405 VENETIAN DRPag� 1 cf :� rrot+�alid without ali three pages
U.S. DEPARTWiENT OF HOMELAND SECURITI
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICATf �
Important: Read the instnactions on pages 1-9.
SECTION A - PROPERTY INFORMATION
A2. Buiiding Street Address (inGuding Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
City
A3. Property Llescription (Lot and Bbck
State
OMB No. 1660-0008
Expires March 31, 2012
A4. Building Use (e.g., Residential, No�-Residen6al, Additlon, Accessory, etc.) T � � `J
A5. Latitude/Longitude: Lat. 27 5911.5 N Long. 82 47 48.5 W Horizo t�MiiN��M��'� 3
A6. Attach at least 2 photographs of the building if the Certif'�cate is being used to obtain flood insurance. CI OF CLEARWA ,
A7. Building Diagram Number�_
A8. For a buflding with a crawispace or endosure(s): A9. For a buiWing with an attached garage:
a} Square footage of crawlspace or enclosure(s) 1640 Sq � a) Square footage of attached garage WA Sy }�
b) No. of permanent flood openings in the crawispace or b) No. of permanent flood open(ngs in the attached garage
enclosure(s) within 1.0 foot above adjacer►t grade 78 within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in ASb 1170 sq in c) Total net area of flaod openings in A9.b 0 sq in
d) Engineered flood openings? � Yes Q No d) Engineeced flood openings? � Yes � No
SECTION B- FIOOD INSURANCE RATE MAP (FIRM) INFORMATION
81. NFIP Community Name & Community Number 62. County Name 83. State
tta. nnap�Panel Number BS_ Suffix 66. FIRM index 67. FIRM Panel B8. Fiood 89. Base Flood ElevaUon(s) (Zone
Date Effective/Revised Date Zone(s) AO, use base flood depth)
12103C - 0106 H 18/Z009 05N7N5 AE 12
610. I�dicate the source of the Base Flood Elevation {BFE) data or base flood depth entered In item B9.
� FIS Profile � FIRM Community Determined [] Other {Describe)
811. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1.988 � Other (Describe)
612. Is the building located in a Coastal Barrier Resources System (CBORS) area o� herwise Protected Area (OPA)? � Yes � No
Designation Oate CBRS OPA
SECTION C- BUILDING ELEVATION fNFORMATION (SURVEY REQUIREDj
C1. Bullding elevations are based on: ❑ Construcxion Drawings• ❑ Buitding Under Construction• � Flnished Construc
`A new Eleva4on Certificate will be required when c�nstn�ctlo� of the building is compiete.
C2. Elevations - Zones A1-A30, AE, AH, A(wi� BFE), VE, Vi-V30, V(with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete
below according to the building diagram specified in Item A7. Use the same datum as the BFE.
Benchmaric Util"¢ed L-NE7 GPS NETWpRK :; Verticai Datum NAVD88
ConversionlCanments
Check the measurement used.
a) Top of bottom floor (including basement, crawlspace, or endosure floor) 7.� feet 8 meters (Puerto Rico onh
b) Top of the neM higher floor 10.28 feet meters (Puerto Rico onh
c) Bottom of the lowest horizorrtal sUuctural member (V Z�es only) .� feet ❑ meters (Puerto Riccb onh
d) Attached garage (top of slab) WA._Q feet ❑ meters (Puerto Ri� onl�
e) Lowest elevation of machinery or equipment servicing the buiiding 7.50 X feet � meters (Puerto Rico onl�
(Descxibe type of equipment and location in Comments)
fl Lowest adjacent (finished) grade next to building (LAG) 7.Q�D feet � meters (Puerto Rico oM�
g) Highest adjacent (finished) grade next to building (HAG) 7:� feet (, meters (Puerto Rico onl�
h) Lowest adjacent grade at lowest elevation of dedc or stairs, inGuding X feet � meters (Puerto Rico oni
strucwrai support
SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This ce�tification Is to be signed and sealed by a land surveyor, e�gineer, or architect autharized by law to certity �evation
i�ormation. ! certify thaf the rnformation on this CerHficate repnssenfs my best efforts to interpret the data avafla6/e.
l understand that any false statement may be punishable by fine or tmpdsonment under 78 U. S. Code, Section 9001.
� Chedc here if c�nments are provided on back of form. Were latitude and bngitude in Section A�rovided by a
licensed land surveyor? ❑Yes No
Ce�tifier's Name ��� N��
KEITH A. STEPHENSON LS 6521
r�le Company Name
' mmn0
� ����
o �, N <
�y �m
�� brn
3 �O ...�
� � �
v CO �
�
� Q
D �
v
�
�
N
cn
c0
W
� ��s t F rcar
F
No.b521
S'fATE OF
�LOR 19i
_ �-.� -� -- - ,s�ia��ui� P• (813)549�4947 ' �
FEMA Form 81-31, Mar 09 See reverse side for continuation. Repiaces all previous editi�ns
� oyc * v� .� ��va rqpw niu�wa an unoc payw
FL1303.1402EC
IMPORiANT: �In these spaces, copy the -esponding information from Section A. For Insurance
Building Street Address (including Apt„ Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Poticy Numbe
405 VENETtAN DR
City
State
ZIP Code � Company NAIC
r.
�,�rl+tcrrn t crc tL 33755 1 �
SECTION O- SURVEYOR, ENGINEER, OR ARCHfTECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevatiort Certificate for (1) �mmunity official, (2) insurance agent/company, and (3) buiiding owner.
Comme�ts
C2.E = AIC UNIT PAD. NOTE: THIS ELEVATION CERTIFICATE IS ONLY VALID FOR THE PERSON OR PERSONS NAMED ON THIS CERTIFICATE.
ELEVA
Signature
3/19/2013
Chedc here if
SECTION E- BUILDING EI.EYATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHDUT BFE)
For Zones AO and A(without BFE), compiete Items E1-E5. If the Certificate is intended to support a lOMA or IOMR-F request, compiete Sections A, B,
and C. For Items E1-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters.
E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent
grade (HAG) and the towest adjacent grade (LAG).
a) Top of bottom floor (induding basement, crawlspace, or enciosure) is _�feet ❑meters �above or ❑befow the HAG.
b) Top of bottotn floor {induding basement, crawispace, or enGosure) is _(�feet Qmeters Qabove or ❑below the LAG.
E2. For 8uilding Diagrarru 6-9 with permanent 800d openings provided in Secti Items 8 and/or 9(see a es 8-9 of instructions), the next higher floor
(elevation C2.b in the diagrams) of the building is _ Q feet �meters ❑ above or �below the NAG.
E3. Attached garage (top of sfab) is � feet Q meters � above or � below the HAG.
E4. Top of piatform of machinery andlor equipment servicing the building is _� feet � meters � above or � below the HAG.
E5_ Zone AO only: If no flood depth number is availabie, is the top of the bottom floor elevated in accordance with the community's floodptain management
ordinance? ❑ Yes ❑ No ❑ Unknown. The locai official must certify this information in Section G.
SEC710N F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or ovmer's authorized represe►rta6ve who completes Sec6ons A, B, and E for Zone A(without a FEMA-issued or community-issued BFE)
or Z�e AO must sign here. The statements in SecBons A, 8, and E are conect to the best of my knowledge.
Property Owners or Owner's Autho�ized Representative's Name
Address
Signature
Comments
City
Date
State ZIP Code
Telephone
❑ Ch k here ff attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The bcal officiai who is authaized by law or ordinance to administer the community's floodpiain management ordinance can compiete Sections A, B, C{or E},
and G of this Elevation Certificate. Gompiete the applicable item(s) and sign below. Chedc the measurement used in Items G8 and G9.
Gt � The iMormadon in Section C was taken from other documentation that has been signed and sealed by a ficensed surveyor, engineer, or archited who
is authorized by iaw to certify eleva6on information. (Indicate the source and date of the elevation data in the Comments area below.)
G2. ❑ A community officia( completed Sec6on E for a building located in Zone A(without a FEMA-issued or community-issued 8FE) or Zone AO.
G3. ❑ The following information (items G4-G9) is provided for community floodplain management purposes.
( G4. Permit Number I G5. Date Permit Issued G6. Date Certificate Of Comp{iance/Occupancy Issued
G7. This permit has been issued fo� � New Construction ❑ Substantial Improvement
G8. Elevation of as-buiR lov�st floar (including basement) of the building ❑ feet ❑ meters (PR} Datum
G9. BFE or (Ir► Zone AO) depth of flooding at the building sfte ❑ feet ❑ meters {PR) Datum
G10. Community`s design flood elevation ❑ feet ❑ meters (PR} Datum
Local Official's Name
Community Name
Signature
Comments
Tide
Telephone
Date
❑ Check here if attaohments
FEMA Form 81-31, Mar 09 Replaces all previous editions