13 CAMBRIA ST � FEDERAL EMERGENCY MANAGEMENT AGENCY
JOB NO O1- �}3 l q�O S/o NATIONAL FLOOD INSURANCE PROGRAM �•M•B� No. 3067-0077
ELEVATION CERTIFICATE Expires July 31, 2ooz
I� �� °� � � � �
C� �j l - � � �,,�J Z �mportant: Read tt�e instructions on pa es 1-7.
> SECTION A-PROPERTY OWNER INFORMATION
� ��ILDING OWNER�S NAME Fo[Ir�rae�►�Tset
� niczLL � c� �c/o ���
BUILDING STREETqpp{2ESS(�nduding Aqt,Un�,Su�e,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. �
G h�l 2► 4 l R-t� �l�Y t�IC Nur3�r
C� ^ STATE
C.���.�'A 21.�1�4'T �L�. � (_ ZIP CODE ;
PROPERTY DESCRIPTION(Lot and Blodc Numbers,Tax Parcel Number,Legal Desqipbon,etc,) �3 7�7
L_o"t-4� a3t.a�k. 3 tZ-��st d /�1
BUILDING U [w� R,��e.� � .� .� 1� �F C.-IL�2w,4-Tb--Q
�_;�Q.,���oati rwamon AccessorV etc. Use a r�„�„�ts area,d necessary)
L�cSldEa l�Ar�
LATITUDEILONGITUDE(OPTIONAL) HORIZONTAL DATUM:
( �#°-##'-##.#�F' or ##:� ❑Nqp 1927 ❑Nqp lygg _ SOURCE: GPS(Type):
❑USGS Quad Map ❑Other.
SECTION B-FLOOD INSURANCE RATE MAp(FIRM)INFORMATION
B1.NFIR COti1��1NITY NAIuE g CpA�NRy��R ���,�
/2 So Io �,.��LLA. S �.srA�
ea.n�aP nr�aa�a a�.su�a �L.
00 O? B6. WDEX 67.FIRM PANEL B9.BASE FLOOD ELEVATION(g)
� ��v�s��a,� ea.�oo�zon�(s) (z«,e Ao,�e de�n a�ooa�,$)
B1o.�►�d'�ate the s«,roe af the ease Flood Ekva6on �-1 � 8 1 Q� 9 t41�� �2 .��
❑FIS Pr�l'de ��dafa a base flood depth enter�ed in B9.
�FIRM ❑Corrxnu�ty Determined ❑Olher(Desaibe):
611.Ind�e the elevation dabum used fa the BFE�B9:0 NGVD 1929
B12.Is tlie buildi located in a Coastal Barrier Resouroes ❑NAVD 1988 ❑Olher(Desaibe):
CBRS area a Olherwise prot�cj qrea OPA? ❑Yes ❑No pes' �p�
SEECTION C•BUILDING ELEVATION INFORMATION(SURVEy REQU�RED)
C1.B�ng elevatia�s are based on:�Constnx�on Drawings` ❑Buik�ng Under Construction
'A new Elevabon C�te w�l be * (�.Fnished Constnidion
required when oonstruction of the builc�ng is oornplete. �
�2 Bu�ny oia9ram Numeer1cse�ctme txi�ns�aq�rr►most�rr�artothe twi�n �whic�m�oerti�cate is�ei .
��Y�the biririlding�Provide a sk�ch a 9 �9�ted-see pages 6 and 7. If no diagram
C3.Elevafi�ons-Zones A1-A30,AE,AH,A(w�h P�9�)
BFE),VE,W-V30,V(w�h BF�,AR.AR/A,ARIAE,AR/A1-A30,AR/AH,AR/AO
CornPlete Items C3.,a-i below aocor�ing to the buading d'iagr�n spedfied in Itern C2 State the dahim used.If the datum is ciifferent from the datum used for the BFE in
Section B�wnvert the daaum to tl�used for fhe BFE,Show field da
measurerr�ents and datum conversion cak;ulation. Use the space Provided or the Commenfs area of
Sedion D or Section G,as appropriate,to document the datum conv�sion.
�m CarversioNCorrurterits
EJevation referenoe mark used Does the eleva�on r�ence�� , ' ..`
a T ��the FIRM? ❑Yes
) oP d bo�om flaa(ir�du�ing b�ent a endosure) i p,�-�m ❑No .� �;1 y1j
b)Top aF r�ext higher floor � ) ,'�
�o.4 flt(m) � . ;'`�' �� �
c)Bottan of low�est horizontal sfi�xxural member(V zones only� �.�}ft(m) ��� , .�� ��,.° '.
c�Att�ed 9ara9?(toP oF sl�) �.A_ft(m) •`��;'
e)Lowest e�vabon of madiinerY.andlor " `e s��^'� °' � f!
�Pment w� ` 1$ �\.t��:s n�
SEMq�f��IIl9��2SCflb21f18�� ` #� i. —1 �, as.. � �S
adl ( � -�'�=ft(m) _ ,a`� -� .,��,�� � '',
�I�west aoent finist�grade(�qG) � ,� �f �,. �° �� .�,�
h��t adla�t(finished)9rade(HAG) .� �(m) � ) Z� �;,r_. .� : ^�• ; �.:
� p�manent openings(flood venfs wifhin 11t —�-. U ft m
i�Total a►ea aF all ) above a�acent grade v � �/f
P�t openin9s�flood ver�s m C3.h � V,�
)� _3Lsq.in.(sq.cxn)
SECTION D-SURVEYpR,ENGINEER,OR ARCHtTECT CERTIFICATIO � � '
This certificafion is to be signed and sealed by a land surveyor,engineer,or archifect authorized by law to certify elevati info 'ion.
1 cefify fhaf the information in Sections A,8,and C on this certificafe represer�fs my best eiforts to interpret the data av ' �g�� �.t�
1 understand thaf an false stateme�ma � unishable b fine orim risonment under 18 U.S.Code,Secdon 1001. ��t �YC�V� S1/CS
CERTIFIER'S NAME M.G,MAYER
LICENSE NUM
TITLE CEO
CAMPANY NAME FLORtDA BENCHMqRK,WC.
� ADDRESS
1������ �� STATE ZIP CODE
SIGNATURE ��ARINATER � ���
DATE �P�E
727 296-0286
FEMA Form 81-31,JUL 00 SEE REVER$E SIDE FOR CONTINUATION
REPLACES ALL PREVIOUS EDITInN�
IMPORTANT: In these spaces,copy the corresp�nding information from Secclion A
BUILDING STREET ADDRESS(Indudin9 APt,Unit,Sui�,ar�dlor BkJg.No.)OR P.O.ROUTE AND BOX N0. . Fr�rliisurarioe Co�npanyil9e: �
CffY �I�urr�t
STATE ZIP COpE "
�4�F�'i��ttlb�' :,� ,
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
�PY both sides of ihis Elevaation Certificate for(1)community o�iaai,(2)insurarxe agent/companY,aiid(3)building owner.
COMMENTS
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A❑��h�rf a�hments
For Zone AO and Zone A(wittaut BF�,oomple�e�te�s E1 thra� h E4. If tl�e pevabon M�HOUT BFE)
Section C must be completed, 9 ��te is intended for use as supporbng mforma�r��a LOMA or LOMRf,
E1.Buil�rg Diagram Number_(Select the bu�ding diagr�n most similar to the building for which this certificate is being completed–sce pagg�6 and 7. If no dagram accu
r�xesents the buil�ng�provide a sketch a photo9raph.) pa r�y
E2.The top of the bottan floor(iriduding basement a endosure)af the buil�n9 is _ft(m)_in.(cm)�]above or ❑belau(chedc one)the highest adjacent grade. (Use
natur�grade�if avaik�ble).
E3.For Buildin9 Dia9r�ns 6-8 with openings(see Pa9e 7),the next higher floor or elevated fl�oor(elevation b)of the buik# is _ft.m
grade. Canplete items C3.h and C3.i on ftont of form. � ( )_in.(an)above the highest adJacent
E4.Fa Zone AO only: If no flood depth number is available,is the top of the baltom floa eae,ra�d in
❑Yes ❑No ❑Unknam. The bcal offia�must �danoe with the oommunity's floodplain,management or�nanoe?
oerti�y th�s i�famation in Section G.
SECTION F-PROPERTY OWNER OR OWNER'S REPRESENTATIVE CERTIFICATION
The property owner or oumer's authorized re�xe�entative who oompl�es SecUons A�B�C(Items C3.h and C3.i only),and E fa Zone A
issued BFE�or Zone AO must sic�he�e. The sta�ements in Se�ions A�B,C,and E are carect bo the best of my knowledge, �wffhout a FEMA-issued or oornmunity-
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESEMATIVE'S NAME
ADDRESS
CITY STATE �p�ppE
SIGNATURE
DATE TELEPHONE
COMMENTS
SECTION G•COMMUNtTY INFORMATION{OPTIONAL) ❑��h��a�m��
The�°���0����bY��a�nanoe to administer the commu ' s
n�y' flooc�lain management ord�narxe can oomplete S��A,B,C(or E),�d G of this Eleva�on
Cerbficate. Complete tlie�plir,able item(s)and sign below.
G1.�The infamation in Section C was tak�from other documentation that has been signed and embossed by a�icensed surveyor,�gineer,or ardiitect who is authori
state a local law to cer6fy elevation infama�on. (Indicate the source and date dthe elevabon data in the Comments�ea below.) �d by
G2.�A communiry offidal oom�leted Section E for a building bcated in Zone A(without a FEMA-issued or community-issued BFE)a Zone A0.
G3.0 The fdbwing information(Items G4G9)is provided for community floo�lain rnan .
a9err�►t purposes.
G4.PERMIT NUIu�ER G5. DATE PERMIT ISSUED
G6.DATE CERTIFICAI'E pF CquPLIA�CUPANCY ISSUED
G7.Th�s permit has been issued fa:0 New Constn�iori ❑Substantial Improvement
G8,Elevation af as�uilt bwest floor('mduc�ng basement)of the buikiing is:
G9.BF �i'�fl0°���the buildng site is: --�'�m�
Datum:
LOCAL OFFICIAL'S NAME --—�'�m� Datum:
TITLE
COMMUNITY NAME
TELEPHONE
SIGNATURE
DATE
COMMENTS
�
❑Chedc here if attachments
FEMA Form 81-31,JUL 00
REPLACES ALL PREVIOUS EDITIONS
D ..,�.�.. 92-39's w> x , ��w
��...y� i � ��
, �:,:
e,� ` '�
� JAN 1 1 2001 �
� ELE9/ATIOId CERTIFDCATE „ = ����'j�� �,"�,�,',�';
*�� � �
EAA�E�AERGENCY lrAANAGE�Ii�NT A � ;'�
PtAN IN &DEU�LOPMEN SUCS Tro�L FIO�JQ lNSURANCB PROGM�1 �
�o� ��
�!nt�I�F L�A doea prov�ds e waivet at n+�nood ir�xana ourchw n�qu� �rdrfr(b �
° sompMana wtah ap�cat�e coeeurKa�►AoodWa�n� s�a��
determmY ths prc;8r mSUr8nC9 proTlum r8t�,Bnd/Ot t0 fuppOrt a rpusSt fOr�LOttK d Mip An1�n�f� af LOM
I�tstructlons for sompiWnp this twm can 0� found on ttn �' �
I�ARHiAT
�� SECTIOPI A PROP�ATY INFARMATiON � � � � ��'' roR��wcecarv,wrw�[ �'� `�'
EtNtD1NC1 O�NNER'S NMAE r p�,��� , ,q.
SUM ERYILL$ ,�; �; "
STREET ADORESS(Y�p I�PR.UnM.Suat atw�a 81tlp.rM+mb�r1�q P.Q ROUTE Ml�80l(NtJA�IBEA Ct7MrANV NAtC MIAAlEII .s:�
9 MBRIA STREET �,�: �
A+4ti
, : on+eq oE9cR�TIpN r..a srww ewc�►a.no.ra we.1
��' LOT 6, RLV�R 3, CLEARWATER BEACH REYISED
'� � sTA�'E zIP c0� �
__CI,EARWATER• FLORIDA '
SECTION B FLOOD UiSUFiANGE RATE YAP(FlR1q WF'ORWITION , �� � �." ��
P►ovide tt�tolbrdn�irom the�oper FIR1A(Se�InsciiCUOns): �
T�
L CA�111UIiTY M�16EA 2 PANEI NUTABER 3.SUFFIX 4.DATE OF Flirl RJDEX S.FIiMi� l lASE F�iDOD lLE1b1T1011
I25096 0007 D 8/19J91 AS p"i�"�'"101p1� 3
s
7.1�������m system�sed on q�e FlRM tor Base Flood Efevario�s �+ ;��� �
(BFE�:'�NGVD'29 ._,OU�er(desa�e�on badc) , x
8.For Zones A or V,where no BFE is provided on the FlRM.a�d t�a c�rtura�rury has s�hsd a 8FE tor this buwd'ap sies.h�icab �:•• �
me community's BFE:=' i ` �.?.!teet NGVD(or othar F1'�A datum-�see Section 8.Poam .`4` �
7?. -� .�
�
SECTIt�N C BtJilDINO E�EVATiON INFORAAATION ;;;���
� t.Usirg tt�e Elevatlon CeRlflcate Instruaio�s,indic►�tv tM diapram nwnber from the d�art�a tound on Papes 5 arxi 6 tha�best �';� "
d�estxbes the su0ject buikiirq's refera�ce level�,_.
2(a).FIRM Zones At-A30.AE,AH,and A(with BFE7. The top ot ths refereocs level flopr irom tM sekcted c�a�am i����,� ;
01 ! � ' �9,g�(eet NGVD(or otl�et FIRM datum-sae Section B,ttem�. APT. 2N REAR 8.71
(bj.FIRM ZOneB V1-V30.VE,end V(with BFE}. Th@ bptrom ot the IOVrESt hOrixOnt�tl gtttx�ral mert�ba�p��reference level trpRf
the selected dia�atn,is at an elevado�of ; ; � � �-:_4est NC3VD(or a4her FIRM d�un-ae�Sattion B.Item�. � ���;�
(cf. FIRM Zone A(wftNOUt BFE). The floor used as ths reterence level trom the selecisd diapram es '.`_�._:leet abov+e�..� ot
belOw� {Ch9Ck OnA) th6 hiqheSi grsd!ed�atent t0 M6 buildinp.
(d1.FIRM Z�AO. The 6o0r used as the reference level from the seleCted dia�am�s =.�..i test aDove t? or beb�w�(check " `�
orse)the hqhest ptade adJS�arn to Me bui�ng. If no fbod depth numb�is avaiaDN.is the bt�inp s bwest Aoa{�
ievel)elevated�aocordance with the commur+itya hoodplain manapen�p ardinar�� `,�' Ybs � Mo � t)ntv�o+�en� � � -
3.Inchc,aU9 the elev8tlOn dBtUm SySt@m used in d@terminiRp thA abov9 rets�9nCe Isvl1 M�+�id0��J NCiVD 79 � Olf�(d�bs
under Cornmerns on Pay�7). (NOTE: N ths eleva�ion dtthun used In msasainQ Ms Msvaeior�a ts�than lhat use�d on
me FJRI�I tssm sscmn 8.ltem 7�then Qan�r me elavat�ns ro a�e datum srsran us.d on a»FtR�I and st�cw u,s�ansrsion -
BWqu�ion under Comments on PaQe?.1 ,;
,
4.Eievation reforenCS marfc used eppeers on FIRM: � Yss _'NO (See l�on PaS,�4)
s.Tne rerere�ce�ew�e�evarion is oassd o�: ?� aaua�cc�nnsauc8on G� �ru�on drawinqs `4
(NOTE tRs9 ot Cor�sOUCOIOn�awrnQs!s enly v�d d tM btaMing dbes no!ret Ra►�fM nNiw►nrxs Jh�M Abor ir�ptaae�in wAicA ;^�
case�a cMO�wi aMy be va1Fd/or ths bcaldin9 durin�ths covrse ol Qaru�udiorR A�j•,pn E1�va�fon Ca�s ;"
wiA�De isqui►ed o►1CI cor+suucDon kt ct,rnplet�.)
6.The e�evatbn of the lowest p�ade immediatey adjacent to the Duilding is: • 8•62 het NGVQ(a othsr FIRl.1�atwn�sss
Seetion 8,hem�.
3ECTIGN 0 COMIiAUN�'T1f IKFOROIATiON ;
t.n n,��m,nay orRaa�resao��s�ae ro��h�a+ua�+o e�a�o�s 5aee�fies a+ae tM►N�renC�I�vel indiealbd M S�Clioet C.ftqm t
+s not tM'low�st floor"as defined in the communitys flootiplsin managernent o�dw�anq.tfw Mwadon d tf�btrldir+p's'lpw�st
tloor'as defined b�r ma ordinance is: .� feet NGVD lor ot�er F1F,�A dahxTM-sM Section g.Itam�.
2.Oa4A o(the start ot construetio�or subscantlal improvement _
f EMA Fpm/1•21�MAY 9p REPIACES Atl PREVrOUS f W TtpNS SE£REVERSE SWE FOA CpNTiNUATIpN
. . _, �.,. „w..._„ _ w.,._...� ........ . ... ,
_ ;
_
. . . - _p....
VGY,RA�� C�.�l„�e� . _ . .
This cs�iticatior+is to bs sqn�d CY a land swwya.��.or arcfiitoct v�ho i�outho�tz�6 by stsa a Iocallsw to cMNy slwadon
�tormatbn whon tM siwatfon iMonnatlon fat Zants At-J130.AE.AH.A I��Q�W V30.VE.and V(w�tt BFFa b nq�drad.,
Canmuniry oMidals who an authotizsd b�►bca!Isw o�o�nar�cs to provids tlo�dpiah man�rt�M inlom�rt.m+I►e�O��
c�dt�ion. In tM caae o!Zonss AO and A(without a FEMA cu commurmY i�wd BFE?.�b�inp ollfcid.a prop�Ar owr�t,ot�r►
owner's tept�s�ntatiw may also sipn tM cwtllfCatfon. � ,!��,�.��� ���; ���
Retsrena iewd c�rams 6.7 and 8•Disthputsh�F��tuns-It the cMifi�r is uc�abi�to c�fN���Y�'��I'�
endosun sizs.locatiot�of sarvidn�squiPm�M.area u;�a.wall opa�inps.�x un�isMd araa F�atu»ia1.then Bst tM Fsaturat:l�`
incfuded in tM csRlfkatlon under Commenta bNo� Tha Wsqfirn ntunbsr.S�etlon C.ftem 1.must st�l Ds ortt�d�. .:�
!certiry that the inlormallon lrt Seutons B atd C on ttrb cord'ricars►�serns my brst c!torfs to�the data ava�7abie. ,
!undersrarnd ihai any talse sretement may bo pra►tsh�W�Dy fine or+mprsa+rrr�urulM 18 t��CaJe�Seclfon/001. < ,�,,.� �r
..r� �::w�, �� < ;_»�
l'
CERTtFlER'S NA�lE UCErtSE MJ1�ER(otA�x S�aq �x�:•. i� :�r �*
GORDON F. KILLION PLS 1 3138 '
Co�w�rn rw�
OWNER KYLLION AND ASSOCIATfiS -
woaess cm , sr�� , za+ ;.
1254- SOUTH HIGHLAND AYE CLEARWATER FLORIDA 346I6 �
�� DEC. 7, 1992 813�443 706T '�
'�a.Y�'L'�..��
shoufd b�m�d�of thb CKtlflcsb for:l)community otflcial,2)insurarr�afl�nt/comPar�►.and 9)Duit�own�•
co�uua�s:
_
o� w� ��
n.s �* �.���
A V A A V
2011ES 20NES ZO►ES D01E5 2qNES
�
�tra�e�a
�sfwvts wi � u�a
i�va R�
lLtv�nO�
MiE ...'Y:�� ;..,,. .a .}4, IVi11Y41 . m ..
ADY�-'!MI :: dlN�t41
QEY►� r+ow � �nw�c! �.�p�rr � � �� .
L/VQ dMOC � .
�:
+`"�,�� Y
r � � ��i y'•h�Y'��.'��� . ..,-.tr���;,. .
'�5 '`�t
t YQ �i�' :���LS°� ��Dd�CM�`•
� • w_..}�-�.}-'�..:�..1'�lra'�'*.ja! GMO� �
lR(�
The��.5�0 11W.l�te U�V��W�1/MA��e��a�Q�1.4.l�������A��V�
ElevaOO�s tor aN A Zonea snould be meas�e0 at ths top of the reterencs Nvei Aoor. �,N`
4t+
� Elavations tor aM V Zones shouid b�mesaurod at tM Donom of the Iowest ha�izontal stnx�ural rt�ert� , �4
„`�,,
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` Paqe 2 � � � �.v �
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. . � , . � . • REAR ( 50.0 FT.) � LS � V �
• + • j's' .
� ' � ' � � JAN 1 1 Z001
; , • . t.s' �xisTia4 APi: . 20.8�
� , S�NiIL' UNIT _
; . ,. ,�,�,k„�,,.fl.. � • PtAN DEVELOPMEN SVCS
. , . C OFCLEARWATER
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. �t k �Nt ti/'l .
F. ' � �h f .. . . . . . �
r . Show alt'exi�t�n and proposed:,s�tructures,giving�,�dimensions and setbacks. Also, # icate
any�a�acent bodies' of water.;and;roadwa�ys ad�acent .to the property. Indicate si� of
aabi l e homes such'as• 12'.<:' ' 0'., 24'.. x 36'..`a >
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