145 BRIGHTWATER DR UNIT 4 � ��� ,^C r��;3 FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
,3 C�'�' R NATIONAL FLOOD INSURANCE PROGRAM
Expires December 31, 2005
:,
' � ELEVATION CERTIFICATE
Important: Read the instructions on pages 1-7. JOB No.030084.2
SECTION A-PROPERTY OWNER INFORMATION For Insuranoe Company Use:
�BUILDING OWNER'S NAME Policy Number
Michael Lozicki, 'oined b Gia Lozicki, his wife
BUILDING STREET ADDRESS(In udi g Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
145 BRIGHTWATER DRIVE ��� �
CITY STATE ZIP CODE
CLEARWATER FLORIDA 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
LOT 4, PARADISE COVE PLAT BOOK 128,PAGES 19-20
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):
( #1#°-##'-##.##" or ##.#�##t°) ❑NAD 1927 ❑ NAD 1983 ❑USGS Quad Map ❑Other:
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME 63.STATE
City of Clearwater 125096 PINELLAS FLORIDA
64.MAP AND PANEL B7.FIRM PANEL 69.BASE FLOOD ELEVATION(S)
NUMBER 65.SUFFIX B6.FIRM INDEX DATE EFFECTIVEIREVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depth of flooding)
12103C0102G G SEPTEMBER 03,2003 SEPTEMBER 03,2IX13 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 Detertnined ❑Other(Describe):_
B11.Indicate the elevation datum used for the BFE in 69:❑NGVD 1929 �NAVD 1988 ❑Other(Descnbe):_
B12.Is the building located in a Coastal Bamer Resourc;es 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' ❑Builtling Under Construdion" �Finished Construdion
"A new Elevation Certificate will be required when construction of the building is complete.
•^2.Building Diagram Number 7 (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,AWA1-A30,AR/AH,ARIAO
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 usetl 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 appropnate,to document the datum cornersion.
Datum NAVD 1988 Conversion/Comments N/A . �-w.,
Elevation reference mark used LP-15, EL.=4.191 Dces the elevation reference mark used appear on the FIRM? ❑Yes �No �. ' '+;�
o a)Top of bottom floor(including basement or endosure) 575 . F=f ft.(m) � ,,��;`� ,4,6 if`'
o b)Top of next higherfloor 15.91 . FT ft.(m) � �e� •�`� ���°
o c)Bottom of lowest honzontal structural member(V zones only) N/A FT ft.(m) o o ' `��` ' � �"
o d)attached garage(top of block) 575 . FT ft.(m) �� � 6�"° ��•� (> � ' �
w � � '
o e)Lowest elevation of machinery and/or equipment � _�; �4�'�' ,� . "
servicing the building(ELEVATOR EQUIPMENT) 11_75. FT ft.(m) /��'r` ��� :'� ��+�'� �=�� {:
o fl Lowest adjacent(finished)grade(LAG) 42 . FT ft.(m) L'"'�'.' z� �'pc�'�"6���, °°. +
o g)Highest adjacent(finished)grade(HAG) 5.1 . Ff ft.(m) � '' Oa/�5/06 �'��"
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 cerfify that the information in Sections A,B,and C on this ceRificate represents my best efforfs to interpret the data available.
1 understand that any false stafement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001.
CERTIFIER'S NAME LICENSE NUMBER
JACK W.SMITH PSM 6140
TITLE COMPANY NAME
PROJECT SURVEYOR KLEIN&STAUB SURVEYING,INC,
•ADDRESS CITY STATE ZIP CODE
8016 Old County Road 54 � New Port Richey FL 34653
SIGNATURE �J DATE TELEPHONE
� �G� �� 05-05-06 (727)834-8140
i
L ---_
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�nsuranoe Company use:
� �
�S!JI�+�ING STREET ADDRESS(Induding Apt,Uni�,Suite,andlor Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number
� 145 BRIGHTWATER DRIVE UNIT No.1-9
, • CITY STATE ZIP CODE Company NAIC Number
CLEARWATER FLORIDA 33767
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
�py both sides of this Elevation Certificate for(1)community official,(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 CerGficate is intentled 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 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(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 Zone AO only: If no flood tlepth 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 owne�'s authorized representative who completes Sections A,B,C(Items C3.h and C3.i only),and E for Zone A(without a FEMA�ssued or community-
issuetl BFE)or Zone AO must sign here. The sfatements 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
�
, DRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
❑Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation
Certificate, Complete the applicable item(s)and sign below.
G1.❑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
or local law to certify elevation information. (Indicate the sour�e and date of the elevation data in the Comments area below.)
G2.❑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 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
G?.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
�MMENTS
❑Check here if attachments
FEMA Form 81-31,January 2003 Replaces all previous editions
�'�OO�I-' Q`°,:�,�� � 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.030084.2
SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use:
BUILDING OWNER'S NAME Policy Number
PARADISE COVE, INC. UNIT No.4
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
145 BRIGHTWATER DRIVE
CITY STATE ZIP CODE
CLEARWATER FLORIDA 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
LOT 4, PARADISE COVE PLAT BOOK 128,PAGES 19-20
BUILDING USE(e.g.,Residential,Non-residenUal,Addition,Accessory,etc. Use a Comments area,if necessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):
� �°_��-�,�� o� �.�°) ❑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-G PINELLAS FLORIDA
B4.MAP AND PANEL B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER B5.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 Detertnined ❑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 REQUIRED)
C1.Building elevations are based on:❑Construction Drawings' 3uilding Under Construction` �Finished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
.;2.Building Diagram Number 7 (Select the building tliagram 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,AWA,AR/AE,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 antl datum conversion calculation. Use the space provided or the Comments area of
Section D or Section G,as appropnate,to document the datum conversion.
Datum NAVD 1988 Conversion/Comments N/A
Elevation reference mark used LP-15, EL.=4.191 Dces the elevation reference mark used appear on the FI RM? ❑Yes �No � ,�'�F���'�,
o a)Top of bottom floor(including basement or enclosure) 575 . FT ft.(m) � �'�+�, �" �$ �'� ,` `''.
o b)Top of next higher floor 15.91 . FT ft.(m) `� � �~ � ��
o c)Bottom of lowest honzontai structural member(V zones only) N/A FT ft.(m) o o `���r;V , �� �- '��•
o d)attached garage(top of block) 575 . FT ft.(m) ��� ,; ��� -. �: ;; � � , �"_� '
o e)Lowest elevation of machinery and/or equipment w@ ���M -�
d � � ,F"• M � �' �� �
seroicing the building(ELEVATOR EQUIPMENT) N/A FT ft.(m) � � " � . .�;� � �;'j�,�.�� �'`
o fl Lowest adjacent(finished)grade(LAG) 42 . FT ft.(m) z�'�' � �3 �s:3�',f'LS 505�Q"��'
o g)Highest adjacent(finished)grade(HAG) 5.1 . FT ft.(m) � „ , � `�,�'I�/��',`� '
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 14 � � '� 'i+
o i)Total area of all permanent openings(flood vents)in C3.h 1280 sq.in. �'"'r?�"�a�"°""`"'
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,8,and C on this certificate represents my best efforfs to interpret the data available.
I understand that any false stafement 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 4 New Port Richey FL 34653
SIGNATURE DATE TELEPHONE
. 10/14/05 (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 com�any use:
BUILDING STREET ADDRESS(Induding Apt.,Unit,Suite,andlor Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number � '
145 BRIGHTWATER 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 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 ZONF AO AND ZONE A(WITHOUT BFE)
For Zone AO and Zone A(without BFE),complete Items E1 through E4. If the Elevation Certificate is intentletl 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 gratle,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 m�hinery 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,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�o�ciai who is authorizc�d by law or��iinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation
Certificate. Complete t"e appiicable item(s)and sign below.
G1.[�The iriformation in Section C was ta!<en i;om other documentation that has been signed and embossed by a licensed surveyor,engineer,or architect who is authonzetl by state
or local law tc certrfy;,lev�tion informa?ion. (Indicate the source and date of the elevation data in the Comments area below.)
G2.❑A con�munity o�aal conp�eted Sec�ion E for a building locatetl in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0.
G3.0 The following informafion(ftc-:rs��-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 basernent)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 � ` ��� ��� � � Q k TITLE
�. �s "q,r - o
� _ ,,.� `
COMMUNITYNAME �'S�� „;� TELEPHONE
�� � ..�-
SIGNATURE ` ,,�>„, s DATE •
COMMENTS �, .: , .�:'�5 s.�" �,;�;��,,�
k S �k
�y�Y.,.. � a'"''0. ..:..&Y t Ev�ai� 5�.!
� �kj i''
❑Check here if attachments
FEMA Form 81-31,January 2003 Replaces all previous editions
4�����.a-,,'�
i p�,
4���,°���'X'="����'��� C I T Y O F C L E A R W A T E R
� °���\' �`f- �� � �'
�'�` ��'� DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
��g g��,- t
��,�� ���`�+q�� POST�FFICE BOX 474g� CLEARWATER� FLO�DA 33758-4748
� '�Sr��- ,,,s9
��`',���,���°s, ���� MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CI.FARWATER,FLO�uDn 33756
���'���"` TELEPxorrE (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
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
.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME B3.STATE
City of Clearwater 125096
64.MAP AND PANEL g5.SUFFIX B6.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
B10. 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. 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.)
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 all permanent openings(flood vents)in C3.h sq.in.(sq.cm)
Comments: ,
Date of Review: � � Community Official:
�evation certificates sha//be maintained by the community and copies with the attached memo made availab/e 6y request
FRANK HIRRARI),MAYOR
GEORGE N.CRE7'EKOS,COUNCILMEMBER JO[IN DORAN,COUNCILMEMRER
PAUL F.GIRSON,COUNCILMEMRER � CARI,FN A.PE7'ERSEN,COUNCILMEMBER
��EQUAL EMYLOYMENT AND AFFIRMA'fIVE ACI'ION EMPLOYER�
' T
,�������
♦1�� �'yE��
�����'=`�f�.� C I T Y O F C L E A R W A T E R
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� �� �
��=_ �y� DEVELOPMENT 8� NEIGHBORHOGD SERVICES DEPARTMENT
�r� __ �°'�
��/a�, �J ��'��q� POST�FFICE BOX 474g� CLEARWATER� FLO�DA 33758-4748
�/Sj, 1, ."`_yi%1r���i�
������9��� �
�. � MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CLEARWATER,FLO�uDn 33756
�����° TFLEPxoNE(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
�Minor corrections have been made in the below marked sections by Community Official
SECTION A-PROPERTY INFORMATION For Insu�ance 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
.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 g8.FLOOD ZONE(S) B9�BASE FLOOD ELEVATION(S)
NUMBER 5/17/2005 EFFECTIVE/REVISED DATE (Zone AO,use depth of flooding)
12103C-0102
B10. 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)
B11. Indicate elevation datum used for BFE in 69:❑ 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: ❑ 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,AR/A1-A30,AR/AH,AR/AO.
Compiete 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 c�rtificates shall be maintained by the community and copies with the attached memo made availab/e by request
FRANK HIBBARD,MAYOR
GEORGE N.CRE'1'EKOS,COUNCILMEMRER JO[W DORAN,COUNCILMEMBER
PAUL F.GIBSON,COUNCILMEMRGR � CARI.EN A.PE"1'GRSEN,COUNCILMEMBER
��EQUAL EMYLOYMEN'P AND AFFIItMA1'IVE ACI'ION EMNLOYER��
. . � • FEDERAL EMERGENCY MANAGEMENT AGENCY
✓ -.
• � NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077
�j� Expires December 31, 2005
a�_ �aa3 ELEVATfON CERTIFICATE
� Important: Read the instructions on pages 1•7. JOB No.030084.2
SECTION A-PROPERTI'OWNER INFORMATION For Insurance Company Use:
BUILDING OWNER'S NAME Policy Number
PARADISE COVE, INC. UNIT No.4
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX N0. Company NAIC Number
145 BRIGHTWATER DRIVE
CITI' STATE ZIP CODE
CLEARWATER FLORIDA 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
LOT 4, PARADISE COVE PLAT BOOK 128,PAGES 19-20
BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,if necessary.)
RESIDENTIAL
fATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUNt: SOURCE: ❑GPS(Type):
( r�°-#�'#'-#�.#f#" or ##.#��°) ❑NAD 1927 ❑ NAD 1983 ❑USGS Quad Map ❑Other. _
SECTION B-FLOOD INSURANCE RATE MAP(FfRM)INFORMATION
B1.NFIP COMMUNITY NAM�&COMMUNIIY NUMBER B2.COUNTY NAI✓lE B3.STATE
City of Clearwater 125096 PINELLAS FLORIDA
B4.MAP AND PANEL B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER 65.SUFFIX B6.FIRM INDEX DATE EFFECTIVE/REVISED DATE B8.FLOOD ZONE(S) (ZoneAO,use tlepth of flooding)
125090-0102 G SEPTEMBER 03,2003 SEPTEMBER 03,2003 AE EL,11.0
B10.Indicate the source of the Bzse Floo�Elevation(BFE)data or base flood depth entered in B9.
❑FIS Proftle �FIRM ❑Community Determined ❑Other(Descnbe):
811.Indicate the elevation datum used for the BFE in B9:�NGVD 1929 �NAVD 1988 ❑Other(Descnbe):_
812.Is the building I�ated in a Coastal Bamer Resources System(CBRS)area or OtheM�ise Protected Area(OPA)? ❑Yes �No Designafion Daie_
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are basetl on:�Construction Drawings` �Building Under Construction` ❑Finished Construction
`A new Elevation Cerfincate will be required when construction of the building is complete.
�C2.Building Diagram Num�r 7 (Select the building diagram most similar to the bu�ding for which this ceriificate is being completed-see pages 6 and 7. if no diagram
axurately represenis the building,provide a skeich or photograph.)
C3.Elevations—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AWA,ARIAE,Ar'�/A1-A30,AR/AH,AR/AO '
Complefe liems C3.-a-i below according to the building diagram specined in Item C2.Staie the datum used.If the datum is different from the datum used for the BFE in
Secfion B,convert the datum to that used for the BFE Show neld measurements and datum conversion calculation. Use the space provided or the Commenis area of
S�,;iion D or Section G,as appropriate,io document the datum conversion.
Datum NAVD 1988 Conversion(Comments N/A �..
Elevation roierence mark used LP-15, EL.=4.191 D�s the elevation reierence mar<used appear on the FIRN? ❑Yes �No •- �,3��Z�.i�
o a)Top of boriom floor(including basement or endosure) 5.75 FT ft.(m) � -���,� ` ,.•�� • '�,�� ��
o b)Top of next hiaher floor 15.91 F-f ft(m) � ``-ur °"� ��.(,�
�
o cj Boriom oi lowest horizonial siruciural memo�r(V zones oniy) N/A �T fi.(m) N ff'. ''``, '`� e�� �- ..-
. '
o d)attached garage(top of block) 575 FT ft.(m) ��� =.+ _ Q � b' '�
o e)Lowest elevafion of machinery and/or equipment w �= `-�
��` "
servicing the building(ELEVATOR EQUIPMENT) NIA . F_f ft.(m) �� � � :f ; � `�
o �Lowest adjacent(nnished)grade(LAG) 4.2 FT ft.(m) z'.�, `- "� • '�'
o g)Highest adjacent(finished)grade(HAG) 5.1 . Ff ft.(m) �� � � '�, L. 05/1 a! �5��\
,.. � -
o h)No.of p�rmanent openings(flood vents)within 1 ft.above adja�nt grade 14 � � ``d y j ; ''�y� `
o i)Total area of ail permanent openings(flood vents)in C3.h 1280 sq.in. "'•.�,�2„
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer,or archi;ect authorized by law to ceriify elevation informafion,
1 certify thaf fhe informafion in Sections A,8, and C on fhis certificafe represents my besf efforts fo interpret the dafa available. �
I undersfand fhat any false sfafemenf 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
• PRtSIDENT ° KLEIN&STAUB SURVEYING,INC.
HDDRESS CITY STATE ZIP CODE
8016 Old County Road 54 New Porl Richey FL 34653
SIGNATURE DATE TELEPHONE
% _ 05/11/05 (727)834�140
FEMA Form 81-31,January 2003 See reverse side fo�continuation. Replaces all previous editions
IMPORTANT: In these spaces,copy the corresponding information from Section A. For insurance company Use: • .
BUILDING STREET ADDRESS Qnduding Apt,Unil,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number � •
145 BRIGHTWATER DRIVE UNIT No.4 .
��N STATE ZIP CODE Company NAIC Number
CLEARWATER FLORIDA 33767
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) �
Copy both sides of fhis Elevafion Cerfifcate for(1)community official,(2)insurance agenticompany,and(3)building owner.
COMMENTS
NIA
❑Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WfTHOUT BFE)
For Zone AO and Zone A(withouf BFE),complete Items E1 through E4. If tne Elevafion Certincale is iniended for use as supporting information for a LOM,A or LOMR-F.
Se;,tion C must be compieted.
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(inciuding basement or enclosure)of the building is _ft.(m)_in.(cm)�ab�ve 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 flo�r(elevation b)of the building is _ft.(m)_in.(cm)above the highest adjacent
grade. Complete ifems C3.h and C3.i on front of form.
E4.The top of fhe platform of machinery and/or equipment servi�ing the building is _ft.(m)_in.(cm)�a�ve or ❑b�low(che�k one)tne highest atljacent grade. (Use
natural grade,if available).
E5.For Zone AO only: If no floo�d2pth number is availabie,is the top of the bottom floor elevated in a�cordance with the communifys floodplain manag�ment ordinance?
❑Yes ❑No ❑Unknown. The local official must certify this information in Secfion G.
SECTfON F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owners authonzed representative who compietes Sections A,B,C(Items C3.h and C3.i only),and E for Zone A(without a FEMA-issu2d or community-
issued BFE)or Zone AO must sign here. The sfatemenfs in Sections A,B,C,and E are correcf fo the best of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZtD REPRESENTATIVE'S NAMt -- �
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COIv1MENTS
❑Check here if attachments
_ SECTION G•COMMUNfTY INFORMATION(OPTIONAL)
I he I�ai o{�cial whe is authnnzed 7y lau�or ordinance to administer tne communitys flo�dplain manag2ment ordinance can compleie Seciions A,B,C(or c),and G of ihis Elevaiion
Cerflncaie �ompleie the ar,plicaG!a ifemjsj and sign below.
G1.�]The inform�;�on in S�ction�l+.�as taken from other dxumentation that has be�n signed and embossed by a licensed surveyor,engin�r,or archilecf who is authonzed by staie
or local la�.�to certi"ry elevat�on intoimation. (Indicate the source and date of the elevation data in the Comments area below.)
G2.�A co;nmur;i`,y officia!corr;n!eted Sec'tion E for a building lo;;aied in Zone A(without a FEMA-issu�or community-issued BFE)or Zone A0.
G3.�The following informaii�r(It�n���r�=G9)is provided for community floodplain management purp�ses.
G4.PERMIT NUMB=k 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-builf lowest flo�r(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 attachmenls
FEMA Form B1-31,January 2003 Replaces all previous editions