191 DEVON DR • 97-11�
� ��.�V�i i0� ��n i i�i��i� -�� •�a?��; .�-�
��es�+nav 3 t. ,993
F��EAAL E3VIEAG�iVCY MANAGE��IIE?VT AGcNC'(
NATiCNAL FLOOO INSURANC� PqOGRAi�1
�,i cNT10N: Use oi this certificate does not provide a�.vaiver of the flood insuranc2 purc�ase . ,�,i; `orm is ly co
�rov�de a�evauon �ntormauon necessary to ensure compiiance with appiicaoie commurnry � c nagem��;nar s. ;
LEtermine che prooer insurancs premium rate. anaior ro support a request for a Lecter ndment pr'�,e�+�5�on (L �� MF}.
Instruciions for campleting this form can be found on t wing p�e�l. ,�
SECTION A PROPFATY INFORMATION F . MPANV USc
BUILOING OWNEFI'S NAME N BER
� -�JAMES W. SOBOLENSKI
STF1EcT ADDRESS(InGutling Ap�,UniL Sude anaior Bldg.Number)OR P.O.ROUTE ANO BoX NUMBER COMP.4NY NAIC vUMBEA
- I91 DEVON DRIVE
CTHER DESCAIPTtON(Lot and 81oGc Numbers,etc.)
LOT 32 AND THE EAST 15 .0 FEET OF LOT 33 , REPLAT OF RAYGTDF. �pR_
Ci7Y STATE ZIP CODE ,
CLEARWATER, BEACH FLORIDA � �
SECTION B FLOOD INSURANCE RATE MAP(FlRM)INFORMATION
�r�ovide the follawing from the proper F1RM (See Instruciions): _ • ,
t.COMMUNITY NUMBER Z PANEL NUMBER 3.SUFFlX a.DATE OF FIRM INDEX 5.FIRM ZONE 6.BASE FLOOD ELEVATION
(in AO Zonea.usa aepth�
125096 0007 D 8/19/91 AE 11
Z.Indicate the elevation datum system used on the FiRM for Base Fiood E3evations(BFc): �NGVD'29 �Other(describe on bacic)
a.For Zones A or V,where no BFE is provided on the FiRM, and the community has established a BFE for this building site, indicate
the communiry's BFE:! � .;!feet NGVD (or other FiRM datum–see Section B, Item 7).
� SECTION C BUILDING ELEVATION INFaRMATION
Using the Elevation Certificate Instructions,indicate the diagram number from the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level�� . � -
Z�a). F1RM Zones A1-A30,AE,AH,and A(with BFE}. The top of the reference level ftoor from the selected diagram is at an elevation
of I ! I I �:�2��aet NGVD (or other FiRM datum–see Section B, Item 7).
(b). FIRM Zones V1-V30, VE,and V(with BFE). The bottom of the lowesi horizontal struciural member of the reference level from
the selected diagram,is at an elevation of I I I I ! !.!�feet NGVD (or other F1RM datum–see Section B, Item�.
(c). F1RM Zone A(without BFE). The floor used as the reference level from the seiected diagram is ' ._feet above�_ or
below❑ (check one) the highest grade adjacent to the building.
� (d). F1RM Zone AO. The floor used as the reference level from the selected diagram is ' '.' feet above_ or below_ (check
one)the highest grade adjacant to the building. If no flood depth number is available. is the building's lowest floor(reference
„ level) eievated in accordanca with the communiry's floodplain management ordinance? _ Yes '_ No ^ Unknown
3.Indicate the elevation datum system used in determining the above reference level elevations:� NGVD'29 — Other(describe
under Comments on Page 2). (NOTE: If the elevaiion datum used in measuring fhe elevations is differenf than that used on
the F1RM (see Secfion 8, Item 7J, then convert the e/evatrons to the datum system usea on ihe FiRM arta snow fhe conversron
equation under Comments on Page 2.)
4.Elevation reference mark usad appears on F1FiM: !� Yes �' No (See Instruciions on Page 4)
5.The reference level elevation is based on: ! X actual construction �' construction drawings
(NOTE: Use of cansiruc�ion drawings is only va/id if the building does not yer have the reference Ievel floor;'n p/ace. in which
casa this certificate will only be valid for fhe building during the course of consrruction. A post-construction cievsiion C�r;;'cat�
wi!!be required onca consiructron is complete.) �
Q.The elevation of the lowest grade immediately adjacent to the building is: 5� ��:_ feet NGVJ (or c;�er FiAM datu.�^-see
� Section B, Item.7).
SECTION D COMMUNITY INFORMATION
•.If the community official responsibie for verifying building elevations specifies;hat the refererce level ind:cated in Sectton C. Item i
i� not the"iowest floor"as defined in the community's floodplain management ordinance,the e!evation of the buiiding's"'owest
floor" as derined by the ordinance is: � ' .._ feet NGVD (or other riRM datum–;ee Section 6. item %'�.
2. Date of the staR of construc;ion or substantial improvement ,
fEN1A Form 81-31�MAY 90 REPI_ACE$ALL PRE'd10U5 cD���O�vi g���c,�cocE giC`=�R CONTiNUA`ON
,
S�CTtON E CERTIFiCAT10N •
This certification is to be signeC by 2�a�C surveyc�, e^ginee-. or architect who is authorized by state or iocal faw t�certity elevation
information when the elevation information for Zones A1—A30, AF, AH, A (with 9FE;,V1—V30,VE, and V (with BFE! is required. �
Community officiafs who are authorized 5y local iaw or ordinance to provide tloodplain management information, may also sign the
certification. In the case of Zones AO and A (without a �EMA or community issued BFE), a building official, a property owner, or an
owner's represeniative may also sign the certi�ica;ian.
Reference Ievel diagrams 6, 7 and B - Distin�uishing �eatures—If the certifier is unable to certify to breakaway/non-breakaway wall,
enclosure size, location of servicing equipment, are2 use, vra!!openings, or unfinished area Feature(s),then list the Feature(s) not
included in the certification under Commen:s below. The diagram number, Section C, Item 1, must still be entered.
!certify fhat?he information in Seciions B and C on this certificafe represents my best efforts to interpret fhe data avai/able.
I understand that any talse siatement may be punishable by frne or imprrsonmenf under 1 B U.S. Code, Section 1007.
CERTIrIER'S NAM� LICENSE NUMBER(or AHix Seal) �
GORDON F. KILLION PLS # 3138
TITL� COMPANY NAME
OWNER KILLION AND ASSOCIATES
AODRESS
1 -A SOUTH HIGHLAND AVE. CLEARWATER FLORIDA 3461b�A� ZiP
SIGNAT DATF PHONE
2/4/99 813 443 7057
Cop s s ould be made o this Certlficate for:1)communtty officia(,2) insurance agent/company,and 3)building owner.
COMMENTS: BENCH MARR USED PINELLAS COUI�TTY DISK MAP # 154, DE-2, EL. 5.714
•
*CORRECTED SCRIBBLER ' S ERROR. �
ON WITN ON PILES,
SLA6 BASEMENT PIERS,OR COLUMNS .
A V A A y
20NES 20NES 2�NES 20NES 20NES �
REFERENCE REFERENCE
LEVEL . � BASE �� REPERENCE
fLOOD LEVEL
ELEVATION
�� T I
�r1::sl:`::.;: :�4�`i!. �1�:<Nr�TVi:q:\`:t f {.��A. �
•l•�' '�V'n
BASE ' ';:.i:.:"'';i' .::;<Td� REFEFENCE BASE
FLOOD ..;':•":i:•:: ADJ1lCEM••.:..q};" FLOOD
ELEVAT1pN 6RADE ' r> . LEVEL
HEFEfiENCE ApdACEMT x;�k. ELEVAT�OrJ
LEVEI 6RADE �
. +
rn��
. �'I .'.� �,. , " ...'.,
:...�l.DJACEhT... .
c�l� . , . :��� ':�. GFnDE �.
Tne Ci2grams 2DOVe ill�snate tne pomts a�whicr tne eie•.a,�ons snould be measured in A Zones anC V Zcnes.
I Jevations for all A Zones should be measureo a?tne too of tne rererence level fioor.
' =ievaro^s to�al! V Zones sr,ou!� be me2s;.rec ut t�e bo:;om c`; •
ne lowes; r,or�zor,al stru�tural msmber. �
i I
�aor�
� 97-113
' � ' ����l�� ���� ��n � �r�Cr�� � �x�-�s'�°av�°i� ,�y93
F��E�AL �cMEAG''ciVCY MANAGE�/lE?VT AGcNC'!
NATICNAL Fi.00D INSURANC� �qOGRANI
,cTcNT10N: Use oi this certificate does not provide a waiver of the flood insuranca purcnase recuiremen,. '�is ;orm is us2ci o�ly co
prov�de a�evation �ntormanon necessary to ensure compiiance with appiicaoie communicy fioocc�ain maragemenc orc.nanc2s. ,o
Cetermine the proper�nsurance premium rate. anaror to support a request for a Lecter or Map Amendmeni or Rev�s+on rLGMA or�OMF}.
Instruciions for ccmpleting this form can be found on the fotlowing pages.
SECTION A PROPEATY 1NFORMATION FOR INSURANCc COMPANV USc
BUIIDING OWNER'S NAME PaL1CY NUMBEa
� �JAMES W. SOBOLENSKI
57REc� ADORESS jlnGuding Apt..UNt.Surte and/or 81dq.Number)OR P.O.ROUTE AND BOX NUMBE� COMP.4NY NAIC NUMBEA
191 DEVON DRIVE
OTHEA DESCRIPTION(Lot antl Block Numbers,etc.)
LOT 32 AND THE EAST 15 .0 FEET OF LOT 33 , REPLAT OF SAYSTDF. Gun _
CITY STATE ZIP CODE .
CLEARWATER; BEACH FLORIDA V
SE�TION B FLODO INSURANCE RATE MAP(F1RM)INFORMATION
Provide the follawing from the proper F1RM (See Instructions►: _ � ,
1.COMMUNITY NUMBER 2.PANEL NUMBER 3.SUFFlX 4.OATE OF FIRM INDEX 5.FIFiM ZONE 6.BASE FL000 ELEVATION
�in AO 2ones,uaa aepth�
125096 0007 D 8/19/91 AE 11
7.Indicate the elevation datum system used on the FIRM for Base Fiood Eievations(BFc}: �NGVD'29 �Other(descnbe on bacic)
8. For Zones A or V,where no BFE is provided on the FiRM, and the communiry has established a BFE for this buiiding site,indicate
the communiry's BFE:� � .._feet NGVD (or other FIRM datum—see SecTion B, Item 7),
,
SECTION C BUILDING ELEVATION INFORMATION
�1. Using the Elevation Certificate Instrucfions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level"�_ .
2(a). FIRM Zones A1-A30,AE,AH,and A(with BFE). The top of the reference level floor from the salected diagram is at an elevation
of I � � � ��2��eet NGVD (or other FiRM datum—see Seciion B, Item 7).
(b). FiFM Zones V1-V30. VE,and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from
the selected diagram, is at an elevation of t i I I � � � �feet NGVD (or other F1RM datum—see Sec2ion B, Item�.
(c). FiRM Zone A(without 8FE). The floor used as the reference levei from the seiected diagram is ' .'_feet above�_ or
below❑ (check one) the highest grade adjacent to the building.
� (d). FiRM Zone AO. The floor used as the reference Ievel from the selected diagram is ' • '.'' feet above_ or below_(checfc
one)the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor(reference
. level) eievated in accordance with the communiry's floodplain management ordinance? _ Yes '_ No _ Unknown
3. Indicate the elevation datum system used in determining the above reference level elevations:� NGVD'29 _ Other(describe
under Comments on Page 2). (NOTE: If the elevafion datum used in measu�ing the elevations rs different ihan that used on
che FlRM (see Seciion B, Item 7�, then conven the elevatrons to the datum system usea on the FiRM ana snow the conversron
equatron under Commenis on Page 2.j
4. E!evation reference mark used appears on F1RM: '�; Yes �! No (See Instruciions on Page 4)
5.The reference level elevation is based on: !X acival construction �_; construction drawings
(NOTE: Use of construction drawings is only valid if ihe building does nof yer have the reference level floor;'n p/aca. in which
case this certificate wi!!on/y be valid for the building durrng fhe course of consrrucfron. A post-consiruction cievatron Car;;rcat�
wiU be required once construction is complete.)
6.The eievation of the lowest grade immediately adjacent to the building is: 5 � ��.-- feet NGVD ;or ct�er FiRM datum-sae
, Section B, Item 7).
SSCTION D COMMUNITY INFOFiMATION
. ?. If'he commurity official responsible for verifying building elevations specifies that the refersrce level indicated in Sec:�on C. ltsm �
:s not the"lowest floor"as defined in the commuNty's floodplain management ordinanc�, the e!evation of the building's"?owest
ftoor" as defined by the ordinance is .� feet NGVO (or other r=iRM datum—see Section 6. item 7'�.
2. Date of the start of construction or substantial improvement
fEMA fo�m 81-31�MAY 90 REPIACES ALL PREVIC�US c�i i i0ivi ,�.E�REVERSE�(�'�=r=R CONTiN�A��ON
S�CTtON E CERTIFICATION '�
This certification is to be signeC by 2�a�C surveycr, e^ginee-, or architect who is authori2ed by state or tocal tau�to certify elevation �
information when the elevation information for Zones At—.A30, AE. AH, A (with BFE;,V1—V30,VE, and V (with BFE? is requ�rad.
Community officials who are authorized 5y local law or ordinance to provide floodptain management information, may also sign the
certification. In the case of Zones AO and A(without a FEMA or community issued SFE}, a building official, a property owner, or an
owner'S representative rray also sign ihe certi;ica;ior.
Reference level diaorams fi,7 and 8 - Distinguishing =eatures—If the certifier is unable to certify to breakaway/non-breakaway wall,
enciosure size, location of servicing eGuipment, are2 use,wa!! openings,or unfinished area Feature(s),then list the Feature(s) not �
included in the certification under Commen:s below. The diagram number, Section C, Item 1, must still be entered.
1 certify thaf fhe information in Seciions B and C on ihis certificate represents my best efforts to interpret the data available.
1 understand ihat any talse statement may be punrshabie by fine or rmprrsonment under 18 U.S. Code, Seciion 1007.
CeATIFIER'S NAM� LICENSE NUMBER(or Attiz Seal)
GORDON F. KILLION PLS # 3138
TITLE • COMPANY NAMc
OWNER RILLION AND ASSOCIATES
ADDRESS
1 —A SOUTH HIGHLAND AVE. CLEARWATER FLORIDA 3461b�A� ZiP
SIGNAT DATF PHONE
2/4/99 813 443 70b7
Cop' s s ould be made o this Certificate for:1)community official,2) insurance agent/company,and 3) buliding owner.
COMMENTS: BENCH MARR USED PINELLAS COUNTY DISR MAP # 154, DE-2, EL. 5. 714
. �
*CORRECTED SCRIBBLER ' S ERROR. �
ON yyRH .
ON PILES,
SLA6 BASEMENT PIERS.GR COLUMNS
A V � � A . A V �.
20NES 20NES ZONES 20NES 20NES �
REPERENCE
REFERENCE �E LEVEL REfERENCE
IEVE: ' FLOOD LEVEL
ELEVATION
��; T I
�`' '�}. i ':+Ni?7,a d:� '�'ft- +
Yt\�'`�., 'a;�tit` :.�f'.�. ' 'itr�:
1 ,J..,''i.i+?�'::'.: ::-::��::�:'r• ':'1'y�:
� FppD .., . �ADJACEM•;:::n'�' REFERENCE FLOOD
�,;:;��..
ELfVAT10N ORADE ' � LEVEL ELEVATION
REFERENCE ApdACENT '�Sk -
LEVEL 6MDE .��:
CJG�i'7'��
' .�.:�I\ I ���: .� .. ... .�..;.
� -�...ADJRCENT...
`�.t�� .�::: �:.�.� ���i�. GRADE ;
7ne^;acrams 2DOVe illustra[e tne pom;s a; whtcr tne eie�a;ions snouid be measured m A Zone�.and V Zenes.
� clevaUOns for all A Zones shoulC be measured at tne co�of thB faT2fSf1C? levet floor.
i •
! =�°'J�110".S!�' 81! V��ft@S ShOUl.'�, `JP ^1E2S::'EO u'�'1E b0`.;0�' 0`tne lowes; r,orizor„al StfU�IU�3' ^12^;b@,•. I
i
!'8�E[