175 BRIGHTWATER DR • 4 � �° � ' '-�• � �� ��ERAL EMERGENCY MANAGEMENT AGENCY
O.M.B. No. 3067-0077
, � - NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002
t��:,���.���>>,,a, � uf�v���RM�N�rLEVATION CERTIFICATE
� � �,S Im ortant: Read the instructions on a es 1 -7.
�,,i'y u:r C��A�2WATEf�ECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use: -'
BUILDING OWNER'S NAME Policy Number '
RENEE D. LENART
17���B R I GHT AT E R D R I�V E uding�4pt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. CompBny NAIC Number.
CLEARWATER BEACH FL.� 346�U�E
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description etc.
JNITS 104THRU 106 gRIGHTWATER ON THE BAY CONDOMINIUM AN� U ITS 204 THRU 206
BUILDING USE(e.g.,Residentiai,Non-residential,Addition,Aocessory,etc. Use Comments section if necessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: �GPS(Type):
( ##°-##'-##.##" or ##.�#' LI NAD 1927 L�NAD 1983 L�USGS Quad Map u Other:
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME 8 COMMUNITY NUMBER B2.COUNTY NAME B T
CITY OF CLEARWATER 125096 PINELLAS L A
64.MAP AND PANEL 85.SUFFIX B6.FIRM INDEX B7.FIRM PANEL BS.FLOOD B9.BASE FLOOD ELEVATION(S)
NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use depth of flooding)
125096-0007 D 8-19-91 8-19-91 AE 11
610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in 69.
U FIS Profile �X �FIRM U Community Determined �Other(Describe):
611. Indicate the elevation datum used for the BFE in B9:�NGVD 1929 U NAVD 1988 LJ Other(Describe):
612. Is the building located in a Coastal Barrier Resources System(CBRS)area or Othervvise Protected Area(OPA)? �J Yes �j No
Designation Date:
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
•. Building elevations are based on: L�Construction Drawings' �JBuilding Under Construction* �X�Finished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
C2.Building Diagram Number 1 (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 C3a-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 M.S.L. Conversion/Comments '
Elevation reference mark used D-2 EL=4.757 Does the elevation reference mark used appear on the FIRM?,<.;��Yes ����No
0 a)Top of bottom floor(inGuding basement or enclosure) 5 49 g.�m� A � _ < �- "'—� r
❑ b)Top of next higher floor N/A._ft.(m) `� � ; ��� • � '
❑ c)Bottom of lowest horizontal structural member(V zones only) N/A._ft.(m) �o '$' ' :'�� ' " ;;� - .-'` °" "
� ❑ d)Attached garage(top of slab) N/A•_ft•(m) E g -;` � : -_ ;:', , `�- l
❑ e)Lowest elevation of machinery and/or equipment N/A W,� ;j ��°1 ? _ � ;; ��+. ;
r
servicing the building ft.(m) E� , "��°' ,'.. �` ` p � "� '" �
❑ fl Lowest adjacent grade(LAG) 5 . 1 ft.(m) z'� ' �,��; ° .� � ,q p,,..�"� .,�-' � �
O g)Highest adjacent grade(HAG) 5 . 3 ft.(m) � � r ,�, i�c� •
D h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade N A � �' , :
❑ i)Total area of all peRnanent openings(flood vents)in C3h N/A sq.in.(sq.cm) #2' 1 � 11-21-00
�
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.
1 certify that the informa6on in Sec6ons A, 8, and C on this certificate represents my best efl'orts to inte►pret the data available.
I understand that any false statement may be punishable by fine orimprisonment under 18 U.S. Code, Section 1001.
CEORGERA.�SHINIP II �ic�n���NUMBER
��E�SIQENT GEOf�P�NYS�P II & ASSOC. INC.
��3�1�E UESOTO BLVD. PALf��-�IARBOR ST�TE �����E '
s� . � y --�! �OB#000734 11°i��-00 7�'E����E
FEMA Form 81-31,A G 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
i .
IMPORTANT: In these spaces,copy the corresponding information from Section A. Forinsurance Company�se` -
BUILDING STREET ADDRESS pnduding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Policy Number ' ' �
175 BRIGHTWATER DRIVE
ATE DE Company NAIC Number
CLEARWATER BEACH F�I. 3�g��
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
�_� Check here if attachments �
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(1MTHOUT BFE)
For Zone AO and Zone A(without BFE),complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting
informa6on 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 enGosure)of the building is � � I ft.(m)LL�in.(cm) L�above or (J below
(check one)the highest adjacent grade.
E3. For Building Diagrams 6-8 with openings(see page 7),the next higher floor or etevated floor(elevation b)of the building is
LL)�•(m)W�n.(cm)above the highest adjacent grade.
E4. 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 I Unknown. The local official must certity 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,and E for Zone A(without a FEMA-issued or
community-issued BFE)or Zone AO must sign here.
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 offiaal who is authorized by law 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)and sign below.
G1. L�The information in Sedion C was taken from other documentation that has been signed and embossed by a licensed surveyor,
engineer,or architect who is authorized by state or local law to certifir elevation information. (Indicate the source and date of the
elevation data in the Comments area below.)
G2. U A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or
Zone AO.
G3. U The following information(Items G4-G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPIIANCE/OCCUPANCY
ISSUED
G7.This permit has been issued for: ��New Construction L�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 �
IJ Check here if attachments
FEMA Form 81-31,AUG 99 REPLACES ALL PREVIOUS EDITIONS