656 BAYWAY BLVD UNIT 11 .. ._ . . .. . . . .. . . . . y �..
� � ' FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No:�3067-0077
, ���—d.�y �q NATIONAL FLOOD INSURANCE PROGRAM Expires De�ember 31, 2005
'"l
• ' ELEVATION CERTIFICATE
• Important: Read the instructions on pages 1-7.
SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use;
BUILDING OWNER'S NAME Policy Number '
BAYWAY TOWNHOMES,LLC V N�T I�
BUILDING STREET ADDRESS(Induding Apt.,Unit,Suite,andlor Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
BAYWAY BOULEVARD (o S � .� `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,if necessary.)
RESIDENTIAL �
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):
( #�#°-##'-##.##" or ##.##fl##°) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME B3.STATE
City of Clea►water 125096 PINELIAS FLORIDA
64.MAP AND PANEL B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX . 66.FIRM INDEX DATE EFFECTIVEIREVISED DATE 68.FLOOD ZONE(S) (Zone A0,use deplh of flood'mg)
125096-0007 D AUGUST 19,1991 AUGUST 19,1991 AE EL.11.0
B10.Indicate the source of the Base Flood Elevafion(BFE)data or base flood depth entered in B9.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Describe):_
611.Indicate the elevation datum used for the BFE in 69:❑NGVD 1929 �NAVD 1988 ❑Other(Describe);_
B12:Is the building located in a Coastal Bartier 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' ❑Fnished Constnx�ion
*A new Eleva6on Certificate 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 compieted-see pages 6 and 7. If no diagram
aocurately represeMs the buiiding,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,AR/A1-A30,AR/AH,AR/A0
Complete Items C3.-a-i below aocording to the building diagram specfied in Item C2.Staie 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 Commants area of
Section D or Section G,as appropriate,to document the datum conversion. ;�''' '��`' � Y�
Datum NAVD 1988 ConversionlComments NIA �••``"'��```��,y�
Elevation referenoe mark used N/A Does the elevation reference mark used appearon the FIRM? ❑Yes �No ' k �,�� .
o a)Top of bottan floor(induding basement or endosure) 17.70 . FT ft.(m) � ;' "L��`�,•'"`�,,�;''•�s��'.� .,
o b)Top of next higherfloor N/A . FT ft.(Rl) �% �'f• �ttr� �,� ';
o c)Bottom of lowest haizontal structural member(V zones only) N/A . FT ft.(m) �� :�v� ,� D "° �• _.! ;
o d)attached garage(top of block) 720 . FT ft.(m) ��g� `��;; � �� �; p ` .
o e)Lowest elevation of machinery andlor equipment ,`�,� ;�;,, �: � � �:�_''
servicing the building(De§cribe in a Comments area) N/A . FT ft.(m) �' ='r��' s N +�`�':� ,•"
o fl Lawest adjacent(finished)grade(LAG) 5.0 . FT ft.(m) z'� .• '� -
o g)Highest adjacent(finished)grade(HAG) 5.1 . FT ft.(m) �`�'�'f 4�,''����. ".
I `��]'•r
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade N/A � ° , ���
o i)Totai area of all permanent openings(flood vents)in C3.h N/A 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.
1 cerfify that fhe information in Sections A,8,and C on this certi�cafe�epresents my best efforts to interpret the data available.
1 understand that any false statement may be punisha6le by fine or imprisonment under 18 U.S. Code,Section 1 DOI.
CERTIFIER'S NAME LICENSE NUMBER ' '
BRUCE A.KLEIN PLS 5052
TITLE COMPANY NAME
PRESIDENT KLEIN&STAUB SURVEYING,INC.
ADDRESS CITY STATE ZIP CODE
8016 Oid County Road 54 New Port Richey FL 34653
SIGNATURE DATE TELEPHONE
. 02/16/04 (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�n�ura�ce com�any use; � �
BUILDING STREET ADDRESS(Induding Apt,Unit,Suite,andlor Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number
BAYWAY BOULEVARD
�� STATE ZIP CODE Company NAIC Number
CLEARWATER FLORIDA 33767
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation CeRificate for(1)community offiaal,(2)insurance agent/company,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 Cerfificate is intended for use as suppoRing information for a LOMA or LOMR-F,
Section C must be compieted.
E1.Building Diagram Number_(Select the building diagram most similar to the building for which this certifirate is being completed—see pages 6 and 7. If no diagram accuratefy
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)�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(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 plaiform of machinery and/or equipment serviang the buiiding is _ft.(m)_in.(cm)�above or ❑below(chedc one)the highest adjacent grade. (Use
natural grade,if availabie).
E5.For Zone AO oniy: If no flood depth number is availabie,is the top of the bottom floor elevated in�cordance with the communit�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 property owner or owners authonzed 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 BF�or Zone AO must sign here. The s�atements 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
4��
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The local o��cal�ho is authonzeti by law or or��rance to administer the community's floodplain management ordinance can complete Sections A,B,C.(or E),and G of this Elevation
Certificate Complete the�plic:,,Ne item(s)and sigi�below.
G1.❑Tha information in Section C was ialcen Trom other documentation that has been signed and embossed by a licensed surveyor,engineer,or architect who is authorized by state
or local I-�w#o ce:�tify ei�aation inform�.ti�n. (Indicate the source and date of the eleva6on data in the Comments area below.)
G2.0 A community offiaal compt��i Sec�icn F for a building located in Zone A(without a,FEMA-issued or community-issued BFE)or Zone A0.
G3.�The following ir,iur^?ation(ItemS�4-G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMff ISSUED G6.DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED
G7.This permit has been issued for:❑New ConsUudion ❑Substantial Improvement.
G8.Elevafion of as-built lowest 800r(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 OFFICIAI'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
❑Check here if attachments
FEMA Form 81-31,January 2003 Replaces all previous editions
e
�$�a���� C ITY OF C LEARWATER
� � ,�I�, �
r � p DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
9� � `` POST OFFICE BOX 474H� CLEARWATER� FLO�DA 33758-4748
�,�E ��
M U N I C I P A L S E R V I C E S B U I L D I N G, l O O S O U T H M Y R T L E A V E N U E,C L E A R W A T E R,F i o�uDn 3 37 56
TE�PxoNE(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 ail 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 e�evation certificate is complete and correct
X Minor corrections have been made in the tielow 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. Company NAIGNumber
CITY STATE ZIP CODE
A3. PROPERTY DESCRIPTION(Lot and Blodc Numbers,Tax Parcel Number,Legal Description,etc.)
A4. BUILDING USE(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)
A5. LATITUDE/LONGITUDE(OPTIONAL): HORIZONTAI DATUM: SOURCE:❑GPS(Type):
��°_��_�.�^ or �.�°) ❑NAD 1927 ❑ NAD 1983 ❑USGS Quad Map❑Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
1.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME 63.STATE
B4.MAP AND PANEL g5.SUFFIX B6.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)
B11. Indicate elevation datum used for BFE in 89:❑ 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 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,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
�/evation certiffcates shall 6e mai tained by t community and copies with the attached memo made available by request
Fenrrx Hissnw�,MAYOR
GEORGE N.CRE'I'EKOS,COUNCILMEMBER JOIIN DORAN,COUNCILMEMBER
PAUL F.GIBSON,COUNCILMEMBER � CARLEN A.PE1'ERSEN,COUNCIIMEMBER
��EQUAL EMPLUYMENT AND AFFIItMATNE ACTION EMPLOYER��
' � FEDERAL EMERGENCY MANAGEMENT AGENCY
� NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077
! • Expires December 31, 2005
'• - � ELEVATION CERTIFICATE
.��3..- �tV 8`� Important: Read the instructions on pages 1•7.
SECTION A•PROPERTY OWNER INFORMATION For Insurance Comparry Use:
BUILDING OWNER'S NAME Policy Number
BAYWAY TOWNHOMES, LLC U�� �"� � �
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,andlor Bidg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
� BAYWAY BOULEVARD
CITY STATE ZIP CODE
CLEARWATER FLORIDA 33767
PROPERTY DESCRIPTION(Lot and Blodc Numbers,Tax Parcel Number,Legal Description,etc.)
Lots 1�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,if nece.ssary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):
( �1#°-##'-##.##" or ##.�#°) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME B3.STATE
City of Clearwater 125096 PINELLAS FLORIDA
64.MAP AND PANEL 67.FIRM PANEL 89.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVE/REVISED DATE 68.FLOOD ZONE(S) (Zone A0,use depth of flooding)
125096-0007 G SEPTEMBER 03,20(13 SEPTEMBER 03,2003 AE EL 11.0
B10.Indicate the source of the Base Flood Eleva6on(BFE)data or base flood depth entered in B9.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Describe):
611.Indicate the elevation datum used for the BFE in B9;Q NGVD 1929 �NAVD 1988 ❑Other(Describe):
B12.Is the building located in a Coastal Barrier Resources System(CBRS)area a 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 Eleva6on Cerfificate will be required when�struction of the building is complete.
'2.Buiiding 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 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,AR/A1-A30,ARIAH,ARIAO
Canplete 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
Sedion B,convert the datum to that used for the BFE.Show fieid measurements and datum conversion calculation. Use the space provided a the Comments area of
Section D or Section G,as appropriate,to document the datum c�nversion.
C�atum NAVD 1988 Conversion/Comments N/A s�,�� ;:��R�b:
Elevation reference mark used N/A Does the elevation reference mark used appear on the FIRM? ❑Yes �No 3 ;>r
t ��,,,�.n -:�
o a)Top of bottom floor(induding basement or endosure) 720 . FT ft.(m) � 1�a�.��.,�'��»����'������
o b)Top of next higher floor 17.70 . FT ft.(m) �' 'V .` °�'" �' �' � �`�,� � .'•
o c)Bottom of lowest honzontal structural member(V zones only) 'N/A . FT ft.(m) N °' ' �� � '�"''`
o d)attached garage(top of block) 7.20 . Ff ft.(m) ����`a�,; '�'r��'" •,�� �',"
1 , �.. ^ r.ar
o e)Lowest eleva6on of machinery and/or equipment �;` y �`���,aq ;.�� .�'
serviang the building(Descxibe in a Comments area) N/A . FT ft.(m) � ' �' ` � � � �" �'.�:�
o �Lowest adjacent(finished)grade(lAG) 5.0 . FT ft.(m) �� '� r': ��$ �;�'`°r��jk^�'�
o g)Highest adjacent(finished)grade(HAG) 5.1 , . FT ft.(m) � r= �. � ,»y �''
� ���[1���!:" , .
o h)No.af 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. t,, n�;�,,,
��1, . _
SECTION D•SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land suroeyor,engineer,or architect authorized by law to certify elevation information.
1 certify fhaf the information in Sections A,B,and C on this certifiicafe represents my best efforts to interpret the data availa6le.
1 understand that any false statement may be punishable by fine or imprisonment under 18 U,S. Code,Secfion 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 ad 54 New PoR Richey FL 34653
SIGNATURE DATE TELEPHONE
• 06/16/04 (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. �
BUILDING STREET ADDRESS(Induding Apt,Uni�Suite,and/or BkJg.No.)OR P.O.ROUTE AND BOX N0. For Insurance Company Use: •
BAYWAY BOULEVARD Policy Number .
CITY . • •
CLEARWATER STATE ZIP CODE
FLORIDA ��s� ��Pa�Y NAIC Number. • ,
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) � •
Copy both sides of this Elevation Cer6ficate for(1)community offiaal,(2)insurance agent/company,and(3)building owner.
COMMENTS
N/A •
SECTION E•BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE�ITHOUTrBFE)��ments
For Zone AO and Zone A(without BFE),complete Items E1 through E4. If the Elevation CeRificate is intended for use as supporting informa6on 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 c�mpleted–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 enclosure)of the building is _fl.(m)_in.(cm)�]above or ❑below(chedc 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(eleva6on 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 platfortn of machinery and/or equipment servicing the building is _ft.(m)_in.(cm)�above or ❑below(chedc one)the higliest 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 local offiaal 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(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 Secfrons A,8,C,and E are coriect 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
SECTION G-COMMUNITY INFORMATION(OPTIONAL) �Check here if attachments
The local official whoj.s authonzEClby IaVi or ordinance to administer the community's floodplain management ordinance can complete Se,.^tions A,B,C(or E),and G of this ElevaUon
Certificate. fi,bmpiete-the appiicableitzm(s)and sign below.
G1.(]The informa�on in 5e�tion C was taken from other documentation that has been signed and embossed by a licensed surveyor,engineer,or archflect who is authorized by state
or local law to cerfrfy elevatipn information. (Indicate the source and date of the elevation data in the Comments area below.)
G2.�A community offiaal cortip'�zted S�ion E fw a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0.
G3.�The following information(Iter�s�4-G9)is provided fa community floodplain management purposes.
G4.PERMIT NUMB[Fs 1 G5. DATE PERMIT ISSUED
G6.DATE CERTIFICATE OF COMPLIANCElOCCUPANCY ISSUED
G7.This permit has been issued for:0 New Construction ❑Substantial Improvement
G8.Eleva6on of as-built lowest floor(induding basement)of the building is:
G9.BFE or(in Zone AO)depth of flooding at the building siie is: —'—ft'�m� Datum:_
__ft.(m) Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE �
COMMENTS
FEMA Form 81-31,January 2003 ❑Check here if attachments
� Replaces all previous editions
•,�. .
�������. CITY OF CLEARWATER
. � ,�I�, �
r �.. p DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
9,Q � � PosT O��cE Box 4748� CLEARWATER� FLO�uDn 33758-4748
"'/QTE � MUNICIPAL SERVICES BUILDING, lOO SOUTH MYRTLE AVENUE,CLEARWATER,Fco�uDn 33756
TELEPHONE�Z� 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
X Minor corrections have been made in the below marked sections by Community Official
SECTION A-PROPERTY INFORMATION For Insarance 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. 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:0 GPS(Type):
(##°-##'-##.##" or ##.##i!##°) ❑NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map�Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
1.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME 63.STATE
B4.MAP AND PANEL 67.FIRM PANEL 69.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX 66.FIRM INDEX DATE EFFECTIVE/REVISED DATE B8•FLOOD ZONE(S) �Zone A0,use depth of flooding)
12103C-0104
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 89.
❑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 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,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(fl od vents)in C3.h sq.in.(sq.cm)
Comments: . �'
Date of Review: Community OfficiaL
��evation certi6cafes shall be aintained b the crorronunity and copies with fhe attached memo made available by requesf
Fwvvx H��snw�,MAYOR
GEORGE N.CREI'EKOS,COUNCILMEMAER JOIIN DORAN,COUNCILMEMBER
Pnu�F.G�xsoN,COUNCILMEMAER � Cax►.EN A.Pe��RSetv,COUNCILMEMBER
��EQUAL EMPLUYMENT AND AFF11tMAT[VE ACTIUN EMPLUYER��
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�� ��c�� CITY OF CLEARWATER
• � ,�l i, �
r�- -�. p DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
9� � � POST OFFICE BOX 474H� CLFARWATER� FLO�Dn 33758-4748
�I�E MUN[CIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CLEARWATER,FLO�uDn 33756
TELEPHONE�72� 5�2-45�7 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 O�cial
SECTION A-PROPERTY INFORMATION For Insurance Company Use:
A1. BUILDING OWNER'S NAME Policy Number
A2.BUILDING STREET ADDRESS(including 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
1.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME B3.STATE
B4.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)
B11. 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 Othervvise 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,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 FIRM7 ❑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 pertnanent openings(flood vents)in C3.h sq.in.(sq.cm)
Comments: . -
Date of Review: Community Official:
�levation certificafes shal/be maintained by the community and copies with the attached memo made available by request
Fw�vx HtssnRn,MAYOR
GEORGE N.CRE'1'EKOS,COUNCILMEMBER JO[IN DORAN,COUNCILMEMBER
PnuL F.G►»soN,CO(JNCILMEMAER � Cn�u.etv A.PE�'e�ts�,COUNCILMEMBER
��EQUAL EMPLOYMENT AND AFFIItMATIVE ACTION EMPLOYER��