161 BRIGHTWATER DR UNIT 4 _6 � ---s3"'�'_ _ _
�` FEDERAL EMERGENCY MANAGEMENT AGENCY
� ` �� �� � �� NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077
�� / /��'a°�%K��T� Expires December 31, 2005
� ELEVATION CERTIFICATE
Important: Read the instructions on pages 1-7. JOB No.020024.2
SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use:
� BUILDING OWNER'S NAME Policy Number
CLEARWATER TOWNHOMES, INC. UNIT No.4
BUILDING STREET ADDRESS(Induding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
161 BRIGHTWATER DRIVE
CITY STATE ZIP CODE
CLEARWATER FLORIDA 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
LOT 4, ISLAND TOWNHOMES Plat Book 127,Pages 46-47
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 82.COUNTY NAME �•�AT�
City of Clearwater 125096-0102-G PINELLAS FLORIDA
B4.MAP AND PANEL B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER 65.SUFFIX 66.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 floai 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):_
612 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.
•.r,2.Building Diagram Number 7 (Select the building diagram most similar to the building for which this certificate is being completed-see pages 6 and 7. If no diagram
accurately represents the builtling,provide a sketch or photograph.)
C3.Elevations—Zones A1-A30,AE,AH,A(w�h BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,ARIA1-A30,ARIAH,ARIAO
Complete Items C3:a-i below aarording 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 areaof
Section D or Section G,as appropnate,to document the datum conversion. . -�i 3`°"n+.�� �_
Datum NAVD 1988 ConversionlComments NIA � ��;��4�r� ��'
Elevation reference mark used LP-15. EL=4.191 Does the elevation reference mark used appear on the FIRM? ❑Yes �No �: �`*,.w' `!¢., Unr �� �
o a)Top of bottom floor(induding basement or endosure) 5.50 . FT ft.(m) � �r°9�;b �.; ''�,0"; �',x.
o b)Top of next higherfloor 15.67 . FT ft.(m) � �" �°'� �A`�'� i �,� '��w��`
o c)Bottom of lowest horizontal structural member(V zones only) N/A . FT ft.(m) 'o� '�,:�� ° � ��,; ' `
o d)attached garage(top of block) 5.50 . FT ft.(m) W� - '��p�� �*� �
o e)Lowest elevation af machine ry and/or e qui pment ,,�� �i ��: .•� �
serviang the building(ELEVATOR EQUIPMENT) N/A . Fi ft.(m) �f�@ '�`"" w, „� � �:�,�� � `
o fl Lowest adjacent(finished)grade(LAG) 4.2 . FT ft.(m) z� �' � ;,�,,'��, � ��
o g)Highest adjacent(finished)grade(HAG) 5.1 . FT ft.(m) � =.9��'`� :�1 C��ii��i- �"
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 14 � � ������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 thaf the information in Sections A,B,and C on this certificate represents my besf efforts to inferpret the data available.
1 understand thaf any false stafement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001.
CERTIFIER'S NAME LICENSE NUMBER
BRUCE A.KLEW PLS 5052
TI7LE COMPANY NAME
• PRESIDENT KLEIN&STAUB SURVEYING,INC.
ADDRESS CITY STATE ZIP CODE
8016 Old Cou oad 54 New Port Richey FL 34653
SIGNATUR DATE TELEPHONE
08114/05 (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,and/or Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number `
161 BRIGHTWATER DRIVE UNIT No.4 "' ��
CITY STATE ZIP CODE Company NAIC Number �
CLEARWATER FLORIDA 337g7
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) •
Copy both sides of this Elevation Cerdficate for(1)commun�y offiaal,(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 supporting information for a LOMA or LOMR-F,
Section C must be completed.
E1.Building Diagram Number_(Select the building diagram most similar to the building for which this certificate is being completed—see pages 6 and 7. If no diagram accurately
represents the building,provide a sketch or photograph.)
E2.The top of the bottom floor(including basement or enclosure)of the building is _ft.(m)_in.(cm)�above or ❑below(check one)the highest adjacent grade. (Use
natural grade;'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 and/or equipment serviang the building is _ft.(m)_in.(cm)❑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 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 FEMAassued 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
�' f SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The local official who is authonzc:d by la�v or ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation
Certific�,tP, Complete tf�e applicable item(s)ana sign below.
G1.❑The information in See��n C was taken f�om 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�tion informatiun. (Indicate the source and date of the elevation data in the Comments area below.)
G2.0 A community offiaal cpm�let��Sec±ion E for a building located in Zone A(without a FEMA-issued or community�ssued 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 COMPLIANCEIOCCUPANCY ISSUED
G7.This permit has been issued for: ❑New Construction ❑Substantial Improvement
G8.Elevation of as-built lowest floor(induding basement)of the building is: _._ft.(m) Datum:_
G9.BFE or(in Zone AO)depth of flooding at the building site is: _._ft.(m) Datum:_
LOCAL OFFICIAL'S NAME TITLE
.�,._,..���y ���
COMMUNITY NAME � ��x ���;,� � TELEPHONE
�!t> 4 i:
SIGNATURE �'��`�� DATE .
COMMENTS �+
c t�'� d"'��'.'e° H'9��.�;
C3���'-`� A ���R
S}�
�9"�°� ��,$�� �x�,.9�..,°'" �
i � ❑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
��'/ �r'✓�r"�C�x>���`r� Expires December 31, 2005
, • ELEVATION CERTIFICATE
Important: Read the instructions on pages 1-7. JOB No.020024.2
• SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use:
BUILDING OWNER'S NAME Policy Number
CLEARWATER TOWNHOMES, INC. UNIT No.4
BUILDING STREET ADDRESS(InGuding Apt,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX N0. Company NAIC Number
161 BRIGHTWATER DRIVE
CITY STATE ZIP CODE
CLEARWATER FLORIDA 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcei Number,Legai Description,etc.)
LOT 4, ISLAND TOWNHOMES Plat Book 127,Pages 46-47
BUILDING USE(e.g.,Residential,Non-residential,AddiUon,Accessory,etc. Use a Comments area,if necessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):
( ##°-##�'-##.#1#" or ##.##�i#°) ❑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 63.STATE
City of Clearwater 125096-8�8�-6�— PINELLAS RORIDA
64.MAP AND PANEL � /� Q B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER 65.SUFFIX IR I DEX DATE EFFECTIVE/REVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depih of floodirg)
12103C010 G , SEPTEMBER 03,2003 AE EL11.0
610.Indicate the s rce of the Base Flood Elevation(BFE)data or base flood depth entered in 69.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Describe):_
611.Indicate the elevation datum used for the BFE in B9:0 NGVD 1929 �NAVD 1988 ❑Other(Describe):_
612 Is the building located in a Coastal Bartier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No Designation Date_
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:�Construcction Drawings' ❑Building Under Construction' �Fnished Construction
'A new Elevation Certificate wiil 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 cerfificate 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,AWA1-A30,AWAH,AWAO
Complete Items C3.-a-i below according to the building dagram specified in Item C2.State the datum used.If the datum is different from the datum used for ihe 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 SecUon G,as appropnate,to document the datum conversion.
Datum NAVD 1988 Conversion(Comments NIA
Elevation reference mark used LP-15, EL.=4.191 Does the elevation reference mark used appear on the FIRM? ❑Yes �No
o a)Top of bottom floor(induding basement or endosure) 5.50 . FT ft.(m) � _ � �
o b)Top of next higher floor 15.67 . FT fl.(m) `� � `
o c)Bottom of lowest honzontal structural member(V zones only) N/A . FT ft.(m) � � :~3 � `: �^. , '
o G ,�_,
o d)attached garage(top of block) 5.50 . FT ft.(m) �� ,�, "
o e)Lowest elevation of machinery andlor equipment w m `� "�'
; �'`��� �
serviang the building(ELEVATOR EQUIPMENT) rUA . FT ft.(m) �@ .,�
o �Lowest adjacent(finished)gratle(LAG) 42 . FT ft.(m) z�''N R!_S 5fl52
o g)Highest adjacent(finished)grade(HAG) 5.1 . FT ft.(m) � 9 0114J0,5
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 14 �
o i)Total area of ail 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 suNeyor,engineer,or architect authorized by law to certify elevation information.
1 certify that the information in Sections A,B,and C on this certificate represents my besf efforfs fo interpret the data available.
1 understand that any false statement may be punishable by fine or imprisonmenf 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 Coun oad 54 New Port Richey FL 34653
SIGNATUR�F� DATE TELEPHONE
� 08/14/05 (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 company use:
BUILDING STREET ADDRESS(Induding Apt,Unit,Suite,and/or Bidg.No.)OR P.O.ROUTE AND BOX N0. Policy Number '
161 BRIGHTWATER DRIVE UNIT No.4 . •
CITY STATE ZIP CODE Company NA�C Number � �
CLEARWATER FLORIDA 33767
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) •
Copy both sides of this Elevation Certificate for(1)community offiaa�,(2)insurance agenUcompany,and(3)building owner.
COMMENTS
NIA
❑Chedc 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 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(induding basement or endosure)of the building is _ft.(m)_in.(cm)❑above or ❑below(chedc 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 plafform 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 floal depth number is available,is the top of the bottom floor e�evated in accordance with the communit�s floodplain management ordinance?
❑Yes ❑No ❑Unknown. The local offiaal must cerGfy this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or oumers authorized representative who cbmpletes 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 sfafemenfs in Secfrons A,B,C,and E are correct to the besf of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME •
ADDRESS CIIY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
❑Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The locai officiai who is authorized by la�v or ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation
Certi6c�;t�. Complete the applicable item(s)anti sign below.
G1.�Tri�information in Seeb,��n C was take��f,rom other documentation that has been signed and embossed by a licensed surveyor,engineer,or architect who is authonzed by state
or Ic�cal I^w to certify elev�ion information. (Indicate the source and date of the elevation data in the Comments area below.)
G2.�A community nffiaal com�leiea Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0.
G3.0 The fdlowing inf�ation(Items G4-G9)is provided for communiiy 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 Construdion ❑Substantiai 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 s�e is: _._ft:(m) Datum:_
LOCAL OFFICIAL'S NAME /„��� ,�-,��` TITLE
�...,.�1."`'ii ' ':1+� i
COMMUNITYNAME :;;, r ::�°,�;� � TELEPHONE
� `'
SIGNATURE '� �-`� DATE
)t �Ta '�j�� .
COMMENTS �
. ...,. �
�-a�,,4 :�'a €"'p�.`'Y".�'y t��'�°`�
E ��* � °. y rv!h d���
� s `rv*J,, ��....�n—s��-- . .
�� �'� '° ' ❑Check here if attachments
FEMA Form 81-31,January 2003 Replaces all previous editions
��$��r�c�� CITY OF CLEARWATER
• V ,�li, �
�, � a DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
` POST OFF[CE BOX 474H� CLFARWATER� FLO►�Dn 33758-4748
�
��'ATER�� MUNICIPAL SERVICES BUILDING, lOO SOUTH MYRTLE AVENUE,CI.EARWATER,FLO�uDn 33756
TELEPHONE�7Z�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
.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME 63.STATE
City of Clearvvater-125096
64.MAP AND PANEL 67.FIRM PANEL 69.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVE/REVISED DATE B8•FLOOD ZONE(S) �Zone AO,use depth of flooding)
12103C0102 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)
612. Is the buildin 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 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 shall be maintained by the community and copies with the attached memo made available by request
Fwuvx HiaRnw�,MAYOR
GEORGE N.CRE'1'EKOS,COUNCILMEMRER JOIIN DORAN,COUNCILMEMBER
PAUL F.GIBSON,COUNCILMEMRER � CARI.EN A.PEI'ERSEN,COUNCILMEMBER
��EQUAL EMYLOYMENT AND AFFIItMATIVE ACTION EMPLOYER��
FEDERAL EMERGENCY MANAGEMENT AGENCY v
• NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077
1�� �a003 Expires December 31, 2005
� � oSs �� ELEVATION CERTIFICATE
Important: Read the instructions on pages 1-7. JOB No.020024.2
SECTION A-PROPERTY OWNER INFORMATION Forinsurance Company Use:
BUILDING OWNER'S NAME Policy Number
CLEARWATERTOWNHOMES, INC. UNIT No.4
BUILDING STREET ADDRESS(Induding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
161 BRIGHTWATER DRIVE
CITY STATE ZIP CODE
CLEARWATER FLORIDA 33767
PROPERTY DESCRIPTION(Lot and Blodc Numbers,Tax Parcel Number,Legal Desaiption,etc.)
LOT 4, ISLAND TOWNHOMES Plat Book 127,Pages 46-47
BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,'rf necessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):
( ##°-#1#'-##.##" or #1#.�) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other:
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNf1Y NAfv�&COMMUNITY NUMBER B2.COUNTY NAME 63.STATE
City of Clearwater 125096 PINELLAS FLORIDA
B4.MAP AND PANEL B7.FIRM PANEL 69.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVEIftEVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depih of flooding)
125096-0102 G SEPTEMBER 03,2003 SEPTEMBER 03,20U3 AE EL.11.0
B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in 69.
❑FIS Profile �FIRM ❑Communiiy Determined ❑Other(Describe):_
611.Indicate the elevation datum used fa the BFE in B9:�NGVD 1929 �NAVD 1988 ❑Other(Desaibe):_
612.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' ❑Finished Construction
`A new Elevation Certificate will be required when construction of the building is complete.
�2.Building Diagram Number 7 (Se�ect 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,AWA,ARIAE,ARIA1-A30,AR/AH,AR/AO
Complete Items C3:a-i below according to the building diagram speafied 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 sp�e provided or the Comments area of
Section D or Section G,as appropriate,to document the datum conversion.
Datum NAVD 1988 ConversionlCanments N/A � � '�
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(induding basement or enclasure) 5.50 . FT ft.(m) � y_ w "�,�• ,. •. �, -
o b)Topofnexthigherfloor 15.67 . FT ft.(m) � � 4,��,•'�w �� ,! �.,�J
� �
o c)Bottom of lowest honzontal structural member(V zones only) N/A . FT ft.(m) o o ��*1,�ti�' N "'�ti; ".J : .,.: .
o d)attached garage(top of block) 5.50 . FT ft.(m) w�; tl ; � � Q,, :
o e)Lowest elevation af machinery andlor equipment -�;; ,.. '`" .
v`��
serviang the building(ELEVATOR EQUIPMENT) N/A . FT ft.(m) E� ; '' � c�`� v,��� . •
o �Lowest adjacent(finished)grade(LAG) 4.2 . FT ft.(m) z y.f!�!4 •",„��� � �' �� •„;r�
o g)Highest adjacent(finished)grade(HAG) 5.1 . FT ft.(m) � ' :, ,�,, •.A$(12�9¢.�- '
�
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. � ^•�.,t...,.
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 cerfificate 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 ad 54 New Port Richey FL 34653
SIGNATURE DATE TELEPHONE
. - 08/12/04 (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 com�any use:
BUILDING STREET ADDRESS(Induding Apt,Unit,Suite,andlor Bldg.No.)OR P.O.ROUTE AND BOX N0. Polic,y Number �
161 BRIGHTWATER DRIVE UNIT No.4 . ' -
�� STATE ZIP CODE Company NAIC Number `
CLEARWATER FLORIDA 337g7
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 ZONE AO AND ZONE A(WRHOUT BFE)
For Zone AO and Zone A(without BFE),complete Items E1 through E4, If the Elevation Certficate is intended for use as supporting information for a LOMA or LOMR-F,
Section C must be c�mpleted.
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,provi�a sketch or photograph.)
E2.The top of the bottom floor(induding basement or endosure)of the building is _ft.(m)_in.(cm)0 above or ❑below(check one)the highest adjacent grade. (Use
natural grade,'rf available).
E3.For Building Diagrams 6�with openings(see page 7),the ne�higher floor or elevated floor(elevation b)of the building is _ft.(m)_in.(cm)above the highest adjaoent
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(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 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 REPRESENTATNE)CERTIFICATION
The property owner or owners authorized representative who completes Sec6ons 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 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 offici�l who is authoiized by I:aw c,urdinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),antl G of this Elevation
Certificate. Complete the applicable i!e�,�(s)and sign below.
G1.�The intormation in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor,engineer,or architect who is authorizetl by state
or loca!law to certifv elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
G2.❑A community official campleted S�ion E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0.
G3.�The followirg informa6on(Ite�ns 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: 0 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 flootling at the building site is: _,_ft.(m) Datum:_
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS i
❑Check here if attachments
FEMA Form 81-31,January 2003 Replaces all previous editions