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OIfB 3067-0077
FEDERAL EMERGENCY MANAGEMENT AGENCY �"'�"'`'"•'�'
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
This form is to be used for: 1) New/Emergency Program consVUCtion (n Speciai Flood Hazard Areas; 2) Pre-FIHM construction after
September 30, 1982; 3) Post-FIRM cor�structian; and, 4) Other buiidings rated as PpshFIRM rules.
Wavne Fs Jan Bover
BUILQlNCa OWNER'S ADDRESS
NAME
760 Eldorado Avenue, Clearwater,�lorida 34630
PROPERTY LOCATION (Lot and Bbck numbers and address if available)
SOrder NO D15/382� � 1
I cartify that the information on this certificate represents my best efforts to interpret the data available. I understend that any faise
statement may be punishable by fine o� Imprisonment under 78 U.S. code, Section 1001.
SECTION 1 ELI(i181LITY CERTIFICATION (Completed by Local Community Permit Otficial or e Registered Professional Engineer,
Arohitect, or Surveyor)
COMMUNITY NO PANEL NO. SUFFIX OA7E OF FIRM FIRM ZONE DATE OF CONSTR. BASE FLOOD ELE�. BUILDING IS
(1n AO Za�e, ues 6pfh) ❑ New/Emar9eney
125096 0007 B 06/01 /83 V7 5 � q� ❑ P�o-FIRM Rep.
❑ PpsFFIFM Reg.
YES NO It is intanded that the buflding described above will be cortstructed 1n compliance with the community's ilood plain
❑ ❑ ordinance. The certifier may rely on community records. The Iowest floor (including basement) will be at an elevation
of ft, NGVD. Failure to construct the building at this elevation may place the building in vlolatlon of
the community's flood plain management ordinance.
YES NO The building descr(bed above has been constructed in compliance with the community's flood piain management
� ❑ ordina�ce based on elevation data and visual inspection or other reasonable means.
If NO is checked, attach copy of variance issued by the community.
YES NO The mobile home located at the address described above has been tied down (anchored) in compllance with the
❑ ❑ community's flood plain management ordinance, or in compliance with the NFIP Speciflcations.
MOBI�E HOME MAKE MODEL YR. OF MANUFACTURE SERIAL NO. DlMENSIONS
X
(Community Permit Official or Registered Professiooal Engineer, ArchRect, or Surveyor)
SECTION II ELEVATI�N�CERTIFICATION (Certified by a locai Community Permit Official or a R�istered Professional Engi�eer,
Architact, or Surveyor.)
� FIRM ZONE A1-A30: I certity that the building at the property location described above has ihe lowest floor (including basement)
� at an elevation of feet, NGVD (mean sea level) and the average grade at the building site is at
. J an elevation of feet, NGVD.
i q> FIRM ZONES V, V1-V30: I certiy that the buildin at the property location descAbed above has the bottom ol the lowest /loor beam
� N at an elevation of �� 5•� feet, NGVD (�a� sea Ievei), a�d the average grade at the building site
i ro is at an elevatlon ot �_ 7 teet, NGVD.
I�
FIRM ZONfS A, A99, AH and EMERGENCY PROGRAM:1 certify that tha building at tha property location described above has the lowest
floor elevation of feet, NCVD. The elevation of the highest adjacent grade nexttothe buiidi�g is fcet, NGVO.
FIRM ZONE AO: I certify that Me building at the property locatlon described above has the lowest floor elevation of
feet, NGVD. The elevation oi the highest adjace�t grade rrext to the build'+ng is feet, NCiVD.
SECTI FLOODPROOFING CERTIFICATION (Certificatloo by a Registered Professionaf Engineer or Architect)
I certify to the best ot owledge, information, and belief, that the building is designed so that the building is wa , with
wail9 substantially impermeable e passage of water and structurai components haring the capabiliry o�f e' ng hydrastatic
and hydrodynamic loads and effects o ncy that woultl be cau5¢d by the fiood depths, pressur �itfes, impact and uplift
forces associated with the bese flood.
YES ❑ NO ❑ In the event of tboding, will thls ot floodproofing ved with human intervention?
(Human intervention means ihat water wi ilding when floods up to the base flood level oc-
cur uoless measures are taken prior to t entry of water (e.g., bolting metal shields over
tloors and windows).
YES ❑ NO ❑ Will the building be ied as a residence?
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September 30, 1982; 3) Post-FIRM construction; and, 4) CiMer buildi�gs rated as Yost-tIHM ruies.
Wavne Fi Jan Bover
BUILDING OWNER'S ADDRESS —
NAME
760 Eldorado Aven�P, Clearwater, Florida 34630
PROPERTY LOCATION (Lot and Block numbers and address if available)
(Order NO D1S/3R9��1
I cert�fy that the iniormation on th�s cert�ticate represents my best efforts to intarpret the data available. i understand that any faise
statemeni may be punishable by fine or imprisonmenY under 18 U.S. code, S�Hon 1001.
SECTION I ELIGIBILITY CEpTIFlCATION (Compieted by Local Community Permk Offida! or a Registered professional Engineer,
Architect, or Surveyor)
MMUNIiY NO PANEL NO. SUFFlX DATE Of FlRM FIFiM ZONE DATE OF CONSTR. BASE F�OOD ELEV. BUIL�IHG IS
pn AO Zone. us� tleP�) ❑ Naw/Ema9��Y
125096 0007 B 06/01/83 V15 14' �P�FF,RMR�
YES NO It is intended that the buflding described above will be constructed in compiiance with the community's flood plain
❑ ❑ ordinance. The certifier may reiy on community records. The lowest floor (including basemant) will be at an eievatlon
of ft, NGVD. Failure to construct the buiiding at this elevation may place the building in vtolation of
the community's flood piain management ordinance.
YES NO The building described above has been constructed in compliance with the communitys floo� plain managemant
� ❑ oMinance based on etevation data and vtsuai inspection or other reasonable means.
If NO is checked, attach copy of variance issued by the community.
YES NO The mobiie home located at the address described above has been tied down (a�chored) in compiiance wlth the
❑ ❑ community's fiood piain management ordinance, or in compiiance with the NFIP Specifications.
MOBiLE HOME MAKE MODEL YR. OF MANUFACTURE SERIAL NO. DIMENSIONS
X
(Community Permlt Official or Registered Proiesslonal Engineer, Archftect, or Surveyor)
SECTION 11
(Certified by a Local Community Permlt Official or a Registerad Professionai Engineer,
Arohitect, or Surveyor.)
FIRM ZONE A1-A30: i certiry that the building at the property location described above has the lowest tioor (including basement)
at an elevation of feet, NGVD (mean sea level) and the average grade at tha buiiding site is at
an elevation of feet, NGVD.
FIRM ZONES V, V t-V30: I certify that the bu'I in at the property location described above has the bottom a7 the /owest ltoor beam
at an elevation of ��•� feet, NGVD (mean sea level), and the average grade at the building site
is at an elevation of R_ 7 feet, NGVD.
FIRM ZONES A, A99, AH and EMERGENCY PROGRAM: I certify thatthe building at the property location described above has the lowest
floorelevation of feet, NGVD. The elevation of the highest adjacent grade next to the buiiding is teet, NGV�.
FIRM ZONE AO: I certify thai Yhe building at the property IocaUon descrii�d above has the lowest tlow elevation ot
feet, NGVD. The eleva8on of t!re highest adjacent grade next to the building is feet, NGVD.
SECTI FLOODPROOFIN� CERTIFlCATtON (CertificaGon by a Registered Professionai Engineer or Architect)
i certify to the best of wledge, information, and belief, that the buiiding is designed so that the buiWing is wa , with
walis substantiaily impermeabie • passags of water and structural components having the capability of ng hydrastatic
and hydrodynamic loads and effects o ncy 2hat wouid be caused by the fiood depths, presaur ties, impact and uplift
forces associated with the bese fiood.
YES ❑ NO ❑ In the event of tiooding, wiil this of floodproafing ved with human intervention7
(Human intervention means that water wi � ding when floods up to the base fiood Ievei oc-
cur unless measurns are taken prior to t nt entry of water (e.g„ bolting metal shfeids over
daors and windows).
YES ❑ NO ❑ Will the building ied as a residence?
if the answer to both questions , the floodproofing cannot be credited for rating purposes an ctual lowest floor must be
completed and certifi . Complefe both the elevation and floodprooftng certificates.
FIR+ MjONES A, A1,-A3Q, V1-V30, AO and AH; Certified Flaodproofed Elevation is f�
THIS CERTtFICATION 1S FOR�SECTION 11 ❑ BOTH SECTIpNS 11 AND 111 (Check One)
CERTIFIER'S NAME COMPANY NAME ItCENSE NO. (orAffix Seaq
TITLE
ADDRESS
TE CITY
ZIP
STATE PHONE
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