53 ASTER FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
i • NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 200:
�3C�a�?0�t�- p�3��- ELEVATION CERTIFICATE
Im ortant: Read the instructions on a es 1-7.
� SECTION A•PROPERTY OWNER INFORMATION ForinsutanceCompvtyUse:
BUILDING OWNER'S NAME Policy Number
WILLIAM&KRISTINE GLEASON
BUILDING STREET ADDRESS(InGuding Apt,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIG Number
53 ASTER STTREET
CITY STATE ZIP CODE
CLEARWATER FL 34630
PROPERTY DESCRIPTION(Lot and Blodc Numbers,Tax Parcel Number,Legal Description,etc.)
LOT 8,MADALAY SUBDIVISION
BUILDING USE(e.g.,Residentiai,Non-residential,Addition,Acoessory,etc. Use a Comments area,if necessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS(fype):
( ##°-##'-#{#.##" or ##.�� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B•FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NANIE&CONNAUNITY NUMBER B2.COUNTY NAME 63.STATE
CITY OF CLEARWATER �ZSCfj(,� PINELLAS FLORIDA
B4.MAP AND PANEL 67.FIRM PANEL 89.BASE FLOOD ELEVATI�V(S)
NUMBER 65.SUFFIX B6.FIRM INDEX DATE EFFECTIVFJREVISED DATE 68.FLOOD ZONE(S) (Zone A0,use depih of floodirg)
]Zjo3L9��102 G 9C.�03 913l03 AE 11
610.Indicate the source of the Base Flood Elevation(BFE)data a base flood depth entered in B9.
❑FIS Profile ❑FIRM ❑Community Determined ❑Ofher(Describe):
611.Indicate the elevation datum used for the BFE in B9:�NGVD 1929 �NAVD 1988 ❑Other(Describe):
B12.Is the buiiding located in a Coastal Bartier Resources System(CBRS)area a Othervvise Protected Area(OPA)? ❑Yes �No Desi nation Date
SECTION C•BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on,❑Construction Drawings* ❑Building Under Construction' �Finished Construction
'A new EJevaGon Certificate will be required when construction of the building is canplete,
� C2,Building Diagram Number 7(Select the building diagram most similar to the building for which this cerfificate is being completed-see pages 6 and 7. If no diagram
accurately represents the building,provi�a sketch or photograph.)
C3.Elevations—Zones A1�30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,ARIA,ARIAE,ARIA1 A30,ARIAH,ARIAO
Complete Items C3.-a-i below aa;ording to the buikJing diagram specified in Item C2.State fhe datum used.If the datum is different from the datum used for the BFE in
Section B,convert the datum to that used fa the BFE.Show field measurements and datum conversion calculation, Use the space provided or the CommenGs area of
Section D or Section G,as appropriate,to document the datum conversion.
Datum ConversionlComments `
Elevation reference mark used TBM Does the elevation reference mark used appear on the FIRM? ❑Yes �No �
O a)Top of bottom tloor(induding basement or endosure) 4. 47 ft,(m) � ��a "�'�'�'�''�e ,
❑ b)Top of next higher floor 15.39 ft.(m) o ,°� ,, . �' ��"
❑c)Bottom of lowest horizontal structural member(V zones only) NA,_ft.(m) o o ' �,•;,,��w�r �:,r ��'`a
0 d)Attached garage(top of slab) 4. 47 ft.(m) E� ;.�'r '�' ,��;� K�.��`�,�
❑ e)Lowest elevation of machinery andlor equipment w a i � '��•I��(J�a'� ' '
serviang the building(Describe in a Canments area) 14,96 ft.(m) ° '�'�� �r i ��� � F, jx"� �
_ �,� � .,�� r�i r . ,�' ,
❑fl Lowest adjacent(finished)grade(LAG) 3.7 ft.(m) z� �;-. .I.�.,-
�v� d� �° ..
❑g)Highest adjacent(finished)grade(HAG) 4. 0 ft.(m) � .#�635 ;7(,'19�05 ��'"
❑ h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 20 �
❑ i)Total area of all permanent openings(flood vents)in C3.h 604.8 sq.in.(sq,an) � � � ,�'°' �
SECTION D•SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
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,8,and C on this certificate represents my best efforfs to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001.
CERTIFIER'S NAME DWAYNE A.RUTH IJCENSE NUMBER 5635
TITLE VICE-PRESIDENT COMPANY NAME GEORGE A.SHIMP II&ASSOC.,INC
� ADDRESS CITY STATE ZIP CODE
3301 DESOTO BOULEVARD PALM HAFtBOR FL 34683
G TURE DATE TELEPHONE
JOB N0. 050570 7/19/05 727-784-5496
FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces all previous editions
IMPORTANT: In these spaces,copy the corresponding information from Section A Fa►nsuranoe Company use:
BUILDING STREET ADDRESS(Induding Apt,Unit,Sui�,andlor Bkig.No,)OR p,0.ROUTE AND BOX N0. PoGcy Number : ' '
53 ASTER STREET
C� �A� ZIP CODE CanpanyNAIC Number
CLEARWATER � ��
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community offidal,(2)insurance agenUcompany,and(3)building ownec, �
COMMENTS
SECTION C3 e)=A/C PAD
❑Chedc 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(w�thout BFE),complete Items E1 through E4. If the Elevation Cerfificate is intended for use as supporting informaGon for a LOMA or LOMR-F,
Section C must be completed.
E1.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 bui�ing,provide a sketch a photograph.)
E2.The top of the bottom floor(induding basement or endosure)of the building is _ft.(m)_in.(cm)�above or ❑below(chedc one)the highest adjac:ent grade. (Use
natural grade,if available).
E3.For Building Diagrdms 6S with openings(see page 7),the next higherfloor or elevated floor(elevatlon b)of the building is _ft.(m)_in.(cm)above the highest adjacent
grade. Complete items C3.h and C3.i on front of foRn.
E4.The top of the plafform of machinery and/or equipment servidng the building is _ft(m)_in.(cm)❑above or ❑below(check one)the highest adjacent grade. (Use
natural grade,if avalable).
E5,For Zone AO only: If no flood depth number is available,is the top�f the bottan floor elevated in accordance with the communit�s floodplain management ordinance?
❑Yes ❑No ❑Unknown. The local offiaal must certify this ir�orrnation in Section G
SECTION F•PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owners authorized representative who completes Sections A,B,C(Items C3.h and C3.i only),and E for Zone A(without a FEMA-issued or community-
issued BFE)or Zone AO must sign here. The statements in Sections A,8,C,and E are correct to the besf of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME �
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
❑Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The local offiaal who is autnorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation
Certificate. Complete the appiicat�e item(s)and sign below.
G1.�The infortna�on in S�tion C was taken from other documentation that has been signed and embossed by a licensed suroeyor,engineer,or architect who is authorized by state
or local law!o certify elevation information. (Indicate the source and date of the elevation data in the Canments area below.)
G2.�A community offic�al a,mpleted Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0.
G3.�The following infamation(Items G4-G9)is provided for commuNty floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF CONIPLIANCE/OCCUPANCY ISSUED
G7.This permit has been issued for:�New Construction ❑Substantial Improvement
G8.Elevation of as-built lowest floor(induding basement)of the building is: ._ft.(m) Datum:
G9.BFE or(in Zone AO)depth of flooding at the building site is: _,_ft.(m) Datum;
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE �
COMMENTS
❑Chedc here if attachments
FEMA Form 81-31,January 2003 Replaces all previous editions
:
CITY OF CLEARWATER
� DEVELOPMENT & NEIGHBORHOGD SERVICES DEPARTMENT
POST�FFICE BOX 474g� CLEARWATER� FLOa�DA 33758-4748
MUNICIPAL SERVICES BUILD[NG, IOO SOUTH MYRTLE AVENL'E,CLEARWATER,FLO�unn 33756
TEI.r:PxoNE(727) 562-4567 FnY(72� 562-4576
MEMO OF REVIEW FOR CORRECTNESS 8� COMPLETION
In accordance with participation in the NFIP/CRS program,all elevation certificates are required to be reviewed for correctness and completion prior to
acceptance by the community. This complete form shall be attached to ail elevation certificates maintained on file and provide with requested copies of
elevation certificates.
The attached elevation certificate requires corrections by the surveyor of section(s) prior to acceptance by the community
The attached elevation certificate is complete and correct
X Minor corrections have been made in the below marked sections by Community O�cial
SECTION A-PROPERTY INFORMATION For Insurance Company Use:
A1. BUILDING OWNER'S NAME Policy Number
A2.BUILDING STREET ADDRESS(inciuding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
53 ASTER STREET
CITY STATE ZIP CODE
A3. PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
A4. BUILDING USE(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)
A5. LATITUDE/LONGITUDE(OPTIONAL): HORIZONTAL DATUM: SOURCE:❑GPS(Type):
(##°-##'-##,##" or ##.#####°) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map❑Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
�.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME 63.STATE
CITY OF CLEARWATER-125096
64.MAP AND PANEL g5.SUFFIX 66.FIRM INDEX DATE B�•FIRM PANEL gg,FLOOD ZONE(S) B9•BASE FLOOD ELEVATION(S)
NUMBER 5/17/2005 EFFECTIVE/REVISED DATE (Zone AO,use depth of flooding)
12103C-0102
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69.
❑ FIS Profile � FIRM ❑Community Determined ❑Other(Describe)
B11. Indicate elevation datum used for BFE in 69:� NGVD 1929 ❑ NAVD 1988 ❑Other(Describe)
812. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes ❑No Designation Date
SECTION C -BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. Building elevations are based on: ❑Construction Drawings* ❑ Building Under Construction* ❑ Finished 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 A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO.
Complete Items C3.-a-i below according to the building diagram specified in Item C2.State the datum used. If 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 Conversion/Comments
Elevation reference mark used Does the elevation reference mark used appear on the FIRM? ❑Yes ❑No
e) Lowest elevation of machinery or equipment servicing the building(Describe in Comments area) ft.(m)
h) No.of permanent openings(flood vents)1ft.above adjencent grade
i) Total area of all permanent openings(flood vents)in C3.h sq.in.(sq.cm) .
Comments: ,
Date of Review: ��, Community Official: _
_ �evation certificates shall be maintained by the community and copies with the attached memo made available by request
7
FRANK HBRAR(),MAYOR
GLORGE N.CRE'I'LKOS,COUNCILMEMBPR JO[IN DORAN,COUNCILM@MBER
PAUL F.GIBSON,COUNCIL�IGMBER � CARLGN A.PC"1'GRSEN,COUNCILMCMB�R
��EQUAL EMPLOYMEN"1'AND Af�F112MA'fIVE AC1'ION EMPLOYER��
��a� n�,�-f �v� �� �
FEDERAL EMERGEN AG T CY O.M.B. No. 3067-0077
�° NATIONAL FL00 I
��f..�-���G�� M �,,�1��{n� Expires December 31, 200;
ELEVATION CE TI Cv
Important: Read the instructions on pages 1-7.
SECTION A-PROPERTY OWNER INFORMATION forinsuranc�CompanyUse:
BUILDING OWNER'S NAME Policy Number
WILLIAM & KRISTINE GLEASON
BUILDING STREEI'ADDRESS(Including Apt.,Unit,Suite,and/or Bidg.No.)OR P.O.ROUTE AND BOX Company NAICNumber
53 ASTER STTREEi'
C�N STATE ZIP CODE
CLEARWATER FL 34630
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
LOT 8,MADALAY SUBDIVISION
BUI�DING USE(e.g.,Residential,Non-residen6al,Addition,Accessory,etc. Use a Comments area,if necessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(fype):
� ��_�'_��„ o� ���� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B•FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNIIY NAME 8 COIvVv1UNITY NUNIBER B2 COUNTY NAME B3.STATE
CfiYOFCLEARWATER (z,�(� PINELLAS FLORIDA
B4.MAP AND PANEL 67.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER 65.SUFFIX 86.FIRM INDEX DATE EFFECTIVFJREVISED DATE 68.FLOOD ZONE(S) (ZoneAO,use depth of floodirg)
IZIo3L�d102 G 9/3ro3 9/3l03 AE
11
B10.Indicale the source of the Base Flood ElevaGon(BFE)data a base flood depth enteretl in B9. �
❑FIS Profile ❑FIRM ❑Community Determined ❑Other(Describe): '�°��m.. v�N;��'�'s��'�°�;r�.�"�"�
B11.Intlicate the elevation datum used for 1he BFE in B9:�NGVD 1929 �NAVD 1988 ❑Other(Describe):
812.Is the building localed in a Coastal Barrier Resources Sysfem(CBRS)area a Otherwise Prolected Area(GPA)7 ❑Yes �No Designalion Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:�Construc�on Drawings' ❑Building Under Consiructioni �Finished Construc6on
'A new Eleva6on Certificate will be required when construction of the building is complete.
2.Building Diagram Number 7(Select the building diagram mosl similar to fhe building for which fhis certificate is being completed-see pages 6 and 7. If no tliagram
accurately represents fhe building,provide a sketch or photograph.)
C3.Eleva6ons—Zones A1 A30,AE,AH,A(wifh BFE),VE,V1-V30,V(with BFE),AR,AWA,AR/AE,AR/A1-A30,AR/AH,AWAO
Complete Items C3:a-i below aarording to ihe lwilding diagram specified in Item C2.State�he datum used.If the datum is different from the datum used for the BFE in
Sec6on B,convert ihe datum to that used for the BFE.Show field measurements and datum conversion calcula6on, Use the space provided or the Comments area of
SecGon D ocSection G,as appropriate,to document the dafum conversion.
Datum'� ConversioNComments
ElevaUon�reference mark used TBM Does ihe elevation reference mark used appear on the FIRM? ❑Yes �No
O a)Top of boitom floor(incJutling basement or endasure) 4. 47 ft.(m) � ,a�' "" �•'�
0 b)Top of next higher floor 15.39 ft.(m) � x�' °` �l'w '
� � '; ,;
❑ c)Bottom of lowest horizontal slructural member(V zones only) NA, ft,m -
❑ d)Attached garage(top of slab) � � °° � g '�� ��r r„� `� r
4. 47 ft.(m) �� ��..��. �� rl�, r,
❑ e)Lowest elevaGon of macl�inery and/or equipment W � '' • �- � tr�, �..E,1�:�.1:t.��
servicing the builtling(Descnbe in a Commenls area) 14.96 ft.m � _ `' �' ��'. � " 1'ay n :
� )
❑ fl Lowest adjacent(finished)grade(LAG) 3.7 ft.(m) ' � "` �?�' ' ;' � ' '4�
❑ Hi hest ad'acent finished rade HAG Z �.� �"��"�' '
9� g � � �9 � ) 4, 0 ft.(m) �� ,#5635 7/19/05 �
❑ h)No.of perrnanent openin gs(flood vents)wilhin 1 ft.a b o v e a tl j a c e n t g r a tl e 2 0 �
❑ i)Total area of all permanent openings(flood vents)in C3.h 604.8 sq.in.(sq.cm) J
. ,,
SECTION D•SURVEYOR,ENGINEER,OR ARCH(TECT CERTIFICATION
This certification is to be signed antl sealed by a land surveyor,engineer,or architect authorized by law to certify elevafion informafion.
1 cerfify that the information in Sections A,8, and C on this certificate represents my best e(forfs fo interpret the data avai/able.
1 understand thaf any false statement may be punishable by fine or imprisonment under 18 U S Code, Section ?001
��RTIFIER'S NAME DWAYNE A RUTH LICENSE NUMBER 5635
�ITLE VICE-PRESIDENT COMPANY NAME GEORGE A.SHIMP II&ASSOC.,INC
ADDRESS CITY STATE ZIP CODE
3301 DESOTO BOULEVARD PALM HARBOR FL 34683
GIVATURE DATE 7ELEPHONE
, ���1 JOB N0. 050570 7/19/05 727-784-5496
FFnnA F„�,., R, �, �........_..,,.,.., __
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
_ NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 200F
C.�,a�0��' �`�3��- ELEVATION CERTIFICATE
Important: Read the instructions on pages 1-7.
SECTION A•PROPERTY OWNER INFORMATION forinsurance Company Use:
� BUILDING OWNER'S NAME Policy Number
WILLIAM&KRISTINE GLEASON
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,ancllor Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
53 ASTER STTREET
CITY STATE ZIP CODE
CLEARWATER FL 34630
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legai Description,etc.)
LOT 8,MADALAY SUBDIVISION
BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,if necessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):
( ##°-##'-##.#{#" or ##.�� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
81.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME 63.STATE
CITY OF CLEARWATER �ZSCtj(� PINELLAS FLORIDA
64.MAP AND PANEL 87.FIRM PANEL 89.BASE FLOOD ELEVATION(S)
NUMBER 65.SUFFIX 66.FIRM INDEX DATE EFFECTIVF�REVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depth of flooding)
]Zja3L'��-0102 G 913�U3 9/3103 AE 11
610.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in 69.
❑FIS Profile ❑FIRM ❑Community Determined ❑Other(Describe):
B11.Indicate the eleva6on datum used for the BFE in 89:❑NGVD 1929 �NAVD 1988 ❑Other(Describe):
612.Is the building located in a Coastal Barrier Resources System(CBRS)area or Othenvise Protected Area(OPA)? ❑Yes �No Designation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:❑Const�uction Drawings' ❑Building Under Construction' �Finished Co�struction
� *A new Elevation Certificate will be required when construction of the building is canplete.
C2.Building Diagram Number 7(Select the building diagram mast similar to the building for which this cerfificate is being completed-see pages 6 and 7. If no diagram
accurately represents the building,provide a sketch or photograph.)
C3.Elevations—Zones A1 A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AWAE,AR/A1-A30,AR/AH,AR/AO
Complete Items C3.-a�below aocording to the building diagram specified in Item C2.State the datum used.If 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
Sec6on D or Section G,as appropriate,to document the datum conversion.
Datum ConversionlComments °
ElevaUon reference maric used TBM Does the elevation reference mark used appear on the FIRM? ❑Yes �No - ;�
❑ a)Top of bottom floor(induding basement orendosure) 4. 47 ft.(m) @ a4�d �_ ,as�= ,
❑ b)Top of next higher floor 15.39 ft.(m) � `� ' ;•����`�5 V�
❑c)Boflom of lowest honzontal structural member(V zones only) NA._ft.(m) N� t•'• �' s�"�`` °°
a d)Attached garage(top of slab) 4. 47 ft.(m) E� ; ,; �°'� �' ��'��, � t
❑ e)Lowest elevation of machinery andlor equipment W@ `" �'"�����
a �,t"; ;� �? .�
servicing the building(Describe in a Comments area) 14.96 ft.(m) � ,�., �r�,�� G ��a�
❑fl L.owest adjacent(finished)grade(LAG) 3.7 ft.(m) z� .s.'�'fJ.�,,.:- `'! -
v u� . x_: ,
❑ g)Highest adjacent(finished)grade(HAG) 4. 0 ft.(m) � #5635. ,7(;19105����"
O h)No.of permanent openings(flood vents)within 1 ft.above atljacent grade 20 �
. :
❑ i)Total area of all permanent openings(flood vents)in C3.h 604.8 sq.in.(sq.cm) � 3 ' �
SECTION D•SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signetl and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.
I certify that the information in Sections A,8,and C on this certificate represents my best efforfs to interpret the data available.
_I understand that any false statement may be punishable by�ne or imprisonment under 18 U S Code Section 1001
CERTIFIER'S NAME DWAYNE A.RUTH LICENSE NUMBER 5635
TITLE VICE-PRESIDENT COMPANY NAME GEORGE A,SHIMP II&ASSOC.,INC
� ADDRESS CITY STATE ZIP CODE
3301 DESOTO BOULEVARD PALM HARBOR FL 34683
G TURE DATE TELEPHONE
JOB N0. 050570 7119/05 727-784-5496
FEMA Form 81-31,Januarv 2003 See reverse side for continuation. RPnlar.PC all nrPVi�iic a�iitinnc
IMPORTANT: In these spaces,copy the corresponding information from Section A Forinsuranoe Company Use: �
BUILDING STREETADDRESS(Induding Apt,Unit,Suite,andla Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number . � �' -
53 ASTER STREET
CITY STATE ZIP CODE Company NAIC Number ;
CLEARWATER � 34g3p
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) _
Copy both sides of this FJevation CeNficate for(1)community offiaal,(2)insurance agenUcompany,and(3)lwilding owner.
COMMENTS
SECTION C3 e)=AIC PAD
❑Chedc 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),oomplete Items E1 through E4. If the Elevation Certificate is intended for use as suppoRing informa6on for a LOMA or LOMR-F,
Section C must be completed.
E1.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 a photograph.)
= E2.The top of the bottom floor(induding basement or endosure)of the building is _ft.(m)_in.(cm)�above or ❑below(check one)the highest adjacent grade. (Use
� natural grade,if available).
E3.For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(eleva6on b)of the building is _ft.(m)_in.(cm)above the highest adjacent
grade. Complete items C3.h and C3.i on front of form.
E4.The top of the pla�orm of machinery andlor equipment serviang the building is _ft.(m)_in.(cm)�above or ❑below(check one)the highest adjacent gratle. (Use
natural grade,if available).
E5.For Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in aa;ordance with the communit�s floodplain management ordinance?
❑Yes ❑No ❑Unknown. The local offiaal must certify this infamation in Section G.
SECTION F•PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owners authorized representative who completes Sections A,B,C(Items C3.h and C3.i only),and E for Zone A(without a FEMA-issued or community-
issued BFE)or Zone AO must sign here. The statements in Secfions A,B,C,and E are correct to the best of my knowledge. �
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
❑Chedc here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The local offiaal who is au�norized by law or ordinance to administer the communitys floodplain management ordinance can wmpiete Sections A,B,C(or E),and G of this Elevation
Cerfificate. Complete ihe apolicaL�P item(s)and sign below.
G1.�The informa+�on in Sertion C was taken from other documentation that has been signed and embossed by a licensed surveyor,engineer,or archited who is authorized by state
or local law!o cer�fiy elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
G2.�A community offic�al completed Section E for a building located in Zone A(without a FEMA�ssued or community-issuetl BFE)or Zone A0.
G3.❑The following information(Items G4-G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6.DATE CERTIFICATE OF COMPLIANCEJOCCUPANCY ISSUED
G7.This permit has been issued for.�New Construction ❑Substantial Improvement
G8.ElevaUon of as-built lowest floor(induding basement)of the building is: _._ft.(m) Datum:
G9.BFE or(in Zone AO)depfh of flooding at the building site is: _,_ft.(m) Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE �
SIGNATURE DATE
COMMENTS
❑Chedc here if attachments
FEMA Form 81-31.Januarv 2003 0�^��^�����^•�,^^..��-�:�:--�
.+. .
CITY OF CLEARWATER
• DEVELOPMENT & NEIGHBORHOGD SERVICES DEPARTMENT
pOST QFFICE BOX 474g� CLEARWATER� F�.oa�DA 33758-4748
MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CLEARWATER, FLO�uDn 33756
TNLEPxorrE (72� 562-4567 Fnx(727) 562-4576
MEMO OF REVIEW FOR CORRECTNESS 8� COMPLETION
In accordance with participation in the NFIP/CRS program, all elevation certificates are required to be reviewed for correctness and completion prior to
acceptance by the community. This complete form shall be attached to all elevation certificates maintained on file and provide with requested copies of
elevation certificates.
The attached elevation certificate requires corrections by the surveyor of section(s) prior to acceptance by the community
The attached elevation certificate is complete and correct
X Minor corrections have been made in the below marked sections by Community Official
SECTION A-PROPERTY INFORMATION For Insurance Company Use:
A1. BUILDING OWNER'S NAME Policy Number
A2.BUILDING STREET ADDRESS(including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
53 ASTER STREET
CITY STATE ZIP CODE
A3. PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
A4. BUILDING USE(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)
A5. LATITUDE/LONGITUDE(OPTIONAL): HORIZONTAL DATUM: SOURCE:�GPS(Type):
(##°-##'-##.##" or ##.###p#°) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map❑Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME 63.STATE
GTY OF CLEARWATER-125096
B4.MAP AND PANEL g5.SUFFIX 66.FIRM INDEX DATE B��FIRM PANEL gg.FLOOD ZONE(S) B9•BASE FLOOD ELEVATION(S)
NUMBER 5/17/2005 EFFECTIVE/REVISED DATE (Zone A0,use depth of flooding)
12103C-0102
610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69.
❑ FIS Profile � FIRM ❑Community Determined ❑Other(Describe)
B11. Indicate elevation datum used for BFE in B9:❑ NGVD 1929 ❑ NAVD 1988 ❑Other(Describe)
B12. Is the building located in a Coastal Barrier Resources S stem(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes ❑No Designation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. Building elevations are based on: ❑Construction Drawings* ❑ Building Under Construction' ❑ Finished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
C2. Buiiding 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 A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO.
Complete Items C3.-a-i below according to the building diagram specified in Item C2.State the datum used.If 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 Conversion/Comments
Elevation reference mark used Does the elevation reference mark used appear on the FIRM? ❑Yes ❑No
e) Lowest elevation of machinery or equipment servicing the building(Describe in Comments area) ft.(m)
h) No.of permanent openings(flood vents)1 ft.above adjencent grade
i) Total area of all permanent openings(flood vents)in C3.h sq.in.(sq.cm)
Comments:
Date of Review: Community Officiai:
�evation certificates shall be maintained by the community and copies with the attached memo made availab/e by request
FRANK HIHRARD,MAYOR
G[ORGE N.CRL7'GKOS,COUNCILMGMBIiR JOI W DORAN,COUNCILMEMBER
PAUL F.GIBSON,COUNCILMEMRER � CARI.GN A.PE"I'ERSGN,COLiNCILMGMHGR
��EQUAL EMYLOYMENT AND f�F1RMA'PIVE AC'170N EMPLOYER��