701 BAY ESPLANADErGVGf�I1L L:IItt_(�VLI\V 1 1�II�1�/1V�.���a��� � rava_��v r
NATIONAL FL•OOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
nt: Read the instructions on paqes 1- 7.
SECTION A- PROPERTY OWNER INFORMATION
NG OWNER'S NAME
& CHARLENE SMITH
NG STREET ADDRESS (InGuding Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
AY ESPLANADE
CJ.M.t�. N0. 3U6/-UUI!
Expires July 31, 2002
For Insurance Company Use: `
Polic�r Number
CL�RWATER BEACH ,..$TATE ziP cooE
r �.
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Pa�cel Number, Legaf Description, etc.)
LOT 1 BLQCK 35 MANOALAY
Apclrtwn, Accessory, etc. use a Comments area, if
LATITUDE/LONG�TUOE (OPTIONAL) HORIZONTAL DATUM: SOURCE: L� GPS (Typa):
{�° -�k' -�qk.�' or �.�M+�� Lj NAD 1927 L� NAD 1983 LJ USGS Quad Map L� Othar.
�
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION `
31. NFIP COMMUN{TY NAME d� COMMUNITY
CITY OF CLEARWATER 125096
B5. SUFFIX
NUMBER
125096-0007 D
83�
87. FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S
EFFECTNE/REVISED DATE ZONE(S) (Zone AO, usa depth of flooding)
8-19-91 AE 10
B10. Indicate the sour�ce of ihe Base Flood Erevat on t�FE) data or base flood depth entered in 69. �i
U FIS Profile U FIRM �J Community Determined �J Other (Describe):
B11. Indicate the elevation datum used for the BFE in 89: ( X � NGV� 1929 U NAVD 1988 �,_J Other (Describe):
612. Is the building focated in a Coastal Barrier Resources System (CBRS) area or Othervvise Proteded Area (OPA)? U Yes U No
Designation Date: Q
SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) 4�
C1. Building elevations are based on: �X �Construction Orawings• �JBuilding U�der Constn�dion' UFinished Construction 1''�
� new Elevation Certificate will be required when construction of the building is complete. `
C �ilding 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 accucately 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 nom p
the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion �
calculatio�. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion.
Datum M. S. L. ConversioNComments `
Elevation re%rence mark used I-3 EL=3. 375 Ooes the elevation reference mark used appear on the FtRM? . �J Yes � No �
❑ a) Top of bottom floor (including baseme�t or enclosure) 4 97 ft.(m) A :.,, :�. � M
m
❑ b) Top of next higher floor 19 . 47 ft.(m) `� '. „
O c) 8ottom of lowest horizontal strudural member (V zones only) NONE . ft.(m) o�_,��, y-
O d) Attached garage (top of slab) 4. 34 ft.(m) � g : �., .
❑ e) Lowest elevation of machinery and/or equipment W '° � : " _ , , , . �
�
servicing the building (Describe in a Comments area.) N/A ft,�m� E g-; :'�, ;: �
❑� Lowest adjacent (finished) grade (LAG) 3 97 ft.(m) z.Q -�' � '
❑ g) Highest adjacent (finished) grade (HAG) � ft.(m) �" ' ' � , Q}
❑ h) No. of pertnanent openings (flood vents) within 1 ft. above adjacent grade � #2512'„ �' :,�.r+� ~ �
C} i) Total area of all permanent openings (flood vents) in C3.h sq. in. (sq. cm) �4
SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION �
This certification is to be signed and seated by a land surveyor, engineer, or architect authorized by law to certify elevation infoRnation.
l cerfify that the in/onna6on in Sec6ons A, B, and C on this ceKificate represents my best eflorts to interpret the data availab/e. r`�
1 undeistand that eny false statemenf may be punishab/e by fine or imprisonment under 18 U S Code, Secfion 100! v
C�EORGE A.�SHIMP I I UC��1S� NUMBER
r� � �
1 � 1 t : 1
�%%'i�///
.���� �.�..��.
. �,,
G�EDKGE��A.--'SFiIMP II & ASSOC. INC.
�FI�Y9 HARBOR ��TE ��'6��DE
JOB#010141 2d�� pl ��4HQ���6
SEE REVERSE SIDE FOR CONTINUATION REPLACES ALI. PREVIOUS EDI710NS
mrc�rc i,/an i: in tnese spaces, copy the corresponding information from 5ection A. For Insurance Company Use:
3UILDiNG STREET ADDRESS (I�cluding Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number
7t�1 BAY ESPLANADE �
%�T1' STATE ZIP CODE Company NAIC Number
SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
;opy both sides of this Elevation Certificate for (1) communiry official, (2) insurance agenUcompany, and (3) building owner. •
:OMMENTS
(_� Check here if attachments
SECTION E- BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(1MTHOUT BFE)
or Zone AO and Zone A(without BFE), complete Items E1. th�ough E4. 1f the Elevation Certificate is intended for use as supporting
formation tor a LOMA o� LOMR-F, Section C must be completed.
1. Building Diagram Number (Select the building diagram most similar to the buildi�g for which this certificate is being completed —
see pages 6 and ?. If no diagram accurately represe�ts the building, provide a sketch or photograph.)
2. The top of the bottom floor (inctuding basement or enGosure) o# the building is LL� ft.(m) LL�in.(cm) (_,j above or U below
(check one) the highest adjacent grade. (Use natural grade, if available.)
3. Fo� Suilding Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is
�,� ft.(m) [_��in.(cm) above the highest adjacent g�ade. Complete Items C3.h and C3.i on front of form.
4. For Zone AO only: If no flood depth number is available, is the top of the boriom floor elevated in accordance with the community's
floodplain management ordinance? I Yes � I No LI Unknown. The local official must certity this infonnation in Section G.
SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
�he property owner or owne�'s 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 conect to
!he best of my knowledge.
�ROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
4DORESS CITY STATE ZIP CODE
�_� Check he�e if attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
ie loca! offiaal who is authorized by law or o�dinance to administer the community's floodplain management ordinance can complete
ections A, B, C(or E), and G of this Elevation Certificate. Complete the applicable item(s) a�d sign below.
1• L) The infonnation 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.)
2. L� A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or
Zone AO.
3. LJ The following information (Items G4-G9) is provided for community floodplain management purposes.
7. This permit has been issued for: �� New Construction L� Substantial Improvement
8. Elevation of as-built lowest floor (including basement) of the building is: _ ft.(m) Datum:
9. BFE or (in Zone AO) depth of flooding at the building site is: _ ft.(m) Datum:
LOCAL OFFlCIAI'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
;.OMMENTS
•
� I Check here if attachments
=MA Form 81-31, JUL 00 • REPLACES ALL PREVIOUS EDITIONS
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
NATIONAL FL•OOD INSURANCE PROGRAM Expires July 31, 2002
- � ELEVATION CERTIFICATE
Im ortant: Read the instructions on a es 1 -7.
SECTION A-PROPERTY OWNER INFORMATION For Insurance Campany Use: `
N�I.DING OWNER'S NAME Policy Number
& CHARLENE SMITH
��DING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg. No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
701 BAY ESPLANADE -
CL�RWATER BEACH �STATE ZIP CODE
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
LOT 1 BLOCK 35 MANDALAY
R ES I D E NT I�L�e.9.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,ii necessary.)
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: L�GPS(Type):
( �klk°-�14k'-##.�#t' or ##.##MMr#� L�NAD 1927 L�NAD 1983 L�USGS Quad MaP L�Other:
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
Bt.NFIP COMMUNITY NAME 8 COMMUNITY NUMBER 62.COUNTY NAME B3 S qT
CITY OFCLEARWATER 125096 PINELLAS �LbR�A
B4.MAP AND PANEL B5.SUFFIX B6.FIRM INDEX B7.FIRM PANEL B8.FLOOD B9.BASE FLOOD ELEVATION(S)
NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use depth of flooding)
125096-0007 D ��-�--"���r{ 8-19-91 AE 10
B10. Indicate the source of the Base Flood E evation FE)data or base flood depth entered in 69.
�J FIS Profile �� FIRM �J Community Determined �_J Other(Describe):
B11. Indicate the elevation datum used for the BFE in 69: �X � NGVD 1929 �_J NAVD 1988 �_J Other(Describe):
612. Is the building located in a Coastal Barrier Resources System (CBRS)area or Otherwise Protected Area(OPA)? �J Yes �X � No
Designation Date:
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. Building elevations are based on: �X �Construction Drawings" �_�Building Under Construction" �JFinished Construction
new Elevation Certificate will be required when construction of the building is complete.
C �ilding 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 accu�ately 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 M.S.L. Conversion/Comments
Elevation reference mark used I-3 EL=3.375 Does the elevation reference mark used appear on the FIRM?- �J Yes �X � No
❑ a)Top of bottom floor(inGuding basement or enclosure) 4 97 ft.(m) � ; ,�r,:�, _
❑ b)Top of next higher floor 19 .47 ft.(m) `� �,A�� .�
O c)Bottom of lowest horizontal structural member(V zones only) NONE . ft.(m) �o ��, , .
O d)Attached garage(top of slab) 4 ,34 ft.�m� E� ,� �_ ; , .
❑ e)Lowest elevation of machinery and/or equipment W " ' \=' . - ,
servicing the building(Describe in a Comments area.) N/A ft,�m� E= L� '.���
` .
O � Lowest adjacent(finished)grade(LAG) 3 .9� ft.(m) i N ', � , � /
O g)Highest adjacent(finished)grade(HAG) —� �ff,(m� � ' '� _ '
❑ h) No.of peRnanent openings(flood vents)within 1 ft.above adjacent grade � #25J.2„ �' �
❑ i)Total area of all permanent openings(flood vents)in C3.h sq.in.(sq.cm) .
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 infoRnation.
I certify that the information in Sec6ons A, 8, and C on this certificate nepresents my best efforts fo interpret the data availab/e.
l understand that an�/alse statement may be punishab/e by fine or imprisonmenf under 18 U S Code, Section 1001
CERTIFIER S NAME LIC��i�NUMBER
GEORGE A. SHIMP II
TT� SIDENT �U�YA���iIMP II & ASSOC. INC.
O�S SOTO BLUD. F��l HARBOR �.T�TE ��6��DE
s�� JOB#010141 2���O1 T�2S4H���6
FEMA Form 1-31,JUL SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use:
BUILDING STREET ADDRESS(Including Apt., Unit,Suite,and/or Bldg. No.)OR P.O. ROUTE AND BOX NO. Policy Number
701 BAY ESPLANADE •
CITY STATE ZIP CODE Company NAIC Number �
CLEARWATER BEACH FL.
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for(1)communiry official, (2)insurance agenUcompany, and (3)building owner. �
COMMENTS
I—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 E1.through E4. If the Elevation Certificate is intended for use as supporting
information 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 or photograph.)
E2.The top of the bottom floor(including basement or enclosure)of the building is L�_�ft.(m) L�_�in.(cm) ��above or L�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(elevation b)of the building is
I_I_I ft.(m) L�_�in.(cm)above the highest adjacent grade. Complete Items C3.h and C3.i on front of form.
E4. 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 Yes � I No � I Unknown. The local official must certify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owner's 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 communiry-issued BFE)or Zone AO must sign here. The statements in Sections A, 8, C, and E are conect 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
I—I Check here if attachments
SECTION G-COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the communiry's floodplain management ordinance can complete
Sections A, B,C(or E), and G of this Elevation CeRificate. Complete the applicable item(s)and sign below.
G1. L�The 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. ��A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or
Zone AO.
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 COMPLIANCFJOCCUPANCY
ISSUED
G7.This permit has been issued for: �_) New Construction �_�Substantial Improvement
G8. Elevation of as-built lowest floor(including 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
•
� I Check here if attachments
FEMA Form 81-31,JUL 00 • REPLACES ALL PREVIOUS EDITIONS