200 BRIGHTWATER DR UNIT 6 & 7 g�'"�""°"�'",����� n�7 � �� FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
i � I� LI NATIONAL FLOOD INSURANCE PROGRAM
` � � ` \ ELEVATION CERTIFICATE E x p i r e s D e c e m b e r 3 1, 2 0 0 5
t � .
` I �a JUL � 4 t003 ; !
Importar►t: Read the instructions on pages 1-7.
SEC110N A-PROPERTY OWNER INFORMATION For lrisurance Comparry Use:
L�. Policy Number
. ..�IT�:�(2.E.�.�����:,.SN� _..
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,andlor Bidg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
,�G�� BRIGHNVATER DRIVE � T ,
��N STATE ZIP CODE
CLFARWATER, FLORIDA 33763
PROP�RTY DESCRIPTION(Lot and Block Numbers,Tax ParcN Number,Legal Description,etc.)
LO7 (G, OF THE PLAT OF"BRIGHTWATER TOWNHOMES",PAT BOOK 126,PAGES 65&66
BUILDING USE(e.g.,Residential,Non-residential,Addfion,Accessory,etc. Use a Comments area,if necessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):
( �/#°-##'-##.##" or ##.##f1#f#� ❑NAD 1927 ❑NAD 1983 �USGS Quad Map ❑Other:
SECTION B-FLOOD INSURANCE RATE MAP(FIRN�INFORMATION
B1.NF�P COMMUNfiY NAME&COMMUNITY NUMBER B2.COl�1TY NAME 83.STATE �
CffY OF CLEARWATER 125096 PtNELLAS COUfVTY FLORIDA
B4.MAP AND PANEL B7.FIRM PANEL 69.BASE FLOOD ELEVATION(S) ��
NUMBER B5.SUFFIX B6.FIRM It�EX DATE EFFECTIVE/REVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depth offlooding) N
1�0007 D AUGUST AUGUST 19,1991 AE EL.11.0 �
B10.Inc�cate the source of the Base Floai Elevation(BFE)data base flood depth entered in 69. N
❑FIS Profile XXX FIRM ❑Canmunity Determined ❑Other(Descnbe): �
B11.Ind�cate the elevation datun used for the BFE in B9:�NGVD 1929 ❑�IAVD 1988 ❑Otl�er(Desaibe): J
612.is ihe bu�c�ng la;ated in a Coashai Bamer R�Systern(CBRS)�ea a Otherwise Prote�ted Area(OPA)? ❑Yes ❑No Designation Date V,1
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) �_
C1.Bui�ing elevations are based on:�Construction Drawings" ❑Buildng Under Construction* XXX Finist�ed Construction
'A new Elevation Certificate wiU be requved when caistruction of fhe building's canplete.
•2.Buildng Diagam Nunber_ (Select the builcing d�agam most san�ar to the builcing for which this certificate is being canpleted-see pages 6 and 7. If no ciagam
�t�y re�r�r,�tn�b�ad�r�,provide a skeb�h or photcx�raph.)
C3.Elevations—Zones A1 y430,AE,AH,A(wiih BF�,VE,V1 V30,V(v�lh BFE�,AR,ARlA,AR/AE,AR/A1-A30,AR/AH,AR/AO
Car�lete ftems C3.-a-i below accord�ing to the bu�dng ciac�n specfied in Item C2.Statate tl�e datrim used.If tt�e dattun is cifferer�from the datum used for the BFE in
Section B,conv�t the daium to that used for ihe BFE.Shaw field measurements and dahm corniersion calculation. Use the space provided or ihe Corrmertls area of
Section D or Section G,as approfxiate,to doctanent the daium conversion.
Dahm NGVD 1929 ConversionlCommenfs N!A 9 ,, , � .
-,� : i
Elevation reference mark used No.155.EL.4.981 Does Uie elevation reference mark used app�on the FIRM? ❑Yes XX No -
�4 1
a)Top of botttan fioa�{ncluding basemerrt or enclos�ue) 6. 50 ft(m) � ,� ,� � ;i
b}Top of next higher floa� 15. 90 it(m) ' � 'w�° -�tii 4� �, �: ` . _
c)Bottcm of lowest horQOr�tal structural memb�(U zones ony) IWA. _ft(m) N°' 'i o-s"� "` �` ..
c�Attached 9arage(toP of slab) 6. 50 ft(m) E° . »' _` ��a r _ �.
e)Lowest elevation of machinery andbr equ�xxnent �� � .� �` �... -
se�vicing the buildmg(Desaibe in a Carnnents area) N/A._ft(m) �� �"�R��A. K�I1� ,
�Low�est adjacer�(firushe�gade(LAG) 6. 0 ft.(m) z m , ., � .
9)�9�adjacent(finst�ed)9ade(HAG) 6. 2 ft.(m) �� ���`�` „�(3 2fQ3,
h)No.o f permanen t openings(fl o o d ven l s)w i�nn 1 i t a b o v e a d jacent gade 14 � - - �' � �
J
)To41 area of aa permanent openings(flood ver�)in C3.h 632 sq.in.
SEC110N D-SURVEYOR,ENGINEER,OR ARCHITECT CERTiFICATION
This ce�ification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certif�+elevation information.
� I certify that the informafion in Secfions A,8,and C on fhis certificate represenfs my best elforts to interpret fhe data available.
1 understand fhat any fatse stafement may be punishab/e by fine or imprisonmenf under 18 U.S.Code,Secfion 1001.
CERTIFIER'S NAME LICENSE NUMBER
BRUCE A KLEIN PLS 5052
T� COMPANY NAME
•PROFESSIONAL SURVEYOR&MAPPER KLEIN&STAUB SURVEYING,INC.
���� ��N STATE ZIP CODE
8016 Old County Roa�54 New Pat Riche� FLORIDA 34653
SIGNATURE ` � DATE TELEPHONE
� 07/12/.03 (72�834-8140
IMPORTANT: In these spaces,copy the corresponding infomiation from Section A For msurance comPary use
BUILDING STREET ADDRESS(Including Apt.,Unit,Suife,anc�or Bldg.No.)OR P.O.ROl1iE AND BOX N0. Foli�!Number �
BRIGHTWATER DRIVE
CITY STATE ZIPCODE ComparryfVAlCNumber
CLEARWATER FLORIDA 33763 •
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTlNUED)
Copy both sides of if�is Elc�ration Certificate for{1)camiunity offiaal,(2}insurance agenbcomparry,and(3)twilding owner. •
COMMENTS
N/A
❑Check her�'rf att�achments
SECTION E-BUILDING ELEVA710N INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A tWITHOUT BFE)
For Zone AO and Zone A(without BFEj,complete Items E1 through E4. If!he Elevation Ce�tificate is intended for use as supporting ir�amation for a LOMA or LOMR-F,
S�tion C must be carpleted
E1.Builcing Diagam Nu�er_tSelect the buildng diagam most sirniiar to the buil�ng for which this certificate is being ctxrpl�ed–see pages 6 and 7. If no cfiagram accurately
reExesents the bu�d�ng,provide a sketch or photog�h.)
E2.The bp of ihe bottan floor(nclucing basement or endosure)of the builcing s _ft(m)_in.(an)�abwe or ❑below(check one}the highest adacent gade. (Use
nat�al gade,if availabie).
E3.For BuikGng Diac�ams 6-8 with openir�gs{see page�,the next M�er floor a eleva�d floor(elevation b)of the buildng is _ft(m)_in.(an)abwe the highest ac�acent
gade. Cornpl�e iterr�s Ci.h and C3.i on front of fam.
E4.The bp of the piatfarn ofnrachinery ancYor equipment servicing the budding is _#t(m)_in.{an)❑abwe or ❑bdow(check one)the highest adjacent grade. (lk�
nahxal grade,'rf available).
E5.For Zone AO ony: If no flood depth n�nber is avail�le,s the top of the bottan fba elevated in accor�arxe vuilh tlie canmunily's floodpiain managernent a c6nance?
❑Yes ❑No ❑Unknown. The local ofiaai must certity Uus irifamation in Section G.
SEC110N F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFlCATION
The properiy�vner or owners author¢ed re�xeser�ative who canpletes Sections A,B,C Q�rns C3.h and C3.i or�y),and E for Zone A(without a FEMA-issued or corrununii�r-
issued BFE}or Zone AO must sign here. The sfaferne�in Sedions A,8,C,avd E are conec�t to the besf ofmy knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZFD REPRESEPlTATNE'S NAME •
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMME(�ITS
❑Check here"rf attachments
SECTION G-CONNUIUNITY INFORMATION(OPTIONAL)
The local official who is author¢ed by!aw a ordinance to actnir�ster ihe commumly's flooc�lain ma�gement orc�nance can complete Sections A,B,C(or�,and G of this Elevation
c�te. complet�the appacab�e iien,(s)and sign below.
G1.d The infama"u n in Szction C tnes taken irom�her docunerdation that has been signed and ernbossed by a licensed s�veyor,engineer,or archi�ct vuho is author¢ed by state
or Ioc�J law to artify elev�ation irn`amation. Qt�cate tl�e source and date of the elevation data in the Corrmienis ar�below)
G2.❑A canmimily olf�al canplet�i Section E for a bu�g located in Zone A(without a FEMA�ssued or communiiy-issuerJ BFE}or Zone A0.
G3.0 The folbwing ir�a�;ration((tars G4G9)is provided fa carrnunity flooc�lain managarier�purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY ISSUED
G7.This permit has been issued for.�New CorsbUC6on ❑Substantial Impraement
G8.Elevation�as-built lowest floa(nduding���the builcing is: __ft{m) Dahm:
G9.BFE or(n Zor�e AO)de{�th of floodng at the builcing site is: __�tm� da�:—
LOCAL OFFICIAL'S NAPAE TITLE
COMMUNITY NAPAE TELEPHQt�
SIGNATURE DATE �
COMMENTS
i - (�' FEDERALEMERGENCY MANAGEMENT AGENCY
'�` �`�' � � �I � E - NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077
�) � - � , � Expires December 31, 2005
ELEVATION CERTIFICATE
'�U� � � Z�03 ' ' Importar�t: Read the instructions on pages 1-7.
! SECTION A-PROPERTY OWNER INFORMATION Fof lnsurarxe Canpary use:
At�� Policy Number
..�_►iY�QF.G...t,�.,�. - -
~ BUILDING STREET ADDRESS(Including Apt.,Unit,Sude,andJor Bidg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
��� BRIGHTWATER DRIVE hi �--�
CITY STATE ZIP CODE
CLEARWATER, FLORIDA 33763
PROP�RTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
LOT � OF THE PLAT OF"BRIGHTWATER TOWNHOMES",PAT BOOK 126,PAGES 65&66
BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,if necessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(1'ype):
� #�°_��-�.� o� �.�p#q#°� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SEC110N B-FLOOD INSURANCE RATE MAP(FlRN�INFORMATION
81.NRP COMMUNfTY NAME&COMMU(�UTY fVlAu16ER B2.COIA�ITY NAME 83.STATE �
CffY OF CLEARWATER 12`.�096 LLAS COUNTY FLORIDA
B4.MAP AND PANEL B7.FIRM PANEL 89.BASE FLOOD ELEVATION{S) N
Nl�viBER 85.SUFFIX � 66.FIRM If�DEX DATE EFFECTNE/REVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depth offloodng) �y
12509G-0i)07 D AUGUST AUGUST 19,1991 AE EL 11.0 G
610.Incicate the sax�e of Uie Base Flood Eledatia� �dat� base ente�ed in B9. N
❑FIS Profile XXX FIRM ❑ ined ❑Oth�(De�nbe):_ �
B 11.Indcate the eledation dahm used for tlie BFE in 69:�NGVD 1929 ❑NAVD 1988 ❑Other{Desaibe):_ df
612.Is the bud�ng 1oca�d in a Coastal Barri�Reso�aces S��stan(CBRS)�ea a Otl�wise Pro#eded Area{OPA)? ❑Yes ❑No Designation Date_ 4i
SECTION C-BUILDING ELEVATION INFORMATiON(SURVEY REQUIRED) �
G
C1.Building elevations�e b�ed on:�Constixtia�Drair,nrx�s' ❑Buildng Uncier Construction* XXX Fnished Construction
'A new Eleration Certifica�wi�be rec�i�ed when constrix�on of tlie bu�ng s canplete.
� 2.Buildng Diag�n Nur�ber_ (Select the buiking d�agarn most sin�to the builcing for which ttus certificate is being car�pieted-see pages 6 and 7. If no ciagam
acauately represenis the buik�ng,provide a sk�h or photograph.)
C3.Elevations-Za�es A1-A30,AE,AH,A(wiih BFE),VE.V1-N30,V(v�atli BFE),AR,AWP4 AR/AE.ARIA1-A'30,ARlAH.AR/AO
Complete ftems C3.-a-i below accorcfux�to tlie buking ciagarn specified in Item C2.State ihe datran used.If tt�e daf�n is cifferer�fran the datrari used for ihe BFE in
Section B,convert the datum to ttrat used for the BFE.Show field rr�anents and daiun corrversion calalation. llse the space pravided or ihe Corrmer�s area of
Section D or Sectiai G,as appropriate,to docuner�ttie dahim conversion.
�:.t.
Dahm NC�"VD 1929 CortuersiorJCanrr�enis t�YA
� ,:
Elevation reference mark used No.155.EL 4.981 Does the ele�ation r�rence mark used appear on the FIRM? ❑Yes XX No
a}Top of boGan floor(nciudng bas�nertt or enciosure) 6. 50 ft(m) � ..:
b)Top of next higher floor 15. 90 R(m) � �' ' ' . -
c)Bottcm of lowest hor¢or�tal struch�ral rr�ernb�(Vzones onty) WA._ft.(m) o o � e� ' "
�Attached garage(top of slab) 6. 50 ft(m) E� - 1 -'
e)Lowest elevation of machrc�ery and/or equryxnent W m
rci � ,�-,
serviang the buiic�ng(Descnbe in a Carvnenls ar�) WA._ft(m) E� �BRU�^E A. K`LEI IV
�Loavest adacent(finishec�gade(I.AG) 6. 0 ft(m) ��
9)F6ghest adj2c;ent{finist�gade(HAG) 6. 2 R(m) � .--07!12l03
h)No.of pamanent openings(flood v��)v,rtftnn 1 ft above ac�acer�t gade 14 � -
)Total area of aM permanent apenings(f�od ver�)in C3.h 632 sq.in
SECTION D-SURVEYOR,ENGINEER,ORARCHITECT CERTIFICATtON
This certifica6on is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.
� 1 certify fhat the informafion in Sections A,8,and C on fhis cer5ficate represenfs my best efforfs fo interpret fhe data availab(e.
I understand thaf any fa�se statement may be punishable by fine or imprisonmenf under i8 U.S.Code,Section 1001.
CERTIFIER'S�IAME LICENSE NUMBER
BRUCE A KLEIN PLS 5052
TfTLE COMPANY NAME
PROFESSIONAL SURVEYOR&MAPPER KLFIN&STAI�SURVEYING,INC.
RDDRESS CITY STATE ZIP CODE
� 8016 Old County Roa�54 New Pat Richey FLOWDA 34653
SIGNATURE � DATE TELEPHONE
• 07/12/.03 (12�834-8140
IMPORTANT: in these spaces,copy the corresponding infomiation from Section A F«irsurance comPary use :
BUILDING STREET ADDRESS(Inclu�ng Apt.,Un�,Staie,and�a Bki�.No)OR P.O.ROIfiE AND BOX N0. Polic,y.Number � . '
BRIGHTWATER DRIVE
CITY STATE ZIPCODE ComparryNAIC.N�rnber `
CLEARWATER FLORIDA 33763
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTiFICATiON(CONTINUED) - •
both sides�this Elevation Certificate for 1 conmun oifiaal, 2 insurarxe a nU `
�PY �) dY � ) 9e �PanY,and(3)buildng owner.
. ;
COMMEfVTS
WA
❑ Chedc here if att�acctunents
SECTION E-BUILDING ELEVATION INFORMATtON(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONEA(WITHOUT BFE�
For Zone AO and Zone A(without BF�,canple�Items E1 through E4_ If tlie Elevation Ce�tificate is in�nded for u�as suppating information for a LOMA or LOMR-F,
Section C must be canpleted
E1.Builcing D�agarn N�rr�ber_(Seled the build�ng deg�n most sir�lar to the build�ng forwf�ch ihis cettificate is being compi�ed—see pages 6 and 7. If no ciagrarn aocuratety
represen�the bu�ng,provide a sketch or P�9"�-)
E2.The b�p of ihe botbxn floor(mdudng basemerrt or endosure)of the b�al�ng is _it(m)_in(an)�abo✓e or ❑bebw(chedc one)ihe highest adacent grade. (lJse
rraival gade,if av�labie).
E3.Fa Buil�ng Diag�ams 6-S with openirx,�s(see page�,the next f�floor a eleva�d floor(elevation b)of the buA�ng is _ft(m)_in.{an)abwe the hi�ad�acent
gade. Car�plete itans C3.h and C3.i on front of fam.
E4.The bp of the plattorm of machinery ancYor e�iprnent serv�ing ihe buddmg s _ft(m)_in.(an)�above a ❑below(check one)the highest ac�acent gade. (lk�e
rnat�gade.rf avaik�ble}.
E5.For Zone AO or1y: If no flood depth nur�er is av�k�ble,s the top of the bottom floa elevated in accordance with ttie carrxrwnily's floodplain management acinance?
❑Yes ❑No ❑Urdccnown. The la�l of6dal mustce�tify this irdamation in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE�CERTIFlCATION
The properiy owner or owners autlia¢ed repr�tive who canpletes Sectiors A,B,C Q�ms C3.h and C3.i or�ly),and E for Zone A(witliout a FEMA-'ssued or canm�iiy-
issued BFE�or Zone AO must sign here. The staf�nerLs in Secbons A,8,C,a�d E a�e corred fo the best ofmy knowledge.
PROPERTY OUVNER'S OR OWNER'S AUTHORIZFD REPRESEt�TATNE'S NAME
ADDRESS CITY STATE ZIP CODE �
SIGNATURE r�n?F �i�nup��
COMMEf�ITS
❑Check here if attachments
SEC710N G-CONRVIUNITY INFORMA710N(OPTIONAL)
The la:al oHicial who is aufhor¢ed by faw or adn�ce to adnirmster fhe canmuroty's flooc�lain marragerrient ord�nance can car�lete Sectiors A,B,C(or�,and G of this Elevation
Cati�cate. Corr�ete the�p6c�le dem(s)and sign belawv.
G1.�The infama`u;n in Section C was talcen irom dher doamenlation that has been si�ed and erribossed by a licer�sed s�mreyor,engincer,a ar�hitect who"s aulhor¢ed by state
or locaf lawto catify elevation infamation. (Inc�cate the sour�e and date of the elevation data in the Corrxnents az�bebw.)
G2.0 A carrurnmily olfiaal corr�pletc�f Section E for a bu8c�g loczted in Zone A(witlmut a FEMA-�sued or community-issued BFE�or Zone A0.
G3.�The foBowe�g infamation(ftar�s G4-G9)is praided for carmiurnty flooc�lain managemer�p�uposes.
G4.PFRMIT NUMBER C�.DATE PERMIT ISSUED C�.bATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED
G7.This penrMt has been issued for.❑New Cor�struction ❑s�,�i i�w�r,�,c
G8.Ele�ration of a�buift lowest floor(nduc�ng��of$ie buil�ng is: _._ft(m) Dahm:_
G9.BFE a(n Zone AO)de{�th of floodng at the buil�ng site s: __ft.(m) Dahm:_
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHO�
SIGNATURE DATE
COMMEMS
•
• •
, , r
� " '� fi `-u CITY OF CLEARWATER
4 �:,�.""E,�
� F � �a� �
. ���'"� '� DEVELOPMENT & NEIGHBORHOGD SERVICES DEPARTMENT
_� -���}� �. ,'
�A '�"• POST OFEICE BOX 4740� CLEARWATER� F�.oa�DA 33758-4748
�'�^ , r MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CI.EARWATER, FLO�uDn 33756
TELFrxorrE(72� 562-4567 F.vc(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 ceRificates maintained on file and provide with requested copies of
elevation certificates.
The attached elevation certificate requires corrections by the surveyor of sedion(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 BRIGHTWATER TOWNHOMES LLC Policy Number
A2.BUILDING STREET ADDRESS(including Apt., Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
200 BRIGHTWATER DRIVE-UNIT 6
CITY STATE ZIP CODE
A3. PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
A4. BUILDING USE(e.g.,Residentiai,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 B2.COUNTY NAME B3.STATE
64.MAP AND PANEL g5.SUFFIX B6.FIRM INDEX DATE B�•FIRM PANEL gg.FLOOD ZONE(S) B9�BASE FLOOD ELEVATION(S)
NUMBER $�18�1992 EFFECTIVE/REVISED DATE (Zone AO,use depth of flooding)
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 B9:� NGVD 1929 ❑ NAVD 1988 ❑ Other(Describe)
612. Is the buildin located in a Coastal Barrier Resources S stem(CBRS)area or Otherwise Protected Area(OPA? ❑Yes ❑No Desi nation Date
SECTION C -BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. Building elevations are based on: ❑Construction Drawings' ❑ Building Under Construction' ❑ Finished Construction
*A new Elevation CeRificate 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 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:
�levation certificates sha//be maintained by the community and copies with the attached memo made availab/e 6y request
FRANK HIftRARD,IVIAYOR
GEORGE N.CRE'fEKOS,COUNCILMEMBER JOI W DORAN,COLINCILMEMBER
PAUL F.GIHSON,COUNCILMEMRBR � CARLBN A.PE7'ERSEN,COUNCILMCMBER
��EQUAL EMYLOYMEN7'AND l�FIRMA'17VE AC7'ION EMPLOYER��
.;,n-.:"„� ,,.�,,.�,�.- _,,�..�, _ __ __ _
��q � j;� �� �� 1:.f 7-� i�
� � M�_ ":i � �, � � FEDERAL EMERGENCY MANAGEMENT AGENCY
���, v._:•=_--�-�-�.-M�—�--_•. : � ! O.M.B. No. 3067-0077
� � �; �e NATtONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
��.��. =� � t�'�� � �} ELEVATtON CERTIFICATE
. �� � �=-
a�
Importattt: Read the instructions on pages 1-7.
. p�v E�p��E t�1 5 E fi v� SECTION A-PROPERIY OWNER INFORMATION For Insurance Compary Use:
UILDI Policy Number i
BUILDING STREET ADDRESS(Including . nd,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number.
��("i BRIGHTWATER DRIVE �i�
��Ty STATE ZIP CODE
CLEARWATER, FLORIDA 33763
PROPERTY DESCRIPTION{Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
LOT � OF THE PLP,T OF"BRIGHIWATER TOWNHOMES",PAT BOOK 126,PAGES 65&66
BUILDING USE(e.g.,Residentiai,Norrresidential,Addfion,Accessory,etc. Use a CommeMs area,ff necessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HQRIZONTAL DATUM: SOURCE: ❑GPS(Type):
( ##°-#1#'-##.##" or ##.#q###� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRIII�INFORMATION
61.NFIP CaviMUNITY NAME&COMMUNITY NIR�BER B2.COUNTY NAME B3.STATE
CffY OF CLEARWATER 125096 PINELLAS COI.�JTY FLORIDA
B4_MAP AND PANEL �( 67.FIRM PANEL 69.BASE FLOOD ELEVATIIX�I(S)
NUMBER B5.SUFFIX 66.FIRM If�EX DATE EFFECTIVElREVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depth offlooding)
125096-0007 D AUGUSTa9-�99�� AUGUST 19,1991 AE EL.11.0
B10.Ind�cate the sour�e�the Base Floal Eleration(BFE�data base flood depth entered in B9.
❑FIS Profile XXX FIRM ❑Canmunity Dete�mined ❑Othe�(Descnbe):
B 11.Incicate the ele�ation datun used fa the BFE in 69:�NGVD 1929 ❑NAVD 1988 ❑Other(Desaibe):
B12.Is the buil�ng la;ated in a Coas41 Bam�Reso�ces S�stem(CBRS)area a Otherwise Proteded Area(OPA)? ❑Yes ❑No Designation Date_
SECTION C-BUILDING ELEVATION INFORNIATION(SURVEY REQUIRED}
C1.Building elevations are based on:�Consht�ction Drav,nngs* ❑Buildng Under Construction* XXX Finist�ed Construction
'A new Ele�ation Certificate wiq be required when caistruction of the butlding is complete.
•;2.Building Diagam Ntrr�ber_ (Select the builcing dagam most sin�ar to the builcing fa which ihis certificate is being completed-see pages 6 and 7. If no ciagram
accuratey reFxesenis the buading,�ro,na�a�c�n or�,otoyra�,.� �
C3.E{evations-Zones A1-A30,AE,AH,A(wiih BFE),VE,V1 V30,V(with BFE�,AR,AR/A,ARlAE,ARlA1-P30,ARIAH,ARIAO �
Corr�plete items C3.-a-i below according to I�e buildng ciagam specfied in Item C2.State the daham used.If ihe dahxn is cif�erent from the dah�m used for tt�e BFE in
Section B,cornr�t the dahxr�to that used for the BFE.Show field measuremenis and dat�m cornrersion calculation. Use the space provided or tt�e Carmertls area of U
Section D or Secfion G,as appropriate,to doarnent the dalum conversion. O
Dahm NGVD 1929 ConuersionlCanmerds N�A N
Elevation r�ference mark used No.155,EL.4.981 Does the elevation r�erence m�k used app�a�the FIRM? ❑Yes XX No � �
a}Top of bottan floor(ndudng basement or enclos�ue) 6. 50 ft(m) � , ^�:,��� h�� ���;,� ,� Ci�
b)Top of next higher floor 15. 90 ft(m) � t���4ry �`,`�Q '�;'�
c)Bottan of lowest horQOntal structural rr�rnba(V zones only) N/A. —ft(m) o Q ;1,.�3{'°°�'� +:a�� "� t
c�Aflached 9arage(toP of slab) 6. 50 ft�m) E�, a R �.� � s�'. � �,�:c^a `.y[
e)Lowest elev�ation of machinery andlor ec��ment �? �� � ` �` I
savicing the buildmg(Describe in a Canmenis ar�) N!A._ft(m) �� BRU�E A.;��� ;.:_ c� ` `°
fl Low�st adjacer�(fini�gade(LAG) 6. 0 ft.(m) �� ,`� -,��� ,� : � ,�� �~:,,
9)Hi9hest adJacent(fins�gade(HA�) 6. 2 ft.(m) � ° �� ��,�07/12/03 ��;,�"'
h)No.of permanent openings(flood ven�)within 1 ft.above adjacent gade 14 � � '� ��' `�G° �'",�,°
)Total area of aa permanent openings(flood ven�)in C3.h 632 sq.in. � �'��
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFlCATION
This ce�ification is to be signed and sealed by a land surveyor,engineer,or architect authorized by faw to certify eleva6on information.
- 1 certify fhat the informafion in Sections A,8,and C on fhis certificate�epresenfs my besf effotfs to inferpret fhe dafa available.
1 uRderstand fhat any false sfatement may be punishab/e by fine or imprisonment under 18 U,S.Code,Section 1Q01.
CERTIFIER'S NAME LJCENSE NUMBER
SRUCE A KLEIN PLS 5052
TITLE COMPANY NAME
•PROFESSIONAL SURVEYOR 8�MAPPER KLFIN&STAUB SURVEYING,INC.
ADDRESS CITY STATE Z►P CODE
8016 Old County R6ad 54 New Pat Richey FLORIDA 34653
SIGNATURE DATE • TELEPHONE
' . 07/12/.03 (72�834-8144
�
IMPORTANT: In these spaces,copy tl�e corresponding infom�ation from Se�tion A For ir�urance compary use
BUIIDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bickj.No.)OR P.O.ROIffE AtVD BOX NQ Polic,y Number � ' `�
BRIGHTWATER DRIVE
CITY STATE ZIPCODE ComparryNAlCNumber '
CLEARWATER FLORIDA 337g3
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy bafh sides of this Elevation Certificate for{1}carmunity offiaal,(2)insurance agent/canparry,and{3)buikiing owner. � , •
COMMENTS
�UA
❑Check her�if attaachments
SECTION E-BUILDING ELEVA710N INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(IMTHOUT BFE}
Fa Zone AO and Zone A(without BF�,arnplete iterns E1 Uuough E4. If the Elevation Certificate is intended for use as suppating infamation for a LOMA or LOMR-F,
Section C must be ccxrpleted.
E1.Builcing Diagam Nunber_(Select the builcfng�most similar to the buifding for which this certificate is being corrpleted—see pages 6 and 7. If no c�agram accurately
reExesents the bul�ng,prwide a sketch or photograph.)
E2.The b�p of the bot�m floor(nciucing basement or�re)of the buiking is _ft(m)_in.(an)❑abwe a ❑below(check one)the hi�est adjacent gade. (lJse
nahual gade,iF availabie).
E3.For Buil�ng Diac�rns 6-8 with openings(see page�,the next higher floor or eledated floor{elevation b)of the buikiing is _ft(m)_in.(an)abwe the highest adjacent
gade. Camplete iterns C3.h and C3.i on frorrt of fam.
E4.The fr�p of the platf�am of machinery and�or equipment senricing the bu�ding s _ft{m)_in.(an)�abwe or ❑below(check one)the highest adjacent�ade. (Use
nahar�gade,if available)-
E5.Fa Zone AO onfy: If no flood depth nunber is available,is the top of the bottan fbor elevated in accobance with the canmunity's floodplain manage�n�t a�nance?
❑Yes ❑No ❑Unknor�m. The laxl oifiaal must ce�tify this irrfamation in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFlCATION
The property owner or owners author"tzed representative who canpietes Sections A,B,C Q�rns C3.h and C3.i oniy),and E fa Zone A(witliout a FEMA-issued or canmuniiy-
issued BFE�or Zone AO must sign here. The sfaf�ne�s in Sections A,8,C,aod E�e correc�f to the besf ofmy know/eo'ge
PROPERTY OWNER'S OR OWVNER'S AUTHORIZED REPRESENTATNE'S NAME •
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
� ❑Check her�"rf attachments
_ _ SECTION G-CONHVIUNITY INFORMATION(OPTtONAI)
The la:al official who is authorQa�d tn�!aw or ordinance to ac}nir�ster the communily's flooc�lain manag�nent orc�nance can canplete Sections A,B,C(or E),and G of tltis Elevation
C�tifica�. Can�ete tt�app�le it�rn(s)and sign below.
G1.�The infamatior i��Secti�r C was taken from otl�er doc�mentation fhat has been signed and�ed by a licensed s�veyor,engine,er,or ar�hitect who is aulhorQed by state
or local lawto artify elevation i�amation. (Ind�cate the source and date of tt�e elevation data in the Canments area below.)
G2.�A�xnmunily a��al c�rr�pleted;ection E for a bu�g located in Zone A(without a FEMA-issued or oorrimuniiy-issued BFE}or Zone A0.
G3.❑The following inforrr�tion(Ite:�ns,r,4-G9)is prwided for cormiunity flooc�lain manag�nertt putposes.
G4.PERIvifT MUM6tR G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCEJOCCUPANCY 1SSUED
G7.TtHS pe�mit has been ssued for.�New Construction ❑Substantial ImFxwement
G8.Ele�ration�as-buift lowest floor(nduding basernen��the builcing is: __ft{m) Dahm:
G9.BFE or(n Zone AO)depth of floocing at the buildng site is: __ft(m) Dahm:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY��IAME TELEPHO(�
SIG�IATURE DATE •
COMMEf�lTS
_ .
� 4
��= '� `� � � C ITY OF C LEARWATER
• �� '� " DEVELOPMENT & NEIGHBORHOGD SERVICES DEPARTMENT
,.,�a.: ,
POST�FFICE BOX 474g� CLEARWATER� FLO�on 33758-4748
MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUF.,CLEARWATER,FLORIDA 3375�
TELErxorrE(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 BRIGHTWATER TOWNHOMES LLC Policy Number
A2.BUILDING STREET ADDRESS(including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
200 BRIGHTWATER DRIVE-UNIT 7
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 ##.##i7##°) ❑ 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 63.STATE
64.MAP AND PANEL 67.FIRM PANEL 69.BASE FLOOD ELEVATION(S)
NUMBER g5.SUFFIX B6.FIRM INDEX DATE EFFECTIVE/REVISED DATE B$•FLOOD ZONE(S) �Zone AO,use depth of flooding)
8/18/1992
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)
B11. Indicate elevation datum used for BFE in 69:� NGVD 1929 ❑NAVD 1988 ❑Other(Describe)
B12. Is the buildin located in a Coastal Barrier Resources S stem(CBRS)area or Otherwise Protected Area OPA? ❑Yes ❑No Desi nation 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 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 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:
�levation certificates shall be maintained by the community and copies with the attached memo made availab/e by request
FRANK HIF3HARD,MAYOR
GEORGE N.CRE7'EKOS,COUNCILMEMBGR �OIIN DORAN,COUNCILMEMALR
PAUL F.GIRSON,COUNC[LMGMB@R � CARI.EN A. PE7'ERSGN,COUNCILMGMN@R
��EQUAL EMPLOYMENT AND AFFIRMA'fIVE ACTION EMI'LOYEK��
� � � � U 1J �� . i � FEDERAL EMERGENCY MANAGEMENT AGENCY
� ��' � NATiONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077
� Expires December 31, 2Q05
' JUL 1 4 �003 � !� ELEVATION CERTIFICATE
ImportaM: Read the instructions on pages 1-7.
p�vE�ppI�ENT SEF1�� SECTIONA-PROPERT(OWNERINFORMATION FwlnsurarxeCanparryUse:
UILDt ' Policy Number
BUILDING STREET ADDRESS(Including Q,pt.,Un�uite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
�2Q� BR�GHTWATER DRIVE �f�/i f
C�T-y STATE ZIP CODE
CLEARWATER, FLORIDA 33763
PROPERTY DESCRIPTION(Lat and Block Numbers,Tax Parcel Number,Legal Description,etc.)
LOT "'� OF THE PLAT OF"BRIGHTWATER TOWNHOMES",PAT BOOK 126,PAGES 65&66
BUILDING USE(e.g.,Residentiai,Non-re�idential,AddiGon,Accessory,etc. Use a Comments area,ff necessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):
� �°_��_�.� a �.�°� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other:
SECTION B-FLOOD INSURANCE RATE MAP{FlRN�INFORINATION
61.NFIP COMMUNff Y NAME&COMMUNITY t�1MBER 82.COlA�1TY NAME 83.STATE
CfTY 0F CLEP�ftWATER 125096 PWELLAS COUNTY FLORIDA
B4.MAP Af�ID PANEL �v( W.FIRM PANEL 89.BASE FLOOD ELEVATION{S)
NUMBER B5.SUFFIX .FIRM If�DEX DAT� EFFECTNFJREVISED DATE 68.FLOOD ZONE(S} (Zone A0,use depth offloodng)
125(XJ60007 D AlK�1ST� AUGIIST 19,1991 AE EL.11.0
B10.Incicate the source of ihe Base Flood Elevation base Aood depth entered in B9.
❑FIS Profile XXX FIRM ❑Commurnty D�ermined ❑Ofh�(De�be):_
B11.Indicate the eledation datun used fa the BFE in 89:�NGVD 1929 ❑NAVD 1988 ❑Otl�er(Desaibe):—
B12.ls the twdc�ng loca�d in a Coas�l Barrier Resarces Sj�stan(CBRS)area a Otherwise Protected Area(OPAJ? ❑Yes ❑No Desic,�ation Date_
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REGIUIRED)
C1.Buik6ng elevations are based on:�Conshuction Dra�r,angs" ❑Buil��g Under Ca�strt�ctiai' XXX Finished Construction
'A new Elcvation Certificate v�G be requ�ed when cor�struction of t�e bu�ng s cariplete.
* 'Z.Buii�ng�iagarr,Nurd�er_ (select me bui�ing a�,most sir,a�to me buil�ng for wrncn tt�s ce�f cate is be;ng c«r�pleted-see pages s and 7. �f no dragrarr,
accuratey represenls tlie bu�g,proNide a ske�h a photoc,g�ph.) V�
C3.Ele�rations–Zones A1-A30,AE.AH,A(wiih BFE),VE,V1-V30,V(with BF�,AR,ARIP4 AWAE.AR/A1-A'i0,AR/AH,AR/AO �
Cornplete ftems C3.-a-i below accord�ng to the bu�ng�agarn specified in Itan C2.Siate ttie dahim used.If tt�e dahxn is cifferent fran the dahen used fa the BFE in
Section B,convert the datrm�to that used fa the BFE.Shaw field�emenis and datun carversion calalation. llse the space pravided or the Carmerds area of U
Seciion D or Secfion G,as apprnpriate.to docuneM the dahun cwiversion. �
Dahm NGVD 1929 ConversioNComments NIA N
Elevation reference mark used No.155.EL 4.981 Does the eleration reference mark used�m tlie FIRM? ❑Yes XX No J
a)Top of bottan floor(nducfing basemerrt a enciosure) 6. 50 R(m) m _ �,rJ
b)Top of next higher floor 15. 90 R(m) �' -;� ` `C
� ,��.� �
m �
c)BoBan of b�st haQOnial sUuchuai memba(Vzones onfy) N!A._ft(m) o o � :�"
d�Attached garage(toP of siab) 6. 50 ft�m) E��,� `',, <
e)Lowest ele�ration of mach�ery ar»d�or equiprnent W mr : °. r . -
ar m � ��,
serviang the bu�dmg(Describe in a Cannen�ar�) NIA._it(m) E� � BRU�E A. I�LFT1 .
�Lowe.st adjacent(finishec�gade(LAG) 6. 0 ft(m) z'm • '�. ,
m�
9)�9����fi����"��) 6. 2 ik(m) m ' 07/12/Q3' , ,_,
h)No.of pamanent openings(flood ven�)wifhin 1 it above ac�acent gade 14 J '. +�: '.`�
)Total area of atl permanent openings(flood vents)in C3.h 632 sq.in �
SECTION D-SURVEYOR,ENGINEER,ORARCHITECT CERTIFtCAT10N �
This certification is to be signed and sealed by a land surveyor,engineer,or architect author¢ed by law to certify elevation information.
- 1 certity that fhe information in Sec6ons A,B,and C on this certificafe represents my best etforfs to interpref the data available.
1 undersfand that any fakse statemenf may be punishable by fine or imprisonment under 18 U.S.Code,SecGon 1001.
CERTIFIER'S NAME LICENSE NUMBER
BRUCE A KLEIN PLS 5052
T(TLE COMPANY�lAME
PROFESSIONAL SURVEYOR&MAPPER KLEIN&STAI�SUKVEYING,INC.
ADDRESS CITY STATE ZIP CODE
• 5016 Old Couniy Rdd 54 New Pat Richey FLORIDA 34653
SIGNATURE � DATE • TELEPHONE
i� _ _ 07/12/.03 {727}834-8140
IMPORTANT: In these spaces,copy tf�e corresponding inforrnation from Section,4 Fa�reu�ance comp�ry use
BUIIDING STREET ADDRESS(Includng Apt.,Uni�Suite,and/or Bk�.No.)OR P.O.ROl1iE AfVD BOX N0. Pd�,y Number � � '
BRIGHTWATER DRIVE .
CITY STATE ZIPCODE ComparryNA�CNumber �
CLEARWATER FLORIDA 33763
SEC710N D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) � �
Copy both sides�this Ele�ration Certificate for{1)caTmunily oficiai,(2)ir�urarxe agenffcmiparry,and(3)building owner. - � •
COMMENTS
N/A
❑Chedc her�'rf att�achments
SECTION E-BUILDING ELEVAl10N INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE�
For Zone AO and Zone A(witliout BF�,canplete tterr�s E1 ihrough E4. If the Elevation Ce�tificate is in�nded for use as suppating infamation for a LOMA a LOMR-F,
Section C must be carpleted
E1.Builcing Diagarn Nunber_(Select the build�ng diag�n most sunilar t�the building for wt�ch this certificate is being carpl�ed—see pages 6 and 7. If no c�agr�n accuratefy
represenls ihe bu�ng,provide a sket�h a phobogaph.)
E2 The�p of the bot�m floor(mclu�rx,�basanent or�e)of ihe buiking is _ft(m)_in.(an)�abwe a ❑below(chedc one)the highest adacent gade. (Use
naiural grade,if availabie).
E3.Fa Buik�ng D'eg�ns 6-8 with openings(see page�,the next hi�er tbor or eleva�d floor{eleuation b)of the bu�ding is _ft(m)_in.(an)abwe the hi�ad�acent
gade. Cmipl�e itans C3.h and C3.i on front of fam.
E4.The t�p of the platFam of machinery and�or ec�pment servicing t�e buicing s _ft.(m)_in.(an)�abae or ❑below(d�edc one)the highest adacent grade. Nse
rtatrr�gade.iF avaihable).
E5.Fa Zone AO ordy: If no flood depth nunber is av�lable,s the top of the bottan floor elevated in accor�dance wilh the caTUnundy's flooc�lain managernent onir�ance?
❑Yes ❑No ❑Unkno+�m. The bcal ofiCial must certify itms infamation in Section G.
SECTION F-PROPERTY OWNER(OR OYVNER'S REPRESENTATIVE)CERTiFlCATION
The properiy owner a owners autlior¢ed representabre who car�pletes Sections A,B,C Q�ms C3.h and C3.i only),and E for Zone A(vuthout a FEMA-iss�ed or canm�ity-
issued BFE)or Zone AO must sign here. The sfateme�ds in Sc�au A,8,C,aod E are coned fo the best ofmy krrowledg��
PROPERIY OWf�R'S OR OWNER'S AUrtiORIZED REPRESEtJTATNE'S NAME
��� CITY STATE ZIP CODE ' �
SIGNATURE npTF rF�Gvunn�
COMME�lTS
❑Check here rf attachments
_ SECTION G-CONAVIUNITY INFORMATION(OPTiONAL)
The bcal of6cial who s authcVV�:d tn��aw or ar5nance to actninister ihe canmuruty's flooc�lain management orcinance can arr�lete Sections/{B,C(or E�,and G of this Elevation
CertificaL.. Cor�tf��pGc�le item(s)and si�t�low.
G1.�The mfamatior�:Sectiar C was talcen fran dher doa mentation that has been signed and a�ssed by a licer�sed siaveyor,en�neer,or ar�hi�ct who is aufhor¢ed by state
or bc�law to c�tify eleva6on infamation. (Indcate ihe sour�e and date of the elevation data rc�the carnments area below.)
G2.�A�rrgnunily a„aal�ed:'�ection E for a bu8�g located in Zone A(vaithout a fEMA-issued or oamiunity-issued BFE�or Zone A0.
G3.�The foUowing infarr�tion(Items G4-G9)is pranded fa corrmuruty flooc�lain managemertt p�uposes.
G4.PERlvlff MUMBtR C�. DATE PERMIT ISSUED G6.DATE CERTIFICATE OF COMPI IANCE/OCCUPANCY ISSUFD
G7.This pem�t has been issued for.❑New Cor�struction ❑Subshantial Imprwement
G8.Ele�ration of as-�alt bu�st floor(ndu�ng beserr�en�of ttie builcing s: __ft{m) Datun:_
G9.BFE or(n Zor�e AO)de{�th of floodng at the biald�ng site is: __{�(m? pa{�:_
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
�