160 BAYSIDE DR .
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� FEdERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3087-0077
NATIONAL FLOOD IN3URANCE PROGRAM Expires J�ily 31, 2002
ELEVATION CERTIFICATE
Irn ortant: Read the InstrucUons oi� a es 1 - 7.
SEC?ION A-PROPERTY OWNER(Nf'ORMAtION For InsUrance Company UsA:��,, .,;,;.
I G U 'S A Policy Um e►
Brian D. & Nadine Thomas , ;;,;,•� ,��,
BUILDING STREEt/\DDRESS(includiny npl.,Unil,Sull�,nnd/or dldh.No.)UR P.O.ROUf E AND B�X NO. Cornpahy NAIC Num6et
160 Bayside Drive
CITY STAlE ZIP COOE
�; ear�ta�er, C�y of � 9 r FL �
RO Y D�SCRi�'fiic�N t_o(an oc um ers,l,�arce7 um er, e � Uescri Uon,etr,.
LQt 14, �lo�ck��Bayside Subdivision No. 3
. �QiL6fRC�U$E'�'e.g., esiaen a, on-residenifa-f,7CTd t on,fT— cc7C essory,e c-IIse Comments sect on�Ti necessary.
Residenti�l
I.,ATI7UDElLONGITUDE(OP71UN/1L) FIURIZUN1nL UATUM: SO RCE: _ G ( ype)�___._______________—_____ ___
( lllt"-NR'-NN.#N" or flN.NN#!1N°) �*�NAD 1927 �_�NAD 1983 �_�USGS Quad Mar I__I Other'----------------
� SECtION g-FLOOb INSUI2ANCE RAtE MAP(FInM)1N�OftMATION
B1.NFIP COMMUNIIY NAME 8�COMMUNITY NUMBER B2.COUNTY NAME B3.StATE
Clearwater, City of 125096# Pinellas FL
�8�.�A���L. 5.S F X B6. -IR vf�NDEX 87.- 1�f2�vT�! J�L 8. 00 -�9.b�S€ U�� U (S)
NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use deplh ot fiooding)
125096-0007 D 8-18-92 8-18-92/8-19-9 AE 11 .0 '
g 10. Indlcale tlie source of(he Base Flood Elevatfon(BFE)dala or base tlood deplh entered in 89.
�__��IS Proffle �*_��IRM �__�Commun(ly belermined �__�Other(Descrfbe):__________________________________
B 11. Indlcale lhe elevallon datum Used tor fhe BFE in 89:�*_�NGVb 197_9 �__�NAVb 1988 (__�Other(Describe):_____________________
912.Is the bullding localed In a Coaslal Barrier Resources Syslem(CBRS)area or Olherwise Prolecled Area(OPA)? �__�Yes �* �No
besignallon bate:--------------------------
SECTION C-BUILbING ELEVATION INFORMATION(SURVEY►2EQUIF2Eb)
C1.8ullding otavallons ere based on: �__�Conslrucllon Drawings' �__�Bpilcling Under Construcllon' �*_�Flnished ConsfrucNon
'!1 new ElevaUon CerUlical�wlll be required when conslruclfon of lhe building Is complefe.
C2.Building biagram Number_1___(Selecl the building dlagram most similar to Ihe building for which Ihis certifir.ale is being completed-see
pages 6 and 7. If no diagram accurately represenls the building,provide a skefch or phofograph.)
C3. ElevaUons-Zones A1-A30,AE,AFi,A(with BFE),VE, V1-V30, V(with BFE),AR,AR/A,AR/AE,AR/A1-A3Q nR/AI l,Af2/AO
Complele ilems C3a-I betow according Io lhe building diagram specified in Item C2.Slate lhe datum used. If Ilie dalum is dilferenl lrom
Ihe dalum used for the BFE in Seclion 6,converi lhe dalum Io that used for the BFE.Show Ileld measurernents and dalum converslon
calculation. Use Ihe space provfded or Il�e Comments area of Section D or Section G,as approprtale,to document Ilie dalum conversion.
Dalum___________ ConversionlCommenls�ee_�.everse co►1m�ents�Sec�ion_D�________________________�—____
Eleval�on reference mark used______________________Does Ihe elevallon reference mark used appear on lhe FIRM7 (__�Yes �*_�No
C1 a)Tvp of bollom Itovr(inr,luding basemenl or enclosure) _ ___ 6. 701f.(m) � � � "•
U b)Top of nexl higher Iloor � -------- NA.__ fL(m) �' � "��`�•+�:,+
U c)Bollom of lowest horizonlal slructural member(V zones orily) _._ ________NA._ _fl.(m) �o fr'�' r .;, � • , .
� U d)/111ached garage((op of slab) car.port_ 6. 0_tt.(rn) � � �+"�� �- ; ;' '� .
U e)Lowesl elevaUori ol machinery and/or equfpment � �' , �y; :�, ; ,,�
servicing fhe building ____.__af c_ 6. 1_ft.(m) E � } � �
- - ti �';',
U f)Lowesl adjacenl qrade(LAG) __6.2 ft.(m) z' � '�� ri ' �
�F,. r : .
r� g)I lighesl adjacent grade(I-IAG) ___ _ -- - 6. 3_IL(m) ° � •� �" �`
O h No.of �ennanent o enln s flood venls wilhin 1 ff.above ad'ar,enl rade__NA__ � • � �� �
1 f p 9 � ) 1 9 _ � ` 51�3��35.,�1'0.-4-02
U I)total area ol all permanent openings(Ilood venls)in C3h_____ NA sq.in.(sq.cm) r ^
�
• SECTION U-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This cerUlication Is to be signed and sealed by a land surveyor,engineer,or archllect aufhorized by i2w io certi(y eievalio�5 iiiturmaUon.
1 cerlify fhaf fhe Informallon in Sectlons/1,B,and C on Ihls cerlifica(e repiesenls my best e(foris fo!n(eipret lhe d�ta evailable.
1 understand that any false s(a(ernenf may be punishable by fine or Imprisonrnenf under 18 U.S. Code, Sec(iorr 1001.
'C€�Ti�T �S LIC
RT�S #�n35—
1 1 CU f'!1 lY tJ/1 F
President '1'ar�eL- Lar�Surveyinq Inc.
�UUT2�SS CIiY Si TE ZIP CODE
�0. Dox 663 Ihanedin_ FL 39697
��"int -�nrE iE Er o�i€
�, t_��,e_...—�,,�� 10-4-02 (727)784.0573
,�n�-�,�m'n�_�� ni►c;�n �f=F RFVFR�:F Slf)F F�1R f:�1N11N11ATInN RFPI Af;FS r,i i Pc��vi�ii��r�tri�N�
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IMPOF2TANT: In these s aces,copy the corresponding Intormatlon from 5ectlon A. For Insur�nce CoM ari ��; .
BUIlDINO 3TREEt AbbRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND 90X NO,
16 0 Ba s i d e Dr. h:�.Y:..,...,w:.��:�.,..�,:,,,:
Pollcy umber
CIIY , '
Clt'dY'Wdt2Y'� Clt Of SrATE � `•:,,� ,:q.:::.
ZIP CODE Company AIC uM t
FL �
SECTION b-SURV�YOR,�NGINEER,OR AFiCNI1ECT CEFttI�ICAtiON(C�NTINUED)
Copy bol�i sides o/fhls Elevallon Certificale for(1)communlly olliclal,(2)insurance agent/company,and(3)buiiding owner.
CO TS
021001 .04 Benchmark City of Clearwater #F-02 Elev=4. 757 '
SECTION E-BUILDING ELEVATION INFORMA'f10N(SURVEY No7 REqUiRED)FOR ZONE AD AND ZONE A(WITHOU7 FE)nts
. For Zone AO and Zone A(without BFE),corriplete Items E1 through E4. !/the Elevallon Cert!/lcate!s Jntended for use ss su
Informafion for a LOMA or LOMR-F, Secflon C must be cornpleted. pporting
E 1.Building biagram Nurnber __(Selecf(he building diagram most similar to the building for which(his certificale is being compleled-
see pages 6 and 7. If ho diagram accurately represents the buildin
E2.The top of Ihe boftom floor(including basement or enclosure)of the bullding isa sketch orpt otograph.)
(check one)the highest adJacent grade. (--�--� �m�(-_I__I�n•(cm) �__�above or (__�below
�3.For�uiiding Dlagrams 6-8 with openings(see page 7),the next h(gher fioor or elevated lloor(eleva(fon b)of lhe buflding is
(-_�__�fl•(m)�__�__�In.(cm)above the hlghesl ad�acent grade,
�4.For Zone AO only. If no flood depth number is available,is the top oi lhe botlom floor eievated in accordance wilh lhe community's
flood laln mana ement ordtnance7 __ Yes � No __ Unknown. The local ofticlal must certif lhls Informatlon tn Sectton G.
SECTION F-p►�pp�RTY OWNER(OR OWNER'S R E P R E S E N t A T I V E)CERTIFICATION
T he properiy owner or owner's authorized representaltve who compleles Secfions A,B,and E for Zone A(withoul a FEMA-fssued or
commuhity-issued BFE)or Zone AO rnust sign here.
RO ERTY O ER'S UR OW ER'S A 1 OR ZED ESENTAT VE'S A E
D ESS
C TY STA ZIP CODE
SIGNAT RE
DA7E TE EP ONE
CO ENTS
SECTION G-COMMUNITY INFORMATION(OPTIONALj -- Check here if ettachments
The focal o�flctal wlio Is aulhorized by law or ordlnance lo adminlster the community's Iloodpialn mahagement ordtnance can complete
Sectlons A,B,C(or E),and G of thls Elevation Cerel(cate. Complete fhe appNcable Ifem(s)and sign below.
G�•�__�7he In/ormalion tn Sectfon C was laken from olher docurnenfation thaf has been signed and embossed by a licensed surveyor,
engineer,or arclit(ect who Is authorized by slale or local law to certify elevallon informatlon. (Indlcale fhe source and da(e of the
elevalion dafa in tlie Commenfs area below.) �
G2. (__�A communt(y olflcial compieled Section E lor a buliding localed in Zone A(witl�out a FEMA-issued or community-issUed BFE)or
Zone AO.
G3. �__�Ttie following informalion(Items Gd-G9)is prov(ded for co►nmunity Iloodplain managemenl purposes. �
G . PER IT BER G5. ER IT SSUED
G6. E C' F C T O CO A CE/OCC A CY
G7.This permit has been issued for. New Construclion �SSUED
G8. E►evatfon of as-bufit lowest floor(including basement)ot lhe build nybStan(ial improvement
G9. BFE or(In�one A�)depth ql llooding a!(he butiding sile is: ---------- •---«•(m)Dalum:
------------
OC O C S A E ------------ •___ft.(m)Dalum:__
----------
TIT E
COMMUN�TY NAMF
itLtI�HUNE � -`�-�-----
SIGNATURE
DATE
CO E �S
__ Check here if attachments •
F�MA F�rm A1-:�1 AI Ir, q�
RFPI Af;FS AI( PRFVIC)I I.S FnITInNR