656 BAYWAY BLVD UNIT 6 � , ' FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
• NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
� • • ELEVATION CERTIFICATE
� p�3 ... C�`t y 4 Important: Read the instructions on pages 1-7. J s Q� b z o Z�? ? . Z
SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use:
BUILDING OWNER'S NAME Policy Number
BAYWAY TOWNHOMES, LLC v 13 LT— �
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAiC Number
(�51Q BAYWAY BOULEVARD
CITY STATE ZIP CODE
CLEARWATER FLORIDA 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Lots 1r18 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 8 COMMUNITY NUMBER 62.COUNTY NAME B3.STATE
City of Cleanvater 125096 PINELLAS FLORIDA
64.MAP AND PANEL 67.FIRM PANEL 89.BASE FLOOD ELEVATION(S)
NUMBER 65.SUFFIX B6.FIRM INDEX DATE EFFECTIVEhZEVISED DATE 68.FLOOD ZONE(S) (Zone A0,use depth of floodirg)
125096-0007 G SEPTEMBER 03,2003 SEPTEMBER 03,2003 AE EL11.0
B10.Indicaie the source of the Base Flood Elevation(BFE)data or base flood depth entered in 69.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Describe):
B11.indicate the elevation datum used for the BFE in B9:0 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 Designation Date_
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:❑Constructia�Drawings' ❑Building Under Construction' �Fnished Construdion
� 'A new Elevation Certificate will be required when construction of the building is complete.
2.Building Diagram Number 7 (Select the buifding diagram most similar to the building for which this certificate is being completed-see pages 6 and 7. If no diagram
aaxuately 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,ARIAH,AR/AO
Complete Items C3:a-i below acxording to the building di�ram 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 Secfion G,as appropnate,to document the datum conversion. �.A�,� ; ,
Datum NAVD 1988 Conversion/Comments NIA � �� ; }
t 4�.,
Eleva6on reference mark used NIA Does the elevation reference mark used appear on the FIRM? ❑Yes �No >: � x ��,,,� ���!'�Ay ��x
o a)Top of bottom floor(induding basement or endosure) 7.20 . FT ft.(m) � � .�,���+►� �.���`��` � ,��
o b)Top of next higher fioor i770 • FT ft•(m) � � •� ,�r*,•.��. �� `�'{� ��
o c)Bottom of lowest honzontal structural member(V zones only) NJA . FT ft.(m) o o `"'s ,�• ;� . E � '` �'���
o d)attached garage(top of block) 7.20 . F7 ft.(m) �� � ' + �1��', �' :�
o e)Lowest elevation of machinery and/or equipment �? � �!�'�- � `��,b � s�
servicing the building(Descnbe in a Comments area) N!A . FT ft.(m) � ,� � �y � N, {Y t,�,� :"
M` �k.. .�+d'SlA tf�:: a �
o fl Lowest adjacent(finished)grade(LAG) _5.0 . FT ft.(m) z'N f .► +A' � y.
o g)Highest adjacent(finished)grade(HAG) 5.1 . FT ft.(m) � '�¢f,�f�6/�04�.'�,t��
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 and sealed by a land surveyor,engineer,or architect authorized by law to ce�tify elevation information.
I certify that the information in Sections A,8,and C on this certificate represents my best effoRs to interpret the data available.
I understand thaf any false statement may 6e 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
• 06/16/04 (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. Fa tnsurance Company use: ' , '
BUILDING STREET ADDRESS(Induding Apt,Uni�Sufle,and/or Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number •
BAYWAY BOULEVARD
��TY STATE ZIP CODE Company NAIC h'umber ' �
CLEARWATER FLORIDA 33767 �
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community offiaal,(2)insurance agent/company,and(3)building owner. •
COMMENTS
NIA
❑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),compiete Items E1 through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F,
Section C musi 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 boriom floor(induding basement or enclosure)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�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 pla�orm of machinery andlor equipment serviang the building is _ft.(m)_in,(cm)�above or ❑below(check one)the higtiest adjacent grade. (Use
naturai grade,if available).
E5.For Zone AO oniy: If no flood depth number is available,is the top of the bottom floor elevated in acxordance with the communi�'s floodplain management ordinance?
❑Yes ❑No ❑Unknown. The local offiaai must certify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owners authorized representa6ve who completes Sections A,B,C(Items 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,8,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 local officiai who is authcsnzetl�y law or ordinance to administer the communitys floodpkaEn management ordinance can complete Sections A,B,C(or E),antl G of this Elevation
Certificate. Complete th�applicable item(s)and sign below.
G1.�The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor,engineer,or architect who is authonzed by state
or loca(law,�certify eievation information. (Indicate the source and date of the elevation data in the Comments area betow.)
G2.�A community officai completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0.
G3.�The following informaiion(items G4-G9)is provided for communiry floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6.DATE CERTIFICATE OF COMPLIANCElOCCUPANCY 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: _._ft.(m) Datum:_
LOCAL OFFtCIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE •
COMMENTS
❑Check here if attachments
FEMA Form 81-31,January 2003 Replaces all previous editions
' . ��� _ d�y, �Y FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
NATIONAL FLOOD INSURANCE PROGRAM
Expires December 31, 2005
� '. '• ELEVATION CERT{FICATE
� Important: Read the instructions on pages 1-7.
SECTION A-PROPERTY OWNER INFORMATION ForinsuranoeCompanyUse:
BUILDING OWNER'S NAME Policy Number`
BAYWAY TOWNHOMES, LLC � (p
BUILDING STREET ADDRESS(Including Apt:,Unit,Suite,and/or Bldg.No.)OR P.O:ROUTE AND BOX NO. Company NAIC Number
BAYWAY BOULEVARD �/�, '�„d
C�N 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-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 CON�AUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME 63.STATE
City of Clearwater 125096 PINELLAS FLORIDA '
B4.MAP AND PANEL 67.FIRM PANEL 89.BASE FLOOD ELEVATION(S)
NUMBER 65.SUFFIX . B6.FIRM INDEX DATE EFFECTIVEIREVISED DATE B8.FLOOD ZONE(S) (Zone AQ,use depih of flooding)
125096-0007 D AUGUST 19,1991 AUGUST 19,1991 AE EL.11.0
B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in 69.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Describe):_
611.Indicate the elevation datum used for the BFE in B9:❑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.Buiiding elevations are based on;�Construc�ion Drawings' �Building Under Construction` ❑Fnished Construction
'A new Elevation Cer'�ficate will be required when constn�ction of the building is complete.
C2.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
accurately represents the buiiding,provide a sketch or photograph.)
C3.Elevations—Zones A1 A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AWAE,ARIA1-A30,AR/AH,AWAO
Complete Items C3:a-i below according to the building diagram specfied in Item C2.State the datum used.If the datum is tlifferent ftom 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 NAVD 1988 ConversionlComments N/A �`'"�"'`'}�� +
.�
Elevation reference maric used N/A Does the elevation reference mark used appearon the FIRM? ❑Yes �No . '�� t : � rt }"��
o a)Top of bottom floor(induding basement or endosure) 1770 . FT ft.(m) � 4-`'�,,t �,• '',*;�*;�. '�,`���} r.
o b)Top of next higher floor N/A . FT ft.(m) � �� � �' ` � ' '�.,� �,
o c)Bottom of lowest horizontal structural member(V zones only) NIA . FT ft.(m) o o, ��:�t ro� ��;� ' �
o d)attached garage(top of block) 720 . FT ft.(m) �� � ;�,� r°' �
w �o � , . �.
o e)Lowes t e l ev a ti o n o f m a c h i n e ry a n d/o r e q u i p m e n t -,; -� ;�� . s� „' ` ;
servicing the buil�ng(Describe in a Comments area) NIA . FT fl.(m) �� ' .*';il ���` � `r �,
o fl Lowest adjacent(finished)grade(LAG) 5.0 . FT ft.(m) z� �'��� " �,��
o g)Highest adjacent(finished)grade(HAG) 5.1 . FT ft.(m) � ;.+,�!�'3 �'p�{9�Q��'.�a
o h)No.of permanent openings(floal vents)within 1 ft.above adjacent grade N/A � �;�!�� '� ��G' a
o i)Totai area of all permanent openings(flood vents)in C3.h N/A sq.in. �`w•:'i�`4.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.
1 certify that the information in Sections A,B,and C on this certificafe tepresents my best efforfs to inferpref the dafa available.
I understand that any false sfafement may be punishabfe 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 14EIN&STAUB SURVEYING,INC.
ADDRESS CITY STATE ZIP CODE
8016 Old Counry Road 54 New Port Richey FL 34653
SIGNATURE DATE TELEPHONE
02/16/04 (727)834�140
FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces all previous editions
IMPORTANT: In fhese spaces,copy the corresponding information from Section A. Fo��nsurance company use: '
BUILDING STREET ADDRESS(Indudirg Apt,Unrt,Suite,and/or 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 Elevatio�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. It the Elevation Cer6ficate is intended for use as supporting infortnation 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 this certificate is being completed—see pages 6 and 7. if no diagram aocurately
represents the buiiding,provide a sketch or photograph.)
E2.The top of the bottom floor(induding basement or endosure)of the building is _ft.(m)_in.(cm)❑above or ❑bel�v(chedc one)the highest adjacent grade. (Use
natural grade,'rf available).
E3.For Building Diagrams 6-8 with ooenings(see page�,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 and/or equipment senriang 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 accordance with the communit�s floodplain management ordinance?
❑Yes ❑No ❑Unknown. The locai officiai must cerfify this informafion in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner a owners authorized representative who compietes Sections A,B,C(Items 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 sfatements in Sedions A,8,C,and E are correct fo the besf of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATNE'S NAME
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
❑Check here if attachments
SECTION G•COMMUNITY INFORMATION(OPTIONAL)
The local aftia�wha is authonzed'.,�y law or ordinance to administer the community's floodpl�n management ordinance can complete Sections A,B,C(or E),and G of this Eleva6on
Certificate: CompletP the an�licabie irem{s)and sign below.
G1.0 The informbtion in�Section C was tak�n from other documentation that has been signed and embossed by a licensed surveyor,engineer,or architect who is authorized by state
or�cal law to ce�±sfy elevation i�formation. (indicate the souroe and date of the elevation data in the Comments area below.)
�2.�A community offiaal cxlmpleted.Sedion E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0.
G3.❑The fdlow;ng'informa�on(Items G4-G9)is provided fa community floodpiain management purposes.
G4.PERMIT NUMBER G5. DATE PERMff ISSUED G6. DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY�SSUED
G7.This permit has been issued for.�New Construcfion ❑Substantial Improvement �
G8.Elevation of as-built lowest floor(induding basement)of the buildng is: _._ft.(m) Datum:_
G9.BFE or(in Zone AO)depth ofi 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
•
. �c 1►'pi►�,
.
�,ru. � CITY OF CLEARWATER
� � ,�I�, �
� � Q DEVELOPMENT & NEIGHBORHOGD SERVICES DEPARTMENT
` POST OFFICE BOX 474H� CLEARWATER� FLO�Dn 33758-4748
9'A�fi%4T E �Cv
MUNICIPAL$ERVICES BUILDING, 100 Sov'rt-t Mnt'n.�AvEtvtJE,CLEARWATER,FLOx�Dn 33756
TE�PxorrE(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 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 complete and correct
_X_Minor corrections have been made in the below marked sections by Community Official
SECTION A-PROPERTY INFORMATION `For I�surance Company Use;
A1. BUILDING OWNER'S NAME Policy Number '
A2.BUILDING STREET ADDRESS(including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. CompBny NAIC Number
656 BAYWAY BOULEVARD-UNIT 6
CITY STATE ZIP CODE
A3. PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legai 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 63.STATE
64.MAP AND PANEL B7.FIRM PANEL 69.BASE FLOOD ELEVATION(S)
NUMBER g5.SUFFIX B6.FIRM INDEX DATE EFFECTIVE/REVISED DATE B8•FLOOD ZONE(S) �Zone AO,use depth of flooding)
12103C-0104
610. Indicate the source of the Base Fiood Elevation(BFE)data or base flood depth entered in Item 69.
❑ FIS Profile ❑FIRM ❑Community DeteRnined ❑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 Construction' ❑Finished Construction
'A new Elevation Certificate wili be required when construction of the building is complete.
C2. Building Diagram Number (Select the building diagram most similar to the buiiding 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,W-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:
�evation certificates shaR 6e aintained b he community and copies with the aftached memo made available by request
F�urrx H�nanen,MAYOR
GEORGE N.CRE'1'EKOS,COUNCILMEMBER JOIIN DOReW,COUNCILMEMBER
Pnu�F.G��ssoN,COUNCILMEMAER � CARLEN A.PEl'ERSEN,COUNCIIMEMBER
��EQUAL EMPLOYMENT AND AFFIItMATIVE ACTIUN EMPLOYER��
. ,
• ���, �'��� CITY OF CLEARWATER
� � , , �
r �. p DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
9/9 � `� POST OFFICE BOX 4740� CLEARWATER� FLO�Dn 33758-4748
�'qTE �� MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CLEARWATER,FLO�unn 33756
TELEPHONE Cl2� 5�2-45�7 Fnx(72�562-4576
MEMO OF REVIEW FOR CORRECTNESS 8 COMPLETION
In accordance with participation in the NFIP/CRS program,ail elevation certificates are required to be reviewed for corredness and completion prior to
acceptance by the community. This complete form shali 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
X 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(including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Gomp�ny NAIC Number
656 BAYWAY BOULEVARD-UNIT 6 '
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 ##.##il##°) ❑ NAD 1927 ❑ NAD 1983 ❑USGS Quad Map Q Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME B3.STATE
64.MAP AND PANEL g5.SUFFIX B6.FIRM INDEX DATE B�•FIRM PANEL 68.FLOOD ZONE(S) g9.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)
811. 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 Othenvise 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 accurately 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/AO.
Complete Items C3.-a-i below according to the building diagram specifled in Item C2.State the datum used.If the datum is different from the datum used for the
BFE in Section B,conveR 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) -
Comments: -
Oate of Review: Community Official:
!i'vation certificates shall be maintaine y the co unity and copies with the attached memo made available by request
FwwK H�sRnxn,MAYOR
GEORGE N.CRE1'EKOS,COUNCILMEMBER JOIIN DORAN,COUNCILMEMBER
PnuL F.G[nsoN,COUNCILMEMRER � CARIEN A.PE1'ERSEN,COUNCILMEMBER
��EQUAL EMYLOYMENT AND AFFIItMATNE ACT10N EMPLOYER��