140 BRIGHTWATER DR UNIT 4 .� �� ����.� ����'7' 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 1-7. JOB No.030094.2
SECTION A-PROPERTY rJWNER INFORMATION For Insurance Company Use:
BUILDING OWNER'S NAME Policy Number
HAR�ORSIDE TOWNHOMES, LLC UNIT No.4
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 4 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
B4.MAP AND PANEL 67.FIRM PANEL 69.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECT!VEIREVISED 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 flood depth entered in B9.
❑FIS Profile �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 Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No Designation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:0 Construction Drawings' � i Building Untler 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 certrficate is being completed-see pages 6 and 7. If no diagram
accurately represents the building,provide a sketch or photograph.)
C3.Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,ARIA,AWAE,ARIA1-A30,AR/AH,AR/AO
Complete Items C3.-a-i below according to the building diagram specified in Item C2.State the datum used.If the datum is different from the datum used for the BFE in
Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion calculation. Use the space provided or the Comments area of
Section D or Section G,as appropriate,to document the datum conversion.
Datum NAVD 1988 Conversion/Comments N/A
Elevation reference mark used IABINS EL.=4.191 Does the elevation reference mark used appear on the FIRM? ❑Yes � f � ��-%�� �
o a)Top of bottom floor(including basement or enclosure) 5.49 . FT ft.(m) N =` ,�`�.•'`� '` �,�,'� _
o b)Top of next higher floor 15.67 . Ff ft.(m) , ffi^ ;��C� y� � -
o c)Bottom of lowest honzontal structural member(V zones only) NIA . FT ft.(m) `` ���' �p � �� "' W�- -
o d)attached garage(top of block) 5.49 . FT ft.(m) �� ° �'' 's
� ''- �'�
o e)Lowest elevation of machinery andlor equipment � �; . • -
servidn the buildin Descnbe in a Comments area 11.2 . FT ft.m � �� � � " a µ
9 9� ) � ) � �c "�' � ' a: �rv �0.: .
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) � •�� 1 :y•�•48'�1�1-04
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 certify that 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 54 New Port Richey FL 34653
SIGNATURE DATE TELEPHONE
r 08/16/04 (727)834-8140
FEMA Form 81-31,January 2003 See reverse side for continuation. Repiaces ali 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 Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number •
140 Bri htwater Drive UNIT No.4
�� STATE ZIP CODE Company NAIC Number
CLEARWATER FLORIDA 33767
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sitles of this Elevation Certificate for(1)community offiaal,(2)insurance agenUcompany,antl(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 floer(elevation b)of the building is _K.(m)_in.(cm)above the highest adjacent
grade. Complete items C3.h and C3.i on front of form.
E4.The top of the platform of machinery and/or equipment servicing the building is _ft.(m)_in.(cm)❑above or ❑below(check one)the highest adjacent grade. (Use
natural grade,if available).
E5.For Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance?
❑Yes ❑No ❑Unknown. The local official must certify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or 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 to fhe 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 offinal who is authorized b�law dr ordinance to atlminister the community's floodplain management ordinance can complete Sections A,B,C(or E),antl G of this Elevation
Certificate. Complete the applicable item(s)and sign below.
G1.❑The irforrr�tion in S�;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 loc:al!aw to;;ertify elevation ir,fvrnation, (Indicate the source and date of the elevation data in the Comments area below.)
G2.0 A communiiy o�aal completed�ection E tor a building located in Zone A(without a FEMA-issued or community-issuetl BFE)or Zone A0.
G3.❑The following in`orrr�ation(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
„ -�a� ( j FEDERAL EMERGENCY MANAGEMENT AGENCY
�Z���1Jt���" �� `��� 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.4
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 4 OF HarborsideTownhomes (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 B3.STATE
City of Clearwater 12509fr0102 PINELLAS FLORIDA
B4.MAP AND PANEL B7.FIRM PANEL 69.BASE FLOOD ELEVATION(S)
NUMBER 65.SUFFIX B6.FIRM INDEX DATE EFFECTIVEJREVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depm of flooding)
12103C0102G G SEPTEMBER 03,2�03 SEPTEMBER 03,2W3 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 ❑Communiry Determined ❑Other(Describe):
B11.Indicate the elevation datum used for the BFE in B9:❑NGVD 1929 �NAVD 1988 ❑Other(Descnbe):
B12.Is the building located in a Coastal Bamer Resources System(CBRS)area or Othenvise Protected Area(OPA? ❑Yes �No Desi nation Date_
SECTION C-BUILDING ELEVATION INFORMATION( RVEY REQUIRE
C1.Building elevations are based on:❑Construction Drawings' Building Under Construction' nished Constru
• 'A new Elevation Certificate will be required when construction of the building is complete.
C2.Building Diagram Number 7 (Select the building diagram most similar to the building forwhich this certificate is being com seet�p�1Y6�n�7.�giagra
accurately represents the building,provide a sketch or photograph.) ���1�
C3.Elevations—Zones A1 A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AWA,AR/AE,AR/A1-A30,AR/AH,AWAO D V P � ��VCS
Complete Items C3.-a-i below according to the building diagram specified in Item C2.State the datum used.If the datum is di ��m�s or e F
Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion calculation. Use the p vi r th �TE F�
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 endosure) 5.49 . FT ft.(m) � �� � w
o b)Top of next higher floor 15.67 . FT ft.(m) � \ ti
o c)Bottom of lowest horizontal structural member(V zones only) N/A . FT ft.(m) �o \ � o
o d)attached garage(top of block) 5.49 . FT ft.(m) E� � , W
o e)Lowest elevation of machinery and/or equipment w`° A
� � I ,2^ s �
serviang the building(Descnbe in a Comments area) 11.2 . Fi ft.(m) E;�
o fl Lowest adjacent(finished)grade(LAG) 5.0 . FT ft.(m) z'�
� �
o g)Highest atljacent(finished)grade(HAG) 5.1 FT ft.(m) � i�5/i 8/05
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 certify that 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 sfatement 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 Roa New Port Richey FL 34653
SIGNATURE DATE TELEPHONE
05/18/05 (727)534�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 com�any use:
BUILDING STREET ADDRESS(Induding Apt,Unit,Suite,andlor Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number . '
140 Bn htwater Drive UNIT No.4
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 o�iaal,(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 completetl.
E1.Building Diagram Number_(Select the building diagram most similar to the building for which this ceRificate 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(inclutling 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 m�hinery and/or equipment serviang the building is _ft.(m)_in.(cm)0 above or ❑below(chec4c 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 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 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.
PROPER7Y 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 officaai who is authori�ed by i�w or ortlinance to administer the communitys floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation
Certificate. Cemplete!�;e app!i�•able item(s)and sign below.
G1.0 The ir�ormation in Sec±ion C:vas taken from other documentation that has been signed and embossed by a licensed surveyor,engineer,or architect who is authonzed by state
or local law to certify elevatiun information. (Indicate the source and date of the elevation data in the Comments area below.)
G2.0 A community offiaal completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0.
G3.❑The following iriformation(Items G4-G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED
G7.This permit has been issued for: ❑New Construction ❑Substantial Improvement
G8.Elevation of as-built lowest floor(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
�J���.,� s ��( i, (^� 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.4
BUILDING STREET ADDRESS(Induding 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(Lotand Block Numbers,Tax Parcel Number,Legal Description,etc.)
Lot 4 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):
� �°_�_�.�� p� �,�) ❑NAD 1927 ❑NP,D 1983 ❑USGS Quad Map ❑Ofher:
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNffY NAME&COMMUNITY NUMBER B2.COUNTY NAME B3.STATE
City of Cleanvater 12509G�9�9�—' PINELLAS FLORIDA
B4.MAP AND PANEL 87.FIRM PANEL 69.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVEIREVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depih of flooding)
12103CA102 G CFp���Q��1rry� SEPTEMBER03,2003 AE EL11.0
B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9.
❑FIS Profile �FIRM ❑Community Determined ❑Ofher(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 Othenxise Protected Area(OPA)? ❑Yes �No Designation Date_
SECTION C-BUILDING ELEVATION INFORMATION( ,RVEY REQUIRE
C1.Building elevations are based on:❑Construction Drawings` Building Under Construction' nished Constru
'A new Elevation Certificate will be required when consVuction 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 com see 6 n 7. agra
accurately represents the building,provide a sketch or photograph.) � � �
C3.ElevaGons-Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AWA,ARIAE,AR/A1-A30,ARIAH,ARIAO D v����vCS
Complete Items C3.-a-i below acxording to the building diagram specfied in Item C2.State the datum used.If the datum is d' t m s or e F
Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion calculation. Use the p vi r th �I�r4TE R
Section D or Seclion 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 endosure) 5.49 FT ft.(m) � �
o b)Top of ne�higher floor 15.67 . FT ft.(m) `� � . '
o c)Bottom of lowest honzontal structural member(V zones only) NIA . FT ft.(m) o o: � '
o d)attached garage(top of block) 5.49 . FT ft.(m) �� , "
o e)Lowest elevation of machinery and/or equipment W;� ; ..�
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�acent(finished)grade(HAG) 5.1 FT ft.(m) � .Q5%i��'��
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.
1 certify fhaf the information in Secfions A,B,and C on this certificate represents my best efforfs to inferpref fhe 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.KLEIN PLS 5052
TITLE COMPANY NAME
PRESIDENT KLEIN&STAUB SURVEYING,INC.
ADDRESS CITY STATE ZIP CODE
8016 Old County Roa New Port Richey FL 34653
S16NATURE DATE TELEPHONE
05118105 (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 Company Use: , ,
BUILDING STREET ADDRESS(Induding Apt,Uni�Suite,andlor Bldg.No.)OR P.O.ROUTE AND BOX N0. Polic.y Number �
140 Bri htwater Drive UNIT No.4 " �
�m' 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 o�iaal,(2)insurance agenUcompany,and(3)building owner.
COMMENTS
NIA
❑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 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 floa(induding basement or endosure)of the building is _ft.(m)_in.(cm)❑above or ❑below(chedc 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(elevabon 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 platform of machinery andlor equipment serviang the building is _ft.(m)_in.(cm)0 above or ❑below(chedc 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 bottan floor elevated in accordance with ihe communit�s floodplain management ordinance?
❑Yes ❑No ❑Unknown. The local affiaal must certify this information in Section 6.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATNE)CERTIFICATION
The property owner or owners authaized representative who canpletes Sections A,B,C(Items C3.h and C3.i only),and E for Zone A(without a FEMA-issued or community-
issued BFEj or Zone AO must sign here.'The statements in Sections A,B,C,and E are correct to the besf of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP CODE .
CI(,�I�T�IRF � II�OTF TFI FPI-I(1NG
COMMENTS
❑Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The local offidal who is authonzed by I�w or ordinance to administer the communit�s floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation
Certi6cat�. Cemplete�;e app!�able item(s)and sign below.
G1.❑The ir��ormatior 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 local law to certify elev�tiun infoi�^ation. (Indicate the source and date of the elevation data in the Comments area below.)
G2.�A community offiaal complete�±Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0.
G3.�The following informat�on(Items G4-G9)is provided fa community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMff ISSUED G6.DATE CERTIFICATE OF COMPLIANCElOCCUPANCY ISSUED
G7.This permit has been issued for.❑New Construdion ❑Substantial Improvement
G8.Elevation of as-built lowest floor(induding basement)of the building is: __ft.(m) Datum:_
G9.BFE or(in Zone AO)depth of flooding at the building site is: _._ft.(m) Datum:_
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
•
❑Chedc here if attachments
FEMA Form 81-31,January 2003 Replaces ali previous editions
.
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_� � � ° � ` CITY OF CLEARWATER
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_.4.
�- ' � DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
�M POST�FFICE BOX 474g� CLEARWATER� FLOa�DA 33758-4748
MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CLFARWATER,FLO�uDn 33756
TECEPxorrE(72� 562-4567 FEvc(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. BUILDING USE(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)
A5. LATITUDE/LONGITUDE(OPTIONAL): HORIZONTAL DATUM: SOURCE:0 GPS(Type):
(##°-##'-##.##" or ##.###i1#°) ❑ 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 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)
611. Indicate elevation datum used for BFE in 69:❑ NGVD 1929 ❑ NAVD 1988 ❑Other(Describe)
612. Is the building 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 accurateiy 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 ali permanent openings(flood vents)in C3.h sq.in.(sq.cm)
Comments:
Date of Review: Community O�cial:
�levation certificates shall be maintained by the community and copies with the attachedmemo made availab/e by request
FRANK HIRBARD,MAYOR
GEORGE N.CRG'1'EKOS,COUNCILMEMftGR JOIIN DORAN,COUNCILMEMBER
PAUL F.GIRSON,COUNCILMEMRER � CARI.EN A.PE"1'ERSEN,COUNCILMEMBGR
��EQUAL EMYLOYMEN'f AND AFFIRMAI'1VE AC7'ION EMNLOYER��