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645 BAYWAY BLVD ��a ,� a�.ti— G►t6 �/� FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 � - - NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005 Jr;b�C� - 63 2 � ELEVATION CERTIFICATE Important: Read the instructions on pages 1-7. SECTION A-PROPERTY OWNER INFORMATION FalnsuranceCanpanyUse' BUILDING OWNER'S NAME Policy Number RODERICK J. &GEORGETTE L. GILLIS BUILDING STREET ADDRESS(Including P,pt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC I�lumber 645 BAYWAY BLVD C�TY STATE ZIP CODE CLEARWATER FL PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) LOT 5,BLOCK B,BAYSIDE SUB BUILDING USE(e.g.,Residenfial,Non-residential,Addition,Accessory,etc. Use a Comments area,if necessary.) RESIDENTIAL LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type): ( ##°-##'-##.##" or �t#.�k� �NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other. SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 61.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNIY NAME B3.STATE � CLEARWATER 125096 PINELLAS FL 64.MAP AND PANEL 67.FIRM PANEL B9.BASE FLOOD ELEVATION(S) NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVEIREVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depth of floodirg) � � 104 G 9-3-03 9303 AE 11 810.Indicate the source of the Base Floal Elevation(BFE)data or base flood depth entered in B9. ❑FIS Profile �FIRM ❑Communiry Determined ❑Other(Describe): 611.Indicate the elevation datum used for the BFE in B9:�NGVD 1929 �NAVD 1988 ❑Other(Describe): B12.Is the building located in a Coastal Bamer Resources System(CBRS)area or Otherwise Protected Area(OPA)� ❑Yes �No Desi nation Date SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1 Building elevations are based on:�Construction Drawings* ❑Building Under Constructlon' �Finished Construction � "A new Elevation Certificate will be required when construction of the building is complete. �2.Building Diagram Number 1(Select the building diagram most similar to the building for which this certificate is being completed-see pages 6 and 7. If no diagram 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,ARIA,ARIAE,ARIA1 A30,AR/AH,AR/AO Complete Items C3.-a-i below aocording to the building diagram specified in Item C2.State the datum used.If the datum is different from the datum used for the BFE in Sec6on B,convert the datum to that used for the BFE.Show field measurements and datum conve�sion qlculation. Use the space provided or the Comments area of Section D or Sedion G,as appropriate,to document the datum conversion. Datum 1988 Conversion/Comments Eleva6on referenoe mark used Does the elevation reference mark used appear on the FIRM? ❑Yes �No � o a)Top of bottom floor(induding basement or endosure) 6. 8 ft.(m) � p�S �� a� c f. o b)Top of next higher floor N.A ft.(m) `� �� *r ° t�il � t '��w�. 'y ��<��`,� f�� J o c)Bottom of lowest honzontal structural member(V zones only) N.A ft.(,r) o o � o d)Attached garage(top of slab) N. A ft.(m) � .;r � o e)Lowest elevation of machinery andlor equipment W m `� +� f � � �"' servicing the building(Descnbe in a Comments area) N.A ft.(m) °' ` '� �,' a` ��=, o fl Lowest atljacent(finished)grade(LAG) 6.0 ft.(m) z m ?: ', '� ~� :.�� "'- o g)Highest adjacent(finished)grade(HAG) 6. 0 ft.(m) `� i U �� , .� ''' ��`,�y o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 0 � ' �;,� � , 3;��-(�,,�{ ; o i)Total area of all permanent openings(flood vents)in C3.h 0 sq.in.(sq,cm) �` �� :-,. .. ,�,� ,� 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. 1 cerfify thaf the information in Secfions A,B,and C on this certificate represents my best efforts to interpret the data available. I understand thaf any false statement may be punishable by�ne or imprisonment under 18 U.S.Code Section 1001. CERTIFIER'S NAME M.G.MAYER LICENSE NUMBER 4495 •TITLE CEO COMPANY NAME FLORIDA BENCHMARK ADDRESS CITY STATE ZIP CODE 1298 LAKEVIEW RD. CLEARWATER FL 33756 SIGNATURE �. DATE TELEPHONE ° ��a`�"'� 03-01-05 727-298-0286 ,, FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces all previous editions � �� _.1 APR 2 7 20�5 � DEVEL�PIVIENT SVCS CITY OF ��._F�FtWATER ��,,,�RTANT: In these spaces,copy the corresponding information from Section A >For Insurenoe canpany use; • BUILDING STREET ADDRESS(Indoding Apt,Uni�Su�te,andlor Bkig.No.)OR P.O.ROUTE AND BOX N0. `Pdicy Number 645 B;�YWAY BLVD �iTY STATE ZIP CODE CompanyNAIC Number .4RWATER FL SECTION D-SURVEYOR,ENGINEER,OR ARCHfTECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community offiaal,(2)insurance agent/company,and(3)building owner. COMMENTS ❑Check here if attachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WfTHOUT BFE) For Zone AO and Zone A(without BFE),complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Secction C must be oompleted. E1.Building Diagram Number_(Select the building diagram most similar to the building for which this certificate is being completed-see pages 6 and 7. If no diagram aocurately represents the building,provide a sketch or photograph.) E2.The top of the bottom floor(induding basement or enclosure)of the building is _ft.(m)_in.(cm)❑above or ❑below(chedc one)the highest adjacent grade. (Use natural grade,if available). E3.For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(devation 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 plafforrn of machinery and/or equipment serviang the building is _ft.(m)_in.(cm)❑above or ❑below(chedc 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 acoordance with the communit�s floodplain management ordinance? ❑Yes ❑No ❑Unknown. The local official must certify this infoRnafion in SecUon G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION e property owner or owners authorized representative who completes Sections A,B,C(Items C3.h and C3.i only),and E for Zone A(without a FEMAassued or oommunity- ;Qd BFE)or Zone AO must sign here. The statements in Sections A,B,C,and E are conect to the best of my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CIlY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS ❑Ch�ere if�chTnts SECTION G-COMMUNITY INFORMATION(OPTIONAL) �'� ,.��a°°�., � �. The local offiaal who is authorized by law or ordinance to administer the communit�s floodpl�n management ordinance can complete Sections R;;B,,��jor Ej;�ri�bf ti�is ElevaHon Cer6ficate. Complete the applicable item(s)and sign below. - • z:; 'r- . G1.0 The informa�on in Section C was taken from other documentation that has been signed and embossed by a licensed suNeyor,engin�a,or�itect wtiois authonzed by state . . or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) . ' ` �; ,:'�' G2.0 A community offidal completed Section E for a building located in Zone A(without a FEMA-issued or community�ssued BFE)or Zone A�.�.^ M'� �.�r'' G3.0 The fdlowing informa6on(Items G4-G9)is provided for communiry floodplain management purposes. �- ` '�' ;4� � ,� ��+ �C: �` ,, G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COIV�LIAN OfiCI�PANCY UF� -1..��'=-, G7.This permit has been issued for:❑New Construction ❑Substantial Improvement G8.Elevation of as-built lowest floor(induding 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 •MMUNITY NAME TELEPHONE SIGNATURE DATE � COMMENTS ❑Check here if attachments FEMA Form 81-31,January 2003 Replaces all previous editions o C��II� _ .._, � � APR �' � 2D05 , DEVEL�PMENT SVCS CITY OF C�,EqRyV,q,TER ��w�"�� [ O.M.B.NO.3067-0077 • Expires July 3'i,2002 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM FLOODPROOFING CERTIFICATE FOR NON-RESIDENTIAL STRUCTURES The floodproofing of non-residential buildings may be permitted as an altema6ve to elevating to or above the Base Flood Elevafion;however,a floodproofing design certification is required.This form is to be used for that cert�cation.Floodproofing of a residential building does not aiter a community's floodplain management elevation requirements or affect the inswance rating unless the community has been issued an exception by FEMA to allow floodproofed residential basemenis.The permitting of a floodproofed residential basement requires a separate certification specifying that the design aomplies with U�e local floodplain management ordinance. FOR INSURANCE COMPANY USE BUILDING OWNER'S NAME POLJCY NUMBER (�ab�(<tG� �.�� C�'U�(7�� L: Gt(�S STREET ADDRESS(InGuding Apt.,Unit,Suite,andlor Bldg.Number)OR P.O.ROUTE AND BOX NUMBER �=�f"_`> �3�d��f�1� �3U:'4�- Vl'�"�1J COMPANYNAICNUMBER � OTHER DESCRIPTION(L t and Blo Numbers,etc.) � L.�' ,!�' P;;,� f`, '�,;�,�o�i r� �uli ��i v i`a�C��f I,C CITY � STATE ZIP CODE �--�.��'-tittiu'f�c 1 c f(___ ('l� �i 7Gs � SECTION I FLOOD INSURANCE RATE MAP(FIRM)INFORMATION Provide the following from the proper FIRM: COMMUNITY NUMBER PANEL NUMBER SUFFIX DATE OF FIRM INDEX FIRM ZONE BASE FLOOD ELEVATION �, � r Qn AO Zones,Use Depth) ��"�� .�i� �-� ��•-��3---�3 �t�= - = t SECTION 11 FLOODPROOFING INFORMATION(By a Registered Professional Engineer or Architect) r'ioacipr6ofing uesig�eievaiion information: u�v� Building is floodproofed to an elevation of .....1 Z.r.�..............feet PlE','offl.(Elevation datum used must be the same as that on the FIRM.) • , ^ `: Height of floodproofing on the building above the lowest adjacent grade is...........�.!..�..............feet. ��Z a ao vE F-L.OpQ, (NOTE.�for insurance rating pwpases,the building's floodproofed design elevation must be at least one foot above the Base Flood Elevation to receive rating credit If the building is floodproofed only to the Base Flood Elevation,then ttie building's insurance rating will result in a higher premium.) SECTION III CERTIFICATION(By Registered Professional Engineer orArchitect) Non-Residential Floodproofed Construction Certification: 1 certify that,based upon development andlor review of stiuctural design,spec�ca6ons,and plans for construction, the design and methods of construction are in accordance with accepted standards of practice for mee6ng the foflowing provisions: The structure,together with attendant utilities and sanitary facilifies,is watertight to the floodproofed design elevation indicated above,witfi walls that are substantially impermeable to the passage of water. AII structural components are capable of resisting hydmstatic and hydrodynamic flood forces,including the effects of buoyancy,and anticipated debris impactforces. I certify that the infortnation,on:this ce�cate represents my best efforts to interpret the data available.I understand that any false statement may be puni�s��diy�prrmprisonment under 18 U.S.Code,Section 1001. ��- F;��/ef*, CERTIFIER S N E �� :+ 4�O�/`, -a, UCENSE NUMBER(or Affix Seal) �'Q``� � �••°'f"t � " ^ ,2-- F PE 2 D I� � TITLE ,� :l�" -�� q �'. �y,,- COMPANY NAME V�' 1 1JV��fZ.. PA��.. �. 1-�d(.c.b� P.�.�L�o�1�jJL'tiuV �'vGtvE�� '�'�DR�S..� �I��,��,� .h,.. �. �.. t ��! .'�' CITY STATE ZIP CODE � �`I�"' `r L�' e�IA�PG B4V��. �l1iV�17/.1�� L � (�� SIGN ... Qy.� � � " �q. DATE PHONE �,' ' �'''� 4-28 •o S �Z�-�3�• 5'o z S : • ` , � / Q M � �� - 1,.: . C ;`r` ,<t,,-�'eo ies should?be ,th` ertificate for:1 communi offiaal,2 Insurance a enUcom ;.� � , .. �-;5., ) tY ) g pany,and 3)buiiding owner. .r�„f. �� r r, ,." �r�' FEMA Form`8�` � V`'�. �'�; Replaces all previous editions F-056(8199) �- '� ��,,. �� o (��II • � � APR � l 2��5 DEVELOPMENT SVCS CITY OF C�.�qRV�lATER