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FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
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oMe aos�-oon
Bapirc� Jra�e 198!
°��� ELEVATION CERTIFICATE
This form is to be used for. 1) New/Emergency Program construction in Special Flood Hazard Areas; 2) Pr�FIRM construction after
September 30, 1982; 3) Post-FIRM construction; and, 4) Other buildings rated as Post-FIRM rules.
BUILDING OWNER'S
NAME
V. Robinson
PROPERTY LOCATION (Lot and Block numbers and address if availabte) _� `-'
Lot 1, Unit 1, Island Estates '�421 Windward Passage�
�r�--
I certify that the information on this certificate represents my best efforts to interpret the data available. 1 understand that any false
statement may be punishable by fine or imprisonment under 18 U.S. code, Section 1001.
SECTION I ELIGIBILI'TY CERTIFICATION (Completed by Local Community Permit Official or a Registered Professional Engineer,
Architect, or Surveyor)
MMUNITY NO PANEL NO. SUFFIX DATE OF FIRM FIRM ZONE DATE OF CONSTR. BASE FLOOD ELEV. BUILDING IS
(In AO Zone. use depth) �}[ New/Emer9ency
125096 0007 B une 1 A-12 11/9/84 11. 00 ❑ p�tFFR �R �
1983
YES NO It is intended that the building described above will be constructed in compliance with the community's flood plain
�[ O ordinance. The certifier may rely on community records. The lowest floor (including basement) will be at an elevation
of 5. 65 ft, NGVD. Failure to construct the building at this elevation may place the building in violation of
the communiry's flood plain management ordinance.
YES NO The building described above has been constructed in compliance with the communir,i's flood plain management
�'O O ordinance based on elevation data and visual inspection or other reasonable means.
If NO is checked, attach copy of variance issued by the community.
MOBILE HOME MAKE MODEL YR. OF MANUFACTURE SERIAL NO. DIMENSIONS
' X
(Community Permit O�cial or Registered Professional Engineer, Architect, or Surveyor)
NAME ADDRESS
TITLE CITY STATE ZIP
SIGNATURE DATE PHONE
SECTION 11 ELEVATION CERTIFICATION (Certified by a Local Community Permit Official or a Registered Professional Engineer,
Architect, or Surveyor.)
FIRM ZONE A1-A30: I certify that the building at the properry location described above has the lowest floor (including basement)
at an �elevation of 5. 65 feet, NGVD (mean sea level) and the average grade at the building site is at
an elevation of 4_ 7 feet, NGVD. _
FIRM ZONES V, V1-V30: 1 certity that the building at the property location described above has the bottom of the lowest floor beam
at an elevation of feet, NGVD (mean sea level), and the average grade at the building site
is at an elevation of feet, NGVD.
FIRM ZONES A, A99, AH and EMERGENCY PROGRAM: I certify that the buifding at the property location described above has the lowest
floor elevation of feet, NGVD. The elevation of the highest adjacent grade next to the building is feet, NGVD.
FIRM ZONE AO: I certify that the building at the property location described above has the lowest floor elevation of
feet. NGVD. The elevation of the highest adjacent grade next to the building is feet, NGVD.
SECTION ttl FLOODPROOFtNG CERTIFICATION (Certification by a Registered Professional Engineer or Architect)
I certify to the best ot my knowledge, information, and belief, that the building is designed so that the building is watertight,'with
walls substantially impermeable to the passage of water and structural components having the capability of resisting hydrostatic
and hydrodynamic loads and effects of buoyancy that would be caused by the flood depths, pressures velocities, impact and uplift
Torces associated with the base tlood.
YES ❑ NQ ❑ !n the event ot flQOding, will this degree of floodproo!ing tre achieved with human intervention?
(Human intervention means that water will enter tfie building when flbods up to the base flood level oo-
cur unless measures are taken prior to the flopd to prevent entry of water (e.g., bolting metal shields over
doors and windows).
YES O NO ❑ �II the building be occupied as a residence?
If the answer to both questions is YES, the floodproofing cannot be credited for rating purposes and the actual lowest floor must be
^ompleted and certified instead. Complete both the elevation and floodproofing certificates.
FIRM ZONES A, A7,-A30, V7-V30, AO and AH;
Certified Floodproofed Elevation is. feet, (NGVD).
fHIS CERTIFICATION IS FOR d(SECTION II ❑ BOTH SECTIONS II AND III (Check One)
;ERTI FIER'S NAME COMPANY NAME LICENSE NO. (or Affix Seal)
Ronald L. Hughes Carter Plumley Engineers, Inc. 3747
TITIE ADDRESS Z�P
Vice President in charge of Su veying, 2433 Gulf to Bay Blvd. 33575
DATE � CITY STATE PHONE
g TURE Florida 799-1763
� � �� _ D� 11/16�'84 Clearwater
_.�__
e Insurance ag n shou attach th4 origlnal copy of the completed form 10 the floo0 �nsurance•po���y aNN���a���••�
the second copv should be supplled to the oollcvholder and the thlyd_coDV retalned_bv the aaent