OMB NO. 1660-0008
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Federal,~ m % r d e n~c ~a n r ~ e h e'Agency
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Flood Insurance Program .
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P.O. Routeland Box No.
C LOS€ST TO &3LF
State
5 ffod6s
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ExDires Febi'uarv 28.2009
Important:' ~ead-the.instructions
on pages 1-8;
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City
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ZIP Code
33782
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A3. Property Description (Lot and Block Numbers. Tax Parcel Number, Legal Description, etc.)
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A5.
A6.
A7.
A8.
~ESidecltih
Building Use (e.g., Residential, on-~esidentlal, ~ddition,Accessory, etc.)
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NAD 1927 .
NAD 1983
LatitudelLongltude: Cat, N $7 53,'0.7 . , . .:. -. Long. W 82 .s o , . sst
: . ..,Horizont,al:Datdm:
Attach at least 2 photographs.ofthe building.if the.certificate.is being us& to obtain floodinsurance.
Building Diagram ~ u m b e r A ::
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an &ached garage, provide:
For a building with a crawl space.or enclosure(s), provlde:
sq .ft
3 2 0 sqft
a) Square footage of attached garage
a) Square footage of crawl space or enclosure(s)
b) No. 6f pehanent'flood openingsin the attachedgarage
b) No; df permanent flood openings in the crawl sljace 0r
walls $ttlin .I
.0 foot above adjacent grade.
enclosure(s) walls within 1.0 foot above adjacent grade
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c) Total net area of flood openings in A8.b
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c) Total:riet area of flood openings in A9.b
sq in
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S E C ~ I Q ~ ~ ( . ~ : - . F I , ; O , O D ~ NRATE
S. ~ , ~MAP~~FIRM~~IN~OPMAT~OH
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81. NFlP Community Name & Community ~ i i m b & '.. - ..
TOW# .oC 1 N O l W S H d r M I
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84. MapIPanel Number
B5. ~ufRx. .
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t2~103COI7G
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82. Cbuhty ~ a k e
Date
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B7, ,FIRM Panel., , .
Effectlve/Revised Date.
4-3-03.
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t=Lo&t?A
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B9. Base FI& Elevation(s) (Zone
AO, use base flood depth)
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88. Flood
Zon&(s)
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810. Indicate the source of the ease ~l&l'€l'eva'~~h
( ~ 6 ~ f d a ' or'base
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flood depth entbred.ln'ltem.69. . :"
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FlS Profile
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Other(D.esbribe) , '
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B l I.lndlcate elevation datum used for BFE.in l t e k ' ~ 9 : : NGVD 1929
~XLNAQD1988 .
attier (6i&+ibe).
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812. ISthe building located In a Coastal Barrier Reiourcds System (CBRS) area or Otherwi.se Protected h a (OPA)?
.'"n'.Yes
Designation Date
CBRS
OPA
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.:BFIRM
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Building Under Construction* '
Ct. Building elevations are based on:
Cohstruction Drawings'
Finished Construction
*A new Elevation Certificate will be required.whenconstruction of the building is complete.
C2. Elevations -Zones A1-A30, AEi AH, A (with BFE), VE, VI.:V30, V (with BFE), AR, ARIA, AWAE;RWAI-A30, ARIAH, ARIAO. Complete Items C2.a-g
below according to thebuildin
Benchmark Utilized P;ddlrtl
P . Vertical.Datuin. .'ELW
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= N#Y
S,8Y
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Conversion/Comments'
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. . Cheak theineasurement
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b)
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Top of bottom floor (hcludlng basement, h w l space. or.ei?closure floor)
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O: feet '.'.
Top of the next higher floor,
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Bottom of the lowest horizontal structural member (V::Zones only)
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a.feet . .
Attached garage (top of slab) .
NOMU
feet .
Lowest elevation of machinay or equlpk"t bir?lci"gthe builda
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(Describe tyPe of equipment In Comments). AC . . .
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L .,b feet "
Lowest adjacent (fiplshed) grade (LAG)
$3
feet,.
Highest adjacent (finished) grade (HAG)
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metek(~uertoRlm only)
matera(Puerto ~ i only)
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meters (Puerto R i w oniy)
meters (Puerto Rico.;only)
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meters (Puerto Rim only)
meters (~uertoRico only)
.::ameters (Puerto Rico only)
"S,ECTDN @:.-:SURVFY,OR, ENGINEER, OR ARCHITECT'CERTZF~CATION
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This certlficatlon Is to be 5igned.andsealid by a laiid siiir'eyoi, engineer, or architect authorized by lawto certify elevation
Information. Ic e q that.the information on thls Certificate mpmsents my best efforts to interpkt the.data available.
Iunderstandthat any false statement may be punishable by fine or imprisonment under'l8 U.S. Code, Section Y001.
w Check here if comments are provided on back of form.
Certifieh Name
LRJW
Title
A?.
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Company Nanie
J ~ r r v ~ w ~ ~
0730
i 0 2 ~ 0 Ad&, U
City
Signature
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SEmldd&F
Date
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FEMA Form 81-31, February 2006
PLACE
License Number
P&&ey
ld
Address
I
r
-1
9-25-2@7
State
ZIP Code
3778
Telephone
' s e e reverse side for continuation'.
Replaces all previous editions
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:'.~S.EC~~~;.D.--SURVEYOR,
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ENGINEER;,OR ARCHITECT CERTIFI%ATION:.(CONTINUEP).
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Copy both sid6s'dfthis ~ l e ~ ~, . l. ~ 6 ~ ~ $ r t(1)komniunity
i ~ ~ a t 6 ~ foffici~11(2j~insir~agen~co&pan).,and
or
(3)tj"ilding b$vn.er;
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Signature
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SECTION E BUILDING.EL'EVATI~NI'NFORMATION(SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
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For Zones A 0 and A (without BFE), bornplate ItepsrE'I-ES. :if thecertificate Is intended to support a LOMA or LOMR-F request, wmplete Sections A, B,
and C. .For items EI;E4,.usa natural.'gr6idii( if 'aviilhHe:.:'C~~tRthe
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measurement,used. In Puert'o~Rico~gnly,
enfer.meters.
E l . ~ r o ~ i h e l e ~ a tlnforh'~d6k'for
ion.
t ~ 6 , f o i f & l r i ~ ~ ~ n d dthe
' ~ appropriate
~eck
ioxes toshow whether tti,e'ele\latlbn
is above or below the highest adjacent
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grade:(HAG) a'ndthe low8:st-aajacentgrad6 (LAG):
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a) Top of bottom fldor (ihduding:-basement,cf+ki;s~ace, or enclosure) Is
"low the HAG.
,b)'Top of bottom floor (includin~~basitinent~craWspacii
or enclosure) is
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feet
meters
above or . below the LAG.
the- next higher floor
E2. For Building-DiaC~rams-6-8
~ t h . ~ e r r n ~ ! n e ~ ! t ~ E ~ W ~ 9 ~ . e n : Items:B:
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r ? $ d e da .~e.8~f.lnstructions),
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(elevation C2.b in the,diagrams)b f b ? puiAin$:!Q":
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fC:; -: I f9.et.i , meteis':,.' above
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.or'ii
:,.,.:,, :. belo.W:ths HAG.
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E3. Attached
(top'~f.siatj).is..I . . . . . . . . . i: .. *:n,feet..n.meters.~
. , .* i .b,o...~ e -.n:.below.the:~~~.;.,
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- 0'feet
meters
above or
below the HAG.
E4. Top of platfom of machinety andlqr equipment sewiclng the building is
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E5. Zone A 0 only:, If lit3floixl .depth~nuii~ber~i~vailab:lq;.is'~the:to~~~f
the bottom floor eievated:ln.iccordancewith.the commlinity's floodplain nianagement
ordihari~e?
. . . . a. y e $
unit"$;*. 'The lo.cal official':ini;~t:~e:iti~~i~is
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information in'~$@ion
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SECTION F PROPERM',QWNER (OR OWNER'S REPRESENTATIVE)~CERTIFICATION
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The property owner or owner's authdrizeid repr6set5t'ative~ h o ; ~ , m p l e t ~ s : . ~ e c.B,
t i and:E.for
i n ~ i ~ , ,~one.fi,~withoiit
a' ~ C ~ ~ - i s s or
u ecommunity-issued
d
BFE)
or Zone A d must sign here. 73e statements:!I, ;Se#ons;&$,.and,E,are
cormct to thebest of my &nowledge..
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Property Ownet% .or Owner's AuKoAted ~ephGntative's:
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Address
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Signature,.
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ZIP Code
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Comments
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Check here if attachment3
'SECTIONG': ~OMMUNIW~NFORMAT~ON
IOPTIO'NAC\
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The local official who is airthorized b9:lai. orordiha~ce,tbegminlsfeithe.comniiinlty'sfloodplilri mihagehint ordrnahce can cbmpiete sections A, B, C (or E),
and G qf this Elevation ~ertificate.'~om~lefe't~$ap~lidab.leIbm(s)
and sign below. Check the,measurementused in ltems G8, and G9.
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The informanoii in S6ctidh ed.w&stikgn from:otheridocumentation.that'has beeh signed and:seale'd:byi.licens6dsheybr, .eligineer;or.architect who
is authorlzed.by law tocertifyelev'ation informationP-.:(Indicatethe source and date of the elevation data in thecomments area-below.]
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- ~ c o m m u n i0ffldi6l~.~ni.~le'ted~~e~ioh
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E foka:b'ulkJing lo.catgd in'zone A (~lthouta FEMA-i$subd 0r'6ohimu~it~-iss~ed~F'~).or
Zone AO.
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The followinQ'iiifofoiiriYtr61i
fltemk;h4:~~9~)
is.pro~dea:forcommunity floodplain
managelment
purpdsds:
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I G4.Permit Number .
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I G6. Date Certificate Of-~om~liance10ccu~anc'~
.issued
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G5.. Date Permit Issued
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G7. This permit has beellissubd for: [ 7 ' ~ e wConstructiori.
Osubstantial lmprovernent
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f?et:.
.meters.(PR) . Datum
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GB. .Elevatipn.ofas-builtlowestS.floor(inquding base.ment)'@ft@:&Ild!ng:
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G9. BF;E.or (iri.Zone AO) .depth of~oodiiiga t " i h. . ,e :. b ~ i i ~ l i ~ .~.s. ..i..t.i..~...:.. . .
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. :~.!~~ei!.:;,n.mat~nn(p$iij
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Local Official's Name
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Telephone
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comments
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[7 Check her? if attachmenh
Building Photographs :
See lnstructiorisfor Item A6.
If using the Elevation Certificate to obtain NFlP fldod insurance, affix at least two building photographs below according to
the instructions for Item A6. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right
Side View" and "Left Side View." If-submitting more photographs than will fit on this page, use the Continuation Page,
following.
t)lirPlCHD
s.U&E~
OF