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...---...-.. ..~_. NATIONAL FLOOD INSURANCE PROGt'tAM ELEVATION CERTIFICATE O.M.B. No. 3067-0077 Expires July 31,2002 For Insl.InInce Compan~ Us. PoRcy Number Company NAIC Number ZIP cooe ;!.~ S"~ I SOURCE: U GPS (l'yps): U USGS QUild MlIp U Other: secnoPf S - FLOOD INSURAHCE RATE MAP (FIRM) INFORMATION 81. NAP COMMUNITY NAMe & COMMUNITY NUMBER 83. STATE c;. ,\ 2.0~3 ......:.co J:::'?, &4. MAPAHD PANEL 85. SUFFIX B6. FIRM INDa: 87. FIRM PANEL. 88. FL.OOD 89. BASE FLOOD ELEVAiJON(S) NUMBER DATE EFFEC"TtVEtJREVISED DATE ZONE(S} (Zone AO, use depth o't/ooding) O~ l~ "/.,, (2..(,...,/<9. I A.c 6<f t B10. Indfcate ftIe SOUI't:8 of the ease Flood Beyatlan (BF~ dsbI Dr bu. trood depth entered in B9. U F'S ProffJe llJ FIRM L.I Community ~ed Ll Other (Describe,: B11.lndlc:atathe elCMIffon datum used lor the SF!:'n B9: W NGVD 1829 LJ NAVD 1988 U Other (Desaftle): 81 Z. 18 the building located In a Coastal Barrier RNOUn:a8 System (CSRS) area or Otl1elWi$e Pn:lteded Area (OPA)? LJ Yes l& No Oeslgnatfon Date: "..) I A . 8ECTlON C - BUILD'NCiI ELevATTON lNFORMA TION .(SOAYE"'t" REQUIRED) . :1. Building ele"'8l1ons are based an: UCansfn.ldjon Drawfngs- LlBullding Under Construction~ I2dFinished Construction "A new EIewtJon Certiffcate win be nsquJred when CC1nstrudfon oflhe building is complete. . :2. BuildIng DI.gram Number -L- (Select the buUdlng diagram mast almBer to the building for which this certificate is being completed - See pages 6 and 7. If no. dIagram accurately repruerms tfle buildIng. pravlde e sketch or photograph.) ::3. elevations - 20n" A1-A30. AE. AH, A (1wIth BFE), VE, V1-V30. V (with 8FE). AR, ARIA. ARIAS. ARIA 1-AJO. ARlAH. ARJAO Complete Items C3e-1 below ec:eording to the buDdIng diagram spedtled In Item C2. State the datum used. If rile datum Is different from t.ne d8llJm u8ed for the BFE in Section B, =nvert the datum 10 /fiat used fer the 8FE. Show field measurements and datum conversion calculation. Use the apace provided or 1he Comm"nts ant8 of Section 0 or Sedlon G, as appropriate, to document the datum conversion. Datum N(l"l.i} ("fa "\ ConvenJionlCammenta" .,...J fA . _ . Elevation reference mal1c used L ,,~_l Does the elevation reference marle: Llsed appear on the FIRM? U Yes lLSl No o a) Top at bottom floor (IncludIng basement or enclosure> ~ '5" . ~ l't{m) ci a b) Top of nut higherfoor -. .t:!../.:!s... It.{m) ~ o c)8otfDm of lowest horizontal structuJ"llI member ~ zones only) .AI/.4. = ft.(m). J ~ a d) Aaac:l'led garage (!.op af .Iab) NI A . _ It.{m) .! 'I a e) Lowest elevatIon of machinery and/or equIpment i ! servfdnp :thebuilding Ale. ~... ...K.. ft.{m) 5 i o 1) lowest adjacent Grade (LAG) JfJ ~ . ..1e..- ft.(m) z! o g) Highest 8dj8C8nt gtade (HAG). 2').2-.~ n.(m} I o 11) No. of pennBnent openings (lIooa vents) with'n 1ft. above aclJaC8nt grade --6J./A- ~ Q i) Total area of all pennanent openings (flood vents) in C3h AJ/A. sq. in. (sq. em) . SECTION 0 - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION I 'l1ls certfffcatron Is to be signed and sealed by eland surveyor, engineer, or architect authorized by law to certtry elevation infocmation. cet1ify that the InformafJon in Sections A, B. anet C an thIs certlf1c;am represents my Ct1$t efforts to interpret th" data 8l1Bilable. understand that any (a(38 statement may be puni:sheble by nn8 orlmprfsonment under 18 U.S. Cods, Sect/on 1001. :ERl'IFIER'S NAME ... . . LICENSE NUMBER 5265 DAVID L. SMITH 'm..e .. COMPANYNAME DAVID r..; SMITH .SURVEYORS .. - IODRES;SM .-CITY ._ .. ..._.._.__ STATE FL...~..ZIP_CQD~3612 TAMPA . OATE. TELEPHONE 81 Go -10 -0 2.- E REVERSE SIDE FOR CONTlNUAilON REPLACES.ALL!,~.~o~~_~~rTIO~S ">- '- . ~~ ~ \ O2