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530 MANDALAY BLVDU.S.DE�'ARTMENTOFHOMELANDSECURITY ��,,,�v��ON'CG�RTI�ICA�E " PEDERAL EMEROENCY MANA(3EMENT AGENCY OMB NO. 'I66O-OOOB NallonalFloodlnsurancePrograia �m�Jprtant: Read the instructions on pages 1-8. Expiration Date: July 31, 2015 SECTION A - PROPERTY INFORMATION ,� ''� � � s;' {�' " y� � � . ' ;� �A1. Building Owner's Name , L/� SAL MnTE.� �-�iNDO ./'�SSoG. ��`�� r ' ,,� . ' . .h .. + * � �� A2. Buflding Street Address (includfng A t., Unit, 5uite, andlor Bidg. No.) or P.O. Route and Box No. �' � •(. '? ',�y ��. �o r•1 � L �oUC_ ��/ (� G' ��; c�ry G LE./�t 12 W/'t�"�� t3 �/� GI� � stat� �L� ziP cod� �3 � G,, A3. Property Descriptlon (Lot and Block Numbers, Tax Peroel Number, Legal Descripffon, �etc.) ..�.._�95-�9°�5-5030 8-00�0- Ioit� � . ,�__, A4. Building Use (e.g., Residentfal, Non-Residential, Addition, Aaceseo�, eto.) ��'MM C'..�R.C.1,�; L MO`j��L A5. Latitude/Longitude: Lat. Z° 5 � Q n, Z" Long. _ � 2 �,�'�_p" Horizontal Atum: ❑ NAD 1927 NAD 1883 A6. Attach at isast 2 photograph of the building if the Certificate is 6einD used to obtain flood inaurance. A7. Building Diagram Number � : Ae. For a buildi�g wlth a orawiapace or enctosure(s) � A9. For a building wfth an attaahed garage: � a) Square footage of crawlspace or enclosure(s) � aq ft a) Square footage of atteched gerege � gq R' b) Number of permanent flood openinps In the crawlspace b) Number of permanent tlood openings tn the attaohed.Darage or enclosure(s) wlthin 1 A foot above adjaoent grade Within 1 A foot above adjAcent grade - c) Total net area of flood openings in AB.b eq in c) Totai net area of tinod openings In A9.b � aq in d) Engineered flood openings? ❑ Yea ❑ No d) Engfneered tlood openinga7 [] Yea [7 No 3ECTION �- F�OQD INSURAINCE RATE IVIAP (FIRM) INFORMATION B1. NFIP Comm�unity Nn�a_mre�C�o�mmunity Number 82. County.Name �� G�E� v�i � 2 � �, /-��j B4. Map/Panel Number 85. SufFlx 68. FIRM Index Date B7. FIRM Panei BS. Flood � 2 � 0�� b � O Z �q g_ �$_ p p Effective/I�?e�vise�d�ate Zone�(s-) � -O Fl1Q. Indloate the source of the Base Flood Elevation (BFE) data or b�se flood depth entered In Item B9. ❑ F�S Proflte G�IRM ❑ Commun(ty Determined ❑ Other/Source: . 811. Indicate elevation datum used for BFE In Item B9: ❑ NOVD 19�9 �NAVD 1988 [] OtheNSource: 812. Ia the buiiding located In a Coastal Barrier Resources Syatem (CBRS) area or Otherwise protected Area (OPA)? Designation Date: ❑ C�3R5 C! OPA ss. scete .�,�a 12 � b� 89. 9ase Flood Elevafton(s) (Zone AO, use�ba1e�flood depth) � ❑ Yes � L�l' No C1. Building elevations are based on: 0 Construcfion Drawinsa" ❑ Buiiding Under Construction' �inished Conatruction ,�.. "A new Elevation Ge�tif(cate will be required wNen oonatruction of the building is complete. ;� C2. �levations -Zones A1-A30, AE, AH, A(with 8FE), VE, V1-V30, V(with BFE), Af�, AR/A, AR/AE, AR/A1-A30, ARlAH, AR/AO. Complete itema C2.a-h below accord(ng to the building diagram speciBed in Item A7. In puertb Rico only, enter meters. � �� Benahmark Utilized: ��Y� �� G�-W�, �}—OZ Vertioal Datum: 5, Z � .� Indicate elevation datum used for the elevations in items a) through h); belpw. C7 NC3VD 1929 �"NAVD 1988 ❑ Qther/Source: 4�_� Datum used for bullding elevati0ns must be the same as that used for;the BFE. ;; , Check the measurement used. ' a) Top of bottom floor (Including basement, crawispace, or enclosure (Ioor) �� 3 I,� teet ❑ meters '--1� b) Top of the next hfpher tloor ,�r' ,.,_ [� teet "[1 meters �� c) Boitom of tFie lowest horizontal atructural member (V Zones only) �, �] feet ❑ meters ``� d) Attached garage (top of slab) _ N [] feet [] meters � e) Lowest elevation of machinery or equipment servicing the building �� C�}'�eet O meters (Deacribe type of equipment and locatlon in Comments) �I ��> f� Lowest adjacent (finished) grade next to buildin8 (LAG) `T � � � re t Q meters .,,� g) Highest adjecent (Finiahed) grede next to buildin0 (HAG) �,�_, �t � meters "� h) Lowest adJacent grade at lowest elevation of deck or stairs, including sttuotural support NLA ❑ feet ❑ meters �•� SECTION D- SURVEYOR, EN�IN�ER, UR ARCHITECT C�RTI�ICATION This certificatlon is to be signed and sealed by a land surveyor, engineer, or architecf authorized by law to ceftify elevatlon �" information. I certlry fhai theJnfnrmallon on thls Cerf/flcate represenfs my best elPorfs to lnferpret fhe data ava!/able. ��='� ,�4 � M�,," �1 un erstand fhat any false stafement may be punlshab/e by fine orJmprisonmenf under 1B U.S. Code, Secflon 1001. �� `� '�'�� d —/Check here if comments are provided on beck of form. Were latitude and longitude in Sey t(on A provided by a , �'��'� �� s r : ,�� ... f� Check here if attachments. Ilcensed land surveyor7 [d'Yes ❑ No tly .�`,� �� . Certifier's Name LARRY L. EVANS License NumbeY PLS # 2937 g''? �� * ��+��+ � �� ° �` � ` Tltle LAND SURVEYOR Company Name EVAN8 LAND SURVEYWC3, INC. ��e Y"• .��`�w��*= �� "� '�', . '��,.t��iY��'.'"`. �°�` � Address 1460 BELTREES 9T�TE. 9 City DUNEDIN, State FL ZIP Code 34898 ,;5,, �, x � •,. ` �;: ._ n.� .1� � r�„ � � ��a w,v Signature Date Telephone (727) 734-3821 Q2`�J"�� , .. � �`:�. �� ,�r;�e , '. ;�''"� � �, i iutv t;ttt i 1r1�� i t, page �. )RTANt: In these spac�s, copy the aorresponding informatton trortt A. 8 � 9 P � r j � C�, zbp4P �;i,Y"�i � n��.�*l�F � sk �1V'��`;�� }: : u n Street Address includin A t., Unit Suite and/or Bldg. No.�) or p.O. (iout� elid Box No. ��i�i �i�t'�� Q ✓ .{� � �:�` "� S '� R8 '� Y 'L �� , 5 iJdt3�� i [�i �. n � �� N.�� - � - �u �-� J � .�. � , �: �, ,�k �:��;��,� ,. �� .�� f , �, ��.;� City State ZIP Code � � � ��r `� ' ��i �'F�2krFt „� GL��1/-�T�-12 1�,�.�c�- ��: ��7� �p:;.: ��'� � �,4 ��.��'�, ��..fi�,k:� SEC710N D- 8UF2VEYOFt, ENQINEER, bF� ARCHITECT CERTIFICAtIdN (CQNTINU�D) ' Copy both sides of this Elevation Gertificate for (1) community otticfal, (2) Insurahce agent/campany, and (3) building owner. : � Comments G2,d �; �I�� 5t�{�g, M��N��-� W/4�j`�CZ 1-}�-}�T'E,1�.5 iNs-T'��.�ED ��NiN� TN- E►3 U t I.-.D I N E,', , ' Signature Date 2 _ � � _ �b �L�- � , , ' 3ECTION �- ILDINC3 �LEVATION INFOftMATION (3URVEY NOT REQUIt2E�) FOR Zl7N� A0 AND ZON� A(WITHOU �FE) : .:,�..._..,.�.� For Zones AO and A(without BFE); complete Items E1-E5. If tha Certlflcate ig intended to suppon a LOMA or LdMR-F tequeat, complete Sections A, 6, and G For Items E1-�4; use natural grede, if availa6le. Check the measurementLsed. ln Puerto Rico oniy; enter metera. , E1. Provide elevation intormafion for the following and cheok the appropriate boxes to ahow whether the elevakion is above orbelow the higheat adjacent grade (HAO) end the lowest edjacent grade (I.AG). , a) Top of bottom ftoor (including basement, oraWlapace, nr enclosure) ig - ❑ feet � meters ❑ above or [] beiow the HAG. b) Top ot bottom floor (including basement, crawlapace, or enclosur�) Is , (� feet [� meters � above or [] below the LAG. �2. For 6uliding Dlagrams 6-9 witli permanent flood openin0a provided in 5ection A, Items 8 and/or 9(ae�e,,pa8es 9-9 oF Instructions), the next higher floor (elevation C2.b in the diagrema) of the buiiding is _ .. ❑ feet ❑ meters ❑ above or (] below the HAG. E3. Attached garage (top o( slab) is . (] feet ❑ meters �] aboVe or [I below the HAG. E4. Top of platform of machinery end/or equipment aervictng tfie buiiding is ❑ f�et [1 meter� l� above or C1 betow the HAG. E5. Zone A0 only: It no flood depth number i� available, Is the top of the bottom flobr elevated in 9ccordanoe with the oommunity's floodplaln mariagement ' ordinance? � Yes O No O Unknuwn. The local oiticial must Ce�tify this InFormation In 5ectlon G. �� SECTION F-�'ROPERTY OWNER (OR OWN�R`� REPRESENTATIVE) CERTIFICATION . .�. � 7he property owner or owner's authoriaed representative Who oompletes Sections A, B, end E for Zone A(without a FEMA-issued or cbmmu�fty-issued BF�) { vr Zone AO must aign here. The statemenfa In Secttons A, B, and E are correcl to the best of my knowledge. � Property Owner'a or Owner's Authorized Representative's Name _ , . fAddresa City State ZIP Code _! , _. ; Slg�ature i Date Telephone ; i , _ _ ._-- � Comments , ; [� c heck here if attachments. SEGTION Q � COMMUNItY IN�C�RMA�'IQN (QPTIdNALj ,; _ . _ lihe local officiai who Is aufhorized by law or ordinance to edmfnlat�r the commNnity'� flo4dpiain management ordinance can aoirlpiste 8ect ons A, B, C(or E), and a o,f thia Elevation Certificate. Complete tha applicabie Item(s) �nd �Ign t�elow. CheCk the me�surement used in Items G8-010.1n Pue�to Rico only, enter meters. C:,1. G1 The informaifon in Section C was taken trom other documentetion that has been signed and sealed by a Ilcensed surveyor, enginee�, or archikect who is authorized by law to certify elevation inform�tion. (Indicate the 's.bu�ce and date of the etevation daka In the Comments area below.) C�2. I� A community offlcial completed Seotion E for a building Iooated in Zone A(wftfiout a FEMA-issued or community-Issued B,FE).or Zone RO. (.�3. [] The following intormation Qtems G4-G10) is provided for community floodplain management purposes: rG4: Permit Number G5: D�te Permit lasued G6. Date Certiflcate Of Compliahce/Occupancy Issued l. C37. Thia permit has been igsued for: ❑ New Constructlon ❑ Substantlal Imprnvem�tlt �8. Elevatfon of as-built lowest floor (including basement) of the buiiding: -..� . ❑ feet Cl meters Datum C39. BFE or (in Zone AO) depth of tlooding at the bullding site; C� te�t �J metera Datum C31Q. Community's design flood elevatlon; ' ❑ feet ❑ metere Datum � Local Qfflr•ial'x Narne Ynl� � Community Name - ' 7elephone ^ Si�nature ----- pete Commenta ❑ Check here If atta�hmenta ' ELEVATION CERTIFICATE, page 3 gu��d�ng Phofiographs See Instructions for Item A6. IMPORTANT: In these spaces, copy the corresponding information from Section A. �'o�t INSUI��INC� GOMPANY, UsE Building Street Address (including Apt., Unit, Suite, and/or Bldg. `No�.) opr P.O. Route and Box No. �' r�/'fL �'�Ul.3l.� V�(�Q PolieyNumber:" City ry State ZIP Code Corripany NAIG NuFnber: ��Ai��t;�T�('` �'��.� �-_ � ; � If using the Elevation Certificate to obtain tVFIP flood insurance, a�x 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 applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. r , - — .�,ry: �. �.,; � � � �`� � �� . . # a: �re, �- s� - � -Y� �E � er � j __.�._�! �- � ! � +teae�� ` � � � �� Q �' �' ��;' '�, � �. � � �7� � T� "%t.. �;: , �� p, ..- � -�-..,.. ...::� _ -..��- . �-- :��.% �, � -�� > '� > 1 �� —� � 4J �� rv�� y � �. - - � ,��~ � u1 � F- Q `�- � � ,� �-� � � .� NJ � l"(5 .�. f� �ELEVATION CERTIFICATE, page 4 guilding Photographs Continuation Page IMPORTANT: In these spaces, capy the corresponding information from Section A. FOR INSURANCE COMPANY USE ' Building Street Address (including Apt., Unit, Suite, and/or Bldg. No. or P.O. Route and Box No. Policy Number. `p �' �' ' +�% !�!� � �` U �..C,1J� (�' L-� City State ZIP Code Company NAIC Number: ��,t��vJ/� 1 �t2 ��Ac.�-E � �� --, - -f-� , � a.,,� w � �� If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify 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 representative examples of the flood openings or vents, as indicated in Section A8. ", � i � r,! � ri_. ? � ,R r� .. -..:;:i'u .. �� ' � �3 � � j .� � `� r� � � � � � ,. w_ � �x��°�� , ; �� _ _-- -- - A.� � µ _ -..__ , � �� w � � � �-�'.'�' � 1� : � ,,•• � � �� `�� .-- �� _ .. . _ �. a+ .�. � _ �_ � ti,_, � .. , � "" -�� .�. � __ _.. �._._� �..xc--�"�"�` '-^°"'"- ,n �,. , � �'" E-i.� , : , � , ,( y � s� � S _:�, ?,, _ r �� ,� 3 - rt .,,;�"'�',. � - ____. ___ .� � �� ; �� . ,_.: �_ . , �^� , _ _ _ ,ri.y __ ; � __ .;, � # � --s- l �� . ;�