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1921 BELCHER RD N Y � � � ��/ �. i � '�� FEDERAL EMERGENCY MANAGEMENT AGENCY � �.��• i�,�,� ,`.�..�_'.. O.M.B. No. 3067-0077 _ �� NATIONAL FLOOD INSURANCE PROGRAM F�cpires July 31, 2002 ApR 1 1 2001 f ELEVATIAN CERTIFICATE : � CS�i 5�: : � Im ortant: Read the instructions on a es 1 -7. ��-�-� -•�- • �._ : :. � & ' i.. P �,_ .�Y ''' SECTION A-PitOPERTY OWNER INFORMATION For Insuranca'Company Use .�� BUi Polwy Number ��-��,,.�. ALBERTSONS �� 4401 -° ��°•� ��`x��==T BUILDING STREETADDRESS(including Apt.,Unit,Suite,and/or Bidg.No.)OR P.O.ROUTE AND BOX NO. Company NAICNumber ,��,__.; , ,=- '� _ _ __. CITY STATE - ZIP CODE - ,. � CLEARWATER FLORIDA 33763 PROPERTY DESCRIPTION(Lot and Biocic Numbers,Tax Parcel Number,Legai Description,etc.) PAR('FT Nn �h �9 1 f, nnnnn 9�(1 n��n :: BUILDING USE(e.g.,Residential,Non-residentiai,Addition,Accessory,eta Use Comments sedion rf necessary.) _ - _ ' NON—RESIDENTIAL LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: �yJ GPS(Type): � � �°_�_�.� ar �.�°� U NAD 1927 (_J NAD 1983 LJ USGS Quad Map U Other. (N.G.V.D. 1929) SEGT!ON R-FLOnD INSt.lRANCE RATE MAP(FIRM)INFORMATION B1.NFIP COMMUNITY NAME 8 COMMUNITY NUMBER B2.COUNTY NAME 63.STATE , CITY OF CLEARWATER/125096 PINELLAS B4.MAP AND PANEL 65.SUFFIX B6.FiRM INDEX B7.FIRM PANEL B8.FLOOD 89.BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVEJREVISED DATE ZONE(S) (Zone AO,use depth of flooding) 125096 —0010 D 8 19 91 6 9 71-8 19 91 "A—E" 65 00' B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in 69. LJ FIS Profile �FIRM U Community Determined Lj Other(Describe): 611. Indicate the elevation 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)? LJ Yes �No Designation Date: SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) '. Building elevations are based on: LJConstruction Drawings' UBuilding Under Construction' �Finished�onstrucKion '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 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. DatumNGVD 1929 ConversioNComments PINELLAS COUNTY DISK "GRAY T" ADJUSTED ELE�IATION: 75.80' Elevation reference mark used ��G�Y T�� Does the elevation reference mark used appear on the FIRM? U Yes LJ No 64.40�. - 0 a)Top of bottom floor(including basement or encfosure) (� � ❑ b)Top of next higher floor b4.48�{_�� a Y.Z,5. �� Lyb�{� °`"" 0 c) Bottom of lowest horizontal structural member(V zones only) N A _ft.(m) o o i ,j � `-., . ❑ d)Attached garage(top of slab) N A _ft•(�n) W W � -� � �'�F , ❑ e)Lowest elevation of machinery and/or equipment A/C UNITS ON ROOF $� ,;;- ` ' � servicing the building�L MACHINERY APPEARS TO B � �ft'�m� E �0 � q ��'- - ❑ �Lowest adjacent grade(LAG) ..50�,�� Z� � • �` ❑ g)Highest adjacent grade(HAG) 6 4..0 5�.(}� � �,pRIL , ..�QO1- 0 h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 0 � „;r� ,,�•~V ❑ �Total area of all permanent openings(flood vents)in C3h 0 sq.in.(sq.cm) GUY D. f '�,�}�;�',j'',L = � 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 fhe info►mafion in Secfions A, B, and C on this certifrcate represents my best efforts to interpiet the data availab/e. I understarrd that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. GERTIFIER'S NAME LICENSE Nt�BER GUY D. HALE PLS. �� 4626 .'TLE COMPANY NAME PROFrSSIONAL LAND SURVEYOR GUY D. HALE LAND SURVEYING ADDRESS CITY STATE ZIP CODE 36 MEA BL OLDSMAR FLORIDA 4677 SIGNATURE DATE TELEPHONE R 2001 1 FEMA Form 81-31,A 99 SE�REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS + .. __ _ ��. � IMPORTANT: In theae spacea,copy the corresponding information from Section A. .Foclnsurance Gmmpany"Use:�'` BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Sldg.No.)OR P.O.ROUTE AND BOX NO. . Policy Number • CITY • STATE ZIP �QDE Company NAIC Number :, CLEARWATER ' ' �� FLORIDA 33763 � '; � � SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT.C�RTIFICATIOPE�GbN71NUED). '� Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agenUcompany,��t!'(3)butldingl�rn�nher. � � COMMENTS FINISHED FLOOR ELEVATION @ FRONT DOOR: 64.40' ' FINISHED FLOOR ELEVATION @ MAINTENANCE DOOR: 64.48' (ALL EOUIPMENT AND MACHINERY APPEAR TO B INSTDE BLTTT1�TNr WTTH AI UNrTS oN Ro� L � �_� Check here if attachments SECTION E-BUILDING ELEVATION INFORAOIATION(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 E/eva6on Certificate is intended for use as supporting infonnation 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 na c�iagr�rn a��ra�ely represents the t�t�i!din�,provE�e��ke±ch o�pholegraph.) E2.The top of the bottom floor(including basement or enclosure)of the building is L��ft.(m)�L�in.(cm) L�above or u below (check one)the highest adjacent grade. E3.For Building Diagrams 6-8 with openings(see page 7),the ne�ct higher floor or elevated floor(elevation b)of the building is ��ft.(m)Luin.(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?�I Yes �I No LI Unknown. The local official must certiy this information in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owners authorized representative who completes Sections 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 i ,�a ' �� Check here if attachments SECTION G-COMMUNITY INFORMATION(OPTIONAL) . The local offiaal who is authorized by law or ordinance to administer the communiry'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. L,J The information in Sedion C was taken from other documentation that has been signed and embossed by a licensed surveyor, e!►gineer,or 2rchitect e�rho is si!h�rzed by state�r lec..�!!v�rt to cer!i!y elev�+,�c�i�afofmation. (lnd�rafs!ha se�a�ee��d date e!+.he elevation data in the Comments area below.) • G2.LJ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3. LJ The following infarmation(Items G4-G9)is provlded for community floodplain management purposes. G4.PERh11T NUMBER G5. DATE PERMIT fSSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ' ISSUED G7.This permit has besn issued for: �New Construction L�Substantial Improvement G8.Elevation 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 9FFICIAL'S NAME TITLE ; COMMUNITY NAME TELEPHONE � � SIGNATURE , DATE t ,- COMMENTS ;; . + . ; , ,. , . ' -- . -__ �_....� ��18�{f�1�F��1��1[� ��• f _. , __ __.. _... , . 4 . ~� . . ��F'U1Ct;S ALL PR� If�Ug�DI71� ONS 1`GMI°1� �'3��, r„ 1