620 BAYWAY BLVD UNIT 6 _ _
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FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077
Expires December 31, 2005
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1 -7. 1� C P a�3���Q �2
SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use:
BUILDING OWNER'S NAME Policy Number
K MOORINGS, LLC UNIT No. � �'��---�
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
620 BAYWAY BOULEVARD
CITY STATE ZIP CODE
CLEARWATER FLORIDA 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Lots 9&10,BLOCK"A" Bayway Subdivision No.5 P.B.38,PGS.38-39
BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,if necessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS(Type):_____
( ##°-##'-##,##" or ##.######°) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other._ ____
SECTION B•FLOOD INSURANCE RATE MAP{FIRM)INFORMATION
B1.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAMc B3.STATE
City of Cleanvater 125096 PINELLAS FLORIDA
B4.MAP AND PANEL B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX 66.FIRM INDEX DATE EFFECTIVr/REVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depth of flooding)
125096-0007 G SEPTEMBER 03,2003 SEPTEMBER 03,2003 AE EL.11.0
B10.indicate the source of the Base Flootl Elevation(BFE)tlata or base flood depth entered in B9.
❑FIS Profle �FIRM ❑Communiry Determined ❑Other(Describe):_
B11.Indicate the elevation datum used for the BFE in B9:❑�d��VD 1929 �NAVD 1988 ❑Other(Descnbe):_
B12.Is the building located in a Coastal Bamer Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No Designation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:�Construction Drawings" _ ❑Building Under Construction` �Finished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
C2.Builtling Diagram Number 7 (Select the building diagram most similar to the building for which this certificate is being completed-see pages 6 and 7. If no tliagram
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,AWA,AR/AE,AR/A1-A30,AR/AH,AWAO
Complete Items C3.-a-i below according to the building diagram spec�ed in Item C2.State the datum used.If the datum is different from the datum used for the BFE in
Section B,convert the datum to that used for the BFE.Show feld measurements and datum conversion calculation. Use the space provided or the Comments area of
Section D or Section G,as appropnate,to do;;ument the datum conversion.
Datum NAVD 1988 Conversion/Comments N/A
Elevation reference mark used LP-15, EL.=4.191 Does the elevation reference maric used appear on the FIRM? ❑Yes �No
o a)Top of bottom floor(including basement or enclosure) 17.23 FT ft.(m) � ' °' "
o b)Top of next higherfloor 27.5 FT ft.(m) `� ° -
�
a' c�
o cj Boitom of lowest horzontal structural member(V zones only) N�A FT ft.(m) o o " . � �
o d)attached garage(top of block) 6.23 FT ft.(m) �� `c�
o e)Lowest elevation of machinery and/or equipment w@ ' ' .�
servicing the building(ELEVATOR EQUIPMENT) 11.3 FT ft.(m) �� '� o.•
�.
o fl Lowest adjacent(fnished)grade(LAG) 5.8 F7 ft.(m) z� � � ' ���`�} � � �
o g)Highest adjacent(f�nished)grade(HAG) 5.9 FT ft.(m) � � `"�07/D 1/04
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 14 � �"
o i)Total area of all permanent openings(flood vents)in C3.h 1280 sq.in.
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed antl sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.
I certify that fhe information in Secfions A,8,and C on this cerfificate represents my best efforfs to inferpret fhe data available.
1 understand that any false sfatement may be punishable by fine or imprisonment under 18 U.S. Code; Section 1001.
CERTIFIER'S NAME LICENSE NUMBER
BRUCE A.KLEIN PLS 5052
TITLE COMPANY NAME
PRESIDENT KLEIN&STAUB SURVEYING,INC.
ADDRESS CITY STATE ZIP CODE
8016 Old County d 54 New Port Richey FL 34653
SIGNATURE DATE TELEPHONE
, �
_ �� 07/01/04 (727)834-8140
FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces all previous editions
IMPORTANT: In these spaces,copy the corresponding information from Section A. For insurance Company use:
BUILDING STREET ADDRESS(induding Apt.,Unit,Suite,andlor Bldg.No.)OR P.O.ROUTE P,ND BOX N0. Poliq�Number
620 BAYWAY BOULEVARD
CITY STATE ZIP CODE Company NAIC Number
CLEARWATER FLORIDA 33767
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community offcial,(2)insurance ag�nUcompany,and(3)building owner.
COMMENTS — —
♦
N/A
❑Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zone AO and Zone A(without BFE);complete Items E1 through E4. If the Elevafion Certincafe is intended for use as supporting information for a LOMA or LOMR-F,
Section C must be completed.
E1.Building Diagram Number_(Select the building diagram most similar to the building for which tnis certifcate is being completed–see pages 6 and 7. If no tliagram accurately
represents the building,provide a sketch or pho(ograph.)
E2.The top of the bottom floor(including basement or enclosure)of the building is _ft.(m)_in.(cm)�above or ❑below(check one)the highest adjacent grade. (Use
natural grade,if available).
E3.For Building Diagrams 6-8 with openings(see page 7),the nexf higher floor or elevated floor(elevation b)of the building is _ft.(m)_in.(cm)above the highest adjacent
grade. Complete items C3.h and C3.i on front of form.
E4.The top of the platform of machinery andlor equipment servicing the building is _ft.(m)_in.(cm)�above or ❑below(check one)the highest adjacent grade (Use
natural grade,if available).
E5.For Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance?
❑Yes ❑No ❑Unknown. The local official must certi"ry this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owners authonzetl representative who completes Sections A,B,C Qtems C3.h and C3.i only),and E for Zone A(witnout a FEMA-issued or community-
issued BFE)or Zone AO must sign here. The sfatements in Secfions A,8,C,and E are correct to fhe best of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
❑Check here if attachments
__ SECTION G-COMMUNITY INFORMATION(OPTIONAL)
–-- ______�..� �_
The lo;;al official who is authonzed by iaw or ordinance to adminisler the community s floodplain management ordinance can complete Sections A,B;C(or E),and G or this Elevation
Certif cate. Complete the applicable i,em(s)and sign below.
G1.�The information in S�ction C was!aken from other tlocumentation that has been signed and embossed by a licensed suroeyor,engineer,or architect who is authorized by state
or local law to certify elevation information. (Intlicate the source and date of the elevation data in the Comments area below.)
G2.�A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0.
G3.�The following information(Items G4-G9)is provided for community floodptain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED
�
G7.This permit has been issued for:0 New Construction ❑Substantial Improvement
G8.Elevation of as-built lowest floor(including basement)of the building is: _._ft.(m) Datum:
G9 BFE or(in Zone AO)depth of flooding at the building site is: _._ft.(m) Datum:_
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
❑Check here if attachments
FEMA Form 81-31,January 2003 Repiaces all previous editions