222 DOLPHIN PT ELEVATION CERTIFICATE O.M.B. No. 3067-0077
FEDERAL EMERGENCY MANAGEMENT AGENCY �p�res luly 31, 1999
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of this certfficate does not provide a waivar of the flood insurance purchase requirement.This form is used only to pro-
vide elevation information necessary to ensure compliance with applicable community floodplain management ordinances,to determine
the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR).You are not
� �quired to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form.
Instructions for completing this form can be found on the following pages.
SECTION A PROPERTY INFORMA710N FOR INSURANCE COMPANY USE
BUILDING OWNER'S NAME POLICY NUMBER
Mounir W. A aib & Govan Assaad
STREET ADDRESS(Including Apt.,Unit,Sui;e and/or Bldg.Number)OR P.O.ROUTE AND BOX NUMBER COMPANY NAIC NUMBER �
222 Dol hin Point
OTHER DESCRIPTION(Lot and Block Numbers,etc.)
Lo� 17 Unit 5A Island Estates of Clearwater
CITY STATE ZIP CODE
Clearwater Florida 34630
SECTION B FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
Provide the following from the proper FIRM (See Instructions):
1.COMMUNITY NUMBER 2.PANEL NUMBER 3.SUFFIX 4.DATE OF FIRM INDEX 5.FIRM ZONE 6.BASE FLOOD ELEVATION
(in AO Zones,use depth)
125096 0007 D ugust 19, 99°1 AE 12.0
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations(BFE): �NGVD'29 ❑Other(describe on back)
8. 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 community's BFE:I I I I I I.U feet NGVD(or other FIRM datum—see Section B, Item 7).
� SECTION C BUILDING ELEVATION INFORMATION
� ,
1' Using the Elevation Certificat��nstructions,indicate the diagram number from the diagrams found on Pages 5 and 6 that best
� describ�s the sutyec;t�bu�iii�g'�reference level � .
� �;a). FIRM Zones A1=/�30,AE,AH,and A(with BFE). The top of the reference level floor from the selected diagram is at an elevation
of��,.��feet NGVD (or other FIRM datum-see Section B, Item 7).;
� (b).FIRM Zones�.1-�3�, VE� and V(with SF�). The bottom of the lowest horizorltal structural member of the reference level from
. .
. ,. .,,..__,_.
� ��'the selected diagram, is at an elevation of I I I I 1 I.0 feet NGVD(or other FIRM datum—see Section B, Item 7).
(c). FIRM Zone A(without BFE). The floor used as the reference level from the selected 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 level from the selected diagram is I ' ,'I feet above❑ or below�I (check
• one)the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor(reference
level) elevated in accordance with the community'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 e/evation datum used in measuring the elevations is different fhan that used on
the FlRM (see Section 8, Item 7], then convert ihe e/evations to the datum system used on the F/RM and show the conversion
equation under Comments on Page 2.)
4. Elevation reference mark used appears on FIRM: _' Yes —' No (See Instructions on Page 4)
5.The reference level elevation is based on: � actual construction �� construction drawings
(NOTE: Use of construction drawings is only valid if the building does not yet have the reference/eve/f/oor in place, in which
case this certificate will on/y be valid for the building during the course of construction. A post-construction Elevation Certificate
will be required once construction is complete.)
6.The elevation of the lowest grade immediately adjacent to the building is:� � .'9 feet NGVD(or other FIRM datum-see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
1 If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item t
�is not the"lowest floor"as defined in the community's floodplain management ordinance,the elevation of the building's"lowest
floor"as defined by the ordinance is: '� .'— feet NGVD (or other FIRM datum—see Section B, Item 7).
2. Date of the start of construction or substantial improvement .
FEMA Form 81-31, AUG 96 REPlACES ALL PREVIOUS EDIT10N5 SEE REVERSE SIDE FOR CONTINUATION
SECTION E CERTIFICATION
This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation
information when the elevation information for Zones Ai—A30, AE,AH,A(with BFE),V1—V30,VE, and V(with BFE) is required.
Community officials who are authorized by local law or ordinance to provide floodplain management information, may also sign t!�
certification. In the case of Zones AO and A (without a FEMA or community issued BFE), a building official, a property owner, or�..
owner's representative may also sign the certification.
Reference levei diagrams 6, 7 and 8- Distinguishing Features—If the certifier is unable to certify to breakaway/non-breakaway wall,
enclosure size, location of servicing equipment, area use,wall openings, or unfinished area Fe�tyre(s ,ttien�(i�t the Feature(s) not
included in the certification under Comments below. The diagram number, Section C, Item::s Pnt�s���i�I�qeDentet�d.
.... ,, � �r. ��. (. . F
I o�rtify that the information in Sections 8 and C on this certificate represents my best efforts�5�terpret theFCata aVai�able.
I understand that any false statement may be punishable by fine or imprisonment unde�28 d�..�.'Cod�'S�ctiorr.100 t.
`±:.» -�'ro"; � .,
� ,,J
,'" �t ' .�, l
CERTIFIER'S NAME LICENSE NUMBE �(6rAffix�Sealj �;•� � e r
Frederick S. Bachmann ��5174 �; �' na=.,,p„�.,°'' �' :�
TITLE COMPANY NAME
Florida Professional Surveyor & Mapper C. A. Peterson, M1�In�"`���,ti` �'
AODRESS CITY STATE ZIP
, 1425 Gulf to Ba oulevar Clearwater Florida 34615
SIG TURE - 3 p 5�97 PHONE
�7 813 446-9568
Copies should be made of this Certificate for:1)community official,2) insurance agenUcompany,and 3)building owner.
COMMENTS:
D
� . � MAR ,
CENTRAL�PERMITT'INC�
9�S -
�
ON 4VITIi ON PILES. •
• SLAB BASEMENT PIERS,OR COLUMNS
A V A A V
ZONES ZONES ZONES ZONES ZONES
REFERENCE
. PEFERENCE BASE IEVEL REFEPENCE
LEVEL FLOOD LEVEI
ELEVATION
_ t
Y.�.::,` ^^}:\..^ _
''�'� ' BASE
BASE � ADJACENT REFERENCE FLOOD
FIOOD
EIEVATiON qEFERENCE Ap,1ACENT GRADE � LEVEL ELEVATiON
LEVEL GRADE
. ?!�.�, I�,�; ,.�..: '.:.:F �%.
�'.�:�A0.IACENT�.
�.�_.��. A1 .,-.;� ,:(� GFADE �.
f•'1!�
The diagrams above iilustrate the points at which the elevations should be measured in A Zones and V Zones.
Elevations for ail A Zones should be measured at the top of the reference level fioor. �
Elevations for all V Zones should be measured at the bottom of the fowest horizontai structural member.
Page 2