Loading...
140 BRIGHTWATER DR UNIT 5 �} ��'� ��Q3_����� FENA ONA FLOODINSURANC PROGRAMCY O.M.B. No. 3067-0077 l� Expires December 31, 2005 ELEVATION CERTIFICATE Important: Read the instructions on pages 1-7. JOB No.030094.2 SECTION A-PROPERTY OWNER INFORMATION For Insuranoe Canpany Use: BUILDING OWNER'S NAME Policy Number HARBORSIDE TOWNHOMES, LLC UNIT No.5 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(Lotand Block Numbers,Tax Parcel Number,Legal Description,etc.) Lot 5 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 ##.#�t#�i#°) ❑NAO 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 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 depth 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):_ B11.Indicate the elevation datum used for the BFE in B9:❑NGVD 1929 �NAVD 1988 ❑Other(Describe):_ B12.Is the builtling located in a Coastal Bamer Resources System(CBRS)area or Othennnse 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.Builtling Diagram Number 7 (Select the building diagram most similar to the building for which this cert�cate 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,ARIAE,AWA1-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 � - ..` , o a)Top of bottom floor(including basement or enclosure) 5.49 . FT ft.(m) N _+���b J��;�,�� � o b)Top of next higher floor 15.67 FT ft.(m) �,��.•'� ° o c)Bottom of lowest horizontal structural member(V zones only) N/A FT ft.(m) ��:,�'�; �� � �� ' 'F � , o d)attached garage(top of block) 5.49 . FT ft.(m) W��, °y`'� � ,�'` ,,,q,; �•t ,._; o e)Lowest elevation of machinery and/or equipment .�; ;�� •, �- ra ��- servicing the building(Descnbe in a Comments area) 11.2 . FT ft.(m) ��!.!1 •r�, ', ` � o fl Lowest adjacent(finished)grade(LAG) 5.0 . FT ft.(m) z'� ��r p �' q .'�� ��''�, 'i;',••c� • � � o g)Highest adjacent(finished)grade(HAG) 5.1 FT ft.(m) � , �1 08/1�/� o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 14 J '.,� , ••-•�•'4�,,�+�"� 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 Secfions A,8,and C on this cerfificate represents my best efforts to interpret the dafa available. I understand that any false statement may be punrshable 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 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 Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number 140 Bri htwater Drive UNIT No.5 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 official,(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 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 completetl—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 6-8 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 and/or equipment serviang the building is _ft.(m)_in,(cm)❑above or ❑below(check one)the highest adjacent grade. (Use natural grade,if available). E5.For Zo�e 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 antl 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 conect 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 local ofi�cial who is authorized by y�w or ordinance to administer the communit�/s floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation Certificate. Cor��lete the applicable item!s)and sign below. G1.❑The information:n Sectiun 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 local law to ceRrfy elevation informa±ion. (Indicate the source and date of the elevation data in the Comments area below.) G2.❑A communiiy official complet?d Sec�ie�E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0. G3.❑The fullowing information(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 �8.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 ��,�, � I���� FEDERALEMERGENCYMANAGEMENTAGENCY 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 OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number HARBORSIDE TOWNHOMES, LLC UNIT No.5 BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bidg.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 Blodc Numbers,Tax Parcei Number,Legal Description,etc.) Lot 5 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 61.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME B3.STATE City of Clearwater 125096-0102 PINELLAS FLORIDA 64.MAP AND PANEL 67.FIRM PANEL B9.BASE FLOOD ELEVATION(S) NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVEIf2EVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depth of flooding) 12103CA102G 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(Descnbe): 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 Otherwise Protected Area(OPA)? ❑Yes �No Designation Date_ SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRE C1.Building elevations are based on:❑Construction Drawings' Building Under Construction' inished Construct • `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 cert�cate is being com RagAY a;d9. ��no�d5agra accurately represents the building,provide a sketch or photograph.) M 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,ARIAO nC C'� n� Complete Items C3:a-i below according to the building diagram specified in Item C2.State the datum used.If the tlatum is differ�rR4ro�tRe�el�Us��i �E�V(�S Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion calculation. Use the�'�e�Gi ��,����ATE F3 Section D or Section G,as appropnate,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 � -"�,� j t� - � ..r�r, o a)Top of bottom floor(including basement or enclasure) 5.49 . FT ft.(m) � -�'^�,�'* ;,��^` � `' � ' o b)Top of ne�higherfloor 15.67 . FT ft.(m) `� ��' •' �` o c)Bottom of lowest honzontal structural member(V zones only) N/A . FT ft.(m) o o ,,..:`;:�y �,�„ ��\ � , o d)attached garage(top of block) 5.49 FT ft.(m) ��; ��' � , o e)Lowest elevation of machinery and/or equipment W� � _�' ' � :� _ ", � _ �." � t'"^ servicin g the buildin g(Descnbe in a Comments area) 11.2 . FT ft.(m) E ,� � ', � � , ,,,,. o fl Lowest adjacent(finished)grade(LAG) 5.0 . FT ft.(m) z�'� �; 3� ����' o g)Highest adjacent(finished)grade(HAG) 5.1 FT ft.(m) U �`�%,°.���p�f���'•�` o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 14 J - 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�� 1 cerfify that the information in Sections A,8,and C on this cerfificate represents my best efforts to interpret the data available. I undersfand fhat any false statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001. W CERTIFIER'S NAME LICENSE NUMBER c� 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 . 05I18I05 (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 insuranoe com�ar,-�se: . .- y 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.5 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 enclosure)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 6-8 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 and/or equipment servidng 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 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,8,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 SIGNATURE DATE TELEPHONE COMMENTS ❑Check here if attachments SECTION G-COMMUNITY INFORMATION(OPTIONAL) The 1oc21 official who is author.zed by�3w or on�inance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation Certifi��te. Complete ii�a apc'i�able item(s)and sign below. G1.�The ir,formation 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 elevation inf�rmation. (Indicate the source and tlate of the elevation data in the Comments area below.) G2.❑A community offiaal compieted�ection E for a building located in Zone A(without a FEMA-issued or community�ssued BFE)or Zone A0. G3.❑The followi��g irformation(?iems 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 �, ` .��,�, FEDERAL EMERGENCY MANAGEMENT AGENCY tu� — � � NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077 ..���f%��'�N I � 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 Canpany Use: BUILDING OWNER'S NAME Policy Number HARBORSIDE TOWNHOMES, LLC UNIT No.5 BUILDING STREET ADDRESS(Induding Apt,Unit,Suite,and/or Bidg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number 140 Brightwater Drive C�Ty STATE ZIP CODE CLEARWATER FLORIDA 33767 PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Lot 5 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 ##.#i#�°) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other: SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 61.NFIP COMMUNITY NAME 8 COMMUNITY NUMBER B2.COUNTY NAME B3.STATE City of Clearwater 12509Fr�9�--� PINELLAS FLORIDA 64.MAP AND PANEL 87.FIRM PANEL B9.BASE FLOOD ELEVATION(S) NUMBER B5.SUFFIX .FIRM INDEX DATE EFFECTIVEIfZEVISED DATE 68.FLOOD ZONE(S) (Zaie A0,use deptl�of flooding) 12103C010?� G ��i;26B3" SEPTEMBER 03,2003 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 ❑Other(Describe):_ 611.Indicate the elevation datum used for the BFE in B9:❑NGVD 1929 �NAVD 1988 ❑Other(Desaibe):_ B12.Is the building located in a Coast�Bamer Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No Designafion Date SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRE C1.Building elevations are based on:�ConsVuction Drawings' Building Under Construction' inished Construd `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 certificate is being com p es 6 and 7. If no diagra accuratety 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,AR/A,ARIAE,AWA1-A30,AR/AH,AR/AO nC I� �� Complete Items C3:a i below aa:ording to the building diagram specified in Item C2.State the datum used.If the datum is differ�rlt4ro���aMrhrus��i �E�V(�S Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion calculation. Use the�'�e�i Gid�,����ATE R Section D or Section G,as appropriate,to document the datum conversion. Datum NAVD 1988 ConversionlComments 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 . FT ft.(m) � � , o c)Bottom of lowest horizontal structural member(V zones only) NIA . FT ft.(m) o o , � ;,, k 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) �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) � . 05/i�3/f35 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 informafion in Sections A,B,and C on this certificafe represents my best efforts to interpret the data available. 1 understand that any false statemenf 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 i8016 Old County R d 54 New Port Richey FL 34653 SIGNATURE DATE TELEPHONE _ 05118/05 (727)834-8140 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,Uni�Suite,ancllor Bk�g.No.)OR P.O.ROUTE AND BOX N0. Policy Number • � 140 Bri htwater Drive UNIT No.5 CITY STATE 7JP 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 fwilding 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.) EZ.The top of the bottom floor(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 6-8 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�ems C3.h and C3.i on front of form. E4.The top of the plafform of machinery andlor equipment serviang the building is _ft.(m)_in.(cm)❑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 bottom floor elevated in accordance with the communit�s floodplain management orcJinance? ❑Yes ❑No ❑Unknown. The local offiaal must certify this information in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owners authorized 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 BFE�or Zone AO must sign here. The sfatemenfs in Sections A,8,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 � CI(;�IOTI IRF IIATF TFI FPI-I(1NF COMMENTS ❑Check here if attachments � �� SECTION G-COMMUNITY INFORMATION(OPTIONAL) The loca;offiad who is author.zed by�3w or�inance to administer the communitys floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation Certfirate, Complete u��a ap�;iable item(s)and sign below. G1.[j The information 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 a local law to certify elevztion information. (Indicate the source and date of the elevation data in the Comments area below.) G2.[]A community offiaal com�ieted Sa.�tion E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0. G3.[]The faiowii;g ir.formation(�ien:s G4-G9)is provided for community 800dplain management purposes. �ERMfT NUMBER G5. DATE PERMIT ISSUED G6.DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED L� 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.BF E 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 ' t�" �, �_� �` � CITY OF CLEARWATER � � �, � ��,.:=; DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT i�� . r,o," _. POST�FFICE BOX 474g� CLEARWATER� F�oa�DA 33758-4748 ��}� MUNICIPAL SERVICES BUILDING, ZOO SOUTH MYRTLE AVENUE,CLEARWATER,FLO�uDn 33756 TELErxorrE(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 B3.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 buildin 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: ❑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 ceRificate 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,ARlA1-A30,AR/AH,AR/AO. Complete Items C3.-a-i below according to the building diagram specified in Item C2.State the datum used.If the datum is different from the datum used for the BFE in Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G,as appropriate,to document the datum conversion. Datum Conversion/Comments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? ❑Yes ❑No e) Lowest elevation of machinery or equipment servicing the building(Describe in Comments area) ft.(m) h) No.of permanent openings(flood vents)1ft.above adjencent grade i) Total area of all permanent openings(flood vents)in C3.h sq.in.(sq.cm) Comments: Date of Review: Community Official: �evation certificates shall be maintained by the community and cropies with the attached memo made availab/e by request FRANK HIRAARI>,MAYOR GEORGE N.CRE'1'EKOS,COUNCILMEMBER JOIIN DORAN,COUNCILMEMBER PnuL F.Gissorr,COUNCILMEMRER � CARI.EN A. PE'PERSEN,COUNCIL�IEMBGR ��EQUAL EMYLOYMENT AND AFFIRMAI'IVE ACTION EMPLOYER��