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140 BRIGHTWATER DR UNIT 3 �.�Ct��G�O'J—�2,.�t�{� FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005 ELEVATION CERTIFICATE Important: Read the instructions on pages 1-l. JOB No.030094.2 SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number HARBORSIDE TOWNHOMES, LLC UNIT No.3 BUILDING STREET ADDRESS(Including 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 3 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.) RESIDENTWAL 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 PINELLAS FLORIDA B4.MAP A,ND PANEL Bi.FIRM PANEL 69.BASE FLOOD ELEVATION(S) NU�4BER 65.SUFFIX B6.FIRM INDEX DATE EFFECTIVEIREVISED DATE 68.FLOOD ZONE(S) (ZoneAO,use depm of flooding) 1250913-0102 G SEPTEMBER 03,2003 SEPTEMBER 03,2003 AE EL.11.0 B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9. ❑FIS F'rofile �FIRM ❑Community Determined ❑Other(Describe): 611.Indicate the elevation datum used for the BFE in B9:❑NGVD 1929 �NAVD 1988 ❑Other(Describe):_ B12.Is the 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` 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 certifcate 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 according to the building diagram specified in Item C2.State the datum used.tf 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 � �� o a)Top of bottom floor(induding basement or enclosure) 5.49 . Ff ft.(m) � �y; .� `Y"` i c;J . o b)Top of ne�higher floor 15.67 . FT ft.(m) � �i, o c)Bottom of lowest horizontal structural member(V zones only) NIA FT ft.(m) "� "�,��,� _ ;�_ o d)attarhed garage(top of block) 5.49 . Ff ft.(m) �� ��` •� �� �� '� `"', �� � o e)Lowest elevation of machinery and/or equipment w@ � � .` `, " �,r N ^k� 1 L " servicing the building(Descnbe in a Comments area) 11.2 . FT ft.(m) �� ° � � �� 'acent finished rade LAG 5.0 . FT ft.m z'm "� � � "a, �- ° o fl Low.st adl ( )g ( ) — ( ) �,�n , .� �, . : o g)Highest adjacent(finished)grade(HAG) 5.1 FT ft.(m) � •`-�8/16/04 ''���'` �, � ': r c= 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 certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information. I cerfify 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,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 R d 54 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 ail previous editions . _ IMPORTANT: In these spaces,copy the corresponding information from Section A. For insurance com�any use: " � � BUILDING STREET ADDRESS(Induding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number 140 Bri htwater Drive UNIT No.3 GTY STATE ZIP CODE Company NAIC Number CLEARWATER FLORIDA 33767 SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agenUcompany,and(3)building owner. COMMENTS 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 builtling 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 builtling is _ft.(m)_in.(cm)0 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 flocr(elevation b)of the building is _ft.(m)_in.(cm)above the highest adjacent grade. Complete items C3.h and C3.i on front of form. E4.The top of the platform of machinery and/or equipment serviang the building is _ft.(m)_in.(cm)0 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 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 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,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 official who is authorized by�sw or ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation Ceruficate. Complete the aaplicable item(s)and sign below. G1.�The informa?ion in Section 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 Ixal la�v to certify elevati�n information. (Indicate the source and date of the elevation data in the Comments area below.) G2.❑A co�nmunity official comp�eted S�,�tion E for a builtling located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0. G3.❑The following information(Itams G4-G9)is provided for community floodplain management purposes. G4.PERMIT NUMBER �5. 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(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 ' , � FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077 -���� t'1��( „ 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. 3 BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number 140 Brightvuater Drive CITY STATE ZIP CODE CLEARWATER FLORIDA 33767 PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Lot 3 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 12509fr0102 PINELLAS FLORIDA B4.MAP AND PANEL B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S) NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVEIREVISED DATE 68.FLOOD ZONE(S) (Zone A0,use depth of Noading) 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.Intlicate 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 REQUI C1.Building elevations are based on:�Construction Drawings� �Building Under Construction' Finished Cons i �A new Elevation Certificate will be required when construction of the building is complete. •C2.Building Diagram Number 7 (Select the building tliagram most similar to the building for which this cert�cate is being -see pa es 6 and 7. If diag accurately represents the building,provide a sketch or photograph.) MAI� 19 200� C3.Elevations—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AWAE,AR/A1-A30,AWAH,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 d��t�l��l�'f�h�BI��Ci.S Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion calculation. Use tl�ro�r���r���i"�'E� Section D or Section G,as appropriate,to document the datum conversion. Datum NAVD 1988 ConversioNComments N/A Elevation reference mark used LABINS EL.=4.191 Does the elevation reference mark used appear on the FIRM? ❑Yes � r _ o a)Top of bottom floor(induding basement or enclosure) 5.49 . FT ft.(m) � .�`ti3�``r���crf�j , , 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� ^�•,;� , . �,. o d)attached garage(top of block) 5.49 . FT ft.(m) �� . '� ,°� x o e)Lowest elevation of machinery and/or equipment w � ' ; � � ? ; F� � i-,+.: � f '' , serviang the building(Descnbe in a Comments area) 11.2 FT ft.(m) �;� ..� ,� o fl Lowest adjacent(finished)grade(LAG) 5.0 Ff ft.(m) z'y A `t' �� � w�"- �., o g)Highest adjacent(finished)grade(HAG) 5.1 FT ft.(m) � * ��05/18/05 �'C� o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 14 � �, '�`�,�1'r:�''`°',° '",�'a` 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. 1 cerfify fhat the information in Sections A,B,and C on this certificate represenfs my besf efforfs to inferpret fhe data available. 1 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 c 05/18/05 (727)834$140 FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces ali previous editions IMPORTANT: In these spaces,copy the corresponding information from Section A. For insurance com�any use: ' BUILDING STREETADDRESS(Induding Apt.,Unit,Suite,andlor Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number 140 Bri htwater Drive UNIT No.3 � , 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 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(including basement or endosure)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 pladorm 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 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 propeRy 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 loca official who is authcnze�oy la�v�r ordinance to administer the community's flootlplain management ortlinance can complete Sections A,B,C(or E),and G of this Elevation Certif�cate. Complete the apr icable item(s)and sign below. G1.[]The informat�on in Section 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 la;al law to certify elevaticn information. (Intlicate the source and date of the elevation data in the Comments area below.) G2.❑A communi;�offiaal comp��ted S�.tion E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0. G3.�The following informatic�(Items�.rl-G9)is provided for community floodplain management purposes. G4.PERMIT NUMBCR 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 all previous editions � � ` FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077 n( „�,�\ry-,.��,�1��( „ Expires December 31, 2005 ��y�;�'�'�w °� �f� 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.3 BUILDING STREET ADDRESS(Induding Apt.,Unit,Suite,andlor Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number 140 Brightwater Drive CIIY STATE ZIP CODE CLEARWATER FLORIDA 33767 PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Lot 3 OF Harborside Tovmhomes (P.6.127,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 61.NFIP COMMUNffY NAME&COMMUNITY NUMBER B2.COUNTY NAME 63.STATE City of Cleafwater 12509Fr�6t62"—"" PINEUAS FLORIDA 84.MAP AND PANEL B7.FIRM PANEL B9.QASE FLOOD ELEVATION(S) NUMBER B5.SUFFIX B6.FIRM INDEX DA EFFECTIVEIREVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depth of flooding) 12103CA102 G TEMBER� SEPTEMBER 03,2003 AE EL11.0 B10.Indicate the source of the Base Flood Elevation(BFE)data or base 800d 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(Desaibe):_ 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 REQUI C1.Building elevations are based on:❑Construction Drawings' j Building Under Construction* Finished Cons 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 -see p 6 and 7. If n di accurately represents the building,provide a sketch or photograph.) MA�� � ZO�� C3.Elevations—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AWAE,AWA1-A30,AR/AH,AR/AO Complete Items C3:a-i below accorcJing to the building diagram specfied in Item C2.State the datum used.If the datum is d� BI��C S Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion calculation. Use tf�ro�r�;���q�E R Section D or Section G,as appropriate,to document the datum conversion. Datum NAVD 1988 Conversion/Comments NIA 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 ne�higher floor 15.67 . FT ft.(m) � ,�-� . ` �, o c)Bottom of lowest honzontal sUucturai member(V zones only) N!A . Ff ft.(m) N� ��i��'ti.. � � o d)attached garage(top of block) 5.49 FT ft.(m) �� . ' "`k �- �' o e)Lowestelevationofmachineryandlorequipment W; " -� �°;_ s serviang the building(Descnbe in a Comments area) 11.2 . FT ft.(m) �� ,_ o fl Lowest adjacent(finished)grade(lAG) 5.0 . FT ft.(m) z � � ` .,� . � , o g)Highest adjacent(finished)grade(HAG) 5.1 FT ft.(m) � j '05/18/05 r ,•?' o h)No.of permanent openings(flood venis)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 certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information. I cerfify thaf the information in Secfions A,8,and C on this certificafe represents my best efforfs to interpref the data available. I understand fhat 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 c 05118/05 (72�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: ' . a BUILDING STREET ADDRESS(Induding Apt,Uni�Suite,andlor BkJg.No.)OR P.O.ROUTE AND BOX N0. Policy Number 140 Bri htwater Dnve UNIT No.3 . • � CITY STATE ZIP CODE Company NAIC Number CLEARWATER FLORIDA 33767 SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) ( • Copy both sides of this Elevation Certficate for(1)community offiaal,(2)insurance agent/company,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 certficate 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 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is _ft.(m)_in.(cm)above the highest adjacent grade. Complete items C3.h and C3.i on front of form. ' E4.The top of the platform of machinery andlor equipment serviang the building is _ft.(m)_in.(cm)❑above or ❑below(check one)the highest adjacent 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 communitys floodplain management ordinance? ❑Yes ❑No ❑Unknown. The laal offiaal 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 c�mpletes Sections A,B,C(Items C3.h and C3.i only),and E for Zone A(without a FEMA-issued or community- issued BFE)'orZone AO must sign here. The statements in Sections A,B,C,and E are cronect to the best of my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME i ADDRESS CITY STATE ZIP CODE • �I�NATI IRF pATF TFI FPHQNF COMMENTS ❑Check here if attachments SECTION G-COMMUNITY INFORMATION(OPTIONAL) The loca offidal who is authcnzed��lao�r or ordinance to administer the communit�s floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation Certificate. Complete the a�icable i±em(s}and sign below. G1.�The informafion in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor,engineer,or architect who is authonzed by state or la;al law io certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2.�A communit�offiaal com�aed S7�ion E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0. G3.❑The following informatic�(Items ir1-G9)is provided for community floodplain management purposes. G4.PERMff NUMBtR G5. DATE PERMff ISSUED G6. DATE CERTIFICATE OF COMPLIANCEJOCCUPANCY 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 � . . . . ' A ���� ; � . `�� ° � CITY OF CLEARWATER � � DEVELOPMENT & NEIGHBORHOGD SERVICES DEPARTMENT POST�FFICE BOX 4740� CLEARWATER� FLOa�DA 33758-4748 � MUNICIPAL SERVICES BUILDING, lOO SOUTH MYRTLE AVENUE,CLEARWATER,FLO�uDn 33756 TECEPxorrE (72� 562-4567 Fnx(72� 562-4576 MEMO OF REVIEW FOR CORRECTNESS 8� COMPLETION In accordance with participation in the NFIP/CRS program,all elevation certificates are required to be reviewed for correctness and completion prior to acceptance by the community. This complete form shall be attached to all elevation certificates maintained on file and provide with requested copies of elevation certificates. The attached elevation certificate requires corrections by the surveyor of section(s) prior to acceptance by the community The attached elevation certificate is complete and correct X Minor corrections have been made in the below marked sections by Community Official SECTION A-PROPERTY INFORMATION For Insurance Company Use: A1. BUILDING OWNER'S NAME Policy Number A2.BUILDING STREET ADDRESS(including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number CITY STATE ZIP CODE A3. PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,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❑Other SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 1.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME 63.STATE � City of Clearwater 125096 B4.MAP AND PANEL 67.FIRM PANEL 69.BASE FLOOD ELEVATION(S) NUMBER B5.SUFFIX 66.FIRM INDEX DATE EFFECTIVE/REVISED DATE Ba•FLOOD ZONE(S) �Zone AO,use depth of flooding) 12103C-0102 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) 611. Indicate elevation datum used for BFE in 69:� NGVD 1929 ❑NAVD 1988 ❑ Other(Describe) B12. Is the building 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. Buiiding 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,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)1 ft.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 FRnrrx H���u�,Mnvoa GEORGE N.CRE'fEKOS,COUNCILMEMRER JOIIN DORAN,COUNCILMLMBER PAUL F.G[BSON,COUNCILMEMBER � CARI.EN A.PE"1'ERSEN,COUNC[LMBMBER ��EQUAL EMYLOYMEN'1'AND AFFIItMA7'IVE AC1'ION EMPLOYER�