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1860 FT HARRISON AVE N ��r�� . ,, �v � ' � �� Q,y FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 Jt��'` NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005 ELEVATION CERTIFICATE • Im ortant: Read the instructions on a es 1 -7. SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use: BUILOING OWNER'S NAME Policy Number .��- M� �e�rzwA�r�.,�,�- � c C BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number /g D /V�e Ri'F� -FO R C�' +23S v f�t/G— C�N STATE D CC.-ERR.�ti t"fclt L.. PROPERTY DE CRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) b �9 S o ooi BUIL NG U E(e. ,Residential, on-reside ial,Addition,Accessory,etc. Use a Comments area,if necessa . APR 1 8 LWJ �Esr.fl�i rsq�. LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: L)GPS(�� ( ##°-##'_##.##" or ##.##�) �NAD 1927 ��NAD 1983 �USGS CGAC _ SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFO T ON 61.NFIP COMMUNITY NAME 8 COMMUNITY NUMBER B2.COUNTY NAME B3.STATE C=rY aF C itw;A � l dS Pr,r�,wA �LD(L.ID� 64.MAP AND PANEL 65.SUFFIX B6.FIRM INDEX B7.FIRM PANEL B8.FLOOD 69.BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use depth of flooding) t.z,o�cnio6 C� cx1- 03- v3 v9-o3 - c�� /� /�!� oc� 610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9. I—I FIS Profile �FIRM �_� Community Determined �_� Other(Describe): 611. Indicate the elevation datum used for the BFE in 69: �_� NGVD 1929 �NAVD 1988 �_�Other(Describe): B12. Is the building located in a Coastal Barrier Resources System(CBRS) rea 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 Certificate will b�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,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 NAV� Conversion/Comments Elevation reference mark used /�'�f1 P RM9 1— � Does the elevation reference mark used appear on the FIRM? Yes �_� No ❑ a)Top of bottom floor(including basement or enclosure) 8 .�ft.(m) �; ,, ❑ b)Top of next higher floor 1 � .5d ft.(m) � .�;g`•�;rm��:'�, G ��'- ❑ c)Bottom of lowest horizontal structural member(V zones only) ��.�ft.(m) g o ° 'd �i<<�1:'��.�',. ❑ d)Attached garage(top of slab) 8 .6C"� ft.(m) E� a ✓i _' ❑ e)Lowest elevation of machinery and/or equipment �m 'us �1�, +b 4; ;. servicing the building (Describe in a Comments area.) �y �ft.(m) �� r ;�—" ��J K S `'- � �� '��v�p -�' .�� ❑ f)Lowest adjacent(finished)grade(LAG) � .D�J ft.(m) z.� � � ❑ g)Highest adjacent(finished)grade(HAG) � .50 ft.(m) $ !/J �!�� ` ❑ h)No.of permanent openings(flood vents)within 1 ft. above adjacent grade N 4 � ae��°'�� J �,.-�,�--�e�o�>:...e'4.. ❑ i)Total area of all permanent openings(flood vents)in C3.h a' f� sq. in.(sq.cm) '��e,,,;,,.,,,.,-_� 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. 1 certify that the information in Sections A, 8, and C on this certi�cate represents my best efforts to interpret the data available. 1 understand that anV fa/se statement may be punishab/e by fine orimprisonment under 18 U.S. Code, Section 1001. CERT IER'S NAMF UCENSElN56�R � ��__�. R�,tirsE}-- 3a TITL€ COM ANY AME ��2DFESS Laa�L— �t,N�2 �� iwGl��rR.cnaC � �uSl� L'JQP ADDR�S CIT� ST E ZIP CODE `��N�JZ Q�-1�� . .Ufil/�A3�.r �C.—. `f fo Q c4 :.IG l'iJ DATE TELEPHON _ �/-/s- ds (�a�� '�3�f•=��2v FEMA Form�1-3f,January 2003 See reverse side for continuation. Replaces all previous editions �CQo?003—(��01 . , ;in�'ORTANT: In these spaces,copy the corresponding information from Section A. For Insurance Company Use: ` � BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,andlor Bldg.No.)OR P.O.ROUTE AND BOX NO. Policy Number CITY STATE ZIP CODE Company NAIC Number • SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for(1)community official, (2)insurance agent/company,and (3)building owner. COMMENTS AL�- TN� �QutPrt�sr � T 1'l� ��,c c ub za3G TS s E i' Rrrs v.�� Tl� �.��> . �Check here if attachments SECTION E-BUILDING ELEVATION INFORMATION (SURVEY NOT REQU�RED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zone AO and Zone A(without BFE),complete items E1.through E5. 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 building,provide a sketch or photograph.) E2.The top of the bottom floor(including basement or enclosure)of the building is I—I—I n- �m)�_��in.(cm)�_�above or�_� below (check one)the highest adjacent grade. (Use natural grade,if available.) E3. For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is I_I_I n•�m)I—I_I�n.(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 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 available,is the top of the bottom floor elevated in accordance with the communitys 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 owner's 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 statements in Sec6ons A,8, C,and E are correct to the 6est 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 floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation Certificate. Complete the applicable item(s)and sign below. G1. �_� The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer,or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. �_�A community o�cial completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3.U The following information(Items G4G9)is provided for community floodplain management purposes. G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED 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 • — -- --- l I Check here if attachments FEMA Form 81-31,January 2003 Replaces all previous editions (� t _ r . .,.J t��+, 1 �'y V { � '� �) ;,.) , ' FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No.3067-007 ,, . � � NATIONAL FLOOD INSURANCE PROGRAM Expires December , 2005 � , ELEVATION CERTIFICATE Im ortant: Read the instructions on a es 1 -7. • SECTION A-PROPERTY OWNER INFORMATION For Insuran e Company Use B DING OWNER'S NAME Policy Number _�E�_ r-lr�_ _—��?_PM,E,,,�— _c. . c.. e . _ _ B IL,DING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg. No.)OR P.O. ROUTE AND BOX NO. Company NAIC Number p Nc�t.ra� �'arLS- A-1JF CITY STATE • _ ��-w� L� �, -- PROPER DESC IPTIO (Lot and Block Numbers,Tax P rcel Number,Legal Descnption,etc) -o�/ oa4'�rs` 3��Q o� Qo�t _ __ _ — � --- ----- -- �BU DI G USE e.g., R sidential,Non-re idential,Add�fon,Accessory,etc. Use a Comments area,if neces � . MAR 2 9 2�5 + ES:�C�6�t'LR� --- -— LATITUDEiLONGiTUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS( pe): ( ##°-##'-##.##" or ##.#####°) j�NAD 1927 �_�NAD 1983 �USGS (��I�dr` '=R1/�C�F� --- � � ••••a� • SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFO °'�""""'""�'� "�= B1. NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME 83.STATE '��,,�tY oF C��4n.w�ar�.2 r�SoQ� ��w��.qs ��or�.,Lp,q -- J 84.MAP AND PANEL 85.SUFFIX 66.FIRM INDEX 67.FIRM PANEL B8.FLOOD 69.BASE FLOOD ELEVATION(S)� II NUMBER DATE EFFECTNE/REVISED DATE ZONE(S) (Zone AO,use depth of floodinyj ', �121�3c�1 D6 09-o3-d� o - - o A�� v� A� i3.00� _VEl�'•_o_o__; 610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9. �_� FIS Profile �� FIRM �_� Community Determined �_� Other(Describe): _________ B11. Indicate the elevation datum used for the BFE in B9: �__� NGVD 1929 �.�NAVD 1988 �_� Other(Describe): ______ ___ -. - B12. 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 Certificate 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 cornpieted 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,ARJAO Complete Items C3.a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is differenl frorn 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 a� v� ConversionlComments _____ Elevation reference mark used MaP RM91 " � _ Does the elevation reference mark used appear on the FIRM" �Yes �__!, No J a)Top of bottom floor(induding basement or enclosure) 8 SOft.(m) m � :� � � ti�'. � I J b)Top of next higher floor i� _.�ft.(m) � •�4� I J c) Bottom of lowest honzontal structural member(V zones only) _ �(0 83 ft.(m) �� j ` . J d)Attached garage (top of slab) _ �— ��.ft�m) E� �-� � e)Lowest elevation of machinery and/or equipment w � - � m - i servicing the building (Describe in a Comments area.) �_�_. OD ft.(m) � � i • � f) Lowest adjacent(finished)grade (LAG) — 8 �h•�m) Z� ,�'/�.VZ,�3 F ��4�tS�"� J g)Highest adjacent(finished)grade (HAG) _ _$_.��ft.(m) � , � , t��+�;. ,lS 3e3;j�-; . � J h)No. of permanent openings (Flood vents)within 1 ft. above adjacent grade_�[� � ' � , � i)Total area of all permanent openings(flood vents)in C3.h�sq. in. (sq. cm) ��'3'� �� I 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 certify that the information in Sections A, 8, and C on this certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ____ CERTI R'S NAM LICENSE NUMBER ��_� F. �AMS�;� 1�3e>'� - ----------- TITLE,.� CO ANY AM� T7ZOFE dJ•�'l._ � �-�NC�3�,rJd.E.�r�'�C,� F( �ANS�.—C'c��d��--- ADURES CI STATE ZIP CODE • � �er,��r�.2 ��J1� . --��v�D�-�J Fe.. 3e,/648 ---- ----- 51GNATUR __-•<. �• �G�• 0,7� T �2 N�3�f- ��.t�--------- FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces all previous editions � � � lF:3.�'ORTANT: In these spaces,copy the corresponding information from Section A. For Insurance Company Use: • ' �BUILD��c;STREETADDRESS(Including Apt.,Unit,Suite,andlor Bldg.No.)OR P.O.ROUTE AND BOX NO. Policy Number O c�. 2r av /9�E GFITY STATE ZIP CODE Company NAIC Number Cc.�AR�co}P�- �. �3� � SECTION D-SURVEYOR,ENGINE�R,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official, (2)insurance agenUcompany,and (3)building owner. COMMENTStOW�SI� �QU:rPMEN'� SERVtCZA1G �17��- Q�1(.I��NG TS �^J TH'E MEcH �ooH ANfl 5�� A��v<- I� cyo ' °"T�� i�r�.isE 'S��z� RS t3�._.E.ni T3u��; '7� EE� '� --�or�►� �� sF'�+��j I I 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 E5. If the Elevation Certificate is intended for use as supporhng 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 building,provide a sketch or photograph.) •E2.The top of the bottom floor(including basement or enclosure)of the building is I—I—I ft•�m)I—L—I in.(cm)�_�above or�_�below (check one)the highest adjacent grade. (Use natural grade,if available.) E3.For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is I—I—I�•�m)I_I—I�n.(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 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 available,is the top of the bottom floor elevated in accordance with the community's floodplain manaqement ordinance?� I Yes � I No � I Unknown. The local official must certify this information in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owner's 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 statements in Sections A,8,C,and E are correct to the best of my knowledge -- PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS C�T�' • SIGNATURE DATE COMMENTS Check chmenls SECTION G-COMMUNITY INFORMATION (OP I ��"V � z, The local official who is authorized by law or ordinance to administer the community's floodpl in mar��n�t-ordfnar�ce,��r�mplet Sections A,B,C(or E),and G of this Elevation Certificate. Complete the applicable item(s) eibw. "'^" � "`�" ' ""'_" G1.�_�The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer,or architect who is authorized by state or local law to certify elevation information. (Indicate the sou�ce and date of the elevation data in the Comments area below.) G2. �_�A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3.U The following information(Items G4-G9)is provided for community floodplain management purposes. • G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPIIANCE/OCCUPANCY ISSUED 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 NAAAE TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS • ��Check here if attachments FEMA Form 81-31,January 2003 Replaces all previous editions . . �' ` * ', •. � Y V-ZONE CONSTRUCTION CERTIFICATE � . The elevated portion of the building and supporting foundation system shail not be subject to collapse, displacement, or other structural damage due to the effects of wind and water loads acting simultaneously on all building components (wind and water loading values to be used are defined in Section III). SECTION V—Certification Signature below certifies (check):_ Section III; �! Section IV; �ections III & IV � � , � uz �MSE�___ ----------------- Certifier's Name� ��.�-�=- -'---"'-- �P�D FESSi aNA l. �A! I�E��—�-------------------------------- Title _��_�---------------�1' ------ -- �� y��..--��N�-.__Co��--------------- • • Company Name ------ 5/3 Y � _l3��?___------------------------ K srv t��2. Street Address_______��---------- `��L�LjsN r State_ ��-02�AA" _---Zip Code 3�6�.��_ City ----_--_� - 5�0�_ Phone No. �_�� 3 i" �O�.d_____ rr�oF. .�--1�__ --- -- s License Numb f+ _ • �_— ,,-:.° Date �'a��a��-- Signatur�� ---��_�__�—��,—_�---- �rl:'`;��1 I C'%�°��,�; SEA� <<<, %'�. :�, .��°. ;�;5��i' ° , = ,� � �� - �� ' � s v„t T � �` ••,` tl e�� . /ta �A��'�Y. '��'��• ..+a � � . D �' � �`ad � � MAR29 � Page 2 of 2 . DEVELOPIViF..t�t C�c� SERVICES DEFyT ___�LE�.�/ATER ..---_.._..._ � i��x��.r� ?, ,�1F � �t�f'EA d. 4a��` ¢'�p �� CITY OF CLEARWATER �+�l e�� • � �« ��_ _._. " a�°'� -�-- �y DEVELOPMENT 8r NEIGHBORHOGD SERVICES DEPARTMENT �.�,�yo �. w'�!��,.r;�� 4� POST OFFICE BOX 474g� CLEARWATER� FLO�DA 33758-4748 ��.��Y MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CLEARWATER,FLORIDA 3375� �� TELEPHONE �7Z� 5�2-4567 Fnx(727) 562-4576 MEMO OF REVIEW FOR CORRECTNESS & 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 requested 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 Official 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 Numbe� 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:❑GPS(Type): (##°-##'-##.##" or ##.#####°) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map�Other SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 1.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME B3.STATE 84.MAP AND PANEL 67.FIRM PANEL B9.BASE FLOOD ELEVATION(S) NUMBER B5.SUFFIX 66.FIRM INDEX DATE EFFECTIVE/REVISED DATE B$•FLOOD ZONE(S) �Zone AO,use depth of flooding) 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) 611. Indicate elevation datum used for BFE in B9:❑ NGVD 1929 ❑ NAVD 1988 ❑Other(Describe) 612. Is the buiiding located in a Coastal Barrier Resources System(CBRS area or Otherwise Protected Area(OPA)? ❑Yes ❑No Desi nation Date 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 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,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 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)1ft.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: ' �levation certificates shall be maintaine y the communiry and copies with the attachedmemo made availab/e by request FRANK HIftBARD,MAYOR GEORGE N.CRE7'EKOS,COUNCILMEMBER JOIIN DORAN,COUNCILMEMBER PAUL F.GIBSON,COUNCILMEMBER � CARI.EN A.PE'1'ERSEN,COUNCILMEMBER ��EQUAL EMPLOYMENT AND E�FIFtMA'I'IVE AC7'ION EMYLOYER�� ♦ � . V-ZONE CONSTRUCTlON CERTIFICATE Property Owner_�_��_r/Qr�E��.IC��C',it�—L_�_-C—=--------------------------- Street Address----��d--�'---t�_—�.r1_!s e�,,, __1�✓�------------------------ Il ' �r Other Description ------ �r" �0.-----�-��---------- ------------------------------ City --�L�A2uf�"T�22__�------------- State__��L_----------Zip Code_�.�� SECTION I— Flood Insurance Rate Map Information Community No. Pan No. Suffix Date of FI IR one se lood Elevation(B E) 1250g(p OooB � 09-03�03 V /� C� SECTION II—Elevation Information NOTE:This certificate is �gl.a substitute for an Elevation Certificate. Elevations shouid be rounded to the nearest tenth of a foot 1. Elevation of the Bottom of the Lowest Horizontal Structura! Member ............................._1�:��feet (NGVD) 2. Base Flood Elevation (BFE) ................................................................................._�'�1�� feet (NGVD) 3. Elevation of Lowest Adjacent Grade ..................___c�,O0 feet (NGVD) .................................................... - - 4. Approximate Depth of Anticipated Scour/Erosion used for Foundation Design ................__°�� feet 5. Embedment Depth of Pilings of Foundation below Lowest Adjacent Grade....................._5� __ feet 6. Datum used: ___�_ NGVD; _______ NAVD 88; _______ Other � SECTION III —V Zone Certification Statement NOTE:A registered engineer or architect must complete this section. I certify that I have developed or reviewed the structural design, plans, and specifications for construction and that the design and methods of construction to be used are in accordance with accepted standards of practice for meeting the following provisions; • The bottom of the lowest horizontal structural member of the lowest floor (excluding piles and columns) is elevated to or above the BFE; and . The pile or column foundation and structure attached thereto is anchored to resist floatation, coliapse, and lateral movement due to the effects of tho wind Rnd wAter IoRdA flctinp Rim�illnnArniRly �n all hiiil�iinp r,�m(�nnAnt9, W�tAr loading values used are those associated with the base flood. Wind loading values used are tl�ose required by tl�e applicable state or local building code. The potential for scour and erosion at the foundation has been anticipated �or conditions associated with the base flood, including wav� action. SECTION IV— Breakaway WVall Certification Statement NOTE:This section must be completed by a registered eng'.,�eer or architect when breakaway walis exceed a design safe loading resistance of 20 pounds per square foot I certify that I have developed or reviewed the structural design, plans, and specifications for construction and that the design and methods of construction to be used for the brc�akaway walls are in accordance with accepted standards of practice for meeting the following provisions; ; . Breakaway wall collapse shall result from a water load less than that which would occur during the base flood; and � Page 1 of 2 � � . V-ZONE CONSTRUC710N CERTIFICATE • The elevated portion of the buiiding and supporting foundation system shall not be subject to collapse, displacement, or other structural damage due to the effects of wind and water loads acting simultaneously on all building components (wind and water loading values to be used are defined in Section III). SECTION V—�ertification Signature below certifies (check): _�_ Section III; ___ Section IV; _L� Sections III & IV Certifier'sName-------�1416'-�--F—��!�i'E�-------- --------------------- Title----�c��€S5YCn�g.�----��r`.GlL--------------------------------------- � Company Name _ �N zNE�E2 and___c�?l�s=12uG�to•�►____�o2.Po2sr_rr�,�_ ��s-------y------3^-'-�--- -- StreetAddress«7�'�___��N&.R.___�OU«UAR�_M�__— City��------------------- State__�%C..------------Zip Code_��i�8--- .,t;:. ��3�� , � c�a,� Licens�e�'I�mb,e�sr -- ---- Phone No. �--�"z�-�'3�'" � ----------- = ---- ------------ — � :�..� '• �.uo..... ; . ' ' =`v ° ;� f� °.�S` _ 2"_ �' ' '° Sig��at�e'�--- — -----------------��-------------- Date ------------y----- `; w �3 �E�-`:' ;<�55Q`� _ J_,T^:, ,,� Q��,., � :r'��..�. , � '��'�'•. :'��vA,�d ��i��'•��.� Page 2 of 2