276 BAYSIDE DR (2) E�.EVATION CERTIFiCATE O M B nlo3067 0077
Exprres Ma y 31, !993
FE�JEAAL EME�GENCY MANAGEME�lT AGENCY
NATIONAL FLOOD INSURANC� PROG�AM
ATTE�lTION: Use ot this certificate does not Arovide a waiver of the flood insurance purchase reau�rement. This form�s used oniv to
� ov�de eievation information necessary to ensure compliance�vitn aoplicable ccmmunity floodolain management crdinances. to
atermme the proqer insurance premium rate. ano'or;o suoport a reauesi for a Letter of Map Amendment or Revisio� ;LOMA or�CMRI.
Instructions for comoieting this forrn can be tound on ihe followin "°"""F
�
SE�TION a PROPERT'f INFOFiMATICN =_.,,. . :..� � � �
:ii1LCING i.\VNEn'S iJAME IC�'NU`d0==. � I �;k
Do��, N� O�T � 20110 `�i_��`r��
?`RE=?aCCRESS uncluding Aot Jnit�uite and:or clCg..Vumoen CR°O. =CU"c?NO EC:<�UMBEn PANV`JAiC':Ut.1BEa � ° �t` [
2.�Cv E D�. . ,r, � ���
�T!�ER oESCa�PT�oN��ot ana E!ocK Numoe�s.etc.; CITY OF CLEARWr�TER
��vs���.. � uN�-r A c.�-r �`N „ �c.ock 1 .�r,.
:.:Tl' STATc =:P�ODE
C,LE-A�w�TF�, �+=LO1�►D!�
SECTICN 8 FLOOD INSURANC� AATE 1AAP(FIRM) INFORMATION
=-�vide the ro�lowing from the oroper FiRM iSee Ins[ructionsl:
���.,1MUNIT`(NUMBER 2.°ANEI NUMBER 3.SUF=1X = JATE��F=�RM iNOEX 5.=IRtJ�CNE 5.ansc=_:;OD ELEVaT;O�
�+n nC Z�aes.�se aeocn�
12Sp� 0007 D Auc�uS�� � •�. � � � 2
l noicate che elevation datum system used on the FIRM for 3ase ��ooa E:evations (6Fc?: _NGVD'29 _Other raescrioe on oacxl
_ ;or�ones A or V, where no 3F�is providea on ;he FfRM. ano:�e community has estabiished a E3FE 'or this buiiding site. inaica[e
�.he community's BF�: ._ feet NG'JD lor other��:�M oatum-see Sec;ion 8. ltem il
S��TION C BUILDING cl.E�/ATION INFORMATION
' Jsing the Elevation C2rtificate Instructions. indicate the diagram numoer�rom the diagrams found on Pages 5 and 5 that best
7escrioes the subject building's reference level
�1. FiRM Zones A1-A30. AE. AH, and A �with BFc';. The too oi�tie reierence tevel floor from the selected diagram �s at an elevanon
of____�,..�Q feet NGVD (or other FIRM datum-see Sec:ion B. Item 7). '!"
b1. FIRM Zones V1-V30, VE, and V(with BF�;. The bottom o�;he iowest horizontai structural member of the reference level from
the selected diagram, is at an elevation of ._ feet NGVD�or other FIRM datum-;ee Section B, Item 7).
ct. FIRM Zone A (without BFE). The floor used as the reference�evel from the selected diagram is -�.:_ teet above _ or
below_; (check one) the highest grade adjacent to the buiiding.
d). FIRM Zone AO. The floor used as the reference level from ihe selected diagram is .� feet above� or below_ (check
one) the highest grade adjacent to the building. If no flood depth number is available, is the buiiding's lowest floor(reierence
level) elevated in accordance with the community's floodplain management ordinance? ; I Yes i No �' Unknown
�. Indicate the elevation datum system used in determining the above reference level elevations:�NGVD '29 :- Other(dascribe �
under Comments on Page 2). (NOTE: N the elevation datum used in measuring the e/evations is different than that used on
the FIRM jsee Section 8, ltem 7J, then convert tlie elevations�o the datum system used vn the FIRM and show the conversion
equation under Comments on Page 2.)
�. �levation reference mark used appears on FIRM: _ Yes � No (See Instructions on Page 4)
�. The reference level elevation is based on: ,� actual construction _ construction drawings
(NOTE: Use ol construction drawings is on/y valid il the building does not yet have the re%rence/evel l/oor in p/ace, in which
case lhis certificate wilf only ba valid for the bvilding during the course o/construction. A post-construction Elevation Certilicate
will be required once construction is comp/efe.J
• �. The elevation of the lowest grade immediateiy adjacent to the building is:����!.L�.� feet NGVD(or other FIRM datum-see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
!f the community official responsibie for verifying building elevations specifies that the refere�ce level indicated in Section C, Item 1
• is not the"lowest floor"as defined in the community's fioodplain management ordinance, the elevation of the building's"lowest
. floor"as defined by the ordinance is: � � � � � !.�� teet NG'JD(or other FIRM datum-see Section B, Item 7).
2_ Date of the start of construction or substantial improvement
F ENIA Form 81-31�MAY 90 REPlACES At'_PREVIOUS EDITIONS SEE REVERSE SIOE FOFi CONTINUATION
T_ _.
_ ._.... ---_---------- ----°°_-_.'-^^-�.-.,�---
----_--- � - - -___ _ _ _
-- ----
:_. . _ .. .ry .. _ _
- - - .. ,- -- : -= _ _
_ _ _
� .� . _ �,.
. . - -
. _ __ .. _ - - - -
' �;r _ . .. '' ... � „�� _ � _.. . :- , ; _ . . . _..: , ._ - - - - ' °
; _. . . • -- - _ ___`,SECTION E CERTIFICATION_ :� - -- ----- � -- _- �
! � � . ' - _ . . - - • -- . . - ,,._ �_.
This certification is to be signed by a land surveyor,engineer,or architect who is authorized by state or local law to certify elevation '
information when the elevation iniormation for Zones A1-A30,AE.AH,A(with BFE),V1-V30,VE,and V(with BFE)is required.
Community o�cials who are authorized by local law or ordinance to provide tloodplain management information, may also sign the
� certification. In the case of Zones AO and A(without a FEMA or community issued BFE�,a building official,a property owner,or an
owner's representative may also sign the certification.
Reference level diagrams 6,7 and 8-Distinguishing Features-If the certifier is unable to certify to breakaway/non-breakaway wall,
enclosure size, location of servicing equipment, area use,wall openings, or unfinished area Featute(sj, then list the Feature(s) not
i
included in the certification under Comments below. The diagram number, Section C, Item t, must still be entered.
� !ceRily that the inlormation in Sections B and C on this certificate�ep�esen[s my best e(forts to rnterpret the data available.
!undersrand ihat any fa/se statement may be punishable by frne or imprisonment unde� 18 U.S. Code, Section 100i.
RoN�� N � .�N �, �'LS � 374-�
� CERTIFIEA'S NAME LIC�NSE NUMBEA(or Atfix Seal)
j PRES���N T C c�FL�►E2ST�NE E1VG�NEE21N('�, ANn SuzvEyrti�
I TITLE ���o, COMPANY NAME
12/4 �C�Lt�v.��-AUD S�T'�,E.E.T CLEAfZV�I/�7E� Ft.o1�ZID�4 34--Cn2S
AO�RESS • CITY STATE ZIP
i
� .
SIGNATUflE ' ya �A^E PHONE �
� _ �- ,) ��
/._LJ
�.9 �;a
Copies should b�r��de;d�f tFtq�Certificate for: 1)community ofiicial, 2) insurance agent/company,and 3) building owner.
COMMENTS:
•
. r. ON MIfiH . ON PILES,
SLAB � _ BASEMEfJT � PIEflS,OR COLUMNS
A V A A V
, ZONES ZONES �� ZONES ZONES ZONES
. - HEFERENCE
FE=cRElKE �E , LEVEt REFEPENCE
IEVE: ��p LEVEI
FI FvATpN
_ t
- J y�.�.r ,�ti.
B�SE " ' :;:;i::.�i:''. 'i:�' BtiSE
.,:. :`�::;: REFEHEt�CE f1000
fIOOD � ..v` �::.. A0.IACEM ::t;�:v. ELEV�iIOr�
GMOE ' ���
EIEV�Tqn REFERENCE AWAGEM `�
IEVEI GRAOE ��.
y.r'-.'ra•:'-.+
,.Y.r,..�•�,:�.
' `��•�" - _ ':✓.�'f�e :�;�y:..f=':
:ri.�:�� � i1- . `'. '�-t�:.•_. �.��.:::::
' .:�,ij.: ':- ::_:iii�:i:�{'' :.).; .
�:.�.:;:: �.'ti'�?�;.:;•,�..;. =i::. ..y.ADJKE7R;.
..�::_�i::';'�':'i=�:'+�:�i W1�DE
" _ . . . , _.. +.��_ ..._... _ _
The diagrams above illustrate the points at wt�ich the elevations should be measured in A Zones and V Zones. _ , •
� _ _ . .
�levations for all A Zones should be measured at the top of the reference level iloor. : . •
Elevations for all V Zones should be measured at the bottom af the lowest horizontal structural member. • �
._ ..._. . ....._.. __.._.. . . .. . -- ._._ ._ _- _ . __ ....... ..__----•--•----- ._ . - --• -• -
_ . . .. . �J'._� � . .� . . � � . � . .. . . . �4. �v� ���f
' ' :µ�.
� Page 2 -_ _ ��,
.. ',� �• ' ' . . —- �.T X-'
.�.�..-..�_.—.�.,.�_�_..v �.r... . ... . . . ... � . ' . . ' r. . - . � .• ,._�� l _�3ird�<+2F�i'S' ^ --.1