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+�?�� FEDERAL EME12(�ENCY MAN�GEMENT AGENCY p.M.B. No. 3087-0077
��1� NATIONAL FL OOD INSUR�NCE PROGRAM �xhires July 31, 2002
,� ELEVAT iON CERTIFICATE
Im ortant: Reac1 the Instru�tio�is on a es 1 - 7.
SEC710N A-PR OPER fY OWNER INf'ORMA710N ror InsUrance Cornpany UsA,�� ,,,,; ,
I G O _ 'S /1 Policy Um et
Brian D. & Nadine Thomas
BUILDING STREET ADURESS(Includhiy�pl.,Unil,Sulln,rni�Uor f31 rlc�.No.)OR P.O.ROU f E nND BOX NO. Compahy N/11C NUmber
160 Bayside Drive _.___ ____.
CI1Y STAIE 7_IF'CODE
��,te r f F'L
ROP tY UESCR PT O ( o an oc um ers,lax Paice Nui n�-L?�UescripUon,elc.)
k A Ba side Subdivi;�ion No. 3
, e.g., es en a, on-res enl a, t on, ccessoi v,etc. se Conttnents sect on necessary.)
Residenti�l
V1TIiUDE/LONGITUDE(OPTIONnL) I IORIZONi/1L Dl11UM: SUURCF: _ GPS(lype)'--__----____-- ___-----_--------
( fIN"-Nlt'-NN.N#" or NN.#HNH#") �*�NAD 1927 I.___I��nD 1983 �___�USGS Quad Ma� �._.�Olher._---_.------------_
SECtION�-�LOOU INSUIUINCE I2AtE MAP(FIRM)tNFO12MATION
�1.NFIP COMMUNITY NAME R COMMUNITY NUMBER 82.COUNfY NnME B3.STl1TE 1
^� earwater, Citv of 125096# ___ Pinellas FL J
-gfi f�n��Nn�n"N€L g's:st Fr x 06. -�TvT NDEX — H7'.FlftAX f'�FJ�L e. - oo� -�s.bns€ �od €v7� o �s�
NUMBER DATE EFFECTIVE/REVISED DnTE ZONE(S) (Zone AO,use deplh of tloodinp)
125096-0007 D 8-18-92 8-18-92/8-19-9 AE 11 .0 '
g10.Indlcate lhe source of ihe Base Flood Elevalion(BFE)data or b�se flood deplh entered in 89.
FIS Prolile * �IRM Commun(I Detennined Other Describe
�__� �__� �__� Y �—� � ��------- ------------------------
B 11. Indlcale lhe elevation datum used for the BFE in 89: �*_�NGVD 197_9 �___�NAVb 1988 �__�Other(Describe):_____________________
B 12.Is the bullding located in a Coaslal Barrler Resources Syslem(CBRS)area or Olherwise Prolected Area(Ot'/1)� �__�Yes �* �No
Designatlon bale:-----------.---------------_-
SECTION C-BUILDING ELEVATfON INF�RMATION(SURVEY REQUIREb)
C1. Buliding Alevellons ere based on: �__�Construcllon Drawings" �.._�Bullcling Urider Conslrucllon' �*_�flnlshed Construcllon
'A new Elevallon CerUficale will be requlred when construclfon of Ihe builcling Is r,omplele.
C2. Buildfng Diagram Number_1___(Selecl the building diaqrarn mosl similar fo ihe building for which Ihis cerlificate is being compleled-see
pages 6 and 7. If no dlagrarn accuralely represents ihe building,provide a skefch or photograph.)
C3. Elevations-Zones A1-A30,AE,11H, A(wilh BFE),VE, V1-V30, V(with BFF_),AR,/iR/A, Af2/AE,AR/A 1-A3�, /1R/AI i,/1R/AO
Cornplele(lems C3a-I below according!o lhe bu(Idin,q diagram specified In Item C2. Sfa(e the dalum used. If the da(um Is differenf Irom
Ihe dalurn used Ior Ihe BFE in Seclion 8,cvnveri Ihe dalum Io that used for lhe 6FE.Show field measurernenls and dalum converslon
calculation. Use lhP space provided or lhe Commenis area of Seclion b or Section G,as appropriale,to document Ihe dalum conversion.
Ualum___________ ConversionlComments See__rey_ezse. COttmtents�Sec�_ion_D�______________________________----
�levalion reference mark used _ Uoes Ihe elevation reterence mark used appear on the FIRM7 (__�Yes �*_�No
-------- ------- - • --
CJ a)Top of bollorn Iloor(incliiding basemenl or enclosure) _. _.__. _- _-_6.7_It.(m) m
------
U b)Top of nexl hiqher Iloor � __-----_-___.NA. ---ft.(m) $ � . .
U c)Boitom oI lowest horizorilal slruciural mernber(V zoi�es orily) ______ _ _ _.NA.___fL{m) � o ,�"� , �
U d) All�ched g�rage(lop of sl�b) c.arp_ort__6. 0_►�.(m) � � � �L � `
�� �, ;
U e)Lowesl elevaUori of rnachinery and/or equipmenl � m , , '
servicing the building _.____3_/c__6. 1_fL(m) E � � � ,
U f)Lowesl adjacenl grade(LAG) ----- --- 6.2_fl.(m) z' � " >
U g)i lighesl adjacenl grade(I InG) -__6. 3_fL(m) � ` ,
U h)No. ol perrnanenl openings(flood vents)within 1 tt. above adjar.Pnl grad� __NA__ � LSf�3035.- 10-4-02
U I)Tol�l area oI all perrnanenl openings(flood venls)in C3h______ NA sq. fn.(sq.cm) �
SEC7ION D-SURVEYOR,ENGINEER,OR ARCFOTECT CERTIFICATIDN
7his certitication is to be signed and sealed by a land surveyor,engineer,or archilect eulhorized by law to cerlily elevalion information.
!r,eNi/y Ihaf Ihe lnforn►aflon in Seclions!1,B,and C on Ihls cerfi�r,ale represents rny best el�oris lo lnfernref llre dala available.
_ 1 undersfand fhat any false sfa[ernent may be punislrable by fine or impriso��menl under 18 U.S. Code, Sec(iorr 1 U01.
_���ti.?7- ..►t's - —tTc€ s
b_C.__Stork R1,S #�303�i-- -
---�CU�f'�NY tJ� F
�enL- '1'ar_c�et; Larl _Su_r�v�e in�.�.I�ric. ____
=e CIIY sIA1E 71f'CUUE
ti 663 __ Ihanedir_�____ FL 39697
_ — -- UAIE IELEf' Ic)NE ------
� `.�,yr,,,�,� 10-4-02 (727)784.0573
,n�_z� ni i��� �1=F RPVFR�;F SIf)F Ff1R(:(1N11N1 M►ION Rrr�i n�:r�;ni i nR�vi��I��r�It�nN�
_ r'U-'�i1 C,?R1n�r��l I
t
IMPORTANT: In these s aces,copy the corresponding Informatlon from Sectlon A. For Insur�nce CoM�eny,,,��i,�,,,,.�,,.,,
BUILDINO 9TREEt AbbRESS(Including Apt.,Unit,Suite,andlor Blr�g.No.)OR P.O.F:OU1E AND BOX NO. Pollcy Numbel ' ,
160 Bayside Dr. � �
.:�.��.�.�A:.:�.�.:�y.4�..:��:::;�.N!��
CIlY STAlE ZIPCODE Company AIC Um t
Clearwater, City of �'L
SECTION U-SURVEYOR,ENGINEF�R,OR ARCHI�i ECT CERtIFICATION(CONTINUEDj
Copy bolh sides ol ihis Elevafion Certificate lor(1)communi(y ofticlal,(2)insc�rance agenUcompany,and(3)building owner.
co ts021001 .04 Benchmark City of Clearw�3ter #F-02 Elev=4. 757 '
l__) Check here if attachments
SECTION E-BUILDING ELEVATION INF�RMATION(SURV�Y NOT 12EqUIRED)FOR ZONE AO AND ZONE A(WitHOUT 8FE)
, For Zone AO and Zone A(without BFE),complete Ilems E1 through E4. If tl�e ElevaUon Cert!/Icale Is lntended for use as supporiing
In�ormalion Ior a LOMA or LOMR-F, Sectlon C must be co►nple(ed
E 1.Butlding Diagram Number_____(Select the building diagram most simila�r to the building for which this cerNficate is being cvmpleted-
see pages 6 and 7. If no diagram accuralely represents the buildtng,pro��ide a sketch or photograph.)
E2.The lop of Ihe boltom floor(including basement or enclosure)of the building is I--�-_I«•(►►�)I--I__I�n.(cm) �__�above or (__�belo�
(check one)the highesl adjacent grade.
E3.For guiiding Diagrams 6-8 with openings(see page 7),the next higher flo�r or eleva(ed Iloor(elevatfon b)ot the building Is �
(__�__�fl.(m)�__�__�In.(cm)above ihe highest adJacent grade.
E4.For Zone AO only. If no flood depth number Is avallable,is the top ot the boUom iloor elevaled fn accordance wilh the community's �-
_ Iloodplain manegemenl ordinance7�__�Yes ���No �__�Unknown. 7he local officla�must certiY this fnformation in Sectton G
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The properiy owner or owner's authorized representative wt►o completes Sections A,B,end E for Zone A(witliout a FEMA-Issued or
communily-lssUed BFE)or Zone At7 must sign here.
RO E TY O ER'S U UW ER'S A 1 OR ZED E RESEN7Ai VE'S A E
D ESS C TY S7A E ZIP CODE
SIGNAI RE DAfE 7E EP ONE
CO ENTS
_ �_ � Check here it attachments
SECTI�N G-COMMUNI?Y INFORMATION(OPTIONAL)
The local ofliclal wlio�s aulhortzed by law or ordlnance to administer Ihe comrnunity's lloodplain managemenf ordtnance can complele
Sectlons A,B,C(or E),and G of this Elevation Certificate. Complete the applfcabie Item(s)and sfgn below.
G1.�__�The informalion tn Sectlon C was taken from olher documentation that has been signed and embossed by a licensed surveyor,
engineer,or arcliilecl who is authorized by state or local law to certily elevalion informallon. (Indicate ffie source and date of the
elevallon data in lhe Comrnents area below.)
G2. (__�A cornmuntly official completed Section E for a building located in Zone A(witliout a FEMA-issued or community-issUed BFE)or
Zone AO.
G3. �__�Tfie following information(Ilems G4-G9)is provided for community lloodplain management purposes.
G . ER T B R G5. ER 17 SSUED G6. T C 1 C T O CO P A CE/OCCD'�AN�CY �
ISSUED '
_--- -
G7.TMs permit has been issued for. �__�New Conslruclion �__�Substanlial Improvement
G8.Elevalton of as-built lowest tloor(including basement)of llie bufiding is: _______�___ ,___ft.(mjbafum:__________,_
G9. BFE or(In Zone AO)depth olllooding al(he building sf(e Is: ____________ .___ft.(m)Dalum�__�_________
OC � C S A E TIT E
CCU�t�lUNiTY tv:P��� t ELtI'i-iUNt
SIGNA7URE DATE
CO E TS �_�_,_...-
�__� Check here i(attach�
FFMA�nrm A1-:31 AI If;9�1 RFPI A(;FS A1 I PRFVIC111,S FI�I: