692 BAYWAY BLVD _ T _
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QEVi sidw► �iuw� /�"//.,OY
�TE: . Ec.Cc. FEDERAL ENIEROENCY MANA4EMENT AGENCY O.M.B.No.3067-0077
�u►�no�uu.�000 ursuwwce�ovt�
�+�sEd � t, �-vs � �' EL�/ATION CERTIFICATE �����3����` ' �'�
�!!L Vc�'y ndA! rw�►p �. . ..
� • ' �' ctio�s o� � .T. �. . , ,. � : � ,
Bu�lDINO N� itCT10N A•MtOplR7y pyyNER INfORMATION Fa knixanc� • .,
e�aa c •• EvE[.o r . . �r�u..:
sTREET�i►ooREgg(M+dudMp Apt,�tJnit,Sul�,��
p .81dp,No.)OR P.O.ROUT€,M1D BOX NO.�r� •�.x��
Cl�'Y �a - ' � � : 't r� ► •` ` � . ' 'y y �
rL. (�� . _ ., . � .. : ,. �, . °8'194TE`' � ` ` ZIP CppE ',' ' 1 y �
� � � d�l./ , , . : ;, .� �,' v ,+ � �
�:�Ne.)
N'4'. ' a � `�
u � E HL. .��O�Y,NC. Ut�a �N�w�q ahi, ) t'
( ���M'�N'�N'�°r'�,�'1 �„��NAO tOQ7 ' • ' �i
�...I NAD 1�83 �� U�$(TYP�� �
� . u usos a,.�a�, u ou� ;
s�cT�oa s..F�oou wsuwwoe w►n�uw � ���aa�
B������„r� ' .f�.
C�T NAIiAE B3.8TATE
8�.MAPMIDPAI�� � '
� O . QATE ' EFFECTIVE/R@NI8E0 OiAT6 89.BASE Fl EI.EVA SI
-p �(8) (Zorw,�o,uW d�pti�.o�poodtrg� `
81�.��1diCAt�iM l01Mi00 0I MN�N��OOd � •• _(, ,��
�1AdOfl(���ddi af�iN�ppd�
I_J FIS P�i�ls (�� � U���rfk�ed dePth atterod k189.
81 t.lndk�te IM���!d for tIw.BFE b 8p: �"'����°�'
s�s. a a�e�rw�ad h a co,sia U Novc�e� �,�►w� U ou��(�e>:
osslpn�tlon Oaa: ����ounoes Systsm(CgRg)aroa or Oths�Protected Area(OPA)� L,J Yes
IXJ No
� �W elsvatlon�an bss��������EVw7YON INFORMATIpH,1g�RVEY REGUIRE�)
�...duildkp pypq��Mt� �������Ot ths bUNdk�p k��ua��• �IFinlshed Constniction
PsOes 8 and 7. Uao -�..�SN�t MM buqdN�p diip�n most�!o ths �
b�udinp.tor wfdcn this oertincak.�Is bein�comp�eted•see
q.ENva�ons-Z�ones A1,A9p ���b t��p�P�'0vide a sk�tch or phofopraph,�
-- Compl�te 1�p.N b�l o w a000nd�p b����VE.W-V30�V(wifh 6FE).AR.ARl A,1 1 R//1 E,A R/A1,A30,AWAH,AR/AO
�O �. � „8�cfloe B�conwr�p�W��sd M Uem C2.Stafs the datum used.Ii the datum is dtterent trom
datum b that used tor ths BFE.Show fleld msasuremenfs and datum oonVersion
/� 22 M����na ai 8�ction D or 8ectbn a��s��,b da�ment ths da
�'`'�"'"'--- tu�n cbnversbn.
O a T a uad S�'I ��w:.��_-- pos�ths Nsvadon►�t�n
v bj�a���b••��a«�c�o.w�.�v�e�s a;. .� � :��ePP�on ths FIRAA� U Yes ��
O c)BWbm o11ow��t ho�iaonf�� � ' R��m� � �'^�.. /2•
O s�����°�q�p� � n�tibsr(V zflnes onlY) _��_��^n,�m� �`y93��
�L.011M�it N♦v��p(�afldlOf�n� �w�:ft•�rt►� y
�1M�(�ab�b a '�
v ��°"►at sd�o�nt t�tt�d)prad� t�0�"a ana.) F�,ecTa.�c �� .59��m�
0 0)�ac�sqnt(�Md)qr�(HAG� • • ��,�R,�m� �
0 �
h)No.ol�pennaneM op�IAood wnb)within 11t.aboye �'�-'��'�m�� �
O ()Total sros ot all pwnw�u pp��(lbod ven4)In p.h ��nt�--�"'-
--�SL s4•In.(�q,cm)
.. .
��n�,uon a m ee sq�,.d,,,�,,,����OR.��tt,oa wtc�cir c�a��car�oN
��Y diaf tl��y� bY a Itnd sury�ror����a��,by law to ce�ti olevatbn
�b � ����nd C on����fa my b�tt Nbr��b!nt � �onnation.
� �+it�s b� �a srpret the data ava!!eble.
.. mMt UAder 1B U.N������.
. .'t,°.< �
. � /
�nu► ° r s '
E Z� � _
� CA E ' 7
'�1A'Fam 81�31�Jaiw�rY Z003 ... p • C P►+ N
. . . . .. � g�i nv��ski� - -
' RePlaces�U Provbus sdijio�s
.
�f7;'�..�.-.7 r-._ . , �
._._ .t--_.-,-....._-_.,......-.-... . .. . . . .... ;�.,'fr.'�- .,:., . . . .
_�',�� i-�r- or
�v;s;dN ���- �o-//-oy
�TE: . EcCc. ' FEDERI4L.EMERGEN�Y W1�tNAQEMENT ACENCY
• NATWNA4 F1.000 IN$URANCE PROQR/tM O.M.B. No.3067-007T.
REV�s�d . t- 4-os � ��� ELEVATION CERTtFICATE . E"pire�oece�n,��3�``'�oo� _ , ..:
c rFY� Add n�sp ?� .�, . � •
. .. . � �,,,:. ,. . : .. .
� � t. R ctlons pn. +� �s 1 -7.
iECZ1ONJh•.p ._
Bu1WINC3 OMINER'S NMAE ' OWNER IN��IRIYIATION Fa Inwranc�Companv Us�:
N D CE'. �V ELd P/�'I�'�I T . • Policy Numbsr
BUILDING STREET ADDREgg(Incwdyq/1q,.l�q.8uit�.sndfor .
q Bldp,No;)OR P.O.ROUT{�M1D BOX NQ:�• .�.. �,, �
,,.::, c «t�,° � P�Y' Number
CITY i4� Yt,,, ,�. F.. . � .t. � .,, o :,,. .`• �$'T�ikl'Ea ° " ' ZIP CODE � • ..
RR Rl'Y DESCRIPTIpPI(Lot and Block d►?.I , .,'_e:,:a ;± ` `,;' � ,,_,
Numb«s.T�t ParcM N�u�b�NF�p�{. :�tc.) .
suu.ou�usE t..a.R..w.�ww,r�-�..,d,�w,�,,w�no�,, ' a '
�D� . A�. ' . . �orY�Nc. w�s ca�Nn.ras area,:�; ' ,�
t� . .
c �ar wr a wr or �.warwr� . L„�wro��r U w�n i� 30URCE: u c�s R�!p•):
' U usc3s cwo� U ome�
. . .
�CTbN B-.FLOOD INStJRAMCE RqTE'MAP(FIRM)INFC)RMATION
et.NFiP COAAAAtM►tiY NAME 3 B2.COUM'TY NAME
�l�' �' 1.E � 83.STATE
,
B4.AAAP MID PANEL B5.$UFFIX �,p � �
NUMBER . B7.FIRM+1> EL 88.FL D 89.BASE FIOOD ELEVA pN(gj
. QATE ' EFFECTII�E/REVISED W1TE 2�(S) (Zons AO.us�d�ptA.ot
t3 C,.A 0� � - -� ..03 uss floau�)
e�0.lndlcats ths soures oi ths Baq Flood Elsvafbn(BFE}dsts or bass flooct�depth snterod in B9. �
LJ FIS PtnlUs (�FIRM . Lj C;pnunuNty DetertNned ,
811.t�dicate ths elsvetlon datum use,d tor tha BFE;In�8�: LI Other(Descxibe);
812.Is the bui U'NCiVO 1929 Q�NqVD 198� U Other(Describe):
����^°CO°i��°�Resauces SYstem(CBRS)area w Otherwlse protected Area(OPA)� ��Yes
�esipnstian Osb: . I�J No
8ECTION C-B�lILpINO ELEVATION INFQRMATION�(8URYEY REQUIRED)
B���va����°�: U�����nfls� UBuildlnp Under ConstrucNon•
�_ `A new Elsvaqon C�tlpq������������e bulldlnp Is complete. �SlFinished Constn,cUon
���m��--�.�s��bu�dkp,diapram mcist simUar to the buAdinfl for which this certiticat�is being completed-see
pafles 8 and 7. If no d{a�ram a�y�y n��V�
C3.Elsvatlons-Zonss A1�1►30,AE.AFl.A(s�ith BFE), ��PfOVide a tketch or photopraph.)
Compkts Itsms C3.a-i bNow �E•�i-V3Ci,V(wlth BFE)�AR.AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO
�°datum used ta'the BFE h Sectlo�g ����q���torlthe FE.Show tield measurements nd�t��i�erent Irom
calculatlon. Uss fhs sP.ao�Provid�d or tM Corn�nsnts ac�sa of Ssctton,D or Sectlon c3 as a oonVersio�
Datum . �y�y�4 � , PProP�iate,to docurr�ent the datum conversion.
ElevaUon roferonce maric used S�'Y :�e�--��-- `
O a T of Dos�ths elevatlon retare
I op botiom poot(y�ck�din����a used appear on the.FIRM? U Yea No
O b)Top ot n�xt hipf�poor ��c�osure)YAQIliFS S. �� ;�m) ,,p� , (�S.I
O c)Bottom of bwsst horizontal o t R.(m) � e�o�.... �':'. .
� st�tu�al msmber(V zonea only) _��� s �Y9'�i�
0 d f►ltacfwd�a�sajp(toP ot tlab) . � ��,� ft.(m) �g , - ,
O e)Lowsit elsvatlon of rt1ac��insy sndlOr�q u i p m s�� -"---3=�=�—.-_,.:ft.(m) w�. '
����(�in s Comrtisnts area.) Ec,�cT►z.r c ►1 .58.h�m� .� - ``
0 ��owest sd��t i(�)�s(u►O) , t'�- � (m) � '
0 fl)�hsst sd )����G� R �� . �
Cl h)No:oGPennanent ope � .'i._h.(m). � ,,� '
o q 7otal area ot au �l��4)��1 ft'�OVe adJacentflrade�_ .
Permanent openkros(11ood venb)I�C3.h�,�_�,in.(sq.cm)
' SECTIpN p.�Ry����Q��R,OR ARC�{RECT CERTIFICATION � r
Thia ceNRcatlon 4 b be sipned snd sesl�d _
I csN/y d�at� ��'�wN4Y��en�nser,w architect euthpriz�'by law to certify elevatlon intom�ation.
!undeistarid �h��'8'�C���a reprossnts my best�//orts to Mteip�ef the data e veilabfe.
�► !alss staterns�t rtw b� b fPne or lm sonment under 18 U.S Code, Section 19Q1.
CERTIFIER'S NAAIE
�� , •' UCENSE NUMBER
;.'!� .x . COMP PIMAE � �
38
.:iNATURE � v � � ' GL • ST E 21P CODE -
DATE TELEPH NE 77
FEMA�Form 81-31�Janu!rY 2003 '" /0 y O - - O
. . .. • 8�i rswrs��Ide to�condnuatlon.
. Replaces all previous ediyons
��Cp��-(�_�4 2 � #
�.� - ,�y` :a�.`!;
IMPORTANT; �n th�s�ip���s,copy 1h�con��po�d�����formstlon trom S�ction A.
BUIIDING STREET AppFiES$�� For Irr.�rance Company Use: t
�p� p w rkludlnp Apl..UMt,Suil�,�nd/ot gldq,No.)OR P.O.ROUTE/1ND BOX NO. Policy Number .
CI-�_B Y . `
� • STA7E ZIP CODE Company NAIC Number +�
SECTION O-SURVEYOR�ENGINEER,OR ARCHIT'ECT�RTIFICATION CO
( NTINUE�)
Copy both aides ot this Elevation Cehf(IcA�e(pr�1�community ofticial,(3)insurance�agenUcompany,a�d(3}building owne'r.� ' '
COMMENTS' r ' ` -� ''
h • �'�"� ,�
M � � , ; � ' �
�� � - , . ,.
� L t �• w c d«► A rs.1� K,,,, ,, . ` ,
1� ..,., .. _ .. .y K � . _
• ' ' 1 . ,. + , . : : .: a� . .i' .
SEC710N�-�UILDING L VATION INFbRMAT1ON(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A
Check here if attact�meqis
For 2one AO and Zone q(wilhout BFE),comp�sta(tems'E1.throu9h E5. If the ElevaUon Certiflcate is intended for use as`suppo U 9BFE)
information Ior a LOMA or LOMR-F,Sectio�C muat be completed.
E 1. B u i l d i n g D i a g r am Nu m ber (Select the buiiding dlagram most simiiar to the building for which this certificate is being comp�eted-
see pages 6 a�d 7. It no diagram ac.curete�y ropresenta the building,provide a sketch or pho t o flrap h.)
E2.The to p of the b o t tom t l o o r pnGudinfl ba�sm����endoaure)of the bufldinp is (_�I ft. m
(check o�e)the hiflhest adjacent prade. (Use nalural prade,lf avaflable.) � ��--�—���'���LI above or�_�below_ .
E3. For Buildinp Diaprams 6-8 with openi�ys(aee�e T);the next hlaher floor or elevated iloqr�(elevatlon b)of Iha building is. t . '
I_I_j tt.+(m)1 I . lirt.(cm)above ths hl9hest adjacent prada. Complete Items C3.h and C3.i on iront of torm.
E4.7he top of the piatfom►of machinery and/or equfpment servicin�the building(a �_�_�ft., m �
(check one)tha.highest adjacent prade. (Use,natu�al grade,ij available.) � ��—�-1 in. (cm)�_�above or�_�below�
E5. For Zone AO oNy: If no flood depth�umbe�1$avallable,Is the top o(lha bottom floor elevated in accordance with the community's
(lood lain mana ement ordinance? Yes No Unknown. The local official must cerlif this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner w ow�e�'s autho�ized representative who completes Sections A,B,C(Items C3.h and C3.i only),and E for Zone A
(without a FEMp-Issued or communfty-issued BFE)or Zone AO must sign here. The statements in Sections A, B, C, and E are cor�ect to
the best o/m knowled e.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADORESS �
' ^ CITY STATE 7ip CODE
SIGNATURE . :•
DATE TELEPHONE
COMMENTS
SECTION G-COMMUNITY INFORMATION(OPTIONAL) Check here i(attachments
Th9 local oKcial who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
Sections q,8,C(or E),�nd G of this Elevatior►Certiryc�te. Cw�plete the applicabl.e(tem(s)and sign below.
G�• �—�me infamation in Section C was takan irom pther d�umentation tliat'tlas been algned and embossed by a licensed suNeyor,
engineer,or afcl�i�ect,who.is autho�lted by state or local law to certify elevation informaGon. (Indicate tha source and date of Ihe �
elevation data in the Comments arsa bebw j '
G2•►_I A community offcial completed Section E for.a building Ioc�atedLin ZoneA{�uvlthout a FEMA-issued or community-issued BFE)or
Zone AO. :. .. �
G3. (_�The following in(ormation(Items G4-G9)is provided for community floodplain management purposes.
G4,PERMIT NUMBER GS. pATE PERMI ISSUEp • `
T G6. DATE CERTIFICA7E OF COMPLIANCEIOCCUPANCY
G 7.T h i s permi t has been issued for: LJ New Constructlon ISSUE�
G8.Elevation o(as-built lowest floor(including basament)of the b Ilu d ng�3�n���mprovement
G9.BFE or(in Zona AO)depth�of flqpding at the building site is: _f��(m) Datum:
� _ft.(m) Oatum:
LOCAL OFFICIAL'S�E "°-"`'�"
TITLE �
coMMUNmr r�nME � ,
TELEPHONE�� �
SIGiVATURE
OATE �p �Arv o 4 �e��
COMMENTS
• � � �
. . _ T S�CS.
. . . �w,.�.�;
FEMA FOrm 81-31,Jarluary 2pQg Check here il aitactunerns
Replaces alt previous edilions
�$��1��� CITY OF CLEARWATER
• � ,�l i, �
� � p DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
9�Q�� _ � POST OFFICE BOX 474H� CLEARWATER� FLO�Dn 33758-4748
` ,qTE �� MUNICIPAL SERVICES BUILDING, 100 Sou1'x Mxx'rt.E AvErruE,CLEARWATER,FLO�uDn 33756
TE�rxorrE(72�562-4567 F.vc(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 compiete 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 sedion(s) prior to acceptance by the community
The attached elevation cert�cate is complete and correct �
X Minor corrections have been made in the below marked sections by Community Official
SECTION A-PROPERTY INFORMATION For Insurance Gompany Use:
A1. BUILDING OWNER'S NAME 'POlicy Numbs�
A2.BUILDING STREET ADDRESS(including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Gompany 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. I.ATITUDE/LONGITUDE(OPTIONAL): HORIZONTAL DATUM: SOURCE:❑GPS(Type):
�;y��_��_�,�^ 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
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)
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 ❑NAVq 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 RECtUIRED)
C1. Buiiding 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 NAVD 1988 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:
��levation ceRificates shal/be maintained bY the crommunity and copies with the attached memo made available by request
-
F[t�nrtK H[BSnRn,MAYOR
GEORGE N.CRE'1'EKOS,COUNCILMEMBER JOIIN DORAN,COUNCILMEMBER
PAUL F.GIBSON,COUNCILMEMAER � CARLF.N A.PE1'ERSEN,COUNCILMEMBER
��EQUAL EMPLOYMENT AND AFFIItMATNE ACTION EMPLOYER��
__ _ _ _ .
_ _ iQ,�� i-�r- os'
JZEVi sida . ,��r- /o'�/�aY
�r •..
NoTE: . Ec.Cc. FEDEi�AL EMEROENCY MANAQEMENT A(�ENCY
NU►r10NAL.'FLOOD INSURi4NCE I�ROaRAM O.M.B.No.3067-0077
Rev�sEd !- �t-vs ' -` ELEVATt4N CERTIFICATE . Expire$o�em�►.s��,.�oo; . �, ,.:.
: �
e�'Y Ad.d ►�►.A. �. . .
p Im t: �cf �� ctions, n. �s 1.7. . . .. .. Y _ .. ,
uCi14N A•;P :'Q1AfNER INR(�RYIATION ` Fu Inswanc�Company Us�:
BUILDIN�3 OyVNER�$NMAE
� L �V E[.d /�9�i✓T� , . PoUCy'Numb�r ;
BuiwiN�s��r�oowESS�ux�+drw�p,.u�,a;suia,andra � •
81dp.No.)OR PAt R0 D BOX NO;.� .�.:���
p . . � :,, ,;� � ,• � �r.;,�, ��., '.� ... ComPSf�t9' , , umber
ClT'Y ; ,, �� � . ..
, . ,
, ,
. . . � .� • .a`4 Y : . ,. '�.
� . � � �i`
� ,: . .. r� r , .? . .:� ,�,.,; ,�.. .:,.,n , •�.�c. .. " �`,:" " ` ZIP CO�E ` . , .: .
�Ldrt�✓bA w' t e ' .�' ,, .,
°�vr-arc�i YC3bFilf'Tla(�j(�,pl afld B�OCk�� aX Lp� .
�' �.�/
su c+.q.�R.aa.�w, ' a ' ' ' .
�QE �dd�o�Aop�noey,�tc. tJa sCa�N��'arp,l� .)
u , � .
( MA�'-NN'-NM.�M"at•If�� � IJ�NA01�27 �,,,�W1D 1983 30URCE: �,,.,J GP8(TYP��
' L.I U8(38;Cwd Map U Other
8ECTION�•„FLOOQ:W$I;I,�ICE RA7'�"MAR �IRM'INFqii1�AT10N \ ,
Bt.NFIP i
C T �E B�.STATE
,
B4.MI1P AND P , 85: FIX : , .87.FIRM P
NUAABER Q1►T� ' ERFECTIYE/R�NI8ED�DitTE 20NE 8 D . B9.BASE F1000 EI.EVA 10N(S)
�A � : Q � ) (Zon�AO.uss dsplh.ot Iloodirp)
" - -»43 , `. .
AM^. w
e�0.Indicau IM sounce ot ttw Bsa Flood Elevatbn Ek�dst�;or baae 11ood depth enterod in 89.
LJ FIS ProtNs - '�FIRM . �,,,J Conxrwnity OebnNned LJ Othsr(De;cribs); �
811.Indicate tM al�vatiun daWm w�d for fIN BFE kf 8�t L,J NG1/01929
812.Is the buUdkp Iocated in a Coa�t�1����s$ystsm(CBRS)a�rea or Othefwise rotected Area(OPA). I_j Yes
OssipnaticK►��tst , �J No
�
SECTION C-6UILDINt�EL@1/�TION INFORMATIOI�I�(SURWEY REGUIREO)
C1.Bulldinp sievati�oru aro based on: LJConstrucUon G �
������� �s i_IBulldlnp Undsr Construdfon• �Finished Constn,ctlort
�'�4�'�d when corntrucdon ot the buUdinfl li complete,
��Winp Draprsm Nuttlbsr�($����W��°most;imila�ta fhe buUdinq tor which this certiBcat�is bein com Isted-see
Pay�8 and 7. H no��y�Y nD�t�ttN bulidinp,provide:a skstch oc 9 p
C3.Elevations-Zones M,A30,I1E�AFI,A(wUh 8FE)�VE,V1=V30�V(with$FE).AR�AR/A,�AEh AR/A1-A30,AR/AH,AR/AO
CO�1°�°���'~b���b�bulldinp.dl�ptim apeciAed In Ibm C2:State the datum used.If lha datum Is different from
ths datum uasd tor Ihe BFE h Set:tlon B.oonwR tl�s datum b that used for ths BF�.ShQw:.fleld measurements and datum oonVersion :
cak�latbn. Uss tlts.sP,sarProvld�d or tM CortMlMnts lrreil ot 8ectioe;D ocSsction O, s a
�a1um ConvedloNCamwnti : $, PP�a�e�to document the datum conversio�.
O a �oi bottom Aoa wed3�'1 �e�-.�..•.• p0e,�the elsvatf6�n rofan
) � t .., used appesr on t�e FIRM? (.,_J Yes (�No '
0 b)toP a nexc t�n�r 0oo�p b�nwnt or�un)Y�t s. �o ,�m� ,
. n�"'� � e�e��:�.�� ' �
O c}Boitom ot k►w�st haimntd'sbuctural rt►anber(V zones only) _NI/� o �'Y4 f °:
O s�l,ow�W ��(toP of+lab) ° �''`u',� ,—.ft.�m� � . ,
) elwatlon ol m�ct�insry andlor�q�nt -"----�---•.-�'� ��
0 n�t���a�O C o m m s n b s ro a.) E L E t r ni c �...,•„_,ri.m • . , _�
0 0)Fi10!►est sclj�cent(Ifnished)�r�ad` HA 3 ' . . �-' .�tl.(m) ��
0 h)No:ot�Pennenent � � ,--�_•�R,(m) � �
O i)Total area of au �����a)��1 R.abovs adJacent flrade,�1 fQ,_
Penne�snt opsnHps(Aood vsnts)in C3.h���q.In.(sq,cm)
- .
.. 8ECTION 0•3UI�V�fOR,ENGINEER,OR ARCH
This csNNcatlon b b be R�GT G TlFICATION
siprwd snd sssi�d by a>land"su�Y+Ya�
�cs�W�►that th�Jnbrrn�yp�y� �M����°f��authorized`by law to certify elevatbn iMortnaUon.
���b �'+'8'�C°A�+��t�nprossnta my best enorts b inte�pret fhe data avalleble.
� �statsmsntm� b� byfb►e a&nOrlsonment under f8 U S Code,
secrron lapi
UCENSE NUMBER
TITl.E ."�' .;�. � � /
88 '
w► ae r s � L ' s e ziP C�oe _
TE l PH NE �
FEMA•Fom�81-31�Jarwh►Zpp;; � � y � - p
. . . .� ' .8�i nwrs�sids Ior contlnuaUon. Replaces all previoua edilions
�
�
�'�c��-03`��
_
. .�.'� �.,�..` �ar`!�
IMPORTANT: �n th�s�spscos�aopy tF��coans ndin (f1fO�matlOn ffOm S�CtIOn A. For Ir��rance Company Use: �
BUIIOING STREET AppREgg���������g ����B� No. OR P. .ROUTE MID BOX NO. Policy Numbec
.�s�e AyW , . �
GTY '
� , STAYE ZIP CO�E Company NAIC Number
SECTION D-SURVEYOR�ENaINEER.OR ARCNITECT ERTIFICATION(CONTINUED)
�MY��h sidss�of this Elevatlon Gro�te tor(1)communfy of(icial,(Y)insurance�agent/company,a�d(3j bulldiri'�owne'r. , ' rt ` '+.;
COMMENTS'
C3E1JG�YI�A� • n' ,j �_ •A,
.`i►.lr�� y.`i9 N flwlQtl� �c�,�..T�. M/��.�1� � '�fL p Gl� a�d�J � r yF� � + � ..
�vn 198A La cwtt r�• w • s
S TE��cT�e.� PAre,l�wwy �r,,. ,, , . .
�ta� BAY AY 13L✓ �,., �. •,.> ,. car„� rt�.'E't n.� � _
� , � �� � ; _:. �� . .; �
SECTION�E-�UILOING L VATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND 20NE A(WITHOUT BFE
Check here if allact�meqts
For Zone AO and Zone A(wilhout BFE),oomplete Nsms'E1.throuflh E5. If the Elovation Certiflcate is intended for use as supporting� ,
�n(ormation tor a LOMA or LOMR-F,Section C must be completed.
E1.Building Diag��m Number (Select the buildinp dtagram most similar to the building for which this cenificate is being comp�eted-
see pa�ea 6 and 7, It no diagram acau�tely�epressn4 the buildiny,p�ovide a sketch or photoyraph.)
E2.The top of the bottom(Ioor(includk►fl ba���pr endo=urs)of ths buildfn�i= ���n. m
(chedc one)the hiphest adjacent prsd�. (Use naturol y�ade,it available.) � ��--�—)��•(cm)I_�above or L�be�o.w_ .
E3.For Buildinp D1a�rarns g.g Miith o ni s �� T 't�next hiflher floor or elevated floor�(s�evation b)oi the buildin �s' ' 4 + 1 '
I.JJ���(�►)Ll,_I�+•(�m)abo e tli � `�4 )� 9.
E4.The top of the plallorm ot machinery a h�q�pj����NIG� �b et�e�^te�s s C3.h and C3.1 on front of(orm. .
� 9 I_I_.I ft..(m)I_I_I in. (cm)�_�above or�_�below,
(check o�e)the.highest adjacent�rode. (Use,natural prade,ij avsilable.) +
E5. For Zona AO oNy: If no flood depth numbeYl!evailable,is the lop o(the bottom floor elevated fn�accordance with the community's
tlood lain mana ement o�dinance? Yea No Unknown. The local offlclal must certif this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'3 REPRESENTATIVE)CERTIFICATION
The propeny owner or owners auU�o�ized tepresoM�Uve who completes Sectfons A,B,C(Itema C3.h and C3.i only),and E for Zone A
(without a FEMA-Issued or comrtwn��y.�s=ued BFE)or Zone AO must sig�here. The stafements in Sections A, e, C, and E are cor�ed�o
the best o/m knowled e.
PROPERTY OWNER'S OR OWNER'$AU7HpRIZEp REpRESENTATIVE'8 NAME
ADORESS
i ' C�N STATE 7!P CODE
SIGNATURE • -'
OATE TELEPHONE
COMMENTS
SECTION G-COMMUNITY INFORMATION(OPTIONAL) Check here i1 auacnments
7h�local oKcial who ls authorized by law or ordinance to adminis����e�muniry'a floodplain management ordinance can complete
Sections A,8,C(ot E),and G c(1hk Ele�at����� �p�eta the appHcabl.e Item(s)and slgn below.
G�• �—�Ths intormation in Soction C waa taks�trom pth�r daCUmenlatlon t}iat'F1a's been slgned and embossed by a licensad suneyor,
enginee�,or a,rc.l�itect,whoJs authaized by state or local law to certity elevation info�mation, (Indicate the source and date of�he �
elevation dat$in t►�e Comments arsa bebw.).
G2. �_�A community of�ficial completed Sedion E(o(,a bui�ding lo�ated�in ZorLeA�(�vlthoul a FEMA-issued or community-issued BFE)or
Zone AO.
G3. �,_�The tollowing information(Items G4_Gg)i$provided for community floodplain management purposes.
GI.PERMIT NUMBER G5. DATE PERMI ISSUEA '
T G8. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY
G7.This permit has been issued fo�: U New Constiuctlon issueo
G8.EtevaUon oI aa-buUt lowest floor(i�cludinp baaement)of the b IuUld ng�����mprovement
G9.BFE or(in Zone AO)depth�of tlqpdin�at the bulldinp sita Is: _f�.(m) Datum:
� _tt.(m) Datum:
IOCAI OFFICIAL'S NAME
TITLE
COMMUNITY NqME �
TELEPFIONE
SIGNATURE j
� oATe JqN p 4 REC'D
COMMENTS
�.
� T SVCis.
FEAAA Fortn 81-31,Janusry 2003 Ch�ck here il sllachmems
Replaces all previous edi�ions
�$�'�r��� CITY OF CLEAR �UATER
� � ,�l i, �
� == p DEVELOPMENT &NEIGHBORHOOD SERVICES DEPARTMENT
9�Q�� � POST OFFICE BOX 4745� CLEARWATER� FLO�uDn 33758-4748
` IQTE MUNICIPAL SERVICES BUILDING, 100 Sou't�t MYxx'r[.E AvEtvuE,CLEARWATER,FLO�uDn 33756
TE�PHOrrE(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 cert�cates are required to be reviewed for correctness and completion prior to
acceptance by the community. This complete foRn shall be attached to all elevation certificates maintained on fiie 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 maiiced sections by Community Official
SECTION A-PROPERTY INFORMATION 'For Insurance�ompany Use:
A1. BUILDING OWNER'S NAME Poticy Numb�r
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
.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME 63.STATE
64.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)
610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth er�tered in Item 89.
❑FIS Profile ❑FIRM ❑Community Determined ❑Other(Describe)
611. Indicate elevation datum used for BFE in 69:0 NGVD 1929 ❑NAVD 7988 ❑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. Buiiding elevations are based on: ❑Construction Drawings* ❑Buiiding Under Construction* ❑Finished Construction
*A new Elevation CeRificate will be required when construction of the building is compiete.
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 NAVD 1988 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: �--�a��"� �/ Community Official: t
�vation ceRificates shall 6e maintained by the community and copies with the attached memo made available by request
FttnNx H[BanRn,MAYOR
GEORGE N.CREI'EKOS,COUNCILMEMAER JOIIN DORAN,COUNCILMEMBER
PAUL F.GIBSON,COUNCILMEMBER � CARIEN A.PE1'ERSEN,COUNCILMEMBER
��EQUAL EMPLOYMENT AND AFFIItMATNE ACTION EMPLOYER��
• pf�ti' � 2 • � o�-�o
. . ,��.r+�c'f
`�.�1 �n ° 3 �--0 3`f3Z F�D�RAL E'.4l�FtGEf+1CY MANAGEIM�NT AGENCY ,. �
r NAT10NAl FI.��D INSURANCE PROGRAM � G.ivi.6. �du. 30o7-vGi 7 �
{ ExPi�es.OPCemSer�1. Z005 ;
ELEVATi�ON ��RTiF1CATE �
Im orta�L• Read ths instructions on a es � -7.
SECTION A-PROPER7Y OWNER INFORMATION For Iruu�ance Company Usr.
BU11,�I UWNER'S NAM�� L�'n�_�����D�C P�t�f Number
-�iv , r
BUILp1nc�STREET ADDRESS(InclUding qpt;,Unk,5.uifC,snU/o{BIEy,Np,)CR P.O.ROUTE ANp BOX NO. ' Company NAiC tiumter
_ l�Q� .BA�lt��aci R�v��, C1�s��Ntl '
c�nr ��EA�Wi4T�'i� - •�� ' . � � rnre ziP cooe
Fc�ei�i1
R ESCRIPTIO (�ot and Block Numoeo,�ax Psresi Number,Logsl Descripllon,etc.} �
S/ �� J1t�C�A L475- .1/_,1,,a'L�'..2�. _�.38' ....��5_�
8!!1!D G US (�.y.�Re�rid��.�iar+�aJdentLf,A<ldkJan,Acee "'' -- _
ssary,eEc. lhre s Comrnents arra.if necessary.l
IATI r� � :�t?...i r+v�aGUn 1 AL DATUM.
( �MM"-�M'-�.�" c► �li►.�') (_J NAO 1927 LJ NAO 1983 SCURCE �;GPS(Typel:_
U USGS Qusd Map �j O!her —
SECTiON d-FLOOD INSURANCE RATE MAP. (FlRMA)INFORMATION
1.NFIP UNI 3.COAMAUN N 82.�OUNTY i+IAAi � 63.STATE
r�' , F- /?50 / c''C�AS R/0�1 . i
• �P�� �.S IN B7. 1 ANEL 9.FL d9.Bl,SE FLO00 �EVATiONISI I
� N�ER DA�3 EFFECTNE/REVISED DATE ZCN S�
'03 . ► � (Zone;i.use depth ot flcoding�
B 10. Indicsl��s sourcu of th�Bss�Flood Elevabon(8FE)data or 5ase flood de �
L)FIS Pro/t1� FIRM P�enter�d in 89.
I.YI �,,,J CommuNry Detertnined U Other(Dtscribe):
BT f. Indicat�tha Nevation datum usedtor tM BFE in 69:��NGVD 1929 U NAVO 1988 LJ Other(Cescrii�e):
8�2•1s tfw bwldinfl bcat�d in a Coastal Barriar Resouress Systern(CBRS)araa or Otherwise Pretected Area(OPA)1 �_j Yes � No
aesi9nsGon Oatr
SECTION C-BUILDING ELEVATION INFORMATON(SURVEY REQUIRED)
CT:euildiny ekvatlons ar:bas�d on; C�nsyucGon Orawings' LJBuilding Under ConstrucUOn' �_�Finished Consvuction
'A nww Elewdon CKtiticste wiU be�+aquirod whsn c�nstruction of�e buildiny is complate.
C2.Bui1d'ng Dlagram Numb�r_�($�Ie�E y�o buil�inq dtayram mos[simila�to the building forwFiicn ihis certiticale is beirg completed-see
pages 6 snd 7. If no diagram�qcurately represents tho building,prqvide a slcetch or photoyraph.)
C3. Elfvations-Zp�as q1-A30,AE,AN,n��u,BFE).VE, V1-V3Q, V(wi�h 8F�),ArT,AR/A,AR/AE,ArZ1A 1-�30,AR/AF;,ARiAG
Complot�Items C3.a-i below according to ths buNdinq dlagram specifiMd ir�Item C2.Shtr iha daturn used.It the daWm is clifferent from
ths dawm us�d tor Uw gpE t�Swc�i�g��y�K���atum W thst uf�d foe th�BFE.Show ttsld mpsur�emonts a�d Catum conversion
caiculation. Usa th�spsae ExeviC�d a the CommMts ti►ea of Saction 0 or Section G,as appropriate,to doc:ument he daQ�m conversicn.
Datum ConvQ�Comments
Elevation refsrsnce rt�ark�Sed F�' Does the elevation reference m rk used appear on the FlRArI?
l� a�Top of bottom floor(inclu�n�basement or enclosure� I_1 Yes �� �vo
O b)Top of next hiyher floor �'�m� Y �' �.y�3�
.�it.(m) �'
O. c)Botto►n of lowest horimntal sWCtural mamber(V zones oiUy) _� _f1.(m) �J
C] d)Alta�,-hed p�rap�(top of slab) -
0 e)lowe�t vtavatlon ot machin�ry�/a$q���nt' ���tt��n� u�
ssrvicin the build p�'C ON /CGM7F ,
9 �rp(Deacrib�M a Commanis uee.) �O1�S!!0� �t.�mj ��I
O t)Lawest sdjac�nt;firwahed)grad�(�qG) •
O yI Hi9hest adja�nt(bnish�d .��.(m) ;H
)9rad�(HAG) ���m�
� h)No.of portnanont opani�gs(11ood vents)wi[hin 1 !t.above adjacent grada.;;��_ Y �
u i)7ota1 ar�a of aD permanMt cponi�y=(ticod w�tt)in C3.h!�,��sq.in:(sq.cm)
SECTtON D-SURVEYOR.ENGINEER.OR ARCHITECT CERTIFICATION
This certifica6on is to be signecl and s�aled by a Iand surveyor,engineer,w arcfiitect auq�i2sd by law to certiF�etevatic�infortnation.
I cefify thst the in/ormafion in Sirclions A,@, and C on this eNtilFCate iapresents rrry best ollbiis to interpret the data availaoie.
1 undsrstu�d that an falso statemvnt me be �nishab/e b firra o�im rtsonment under 18 U.S. Code. Secri�n t00;.
C-�—.-�r.B�_ _ -
UCENS NUMBER ---'"-
.1DDR�,S$ I1.Pr N 9y��I�Y D R COWIPANY �y .� —
�"• `F,�►Sf,�i.�L'�L
1 C I��� ��� . _
�_ LP CGDE
_--�__ q. [S,� e�E NE�-_._.�1�- -
FEMAFOnn81•3t,Janu � � _. qg-��3�D •
�j�3 S�ee roversw sid�for�CnpnuaUon. R�places all orevious aUitions
• • � .. . � . �. A .
. �
� i
M
IMPORTANT: 1�2t��sa sp,���PY!bs corras�sandln
GTY �gT��— �j�lorntatlo�lfroen 8�c!!pn A, For Insivar+cc Com�nrw Usc:
��LI �'����a�q.No•)OR P.O.ROl1TE MID BOX NO. PoUry Numcer
�� T— . LP�OpE �pam NqIC Ivumber
s�Cn� ������•�a�N�ER OR/1RCHITECT C�RTIFlCATION(CONTiNUED)�
�PY�h sW�s of tltis Elw�tion GAiAcaLs for t t)aammunity onicW,(2)insurarx� y
COI�NAENTS �� ��Pi�y.and(3)buitdin9 owner.
' � # �� .3 ii
, . l = 5. �� . , . -
3ECT70N�-9lIJtDING FLEVATION INFORMATIW�1�SLIRVEY NOT R�QkfIRED)FOR 20NE AO 1W0 ZANE A{tAA HrOUT BF�J rxs
`cr Zor�AO snd Zone A(without BFE).compl�t�IMns E1.
:titanwtia�tor s tOMA ar IOMR.F.S�ctio�C must ba wmpls�h E5. If 1hs FJ�vatfon C�rtilicab is intended t'or use as supportin9
_1.Buildl►q Oisy�am Numoer (S�,t w�bt�mp diagnm most similarto the build'ui for which�is
?2.1?►�p��s 6 and 7. ff no dis�r�m acwrsWY►�D►�s�r►ts IM buildin9.Provid�a skltch or -�Stiftcate is be�ng cempleted-
top of tfN bot0om fbor M�k�d�p b�s�nwnt or endpsuti)of 1ht bui{diny 1s Photoyraph,)
(ch�ck on�j th�hiph�st sdjacentl�ad�• (Ua�n#lural�rad:,iisvsilay#m.) - �'�"J it.(ml 1 1 l in.(u►�)�ahove ar U below
��'�Of B��^9��+^�s 6-8`"'i�h cP�ninfls(sN pap�7),th�n�xt hi�h�r Iloor or�l�vatW floor(elevatlon b)of the buildinq is �
=4. T�R(m)�=-pn..(cm)abovr tM hl�st sdlacMt�rsde. �cmplat�Itams C3h snd C3.1 on fr�onl of furtn. .�� .
�P�tM pl�tfbrm ot rt�id�y�aridlbr�t sNWdnQ!h�butld�ng u l 1 1 R.!m)I 1 I in.(cm)LI abo ve o��1 below
(c�ck ony 11►�NqhK,t adjsc�nt �ad�,tf av�llab►o.)
35.For Zon�AO aNy: If no Aood cypth nurnber is availaWt,is th�to uf tha bottom
800dolsin manaa�m�nt ordinanc�?I I Y�s I I No ( 1 Unknown Ths loc�l p}(,�1 v��G��r���"'���'e��'nmun'rty's
� sECT10N F PROPERTY��(OR ONMER's}tEpR�S,ENTA ��informatFon in Sechon G
T►'e DroP��Y own�r or ownera suthoriz�d r� T���CERTIFlCATWN
(without s FE1�Aq,.isswd or communi P�s�fbtlw wffo eompl�t�s S�ct�ons A B.C(tl�ms C3.h and C3.f onl
ty-issu�d BFE)or Zen�AO must si�n here. Thw sial�monts in SecUons q.B, C.�and E are corrsct ro
the b�st of my kno�yMdee
PROPERTY OWNER'S�R OWNER'S AUTHORIZED REPRESENTATIVE'S NWME .__.— _.. _.._ ._ --.--
�DO11LS5 — __
' C� � �— STATE� ZIP CODE . —
S1G74ATVRE '
OATE TEI�PHt)IaE '
COIuqAE1VT5 _ ,
3EGTON G-COMMt�N1TY INfORliATOli(Or"TICI�iI►L) Cr�c�c nere ir aetachmenrs
fhe locsl oAidal who is auihori�d by law or ordkanee to sdrtdniste�tha comrtwMtya flooddsin manag�nwr+t adinance can complete
3eciiar�s A.8.C(or E�snd G of thia El�vaion C+rtificst�. Comp�t�thw applicabl�itsm(s)a�al sign beJow.
31.U Th�ir�fomnation in S�ctio�C was taktn irom ot��dxumsnhdon�t has baen siqnod and emboated by a licensed surveyor,
enqi�ew.or architect wfw is aulhoriz�d by sqte or loeal'law to
��,���a�����n��b�,) .. cortiiy elevatioa infumnatlon. (Indicate the s.�u�e and date uf tl�e
'2.�--�A�m�Y o��)comP��t�d S�ctlon E tor s buildinq locat�d ih Zone A(without a FEMA-;sawd a w�u�u�,;ty-issued 8FE)o�
Zon�AO.
�. l._J The fdlowin9 in i o r maao�ptsms Ca4-G9)Is arovided ffor cornrrwnity fwbdplai�manas�ment purpostts.
Go.PERMIT NUMBER G5. DATE PERMIT ISSUED ' +
. G6. DAT'E CERTIFICATE QF CAMPUANCE/OCCUPANCY !
37.This p�rrt�it has bNn issu�d for, � ISSUED —�
38.Owstion of as�uilt lorwst Aoor • �"'�N�w Construcben- U SubsfanGal Improv�ment
�6.BFE ar(+Rt Zr��a AA ������i b�s�rn�ntj of fh�buildEnq Is: , .
1 d�'P�ot���st tlh buildMq ti4s is: . —�(m) Datum:
i ft-(m) Datum:
LOC�OFFlCtAL'S NMAE
TI7'l,c
COMAAl�1Tf NMIE
TELEPHONE
SIGNAT�IRE
DATE—'�—"'
COMQAENTS
FEM/1 Fortn 81-31,Jirluuy Zpp3 — I I Check here if attxlKnen�a
Replaces all previous Qdition;,
_ _
. . _ . _ _ _____ __�___`_._. _
______ �,.��� _ r... �--
,
r -- ' "" � �F��ERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
f ' � � �� `�' �i � �' �'�- � !NATIONAL FLQOD�INSURANCE PROGRAM �
, �4 i __��, .�,._.,�,_... �; Expires July 31, 2002
� ` �;, �� � `' ELEVATION CERTIFICATE
�, ;, ';, �AUG 1 � 2��1 ' � �GP 2.f.b[��7� Co �
�.Im ortant: Read the instructions on a es 1 -7.
�.,,_.�,,..�..,._........_...�.�-- , $ECTION A-PROPERTY OWNER INFORMATION Far Insurar�ce Gcxt�pa,ny.Use:
BUILDI � ` `_ � � �+ PoliGy�+1�1[nber
�� „8 r .... ,.� . ! .
C��
Is �� I���Tael Welch & Sue Cros '
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Compal�y;PIA��l+ltir►tbe� ,
692 Bayway Blvd.
CITY STATE ZIP CODE
C1@drWat2r F1 nri�7a �d�'�(1
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Lots 21 & 22, Block A, Bayside No. 5, Pinellas County, PB 38, PG 38
BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use Comments sedion H neoessaryJ
Non-residential
LATITUDFJLONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: L�GPS(Type):
� �#'_##�_##,##° or ##,#�l###' L�NAD 1927 U NAD 1983 L�USGS Quad Map u Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME 8�COMMUNITY NUMBER B2.COUMY NAME B3.STATE
Clearwater 125096 Pinellas
64,MAP AND PANEL 65.SUFFIX 86.FIRM INDEX B7.FIRM PANEL B8.FLOOD B9.BASE FLOOD ELEVATION(S)
NUMBER DATE EFFECTIVElREViSED DATE ZONE(S) (Zone AO,use depth of flooding)
0014 D 8-19-91 8-19-91 AE 11 & 12 feet
610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9.
u FIS Proflle �J FtRM U Community Determined U Other(Describe):
B11. Indicate the etevation datum used for the BFE in B9:U NGVD 1929 U NAVD 1988 U Other(Describe):
612. is the building located in a Coastal Barrier Resources System(CBRS)area or Othervvise Proteded Area(OPA)? L�Yes �No
Designation Date:
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REGIUIRED)
Buiiding elevations are based on: L�Construction Drawings* uBuilding Under Construction• Finished Construction
•A new Elevation Certificate wilt be required when construction of the building is complete.
C2. 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,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO
Complete Items C3a-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 ConversioNComments See SeCtion "D"
Elevation reference mark used Dces the elevation reference mark used appear on the FIRM? �J Yes � x�No
�] a)Top of bottom floor(inGuding basement or enclosure) 5•�3 ft.(m) �
�] b)Top of next higher floor � 5'?�_ftdm) � o
❑ c)Bottom of lowest horiznntal structural member(V zones only) N A_ft•(m) �a
❑ d)Attached garage(top of slab) N A—�.(m) W W
�I e)Lowest elevation of machinery and/or equipmeM
servicing the building (AC) 10.7 7 ft,�m� �� 8–0 6–01 L S 5 3 3 0
{�1 �Lowest ad jacent grade(LAG) 5•$_ft.(m) z'�
{�] g)Highest adjacent grade(HAG) 6. 0, ft.(m) � p�
❑ h)No.of permanent openings(flood vents)within 1 ft,above adjacent grade N�A � ��,� �, A
O 7 Total area of all permanent openings(flood vents)in C3h N/A sq.in.(sq.cm)
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 ir�fortnation.
I certify that the info►mation in Sec�tions A, 8,and C on this cerdficate repr+esents my besf efforts to inteipret the data availa6le.
I understand that any false statement may be punishable by fine or imprisonmenf under 18 U.S. Code SecBon 1001.
CERTIFIER�s w4�neTerrence L. Ralston LS���330 NUMBER
COMPANY NAME
Professional Surveyor & Mapper Georqe F. Younq, Inc.
ADDRESS 299 Ninth Street North St. Petersbur FL� 33701 E
SIGNATURE � DATE 8—0 6—01 TEL�P�Q��8 2 2-4 31 7
. 2
FEMA Form 81-31,AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
�
IMPORTANT: In these spaces, copy the corresponding information from Section A. Eor Insurance Company Use:�
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Policy Number
CITY STATE ZIP CODE Company NAtE Number.
Clearwater FL 34630
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community official, (2)insurance agenUcompany,and(3)building owner.�
connnnEnRS BENCHMARK USED: Pinellas County Engineering Department Map No. 1 56,
Located at the South side of the intersection of Parkwav Dr. & Bavwav Blvd.
having a published elevation of 5.283 NGVD ( 1929) .
NOTE: Bottom f loor elev.-Unit 1 1 4,next higher f loor-Unit1 28 �_� 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 CertiBcate is intended for use as supporting
information for a LOMA or LOMR-F, Section C must be completed.
E1. 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.)
E2.The top of the bottom floor(including basement or endosure)of the building is LL)ft.(m)LL�in.(cm) �)above or �below
(check one)the highest adjacent grade.
E3.For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is
LI_I�dm)LL�in.(cm)above the highest adjacent grade.
E4.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?L�Yes L�No L�Unknown. The local official must certify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owner's authorized representative who completes Sedions A, B,and E for Zone A(without a FEMA-issued or
community-issued BFE)or Zone AO must sign here.
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 official who is authorized by law or 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 item(s)and sign below.
G1. ��The information in Sedion C was taken from other documentation that has been signed and embossed by a licensed surveyor,
engineer,or architect who is authorized by state or Iocal law to certify elevation information. (Indicate the source and date of the
elevation data in the Comments area below.)
G2.(�A community offiaal completed Section E for a building bcated in Zone A(without a FEMA-issued or commun'dy-issued BFE)or
Zone AO.
G3. U The following information(Items G4-G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. OATE CERTIFICATE OF COMPLIANCE/OCCUPANCY
ISSUED
G7.This permi3 has been issued for: L�New Construction U Substantial Improvement
G8. E�evation of as-built lowest floor(inGuding 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,AUG 99 REPLACES ALL PREVIOUS EDITIONS