965 BAY ESPLANADE FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
�D~ ���j� �� � � � NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
ELEVATION CERTIFICATE S��,�_ ,�..� ���,�
NOV 1 6 2006 fmportarrt: Read fhe instructions on pages 1-7.
• SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use:
����'I���S�iCES DEPT Policy Number
i H�,R6��IROCD�DIRVIMI
UILDING STREET ADDRESS(Incfuding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX N0. Company NAIC Number
965 BAY ESPLANADE
CITY STATE ZIP CODE
CLEARWATER BEACH FL 3376�
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
LOTS 7,8,9,SOUTH 12 OF LOT 6 8�NORTH 40'OF LOT 10,BLK 265,CARLOUEL SUB
BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,'rf necessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS(Type):
( ##°-##'-##.##" or �f#.#tl�°) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME 63.STATE
CLEARWATER-125096 PINELLAS FLORIDA
64.MAP AND PANEL B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVEIREVISED DATE 68.FLOOD ZONE(S) (Zone A0,use depth of iboding)
12103C0064 G 9�I03 9f3ro3 AE 11'
610.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Desaibe):_
B11.Indicate the elevation datum used for the BFE in B9:0 NGVD 1929 �NAVD 1988 ❑Other(Describe):_
B12.Is the building located in a Coastal Bamer ResourCes System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No Designation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevafions are based on:0 Construuction Drawings' ❑Building Under Construction` �Finished Construction
+ `A new Elevation Cerfificate will be required when construc6on of the building is complete.
C2.Building Diagram Number 7(Select the building diagram most similar to the building for which this certificate is bang 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,ARJA,ARIAE,ARIA1 A30,AR/AH,AR/AO
Complete Items C3-a-i below according to the building diagram speafied in Item C2.State the datum used.If the datum is differer�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 sp�provided or the Comments area of
Section D or Sedion G,as appropriate,to da.ument the datum conversion.
Datum See Secfion D ConversionlComments See Section D
Elevation reference mark used See Sec.D Does the elevation reference mark used appear on the FIRM? ❑Yes �No ,,�a sq r
o a)Top of bottom floor(induding basement or endosure) 8. 89 ft.(m) � y °;�: �`r ,��'�-
cn � e�aaaa, r-�'.� a, -
o b)Top of neact higher 800r 11 .02 ft.(m) � �G�, �_; 46 �
o c)Bottom of lowest horizontal structural member(V zones only) N.A ft.(m) o o � '��,�� ,;-r - `` J r
o d)A t t a c h e d garage(top o f s l a b) 8. 8 9 ft.(m) £� " �Q , ;� ���+ �'
o e)Lowest elevation af machinery andlor equipment W � �; .� � _
serviang the building(Desaibe in a Comments area) 11 .03 ft.(m) £ � �. °
� �� � ,
o f}Lowest adjacent(finished)grade(LAG) 6.50 ft.(m) �� : a '� �_ e��y=,
o g)Highest ad�acent(6nished)grade(HAG) 10. 10 ft.(m) � ;� -�>� �
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 3 � �c° ° `3 ''=`
J
o i)Total area of all permanent openings(flood vents)in C3.h 810.82 sq.in.(sq.an) `�a=,, �° - • `
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 inform ion.
1 certify fhat the information rn Sectrons A,8,and C on fhis certifrcate represents my best efforts to interpret the data avaifable.
1 understand fhat any fafse sfatemenf may be punishable by fine or impnsonment under 18 U,S.Code,Section 1001,
CERTIFIER'S NAME JOHN C.BRENDLA LICENSE NUMBER 1269
TITLE REGISTERED LAND SURVEYOR COMPANY NAME JOHN C.BRENDLA&ASSOCIATES,INC.
� ADD S CITY STATE ZIP CODE
`` '' 401 82�'�AV UE NO PINELLAS PARK FL 33781
�' SI NATU DATE TELEPHONE
10/17106 727-576-7546
FEMA F 81 1,January 2003 See reverse side for continuation. Replaces ail previous editions
��aoo�- o3a�3
IMPORTANT: In these spaces,copy the corresponding infonnation from Section A. Fa Insurance Company Use:
BUILDING STREET ADDRESS(Induding Apt,Unrt,Suite,andlor Bldg.No.)OR P.O.ROUTE AND BOX N0. Poli�y Number
965 BAY ESPLANAJE
CffY STATE ZIP CODE Comparry NAIC Number
CIEARWATER BEACH FL 33767
SECTION D-SURVEYOR,ENGINEER,OR ARCHRECT CERTIFICATION(CONTINUED)
y both sides of this Elevation Certificate for(1)community affiaal,(2)insurance agent/company,and(3)building owner.
COMMENTS
c3e)AC PAD
BENCHMARK USED:#152,AURAL RM 31973,EL=6.193'N.G.V.D.,ADJUSTED TO EL=5.40'N.A.V.D.
❑Chedc here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WRHOUT BFE)
Fo�Zone AO and ZoneA(witliout BFE�,complete Items E1 through E4. If the Elevabon CPrtificate is intended for use as suppal�g i�formation fa a LOMA cr!On�R-F,
Section C must be completed.
E1.Building Diagram Number_(Se�ect the bu�ding diagram most simdarto the budding for which this oerfificate is being canpleted-see pages 6 and"/. �f no diagram aaa�rately ,
represents the bui�ing,provide a sketch or photograph.)
E2.The top af the bottom floor(induding basemer�or endosure)of the building is _ft,(m)_in.(cm)�above or ❑below(chedc a�e)the hiqhes�t adjacent grade. (Use
natural grade,if available).
E3.For Build'mg Diagrams 6-8 wi'�openings(see page�,the next higher floor a eleva�ed fioor(elevation b)af the building is f ft.(m)�in.(cm)at!�ve thE hghest a�a�t
grade. Complete items C3.h and C3.i on front of form.
E4.The top of the�atfaam of machinery andlor equipment serviang the building is _ft.(m)_in.(cm)❑above or ❑below(chedc one)the highest aC;�cent grade. (Use
natural grade,'rf available).
E5.For Zone AO a�ly: If no floai depth number is available,is the top of the bottan floor elevated in accadance with the community's floodpiain management arlinanrz?
❑Yes ❑No ❑Unknown. The bcal oifici�must certify this information in Section G.
SECTION F•PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFiCAT10N
The properry�ner or awner's authorized rep�esenta6ve who completes Seclions A,B,C(Items C3.h and C3.i only),and E fa Zone A(w�hout a FEMA�ssued or communiiy-
issued BFE)or Zone AO must sign here. The sfatemer�s in Sections A,B,C,and E are cor►ect fo the best of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
�RESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
❑Chedc here if attachments
SECTION G•COMMUNRY INFORMATION(OPTIONAL)
The loql oifidal who is authorized by law or ordinance to administer the c�rnmunit�s flood�ain m�agement a�n�ce can complete Sections A,B,C(or�,and G o�this Eleva�ion
Certificate. Complete the ap�'�able iterr�(s)�d sign bebw.
G1.[]The i�forma6on in Section C was taken from other documenta6on that has been sigr�ed and embossed by a licensed suroeyor,engineer,or architect who is authorized by state
or local law to certify elevation i�formation. (Indicate the sourGe and date of the elevation data in the Comments area below.)
G2.�A community ofliaal completed Section E for a building located in Zor�A(without a FEMA-issued or communiiy-issued BFE)or Zone A0.
G3.�The fdlowing irrformation(Items G4-G9)is provided for communiiy floodpl�n management purposes.
G4.PERMff NUfv�ER G5. DATE PERMff ISSUED G6.DATE CERTIFICATE�COMPLIANCEIOCCUPANCY ISSUED
' G7.This permit has been issued for:�New ConsWction ❑Substantial Improvement
G8.ElevaUon af 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
�MEP�TS
—— � ",� � �� . �'�� � �'i�,�t':��.�!
�: ❑Check here if attachments
FEMA Form 81-31,Jaruary 2003 Replaces all previous editions
i
� ;
C ITY OF C LEARWATER
� DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
POST�FFICE BOX 474g� CLEARWATER� FLO�DA 33758-4748
MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUF.,CLEARWATER,FLORIDA 3375�
TECEPxo!vE (72� 562-4567 Fa,x(727) 562-4576
MEMO OF REVIEW FOR CORRECTNESS & 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
CITY:CLEARWATER 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 B2.COUNTY NAME 63.STATE
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 AO,use depth of flooding)
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)
811. Indicate elevation datum used for BFE in 69:� NGVD 1929 ❑ NAVD 1988 ❑Other(Describe)
B12. Is the building focated in a Coastal Barrier Resources System(CBRS)area or Otherv✓ise 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 CeRificate will be required when construction of the building is complete.
C2. Building Diagram Number (Select the building diagram most simiiar 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: J'��� � Community O�cial: l,
�levation cerfificates shall be maintained by the community and copies with the attached memo made availab/e by request
•
FRANK H[RRARI),MAYOR
GEORGE N.CRE"PEKOS,COUNC(LMEMBER JOl1N DORAN,COLINCILM@MRER
PAUL F.GIASON,COUNCIL�IEMRER � CARLEN A.PE7'ERSEN,COUNCIL�IBMftER
��EQUAL EMPLOYMEN"I'AND f�FIRD4A'fIVE AC1'lON EMPLOYER��
� --_•>--� FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.6. No. 3067-0077
O��� �'r '�� � � � NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
. ELEVATION C�RTtFICATE w
Nav � � zoos ,�'��a����_ ��.��} ������;��,�-
Importarrt: Read the instructions on pages 1-7.
� SECTION A-PROPERTY OWNER INFORMATION For insurance Company Use:
���UCS��VIM T Policy Number
UILDING STREET ADDRESS(InGuding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX N0. Company NAIC Number
965 BAY ESPLANADE
CITY STATE ZIP CODE
CLEARWATER BEACH FL 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Descripfion,etc.)
LOTS 7,8,9,SOUTH 1/2 OF LOT 6&NORTH 40'OF LOT 10,BLK 265,CARLOUEL SUB
BUILDING USE(e.g.,Residential,Non-residential,Addition,Acoessory,etc. Use a Comments area,'rf necessary.)
RESIDEMIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS(Type):
( ##°-##'-##.##" or ##.�� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B-FLOOD INSURANCE RATE MAP(FlRM)INFORMATION
61.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME B3.STATE
CLEARWATER-125096 PINELLAS FLORIDA
64.MAP AND PANEL B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER 85.SUFFIX B6.FIRM INDEX DATE EFFECTNEIREVISED DATE BS.FLOOD ZONE(S) (Zone A0,use depth of fbodmg)
12103C0064 G �J13�b3— 9I31D3 AE 11'
610.Indicate the source of the Base Flood Elevation(BFE)data a base flood depth entered in 69.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Desaibe):
611.Indicate the e�evation datum used for the BFE in B9:�NGVD 1929 �NAVD 1988 ❑Other(Describe):
B12.Is the buildng located in a Coast�Bamer ResourCes System(CBRS)area or Olhervvise Protec,ted Area(OPA)? ❑Yes �No Desi nation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:❑Construdion Drawings' ❑Building Under Construc4on' �Fnished Construction
"A new Elevation Cerfificate will be required when constnx�ion of the building is complete.
L�;2.Building Diagram Number 7(Select the building�agram most similar to the bu�ding for which this certificate is being canpleted-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,AWA1-A30,AR/AH,AR/AO
Complete Items C3:ai below according to the building diagram speafied in Item C2.State the datum used.If the datum is drfferer�from the datum used for the BFE in
SecUon B,convert the datum to that used for the BFE.Show 6eld measurem�ts and datum conversion qlculation. Use tlie spaoe pro�rided or tt�e Comments area of
Section D or Sedion G,as appropriate,to document the datum carversion.
Datum See Section D ConversioNComments See Secfion D
Elevation reference mark used See Sec.D Dces the elevation reference mark used appear on the FIRM? ❑Yes �No —�—
o a)Top of bottom floor(induding basement or endosure) 8. 89 ft.(m) � �.Q
o b)Top of next higher floor 11.02 ft.(m) `� f��
0 0�Boe«n o�iowesc no�zor,ca�sa�n,r�mem�r�v zon�or,iy� N.A ft.(m) o o � �
o d)Attac�ied garage(top of sfab) 8. 89 ft.(m) E a �� �
o e)Louvest elevation of machine ry andlor e qui p ment w � t
senriang the building(Describe in a Comments area) 11 .03 ft.(m) � � � 1�, /A
o �Lowest adjacent(finished)gracie(LAG) 6.50 ft.(m) z' _ �� , � �,
o g)Highesf adjacent(finished)grade(HAG) 10. 10 ft.(m) �� � \�
d �
o h j No.of permanent openings(flood vents)within 1 ft.above adjacent grade 3 J I
o i)Total area of all permanent openings(flood vents)in C3.h 810.82 sq.in.(sq.an) ��
SECTION D•SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATtON
This certiflcation is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation inform ion.
I certify that the informafion in Sections A,B,and C on fhis certifrcafe represents my best effoRs to rnterpret the data available,
I understand fhat any false statement may be punishable by fine or imprisonment under 18 U.S Code Section 1001
CERTIFIER'S NAME JOHN C.BRENDLA LICENSE NUMBER 1269
TITLE REGISTERED LAND SURVEYOR COMPANY NAME JOHN C.BRENDLA&ASSOCIATES,INC.
DD S CITY STATE ZIP CODE
��' 401 82^�AV UE NO PINELLAS PARK FL 33781
� SI NATU � DATE TELEPHONE
10117/O6 727-576-7546
� FEMA F 81 1,January 2003 See reverse side for continuation. Replaces all previous editions
��aoo�- 03�?33
IMPORTANT: In these spaces,copy the coResponding information from Section A. For Inswance Canpany Use:
BUILDING STREET ADDRESS(Induding Apt,Unit,Suile,andlor Bkig.No.)OR P.O.ROUTE AND BOX N0. Policy Number
965 BAY ESPtANADE
CITY STATE ZIP CODE Company NAIC Number
CLEARWATER BEACH FL 33767
SECTION D-SURVEYOR,ENGINEER,OR ARCHRECT CERTIFICATION(CONTINUED)
•�py both sides of this Elevation Certificate for(1)community offiaal,(2)insurance agenUcompany,and(3)building owner.
COMMENTS
c3e)AC PAD
BENCHMARK USED:#152,AURAL RM 31973,EL=6.193'N.G.V.D.,ADJUSTED TO EL=5.4(Y N.A.V.D.
❑Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BF�
For Zone AO and Zone A(without BF�,complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting irfiamation fa a LOMA cr LOnAR�,
Section C must be completed.
E1.Building Diagram Number_(Se�the buAding diagram most simtlarto the buil�ng for which this oertificate is being canpleted—see pages 6 ard 7. If rm diagram accur��teiy
represents the buikiing,Provide a sketch or Photo9raph•)
E2.The top af the bottom floor(induding basement or endosu�e)of the building is _ft.(m)_in.(cm)�above or ❑below(chedc a�)the hi�est ac�jacent grdde. (Use
natural grade,if available).
E3.Fa Buildng Diagrams 6�8 wiih openirx�s(see page�,the next higher flooror elevated floa(eleva6on b)of the lwdding is _ft.(m),_in.(an)a�we thE highest ac�aoent
grade. Complete items C3.h�d C3.i on fratt�fam.
E4.The top aF the platform of machinery andlor equiprnent serviang the building is _ft.(m)_in.(cm)�above or ❑below(chedc one)the hi�est ad;'aoent grade. (Use
natural grade,rf available). '
E5.For Zone AO aily: If no flood depth number is available,is the top af the bdtan floor elevated in accadance with the communiiyls floodpk�in management c�dinanr.�?
❑Yes ❑No ❑Unknown. The bcal o�Caal must cerfify this ir�formation in Section G.
SECTION F-PROPER'f`(OWNER(OR OWNER'S REPRESENTATNE)CERTIFiCAT10N
ihe properiy owner or ownei's authorized representative who canpletes Sec6ons A,B,C(Itans C3.h and C3.i only),and E fior Zone A(wiihout a FEMA�ssued or community-
issued BF�or Za�e AO must si�►here. The statemer�s in Sedior►s A,�C,arxl E are coned to N�e besf ofmy Mmwledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESEMATIVE'S NAME
• RESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
❑Chedc here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The local offid�who is authorized by law or ordinance to administer the communih/s floodplain management ordnance qn complete SecUais A,B,C(or�,and G aF this FJe�rabon
Certificate. Complete the applic�able item(s)and sign belo�w.
G1.�The informaUon in Seclion C was taken from other documentatlon that has been signed and embossed by a license�suroeyor,engineer,or architect who is authaized by state
or local law to certii(y elevation information. (Indicate the source and date of the eleva6on data in the Comments area below.)
G2.�A community offia�completed Section E for a building located in Zone A(without a FEMA-issued or community�ssued BFE)or Zone A0.
G3,�The folbwing ir�ormation{Items G4-G9)is provided for community floodplain management purposes.
G4.PERMIT NUA�BER G5. DATE PERMff ISSUED G6. DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY ISSUED
G7.This permit has been issued for 0 New Construction ❑Substan6al Improvement
G8.Elevation of as-built lowest floor(induding basement)of the building is: __ft.(m) Datum:
G9.BFE or(in Zone AO)depth af flooding at the lwil�ng site is: __ft(m) Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
4MENTS
�
� ��� w` "� � ",��".�,.�"�
_ �
% ^� � �.�� . � . a
❑Check here if attachments
FEMA�orm 81-31,,iai;�ary 2003 Replaces all prevRous editions
. �
: CITY OF CLEARWATER
� ;°
DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
POS7'QFFICE BOX 474g� CLEARWATER� F�.o�DA 33758-4748
�' MUNICIPAL SF,RVICES BUII.DING, IOO SOUTH MYRTI.E AVENUF.,CLEARWATER, Fi.o�uDn 33756
TE1.�:exotiE (727) 562-4567 Fnx(727) 562-4576
MEMO OF REVIEW FOR CORRECTNESS & 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 ali 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
CITY:CLEARWATER 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 ##.####!k°) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map❑Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
i.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME 63.STATE
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�AO,use depth of flooding)
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 B9:❑ NGVD 1929 ❑ NAVD 1988 ❑Other(Describe)
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise 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 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 fieid 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 certi�cates shall be maintained by the community and copies with fhe attached memo made available by request
FRANK H[RRARI),MAYUR
GEORGE N.CRL'fEKOS,COUNCIIMGMBGR JOIIN DOKAN,COUNCII.MEMFiGR
PAUL F.GIRtiON,COUNCILM@MAGR � CARL6N A. PC"1'�RSGN,CUUNCILMCMriIiR
��EQUAL EMYLOYMENT AND AFFIFtMA'fIVE AC7'ION EMPI.OYER��
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
�, �- � �,'�, ,� NATIONAL FLOOD INSURANCE PROGRAM Expires December 31,2005
I} ,�� (`� '�`�'"�� ELEVATION CERTIFICATE ,
� �l�/ ���-o� ��� �fi�
Imporra�rt: Read the instructions on pages 1•7.
� � � SECTION A-PROPERTY OWNER INFORMATION For Insuranoe Comparry Use:
ILDI OWNER'S NAME Policy Number
I (�;p,IpnDQ��A�@I�IIII��P1P D/� l
ILDIN Unit,Suite,and/or Bidg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
E PLANADE
CRy STATE ZIP CODE
CLEARWATER BEACH FL 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
LOTS 7,8,9,SOUTH 12 OF LOT 6&NORTH 40'OF LOT 10,BLK 265,CARLOUEL SUB
BUILDING USE(e.g.,Residential,Non-residential,Addition,Acoessory,etc. Use a Commerrts area,rf neoessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):
( ##°-##'-##.##" or #I#.�k� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME&COMMUNITY NU�ER B2 COUNTY NA� B3.STATE
CLEARWATER-125096 PINELIAS FLORIDA
64.MAP AND PANEL 67.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
�----NtiN1BER-- B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVEIREVISED DATE B8.ROOD ZONE(S) (Zone A0,use depth of flooding)
12509fr00f 4 � G 9l31Q3 913I03, AE 11'
B10.Indiq�tlie source of the Base Flood Elevation(BFE)data or base floaJ depth entered in B9.
❑FIS Profile �FIRM ❑Communily Determined ❑Other(Desaibe):_
B11.Indicate the elevation datum used for the BFE in 69:�NGVD 1929 �NAVD 1988 ❑Other(Describe):_
612.Is the building located in a Coastal Bamer 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 Construc�on
*A new Elevation Certificate will be required when construction of the buil�ng is compl�e.
�C2.Building Diagram Number 7(Sdect the�ilding diagram most similarto the building for which this certificate is being completed-see pages 6 and 7. If no diagram
accurately represents the buikling,provide a sketch or photograph.)
C3.Elevations-Zones A1 A30,AE,AH,A(w�h BFE),VE,V1-V30,V(with BFE),AR,ARIA,ARIAE,ARIA1-A30,ARIAH,ARIAO
Complete Items C3.-a-i b�ow acoording to the building dagram specified in Item C2.State the d�um used.If the datum is diffeerer�fcom the da�um used fa the BFE in
Section 8,c�vert the datum to that used for the BFE.Show field measurerr�ts and datum conversion cakx�lation. Use the space provided or the Commenis arez of
Section D or Section G,as appropriate,to docx�ment the datum conversion.
Datum See Sec�on D ConversioNComments See Secfion D ,y t„��;�;;-.; a,�J
Elevation reference mark used See Sec.D Does the elevation reference mark used appear on the FIRM? ❑Yes �No ' ^ 6
4,�`' tv�;:t'?;�� .� °f„
a)Top of bottom floor(induding basement or endosure) 8. 89 ft(m)� ' ,�'` , p��.+o,��,�w� "
b)Top of next higher floor 11 .,02 ft.(m) " °`� ` ° °
c)Bottan of lowest horizontal sVuctural member V zones onl rUA._ft.m �,.�'�; � � ��>W
( y) ( ) �� � �
dj Attached garage(top of slab) 8. 89 ft(m)— .�a� „ ,,c F,�;�� �
e)Lowest elevation of machinery andlor equipment 4 ��" ' � � <
servian the buildin Desaibe in a Comments area � NIA. ft.m �� ` , - � �� ;
9 9� ) � ( ) :
�Lowest adjacent(finished)grade(LAG) 8.4 ft.(m) ' �• ° �"/'�
g)Highest adjacent(finished)grade(HAG) 10. 30 ft.(m) °'� �� I►' '
..°':e � a mn ��,���' �`�'��
h)No.of permanent openings(flood vents)within 1 ft.above adjaoent grade 3 �`"��,A -w�,� �.;��� �a°
i)Total area of all perman�t openings(flood vents)in C3.h 810.82 sq.in.(sq.an) � ' ��m ������;�v�
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by!aw to certify elevation ir�ormati .
f certify thaf the information in Sections A,8,and C on this cerfifrcate represents my best efforts to irrterpret the data available.
I understand that any false statemenf may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001.
CERTIFIER'S NAME JOHN C.BRENDLA LICENSE NUMBER 1269
TITLE REGISTERED LAND SURVEYOR COMPANY NAME JOHN C.BRENDLA&ASSOCIATES,INC.
, ' � ADD CITY STATE ZIP CODE
401 2�A UE TH PINELLASPARK FL 33781
SIG ATU DATE TELEPHONE
9l16/05 727-57fr7546
FEMA orm -31,January 2003 See reverse side -continuation. Replaces all previous editions
't.1` '��,}i–`-' �-� � `'' �.1�t;�%J
IMPORTANT: In these spaces,copy the corresponding information from Section A. For insurance Campany Use: �
BUILDING STREET ADDRESS(Induding Apt,Unit,Suile,and/or Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number
965 BAY ESPLANADE
��y STATE ZIP CODE Company NAIC Number
CLEARWATER BEACH FL 33767
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
�opy both sides of this Elevation Certificate for(1)community offidal,(2)insurance agenUcompany,and(3)building owner.
COMMENTS
BENCHMARK USED:#152,AURAL RM 31973,EL=6.193'N.G.V.D.,ADJUSTED TO EL=5.40'NAV.D.
❑Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURYEY 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�evatron Cer6fificate is ir�er�ded for use as supporfing information ftu a LQMA or LOMR-F,
Secfion C must be canpleted.
E1.Building Diagram Number_(Select the buiiding dagram most similarto the building for which this cefificate is being canpleted—see p��s 6 and 7. If no diayra��accurately
represents the bui�ing,provide a sketch or 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)tha highest adiacent grade. (Use
natural grade,if available).
E3.For Buiiding Diagrams 6-8 wilh�ngs(sce page 7),the next higher floor or elevated floor(efevation b)aF the building is _ft.(m)Ain.(an)�ova T.ne hic�est�cf}acent
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)Q above or ❑below(chec�c or�e1 the hi�hest adjacent grade. (Use
natural grade,'rf available).
E5.For Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the communit�s floal�lain manayement ardinance�
❑Yes ❑No ❑Unknown. The la�l offiaal must oertiiy this irrfoRna6on in Sec�on G.
SECTION F-PROPERTY QWNER(OR OWEVER'S REPRESENTATIV�CERTIFICATION
The property owner or o�mers author'v.�ed representative who canpldes Sections A,B,C(Ite�ns C3.h�d C3.i only),and E for Zo�e A(without a FEMA�ssued or oommunity-
issued BFE)or Za�e AO must��here. The sh�emerrfs in Sea6"onsl�8,C,and E are conedfo the bestofmy/vrowledge
PROPERTY OWNEaS OR OWNER'S AUTHORIZED REPRESENTATIVE'S IVAME
��DRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
❑Check here if attachments
SECTION G-COMMUNfTY INFORMATION(OPTIONAL)
The local offidal who is authorized by law�x ordinance to admin�the eorrununity's floodpl�n m�nt or�nance can complde S�s A,B,C(or E},�d G�this Qeva6on
Certi6cate. Complete the applicable item(s)�d sign below.
G1.❑The information in Section C was taken from other tla.umentation that has been signed and embossed by a licensed surveyor,engineer,or architect who is authorized by state
or local law to certify elevation ir�ormation. (Indicate the source and date of the elevation data in the Comments area below.)
G2.0 A community official completed Sedion E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0.
G3.0 The following iriformation(Items�4-G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMff ISSUED �6.DATE CERTIFICATE OF COMPLIANCFJOCCUPANCY 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)depth af flooding at the building site is: __ft.(m) Datum:
LOCAL OFFICIAL'S NAME TITLE !
COMMUNITY NAME TELEPHONE
SIGNATURE ,DA�E �, ..� • . �„�
s ' , •t 'f. ,
�MMENTS a
`1!' S ' 1 ° .
. ',^.
� ❑Chedc here if attachments�
FEMA Fom��81-3�,,:�nuary 2003 Replaces all previous editions