665 BAY ESPLANADEU.S.DEPARTMENTOFHOMELAND9ECURITY ��E�ATION C�RTIFI�✓A�E
FEpERAL EMEROENCY MANA�EMENT AOENCY OMB N0. 'I66O-OOOB
NaHonall+loadlnsimanceProgram ��ppp�-{ant: Read the instructions on pages 1-8. Expiration Date: July 31, 2015 �
' 3ECTION A = PROPERTY INFORMATION
A1. Builtl(ng Owner's Name
�i�A� M�SGi�u _
�A2. Buildin Street Address (Including Apt., Unit, Suite, and/or Bldg. No.) or F'.O. Route and Box No.
� � . �,I . � """
City �._._
G L,l�� �
I�i ■
.353?rT'r-,
A4. Buliding Uae (e.g., Reaidential, Non-Residential, Addition, Aaoe�qe��, etd.} /-,t P/�S(��/W �JJ�� /
A5. Latitude/Longitude: Lat _ Z_% ° 5�� ��j. 3" �on9. �j ��'. ?�j. Q'' Ho�laontal Datum: ❑ NAD 1927 NAD 1883
A6. Attach at laast 2 photographs o( the buliding lF the Certificate is being used tv obtain flood inaurance.
; A7. Buildinp Diegram Number .�
• Ae. F'or a building with a crawlspace or enclosure(s): A9. For a building with an attaohed garage: . �
a) Square footage of crewl�paoe or enclosure(s) �}�C sq R a) Squ�re footape of atteohed gare8e � sq �
b) Number ol permanent ��i��#;openings In the crawiepace � 6) Number of permanent flood'openings in the attaahed Qarage
or enclosure(s) within 1���idt"above adjacent grade wfthin 1.O foot above adjAcent grede
c) Total net area oi flood o���5�i9ga in AB.b sq in c) Total net area of flood openings in A9.b aq In .
d) Engineered flood openings'7 ❑ Yes ❑ Na d) Engtneered flood openinps2 ❑ Yes ❑. No
3ECTION B� FLOOD IN3URANGE RAT� MAR (FIRM) INFORMATION
B1. NFIP Community Name & Community Number B2. County Name B3. State
G L.F�41� v,l/-�T ��'. ) z 5 0 9(p {'I N E. l: l�/�S �L. ,
- B4. Map/Panel Number 85, Sufflx B6. PIRM Index Date B7. FIF�M Panel B8. Fiood
� Z, � Q��„ � � Q Z �. g_� g_ �a Effectfve/Revised Date on�e(.$)
/ ,9-,0� -�3 '
� 810. indicate the source ofthe Base Flood Elevatlon (gFE) data or tiaee flood depth entered in Item Be,
❑ FIS Proflle [[1�FIRM ❑ Commuhity Determined � OtheNSOUrce: .
811. Indicate elevatlon datum used forBFE In Item B9: 0 NQVD 1Q29 t�J' NAVD 1988 ❑ OthedSource:
B12, la the building located in a Cvastal B�rrier Resources Syatem (CBRS) area or Othne OPA protected Area (OPA)?
Qesignatfon Date: (] c�RS .
SEG710N C - BUILDINO ELEVAI'ION
B9. Base Flood Elevatfon(s) (Zone
AO; ys �base flood depth).
1.
N (3URVEY REQUIRED) ,
C1. 8u(Iding elevations are based on: C) Conatruction Drawings" ❑ Building Under Construaflon" I�Finlahed Constructlon
"A new Elevation Certificate will be required when construction of the 6uflding fg oomplete. -
C2. Elevationa -�onea A1-A30, AE, AH, A(with BFE), VE, V1-V30, V(with BFH), AR, AR/A, Aft/AE, AR/A1-A30, AR/AH, AR/AO. Complete iteme C2.a-h
below according to the building dfegram specified (n Item A7. in Puertb Rico onty, enter metera.
8enchmark Utiiized: ir)'�/ �N� �-C�,� Vertical Datum: 2� �O�q'�
Indicete elevation datum used (or the elevatione in items e) through h) belpw. � NOVD 1929 AVD 1988 � pthedSource:
Datum used for buiiding elevatiqn$ must be the same as that u�ed fortfie BFE. ,
Check the measurement uaed.
a) Top of boftom floor (inciuding basement, crawispece, or enclosure 800r) �"r, feet ❑ meters
b) Top of the next higher floor . '[�eet � � meter$.
c) 6ottom oF the lowest horizontai structural member (V Zones only) � j] feek C� meters
� d) Attached garage (top of slab} N�l�. ❑ feet C] meters
e) Lowest elevatfon of machinery or equipment servicing tha buildfng �. Z [�eet CI meters
(Desc�lbe type of equiprn�ht and locatlon in Comments)
� Lowest adjacent (finished) grade next to building (LAO) 3,�P �et ❑ meters
g) Higliest adJacent (Mished) grade next to bulldfi0 (HAq) �,,� feet � metecs .
h) Lowest adJacent grade at lowest elevation of deck or staira, including structutal.support � V . CI feet ❑ meters
SECTION D- SURVEYOR, ENC3IN�ER, OR ARCHIT�CT C�RTIFICATION
Th(s certiflcation fs to be sigrted and sealed by a land sufveyor, engineer, or architect authorized by law to cerlify elevatfon
information. ! ce�tlry thal the lnfo►madon on fhls Cen/flcaPe represents my besf e/forfs to lnterpref the dafa avallable.
I undersfand that any fa/se sfafemenf may be pun/sJ�able by frne orlmpHsanment under 18 U.S. Code, SecHon 100>.
C�Check here if comments are provided on beck of iorm. Were latitude and longitude in SecUon A provided by a
I�Check here if attachments. Iicensed land surveyor? �Yes ❑ No
(❑ Yes L�J No
C�rtifler's Name LARRY L. EVANS
Title LAND SUF2VEYOR
Address 1460 BELT_REES ST� STE: 9
Signature
Lfcense Number PLS # 2937
Company Name EVANS LAND SURVEYINO, INC.
City DUNEDIN, State FL ZIP Cotle 34698
Date I Z- I 0- l 4 Telephone (727) 7343821
_ "" ` ' �.
, �-. `�
1. ���.,�,a�.� �'
_ aT�,Y^MS,.i.�.-� .. � .
' _ ,a•��.F��:::
� �� � ::? � . ' . '
n �
��.�:V,IA I IUN 4kFt 11P14A I k, �ag� �
�?tJRTANt; In tFtese spac�s, copy the ca
9uild(ng Street Address (including Apt,, Unit, Sufte,
=��.������,�,N- p.�
ctEy G I�l- �2 �v�/',4- -r� P
rresponding Inforrnatlan trom Seation A.
and/or� Bidg o.) or P.O. Route end Box Na
State r' 21P Cude ��.7�
t`�
665 BAY ESPLANADE
BCP2014-12315
NON-SUB/ WINDOWS
MASCIO, LINA
3EG710N D-� SURVEYOR, ENC�INE�R, OR ARCHITECT CEFITI�ICATIO Zoning: Tourist Atlas #: 2�
_ --
---- �__ _ _—
Gopy both gides of thla Hlevation Certlflcate for 1 Cammunit a(flc(al, 2 insurance a ent/com an and 3 bulidin owner.
. O Y t) 9 P Y� O 9
Comments � '
G 2. � 2 � I �j' '�^-� E�L�. V� j l D/`.I b � l.-E G
� f TR�c,��. �z��nt���,Es,
/��c. �n�► PK.��.�� � `a /� �Z E. l�,�o� (-" ,� t� ±V �'7' �..P, l�lp�l �iZ j� ��TG R..S y�i�.� �► 0 � .
D�n�l�ufl'' UN��S�
' Signature Date :
. , 1Z-Id-14 '
8ECTI0 �- ILpIN[3 �LEVATION INFORMATION (SURVEY NOT REqUIR�pj FQR ZONE AO AND ZON� A(WITHOU RF�j .
; For Zones AO and A(without BFE); compiete Iteme Et-E6. If tha Certlfioate Ia intended to auppott a LOMA or LOMR-F requesf, compiete Sectiane:A, B,
and C. For Items E1-�4, use natural grede, If avaitable: Check the measurement used. In Puerto Rlco only, enter meters:
` E1. Provld2 elevation information for tha following and check the appropriate boxes to show whether the eleveklon Is above o� beiow the higheat ad)acent
grede (HAO) end the loweat adJa�enf grade (LAG).
a) Top of boitom floor (Including baaement, orawlepace, or enciosure) is Q feet ❑ meters � above or i] below the HAO.
b) Top of bottom floor (lncluding besement, crawlepace, or enclosure) is . (] feet ❑ meters C] above or C] below the LAG.
[2. For Buliding Dta�r�ms 6-9 witfi permanent flood openinga provided in Section A Items 8�nd/or 9(se�e pages 8-9 of Instructiona), the next higher floor
(elevation C2.b in the dlegrema) of the building is O feet ❑ metero ❑ above or U below the HAO.
E3. Attached garage (fop ot slab) is p feet ❑ meters ❑ above or ❑ below lhe HAO.
E4. Top of platform. of machtnery and/or equipment aervicing the building is ❑ feet ❑ meters [) abave or �7 below the HAG.
E5. Zona AO only: If no ifood depth number is avaliable, is the top of the bottom floor elevafed in accordanoe with the commun(ty's floodplaln management '
. ordinance7 [� Yes ❑ No ❑ Unknown. The IocaF otflcial must ce�tlty this Information fn 5eotlon (�.
..s.
SECTION F-- pROp�RTY OWN�R (OR OWNER'S. REPRESENTAtIVE) CERTIFICATIUN
The properly owner ar owner's autFiorized representetive who completea SecQone A, B, end E ior Zone A(without a FEMA-fsaued or.community-)ssued BFE)
Qr Zone AO muat sign here. The statements In Sectlons A, 6, and � are correct to the beat of my knowledge.
Property Owner's or Owner's Authorized Represent�tive's Name
Addreae City Stete ZIP Code
5lgnature � bate Telephone �
Comments
- �
L7 Gheck hera if attachments.
� sECTION O - COMMUNI;TY IN�QRMA7IAN (�PTION.AL) ; . :
1;he local oFfloial who is authorized by law or o�dinance b adminlater the community's iloodplain menegement ordfnance can compiete Sections A, B;. G(or E), �nd O
p.F this Elevation Certiflcate: Complete the applic�ble )tem(aj and eign below. Check the measur�ment used In Items GA=O1 Cl. ln F'uerto R(co only, enter met�rs.
G1. ❑ The information in SecHon C was taken firorri other dooumentatlon that hae been aigned and sealed by a Ifcenaed surveyor, engineer; or architect who
(a authorized by law to certify elevation in(ormatlon. (Indicate the eource and date of thd elevatlon data tn ttie Commenta.a,rea below.)
C32. ❑ A community offlcial completed 3ection E for a buflding Ioaated in Zone A(without a FEMA-Iseued or community-issued BFE) or Zone AO.
C33. [] Tt�e (oliowiny In(ormation Qtema 04-010) Is provlcled for community Iloodpletn management purpoaess
G4. Pennit Number O5. Date Permit Issued C38. Date Cettlticate OF CompOance/Occupancy Issued
G7. This permit has been iseued for. f] New Cvnstructlon Q 5ubstantial Improvement
G8. Elevation of as-built Iowest flooP (including basement) vf the building: . [j feet ❑ metera Datum
G9. BFE ar (in Zone AO) depth of ftaod(ng at the buflding site; ❑ feet Cl metera Datum
�10. Community's de9lgn flaod elevet(oh: O teet 0 meters Datum
Local Qfticial's Name
Community Name
Signature
Comments
Title
Telephone
Date
] Cheak here If anachmente.
EL.EUATlON CERTIFICATE, page 3 gui�ding Photographs
See Instructions for Item A6.
IMPORTANT: In these spaces, copy the corresponding information from Section A.
Buildinq Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
I_� P n _ �n _._ _ . - -
City �Ln i�� � � State -- , ZIP Code a, ��� % �prripany NAIC Number.
n� �
; i
If using the Elevation Certificate to obtain NFIP 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 exampies 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.
�
— � ,�'
� � �_ � ,w�
"� j�� �il �� � ,�
,,,,,.oN ,......,-,. �.
� i�;, i���u��s�imu�,. �u�ii. � _
�� i,�� �fi��i . -�nnu� n��� �n-i�� E �,�:� �`�
- - �.;
� _- il � ��
� � �.
� � , �,
� � .,�
� ��
� ,�
� ���� �.
��
� �
,K� ''�
;
` t . . ��-�'��� . ��� �� �'�' �9 � ..i' � .. - �� �� �", ..
� ���
„ , , ...,,_T� ., . .,
.
- � ... ,;. ;, .
,,._
:
,
,
�, �
- � ,� . . � .� . .. � ..
�.` .r���
. ,,
� ,.- �, _
-� �r„
a���;
, � � F �;_. v_
� ,w,. ,�. , �.
� ��� « y
---�°-k,� i�p ��:�.. � � :
e a � _
�-� ,' '�` y ''� ���-' � . — r— {g-�
k
— — --
'� � ��
��� �� � ��
�
>
�
oL
�
i, /
�'
�
�