Loading...
600 MANDALAY AVE� 4a ` U.S.DEPj1RTMENTOFHOMELANDSECURITY ELE\/ATION CERTIFICA�'E FEDERAC EMERdENCY MANAOEMENT AOENCY Nadonal Flood Insurance Program : Important: Read the instructions on pages 1-8. ' SECTION A - PROPERTY INFORMATION A1. BuIlding Owner's Name �' � ��G I A2 Buildi g Street Address (including Apt., Unit, uite, and/or Bidg. No.) or P.O. Route and Box No. n�0 N�i-�� ��n1U� c�ry G��/-� IZ �nl st�te �� ziP coae -3 l�7"�-� ��.l� �-I-4 � A3. Propertv Descriotion n_nt p�� Ri,,..4 n�.,...�--: ,---- ., ' ��� � OMB No. 1660-0008 Expiration Date: July 31, 2015 v ZZ, • � <jp ---••� -._, ." �� �•u���ue�, �egai uescri t�on, etc.) �(o�D b � 1� 13LC� �EV, Mr�P �f C�in/�Z, �E/�GF-i A4. Bullding Use (e.g., Residential, Non-Residentiai Addition, Accessor , etC.) GON►ME./�Z GI r4 l.. A5. Latitude/Longitude: Lat. 27° 5� � D� ,'rv' '� Long. BZ° � O' A6. Attach at least 2 photograph of th.e building if the Certiflcate la being used to obtaln flood ineurence. zontal Datum: ❑ NAD 1927 NAD 1883 A7. Buiiding Diagram Number � A6. For a building with a crawispace or enctoaure(s): a) Square footage of crewispace or enclosure(s) � A9� For a building wtth an attached garage: . N/� ` b) Number of permanent flood openings in the crawlepace sq ft a) Squa�e footage of altached garage $q {� or enclosure(s) within 1.0 foot abave adjacent grade b) Number of permanent tlood openinga in:the attached garage c) Total net erea of flood openings in AS.b ' with(n 1.O foot above adj8cent grade. d) Engineered flood openings? ❑ ye8 $q �" c) Totai net area ot tlood openinga In A9.b 8p �n _❑ No d) Engineered (lood openfn9s? ❑ Yes p No SEGTION �— FLOOD INSURANGE RATE MAP ( F I R M) I N F p R M A T I O N B1. NFIP Community Name & Community Number 62. Count Name C L.� R W�T � IZ 12 �j a 9(o Y Pi N E �.l_,A� s Ba. state ,�l , 84. MapiPanel Number 85, SufBx B6. FIRMindex Date B7. FIRM Panel 88. Fiood � 2103 � Q � D Z,. �, ,g _ ��_ b Effective/Revised Date Z ne(s) `� -a3-o3 � ! B10. Indicate the source of the Ba e Flood Elevatlon (BFE) data or base flood depth entered in Item B9, ❑ FIS Profile FIRM ❑ Community Determined ❑ Other/Source: . B11. Indicate elevat(on datum used for BFE in Item 88: O NGVD 1929 �AVD 1988 ❑ Other/Source: 812. Is the buflding located in a Goastai B�rrier Resources System (CBRS) area or Othervvise Protected Area (OPA)? Designation Date: ❑ CBRS . ❑ OPA 89: Ba�e Flood Elevation(s) (Zone Al;ause base flood depth) ❑ Yes L�!'No SECTION C— BUILDIN� ELEVAI'ION INFORMATIDN (SURVEY REQUIRED) Ct. Building elevations are based on: ❑ Construction Drawings' ❑ Buildtng Under Constructio�• Finiehe� C�nstructi�n "A new Elevation Certiflcete will be required when construction of the huilding is complete. C2. @levations — Zones A1-A30, AE, AH, A(with BFE), VE, Vt—V30, V(vWth BFE), AR, AR/A, AR/AE, AR/A1—A30, AR/AH, AR/AO. Complete Items C2.a—h below according to the buildin dfagrem specified in Item A7. In Puertb Rlco only, enter metera. Benchmark Utillzed: C 1 T� b GLIx1 R� Ve�tical Datum: .,� . 2 � N/�V D�g8 � Indicate elevation datum use for the etevatfona in Rems a) through h) belaw. ❑ NGVD 1929 NAVQ 1988 ❑ QthadSource: Datum used for building elevatlq�s must be the same as thet used fot'the BFE. Check the measurement used. a) Top of bottom floor Qncluding basement, crawlspece, or enclosure floor) "rJ .`� �eet ❑ meters b) Top of the next high�r floor N�� ❑ feet [I metens . c) Bottom of tFte Iowest horizontal structurat member (V Zones only) �--- I] feet ❑ meters � d) Attached garage (top o( slab) �'°/A _ ❑ feet ❑ meters e) Lowest elevation of inechinery or equipment servicing the buildfng �, 2 eet ❑ metefs ' (Describe type of equfpment end location in Commenta) � Lowest adjacent (finished) grade next to building (LAG) �� �et ❑ meters g) Highest adjacent (fln(shed) grade next to buiidln� (HAG) �! �pt p meters , h) Lowest adJacent grade at lowest elevation of deck or ataira, fncludfng atructural support �, � feet D:meters SECTION D- SURVEYOR, ENOINEER, OR ARCHITECT CERTIFICATION This certificatlon fs to be signed and sealed by a land surveyor, englneer, or architect authorized by law to certify elevation information. I cerfl/y thaf fhe lnformaflon on fhls Cerfllicafe represents my best efforts to lnterpret the data avallab/e. I, �u,/nderstend fhat any false stafemenf may be punlshable by flne orlmprisonmenf under 18 U.S. Code, SecHon 1001. Lv� Check here if comments are provided on back of form. Were latftude and longitude in S�t(on A provfded by a Ckl� Check here i( attachments. Iicensed land surveyor'7 0' Yes ❑ No CediBer's Name LARRY L. EVANS License Number PLS # 2937 Tftle LAND SURVEYOR Company Name EVANS LAND SURVEYING, INC. Address 1460 BELTREE9 5`T,�STE. 9 C(ty DUNEDIN, State FL ZIP Code 34698 Sfgnature oace 4—o6-zoi� Telephone (727) 7343821 ���_,�-��A {a° � �T .�'��� a���i��: ! ��,:tVA I WN t:kK l IFI(:A I t, p8g@ E T' , F�CTRTANT: In these spaces, copy the corresponding Informattori from Section A. ^'`�� � `- � �' �; B u i l d( n g S t re e t A d d r e s s i n c l u d i n g A p t., U n i t, S u i t e, a n d/ o r B l d N o.) o r P. O.R o u t e a n d B o x N o. ��,�� ', �,., r, ��:«, ��'��, Q 0 Nl !J .�D I.. � V E. J*1 ��.,. f ��� C(fy State ZIP Code � �' CLE,�fLV�/�T�12.. i�E/kGN- L, 337�7 SEC710N D- SURVEYOR, ENOINEER, OR ARCHITEGT CERTIFICATION (CONTINUED) Capy both sidea of this Elevation CertlRcate for (1) community offlcial, (2) Insurance agenUcompany, and (3) buiidfng owner. aomments G Z��l: I 5.�� C L� V'/�Ti ot�1 D� E�LEGYF� I G�L 0 UT L�.1'S., / ` Slgnature ��/1/G�,,�./1 : Date �I _ b B_ ZU I L� V ' l/ `i' �; 3ECTION E— ILDINC3 ELEVATION INFORMATION (3URVEY NOT REGIUIR�D) FOR ZONE AO AND ZON� A(WITHOUT BFE� : ; �-� i For Zonea AO and A(without BFE); compiete Items E1—E5. If the Certificate la Jntended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For Items E1—�4, use natu�el g�ede, if available: Check the measurement used. In Puerto Rico oniy, snte� meters. E1. Frovfda elevation information (or the following and check the appropriate boxee to ahow whether the elevatlon Ia above or below the highest adjacent grede (HAO) and the Iowest adjacent grade (LAG). a) 7op of bottoln tloor Qncluding basement, arawispace, or enclosure) is ❑ feet ❑ meters ❑ abova nr [] balow the HAG. b) Top of bottom floor (including basement, crawispace, or enalvaure) is L7 feet ❑ meters 0 above or [I below the LAG. E2. For Building Diagrema 6—� witFi permanent flood openin0a provided in Section A Items 8 and/or 9(see�pages 8-9 of Instructions), the next higher floo� (elevation C2.b in the diegrema) oi the building is ❑ feet ❑ meters ❑ above or CJ below the HAG. E3. Atteched garage (top of slab) Is . I� feet ❑ meters ❑ above or ❑ below the HAO. E4. Top of platform of machinery and/or equipment servfcing the buiiding 7s ❑ feet ❑ meter9 L� above or � below the HAG. E5. Zone AO �nly: If no tlood depth number is avallable, is the top of the bottom floor elevated in accordanoe w(th the community'a iloodplaln managemant ' ordinance? ❑ Yes ❑ No ❑ Unknown. The Iocal-of(icial must certlfy thla informatfon in Seotion G. � SECTION F— pROP�RTY OWNER (OR OWN�R'S REPRESENTATIVE) CERTIFICATION . The property owner or owner's autho�ized representat(ve who completes 5ectlona A, B, and E for Zone A(without a FEMA-fssued or.communtty-Issued BFE) or Zone AO must sign here. The statements in Sectlons A, B, and E ere correct to the Dest of my knowledge. � Property Owner's or Ovmer's Authorized Repreaentative's Name Addresa City Stete ZIP Code Sig�ature Commenta bate Telephone S 0�' . i- . .t:•�u=� � SEGTION � - COMMUNI,7Y IN�ORMATIUN (QPTIDNAL) 1'he local official who is authorized by law or orclfnance to administer the commt�nity's floodplatn management ordinance can complete Sections A, B, G(or E), �nd O oi this Elevation Ce�titicate. Complete the applicable Item(s) end sign below. Gheck the measurement used in Items G8=O10. In Puerto Rico only, enter meters. G1. ❑ The informatfon in Section C was taken from other documentatlon that has been sipned and sealed by a Ifcensed surveyor, enginee�, or arohitect who is authorized by law to aertffy elevation information. (Indicate the source and date of the eleyatlon data in the Comments area below.) G2. C7 A community official completed 3ectfon E for a building located in Zone A(without a FEMA-iasued or community-issued BFE) or Zone AO. G3. ❑ The foilowing informetion (Items GR—G10) is provlded for community floodplain management purpoaes: C34. Permit Number G5. D�te Permit Issued G6. Date CertiBcate Of Compliance/Occupancy Issued G7. This permit has been Issued for: CI New Constructlon ❑ 5ubatantial Improvement , G8. Elevatlon of as-built loweat floor (including basement) af the building: ❑ feet ❑ meters Datum G9. BFE or (in Zone AO) depth of flooding at the bufiding site: ❑ feet ❑ meters Datum G70. Community's design flood elevation: ❑ feet ❑ meters Datum. Looal Ofticial's Name Community Nama Signature Comments Title Telephone Date ■ � ❑ �b,eek here i(;a�tt �,hments. � � T t ELEVEiT10N CERTIFICATE, page 3 Building Photographs See Instructions for Item A6. IMPORTANT: In these spaces, copy the corresponding information from Section A. FC�R INSURANC� CdMPANY �JS�, , Building Street Address (inciuding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. PolicyNumber _ t�co �L1J�N.���t�Y �-v'c� uL, City � State ZIP Code Cbrr�pany NAIC NuMber C.�L►=� fZ V�1 1 L l� � �/-� �-1-� -�-L . � �, �' � If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicabie, photographs must show the foundation with representative examples of the fiood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. r_=�;;.�'.�,�.,. �^�----.-.-a.,.:� �'� ��y j � � � � t: � ^� j" ^�� - ' B�, — , � �/it�"dQ J�;d���i.�e -_ - �,�� �, _ ; ,;. � �.� � -.. � � __�.,�.a,...., _ � ` I s. � � � .. . �. �. .. _ ._..__.,_,,,,.� r.. ��� ' � �, q _ '��r--- �„°'--_ �.. ��� _�„ � ` - - �. � �, ;s,�.,a, e�,�. ��� �t , _ --� — ---� _ _ .- ,� �- , , � �. . . � � . .. � �� � �11 � � � � �� �^ - l � � � Y � G i � � �1� � � �-.�i �