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181 BRIGHTWATER DR UNIT 5 � � FEDERAL EMERGENCY MANAGEMENT AGENCY ` n NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077 . � ,,,,��o'��'j']�7 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.5 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 5,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 62.COUNTY NAME 63.STATE City of Clearwater 125096-� PINELLAS FLORIDA B4.MAP AND PANEL 67.FIRM PANEL B9.BASE FLOOD ELEVATION(S) NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVFJREVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depth of flooding) 12103C0102G G SEPTEMBER 03,2003 SEPTEMBER 03,2003 AE EL.11.0 -• B10.Indicate the source of the Base Flood Eleva6on(BFE)data or base flood depth entered in 69. ❑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 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 forwhich 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,AWAO Complete Items C3.-a-i below according to the building diagram specified in Item C2.State the datum used.If the tlatum is tlifferent from the datum used tor 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 (192914.981-(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(including 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) N/A . FT ft.(m) o o i o d)attached garage(top of block) 5.0 FT ft.(m) �� I a o e)Lowest elevation of machinery and/or equipment W� �� . seroicing the building(Descnbe in a Comments area) 11:0 . FT ft.(m) E@ � o fl Lowest adjacent(finished)grade(lAG) 4.5 . FT ft.(m) z'� o g)Highest adjacent(finished)grade(HAG) 4.7 FT ft.(m) � �� 1�/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 that the information in Sections A,B,and C on this certificate represents my best efforts fo interpref 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 BRUCE A.KLEIN PLS 5052 TITLE COMPANY NAME � ' • PRESIDENT � KLEW&STAUB SURVEYING,INC.-. ADDRESS CITY STATE ZIP CODE 8016 Old County �Vew Por#Richey FL 34653 SIGNATURE ; DATE TELEPHONE . , 11/22/05 (727)834�140 FEMA Form 81-31,January 2003 See reverse side for continuation. Repiaces all previous editions IMPORTANT: In these spaces,copy the corresponding information from Section A. For insurance compa,�use: � BUILDING STREETADDRESS(Induding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number 181 Bri hiwater Drive, UNIT No.5 �. ,r � 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,antl(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�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 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 owne�'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 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 local officiai who is author�zed by law o�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 i�formation in Section C was ta;�en from other docume�tation that has been signed and embossed by a licensed suroeyor,engineer,or architect who is authorized by state or loca!law to certiP;elevati�r�information. (Indicate the source and date of the elevation data in the Comments area below.) G2.❑A community official ccmp!�ted Sec.�tion E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0. G3.❑The failowing information!Items G4-G9)is provided for community floodplain management purposes. G4.PFRMIT 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 building site is: _._ft.(m) Datum:_ LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME < < TELEPHONE SIGNATURE DATE • COMMENTS NpV 2 2 2Q05 ❑Check here if attachments FEMA Form 81-31,January 2003 Replaces all previous editions � ; . FEDERAL EMER�ENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077 . . �t��p'�j�� Expires December 31, 2005 l 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. 5 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 5,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 125096a PINELLAS FLORIDA B4.MAP AND PANEL B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S) NUMBER B5.SUfFIX B6.FIRM IND ATE EFFECTIVEIREVISED DATE 68.FLOOD ZONE(S) (Zone A0,use depfh of floodir�g) 12103C01 � G SEP R 03,2003 SEPTEMBER 03,2003 AE EL11.0 - B10.Indicate the so ce of the Base Flood Elevation(BFE)data or base flood depth entered in B9. ❑FIS Profile �FIRM _ ❑Community 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 INFORMATtON(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 cer6ficate 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,AWAE,AR/A1-A30,AR/AH,AR/AO . Complete Items C3.-a-i below aa;ording 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�.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 enclasure) 5.0 . FT ft.(m) � •,'a'` � o b)Top of next higherfloor 14.94 . Ff ft.(m) � j��',.i�� I `- = o c)Bottom of lowest honzontal structural member(V zones only) N/A FT ft.(m) o o � J "��J � . `_� o d)attached garage(top of block) 5.0 . FT ft.(m) �-� ; , ,'��y � o e)Lowest elevation of machinery and/or equipment W� ; -.t _u- �n, : serviang the building(Descnbe in a Comments area) 11:0 . FT ft.(m) �� , , o fl Lowest adjacent(finished)grade(LAG) 4.5 . Ff ft.(m) z m �'�. �'j� � � o g)Highest adjacent(finished)grade(HAG) 47 FT ft.(m) � '�.y` •�.1/22/0�. �,^' 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 information in Sections A,B,and C on this cerfificafe represents my besf efforts to interpret fhe data available. I understand that any false sfatement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001. CERTIFIER'S NAME LICENSE NUMBER BRUCE A.KLEIN j, PLS 5052 �TITLE :COMPA�IY.NA�1�� PRESIDENT ;� KLE�N&STAIfB�IJRVEYING INC � ' ADDRESS '-:CI�'� ` STATE ZIP CODE 8016 01d County "'roew Por#Riehey �` FL 34653 SIGNATURE DATE TELEPHONE , . 11/22I05 . (727)834�140 i _. FFMA Fnrm R1-31 .lannarv 9f1(13 Saa ravPrca Siria fnr r.nntirniatinn Ranlacas all nrauinns a�iitinnc IMPORTANT: In these spaces,copy the corresponding information from Section A. For insurance compan�!ise: , � 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.5 • � 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 offiaal,(2)insurance agenVcompany,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 endosure)of the building is _ft.(m)_in.(cm)�above or ❑below(cher,k one)the highest adjacent grade. (Use natural grade,'rf 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 building is _ft,(m)_in.(cm)❑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 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 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�ssued or community- issued BFE)or Zone AO must sign here. The statements in Sections A,B,C,and E are correct fo 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-COMMUNRY INFORMATION(OPTIONAL) The local offiaai who is'author�zed by 1aw os ordinance to administer the communit�s flootlplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation Certificate. Complete the applicable i�em(s).and sign below. G1.Cj The information in S.ection C vdas t�k°n from other documentation that has been signed and embossed by a licensed surveyor,engineer,or arch�ect who is authonzed by state or loca!law to certif;elevati�ra information. (Indicate the source and date of the elevation data in the Comments area below.) G2.�A community official ccmo��ted�edion E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0. G3.❑The follow�ng information!Items G4-G9)is provided for community floodplain management purposes. G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6.DATE CERTIFICATE OF COMPLIANCElOCCUPANCY ISSUED G7.This permit has been issued for: ❑New Construdion ❑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 ! COMMENTS N�V � 7 2QQ� ❑Check here if attachments FEMA Form 81-31,January 2003 Replaces all previous editions . . . ` . � , ��,� F.. s �� $�" `� } �°�� CITY OF CLEARWATER � � F . �'�'��£ � � �� g�� °�� r DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT � ;��4 , �.., � �:,�� i£}�.,y-, ''�'""" POST�FFICE BOX 474g� CLEARWATER� FLO�DA 33758-4748 � �r,,�, MUNICIPAL SERVICES BUILDING, 1��SOUTH MYRTLE E�VENUE,CI.EARWATER,FLO�uDn 33756 TELErxorrE(72� 562-4567 Fn�c(72� 562-4576 MEMO OF REVIEW FOR CORRECTNESS 8� COMPLETION In accordance with participation in the NFIP/CRS program,all elevation certificates are required to be reviewed for correctness and completion prior to acceptance by the community. This complete form shall be attached to all elevation certificates maintained on file and provide with requested copies of elevation certificates. The attached elevation certificate requires corrections by the surveyor of section(s) prior to acceptance by the community The attached elevation certificate is complete and correct X Minor corrections have been made in the below marked sections by Community O�cial SECTION A-PROPERTY INFORMATION For Insurance Company Use: A1. BUILDING OWNER'S NAME Policy Number A2.BUILDING STREET ADDRESS(including Apt., Unit,Suite,and/or Bidg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number CITY STATE ZIP CODE A3. PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) A4. BUILDING USE(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) A5. LATITUDE/LONGITUDE(OPTIONAL): HORIZONTAL DATUM: SOURCE:�GPS(Type): (##°-##'-##.##" or ##.#####°) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map 0 Other SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 1.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME 63.STATE 84.MAP AND PANEL 67.FIRM PANEL 69.BASE FLOOD ELEVATtON(S) NUMBER g5.SUFFIX B6.FIRM INDEX DATE EFFECTIVE/REVISED DATE B$•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 69:❑ 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 simiiar 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 Ai-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 certificates shall be maintained by fhe community and coples wifh the attached memo made available by request FRANK HIAF3ARD,MAYOR GEORGE N.CRE'1'EKOS,COUNCILMEMBER JO[IN DORAN,COUNC[LMEMBLR PAUL F.GIRSON,COUNC[LMEMBER � CARLEN A.PE'PERSEN,COUNC(LMPMRER ��EQUAL EMPLOYMENT AND Af�F11tMA'I'IVE ACTION EMPLOYER�� _ _ � � � � C �`'�� 3 � � FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077 - . ' Expires December 31, 2005 � • ' y 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.5 BUILDING STREET ADDRESS(InGuding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number 181 Brighiwater Drive CIIY STATE ZIP CODE CLEARWATER FLORIDA 33767 PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Lot 5,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 COMMUNfiY NAME&COMMUNITY NUMBER 62.COUNTY NAME B3.STATE City of Clearwater 125096- PINELLAS FLORIDA 64.MAP AND PANEL B7.FIRM PANEL 69.BASE FLOOD ELEVATION(S) NUMBER B5.SUFFIX 66.FIRM INDEX DATE EFFECTIVE/REVISED 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 B9. ❑FIS Profile �FIRM ❑Community Determined ❑Other(Describe): 611.Indicate the elevation datum used for the BFE in 69:❑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 Construdion "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 forwhich this cert'rf'icate 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,AWAE,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 (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 � a, ,,,,d`�1r� o a)Top of bottom floor(including basement or enclosure) 5.0 . FT ft.(m) � w--` ��`; � � o b)Top of ne�higher floor 14.94 , FT ft.(m) �� F r o c)Bottom of lowest honzontal structural member(V zones only) NIA . FT ft.(m) o o �' "�',��j `•'.��a!�j� o d)attached garage(top of block) 5.0 . FT ft.(m) �� ;�{� _'� � ;�;�� `w , o e)Lowest elevation of machinery andlor equipment �� °, . �_� KA'"� ��% � '` " servian the buildin Descnbe in a Comments area 11.0 . FT ft.m � ' �" '�'r "�• � 9 9� ) � ) E� �i , � .,�„� � . .fi... : o fl Lowest adjacent(finished)grade(LAG) 4.5 . FT fl.(m) z�'� �r 'k�+ � �;;='•";� '" , o g)Highest adjacent(finished)grade(HAG) 47 FT ft.(m) � ��t ,�,,, QC�(z�/�5 r v;�;' o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 6 � 's�s�,��'� -.:.� � 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 the information in Sections A,8,and C on this certificate represents my best efforts to interpret the data available. I undersfand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code,Secfion 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 / � 05/26I05 (727)834-8140 FEMA 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 Bidg.No.)OR P.O.ROUTE AND BOX N0. Policy Number , 181 Bri htwater Dnve, UNIT No.5 , � ' CITY STATE ZIP CODE Company NAIC Numoer CLEARWATER FLORIDA 33767 SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) c--�r: -� Copy both sides of this Elevation Certificate for(1)community offiaal,(2)insurance agent/company,a c� i wner. ;�£ : , :.. , COMMENTS �� ITEM C3e IS ELEVATOR ' � � � � ��e�� _. U�`V"�L�PMEI'JT��\��' C�TY �F � eck here if attachments SECTION E-BUILQING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A HOUT BFE) For Zone AO and Zone A(without BFE),complete Items E1 through E4. If the Elevation CeRificate 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 certifcate 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 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 antl C3.i on front of form. E4.The top of the platform of machinery and/or equipment seroicing 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 onty: if no flootl 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 Sections A,8,C,and E are correct fo 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��5cial who is authorized by law�r ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation Certificate. Com�lete the applicable iten�s;and sign below. G1.❑The informafi�n in Section C wa��ken from other documentation that has been signed and embossed by a licensed surveyor,engineer,or architect who is authorizetl by state er lo:,al law to certi{y elevaton information. (Indicate the source and date of the elevation data in the Comments area below.) G2.❑H community offia�;compieted Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0. G3.❑The following info!mation;!tems 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: �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 � COMMENTS ❑Check here if attachments FEMA Form 81-31,January 2003 Replaces ali previous editions