Flood Control - Elevation Certificate - 1597 S Whitby Lane - Lakeland Estates - 4/10/2000
FEDERAL EMERGENCY MANAGEMENT AGENCY
NA llONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
O.M.B. No. 3067-0077
Expires July 31, 2002
1m ortant: Read the instructions on a es 1 - 7,
SECTION A. PROPERTY OWNER INFORMATION
For Insurance Company Use:
Policy Number
ZIP CODE
6 '!:. Co \ (.,
R \STDtJ - N
BUILDING STREET ADDRESS (Including Apt.. Unit. Suile. and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
S S. fA} \ L t '
CITY (l- STATE
TlC:llE I 0
PROPERTY DESCRIPTION (Lot and Block Numbers. Tax Parcel Number, Legal Description. etc.)_
LOT 10 FSLc'JC\t- \ L..A-~ L..kN'i;:) ~'T1arrE~
BUILDING USE (e.g.~ Residential. Non-residential. Addition. Accessory, etc. Use Comments section if necessary.)
~es\~\A'-
LATITUDE/LONGITUDE (OPTIONAL)
( It#". #If - It#,##' or It#.#####")
Company NA1C N~rnbor ..
HORIZONTAL DATUM:
1..1 NAD 1927 1....1 NAD 1983
SOURCE: 1.....1 GPS (Type):........................................................ ......m.......
L-I USGS Quad Map I_I Other:_______
SECTION B. FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. COUNTY NAME B3. STATE
EAGLE 1<.0 0 ~* A :c..D
84. MAP AND PANEL 85. SUFFIX 86. FIRM INDEX 87. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATlON(S)
NUMBER ~ DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth of nooding)
IlcoO'C01~, . " <JOt . 'Z. ~ ... q~ , oat . Zz... "" A~ 2 SI7.2.e,
Bl0. Indicate the source of the Base Flood Elevalion (BFE) data or base flood depth entered In 89.
I_~I FIS Profile ' 1)(1 FIRM 1--' Community Determined I_I Other (Describe):
811. Indicate the elevation datum used for the BFE in B9: IXI NGVD 1929 1--1 NAVD 1988 I_I Other (Describe): _____
812. Is Ihe building located in a Coaslal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? I_I Yes IX I No
DeSignation Oale:___________
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C 1. Building elevations are based on: 1_IConstrucllon Drawings' 1--,-IBullding Under Construction' 1~IFinished Construction
. A new Elevation Certificate will be required when construction of the building is complete.
C2. Building Diagram Number ~ (Select the building diagram most similar to the building for which this certificate is being completed - see
pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
C3. Elevations - Zones A l-A30, AE, AH, A (with BFE), VE, Vl-V30, V (with BFE), AR. ARlA, ARlAE, ARIA 1-A30, ARJAH, ARlAO
Complete Items C3a-i below according to the building diagram specified in Item C2. State the datum used. It the datum is different from
the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion
calculation. Use the space provided or the Comments area of Section D or Section G. as appropriate, to document the datum conversion.
Datum lli.\lD~<1.. Conversion/Comments R l"\JD....8....= 'Z..S'1} S ,v, --..t:li-cl.~ ?.q A<\NEL I ~
Elevation reference mark used_KMlQ____ Do~s the elevation reference mark used appear on the FIRM? ': ~I Yes I_I No
o a) Top of bollom floor (induding basement or endosure) _~ 8.1.71 It.(m) m ~OWV- /:.
o b) Top of next higher noor __ 'ZS't ~ .03 It.(m) ~ ~ ST J'\IG~
o c) Boltom of lowest horizonlal structural member (V zones only) __~_ .. It.(m) ill iI ~\ I/~ ~
o d) Attached garage (top of-slab) _---1- S8\ _' 38_ ft.(m) j ~ ~
o e) Lowest elevation of machinery and/or equipment . 8036
servicing the building __~582.. . gB ft(m} l ~
o f) Lowest adjacent grade (LAG) __....kS80 _ .~ ft(m) -l,~
"Ul
o g) Highest adjacent grade (HAG) __-.?..S'6Q.... .8G:a. fL(m) i
o h) No. of permanent openings (nood vents) within 1 ft. above adjacent grade --1fa._ :1
, 0 i) Total area of all permanent openings (flood vents) in C3h --~4- sq. in. (sq. cm)
SECTION 0 - SURVEYOR, ENGINEER. OR ARCHITECT CERTIFICA TtON
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
I certify that the information in Sections A. B. and C on this certificate represents my best efforts to interpret the data avai/able.
I understand that any false statement may be punishable by fine or impn'sonment under 18 U.S. Code, Section 1001.
CERTIFIER'S NAME C^ to' /~ LICENSE NUMBER a......o,:a 1_
1'"'\1'1- ~E::\C:\~ O'....J ~\Q
TITLE COMPANY NAME
c...\ \J \ \- E.j-..I~~ N~ 'S:t\ t'I\ 6"NG.\ ~-.lE'bte...5
5'"1 <.c:> OS. CA~rib'- ~\.".\ft) CITY ~"O,"S~ 'STATE \D ZIP CODE e3707-
DATE TELEPHONE (ZOS ') 38 ~ - q l 70
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ADDRESS
SIGNATURE
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.~
IMPORT ANT: In the.. .pac.., copy the corresponding In'onnaUon from Section A.
BUILDING STREET ADDRESS (Including Apt., Uni\. Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
OJ ~. W eo \'-.\ '
CITY
f:AC:;1. L.E.
For In.uriinca CompariY:IJ~~i:'://
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STATE
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SECTION 0 - SURVEYOR, ENGINEER. OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenVcompany, and (3) building owner.
COMMENTS
NCNE..
'--I Check here if attachments
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO and ZONE A (WITHOUT BFE)
For Zone AO and Zone A (without BFE), complete Items E11hrough E3. "the Elevation Certificate is intended (or use as supporting
information for a LOMA or LOMR.F, Section C must be comp/eled.
E 1. Building Diagram Number _ (Select the building diagram most similar to the building for which this certificate is being completed -
see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
E2. The top of the bottom floor (including basemenl or enclosure) of the buildIng is 1_1_1 fl.(m) 1_1_lin.(cm) I_I above Dr 1-1 below
(check one) the highest adjacent grade.
E3. For Zone AO only: if no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's
floodplain management ordinance? I I Yes I_I No I_I Unknown, The local official must certify this information in Section G.
SECTION F. PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The properly owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or
community-issued BFE) or Zone AD must sign here.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS
CITY
STATE
ZIP CODE
SIGNATURE
DATE
TELEPHONE
COMMENTS
I_I Check here if attachments
SECTION G. COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance 10 administer the community's floodplain management ordinance can complete
Sections A, 8, C (Of E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below.
G1. I_I TIle information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor,
engineer, or architect who Is authorized by state or local law to certify elevation information. (Indicate the source and date of the
elevation data in the Comments area below.)
G2. I_I A community official completed Section E for a building located In Zone A (without a FEMA-Issued or community.issued BFE) or
Zone AG.
G3. I-I The following information (Items G4-G9) Is provided for community floodplain management purposes.
G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY
ISSUED
G7. This permit has been issued for: 1--1 New Construction 1__1 Substantial Improvement
Ga. Elevation of as-buill lowest floor (including basement) of the building Is: ______ ' __ It.(m) Datum: ______
G9. BFE or (in Zone AO) depth of flooding at the building site is: _____ . _ ft.(m) Datum:
SIGNA TURE
TITLE
TELEPHONE
DATE
LOCAL OFFICIAL'S NAME
COMMUNITY NAME
COMMENTS
f':'F'MA F'nrm R 1_11 Allr. QQ
'-_I Check here if attachments
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