1370 TUSCOLA STU.S. [lEPARTTI�NT Df HUMEIAND SfCURITY ����, ���� �����+��'� ��
FEBERIU. EtAER6ENCYlYt;1NJ1l�'iE�AENt 1LGENCY OM$ NO. f�O-OQO$
�:�t���ru�l fl�r,..! l��cter�tii. �' I'i���r'��ni �{jrypaKant: Read ihe irastructions ors pages 1-9. Ezptrat�on Date: Ju�y 3t, 1`�1,�'3
SE+C7'itiW A-#'l�i3PER7Y HrFfl�lY1A'�F{Nl F�t sNSU►�iCE COtutPr�NY uSE
At Buikiing Owner's Name Fatm�r Can� p�, �:
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A2 Butid+ng Street Address (�nGludmg Apt . Unrt. Suate, andror Bfdg. No.} or PA. Raute and Box No. Company AiAiC"Number:
1370 Tuscala Siraet
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Clty Ciearnater _ S�ate fL 21P Code_ 33756 _. __ _-
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A3 Property Descn�Uon (i.ot and Bloek Numbers. Tax Parcei Nurnber, Legai Descnption. etc )
Lot t3. Btock 4. Lakeriew Est,ates 1"' Add�hon
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Aa 6uEkiErsy Use i� g., Res�dent�a{. No�-Res�denUal, Add�GOn, Accessory, etc.) Res�dentFa�
A5, lai�tude!Longitude; Lat. '27d .57' 07 84" N Lonc� 82d� 37 7Q" W Norizontai Datum ❑ NAQ 1927 � NAd 1983
A6 Attach at least 2 phc�tayrapY�s oi the budding ifi the Certificate is being used ta abtair� fiood insurance.
A7 Bu�ldmg piagram Number JA
A8. Fpr a budd�rtg witt� a craurlspaGe or enclasure�s) A9 Ftr� a buiidmg w�th a� aKached garage
at Syuare tc>otage ot cra�space or enclosure(s) NR sq ft a1 Square footage of aitaChed ga�age 325 U sq ft
bj Nu�nUer ot permarier�t fioud operamgs in tfie crawispace b? Number ot permanent flood opernngs rn the attached garage
or enclosure(s) with�r� 1.O ioat at�ove ad�acent grade NA �nnthtn 1 0 foal above atl�acent grade �
c) 7atal ne� area ot flood openings in A£3.b NA sq �n c) Totai net area of fiood o
d) Eng4r�eereci (Ic7od oper�Fngs? ❑ Yes 0 No d} Engineered Hcaod openings?ngs ��Q Yes���-1 sq in
� No
SECTtON 8— FLOQD INSUFtANCE RA7E MAP (FbRM) lNFOR�IIA7iON
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1 Bt NFIP Cammurnty Name 8 Commun�ry Number i B'L County Name � 63 Siate `
1 Gearv,r�ter 125U9ti { Pine+las � Ftorrda _ S
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f B4 Map%Panel Number 85. Suff�x ! B& FIRM index Date i B7 FIRM Pariei : 88 Ftood I B9 Base Flood Eleva�on(si (Zone ?
� 12103C �109 � N ( 5�17�45 } EHect�vetRevased Date � Zor�{s) � AO. use base ftood depthj {
i_ _a i � 5117/05 1 AE _ � 26 Q' & 28.0' ,
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6tq lnd�cate the source of the 8ase Fio�aci Elevaiion (BFE� data ar base ftaod depth entered in Uem 89
❑ FIS Profiie � FIRM ❑ Community Determ�ned ❑ pther,`$ource;
Bt t tnd�cate elerv�tton datum used ior BFE in Item B9 ❑ NGVD 5929 � NAVR 1988 Q fl;t�riSoutce.
812 Is the bu�tdmg fcx:at�d m a Coastal Barr�er Resources System (CBRS) area or Otrienvrse Protected Rrea (OPAI? ❑ YFS � No
Designai�on Date �__ ❑ CHRS ❑ dPA
SECTION C— BUIIDING ELEVATION INFORMATION (SURYEY REG2WRED)
Ct suddh�g eiev��tiUns are based on ❑ Construdion pravr�ngs' ❑ Bui�ding Untler Constructian' � Flnished Cor�siruci�or
'A new Efevation C�:rtlficate Hnil be reqinred when construCtion of the Uuddiny is �omplete.
C2 El�vat�ons - 2ones A1 -A3p. Af. AH, A{wrth ESFE1, VE. Vt--V30. V(wnlh BFE), AR. AF2,'A, AR:AE, RR/At—A30, ARlAH. ARiA�. CompleEe Items
betc�w acCOrdirrg to the burfdirtig dlagram speaEed i� Item A7. in Puerto Rico aniy, enter meters.
Benc;hmark Ut,l�zed ,t t�f learxatgr C,-� Vert�ca�1 i3atum: �AVD 19$8
ind�cate etev�t�Gn datum usc;tl for the efevat�ons �r� items a> mrough h} below ❑ NGVD 1929 � NAVD 1988 L7 Other�Source Y cmp
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Dat�im used for bu+lding eieva[ions must be thc sarne as that used fur the BFE. u^ �
a) Tap oi botta�n tloor �mG�d+ny bayement. uawlspaee, r�r enelosure floor>
b) Tap af the raext hightr flopr
ci Bottom of the ivwest hnnrontal structural member (V Zones oniy)
d) �ttached garage; {iop of stab)
e} Lowest eievation ot rnachinery or eqwpment serwGng the buliding
(Descrrbe type oi equ�pment anci locat�on �n Cornmentsj
i) Lawest ad�acent [finished) grade next to bu�iding (�AG)
c�� N�yhest ad�ae,e+�t �tin�shtd) gratle rText to buald�ng �HAG)
h} Lawest ad�acent grade ai lowest elevaU�n of deck or sla�rs, �r�d�drng structural support
2Q 7
N.A
N_A
27 5
28 0
26. d
27 5
fV.A
Check ttie measurement used
� feet ❑ meters
� feet Q meiers
� (eet ❑ meters
� teet p me�ers
� feet ❑ meters
� feet ❑ meters
� fe�et ❑ meters
� feet � meters
SECTIQN U— StiRVEYOR, ENGit�IEER, OR ARCNITECT CEftTfFI�ATiON
This certiflr,atir�n �5 to be s�gned antl �eaied by a land surveyor, eng�neer, c�r a�chitect authonzec! by law ko c;ertlfy elevaf�on
intormat�on_ 1 rertdy that trrr� �nlormatrorz on thrs Certibcat� represerrts my best eKvrts �a interpret the data avarlable
I uncierstarxc� ll�at any false slat�srrrent �nay be pun�s/�able by hne or impr�sonment under 18 U. S Cocie, Sectron 100t
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❑ Check here �f attachments licensed land surveyor? � Yes ❑ No �'
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Cert�f�ers N�me Edward D Murphy License Nurrtber 5333
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Tiile Praf. Laxui Surveyc�r Co�r�pany Narr�� Murphy's Land Survey+ny. 4nc
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Address 576 � i"' AvenuQ N , ��ty St Petersburg State FL ZIP Code 33710
Siynatu�e� �_.y,o,-tA..i�j�A�TJV _ .
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`F� ` te 10.22�1�7 Fe4ephone 727�347-874d
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FEMA Farm 086-0-33 �7112)
5ee reverse side for c:ontinuation
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Rep{a�s all previous ed►ti�rv�.
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