838 BRUCE ST ` FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
` ' NATIONAL FLOOD INSUi�ANCE PROGRAM
Sa��l��C>�I !C/3l ��r� ELEVATION CERTIFICATE Expires December 31, Zoos
��� `� � v`� ��� Important: Read the instructions on p es 1-7.
SECTION A•PROPERTY OWNER INFORMATION For��suranaeGc�nparry use:
BUIL@ING OWNER'S NAME PoHcy Number '
MARTIN GREENBURG
BUILDING STREET ADDRESS(InGuding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
838 BRUCE ST
CITY STATE ZIP CODE
CLEARWATER FL 33767
PROPERTY DESCRIPTION(Lot and Blodc Numbers,Tax Parcel Number,Legal Description,etc.)
LOT 9&NORTH 1/2 OF 10,MANDALAY
BUILDING USE(e.g.,Residential,Non-residential,Addition,Acoessory,etc. Use a Comments area,if neoessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):
( ##°-##'-##•##" or ##.#�!J##� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
81.NFIP COMMUNITY NAME&COMMUNITY NUN�ER B2.COUNTY NAME 63.STATE
CLW 125096 PINELLAS FL
B4.MAP AND PANEL B/.FIRM PANEL 89.BASE FLOOD ELEVATION(S)
NUMBER 65.SUFFIX B6.FIRM INDEX DATE EFFECTIVEIREVISED DATE 88.FLOOD ZONE(S) (Zone A0,use depih of flooding)
125096�0102 G 9,3-03 9-3-03 AE 11
B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Describe):_
611.Indicate the eleva6on datum used for the BFE in B9:❑NGVD 1929 �NAVD 1988 ❑Other(Describe):
612.Is the building located in a Coastal Bartier ResourGes System(CBRS)area or Otherw�se Protected Area(OPA)� ❑Yes �No Desi nation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:❑Construction Drawings' ❑Building Unde.�Construction* �Finished Construction
'A new Elevation Certificate will be required when construction of the building is complE�te.
C2.Building Diagram Number 7(Select the building diagram most similar to the building for which this certificate is being canpleted-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,AWA,AWAE,AWA1-A30,AWAH,AWAO
Complete Items C3.-a-i below according to the building diagram speafied 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 1988 ConversionlComments
Elevation reference mark used Does the elevation reference mark used appear on the FIRM? ❑Yes �No
o a)Top of bottom floor(induding basement or endosure) 9. ��ft.(m) � � ��y��
o b)Top of ne�higher floor ni,���.�m� �
� --_ . _.
o c)Bottom of lowest horizontal structural member(V zones only) N.A ft.(m)
o d)Attached garage(top of slab) 4. 8 ft.(m) E�
o e)Lowest elevation of machinery andlor equipment W � �
serviang the building(Descnbe in a Comments area) 9.U ft.(m) �� ;. �;
o�Lowest adjacent(finished)grade(LAG) 3.2 ft.(n!) z m �;�, •q
o g)Highest adjacent(finished)grade(HAG) 4. E ft.(m) �� °
o h)No.of permanent openings(flootl vents)within 1 ft.above adjacent grade 29 � �-���,�jc
o i)Total area of all permanent openings(flood vents)in C3.h 3792 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 architsct authorized by law to certify elevation information.
I certify fhat the information in Sections A,8,and C on this certi�cate represents my best efforfs to interpret the data available.
I understand that any false statement may be punishable by�ne or imprisonment under 18 U.S. Code,Section 1001.
CERTIFIER'S NAME M.G.MAYER LICENSE NUMBER 4495
TITLECEO - COMPANY NAME FLORIDA BENCHMARK
,
ADDRESS ';: CITY STATE ZIP CODE
1298LAKEVIEWAD �'°:� CLEARWATER FL 33756
SIGNATIlR�'" "� F.- `- DATE TELEPHONE
'' <., �., ' � : :�: , 02-13-04 727-298-0286
,.� -
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FEMA Fomi 81'-3a,���u�ry;�003 ` See reverse side for continuation. Replaces all previous editions
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' �NiPGRTAMT: In these spaces,copy the corresponding information from Section A. FalnsuranceComparryUse:
' BUILG;'•�G STREET ADDRESS(Induding Apt,Unit,Suihe,andlor Bkig.No.)OR P.O.ROUTE AND BOX N0. Po�cy Nurr�er
$38 BRUCE ST
CITY ' STATE ZIP CODE Company NAIC Number
CLEARWATER BEACH FL 33767
_ SECTION D•SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community offiaal,(2)insurance agenVcompany,and(3)building owner.
COMMENTS
VENTS IN HOUSE 21,TOTAL SQ INCHES 2720.
VENTS IN GARAGE 8,TOTAL SQ INCHES 1072
❑Check here if attachments
SECTION E•BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WRHOUT BFE)
For Zone AO and Zone A(without BFE),complete Items E1 through E4. If ihe Elevation Certificate is intended for use as supporting infortna�on for a LOMA or LOMR-F,
Section C must be cbmpleted.
E1.Building Diagram Number_(Select the building tliagram most similar to the building for which this certificate is being completed—see pages 6 and 7. If no diagram accurately
represents the building,provide a sketch or photograph.)
E2.The top of the bottom floor(induding basement or endosure)of the building is _ft.(m)�in.(cm)❑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 adjaoent
grade. Complete items C3.h and C3.i on front of form.
E4.The top of the platfoRn of machinery andlor equipment serviang the building is _fl.(m)_in.(cm)0 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 bottan floor elevated in accordance with the communit�s floodplain management ordinance?
❑Yes ❑No ❑Unknown. The local official must certify this infortnation in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The propeRy owner or owners authorized representative who completes Sedions A,B,C(Items C3.h�d C3.i only),and E for Zone A(without a FEMA�ssued or community-
issued BFE)or Zone AO must sign here. The statements in Sections A,B,C,and E are correct to the best of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
❑Check here if attachments
� __ SECTION G-COMM�JNITY!NF!?RMATION(OPTIONAL)
The local offiaal who is authorized by law or ordinance to administer the communit�s floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation
Cer6ficate. Complete the applicable item(s)and sign below.
G1.❑The information in Section C was taken from other documentaUon that has been signed and embossed by a licensed suroeyor,engineer,or architect who is authorized by state
or local law to certify elevation infortnation. (Indicate the source and date of the elevaiion data in the Comments area below.)
G2.❑A community offiaal completed Sedion E for a building located in Zone A(without a FEMA-issued or community�ssued BFE)or Zone A0.
G3.0 The fdlowing information(Items G4-G9)is provided fa 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 Construction ❑Substanti�Improvement
G8.Elevation of as-built lowest floor(induding basement)of the building is: _._ft.(m) Datum:
G9.BFE or(in Zone AO)depth of flooding at the building site is: _._ft.(m) Datum:_
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE ' DATE
�
COMMENTS
❑Check here if attachments
FEMA Form 81-31,January 2003 Replaces all previous editions