430 LEEWARD ISLAND E�EVATION CERTIFiCATE O.MB No30670077
Exprres May 31, 1993
� FEDERAL EMEAGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ENTION: Use of this certifica;� does not provide a waiver of the flood insurance purchase requirement. This form is used only to
vide elevation.ntormation nec�ssary to ensure compliance with applicabie community floodplain management ordinances.to
termine the prcoer+nsuranc2 Fremium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR).
Instructions tor completing this form can be found on the following pages.
SE�TION A PROPERTY INFORMATION FOR INSUfiANCE C0IAPANV USE
BU�LDING OWNEn S?JAME POLICY NUMBER
TPrrPll V & Gin� 1 Nawk�
STREET ADDRE55:�auding Aot..'Jn+t.;,,�te and:or B�dg.Number►OR P.O.FOUTE ANO BOX NUMBER COMPANY NAIC NUMBER
OTHEH OESCRIPT'CN�LOt and B�ock N��pars.etc.)
lnr 4 Tsl_and F�r�1'�.� of Glear,;,a�er , unit 1
C17.,� STATE ZIP COOE
r1 Pa,-warPr RP�h Florida
ScCTION 8 FLOOD INSURANCc RATE MAP(F1RM) INFORMATION
Provide the follow�ng from the prc�er F!Rh1 (See Instructionsl:
� COMMUNITY`:UMBER �. �=�EL^IUMBER 3.SUFFIX 4.DATE OF FIRM INDEX 5.FiAM ZONE 6.BASE FLOOD ELE`IATION
iin AO 20ne5.u5e death)
125096 ��007� B. June 1 , 1983 A-12 E-11
7. Indicate the efevation datum s}�:em used on the FIRM tor Base Flood Elevations(BFE): S NGVD'29 �Other(describe on back)
8. For Zones A cr`/.:vhere no EF= ;a provided on the FIRM, and the community has established a BFE ior this building site, indicate
lhe communitv s 5FE: ,.— feet NGVD (or other FIRM datum-see Section B. Item �).
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Efevation Certificate -structions.indicate the diagram numoer from the diagrams found on Psges�and 6 that best
.describes the suoiect buildina� -eference level �_ .
a). FIRM Zones at-A30. AE.A�-. and A(with BFE). The top of the reference level floor from the setected diagram is at an elevation
ot_�.�feet NG'�.� (or other FIRM datum-see Section B. Item i).
(b). FIRM Zones V1-V30. VE. ar� V(with BFE). The bottom ot the lowest horizontaf structural member of the reference level(rom
the selected aiagram. is at a- alevation ot( � I ! � ._feet NGVD(or,other FIRM datum-see Section 8. Item 7).
(c). FIRM Zone A(without BFE`. The floor used as the reference level irom the selected diagram is —.— feet above� or
below! (c�eck one) the h:�nest grade adjacent to the building.
(d). FIRM Zone AO. The tloor usad as.the reference level From the selected diagram is � .._feet above_; or below;_.;(check
one) the highest grade adjac�nt to the building. If no flood depth number is available,is the building's lowest floor(reterence
level)elevated in accordanc� wilh the community's floodplain management ordinance? _ Yes No r' Unknown
3. Indicate the elevation datum sy=;em used in determining the above reterence level elevations:_ NGVD'29 � Other(describe
under Comments on Page 2). VOTE: Il the elevation datum used in measuring the elevations is dillerent than that used on
the F1RM jsee Section 8, !te►r, �. Ihen convert the elevations to the datum sysfem used on the FlRM and show the conversion
equation under Comments on�age 2.)
4. Elevation reference mark used �apears on FIRM: ❑ Yes �No {See Instructions on Page 4)
5.The reterence'evel elevation is �ased on: ❑ actual construction _ construction drawings
(NOTE: Use ol construction dr�wings is only valid il the building does not yet have the relerence level floor in place,in wh;ch
case this certilicate will on/y be .alid lor the building during the co�rse ol construction. A post-construction Elevalion Cerfilicafe
wil!be required once consfrucfic�is comp/ete.)
6.The elevation of the lowest grac�immediately adjacent to the building is:''�.g' feet NGVD(or other FIRM datum-see
Section B, Item 7).
SECTION D C�MMUNITY INFORMATION
.'i the community official respon= ble 1or verifying building elevations speci(ies that the reference Ievel indicated in Section C, Item 1
s not the"lowest floor"as defir�d in the community's tloodp►ain management ordinance,the elevation of the building's"lowest
floor"as detined by lhe ordinar;�is: �J.0 feet NGVD(or other FIRM datum-see Section B, Item 7).
2. Date of the start o(constructior �r substantial improvement
FEMA Form 81-31�MAY 90 REPLACE$ALL PREVIOU$EDITIONS SEE REVERSE SIDE FOR CONTINUATION