10 CAUSEWAY BLVD �---�
U.S•DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
F�deral�rriergency Management Agency Expires March 31, 2012
National Flood Insurance Program Important: Read the instructions on pages 1-9. �1'��.Qlt-Q(�g'�
SECTION A-PROPERTY INFORMATION j � ��.�$�� „=
A1. Building Owner's Name CITY OF CLEARWATER (11-102-3) �z � �, '�'=
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A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. ;, � ���� ������'
`DCAUSEWAY BLVD a;���. `�..��%:�° ..���� � � � -:��::
City CLEARWATER State FL ZIP Code 33767
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
CLEARWATER BEACH CONCESSION(NEW BATHROOMS)
A4. Building Use(e:g.,Residential,Non-Residential,Addition,Accessory,etc.)NON-RESIDENTIAL
A5. Latitude/Longitude:Lat.27°58.63'N Long.82°49.71'W Horizontal Datum: ❑ NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 16
A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) N/A sq ft a) Square footage of attached garage N/A sq ft
b) No.of permanent flood openings in the crawlspace or b) No.of permanent flood openings in the attached garage
enclosure(s)within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b _ sq in c) Total net area of flood openings in A9.b _ sq in
d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes ❑ No
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61.NFIP Community Name&Community Number B2.Counry Name 63.State
CLEARWATER 125096 PINELLAS FL
64.Map/Panel Number B5.Suffix B6.FIRM index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone
12103C0102 G Date EffectivelRevised Date Zone(s) AO,use base flood depth)
8/18/09 9/03/03 VE 13.0'
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 Item 69: ❑ NGVD 1929 � NA4'D 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 ❑ CBRS ❑ OPA
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 buiiding is complete.
C2. 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�tems C2.a-h
below according to the building diagram specified in Item A7. Use the same datum as the BFE.
Benchmark Utilized CITY BM G-03Verticai Datum 4.749'(NAVD 1988 DATUM)
Conversion/Comments
Check the measurement used.
a) Top of bottom floor(including basement,crawlspace,or enclosure floor)8.7 �feet ❑meters(Puerto Rico only)
b) Top of the next higher floor N/A._ ❑feet ❑meters(Puerto Rico only)
c) Bottom of the lowest horizontal stnactural member(V Zones only) N/A.._ ❑feet ❑meters(Puerto Rico only)
d) Attached garage(top of slab) N/A._ ❑feet ❑meters(Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building N/A._ ❑feet ❑meters(Puerto Rico only)
(Describe type of equipment and location in Comments)
� Lowest adjacent(finished)grade next to building(LAG) 6.3 �feet ❑meters(Puerto Rico only)
g) Highest adjacent(finished)grade next to building(HAG) 7.2 �feet ❑meters(Puerto Rico only)
h) Lowest adjacent grade at lowest elevation of deck or stairs,including N/A.._ ❑feet ❑meters(Puerto Rico only)
structural support - --
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION , , .� v��,}e'!�.�� ;,� .�
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevatiom �a' �' '"' ; ,
information. I certify that the information on this Certificate represents my best efforts to interpret the data available. ,� ����}�+�' �:��` �` . �� ;
1 understand that any fa/se statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001 ,'� ��"'�'� �` `��, : �
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❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by�a°7;, y'` '�` #� �,
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licensed land surveyor? � Yes '. ❑ NA:� �ti ��T � � �o-� ��� ��
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Certifier's Name Albert P.Carrier License Number 6488 ���. 4 `- o F ��.�s„,�•„
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Title Prinicpal Company Name Deuel&Associates LB#107 . � � ,.� ;; =
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Address 4625 East Bay Drive,Suite 211 City Clearwater State FL ZIP Code .339�i�'y � ���`i' � �, �ut'�;�w�' '� r
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Signature Date 2/13/12 �° "� ,�,;x,�����,�"' � t�,, ., �
Tele hone 727-822-4151 � �"X ; ��� ��"�������' � �
FEMA Form 81-31, Mar 09 See reverse side for continuation. Replaeesall previou5`editions'
U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATiC�N CER�IFiCATE OMB No. 1660-0008
Federal Emergenoy Management Agency Expires March 31, 2012
National Flood Insurance Program Important: Reac�the instructions on pages 1-9.
SECTION A-PROPERTY INFORMATION For Insurance Company Use:
A1. Building Owner's Name CITY OF CLEARWATER, FLORIDA ' Policy Number
A2. Building Street Add�ess(inciuding Apt.,Unit,Suite,and/o�Bldg.No.)or P.O.Route and Box No. Compeny NAiC Number
10 CAUSEWAY BLVD
City CLEARWATER State FL ZIP Code 33767
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description;etc.)
NO DESCRIPTION OR PARCEL ID NUMBER FOR THIS SITE.
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)NON-RESIDENTIAL
A5. LatitudelLongitude:Lat.27 58 37.21 N Long.82 49 42.45W Horizontal Datum: ❑ h1AD 1927 � NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being usecl ta obtain flood insurance.
A7. Building Diagram Number 1
A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) N/A sq ft a) Square footage of attached garage N!A sq ft
b) No.of permanent flood openings in the crawlspace or b) No.of pertnanent flood openings in the attached garage
enclosure(s)within 1.0 foot above adjacent grade N/A within 1.0 foot above adjacent grade N!A
c) Total net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b N/A sq in
d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings?: ❑ Yes � No
SECTION B-�I_OOD INSURANCE�ATE MAP(FIRM)INFORMATION
61.NFIP Community Name&Community Number B2.County Name 63.State
CITY OF CLEARWATER,FL /125098 PIMELLA:; FLORIDA
64.Map/Panel Number 65.Suffix 66.FIRM Index B7.FIRM Panel 68.Flood B9.Base Flood Elevation(s)(Zone
12103C0102 G Date Effective/Revised Date Zone{s) AO,use base flood depth)
` Aug. 18,2009 SEPT.3,2003 VE 13.0
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)
B11. Indicate elevation datum used for BFE in Item B9: ❑ PJGVD 1929 � NAVD 1988 ❑ Other(Describe)
812. Is the building located in a Coastal Barrier Resources System(CBRS)area or Othervvise Protected Area(OPA)? ❑ Yes � No
Designation Date N/A ❑ CBRS ❑ OPA
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SECTION C-BUILDING ELEVATION INFORiVlATION(SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construdion Drawings" � Building Under Construdion* ❑ Finished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
C2. 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 C2.a-h�
below according to the building diagram specified in Item A7. Use the same datum as the BFF.
Benchmark Utilized CITY PLANSVertical Datum NAVD88
R
Conversion/Comments N/A
Check the measurement used.
a) Top of bottom floor(inGuding basement,crawlspace,or enclosure floor)8.75 �feet ❑meters(Puerto Rico only)
b) Top of the next higher floor N/A.__ ❑feet ❑meters(Puerto Rico only)
c) Bottom of the lowest horizdhtal structural member(V Zones only) N/A. ❑feet ❑meters(Puerto Rico only)
d) Attached garege(tap of slab) N/A. ❑feet ❑meters(Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building NOT SET. ❑feet ❑meters(Puerto Rico only)
(Describe type of equipment and location in Comments)
� Lowest adjacent(finished)grade next to building(LAG) 6.3 �feet ❑meters(Puerto Rico only)
g) Highest adjacent(finished)grade next to building(HAG) 8.7 �feet ❑meters(Puerto Rico only)
h) Lowest adjacent grade at lowest elevation of dedC or stairs,including 6.3 �feet ❑meters(Puerto Rico only)
strudural support �
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer,or archRed authorized by law to certify elevation
information. ►certify that the infom►ation on fhis Certificate represents my best ef/orts to Arte►pret the data available.l `�` a� ''�!
underst2nd that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1�1.� " �L�' ��O i�t �';
Check here if comments are provided on badc of fonn. Were latitude and longitude in Section A provided by a =+`� ' ��� r��
licensed land surveyor? � Yes ❑ No =�� �
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Cert�er's Name Eugene T.Caudell License Number PLS 4821 • � --, r,.,�ti � :�% !t
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Title Land Surveyor Company Name Self - �aJ• ��; �
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Address 2321 Pin Oak Ln E. City Clearwater State FL ZIP Code 33759 a`�, ,,� �, •,�.;,;;;a M
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Signature r'��� Date Oth 1/2012 Telephone 727 459-9186 t�� ��'�` '
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FEMA Form 81-31,Mar 09 See re�+PrSP side for continuation. Replaces all previous editions
,
IMPORTANT: In these spaces,copy the corresponding in`rormation from Section A. For Insurance Company Use:
Building Street Address(including Apt.,Unit,Suite,and/or Bidg.No.)or P.O.Route and Box No. Policy Number
10 CAUSEWAY BLVD
City CLEARWATERState FL ZIP Code 33767 Company NAIC Number
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agenUcompany,and(3)buildin�qwner.
Comments SITE PRESENTLY UNDER CONSTRUCTION. NO MECHANICAL FOUND MAY BE ON ROOF OF EXISTING STRUCTURE.
��
Signature Date 01/11/2012
❑ Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) �
For Zones AO and A(without BFE),complete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B,
and C. For Items E1=E4,use natural grade, if available. Check the measurement used. In Puerto Rico only,enter meters.
E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent
grade(HAG)and the lowest adjacent grade(LAG).
a)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or❑below the HAG.
b)Top of bottom floor(including basement,crawlspace,or enclosure)is ___ ❑feet ❑meters ❑above or❑ below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(se2 pages 8-9 of Instructions),the next higher floor
(elevation C2.b in the diagrams)of the building is ❑feet ❑meters 0 above or ❑below the HAG.
E3. Attached garage(top of slab)is ❑feet ❑meters ❑above or ❑below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is ❑feet ❑meters ❑above or❑below the HAG.
E5. Zone AO only: If no flood depth number is available,is th�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.
SECTIO F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owner's authorized representative who completes Sections A,B,and E for Zone A(without a FEMA-issued or community-issued BFE)
or Zone AO must sign here. The statements in Sec6ons A,8, 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 official who is authorized by law or ordinance to administer the community's floodplair management ordinance can complete Sections A,B,C(or E),
and G of this Elevation Certificate. Complete the applicable item(s)and sign below. Check the measurement used in Items GS and G9.
G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who
is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
G2. ❑ A community official compl�ted Section E for a building iocated in Zone A(without a FEMA-issued or community-issued BFEj or Zone AO.
�
G3.❑ The following information(Items G4-G9)is provided for community floodplain management purposes.
G4.Permit Number G5. Date Permit Issued G6. Date Cert�cate Of CompliancelOccupancy Issued
G7. This permit has been issued for. — - "' '-'" ` ' " '' - --`
G8. Elevation of as-built Iowest floor aoa�-n'"routlny request pad 7884 :um
G9. BFE or(in Zone AO)depth of flo °"""° �um
G10.Community's design flood eleval ROUTING - RE(�E.�ST tum
P�ease
Local Official's Name ❑ READ To L..?�I �a ��— v�d ��
Community Name ❑ HANDLE
Signature ❑ APPROVE
end T
Comments ❑ FORWARD Ll�� '�� ��0�
❑ RETURN
❑ KEEP OR DISCARD
� ❑ REVIEW WITH ME ❑Check here ff attachments
FEMA Form 81-31, Mar 09 Replaces all previous editions
Date From