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1912 CALUMET ST #CNage�of3 l� ( _ a �_ � �j- �Q� QQ ��'� ��dv U.S. DEPARTMENT pF HOMEtAND SECURITY G� Federal Emergency Mana ELEVATION CERTIFIC National Flood Insurance roy�mA9e"� ATE OMB No. 166p-0008 Important: Read the instructions on a �p��es February 2g, 2pG�, _ P 9es 1-8. - _ �� B�U �"9� Ner's Name SECTION A- PROPERTY INFORMATION For Insurance CompanY Use: A2. Building Street Address {indudin A Policy Number 1912 CAL 9 P��, Unit, Suite, and/or Bidg. No.) or P.O. Route and Bpx No. TREET g ITE �� mpany NAIC Number ��RRWA7ER A3 a� ----° State _ A4. Building Use (e.g., Resitlential, Non-Residen6al, Addition, A��o�, �� A5. Latitude/Longitude: Lat. N 27d 59 087' A6. Attach at least 2 photoyraphs of the building if the Certificate s be,^9 �� 90 obtain flood insurance. A7• Building Diagram Number H�ontal Datum: [� NAD 1927 � Nqp 1983 A8. For a building wi(h a cravN s— a) Square footage of crawl �ce or endosure(s). Provide: space or enGosure(s) A9� For a building with an attaGied gar� e, b) No. of pertnanent flood openings in the crawl sPace or �� ft ai Square footage of attached garage provide" enclosure(s) walls within 1.0 foot abovy adjacent grade /r a _ � sq ft c) Total net area of fl p� 9 b) No. of permanent flood op��js in the attact� ya�9e �d o nin s in AB.b walls within 1.0 foot aboye ad�acent �— ��n c) Toql net area of flood o 9�de �_ Penings in q9.b cCrr�r... .� � cn in - "�� - rWUD INSURANCE ReTe u.o Name INFORMATION �� •-•. � �nm rane� 68. Flopd 12103C - 0107 H Effecxive/Revised Date Zone�s� B�O. Indicate the source of the Base Flood E e! U'on (BFE) data or base flo� dep entered in Item 69. AE ❑ FIS Prpfile � FtRM B11. Indicate efevation datum � Community p�e�� Other (Descripe� 612. Is the building lopted in a CoastaBgarrier Rm B9: ❑ NGVD 1929 Designation Date �souroes System (CBRS) a� o�r pthenMS� ProO � AreaD ( pq� � CBRS � OPA �.- -"• •��• �- au��.u1NG ELEVATION INFORMATION /SURVGV c�.,�...,.-.,. Ci. Buildinn n�e�.�s:,..._ _ - • ��+w ��evauon(s) (Zone AO, use base floo� depth) � Yes � No w�, w�- LJ Constr�ction Drawing � -- -..�•.,� 'A new Elevation Certificate will be requfr�ed when cons S ❑ Building Uncier Con,qtN�{�on` C2. Elevations -Zones A1 q30, AE, AH, A �� °f the building is complete. � Finished Construction (with BFE), VE, V1-V30, V(�th BFE), AR, AR/A, AR/AE, AR/A1 A3p, q�qH q�A� �mplete Items C2.a� be�o�n+ eccording to the building diagram specified in Item q7. Benchmark Utilized �5 7� g�F�DT � A[�-..Fa 993 - �� S' Vertical Datum�_gg ConversioNCommerrts TRAV p1� �_ N CM_ �y� g E� C� P�N�PPL Rn- d' F r; � G 4LT HWY � o a) Top of bottom floor (indudin Ch� � m��nt used. 9 basement, craw� space, or enGasure floor) 52 p5 �]X feet b) Top of the next higher floor � meters (Puerto Ri� only) �) Bottom of the lowest twrizontal structure� member (V Zones only) ��a � f� � meters (Puerto Rico only) d) Attached garage (top of sfab) —� f�t ❑ meters (Puerto Rico onfY) e) Lowest elevation of machinery or equipment serviciny trye building �� t ❑ meters (Puerto Rico only) (Describe bPe of equipm�t in Commerrts) - Q feet ❑ meters (Puerto Rico only) � �owest adjacent (fmished) 9rade (LAG) g) Highest adjacent (finished) grade (HAG) —`r'� � � f�t ❑ meters (PUerto R' � /�� ico only) , �' 51 69 Q feet � meters (Puerto Rico only) � SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and �I� by a land surveyor, engi�, or art�itect a informaUOn. l certi(y U�at the information on this Certifiqte re �� bY �w to certi(y eleva�n 1 underStand that any fal5e statement ma be �nts my best e/forts to inferExet the data available. y punishable by fine orimprisonment under 18 U,3. Code Se�� pp� �� r X Chedc here if comments are provided on back of form. Ce�er's Name J v r e la R h �icense Number rn�e a.�,ro��..,..� �..---- -- • • - Company Name agna[ure --- -paz. �., r� Js� � � ��s yl1�/2009 Telephone ' 1- 1 FEMA FOm181-31, February 2006 See �eve�se side fo� cAntinuatio�. �:Y G�NSE lVUMg Q� , 6�g� � �� .�..-- T.ti 4 y � �o,, srn� oF Q¢ F� FLORIDA �P s'�N'4� S URV£`*�4 � 9/25/2009 Reptac�s aN p�ev�o�s etln�o�s Page 2 of 2 ` FL0909.OP10 IMPORTANT: In these spaces, copy the (inGuding Apt., Unit, Suite, City information from Section A. ) or P.O. Route and Box No. State For Insurance Company Use: Policy Number ZIP Code � Company SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community offiaai, (2) insurdnce agenUcompany, and (3) building ownec M�� IS AIR CONDITIONING Centerline Road Elevation: 50.60 Signature j�� /„r Date 9/2�� J ❑ Check here if attachments SECTION E- BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE), �mplete Items E7-E5. If the Certificate is intended to support a LOMA or LOMR-F request, compiete Sedions A, B, and C. For Items E1-E4, use natural grade, 'rf available. Chedc the measurement used. In Puerto Rico only, enter meters. E1 E2. E3. E4. E5. Provide elevation information for the following and check the appropriate boxes to shav whether the elevation is above or below the highest adjacent grade (HAG) and the iowest adjacent grade (LAG). a) Top of bottom floor (induding basement, crawl space, or endosure) is ❑X feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom fl�r (indudin9 basement, crawl space, or enGOSUre) is � feet ❑ meters ❑ above or ❑ below the LAG. For Buiiding Diag2ms 6-8 with permanent flood openings provided in S A Items 8 andlor 9(seep� e 8 of InsVudions), the next higher floor (eleva6on C2.b in the tliagrams) of the buiiding is � feet meters ❑ above or LJ below the HAG. Attached garage (top of slab) is � feet � meters � above or � belaw the HAG. Top of piattorm of machinery and/or equipment serviang the building is Q feet ❑ meters � above or � below the HAG. Zone AO onlr If no flood depth number is available, is the top of the bottan floor elevated in accordance with the communit�s floodplain management ordinanoe? ❑ Yes ❑ No ❑ U�known. The local official must ceRify this infortnation in Section G. SECTIONF-PROPERTY0IAMER(OROWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owner's authorized representative who completes Sec�tions A, B, and E for Zone A(without a FEMA-issued or community-issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address Signature Comments City Date State ZIP Code Telephone ❑ Chedc here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplam management ordmance pn cwnplete Sed�ons A, B, C(or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8. and G9. G1. � The infqrtnation �n Section C was taken from other documentatlon that has �en signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information_ (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or Zone AO. G3. ❑ The following infortnation (Items G4.-G9.) is provided for community floodplain managem�t purposes. G4_ Permft Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for. ❑ New ConsVUCtion ❑ Substantial Improvement G8. Elevation of as-built lawest floor (induding basement) of the building: ❑ feet ❑ meters (PR) Datum G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters (PR) Datum Local Official's Name Community Name Signature TRIe Telephone Date ❑ Chedc here if attachmerrts FEMA Form 81-31, February 2006 Replaces all previous editions . ; � Buiiding Photographs See Instructions for Ite A6. For Insurance Co pany Building Sireet Address including Apt., Unit, Suite, and/or Bldg. No. or P.O. Route and Box No. Poi�cy Nu er 1912 CALUMET STREET SUITE C Ciry State IP Code Co panyNAICNu er If using the Elevation Certificate to o tain NFIP flood insurance, affix at least t o uilding photographs elo according to the instructions for Ite A6. Identify all photographs ith: date taken; "Front View" and "Rear Vie�'; and, if required, "Right Side View" and "Left Side View." If submitting more photographs than ill fit on this page, use the Continuation Page, follo ing. ��",��/ � 1 Ji L, ��`Y, _�� . i� � � ;�� ;� �1 �-� �� A � ��i l ti; ,� .. � t,� F � -�^#�� "a�� `,'� ��It�� U�� f��c, !� �� , t� � :�� . . 4� � � �,•._ ,r ��,� - J�If2 E �� , �..o+,, $ � ,� "=' _ � � G�A�'S j� � �� ,r,"� �c �"�= � � '� . , 'W,. i _. ' y . . i :�i(t 1 I� - �`-: