181 BRIGHTWATER DR UNIT 4 FEDERAL EMERGENCY MANAGEMENT AGENCY
�• � � ��� �� � NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077
Q � 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.4
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bidg.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 4,VILLA DEL SOL OF CLEARWATER P.B.128,PGS.2&29
BUILDING USE(e.g.,Residentiai,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
61.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME B3.STATE
City of Clearwater 125096-� PiNE��+s 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 depth of flooding)
12103C0102G � SEPTEMBER 03,2003 SEPTEMBER 03,2003 AE EL.11.0
B10.Indicate the source of the Base Flood Elevation(BFE)data or base floal depth entered in B9.
❑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 builtling 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 builtling 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,AR/A1-A30,AR/AH,AR/AO
Complete Items C3:a-i below according to the builtling diagram specified in Item C2.State the datum used.If the datum is tlifferent from the datum used for the BFE in
Section B,convert the datum to that used for the BFE.Show field measurements antl 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�4.191=0.77
Elevation reference mark used LABINS EL.=4.191 Does the elevation reference mark used appear on the FIRM? ❑Yes � Y. �
.> �,��y��,� � �;'',.3 �
o a)Top of bottom floor(including basement or enclosure) 5.0 FT ft.(m) � ,y� ' ��,� '
o b)Top of next higher Floor 14.94 FT ft.(m) � �.�1` c�
� ., a _ . ,
o c)Bottom of lowest horizontal structural member(V zones only) N/A . FT fl.(m) o o � � ��,�` �� ' ;;,;,►
o d attached ara to of block 5.0 FT ft.m �� � ::�- � - °�' �
) 9 9e� p ) � ) w � -, a tA. � -
o e)Lowest elevation of machinery and/or equipment _� '.. ' �,��
servicing the building(Descnbe in a Comments area) 11.0 FT ft.(m) � @ t� T r,� E� � .�;,;;
o fl Lowest adjacent(finished)gratle(LAG) 4.5 . Ff ft.(m) z� �,'� �� F" cr� �y �,`•
o g)Highest adjacent(finished)grade(HAG) 47 F=f ft.(m) " ' � -:,11/22/f1� �
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 6 � �� �° ���''Y�.�, '
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 sealetl by a land surveyor,engineer,or architect authorized by law to certify elevation information.
1 certify that the information in Sections A,B,and C on this cerfificate represents my best efforfs to inferpret the data available.
I understand that any false stafement may be punishable by�ne or imprisonment under 18 U.S. Code,Section 1001.
CERTIFIER'S NAME LICENSE NUMBER
BRUCE A.KLEW PLS 5052, '•
TITLE COMPANY NAME
• PRESIDENT KLEIN&STAUB SURVEYING,INC.
ADDRESS CITY STATE ZIP CODE
8016 Old County Ro d 54 New Port Richey FL 34653
SIGNATURE DATE TELEPHONE
� 11/22I05 (727)834�140
FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces ali 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,antl/or Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number � ►
181 Bri htwater Drive, UNIT No.4
��N 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 builtling diagram most similar to the building for which this certificate is being completed—see pages 6 antl 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 ne�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 and/or equipment servicing the builtling 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-
issuetl BFE)or Zone AO must sign here. The stafements 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
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The loca offiCial who iS 3uthOr�zed by,taw 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)ard sign below.
G1.�The ir;��rmation i�Section C wa�taken from other documentation that has been signed and embossed by a licensed surveyor,engineer,or architect who is authorized by state
vr local law to ce�trfy e!cvaticr�nforrriatlon. (Indicate the source and date of the elevation data in the Comments area below.)
G2.❑A commu�ity o�iUal completed Sec,�tion E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0.
G3.0 The follov✓ing information(Iteris G4-G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED
G7.This permit has been issued for: 0 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 builtling site is: _._ft.(m) Datum:_
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE NOV 2 2 2�5 DATE •
COMMENTS DE1/ QPM� 'r ��^4�'
CITY OF C;I F�R►n�n-rc�
. ,�,«
❑Check here if attachments
FEMA Form 81-31,January 2003 Replaces all previous editions
. FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
. t 'O r�i �i►��"� '� NATIONAL FLOOD INSURANCE PROGRAM
�1 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.4
BUILDING STREET ADDRESS(Induding 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 4,VILLA DEL SOL OF CLEARWATER P.B.128,PGS.28-29
BUILDING USE(e.g.,Residentiai,Non-residential,Addition,Accessory,etc. Use a Comments area,'rf 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-� PiNEw+s FLORIDA
B4.MAP AND PAN � (� 67.FIRM PANEL 69.BASE FLOOD ELEVATION(S)
NUMBER 65.SUFFIX 66.FI M IND DATE EFFECTIVEIf2EVISED DATE 68.FLOOD ZONE(S) (Zone A0,use depih of flooding)
12103C0102 G _ , 3 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 ❑Gommunity Determined ❑Other(Descnbe): _ _
B11.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 Construc�on' �Finished Construdion
'A new Elevation Cerhficate 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,ARIA,AR/AE,AR/A1-A30,ARIAH,AR/AO
Complete Items C3.-a i below according to the buiiding 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 Sec6on G,as appropriate,to document the datum conversion.
Datum NAVD 1988 Conversion/Comments (1929)4.981�1988�.191=0J7
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 endosure) 5.0 . FT ft.(m) � �.
� Y �.:
o b)Top of next higher floor 14.94 . FT ft.(m) `�
-o !-..� ' x �
o cJ Bottom of lowest honzontai structural member(V zones only) N/A . FT ft.(m) y� ,: �`
o d)attached garage(top of block) 5.0 . Ff ft.(m) �� �° ."'�� .
o e)Lowest elevation of machinery andlor equipment W� : -
� � t� ' �.
servicing the building(Descnbe in a Comments area) 11.0 . FT ft.(m) �m
�
o �Lowest adjacent(finished)grade(LAG) 4.5 . FT ft.(m) z'N a �. ,,�. `°
o g)Highest adjacent(finished)grade(HAG) 4.7 FT ft.(m) � ' ��� 11/22/05�. '
o h)No.af 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 CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorizetl by law to certify elevation information.
I cerfify thaf the information in Secfions A,B,and C on this cerfificate represents my best efforts to interpret fhe data available.
1 understand that any false sfafemenf may 6e punishable by fine or imprisonment under 18 U.S.Code,Section 1001,, ;;-_
CERTIFIER'S NAME LICENSE NUMBER . ,
BRUCEA.KLEIN � `- P��{5952,�.. ���
ss
�TITLE COMPANY NAME � �
PRESIDENT 1�EIN&STAUB SURVEYWG INC �"'
ADDRESS CITY STATE ZIP CODE
8016 Old County Ro d 54 New Port Richey.. . FL _; 34653
SIGNATURE DATE ' �� � . �EI.�PHONE
c 11/22I05 : (727)8348140
FEMA Form 81-31.Januarv 2003 See reverse side for continuation. Reolaces all orevious editions
IMPORTANT: In these spaces,copy the corresponding information from Section A. Forinsurance 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.4 ,
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),compiete 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(chec;k one)the highest adjacent grade. (Use
natural grade,if available).
E3.For Building Diagrams 6-8 with openings(see page 7),the ne�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 and/or equipment serviang 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 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 Sec�tions A,B,C(Items C3.h and C3.i onty),and E for Zone A(without a FEMA�ssued or community-
issued BFE)or Zone AO must sign here. The sfatemenfs in Sections A,B,C,and E are correcf to the best of my knowledge. •
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CIIY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
❑Check here if attachments
;,. " SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The loca n�'icial who is�uthorized by�-�aw 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)an�sign below.
G1.Q T��e irt�brmatior.in SeGtion C w�ta�Cen from other documentation that has been signed and embossed by a licensed surveyor,engineer,or architect who is authonzed by state
?;�r IocU�law to ceRify.e'tivaticer�nfor�iatlon. (Indicate the source and date of the elevation data in the Comments area below.)
G2.❑A commurity ofiUal completed Sec.-tidn E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0.
G3.❑The following information(Iterris�4-G9)is provitled for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED
G7.This permit has been issued for: ❑New Construction ❑Substantial Improvement
G8.Elevation of as;built lowestfloor(including basement)ofthe building is: _._ft.(m) Datum:_
G9.BFE or(in Zone AO)depth of flooding at the builtling site is: _._ft.(m) Datum:_
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE �Q�/ 2 2 �� DATE !
COMMENTS DEVEi c�pM���,- ovn�,
CITY OF CLEI�F?�n►n-rC�
❑Check here if attachments
FEMA Form 81-31,January 2003 Replaces all previous editions
� �*�,�'�.�f f.z
���` C ITY OF C LEARWATER
�$a�� S j �� .
� � �� � �ua5�+�
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�>�-� ��_�� ��= -" DEVELOPMENT 8r NEIGHBORHO(�D SERVICES DEPARTMENT
�,�
,''� `i '-,. POST�FFICE BOX 474g� CLEAf2WATER� F�o�DA 33758-4748
�` � MUNICIPAL SERVICES BUILDING, ZOO SOUTH MYRTLE AVENUE,CI.FARWATER,FLO�unn 33756
TELEPxorrE (72'� 562-4567 Fnx(72� 562-4576
MEMO OF REVIEW FOR CORRECTNESS 8� COMPLETION
In accordance with participation in the NFIP/CRS program, all elevation certificates are required to be reviewed for correctness and completion prior to
acceptance by the community. This complete form shall be attached to all elevation certificates maintained on file and provide with requested copies of
elevation certificates.
The attached elevation certificate requires corrections by the surveyor of section(s) prior to acceptance by the community
The attached elevation certificate is complete and correct
X Minor corrections have been made in the below marked sections by Community Official
SECTION A-PROPERTY INFORMATION For Insurance Company Use:
A1. BUILDING OWNER'S NAME Policy Number
A2.BUILDING STREET ADDRESS(including Apt., Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
CITY STATE ZIP CODE
A3. PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legai Description,etc.)
A4. BUILDING USE(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)
A5. LATITUDE/LONGITUDE(OPTIONAL): HORIZONTAL DATUM: SOURCE:❑GPS(Type):
(##°-##'-##.##" or ##.#####°) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map❑Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
1.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME B3.STATE
64.MAP AND PANEL B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER g5.SUFFIX B6.FIRM INDEX DATE EFFECTIVE/REVISED DATE B$•FLOOD ZONE(S) �Zone AO,use depth of flooding)
12103C0102 5/17/2005
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)
B11. Indicate elevation datum used for BFE in B9: ❑ NGVD 1929 ❑ NAVD 1988 ❑ Other(Describe)
612. Is the building located in a Coastal Barrier 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.
C2. Building Diagram Number (Select the building diagram most similar to the building for which this ceRificate is being completed-see pages 6 and 7. If no
diagram accurate�y 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:
�elevation certificafes shall be main�ained 6y the communify and copies with the attached memo made availab/e by request
FRANK HIRRARD,MAYOR
GEORGE N.CRE'CEKOS,COUNCILMEMBBR JOIIN DORAN,COUNCILMEMRER
PAUL F.GIBSON,COUNCILMEMBER � CARI.BN A.PE7'ERSEN,COUNCIL�fEMBLR
��EQUAL EMYLOYMEN'f AND AFFIItMATIVE AC170N EMNLOYEft��
�C��q a��5/—�:� 1� 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.4
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX N0. Company NAIC Number
181 Brightwater Drive
CITY STATE ZIP CODE
CLEARWATER FLORIDA 33767
PROPERTY DESCRIPTION(Lot and Blodc Numbers,Tax Parcel Number,Legal Description,etc.)
Lot 4,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 COMMUNIN NAME&COMMUNIN NUMBER B2.COUNIY NAME B3.STATE
City of Clearwater 125096- PINELLAS FLORIDA
64.MAP AND PANEL B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX 66.FIRM INDEX DATE EFFECTIVEIREVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depth of flooding)
12103C0102G G SEPTEMBER 03,2003 SEPTEMBER 03,2003 AE EL.11.0
610.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Describe):_
B11.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 Resoum,es 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.
•C2.Building Diagram Number 7 (Select the building diagram most similar to the building for which this cerhficate 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,ARIA1-A30,AWAH,ARIAO
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 ConversioNComments (1929)4.981-(1988)4.191=0.77
Elevation reference mark used tABINS 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) � °'�;�$ �� �,'g� `'+r
o b)Top of next higherfloor 14.94 . FT ft.(m) � .�:;a"���,�� ��• ��`f
o c)Bottom of lowest honzontal structural member(V zones only) N/A . FT ft.(m) N� .;�. 4"� �:,��
o d)attached garage(top of block) 5.0 . Ff ft.(m) �� ;�> >'� ��� - °• ',
o e)Lowest eleva6on of machinery and/or equipment W� �, �' �� �1l .� .v! ` --
� ` . 1�• .,,
serviang the building(Descnbe in a Comments area) 11.0 F=f ft.(m) �� � � " '� �'�; � �=
o fl Lowest adjacent(finished)grade(LAG) 4.5 . Ff ft.(m) z'� ' ,�� �,��''" �� ,�
o g)Highest atljacent(finished)grade(HAG) 47 FT ft.(m) � r�,+`����R' � 5,.�5�; , '�
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 6 � i M t, ��F
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 information in Sections A,B,and C on this cerfificate represents my best 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 KLEIN&STAUB SURVEYING,INC.
ADDRESS CITY STATE ZIP CODE
8016 Old County Road 54 New PoR Richey FL 34653
SIGNATURE DATE TELEPHONE
05/26/05 (727)834�140
A 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 insurance company use:
BUILDING STREETADDRESS(Induding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number , <
181 Bri htwater Drive, UNIT No.4 � . � �
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 agent/company,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(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 adjacent
grade. Complete items C3.h and C3.i on front of form.
E4.The top of the plaiform of m�hinery 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 ortlinance?
❑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 stafements in Sections A,B,C,and E are cor�ect to fhe 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 onicial wh�is authonz�J by laar c;ordinance to administer the community's flootlplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation
CeRificae. ComF;ete th°applicable i!e�T(s)and sign below.
G1.�The informa�io�in Sactier�:wa:,taken from other documentation that has been signed and embossed by a licensed surveyor,engineer,or architect who is authorizetl by state
or local law to ce;Gfiy elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
G2.❑A community�ffiaal completed Section E for a building located in Zone A(without a FEMA-issued or communily-issued BFE)or Zone A0.
G3.�The fo!lo��ing informar,r�(ItF+rns 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-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
3
COMMUNITY NAME TELEPHONE ,,y,j� ""
SIGNATURE DATE k�r;� ' •
��'� � � �dQS �
COMMENTS
N-^�9/��..� P�1 L'�!�i f![�'''ti I"Y' ['�t r�gr.
��e�S-C.7'B—i Va C.�,.,_r.�,���'�.o+�.�
�'1 T�'--C�l-F���l�,�,�n���—
❑Check here if attachments
FEMA Form 81-31,January 2003 Replaces all previous editions