140 BRIGHTWATER DR UNIT 2 �$C� ��3�'I Z`'�}t� 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.030094.2
SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use:
BUILDING OWNER'S NAME Policy Number
HARBORSIDE TOWNHOMES, LLC UNIT No.2
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
140 Brighiwater Drive
CITY STATE ZIP CODE
CLEARWATER FLORIDA 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Lot 2 OF Harborside Townhomes (P.B.127,Pgs.80-81
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 63.STATE
City of Clearwater 125096 PINELLAS FLORIDA
64.MAP AND PANEL B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTiVFJREVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depih of flooding)
125096-0102 G SEPTEMBER 03,2003 SEPTEMBER 03,2003 AE EL.11.0
B10.Indicate the source of the Base Flood Elevation(BFE)data or base floai 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 Resources System(CBRS)area or Otherw?se 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' inished 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 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,AWA1-A30,ARIAH,AR/AO
Complete�Items C3.-a-i below according to the building diagram specified in Item C2.State the datum usetl.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 N/A
Elevation reference mark used LABINS EL.=4.191 Does the elevation reference mark used appear on the FIRM? ❑Yes � s ��_� R
.mt�t'�,F,"� '�f,,• ,
o a)Top of bottom floor(including basement or enclosure) 5.49 FT ft.(m) � - s,�� ��' f,;�
o b)Top of ne�higher floor 15.67 . FT ft.(m) � =!$� °� ,�
o c)Bottom of lowest horizontal structural member(V zones only) N/A FT ft.(m) N� '�/���`�' La �
o d attached ara e to of block 5.49 FT ft.m �� { ' `t
) 9 9 � p ) � ) � � . :�� �.., ,
o e)Lowest elevation of machinery and/or equipment �� �{ :'— �' ��
servicing the building(Descnbe in a Comments area) 11.2 Ff ft.(m) �� � �� �-- � . =-
o fl Lowest adjacent(finished)grade(LAG) 5.0 FT ft,(m) z m �P +4'`�' � `�' � ' ,
o g)Highest adjacent(finished)grade(HAG) 5.1 FT ft.(m) �� �'�;� *���'48/1�[ ��;�`'�
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 14 � ��� � �
o i)Tot31 area of all permanent openings(flood vents)in C3.h 1280 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 fhat the information in Sections A,B,and C on this certificate 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
BRUCE A.KLEIN PLS 5052
TITLE COMPANY NAME
PRESIDENT KLEIN&STAUB SURVEYING,INC.
ADDRESS CITY STATE ZIP CODE
8016 Old County Ro New Port Richey FL 34653
SIGNATURE DATE TELEPHONE
_ 08/16/04 (727)834�140
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 STREET ADDRESS(Induding Apt,Unit,Suite,and/or Bidg.No.)OR P.O.ROUTE AND BOX N0. Policy Number �
140 Bri htwater Drive UNIT No.2
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 agenUcompany,and(3)building owner.
COMMENTS
N/A
❑Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zone AO and Zone A(without BFE),complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F,
Section C must be completed.
E1.Building Diagram Number_(Select the building diagram most similar to the building for which this certificate is being completed—see pages 6 and 7. If no diagram accurately
represents the building,provide a sketch or photograph.)
E2.The top of the bottom floor(induding basement or 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 accortlance with the communiry's floodplain management ordinance?
❑Yes ❑No ❑Unknown. The local official must certify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owners authorized representative who completes Sections A,B,C(Items C3.h and C3.i only),and E for Zone A(without a FEMA-issued or community-
issued BFE)or Zone AO must sign here. The statements in Sections A,B,C,and E are correct to the 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 IoC81 off�G21 who is 4uthonred by iaw cr ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation
CeRificate. Cc�nplete the applicable item(s)and sign below.
G1.�The ii�fiormatien in Section C was taken from other documentation that has been signetl and embossed by a licensed surveyor,engineer,or architect who is authorized by state
or local law to certrfy elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
G2.❑A community offiaal cam6f�:ted Ss�ion E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0.
►'
G3.❑The foll�wing information(Items G4-G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY ISSUED
G7.This permit has been issued for: �New Construction ❑Substantial Improvement
G8.Elevation of as-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 all previous editions
FEDERAL EMERGENCY MANAGEMENT AGENCY
� � NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077
Expires December 31, 2005
- ELEVATION CERTIFICATE
�Z���-'� �Impol'fant: Read the instructions on pages 1-7. JOB No.030094.2
SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use:
BUILDING OWNER'S NAME Policy Number
HARBORSIDE TOWNHOMES, LLC UNIT No.2
BUILDING STREET ADDRESS(InGuding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
140 Brightwater Drive
CITY STATE ZIP CODE
CLEARWATER FLORIDA 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Lot 2 OF Harborside Townhomes (P.B.127,Pgs.80-81
BUILDING USE(e.g.,Residential,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
61.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME 63.STATE
City of Clearwater 125096-0102 PINELLAS FLORIDA
64.MAP AND PANEL B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER 85.SUFFIX B6.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 .
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):_
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 Bartier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No Designation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUI
C1.Building elevations are based on:❑Construction Drawings" J Building Under Construction' inished Const
• 'A new Elevation Certificate will be required when constniction of the building is complete.
C2.Building Diagram Number 7 (Select the building diagram most similar to the building for which this certficate is being c -see pa s 6 and 7. If no dia
acxurately represents the building,provide a sketch or photograph.) MAY 19 2005
C3.Elevations—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AWA,ARIAE,AR/A1-A30,ARIAH,AWA�
Complete Items C3.-a�below according to the building diagram specified in Item C2.State the datum used.If the datum is d �1���f�I�B��/(�S
Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion calculation. Use tl�e��ro�'or��r���fi-E�
Section D or Section G,as appropnate,to document the datum conversion. ''• e
Datum NAVD 1988 Conversion/Comments N/A ;,st ,.���
Elevation reference mark used LABINS EL.=4.191 Does the elevation reference mark used appear on the FIRM? ❑Yes � �ti r��, �� • t;
o a)Top of bottom floor(induding basement or enclosure) 5.49 . FT ft.(m) � �' �"
..� ,.� ° -.
o b)Top of ne�higherfloor 15.67 . FT ft.(m) � `M.t�.`<,�ti� �� �,,, ,�� ,�
o c)Bottom of lowest horizontal structural member(V zones only) N/A FT ft.(m) o o � a� cr:+ ' � � >.
�� �,.,
o d)attached garage(top of block) 5.49 FT ft.(m) �� � :�, [�'.'�,. , �
o e)Lowest elevation of machinery andlor equipment �� -,l, . ° � �,.' ��.�
serviang the building(Descnbe in a Comments area) 11.2 . FT ft.(m) ?� . :I- r„vz.� „� �'�f,�'^
o fl Lowest adjacent(finished)grade(LAG) 5.0 FT ft.(m) z� �°} ' , ' �.
�`L',
o g)Highest adjacent(finished)grade(HAG) 5.1 FT ft.(m) U �;�`°`p�:�`
o h)No.o f permanen t openings(fl o o d ven ts)wi t hin 1 ft.a b ove a djacen t gr a de 1 4 J •°'A, � �Z
o i)Total area of all permanent openings(flood vents)in C3.h 1280 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 Secfions A,B,and C on this cerfi�cate represenfs my best efforts to interpret the data available.
I understand thaf 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 KLEIN&STAUB SURVEYING,INC.
ADDRESS CITY STATE ZIP CODE
8016 Old County Road New Port Richey FL 34653
SIGNATURE DATE TELEPHONE
� 05/18I05 (727)834�140
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. Forinsurance com�any use:,
BUILDING STREET ADDRESS(Induding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number � +
140 Bri htwater Drive UNIT No.2
CITY STATE ZIP CODE Company NAIC Number
CLEARWATER FLORIDA 33767
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) •
Copy both sides of this Elevation CeRificate for(1)community official,(2)insurance agenVcompany,and(3)building owner.
COMMENTS
N/A
❑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 boflom floor elevated in accordance with the communiiy's Boodplain 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,B,C,and E are correct to the best of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME •
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
❑Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The locai offici.al who is authonzed 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 appli�able item(s)and sign below.
G1.❑The informatior in Sec:tion 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 locai law to certify elevatic^.infor�ation. (Indicate the source and date of the elevation data in the Comments area below.)
G2.❑A community offiaal compiated S�:tion E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0,
G3.�The follo�ving;nfr,,;nation(items G4-G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY ISSUED
G7.This permit has been issued for: ❑New Construction ❑Substantial Improvement
G8.Elevation of as-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
❑Check here if attachments
FEMA Form 81-31,January 2003 Replaces all previous editions
c
FEDERALEMERGENCY MANAGEMENT AGENCY
, � NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077
Expires December 31, 2005
- ELEVATION CERTIFICATE
���-��—'� �Impo7fant: Read the instructions on pages 1-7. JOB No.030094.2
SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use:
BUILDING OWNER'S NAME Policy Number
HARBORSIDE TOWNHOMES,LLC UNIT No.2
BUILDING STREET ADDRESS(Induding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
140 Brightwater Drive
CITY STATE ZIP CODE
CLEARWATER FLORIDA 33767
PROPERTY'DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Desaiption,etc.)
Lot 2 OF Harborside Townhomes (P.B.127,Pgs.80-81
BUILDING 11SE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,if necessary.)
RESIDENTIAL
LATITUDE/l_ONGITUDE(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 COMMUNfTY NAME&COMMUNIIY NUMBER 82.COUNTY NAME �•�A�
CI�/Of CI881fW8te� 125096-01� PINELLAS FLORIDA
64.MAP AND PANEL ( B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUNiBER B5.SUFFIX B6. IR INDEX DATE EFFECTIVEIREVISED DATE 68.FLOOD ZONE(S) (Zone A0,use depth of flooding)
12103(A102 G , 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 F'rofile �FIRM ❑Community Determined ❑Other(Descobe):_
B11.Indicate the elevation datum used for the BFE in B9:0 NGVD 1929 �NAVD 1988 ❑Other(Describe):_
B12.Is the building located in a Coastal Bamer ResourCes System(CBRS)area or Othenvise Protected Area(OPA)? ❑Yes �No Designation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUI
C1.Building elevations are based on:❑Construction Drawings' �Building Under Construction' inished Cons
*A new Elevation Certificate will be required when construction of the building is complete.
.C2.Building Dhagram Number 7 (Select the building diagram most simi�ar to the building fa which this certificate is being -see s 6 and 7. If no di
accurately represents the building,provide a sketch or photograph.) MAY 1 9 2005
C3.Elevations–Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AWA,AWAE,AR/A1-A30,ARIAH,AR/A�
Complete Items C3.-a i below according to the building diagram spea6ed in Item C2.State the datum used.If the datum is d � B�b�C'is
Section B„convert the datum to that used for the BFE.Show field measurements and datum conversion calculation. Use t el��ro�'or������fiE R
Section D or Section G,as appropoate,to document the datum c�nversion.
Datum NAVD 1988 Conversion/Comments N/A
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) 5.49 . FT ft.(m) � ,
o b)Top of next higher floor 15.67 . F=f ft.(m) `� ,
o c)Bottom of lowest honzontal structural member(V zones only) NIA . FI" ft.(m) �� �`� -� ,.' `�`
0 0� ,
o d)attached garage(top of block) 5.49 . FT ft.(m) W� _ ``� _ _
o e)Lovuest elevation of machinery and/or equipment - -
serviang the building(Describe in a Comments area) 11.2 . FT ft.(m) �� � /� p °'L'
o fl Low��t adjacent(finished)grade(LAG) 5.0 . FT ft.(m) z� _ ;
o g)Highest adjacent(finished)grade(HAG) 5.1 FT ft.(m) � � �� :Q�/;1�/(15'�`.
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 14 � ' �`
o i)Total area of all permanent openings(flood vents)in C3.h 1280 sq.in.
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certific:ation is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.
I certify thal fhe informafion in Sections A,B,and C on this certificate 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,Secfion 1001.
CERTIFIER'S NAME LICENSE NUMBER
BRUCE A.YCLEIN PLS 5052
TITLE COMPANY NAME
PRESIDENT KLEIN&STAUB SURVEYING,INC.
ADDRESS CITY STATE ZIP CODE
• 8016 Old Couniy Road New Port Richey FL 34653
SIGNATURE DATE TELEPHONE
05118105 (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 STREET ADDRESS(Induding Apt,Uni�Suite,and/or Bidg.No.)OR P.O.ROUTE AND BOX N0. Policy Number � ,' �
140 Bri htwater Drive UNIT No.2
�m' STATE ZIP CODE Company NAIC Number
CLEARWATER FLORIDA 33767
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) r •
Copy both sides of this Elevation Certificffie for(1)community official,(2)insurance agenVcompany,and(3)building owner.
COMMENTS
N/A
❑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 fa use as suppoRing 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 endasure)of the building is _ft.(m)_in.(cm)❑above or ❑below(check one)the highest adjacent grade. (Use
natural grade,'rf available).
E3.For Building Diagrams 68 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is _ft.(m)_in.(an)above the highest adjacent
grade. Complete items C3.h and C3.i on front of form.
E4.The top of the plafform of machinery and/or equipment sennang the building is _ft.(m)_in.(cm)❑above or ❑below(chedc one)the highest adjacznt grade. (Use
natural grade,'rf 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 communit�s floodplain management ordinance?
❑Yes ❑No ❑Unknown. The local official must certify this information in Section G.
SECTION F•PROPERTY OWNER(OR OWNER'S REPRESENTATNE)CERTIFICATION
The property owner or owners authorized representative who canpletes Sections A,B,C(Items C3.h and C3.i only),and E fa Zone A(without a FEMA�ssued or community-
issued BF�or Zone AO must sign here. fie sfatements in Sections A,8,C,and E are conect to the best of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
f
ADDRESS CITY STATE ZIP CODE •
CI(,�IdTI IRF 116TF TFI FPI-I(1�IF
COMMENTS
❑Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The loca offiaai who is aothorzed by law or ordinance to administer the communit�ls floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation
Cer6ficate. Complete the appl;:,able itemf,$)and sign below.
G1.�The information in Section C w�taken from other documentation that has been signed and embossed by a licensed surveyor,engineer,or architect who is authorized by state
or locai�aw to certify elevatic�ir�or�ation. (Indicate the source and date of the elevation data in the Comments area below.)
G2.0 A community offiaal compieted S�:tion E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0.
G3.❑The fdlou✓ing i�fr,;;nation(iterr�G4-G9)is provided forcommunity floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED
G7.This permit has been issuetl 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 800ding 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 ail previous editions
� ` C ITY O F C LEARWATE R
� DEVELOPMENT & NEIGHBORHOGD SERVICES DEPARTMENT
POST OFFICE BOX 474H� CLEARWATER� FLO�DA 33758-4748
MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CI.FARWATER,Fco�uDn 33756
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 Policy Number
A2.BUILDING STREET ADDRESS(including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
CITY STATE ZIP CODE
A3. PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
A4. BUILDIN(3 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 63.STATE
City of Clearwater 125096
64.MAP AND PANEL g5.SUFFIX 66.FIRM INDEX DATE B�•FIRM PANEL gg.FLOOD ZONE(S) B9�BASE FLOOD ELEVATION(S)
NUMBER 5/17/2005 EFFECTIVE/REVISED DATE (Zone AO,use depth of flooding)
12103C-0102
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 B9:❑ 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 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 certificate is being completed-see pages 6 and 7. If no
diagram ac:curately 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,conveR 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 ce�tificeites shall be maintained by the community and copies with the attached memo made availa6/e by request
FRANK HIBRARD,MAYOR
GEORGE N.CRE'CEKOS,COUNCILMEMABR JOIIN DORAN,COUNCILMEMBER
PAUL F.GIASON,COUNCILMEMAER � CARLEN A.PE'1'ERSEN,COUNCILMLMBER
��EQUAL EMPLOYMENI'AND AFFIf2MATIVE AC1'ION EMPLOYER�