100 BAYSIDE DR %�'�/' ��r���Nl�L'— FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No.3067-0077
�� � �J ��C � L; f L' ��' NATIONAL FLOOD INSURANCE PROGRAM Expires December 31,2005
/
ELEVATION CERTIFICATE
Importar�: Read t�e in�uctions on es 1-7. �'l�/ff��/�� �rG'''°�� �- �f�y�� �. c�%c
SECTION A-PROPERTY OWNER INFORMATION Fa Inswance CompArry use:
�3JILDING OWNER'S NAME Policy Number
VOELLER CONSTRUCTION
BUILDING STREET ADDRESS pnduding Apt,Unit,Suite,and/or Bklg.No.)OR P.O.ROIffE AND BOX NO. Company NAIC Number
100 BAYSIDE DRIVE
CRy STATE ZJP CODE
CLEARWATER R 33767
PROPERTY DESCRIPTION(Lot and Bla;k Numbers,Tax Paroel Number,Legai Description,etc.)
LOT 1,COLUMBIA SUBDMSION NO.5
BUILDING USE(e.g.,Resider�tial,Nor�resideMial,Addition,Acoessory,�c. Use a Commenis ar�ea,ff neoes.sary.)
NON RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(fype):
� ##°-�-##.#�^ o� #�.#�►#°� ❑nwo�s2� ❑ruw�sas ❑uscs civad nnap ❑o�,er.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMv11NffY NANE&COW1��l1NffY NUNBER 62.COUMY NAME 63.STATE
CLEARWA7ER BEACH-125096 PINELLAS COIRJTY FLOR�A
B4.MAP AND PANEL 67.FIRM PANEL B9.BASE ROOD ELEVATION(S)
NUIvBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVEIREVISED DATE B8.ROOD ZONE(S) (Zone A0,use depih af floodin9)
12103C-0102 G 09A.'�'L003 09A3/2003 AE 11FT
610.Indicate the souroe of the Base Fbod Eleva6on(BFE)data a base flood depth entered in B9.
❑FIS Profile �FIRM ❑Community Determined ❑Olher(Desaibe):
B11.Indicate the eleva6on datum used for the BFE in B9:�NGVD 1929 �NAVD 1988 ❑Otl�er(Desaibe):_
B12 Is the bui�rg loc�ed in a Coast�Barrier Resouroes System(CBRS)area a Otherwise Proteded Arez(OPA)? ❑Yes �No Designation DateNlA
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevatia�s are based on:0 Construction Dra�ings` �Buildng Under Construction' [�;Rnist�ed Construction
'A new Elevation Certificate will be required when con�af the buldng is oarplete.
•C2.Buil�ing Diagram Number 6(Select the bui�ing diagram most simlar to the buil�ng for which this oer6fic�e is beirg completed-see pages 6 and 7. If no ciagram
accurately represents the buil�ng,provide a sketch a photograph.)
C3.E�evations—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(w�h BFE),AR,AWA,AR/AE,AWA1-A30,AR/AH,ARIAO
Canplete Items C3.-a-i bebw aocor�ing to the buil�ng dagram speafied in Item C2.St�e the datum used.If the datum is dfferent from the dah�m used fur tl�e BFE in
Section B,oonvert the da�um to tl�at used for the BFE.Show field measure�nents and datum oonversion ca�ulation. Use the space pro�ri�ed or the Corrxr�ents arez of
Section D or Sedion G,as appropriate,to document the datum conversion.
Datum NAVD 1988 Conversion/CanmenLs NGVD29-0.86'=NAVD88
Elevation r�ererice maric used LP-15 Does the elevation�eference mark used appear on the FIRM? ❑Yes �No � �, .
o a)Top of bottom floor(indu�ng basement or endosure) . 4. 68 ft.(m) � `�,���'"� .
o b)Top of next hi�er floor 15.78 ft.(m) �� �
o c)Bottan of lowest haizontal strudural member(V zones only) WA._ft.(m) �o '
o d)Attadied garage(top of slab) 4. 68 ft.(m) $� � �^" „�
o e)Lowest elevatiai of machinery and�or equiprr�ent �� � � ''s. � �� , " ,,(��
and 'U`
servicing the buil�ng(Desaibe in a Canments area) WA._ft.(m) � „ � ., _
o�Lowest a c�acent(finishe�grade(LAG) 4.50 ft.(m) z� � ��.`�
o g)Highest adjacent(6nishe�grade(HAG) 5. 4 ft.(m) � i' ' � '�
o h)No.of p e r m�ent o p e ni n gs(flood vents)within 1 ft.above adjaoent grade NONE � � �
o i)Total area of all permanent openings(flood vents)in C3.h WA sq.in.(sq.an) � _
SECTION D-SURVEYOR,ENGINEER,OR ARCHRECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.
I cerfdy that the informafion in Sections A,8,and C on this certificafe represenfs my besf efforts to inferpret the dafa available.
I understand that any false statement may be punishable by fine orimprisonment under 18 U.S.Code Section 1001,
CERTIFIER'S NAME
DAVID W.STINSON IJCENSE NUMBER LS4122
TITLE
PROFFESIONAL LAND SURVEYOR& MAPPER COMPANY NAME GROUP 3 SURVEYING&MAPPING,INC.
� ADDRESS CITY STATE ZIP CADE
3607 ALTERNATE 19 SUffE C PALM HARBOR Fl- 346�
SIGNATURE DATE TELEPHONE
" . 09113/2005 727-943-9533
FFMA Fnrm R1_31 .laniiarv 9(1(1A �aa rPVarca citlP fnr rtnnfinnati�n Ronlaro?c all nravinuc c±rlitinnc
IMPORTANT: In these spaces,copy the comesponding information from Section A F«iru�ance Car,peny use:
BUILDING STREEf ADDRESS(Indudng Apt,Un�,Sui�,and/a Bldg.No.)OR P.O.ROUTE AND BOX N0. Poky Nurnber
100 BAYSIDE DRIVE
CffY STATE ZJP CODE Carperry NAIC Number
CLEARWATER BEHCH FL 33767
SECTION D-SURVEYOR,ENGINEER,OR ARCH(TECT CERTIFICATION(CONTINUED) •
Copy both sides of this Elevation Certif�ate fa(1)communiry oifiaal,(2)insurance agentloompany,and(3)build�ng owner.
COMMENTS
❑Chedc he�e if athachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
Fa Zone AO and Zone A(without BFE),oomplete 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.Build�ng Diagr�nn Number_(Sded the bu�d'mg�agrarn most sirrii�to the buil�ng ftx which this ce�fiqte is being cornpleted—see pages 6 and 7. If no c�agram aa;uratdy
represents the bui�ng,provide a sketch a'photograph.)
E2.The top of the bottom floor(induding baserr�ent a endosure)of the buikGng is _ft.(m)_in.(cm)�above a ❑belo�w(c�edc one)the highest adacerit grade. (Use
nahfral grade,ff av�lable).
E3.For Buil�ng Diagrarrs 6-8 wilh openirgs(sce page 7),the next higher floor or elevated floor(elevation b)aF ihe building is _ft.(m)_in.(an)above the highest adaoer►t
grade. Complete�errs C3.h and C3.i on ftont af fam.
E4.The top of the pla�am of machinery ar�dlor equiprr�ent servicing fhe buil�ng is _ft.(m)_in.(an)��ove a ❑belaw(d�eck one)the higt�est ac�acent grade. (Use
natural grade,if available).
E5.For Zone AO only: If no flood depth number is available,is the top of the bottom floa eleva�ed in acoadarxe with Uie oorrmunit�/s floodplain managerr�ent arhnance?
❑Yes ❑No ❑Unkna�m. The bc�ll o4fiaal must oertify tlNS ir�arriation in Section�.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATNE)CERTIFICATION
The pmperty owner a owners authorized reGxesentative who oompletes Sections A,B,C(Items C3.h and C3.i only),and E fa Zone A(withouf a FEMA-issued a oanmunity-
issued BF�or Zone AO must sign hene. The statem�ts in SecGons A,8,C,�d E are carecf to tl►e best of my kr►owledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADORESS CITY STATE ZIP CODE •
SIGNATURE DATE TELEPHONE
COMMEMS
❑Chedc here'rf attachments
SECTION G-COMMUNffY INFORMATION(OPTIONAL)
The loc�offr�al who is aut�orized by law a ordnanoe to administer tt�communit�s floodplain m�agement or�inance can oomplete Sedions A,B,C(or E),and G of this Elevation
Cer6fir.ate. Complete the applicable item(s)and sign belouv.
G1.�The irrfarnation�Section C was talcen from dher doaimentation th�has been sigr�ed and erribossed by a�sunreyor,en�incer�a arduted who is aulhorized by sta�e
or local law to certify elevaation ir�faormation. (Inc�Cate the source and date ai the elevaaAion daka in the Commenis area bebw.)
' G2.�A communiry o�fidal oomple4ed Section E for a build�ng bcated in 7_one A(wiUiart a FEMA-issued or comm�mity�.ssued BFE)or Zone A0.
G:i.�The tdbwing ir�amation(ttems G4�9)is provided for oommuniry floodplain managen�ent purposes.
�G4.PERMff NUMBER G5. DATE PERMIT ISSUED G6.DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED
--L_
G�.This permit has been issued fa:�New Caistrudion ❑Substar�ial Improvement
G&:FJevation of as-buift lowest floor(induding basement)of the bui�ing is: _._ft.(m) Da�um:
G9.E3FE or(n Zone AO)depth of floodng at the buil�ng site is: _._ft(m) Datum:
LOCAL OFFICIAL'S NAME �� TITLE
�'
COMMUNITY NAME �:�, �� ,�: � TELEPHONE
SIGNATURE , DATE
COMMENTS ` � L
,�7 _. ,.,���6'�� ��IU� �
�-�'�' �i� ��._�'��.����� ❑Chedc here if attachments
FENL'�Form 81-31,Januarv 2003 Replaces all previous editions