321 CORONADO DR ' 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.
�) SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use:
BUILDING OWNER'S NAME Policy Number
ROLAND ROGHERS
BUILDING STREET ADDRESS(InGuding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
321 CORONADO DRIVE
CITY STATE ZIP CODE
CLEARWATER FLORIDA 33767
PROPERTY DESCR(PTtON(Lot and Bfock Numbers,Tax Parcel Number,Legal Description,etc.)
Lot 6,BLOCK A, COLUMBIA SUBDIVISION No.2 P.B.21,PGS.79
BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,if necessary.)
RESIDEfVTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):
( ##°-#1#'-##.##" or ##.�°) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMNIUNffY NAME&COMMUNITY NUMBER B2 COUNTY NAME B3.STATE
City of Clearwater 125096 PINELLAS FLORIDA
B4.MAP AND PANEL 67.FIRM PANEL / B9.BASE FLOOD ELEVATION(S)
NUMBER 65.SUFFIX B6.FIRM IN ATE EFFECTIVEiREVISED DfflE B8.FLOOD ZONE(S) (Zone A0,use depih of floodirg)
125096-0102 G SEPTEMBER 03,2003 SEPTEMBER 03,2003 AE EL11.0 812.0 �V
B10.Indicate the source of the Base Flood Eleva6on(BFE)data or base flood depth entered in B9. �
❑FIS Pro61e �FIRM ❑Community Determined ❑Other(Describe):_ "�
B11.Indicate the elevation datum used for the BFE in 69:�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) �
6'
C1.Buiiding elevations are based on:❑Construction Drawings' ❑Building Under Construction' �Finished Consiruction
*A new Elevation Certificate will be required when consUuction of the building is complete.
��2.Building Diagram Number 1 (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,AWA,AWAE,AWA1-A30,AWAH,AR/AO
Complete Items C3.-a-i below according to the building diagram specfied in�tem 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 LP-15, EL.=4.191 Does the elevation reference mark used appear on the FIRM? ❑Yes �No , •ti t+�}.:'
o a)Top of bottom floor(induding basement or endosure) 5.05 . FT ft.(m) � __ "�+���°J>�` ��,
o b)Top of ne�higherfloor N/A FT ft.(m) � '�.r•,•' .,;' 1� � t
o c)Bottom of lowest horizontal structurai member(V zones oniy} N/A FT ft.(m) o o =�o�� ''� y'� � �
o d)attached garage(top of block) N/A . FT ft.(m) E� � ;"� ',ir� �'
� �� +rF
o e)Lowest elevation of machinery and/or equipment �� � �� Q ' �
� -
serviang the building(ELEVATOR EQUIPMENT) N/A FT ft.(m) �� ; :'"" � � ; `� �.
o �Lowest adacent(finished)grade(LAG) 43 . FT ft.(m) z'm ' , s' y, e�
m� ` �rT
o g)Highest adjacent(finished)grade(HAG) 4.5 . FT ft.(m) � , 11�`�5/�4�t���
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade N/A ° '� � ` � s�` f?�'"�
-� t - � , �a ; x�
o i)Total area of all permanent openings(flood vents)in C3.h NIA sq.in. '.+. ';�� �
4 �..���'t��
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION I �'�<�: -.,
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.
f cedify that fhe informafion in Secfions A,8,and C on this cerfificafe represents my besf efforts to interpret the data availa6le.
1 understand that any false sfatement may be punishable by fine orimprisonment under 18 U.S. Code,Secfion 1001.
CERTIFIER'S NAME LICENSE NUMBER
BRUCE A.KLEIN PLS 5052
TITLE COMPANY NAME
!'RESIDENT KLEIN&STAUB SURVEYING,INC.
HDDRESS CITY STATE ZIP CODE
8016 Old County Ro 54 New Port Richey FL 34653
SIGNATURE DATE TELEPHONE
, 11/25/04 (727)834-8140
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.,Uni�Suite,and/or Bk1g.No.)OR P.O.ROUTE AND BOX N0. Policy Number
321 CORONADO DRIVE . , •
CITY STATE ZIP CODE Company NAIC Number
CLEARWATER FLORIDA 33767
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED} � �
Copy both sides of ihis 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 compleied.
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 buildng,provide a skeich or photograph.)
E2.The top of the bottom floor(nduding basement or endosure)of the building is _ft.(m)_in.(cm)�above or ❑below(check one)the highest adjacent gratle. (Use
natural grade,if available).
E3.For Building Diagrams 6-8 with openings(see page 7),the ne�higher floor or elevated floor(elevation b)of the building is _ft.(m)_in.(an)above the highest adjacent
grade. Complete items C3.h and C3.i on front of form.
E4.The top of the platform of mac;hinery 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 depth number is availabie,is the top of the bottom floor elevated in accordance with the communitys floodplain management ordinance?
❑Yes ❑No ❑Unknown. The la�l offiaal must cefify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The properry owner or owners authorized representative who completes Secfions 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 statemenfs in Secfions A,B,C,and E ars correct fo 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-COMMUNfTY INFORMATION(OPTIONAL)
The lo:�ai offidal who is a:,iFtirzed 5y law or ordinance to administer the community s floaipiain management ordinance can complete Sections A,B,C(or E),and G of this Elevation
Certificate. Complete ihe app';��,a�le item(sj and sign below.
G1.�The in�smatia�in Sectio C was taken from other documentation that has been signed and embossed by a licensed surveyor,engineer,or architect who is authorized by state
ur local law to c,�P;ify elev�t�on inf�rmation. (indicate the source and date of the elevation data in the Comments area below.)
G�.❑P=;ommur;y offidUf cor.Ij�eted Szc,tion E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0.
G3.f]Tf�following information Qtems.�-G9)is provided for community floodplain management purposes.
G4.PcRP,AIT NUMBER G5. DATE PERMIT ISSUED G6.DATE CERTIFICATE OF COMPLfANCE/OCCUPANCY ISSUED
�—
G7.This permit has been issued for.❑New Construction ❑Substantial improvemeni
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,jm� __ 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
. ����� n
��� y d{�"lAs
� �``°�" '�� .� C ITY OF C LEARWATER
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�.,F ��� <�a � DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
� � `` `<'` POST�FFICE BOX 4748 CLEARWATER FLO�DA 33758-4748
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�z%y MUN[CIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CLEARWATER,FLO�uDn 33756
TELEPHONE�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�equested copies of
elevation certificates.
The attached elevation certificate requires corrections by the surveyor of section(s) prior to acceptance by the community
X The attached elevation certificate is complete and correct
Minor corrections have been made in the below marked sections by Community O�cial
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:0 GPS(Type):
(##°-##'-##.##" or ##.#####°) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map❑Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
NFtP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME B3.STATE
B4.MAP AND PANEL g5.SUFFIX 66.FIRM INDEX DATE B�•FIRM PANEL gg.FLOOD ZONE(S) B9�BASE FLOOD ELEVATION(S)
NUMBER EFFECTIVE/REVISED DATE (Zone A0,use depth of flooding)
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 89: ❑ 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 CeRificate 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,conveR 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)1 ft.above adjencent grade
i) Total area of all permanent openings(flood vents)in C3.h sq.in.(sq.cm)
Comments:
Date of Review: Community O�cial:
�evation certificates shall be maintained by the community and copies wifh fhe attached memo made available by request
FRANK HIBAARll,MAYOR
GGORGE N.CRG7'EKOS,COUNCILMGMRER JOIIN DORAN,COUNCILMEMBER
PAUL F.GIBSON,COUNCILMEMBER � CARLGN A.PE7'ERSEN,COUNCILMEMBLR
��EQUAL EMYLOYMEN'I'AND E�FIWNA'I'IVE ACTION EMPLOYER��
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.
SECTION A-PROPERTY OWNER INFORMATION For�nsurance Company Use:
BUILDING OWNER'S NAME Policy Number
ROLAND ROGHERS
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
321 CORONADO DRIVE
C�N STATE ZIP CODE
CLEARWATER FLORIDA 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Descrip6on,etc.)
Lot 6,BLOCK A, COLUMBIA SUBDIVISION No.2 P.B.21,PGS.79
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):__
� ##�-##�-##•##" o� �#•#�#t`°) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUN71'NAME 63.STATE
City of Cleanvater 125096 PINELLAS FLORIDA
B4.MAP AND PANEL B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVFJREVISED DATE 68.FLOOD ZONE(S) (Zone A0,use depth of flooding)
125096-0102 � SEPTEMBER 03,2003 SEPTEMBER 03,2003 AE EL.11.0&12.0 �.1
B10,Indicate the source of the Base Flootl Elevation(BFE)data or base flood depth entered in 69. �
❑FIS Profile �FIRM ❑Community Determined ❑Other(Describe):_ -�
811.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 Resoum,es System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No Designation Date o�
SECTION C•BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) --�
6�'
C1.Building elevations are based on:0 Construction Drawings* ❑Building Under Construction* �Finished Construction
'A new Elevafion Certificate will be required when construcfion of the building is complete.
,2.Building Diagram Number 1 (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,AWA,AWAE,AWA1-A30,AR/AH,AWAO
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 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 appropriate,to document the datum conversion.
Datum NAVD 1988 Conversion/Commenis N/A
Elevation reference mark used LP-15, EL.=4.191 Does the elevafion reference mark used appear on the FIRM? ❑Yes �No -
o a)Top of bottom floor(induding bzsement or enclosure) 5.05 FT ft.(m) � w ',� n' r�f , �°��,
� ,. , �,..����.�J �$ .
o b)Top of next higher floor N/A F=( ft.(m) � ;.�' x,m ,,� '
+ 3 ,
o cj Bottom of lowesf horizonfal structural member(V zones only'� N/A FT tt.(m) y� a° �"`s•,°tiq ': ��, G'' f� ,
o d)ariached garage(top of block) N/A FT fl.(m) �� "� o o A`�` ` y''' •, � �
o e)Lowest elevation of machinery and/or equipment W '° X:� ., � °+�'�
servidng the building(ELEVATOR EQUIPMENT) N/A FT ft.(m) �� ' °�" � � �*F
o fl Lowest adjacent(finished)grade(LAG) 4.3 FT ft.(m) �� � o�p�; �, �t �:
o g)Highest adjacent(finished)grade(HAG) 4,5 F=f ft.(m) � t� '_. .,� ' 11S'�5/ 4`.> .'��� `
o h)No.o f permanent openings(flood vents)within 1 ft.above adjacent grade N/A J �..� �.�:C�,_-1 '
o i)Total area of all permanent openings(flood vents)in C3.h N/A sq.in. � s� �t�n.� �
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 cerfify that the informafion in Sections A,B, and C on this certificate represents my best efforfs to interpret the data available.
1 understand that any false siatement may be punishabfe by fine or imprrsonmenf under 18 U.S. Code, Sectron 1001.
CERTIFIER'S NAME LICENSE NUMBER
BRUCE A.KLEIN PLS 5052
TITLE COMPANY NAME
'RESIDENT KLEIN&STAUB SURVEYING,INC.
HDDRESS CITY STATE ZIP CODE
8016 Old County Ro 54 New Port Richey FL 34653
SIGNATURE DATE TELEPHONE
11/25/04 (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 5ection A. For insurance com�any use
BUILDWG STREET ADDRESS(Induding Apt.,Unit,Suite,andlor Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number
_ 321 CORONADO DRIVE , . ,
CITY STATE ZIP CODE Company NAIC Number
CLEARWATER FLORIDA 33767
SECTION D-SURVEYOR,ENGINEER,OR ARCHfTECT CERTIFICATION(CONTINUED) •
Copy both sides of this Elevation Certificate 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 buiiding,provide a sketch or photograph.)
:2.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
naturai grade,if available).
E3.For Buiiding 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 servicing the buiiding 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 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 •
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
___� ❑Check here if attachments
` _y SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The lo:ai�ff�cial who is a�if�,��rzeu�y ia�v or ordinance to administer the community s floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation
Certifcate. Complete ine app,�!,��ble ifem!sj and sign below.
G1.�The int;;.�natio��in Sech�n C was taken from other documentation that has been signed and embossed by a licensed surveyor,engineer,or architect who is authonzed by state
ur local law to cErtify elev�f�on in+ormation. (indicate the source and date of the elevation data in the Comments area below.)
G2 []A:ommur„�offic���cor�r�:eted S�c:tion E for a building located in Zone A(without a FEMA-issued or communiry-issued BFE)or Zone A0.
G3.f]Tir following information fltems�4 G9)is provided for community floodplain management purposes.
G4.PcRn,�;T NU�dER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED
I
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