656 BAYWAY BLVD UNIT 1 ` ' �j FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
� v" �� � NATIONAL FLOOD INSURANCE PROGRAM
. �• �� Expires December 31, 2005
� � �� ELEVATION CERTIFICATE
�pp�. ���q Important: Read the instructions on pages 1-7. J s �� b Z o Z '�'1 '7 - Z
SECTION A-PROPERTY OWNER INFORMATION For Insurance Comparry Use:
BUILDING OWNER'S NAME Policy Number
BAYWAY TOWNHOMES, LLC U 1J t'r �
BUILDING STREET ADDRESS(Inciuding Apt.,Unit,Suite,and/or Bidg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
(p�(p BAYWAY BOULEVARD
CITY STATE ZIP CODE
CLEARWATER FLORIDA 33767
PROPERTY DESCRIPTION(Lot and Blodc Numbers,Tax Parcel Number,Legal Description,etc.)
Lots 15-18 Bayway Subdivision No.5 P.B.38,PGS.38-39
BUILDING USE(e.g.,Residential,Non-residentiai,Addition,Accessory,etc. Use a Comments area,'rf necessary.)
- RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATIJM: SOURCE: ❑GPS(Type):
( ##°-##'-##.##" or ##.�°) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECT�ON B•FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME B3.STATE
City of Cieanvater 125096 PiNE�v�s FLORIDA
64.MAP AND PANEL B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER 65.SUFFIX 66.FIRM INDEX DATE EFFECTIVEIREVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depih of floodirg)
125096-OD07 G SEPTEMBER 03,20U3 SEPTEMBER 03,2IX13 AE EL.11.0
610.Indicaie the souroe of the Base Flood Elevation(BFE)data or base floai depth entered in B9.
❑FIS Profile �FIRM ❑Community Determined ❑Ofher(Describe):_
611.Indiqie the elevafion datum used for the BFE in 69:�NGVD 1929 �NAVD 1988 ❑Other(Describe):_
612 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:�Constniction Drawings' ❑Building Under Construction' �Finished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
.2.Building 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 diagram t
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,AR/AE,AWA1-A30,AR/AH,AR/AO
Complete Items C3:a�below according 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
Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion caiculation. Use the space provided or the Comments area of
Section D or Section G,as appropnate,to document the datum conversion. ,;� `
.r: "r�, �,:x.n�.,�.
Datum NAVD 1988 ConversionlComments NIA �.' ,; •�
�
Elevation reference mark used NIA Does the elevation reference mark used appear on the FIRM? ❑Yes �No ± E ��', ���.r � �,�
o a)Top of bottom floor(including basement or endosure) 7.20 . FT ft.(m) � . ���,�:�>>'��,� ' �;.; .
� �,,, a M r ' ,,w"
o b)Top of next higher floor 17.70 . FT ft.(m) {; �,�,
o c)Bottom of lowesi hor¢ontal structural member(V zones only) N/A . FT ft.(m) �o o � ,�� �, ' � a �.
o d)a tt a c h e d g a r a g e(t o p o f b l o c k) 7.2 0 . F T ft.(m) f;��'w�. �''� '� � Y� �
�
o e)Lowest elevation of machinery and/or equipment ,,`� ,� + :w � �, .,e,' ,�M
servicing the building(Describe in a Comments area) NIA . FT ft.(m) E�:; ' � �,' � �' ,`'
o fl Lowest adjacent(finished)grade(LAG) 5.0 . FT ft.(m) z� ' ,� .�',�� �,a��
o g)Highest adjacent(finished)grade(HAG) 5.1 . FT ft.(m) � �J f� '�•06J1��'`
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 14 ; = ; '�. �,� '�` "
. �'
o i)Total area of ail permanent openings(flood vents)in C3.h 1280 sq.in. �
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.
I cerfify thaf the informafion in Secfions A,B,and C on this cer6�cate represenfs my best efforts to inferpret the data available.
1 understand that any false statement 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 Road 54 New Port Richey FL 34653
SIGNATURE DATE TELEPHONE
• 06116/04 (727)834�140
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 msurance com�any use: �
BUILDING STREET ADDRESS(Induding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number ��
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 offiaal,(2)insurance agenUcompany,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 Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F,
Sertion C must be completed.
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 accurately
represents the building,provide a sketch or photograph.)
E2.The top of the bottom floor(induding basement or endosure)of the building is _ft.(m)_in.(cm)0 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 next 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 serviang the building is _ft.(m)_in.(cm)❑above or ❑below(check one)the higtiest 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 acxordance with the community's floodplain management ordinance?
❑Yes ❑No ❑Unknown. The local official must certify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The propeRy owner or owners authorized representative who completes Sections A,B,C(I#ems C3.h and C3.i only),and E for Zone A(without a FEMA-issued or community-
issued BFE)or Zone AO must sign here. The statements in Sections A,B,C,and E are correct to the 6est of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME •
ADDRESS GTY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
❑Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The local offia�i who is authorizPd by law cr ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation
Certificate. Complete the applicable it�;n(s)and sign below.
G1.0 The�nformation in Section C was taken from other documentation that has been signed and embassed by a licensed surveyor,engineer,or architect who is authorized by state
or local law to cerf�y elevation information. (Indicaie the source and date of the elevation data in the Comments area below.)
G2.�A community offiaal oompleted Section E for a building located in Zone A(without a FEM.4-issued or community-issued BFE)or Zone A0.
G3.❑The following informaiion(Items G4-G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6.DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED
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: _._it.(m) Datum:_
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE '
SIGNATURE DATE �
COMMENTS
❑Check here if attachments
FEMA Form 81-31,January 2003 Replaces all previous editions
_.....T_ � .,._
_ _ __ _ �
' FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
�'���~ �{�l7� NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
- ELEVATION CERTIFICATE
� Important: Read the instructions on pages 1-7.
SECTION A•PROPERTY OWNER INFORMATION For Insu�anoe Company Use;
BUILDING OWNER'S NAME Policy Number`
BAYWAY TOWNHOMES, LLC U Il) T
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
BAYWAY BOULEVARD � �L V �
CITY STATE ZIP CODE
CLEARWATER FLORIDA 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) '
Lots 15-18 Bayway Subdivision No.5 P.B.38,PGS.38-39
BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,'rf 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
61.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME 63.STATE
City of Cleanvater 125096 PINELLAS FLORIDA
B4.MAP AND PANEL B7.FIRM PANEL � 69.BASEFLOOD ELEVATION(S}
NUMBER 65.SUFFIX . B6.FIRM INDEX DATE EFFECTIVEIREVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depth of floodirg)
125096-0007 D AUGUST 19,1991 AUGUST 19,1991 AE EL.11.0
610.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9.
❑FIS Profile �FIRM ❑Communiiy Determined ❑Other(Describe):_
611.Indicate the elevation datum used for the BFE in 69:❑NGVD 1929 �NAVD 1988 ❑Other(Describe):_
612:Is the building located in a Coastal Bamer Resouices System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No Designation Date_
�CTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:�Construction Drawings` �Buiiding Under Construction` ❑Finished Construction
A new Elevation Certificate wiil be required when constniction of the buildng is complete,
C2.Building Diagram Number 7 (Select the building diagram most similar to the buildi�g for which this cert�cate is being completed-see pages 6 and 7. If no diagram
accurately represents the building,provide a skeich or photograph.)
C3.Elevations—Zones A1 A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AWA,AWAE,AWA1-A30,AWAH,AWAO
Complete Items C3.-a-i below according to the building diagram specified in item C2.State the datum used.If the datum is d'rfferent from the datum used for the BFE in
Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion calculation. Use the space provided or the Comme�ts area of
Section D or Section G,as appropnate;to document 41��tum conversion. .�,,,�.,,��,��,
Datum NAVD 1988 ConversioNComments N/A ' '�q e�,,
Elevation reference mark used N/A Does the elevation reference mark used appearon the FIRM? ❑Yes �No :�� �*�e*+.�R�: :J� �I�
o a)Top of bottom floor(induding basement or enclosure) 17.70 . FT ft.(m) � �' �• . �"' :` ', � t��
o b)Top of next higherfloor NIA . FT ft.(m) � :�.,,( o�� � � �,�.� .0����F ;
� �.�, � , �r.
o c)Bottom of lowest honzontal structural member(V zones only) N/A . FT ft.(m) o� ;�._,, xa ="""+ a ""
, � ;
o d)attached garage(top of biock) 7.20 . FT ft.(m) W� �' �� � :} ; �� .:
o e)Lowest elevation of machinery and/or equipment -,; ;-��'�1�. ,"�' '
servian the building(Describe in a Comments area) NIA . FT ft.(m) ��'� `;�' i� '' '� �sv=4/ "
9 �,,
o fl Lowest adjacent(finished)grade(LAG) 5A . FT ft.(m) z�'�� �'_�'`���� �� .•'��
o g)Highest adjacent(finished)grade(HAG) 5.1 . FT ft.(m) � � "o� �,��� ����' ,- ���
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade N/A � *x.��t� � +"
o i)Total area of all permanent openings(flood vents)in C3.h N/A sq.in. s°�.,.,: _
SECTION D•SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.
I certify thaf the information in Sections A,B,and C on this cerfificate represents my best efforfs to inferpret fhe data available.
1 understand that any false statement may be punishabfe by fine or impnsonment under 18 U.S. Code,Section 100L
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 Couniy Roa Nzvu PoR Richey FL 34653
SIGNATURE DATE TELEPHONE
02J16/04 (727)834�140
FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces aliprevious editions
IMPORTANT: In these spaces,copy the corresponding information from Section A. For insurance comPany use: ' '
BUILDWG STREET ADDRESS(induding Apt.,Unit,Suite,andlor Bklg.No.)OR P.O.ROUTE AND BOX N0. Policy Number
BAYWAY BOULEVARD '
��n 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 offiaal,(2)insurance agenUcompany,and(3)building ownec
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 Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F,
Sectiore C must be com�eted.
E1.Building Diagram Number_(Select the building diagram most similar to the building for which fhis cerfificate is being completed—see pages 6 and 7. If no diagram acxurately
represents the buildng,provide a sketch or photograph.)
E2.The top of the bottom floor(induding basement o�endosure)of the building is _ft.(m)_in.(cm)�above or ❑below(chedc one)ihe highest adjacent grade. (Use
natural grade,'rf availabie).
E3.For Building Diagrams 6-8 with openings(see page 7),the next 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 plafform of machinery and/or equipment serviang the building is _ft.(m)_in.(cm)�above or ❑below(check one)the highest adjacent grade..(Use
natural grade,'rf available).
E5.For Zone AO only: If no flood depth number is availat�e,is the top of the bottom floor elevated in acxordance with the communit�s floodplain management ordinance?
❑Yes ❑No ❑Unknown. The locai offia�must cer�fy this information in Section G.
SECTION F•PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The propeRy owner or owners authorized representative who completes Sections A,B,C(Items C3.h and C3.i oniy),and E for Zone A(withouf a FEMA-issued or community-
issued BFE�or Zone AO must sign here. The statements in Secctions A,B,C,and E are correct to the 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 locai offic��l who is authori�ed by faw or erdinance to administer the community's floodpl�n management ordinance can complete Sections A,B,C(or E),and G of this Elevation
Cerfifi��. Gompiete ihe appiicable item;s)and sign below.
G1.❑The i�formation in Section C�Mas taken from other documentation that has been signed and embossed by a licensed surveyor,engineer,or architect who is authorized by state
or loc�law to certi'ry eleva`.�on inf�irmation. (indicate the source and date of the elevation data in the Comments area below.)
�2.�A community offiaal completed Scttion E for a buiiding located in Zone A(without a,FEMA-issued or community-issued BFE)or Zone A0.
G3.�The foliowing'orma6on(ltems G4-G9)is provided fa community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMfT ISSUED G6. DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY ISSUED
G7.This permit has been issued for.❑New Construdion ❑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
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
❑Check here if attachments
FEMA Form 81-31,January 2003 Replaces all previous editions
.v
, $�at,�.
� ��, � CITY OF CLEARWATER
� � , ,
� = p DEVELOPMENT & NEIGHBORHOaD SERVICES DEPARTMENT
9��� — � POST OFFICE BOX 474H� CLEARWATER� Fw�DA 33758-4748
qT'E `�� MUNICIPAL$ERVICES BUILDING, 100 Sou'r[-t Mnrri.E AvErtuE,CLEARWATER,FLO�uDn 33756
TE�PxorrE(72� 562-4567 Fnx(72� 562-4576
MEMO OF REVIEW FOR CORRECTNESS 8 COMPLETION
In accordance with participation in the NFIP/CRS program,all elevation certificates are required to be reviewed for correctness and completion prior to
acceptance by the community. This complete form shall be attached to all elevation certificates maintained on file and provide with requested copies of
elevation certificates.
The attached elevation certificate requires corrections by the surveyor of section(s) prior to acceptance by the community
The attached elevation certificate is compiete and correct
_�_Minor corrections have been made in the below marked sections by Community Official
SECTION A-PROPERTY INFORMATION 'For Insurance Company Use:
A1.BUILDING OWNER'S NAME Poliey Number
A2.BUILDING STREET ADDRESS(including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. 'Company NAIC Number
CITY STATE ZIP CODE
A3. PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
A4. BUILDING USE(e.g.,Residentiai,Non-Residential,Addition,Accessory,etc.)
A5. LATITUDE/LONGITUDE(OPTIONAL): HORIZONTAL DATUM: SOURCE:0 GPS(Type):
(##°-##'-##.##" or ##.#�##°) ❑NAD 1927 ❑ NAD 1983 ❑USGS Quad Map❑Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME 63.STATE
64.MAP AND PANEL g5.SUFFIX 66.FIRM INDEX DATE B�•FIRM PANEL gg,FLOOD ZONE(S) B9.BASE FLOOD ELEVATION(S)
NUMBER EFFECTIVE/REVISED DATE (Zone AO,use depth of flooding)
12103C-0104
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in item B9.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Describe)
611. Indicate elevation datum used for BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Other(Describe)
B12. Is the buildin focated in a Coastal Barrier Resources S stem 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 Construction* ❑Finished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
C2. 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 accuratefy represents the building,provide a sketch or photograph.)
C3. Elevations—Zones A1-A30,AE,AH,A(with BFE),VE,Vi-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/A0.
Complete Items C3.-a-i below according 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 Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion calculation. Use the space provided or the Comments
area of Section D or Section G,as appropriate,to document the datum conversion.
Datum Conversion/Comments
Elevation reference mark used Does the elevation reference mark used appear on the FIRM? ❑Yes ❑No
e) Lowest elevation of machinery or equipment servicing the building(Describe in Comments area) ft.(m)
h) No.of permanent openings(flood vents)1 ft.above adjencent grade
i) Total area of all permanent openings(flood vents)in C3.h sq.in.(sq.cm)
i
Comments: � �� � /
Date of Review: �/ Community Official:
�vation certificates shall be maintained by the coirvnunity and copies with the attachedmemo made availa6/e by requast
F[�w[c H�BSnxn,MAYOR
GEORGE N.CRE1'EKOS,COUNCILMEMBER JOIIN DORAN,COUNCILMEMBER
PAUL F.GIF3SON,COUNCIIMEMRER � CARLEN A.PE7ERSEN,COUNCILMEMBER
��EQUAL EMPLOYMENT AND AFFIItMATNE ACTION EMPLOYER��
_ _
.
. •
���r� �
� ��. C ITY OF C LEARWATER
. v ,�li, �
r �. p DEVELOPMENT &NEIGHBORHOOD SERVICES DEPARTMENT
9� � ` ` POST OFFICE BOX 474H� CLEARWATER� FLO�uDn 33758-4748
�',qTE �� MUNICIPAL SERVICES BUILDING, lOO SOUTH MYRTLE AVENUE,CLEARWATER,FLOx�Dn 33756
TE�rxorrE(72� 562-4567 Fnx(72� 562-4576
MEMO OF REVIEW FOR CORRECTNESS� COMPLETION
In accordance with participation in the NFIP/CRS program,all elevation certificates are required to be reviewed for correctness and compietion prior to
acceptance by the community. This complete form shall be attached to all elevation certificates maintained on file and provide with requested copies of
elevation certificates.
The attached elevation certificate requires corrections by the surveyor of section(s) prior to acceptance by the community
The attached elevation certificate is complete and correct
Minor corrections have been made in the below marked sections by Community Official
SECTION A-PROPERTY INFORMATION For Insurance Company Use:
A1. BUILDING OWNER'S NAME Policy Numbe�
A2.BUILDING STREET ADDRESS(inciuding Apt.,Unit,Suite,and/or Bidg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
CITY STATE ZIP CODE
A3. PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
A4. BUILDING USE(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)
A5. 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
.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME B3.STATE
64.MAP AND PANEL g5.SUFFIX 86.FIRM INDEX DATE B�•FIRM PANEL gg,FLOOD ZONE(S) B9•BASE FLOOD ELEVATION(S)
NUMBER EFFECTIVE/REVISED DATE (Zone AO,use depth of flooding)
12103C-0104
610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Describe)
611. Indicate elevation datum used for BFE in 69:❑NGVD 1929 ❑NAVD 1988 ❑Other(Describe)
612. Is the buildin located in a Coastal Barrier Resources S stem 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 Construdion' ❑Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Building Diagram Number (Select the buiiding 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,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO.
Complete Items C3.-a-i below according 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 Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion calculation. Use the space provided or the Comments
area of Section D or Section G,as appropriate,to document the datum conversion.
Datum Conversion/Comments
Elevation reference mark used Does the elevation reference mark used appear on the FIRM? ❑Yes ❑No
e) Lowest elevation of machinery or equipment servicing the building(Describe in Comments area) ft.(m)
h) No.of permanent openings(flood vents)1ft.above adjencent grade
i) Total area of all permanent openings(flood vents)in C3.h sq.in.(sq.cm)
Comments: � �
Date of Review: Community Official:
#vation certificates shall be mai tained 6y t e community and copies with the attachedmemo made available by request
Fw�rx Hissnen,MAYOR
GEORGE N.CRE1'EKOS,COUNCILMEMAER JO[IN DORAN,COUNCILMEMBER
Pnut F.GinsoN,COUNCILMEMAER � CARLEN A.PE1'ERSEN,COUNCILMEMBER
��EQUAL EMPLOYMENT AND AFFIftMATNE ACT10N EMPLOYER��