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<br />- '6, TIONAL FLOOD INS U RAN-c-e-'PR'o GRAM
<br />ELEVATION CERTIFICA"..i.
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<br />V.IVI.C. NO. ,jUO{-UU/ f
<br />Expires July 31,2002
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<br />Important: Read the instructions on pages 1 - 7.
<br />. .---,..--- --- -- - .SECTION A': PROPERTY OWNER INFORMATION
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<br />For Insurance Company Use:
<br />Policy Number
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<br />BUILDING OWNER'S NAME
<br />V~~J......<;c.. ,,4, T\.......'^"""l""-~
<br />BUILDING STREET ADDRESS (Including Apt., Unj~ Suite, and/or 8ldg. No.) OR P.O. ROUTE AND BOX NO.
<br />'-( q ~ y. 5" +-.1 ~ + ""-ee.. ~
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<br />CITY STATE
<br />'2-Cfih ~('"" h~. \\? . J:" L .
<br />PROPER DE CRIPTION (Lot and 810ck Numbers, Tax Parcel Number, Legal Description, etc.)
<br />L - (( 6 - II:> ore..: oS \=;: l"" sot-A U ~ - ~ ~ t .fG.:;1
<br />8UILDING US (e.g., Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.)
<br />Re5iDervTi A L
<br />LA TlTUDE/LONGITUDE (OPTIONAL)
<br />( ##0 _ ## _ ##:W or ##.#####j
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<br />Company NAJC Number.
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<br />ZIP CODE
<br />;'~5~ I
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<br />HORIZONTAL DATUM:
<br />U NAD 1927 U NAD 1983
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<br />SOURCE: U GPS (Type):
<br />U USGS Quad Map U Other:
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<br />SECTION e - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
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<br />81. NFIP COMMUNITY NAME & COMMUNITY NUM8ER 82. COUNTY NAME 83. STATE
<br />C ~ -+_ ~ 'Z .. \ \ ~ ~ 0 ~"3 S "'" 5 C. 0 }::'.? .
<br />84. MAP AND PANEL 85. SUFFIX 86. FIRM INDEX 87. FIRM PANEL 88. FLOOD 89. BASE FLOOD ELEVATlON(S)
<br />NUMBER DATE EFFECTlVEIREVISED DATE ZONE(S) (Zone AO, use depth of flooding)
<br />oS- c.... ,.;t '-'/"11 (-::l..(,-,(q I .A.6 6't '
<br />B10. Indicate the source of the Base Rood 8eyation (SF;:) data or base flood depth entered in 89.
<br />U FIS Profile L.A1 FIRM .. U Community Determined U Other (Describe):
<br />B11.lndicatethe elevation datum usedfcrthe8FEin B9: IlU NGVD 1929 LI NAVD 1988 U Other (Describe):
<br />812. Is the building located in a Coastal 8anier Resources System (CBRS) area or Otherwise Protected Area (OPA)? U Yes ~ No
<br />Designation Date: ~ I A.
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<br />SECTION C - 8UILDING ELEVATION INFORMATION (SURVEY REQUIRED)
<br />C1. Building elevations a~ based on: UConstrudion Drawings* LJBuilding Under Construction* WFinished Construction
<br />*A new Elevation Certificate will be required when construction of the building is complete.
<br />C2. Building Diagram Number...l- (Select the building diagram most similar to the building for which this certificate is being completed - see
<br />pages 6 and 7. If no. diagram accurately represents the building, provide a sketch or photograph.)
<br />C3. Elevations - Zones A1-A30, AE, AH, A (with BFE), VE. V1-V30, V (with BFE), AR, ARiA, ARlAE, ARiA 1-A30, ARlAH. ARlAO
<br />Complete Items C3a-i below according to the building dIagram specified in Item C2. State the datum used. If the datum is different from
<br />the datum used for the BFE in Section S, convert the datum to that used for the BFE. Show field measurements and datum conversion
<br />calculation. Use the space provided or the Comments area of Section 0 or Section G, as appropriate, to document the datum conversion.
<br />Datum lUG "0 I"';z. "\ Conversion/Comments. . . ..J fA . - .
<br />Elev~ refe~ used L eC _ ~ D. oes the elevation reference mark used appear on the FIRM? U Yes I.2Sl.. No
<br />o ~ gf~(induding basement or ~ndosu~)-. ~ ~? . "3 ft.(m) ~
<br />o b) Top of next higher floor ;;!,i..4 ._ft.(m) ~
<br />o c) Bottom of Icw~st horizontal structural member 01 zones only) A . _ ft.(m). ~ ~
<br />o d) Attached garage (top of slab) AI / A . _ ft.(m) ~ ~
<br />o e) Lowest elevation of machinery andlor equipment . ~ :
<br />I C1>-
<br />servicin~1:the .building A c. ~ 4f . -1L ft.(m) ~ ~
<br />o ~ Lowest adjacent grade (LAG) ':--'"--:;-d:"CC.: (j:$ . Je.... ft.(m) ~ j
<br />o g) Highest adjaCent grade (HAG) . '... ~ L.,J.::z.. ft.(m) f'
<br />o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade ~ :3
<br />o i) Total area of all pennanent openings (flood vents) in C3h AJ IA sq. in. (sq. em)
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<br />SECTION 0 -SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
<br />This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
<br />I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available.
<br />I underst~d that any false stateme~~ ~a!,- b: ~_~~~~e by fine or imprisonment under 18 U. S. Code, Section 1001.
<br />CERTlFlERSNAME .. ..."C_ ... '.-'..___~_"'__' __,_n -. UCENSENUM8ER. ____.___._..._..._n
<br />DAVID L. SMITH :..~/'- . 5265-. , "_c,'
<br />TITLE'-PSM --- .~_-. .~-..'~~_~~..'~.'~:....~-"'...~..'" ._...._......'.:._.CO. MPANYNAME. ----.SMIrnn-.SURVE- YORS-~~~.::'-"
<br />_ ....---......,......--.-...,....-- .... ..-....-DAVID L.-.J..c. -~
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<br />ADDRESS .~.:c-.:..~;..;.cn::~TAMPA:..-.sTATE..FL: -..~.~:-90J;lb3612 .
<br />_._.~~ -;0 "'"0 2--"".- ,._.TE~I-Ipf-.!~( 813
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