ugeci In Items G8-010. In Puerto Rico only, enter rneters.
G7 •❑ The infarmatlon in Section C was taken trom othe d
O2. ❑
G3. ❑
... .,
is authorized by law to certify eteyation i�tormatlon. (Indicateathe sourcea nd datetof the elevetion da a in�the om�n� a�q �j�'�°r erchftect who
A communfty offictai completed 3ection E for a bupding Iocated in Zone A(without a FEMA-Issued or communfty-issued BFE) or Zone AO,
The foliow(n8 information (Items G4G10) is provided (or community tloodpialn manegement purposes,
..:. .�.._�--
� .. . ������a I�u1114C1
G5. Date Permit Issued
57: This perm(t has been lasued fo�: ❑ New Constructlon
❑ Substanti I I
G6. Date Certtflcate Of Compliance/Occupancy Issued
.38. Elevetion of as-buiR iowesi floor ��nc�uding basement) oi the building: a mprovement
39. BFE or (in 2one AO) depth of tlooding at the buflding elte: ��ee� � meters
310. Community's desig� flood elevation: ❑ feet ❑ metets
❑ feet ❑ meters
Local Ofticial's Name
Tltie
Community Name _
Telephone
5ignature _ __ _.
Date
Comments
Datum
Datum
Datum
�1�= , �, : :i: iL�� =
� EL�V�ITION CERTIFICATE, page s guiiding Photographs
,
aee Instructions for Item A6.
IMPORTANT: In these spaces, copy the correspo�ding info�mation from Section A. FOi� INSURANG� COMPAt�Y.t�SE�
,'la:
Buiiding Street Address (inclu�ing Apt., Unit, Suite, and/or Bid . No.j or P.O. Route and Box No. PWicy Number. ; f
��..� N N �f�N�� � - -
Ciry State • ZIP Code Compatty NAit� N�1tNber '
C.LE�4�.�/�TE� �Ef}�-,f-f � � 33����
. , ,.
..,... ., , _. _: : . , .
_. . _ �
If using the Elevation Cefificate to obtaln NFIP flood insurance, affix at least 2 building photographs below according to the instructions
fior Item A6. Identitj+ all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side
;View.' When applicable, photographs must show the foundation with reprRSentative examples of the flood openings or vents, as
indicated in Section A8. lf submitting more photographs than will fit on this page, use the Continuation Page.
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