1021 BAY ESPLANADE . �
F�DERAL EMERGENCY MANAGEMENT'. �,ENCY O.M.B. No.3067-0077
NATIONAL FLOOD INSURANCE PROGRAM Explres December 31,2005
� ` �' ELEVATION CERTIFICATE
Im ortant: Read the instructions on a es 1 -T.
, SECTION A-PROPERTY OWNER INFORMATION ....................................................................................:..........................._..�_
F�:f':IFi�:f�€a:hc�:Ctatri(a�i�.::tilaa�::::=c=:�:.=_-::
BUILDING OWN�R'S NAME _����,.�����
....... .._......_.............__.._......._....................__.
M�S �l.$ ::::::::::::��:::::::::::::::-:_:::::::::�:;E.'��'_::::�:;:;;::::�::=::::::::�=n
...._..........._._�
--::::.::::._.::-::::::::::::::::::::::::-::;�:::s�_:::::;;::::_s::::::-::::.--:=:
BUILDING STREET ADDRE88 Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. -��mp��y:�����m�j�.;:;;_:,;:,;,.;���,
)t�Z I �S L /*1�D ......._._......__
...� _............................�._........._.._._.
:::::;:::-:-:;::-:::=.;.,,:::::s-::-::::.:::::.::::.:::::::::::::=:::::::::::::�::�::,_-�:
CITYG����A rE� ���G u STATE �� ' ZIP CODE 3 3 �
PROPERTY DEScRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
LoTS �1 A�. � r�W 'iZ �e7 S SLO GK 27�
BUI DING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. se a Comments area,if neceasary.) '—'
�c���ENrr,�-L
LATITUDE/IONGITU �(OPTIONAL} HORIZONTAL DATUM: �
( ##°-##'-##.##" or ##.#N##�°) I�{NAD 1927 �_�NAb 1983 SOURCE: � GP8(TYpe):s_�` T_r
� �'USGS Quad Map �_�Other �_�_____�_
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME&COMMLI!!?Y NU^ABER $2,COUNTY NAME 83.STATE
c���t���`t��,/ ►25�9� 1'ir����,�5 ��,
B4.MAP AND PANEL B5.SU FIX B6.FIRM INDEX B7.FIRM PANE B8.FLOOD 89.BASE FLOOD ELEVATION(S)
�2 l ONUMBER DATE EFFEC7IVE/REVISED DATE ZONE S
''j C, DO lo Q- � p p o ��,� ) (Zone��u�depth of flooding)
�- �- .3 9- 3_�0,3
610.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9.
�__�FIS Profile �k(FIRM �__�Community Determined �__�Othe�(Describe):______ _
B11.Indicate ihe elevation datum used for the BFE in B9:�__�NGVD 1929 �JS�NAVD 1988 �__�Other(Describe):_____, V �
B12,Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? �_�Yes �,��No� C7
Designation Date:____ C1
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) �
C1.Building elevations are based on: �__�Construction Drawings" �__�Building Und�r Construction' �,�,�Finished Construction g
• "A new Elevation Certificate will be required wlien oonstruction of the building is complete. .�
C2.Building Dfagram Number��(Select the building diagram most similar to the building for which this certificate is befng completed-sea �
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,ARlA1-A30,AR/AH,AR/AO vV
Complete Items C3.a-i below according to the building diagram specified in Item C2.5tate the datum used.If the datum fs 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 converaion �
calculation. Use the space provided or the Comments area of Section D or Section G,as apprapriate,to document the datum conversion.
Datum NGV V I 2
.�9 Conversion/Comments____��79
Elevation reference mark used___�,'3_�_____ poes the elavation reference mark used appear on the FIRM? �_�Yes ��No
0 a)Top of bottom floor(including basement or enclosure) __„__ 3 , Z ft.(m) � .
❑ b)Top of next higher floor 4 .4 ft•(m)
❑ c)Boftom of lowest horizontai structural member V zones onl ^ �/A
d
� Y� --------.__ft.(m) � L.S, �� �g 3 7
u d)Attached g a r a g e(t o p o f s l a b) __¢,¢ ft.(m) (�� �( � �
❑ e)Lowest elevation of machinery and/or equipment �� � �,J/),r���
l�J► ��r�
s e rv i c i ng t h e b u i l d i ng(D escribe in a Comments area.) _____�_5 , 8 ft.(m) �� � p_
/ � O
O fl Lowest„adjacent(finished)grade(LAO) 3.1_ft.(m) z� 9- 3
O g)Highest adjacent(finished)grade(HAG) _�,�ft.(m) �
0 h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade_T�__
❑ i)Total area of ail permanent openings(flood vents)in C3.h 8(0� sq,in.(sq.cm)
3ECTION D-SURVEYO�2,EN(iINEER,OR ARCHIT�CT CERtIFICATION
This ce�tification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation infortnation.
I certify that fhe informaflon in Sections A,B, and C on fhis certi�cate represents my best effo�ts to interpret fhe data avallable.
!understand that any false statement may be punishable by fins or imprisonment under 18 U S Code, Sectlon 1001
CERTIFIER 5 NAME LICENSE NUMBER
Larry L. Evans L.S. �� 2937
TITLE gurveyor COMPANY NAME
Evans Land Surveying, Inc.
• ADDRESS 1460 Beltrees Street. Ste. 9 ��N Dunedin, 3TATE . ZIPCOpE 34698
SIGNATURE DATE tELEPHONE �
f lo-ug-o3 (727} 734-3821
FEMA Form 81-31, anu 2003 5se reverse side for continuation. Replaces all previoue editiona
�................................................................................._.....................
IMPORTANT: In these s aces,cy� , the correspondin Informatioh from Section A ':Fa.r:l�a��ra�::'�m:..;`:::�s�:'::..::::::::`::`:
BUILDING STREETADDRESS Includi A t. U t pIC`_ `umti.er:::::: ::::::::::::::::::::=::::=:::':::::::�::::::::
( n9 p , nl�Suite�and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. P,....aY.�:-�::::::::::-_-:::::.::�:::::::::::::::-:;::::::::::�:::::::::::::::::::::::::::::
�o Z 1 � �S J:� ,...:.._..�.
.._......._........................................._.............................................................
cirir -- - =
,.
, N , �:._.:::::::::::-::::_�.-:�,:::::
G � STATE L ZIP CODE s:.._�.C13�!�5�:::::.-:.:..::::::::.�.....:_:::-:::......::,::�::..................
��w,�r � .�,F.-��N 3� � �
� �...... . __..._....
:-:::: ::::::...:-�::::::_�:::::-::-�:::::::::::::::::::::--_::-::::::_:..:::.-
• SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICAtION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agendcompany,and(3)buitding owner.
COMMENT8
rt
I_.I Check he�if attechments_
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT I�EQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zone AO and Zone A(without BFE),complete Items E 1,through E5. If the Elevatlon 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 io the building fur 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 �__���ft.(m)�__�__�in.(cm)�__�above or�_�below
(check onej the highest adjacent grade. (Use natural grade,if available.)
E3.For Buitding Diagrams 6-8 witf�openings(see page 7),the next higher floor or eleveted floor(elevation b)of the building is
I--I--I 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 platform of machinery and/or equipment servici�g the building is �__�--�ft.(m)I--I--I in.(cm)�__�above or�__�below
(check one)the highest adjacent grade. (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 accordance with the cvmmunity's
floodplain^enaAement ordinanceT��Yes �__�No I__I Unknawn. the local official must certify this informetfon*n Sect�on(3. �
SECtiON F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owner's authorized representative who completes Sectfons A,B,C(Items C3,h and C3.1 only),and E for Zone A
(without a FEMA-issued or community-issued BFE)or Zone AO must sign here. The statements!n Sectlons A,8, C,and E are correcf to
the besf of my knowledge.
PROPERTY OWNER'3 OR OWN�R'S AUTHORIZED REPRESENTATIVE'S NAME
• ADDRESS CITY STAtE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS '
���Check here(f attechments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The locai offic(al who is authorized by lew or ordinance to administer the communily's floodplain management ordinance can complete
Sections A,B,C(or E),end G of this Elevation Certiflcate. Complete the applicable item(s)and sign below.
G1.�__�The information in Section C was taken from other documentation that has been signed and embassed by a licensed surveyor,
angineer,or architect who is authorized by state or local law to certify elevation lnformation: (Indicate the sour�e and date of the
elevation data in the Comments area below.)
G2. �__�A communily 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 InformaUon(Items G4-G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED +. G8. bATE GERTIFICAtE OF COMPLIANC�lOCCUPANCY
' I5SUED
G7.This permit has been issued for: �__�New Constructfon �__�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 aite is: _�_�_�_ T_ft.(m) Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME 1'ELEPHONE
SI�NATURE DATE
COMMENT8
�
I!I CheGk here ff attachments
. I`EMA F�m 81-31,.la�uary 2003 Replaces all ptev(ous editions
.
+ CITY OF CLEARWATER
• DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
POST OFFICE BOX 474g� CLEARWATER� FLOa�DA 33758-4748
MUNtCIPAL SERVICES BUILDING, ZOO SOUTH MYRTLE AVENUE,CLEARWATER,FLO�uDn 33756
TELFPxoNE (727) 562-4567 Fnx(72� 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
X The attached elevation certificate is complete and correct
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
CITY STATE ZIP CODE
A3. PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
A4. BUILDING USE(e.g.,Residentiai,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
1.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME B3.STATE
B4.MAP AND PANEL g5.SUFFIX B6.FIRM INDEX DATE B��FIRM PANEL gg.FLOOD ZONE(S) B9•BASE FLOOD ELEVATION(S)
NUMBER EFFECTIVE/REVISED DATE (Zone AO,use depth of flooding)
810. 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)
611. Indicate elevation datum used for BFE in 69: ❑ NGVD 1929 ❑ NAVD 1988 ❑ Other(Describe)
612. 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 alI permanent openings(flood vents)in C3.h sq.in.(sq.cm)
Comments:
Date of Review: Community Official:
�levation ceRificates shall be maintained by the community and copies with the attached memo made available by request
FRANK HIRRAftD,MAYOR
GEORGE N.CRF.'1'EKOS,COUNCILMEMBER JOI W DORAN,COUNCILMEMRER
PAUL F.GIBSON,COUNCILMEMRGR � CARI.@N A.PE"1'[RSEN,COUNCILMCMAER
��EQUAL EMPLOYMEN'I'AND AFFIItMA"PNE AC1'lON EMPLOYER��
.........................................�.................._.........._........._......._...�.._....
IMPORTANT: In these s aces,co, , the corresponding information from Section E,. =:Fo.E�ia�ura��::�prnpa.�y`_k]:s���=-_:�__�':
_. ._
BUILDING STREET ADDRESS(Including Apt.,Unit,Siiite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. ;F�l[a�r��J�l�er=_=��;:;T:�_-=W�:��:;-';
_�. _ -:.
� �o Z� ►3 �5 L- 1�� = � _- .,
______�...._..___.. �__
CITY STATE L ZIP CODE i=CtS[tSjs�l�y�r_::^µ::�N�1._.;_�,=�a;:
Gc�K.t,�l/kY�-� s�,E,AG�{ � 33 � :�:.--l--��:°_�-=�_�_::_::-�:�=�=��
• SECTION D-SURVEYOR,ENGINEER,bR ARCHITECT CERTIFIGAtIdN(CONTINUED) -
Copy both sides of this Elevation CertifiCate for(1)community official,(2)insu�ance agenVcompany,and(3)building owner.
COMMENTS
._. __�_
I�I Checic here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NbT ttEqU1RED)FOR�ON�AO AND ZONE A(WITHOUT BFE)
For Zone AO and Zone A(without BFE),complete Items E1.through E5. If the Elsvation Certificate is intended foc use as supponing.
information for a LOMA or LOMR-F,Section C must be completed.
' E1.Building Diagr�m IVumber__�(Select the building diagram most similar#o tha 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 �__���ft.(m)�_���in.(cm)�_)above or�_�below
(check one)the highest adjacent grade. (Use natural grade,if availableJ �
E3.For Buitding 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 edjacent grade: Compiete Items C3.h and C3.i on front of form.
E4.The top of the platform of machinery and/rn'equipment serviCing the building Is �__�_)ft.(m)(__�_�in.(cm)���above or�__)below
(check one)the highest adjacent grade. (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 accordance with the community's
_floodplain menagement ordinance7 L�Yes �_I Na I�I Unknawn. the local officiai must certify this informetion wn Sect on(3. �
SECt10N F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICI4TION
The property owner or owne�'s authorizsd representative who completes Sections A,B,C(Items C3.h and C3.i onty),.and E far Zone A
(without a FEMA-issued or community-issued BFE}or Zone AO must sign here. The statements!n Secfions A,B, C,and E are correct to
the besf of my knpwledge.
PROPERTY OWNER'9 OR OWNER'S AUTHORIZE,D REPRESENTATIVE'S NAME
ADDRESS CITY STA7E ZIP CODE
. SIGNATURE DATE TELEPHONE
COMMENTS '
�».,
I._..I Check here if attachments
SECTION G-COMMUNITY INFORMAT(ON(OPTIONAL)
The Iqcal officiaf who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
Sections A,B,C(or E),and G of this ElevaUon Certiflcate. Complete tha applicable item(s)and sign below.
G1:��The information in 5ection C was taken#rom other documentation that has been signed and embossed by a licensed surveyor,
engineer,or architect who is authorized by state or local law to ce�tify elevation information: (Indicate the soutae and date of the
elevation data in the Comments area below.)
G2.�_�A communily official completed Section E for a building located In Zone A(without a_FEMA-issued or communily-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 GERTIFICAt6 OF COMPLIANC�lOCCUPANCY
' ISSUED
G7.This permit has been issued for. �_�New Construction �_�Substantfal improvement.
G8.Elevation of as-built lowest floor(including basement)of the buiiding is: ___`____ _ft.(m) Qatum:
G9.BFE or(in Zone AO)depth of flooding at the building site is: _.,.__i _ T_�.(m) Datum:
LOCAL OFFICIAL'S NAME TITLE .
CONIMUNITY NAME 1'ELEPHONE
SIGNATURE DATE
COMMENTS
r
►_►Cheok here ff attachments
FEMA F�rm 81-31,danuary 2003 Replaces ell ptevious editions
1� F�DERAL EMERGENCY MANAG�MENT`.,�,ENCY
�}/'�`� NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No.3067-0077
Expires December 31,2005
' ��N ELEVATION CERTIFICATE _
�� � Im ortant: Read the instructions on a es 1 -7.
. ,-........_.__.......:._._...._......._......------.._......._.__.._._..._..--�_..._
� SECTION A-PROPERTY OWNER INFORMATION ::Fv:i`at'i�":t�i���:�on�pain=�Iat�:-===s=_=:
BUILDING OWNER'S idAME ;:.P�I�Jfi]YG�1�F�=�==__ -'-__-:�-�'=:
J rn�s i t_,s , ��-::,�_:_:=--:=___-�_-��-_:.:=;,,�
-._._............._...----..._..-.-_.-._.:=::.._..=_.___.........::-_..
BUILDING STREET ADDRESS Including Apt.,Unit,3uite,andlor Bidg.No.)OR P.O.ROUTE AND BOX NO. ��t7tYtp�t7y_N�lI�Is(E�t'�l7et�::::�.-�'��;`.�'
jDZ 1 F 5 L !*13��- :-::.-�__-_::-=--�:=_��.�---:-:-:--_--__-:
-:-:::::,:-..............__..__....,..,..----..._.__...�...._._....._....-------
c►n����wAT�� ���G�j STATE �� , ZIP CODE 3 3�'�7
PROPHRTY DES RIPTION(Lot and Block Numbers,Tax Parcel Number,Legai Description,etc.)
LoTS �, �- � �H1 `ia �d7 5� g�oc.K 273. �
BUI DING USE(e.g.,Resfdentiai,Non-residential,Addidon,Accessory,etc. e a Comments arQa,if necesssry.)
�G5 t 9�NT1,�-L
LATITUDE/L.ONGITU �(OPTIONAL) HORIZONTAL DATUM:
( ##°-#Jf'-##.#1#" or ##.�°) j�NAD 1927 SOURCE: � GPS(Typ�):_�
�_�NAb 1983 ��USGS Quad Map �_�Other � -
3ECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMA710N
B1.NFIP COPMAUNITY NAME 8 COMM�!(�!?'!fdUP�9E4� p2.�OUNTY NAME p���LILAS s3.STATE
�c,�,K�nlPc'T�K./ ' S�9�O �L�
B4.MAP AND PANEL FFIX B8.FIRM INDEX B7.FIRM PANE B8.FLOOD 69.BASE FLOOD ELEVATION(S)
NUMBER DATE EFFEC7IVElREVISED DATE ZONE(S) (Zone AO,use depth of flooding)
1210�C oo(v¢ C7 �-o�—o� g—o.3—�3 ,�If �/. �
B10.Indicate the source of the Base Flood Elevation(6FE)data or base flood depth entered in B9.
j,��FIS Profile ���FIRM �)Community Determined ___(_._�Qther.(Describe):-- - . _.,________ ____
811.Indicate the elevation datum used for the BFE in B9:�__�NGVD 1929 ���NAVD 1988 �__�Other(Describe):_
B12,Is the buitding located tn a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? �_�Yes �,��No �T-
DesignaBon Date:_ ��
---------- -�
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIR�D� 1`�
• C1.Building elevations are based on: �_�Constructfon Drawings' (_�Building Und�r Construction' �,�,�Finished Construction g
'A new Elevation Certificate wiil be required when oonstruction of the building is complete. —�
C2. Building Diagram Number��{Select the building diagram mast similar tq the building for which this certificate is being completed-sea d
pages 6 and 7. If no diagram accurately represenFs ihe building,provide a sketch or photograph.) v;
C3.Elevations-Zones A1-A30,AE,AH,A(with 8FE),VE,V1-V30,V(with B�E),AR,AR/A,AR/AE,AR/A1-A30,Ar't/AH,AR/AO c+�
Complete Items C3.a-i below according to the building diagram specified in Item C2.State the datum used.if the datum ia different from �.►
the datum used for the BFE in Section B,convert the datum to that used for th�BF�.Show fietd meesurements and datum conver,sion �
calculation. Use the space provided or the Comments area of Section D or Section G,as appropriate,to document the datum conversion.
Datum NGV D I 29 Conversion/Comments__!0,79_ ^, `____________ _____
Elevation reference mark used,�'3 .�_ Does the elevation reference mark used appear on ihe FIRM? �_�Yes ��No
❑ a)Top of bottom floor(including basement or enclosure) ` -3. 2- ft.(m) �
❑ b)Top of next higher floor _____���ft.(m) ��
0 c)Bottom of lowest horizontal structural member(V zones only} __!�/A , ft.(m1 �o L.S, �� �9"�7
u d)Attached garage(top of slabj � �,�ft.(m) �� , �+'���,.��
O e)Lowes t e leva tion o f mac hin ery a n d/o r eq uipmen t -,� V F•F�
`, "a
servicing the buiiding(Describe in a Comments area.) �__ 5. � ft.(m) �� l o_�S-p3
❑ fl Lowest adjacent(finishedj grade(LAo) _�_�._ 3.1_ft.(m) z�
0 g)Highest adjacent(finished)grade(HAG) __�,�ft.(m) �
❑ h)No.of perrnanent openings(flood vents)within 1 ft.above adjacent grade_�___
❑ i)Totai area of all permaneM openings(flood vents)in C3.h 8(o� aq.in.(sq.cm)
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERtIFICATION
This certification is to be gigned and sealed by a land surveyor,engineer,pr architect authorized by law to certify elevation infortnation.
!cerfity thet the informativn in Sections A,B, artd C on this certificate represenfs my best efforts to interpret the data available.
1 undersfand fhat any t'alse sfatement may be punishable by�ne or imprisonment unde.r 18 U.S. Code, Section 1001.
CERTIFIER'S NAME LICENSE NUMBER L.S. �� 2937
Larry L. Evans
TITLE surveyor COMPANYNAME �vans Land Surveying, Inc.
• ADDRESS 1460 Beltrees Street, Ste. 9 ��n Dunedin, 3TATE . ZIPCODE 34698
SIGNATURE DATE 10-�g-o3 7ELEPHONE E72�} 734-3821
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FEMA Form 81-31, anu 2003 See reverse side for continuation. Replacea atl previous editions
' Ci�RTTPlED TO : NOPWEST MORTGAGE INC. G1.0. 2350
- CENTURY TITLF & ABS'I'RACT INC.
. OLD REPUBLIC �VATIONAL TITL� II�lSURANCis CO.
JOE�N E. kILGORE
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"�OUNDARY SURVEY° � �
t_[GEND•r.i.a.aFOl1ND IRQN RO�; F.C.IR= FOUN� CAPP[D IRON R00; S.C.I.R.= ;E'f CMPN IRON R00; F.I.P.d FOUND�IRON PIPE;
•F.C.I.P.mFOUNO CAPPE� IRON PIPE• F.N.O.=f"OUND NNL dc UISK; S.N.LI.:� tiET N/JL A� DI'�C; F.C.I.I.a FIXJND CONCRETL AIONUFAENT; - �
P.R.i.t.= PERAiAPJENT RfFER[,!w:E I.iOr:!JRiE:T: f`.C.;'.•-P�.^.IdAY,f.!!T COF;7l70L PQtN7: P.l.=re�r:T O� IN?EI2�CT10N: `2,N!= RICNT C1!° W,",Y;
• ElEV.a ELEYATION; C.0.5.� CONCRET[ [1LOCK SIRUCTURE; CUPlC.4 CUNCR�TE; ASPIi.� ASPtIALT; PAVI'.� PAVE�AEN(; --
COV.m COVERED; Om DEED; SEC.o SECTION; 7Xi'.m TOWNSFIIP; RCE.o RANGI; P=PLA7; 41.o AIGSURED; ESMT.� EA5ElAhT7T; j%��COVQtCD AREA
lir RADIUS; A.- ARQ G-CHORD; G0.- CHORD DEARINC; STYr 5T(XtY: C.L.F.- CHAIN LINK FENCE; W.F.- W00� FENCE �-=•
n surveY or- LOT 1 7 , BI,OCK "256" , CARLOUEL SUBDIVISION
AS R�CORDED IN i'LAT [300K �t7, f'�GL-"ltD Cvl�Z, OF 11-i[ f�U�UC RECORDS OF P(NELLAS COUN7Y, FLORIDA.
I, ritllJA1/ G I(fi111NC, 11�E SUR�LIOR IN RESt'CN9UlE GIMCE, CCliTll'Y IU7 IIL SURVf.Y RCPit[:lllTFD ItfRC(X�,AS 1lCI.l1NC i1tC UINI1lU4 TfdINICN.ST/WOM�S SLT FOftTll (!Y
� 111G FlU1tIpA f10Ntt>(X W!U SUR�tI'OftS,f'URSUANT lt7 SECIi(�! 472027 OF lllf(LUItIUA !:fAlUIES I.S fMtES(7tllk:l) W �IM1LT2 NIC17-6 ULPT.Of(MtOFE1`.�ONAL Nf(11V�11(kl,
(NOf VAL1U UNI�SS S7JLLtJl 1N7l1 AN ELIHISSIU SUNVEYOIYS tif_AL)
fLEVATION ;TATCAlENT: 1}IIS IS TO CERiif�f THAT 5YE IIAVE OD7AIN� P1LVA710N: 9I01NJ I IEREON, OI �Ilf A130VC DCSCRIOED LAMD. 711LSE CILVAT10N5
SH�WN }tEREDN N2[ OASED OtJ 1FIE NATIONAL VL1211CA1_ UATUTA, 1U20, [3ENCFIAIARK , SUPPU[D [3Y T)1E ENCINEERINC
DEPL, COUNIY, RORIDA. FLOOD ZONE�DISI1NCTlONS ARE OASED UPDN TFI CY AIANACEAIENT ACQdCYS IAAPS ISSUED TO US.
OU[ 70 INCONSISTENCIES FOl1ND IN T}IESE AIAPS, '(}I[ ZONES ARE Ml APPRDb6�A7E ESl11AAilON 70 'fl�[ REST OF OUR AoIL1TY.
C0IAAIUNI7Y No PANFl No. AIAP pAT[: � /� APPEARS TO I]E �� '� (3AS FIpOD EUVATION
� 2.1'�� ��/f✓ � �I��q/ IN FLOOq TONC /��. ,/� ��
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DRAVrtJ [lY: DATL': API'ROVIiD DY-
� A�LIED SURVLYING � � >*
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/�� �1 L���_�__ 2124 SUNNYUALL-: DLVp. r� '� y
CLL-�RWATER, FLORIDA, 34fi25 � #
� (]�{[CKEO OY: SCALE �f _ � e��+;��M` �, �� ��
� � ;� ' 727-44G-i2G:i �L11A11 C. }C1:A'1'1NG ILL .�'U
t,Jt//� --- --- — �V 0423
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