181 BRIGHTWATER DR UNIT 3 FEDERAL EMERGENCY MANAGEMENT AGENCY
� ' • � 0���� NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077
Expires December 31, 2005
• s 6� ELEVATION CERTIFICATE
Important: Read the instructions on pages 1-7. JOB No.030111.2
SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use:
BUILDING OWNER'S NAME Policy Number
DIGIOVANNI PARTNERS, LLC UNIT No. 3
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
181 Brighiwater Drive
CITY STATE ZIP CODE
CLEARWATER FLORIDA 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Lot 3,VILLA DEL SOL OF CLEARWATER P.B.128,PGS.2&29
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 ##.##�#°) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other:__
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61.NFIP COMMUNITY NAME 8 COMMUNITY NUMBER B2.COUNTY NAME B3.STATE
City of Clearwater 125096� PINELLAS FLORIDA
64.MAP AND PANEL B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER 65.SUFFIX B6.FIRM INDEX DATE EFFECTIVEIREVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depih of flooding)
12103C0102G G SEPTEMBER 03,2003 SEPTEMBER 03,2003 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):_
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:❑Construction Drawings` ❑Building Under Construction� �Finished Construction
`A new Elevation Certificate will be required when construction of the building is complete.
•;,2.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 building,provide a sketch or photograph.)
C3.Elevations–Zones A1 A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AWA,AR/AE,AWA1-A30,ARIAH,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 appropnate,to document the datum conversion. � ..; ,�
Datum NAVD 1988 Conversion/Comments (1929)4.981-(1988)4.191=0.77 �� '°�'i 5 `
�:-° .�
Elevation reference maric used LABINS EL.=4.191 Does the elevation reference mark used appear on the FIRM? ❑Yes � �y `�—�
o a)Top of bottom floor(including basement or enclosure) 5.0 . FT ft.(m) � �`c,d ��,^, a q' ,.,'� `�
o b)Top of next higher floor 14.94 FT ft.(m) `� �� � �•
o c)Bottom of lowest horizontal structural member(V zones only) N/A FT ft.(m) o o � � 'R`"' �r � �
� .
o d)attached garage(top of block) 5.0 FT ft.(m) �� ' �--¢ =_" a °
..��,
o e)Lowest elevation of machinery and/or equipment �� �� �, �` '�'' `�
servicing the building(Descnbe in a Comments area) 11.0 . FT ft.(m) �@ ,,� • ,� °`�a
o fl Lowest adjacent(finished)grade(LAG) 4.5 FT ft.(m) z'� r,�'"`° �a�,,,?`a
� N� � 'F'1/2�/0�'
o g)Highest adjacent(finished)gratle(HAG) 4.7 FT ft.(m) � ,
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 6 � '
o i)Total area of all permanent openings(flood vents)in C3.h 1728 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.
I certify that fhe informafion in Sections A,B,and C on this certificate represents my best efforts to interpret the data availa6le.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001.
CERTIFIER'S NAME LICENSE NUMBER
BRUCE A.KLEIN PLS 50�2
TITLE COMPAMY NAME
• PRESIDENT KLE1N&STAUB SURVEYfNG,IN�.� ,,;
ADDRESS CITY STATE ZIP CODE
8016 Old County Ro New Port Richey FL 34653
SIGNATURE DATE TELEPHONE
i 11/22/05 (727)834�140
FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces ail previous editions
IMPORTANT: In these spaces,copy the corresponding information from Section A. For insurance com�any use:
BUILDING STREET ADDRESS(Induding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number �
181 Bri htwater Drive, UNIT No.3 �
CITY STATE ZIP CODE Company NAIC Number � �
CLEARWATER FLORIDA 33767
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) �
Copy both sides of this Elevation Certificate for(1)community off cial,(2)insurance agenUcompany,and(3)building owner.
COMMENTS
ITEM C3e IS ELEVATOR
❑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 Certificate is intended for use as supporting information for a LOMA or LOMR-F,
Section C must be completed.
E1.Building Diagram Number_(Select the building diagram most similar to the builtling 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 enclosure)of the building is _ft.(m)_in.(cm)❑above or ❑below(check 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 atljacent
grade. Complete items C3.h and C3.i on front of form.
E4.The top of the platform of machinery and/or equipment servicing the building is _ft.(m)_in.(cm)❑above or ❑below(check 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 community'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 owner's 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 Secfions 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-COMMUNITY INFORMATION(OPTIONAL)
The local c'ficial wha is aur�orized by law or ortlinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation
Certificate. Comp�e�e the applicabie item(s)and sign below.
G1.�The information ir Ser,±+on C N;as taken:from other documentation that has been signed and embossed by a licensed surveyor,engineer,or architect who is authorizetl by state
cr local law to certfi�eievation'ir�formation. (Indicate the source and date of the elevation data in the Comments area below.)
G2.❑A communiiy official�rnpleted Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0.
G3.�The following informafion(Items G4-G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY ISSUED
G7.This permit has been issued for: ❑New Construction ❑Substantial Improvement
G8.Elevation of as-buift lowest floor(including 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 d TELEPHONE
SIGNATURE DATE •
COMMENTS NOV 2 2 2005
r,r��t��IT--�V��
r v n� �'^� F A R W�T F F� ❑Check here if attachments
FEMA Form 81-31,January 2003 � Replaces all previous editions
„ � FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077
Expires December 31, 2005
' ' ��”��� � ELEVATION CERTIFICATE
Important: Read the instructions on pages 1-7. JOB No.030111.2
SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use:
BUILDING OWNER'S NAME Policy Number
DIGIOVANNI PARTNERS, LLC UNIT No. 3
BUILDING STREET ADDRESS(Inciuding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
181 Brightwater Drive
CITY STATE ZIP CODE
CLEARWATER FLORIDA 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcei Number,Legal Description,etc.)
Lot 3,VILLA DEL SOL OF CLEARWATER P.B.128,PGS.28-29
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 ##.�°) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME B3.STATE
City of Clearwater 125096 PI�LAS FLORIDA
B4.MAP AND PANEL , 67.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6.FI DATE EFFECTIVElREVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depth of tiooding)
12103CA102 G SEP BER 03,2003 SEPTEMBER 03,2003 AE EL11.0
B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Descnbe):_
811.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.Building elevations are based on:❑Construction Drawings' ❑Building Under Construction* �Finished Construdion
'A new Elevation Certificate will be required when construction of the building is complete.
„2.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 building,provide a sketch or photograph.)
C3.Elevations—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AWA,AR/AE,AWA1-A30,AR/AH,AR/AO
Complete 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
SecGon 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 Seclion G,as appropriate,to document the datum conversion.
Datum NAVD 1988 ConversionlComments (1929)4.981{1988)4.191=0.77
Elevation reference mark used LABINS EL.=4.191 Does the elevation reference mark used appear on the FIRM? ❑Yes � _,
o a)Top of bottom floor(induding basement or enclosure) 5.0 . FT ft.(m) �
o b)Top of next higher floor 14.94 FT ft.(m) � , , `
o c)Bottom of lowest horizontal structural member(V zones only) NIA FT ft.(m) N� '° ` '
o d)attached garage(top of block) 5.0 . FT ft.(m) �� ,
o e)Lowest elevation of machinery and/or equipment W `° , .`
servidng the building(Describe in a Comments area) 11.0 . FT ft.(m) E@ ,
o fl Lowest adjacent(finished)grade(LAG) 4.5 . FT ft.(m) z'm
�
o g)Highest adjacent(finished)grade(HAG) 4.7 FT ft.(m) � 11/22/05 ^
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 6 �
o i)Total area of all permanent openings(flood vents)in C3.h 1728 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.
I certify thaf the information in Sections A, B,and C on this certificate represents my best efforts to interpret the dafa available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001.
CERTIFIER'S NAME LICENSE NUMBER
BRUCE A.KLEIN -,��. -� ;; . ;p�$5�2
*TITLE COMPANY NAME; � . ;� .�
PRESIDENT KLEIN&SFAUB SURVE�fNG,IN� , '� ;
ADDRESS CITI� S7�T�` ZIP CODE
8016 Old County Ro New Port Richey FL'�' 34653
SIGNATURE DATE TELEPHONE
11/22/05 , (727)834�140
FFMA Fnrm R1_'�1 .lanuarv�M� Saa ravarca cida fnr cnntiniiatinn Raniar.ac all nraviniis arlitinns
IMPORTANT: In these spaces,copy the corresponding information from Section A. For insurance com�any'use: T
BUILDING STREET ADDRESS(Induding Apt.,Unit,Suite,and/or Bidg.No.)OR P.O.ROUTE AND BOX N0. Policy Number
181 Bri htwater Drive, UNIT No.3 ' , � ,
CITY STATE ZIP CODE Company NAIC Number
CLEARWATER FLORIDA 33767
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.
COMMENTS
ITEM C3e IS ELEVATOR
❑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 Certificate is intended for use as supporting information 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 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(check one)the highest adjacent grade. (Use
natural grade,rf 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 platform of machinery andlor equipment serviang the building is _ft.(m)_in.(cm)❑above or ❑below(check one)the highest adjacent grade. (Use
natural grade,rf available).
E5.For Zone AO only: If no flood depth number is available,is the top of the bottom 800r elevated in armrdance with the communitys 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 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 Sections A,8,C,and E are conect 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
, i � SECTION G-COMMUNITY INFORMATION(OPTIONAL)
� r
The local c'ficial wha is a�ir��rized 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
Certifiate. Compiete the applicahie item(s)and sign below.
G1.❑The information in Sec±�on C w�as;take�,from other documentation that has been signed and embossed by a licensed surveyor,engineer,or ar�hitect who is authonzed by state
cr local law to certify eievationirirormation. (indicate the source and date of the elevation data in the Comments area below.)
G2.❑A communiiy official a�mpieted Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0.
G3.�The following informafion(liem5 G4-G9)is provided for community floodplain management purposes.
C4.PERMIT NUMBER G5. DATE PERMff 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(including 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 D TELEPHONE
SIGNATURE DATE �
COMMENTS NOV 2 Z 2�0�
�,r.��� r�annFn�T �VC`.�
,�Tv n� r.� FARWRT�FR ❑Checkhereifattachments
FEMA Form 81-31,January 2003 Replaces all previous editions
.
' <' .,.�,.-�� �'
� ' `�� �v C ITY OF C LEARWATER
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r���t
_d,,�., � DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
.�,�. ,.}
POST OFFICE BOX 474H� CLEARWATER� FLOa�DA 33758-4748
MUN[CIPAL SERVICES BUII.DING, IOO SOUTH MYRTLE AVENUE,CI.EARWATER, FLOa�Dn 33756
TEi.FPxoNE (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 Insurance 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:❑GPS(Type):
(##°-##'-##.##" or ##.###if#°) ❑ 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 83.STATE
B4.MAP AND PANEL g5.SUFFIX 66.FIRM INDEX DATE B�•FIRM PANEL gg.FLOOD ZONE(S) B9 BASE FLOOD ELEVATION(S)
NUMBER 5/17/2005 EFFECTIVE/REVISED DATE (Zone AO,use depth of flooding)
12103C0102
610. 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)
611. Indicate elevation datum used for BFE in 69:❑ NGVD 1929 ❑ NAVD 1988 ❑ Other(Describe)
B12. Is the buildin located in a Coastal Barrier Resources System(CBRS)area or Othervvise Protected Area(OPA)? ❑Yes ❑No Designation Date
SECTION C -BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. euilding 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 ConversionlComments
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 buiiding(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:
�elevation certificates shall be maintained by the community and copies with the attached memo made available by request
FRANK HIBBARD,MAYOR
GEORGE N.CRG'1'EKOS,COUNCILMBMAER JOf IN DORAN,COUNCILMEMBGR
PAUL F.GBSON,COUNCILMEMA@R � CARLGN A. PE7'ERSEN,COUNCILMGMRER
��EQUAL EMYLOYMENT AND f�FIFtMA7'NE AC7'ION EMI'LOYER�
���� �G��_ �, 3� T7 FEDERAL EMERGENCY MANAGEMENT AGENCY
� NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077
. ' Expires December 31, 2005
• � � ELEVATION CERTIFICATE
Important: Read the instructions on pages 1-7. JOB No.030111.2
SECTION A-PROPERTY OWNER INFORMATION For Insurance c'ompany Use:
� BUILDING OWNER'S NAME Po:u,y Number
DIGIOVANNI PARTNERS, LLC UNIT No. 3
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
181 Brightwater Drive
CITY STATE ZIP CODE
CLEARWATER FLORIDA 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Lot 3,VILLA DEL SOL OF CLEARWATER P.B.128,PGS.28-29
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 ##.�t#°) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other:___
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME 63.STATE
City of Clearwater 125096- PINELLAS FLORIDA
B4.MAP AND PANEL B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVFJREVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depih of iboding)
12103CA102G G SEPTEMBER 03,2003 SEPTEMBER 03,2003 AE EL.11.0
B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Descnbe):_
611.Indicate the elevation datum used for the BFE in 69:�NGVD 1929 �NAVD 1988 ❑Other(Descnbe):_
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:�Construction Drawings` �Building Under Construction' ❑Finished Construction
'A new Elevation CerUficate will be required when construction 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 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,ARIAH,ARIAO
Complete Items C3.-a-i below according to the building diagram specfied 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 (1929)4.981-(1988�.191=0.77 y��;��a
Elevation reference mark used LABINS EL.=4.191 Does the elevation reference mark used appear on the FIRM? ❑Yes � .�- ,,,�e , X-, _: t�i
o a)Top of boflom floor(including basement or enclosure) 5.0 . F=f ft.(m) � _-t �""',,,,p x ;�a..�, ++,
o b)Top of next higher floor 14.94 . FT ft.(m) �' .' ,:�'��+'`' � �,+ �'�.f`-, `
,.�
o c)Bottom of lowest honzontal structural member(V zones only) N/A FT ft.(m) o o �`,,},.-.� --
o d)attached garage(top of block) 5.0 FT ft.(m) �� � "� �� � '�� �
o e)Lowest elevation of machinery and/or equipment �� � �o •<�,���.� y y(��H- ('
serviang the building(Descnbe in a Comments area) 11.0 . Ff ft.(m) �� "�, �,� ���'.',;�'
o fl Lowest adjacent(finished)grade(LAG) 4.5 FT ft.(m) N N � �`y.•A��• �
o g)Highest adjacent(finished)grade(HAG) 47 FT ft.(m) � ���a�'�,4���'/Q��`
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 6 J ''
o i)Total area of all permanent openings(flood vents)in C3.h 1728 sq.in.
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATIO
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.
I certify that the information in Sections A,B,and C on fhis certificate represents my besf efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIER'S NAME LICENSE NUMBER
JACK W.SMITH PSM 6140
TITLE COMPANY NAME
PROJECT SURVEYOR K�EIN&STAUB SURVEYING,INC.
ADDRESS CITY STATE ZIP CODE
8016 Old County Road 54 New Port Richey FL 34653
SIGNATURE DATE TELEPHONE
05/26/05 (727)834�140
F orm 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 insuran�com�any use:
BUILDING STREET ADDRESS(Induding Apt,Uni�Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number , � ' '
181 Bri htwater Drive, UNIT No.3 � •
CITY STATE ZIP CODE Company NAIC Number N �
CLEARWATER FLORIDA 33767
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) �
Copy both sides of this Elevation Certificate for(1)community offiaal,(2)insurance agenUcompany,and(3)building owner.
COMMENTS
ITEM C3e IS ELEVATOR
❑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 Certificate is intendetl for use as supporting information 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 accurately
represents the building,provide a sketch or photograph.)
E2.The top of the bottom floor(including basement or enclosure)of the building is _ft.(m)_in.(cm)❑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 platform of machinery andlor equipment serviang the building is _ft.(m)_in.(cm)�above or ❑below(check one)the highest adjacent grade. (Use
natural grade,if available).
F5.For Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in acc;ordance with the community'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 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 Sections A,B,C,and E are correct to the besf 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 off�cial who is�au±horized by!aw cr ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation
CeRificate. Complete the applicable item(s�and sign below.
G1.�The infor�ation in Secdon 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 local law to certify e�zvation information. (Indicate the source and date of the elevation data in the Comments area below.)
G2.❑A community offiaal completed S�,~tion E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0.
G3.❑The following inron natian(Items G4-G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY ISSUED
G7.This permit has been issued for: 0 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 OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE ��.r � � �nnc '" •
COMMENTS
r�f����T SVUS
e �r����chments
FEMA Form 81-31,January 2003 Replaces all previous editions