550 BAYSHORE BLVD N .� .� .� FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
� ' �- (i=} � , � f : " ,; NATIONAL FLOOU INSURANCE PROGRAM
,, L ��� � ,, ,; Expires July 31, 2002
�� !�-� � � �`° � �i ELEVATION CERTIFICATE
� ` � �.
Q�? � � Important: Read the instructions on pages 1-7.
' SECTION A-PROPERT(OWNER INFORMATION Fa Insurance Company Use:
� �� �p�:� I��'� Policy Number
�
� ,,9 .
ADDRES���rx;ludin�Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
550 N.BAYSHORE BLVD.
CITY STATE ZIP CODE
CLEARWATER FL 33759
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Uescription,etc.)
LOT 3,DEL ORO PLACE
BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,'rf necessary.)
RESIDENTAL
LATITUDEJLONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(fype):
( ##°-##'-##.#�X' or ##.ti#l!##� ❑NAD 1927 ❑NAD 1983 ❑USGS Ouad Map ❑Other:
SECTION B•FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
Bt.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME 83.STATE
CffY OF CLEARWATER 125096 PINELLAS FLORIDA
64.MAP AND PANEL 65.SUFFIX 67.FIRM PANEL B9.BASE FLOOD ELEVATIt�N(S)
NUMBER 66.FIRM INDEX DATE EFFECTIVE/REVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depih of flooding)
0011 D 9119191 911951 AE 10'
B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9.
❑FIS Profile �FIRM ,�Community Determined ❑Other(Describe):
B11.Indicate fhe elevation datum used fa the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Other(Desaibe):_
B12.Is the building located in a Coast�Bamer Resourc�s System(CBRS)area a Otherwise Protected Area(OPA)? �Yes �No Desiqnation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:�Construction Drawings' ❑Building Under Conshuction' �Fnished Construction
*A new Elevation Certificate will be required when consVuc�on of the building is oanplete.
�ilding Diagram Number 1(Select the building diagram most similar to the building fa which this cert'rficate is being oanpleted-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,ARIAE,AR/A1-A30,AWAH,AWAO
Canpiete Items C3.-a-i below according to the twilding diagram speafied in Item C2.State the datum used.If the datum is d'rfferent from the datum used for the BFE in
Section B,oonvert the datum to that used for fhe BFE.Show field measurements and datum conversion calculation. Use the space provided a the Comments area of
Sec�on D or SecUon G,as appropriate,to document the datum conversion. ����'$a�"•`, p 7�� ;
Datum Conversion/Comments_ �-'�°:"?� B«�b�,�^��, m,,,
P` �' .; �"�:�.
Elevation reference maric used Does the elevation reference mark used appear on the FIRM? ❑Yes �No y o �n �� ��
.. ,,
o a)Top of bottom floor(induding basernent or endosure) 15. 7 ft.(m) � �:��`�° ( � �,,, 8��,`���, �:;
o b)Top of next higher floor rUA._ft.(m) �' > '`� '�,�'" ' � ��:' °��`': o �°
o c)Bottan of lowest haizontal strudural member(V zones only) N/A._ft.(m) � °' �'°� Z� �.�' �"� < . �
o d)Attached 9arage(top of slab) 14. 3 ft.(m) w � � R a�Z � � ,�`� - �
o e)Lan�est elevation of machinery andlor equiprr�ent _m ;�a ��,. ��;�z �t , �
servicing the building(Describe in a Comments area) 14.2 fl.(m) �� '��'�`� �� '."v "
o fl Lowest adjacent(finished)grade(LAG) 14.1 ft.(m) z'� ' � • `°Q °°r� �
o g)Highest adjaoent(finished)grade(HAG) 14. 2 ft.(m) N N -' ���`4
� �,,,,;;., ..
o h)No.of permanent openings(fiood vents)within 1 ft.above adjacent grade_ �
o 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 information.
1 certify that the information in Sections A,B,and C on fhis certificate represents my best efforfs to interpret the data availa6le.
1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code Section 1001
CERTIFIER'S NAME;GALEN K.BELL LICENSE NUMBER:4224
TITLE:PROFESSIONAL SURVEYOR&MAPPER COMPANY NAME:AMERICAN SURVEYING&MAPPING,INC.
�tESS CITY STATE ZIP CODF
320 E.SOUTH STREET,STE.180 ORLANDO FL 32801
SIGNATURE � DATE TELEPHONE
8I10/01 (407)426-�979
FEMA Form 81-31,JUL 00 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
IMPORTANT: In these spaces,copy the corresponding information from Section A ' Fa Insurance Company Use:
BUILDING STREET ADDRESS(Induding Apt,Unit,Suihe,ancilor Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number
550 N.BAYSHORE BLVD.
CfTY STATE ZIP CODE Canpany NAIC Number
CLEARWATER FL 33759
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) •
Copy both sides of this Elevation Certificate for(1)community offiaal,(2)insurance agent/company,and(3)twilding owner.
COMMENTS
ELEVATIONS SHOWN HERE ON ARE BASED ON PINELLAS COUNTY DATUM;
MACHINERY DESCRIBED IN C�E IS AN A/C UNIT
❑Chedc here if attachments
SECTION E•BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zone AO�d Zone A(without BFE),complete Items E1 through E4. If the Elevation Certificate is intended fa use as supporting information fa a LOMA or LOMR-F,
Section C must be completed.
E1.Quiiding Diagram Number_(Select the building diagram most similar to the building fa which this certificate is being completed—see pages 6 and 7. If no diagram accurately
represents the lwi�ing,provide a sketch or photogr�h.)
E2.The top of the bottan floa(induding basement a endosure)of the building is _ft.(m)_in.(an)❑above a ❑below(chedc one)the highest adjacent grade. (Use
natural grade,if available).
. E3.Fa Building Diagrams 6-8 with openings(see page 7),the ne�higher floor a elevated floor(elevation b)of the building is _ft.(m)_in.(cm)above the highest adjacent
grade. Canplete items C3.h and C3.i on front of fam.
E4.Fa Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accadance with the canmunit�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 aumer a ownei's authaized representative who completes Sections A,B,C(Items C3.h and C3.i only),and E fa Zone A(without a FEMA�ssued a community-
issued BFE)a Zone AO must sign here. The statements in Sec�ons 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 I�.�I r.�fia�l�,N,io is autha�-ed by i��rw cx ordina�ce to administer the oommunity's floodplain management adinance can complete Sections A,B,C(a E),and G of this Elevation
CertiFate Ccxr�r 4ete t�e appiicable ftem(s)�d sien below.
Gt.[]T`��informatia�in Sc,�ion C was taken frc,n other documentation that has been signed and embossed by a licensed suroeya,engineer,or architect who is authorized by
state�r Iccal I�v to certify�le��ation�rfamation. (Indicate the source and date of the elevatia�data in the Comments area belcr,v.)
G2.�A community offiaal axn�letc�i Sedion E fa a building located in Zone A(without a FEMA�ssued a communityassued BFE)or Zone A0.
G3.�The fdkriving infamation(I±ems G4-G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMfT ISSUED G6.DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY ISSUED
G7.This permit has bcen issued for: ❑New Construction ❑Substantial Improvement
G8.Elevation of as�uilt 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) Dafum:
�OCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS �
❑Chedc here if attachments
FEMA Form 81-31,JUL 00 REPLACES ALL PREVIOUS F_DITIONS