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1225 HIGHLAND AVE S _ - _ ' ''�C �� Z� II � � �� 1 � � �U.S.DEF�ARTMENTOF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 � Federal Emergency Management Agency Expires March 31, 2012 National Flood Insurance Program Important: Read the instructions on pages 1-9. � SECTION A-PROPERTY INFORMATION For Insu�ance Company'Use: ' A7. Building Owners Name PINE BERRY SENIOR LTD PTR f'�a19c�y Nt��fb"�i` "' �� :,� �+�,M A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. �Coljiip�lly��AIG;Numbe�'-: 1225 SOUTH HIGHLAND AVENUE ,.,.. ,,, .. City CLEARWATER State FL ZIP Code 33756 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) TAX PARCEL NUMBER 23-29-15-29034-000-0060 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)RESIDENTIAL A5. Latitude/Longitude:Lat.27°57'08.6" Long.82°46'26.5" Horizontal Datum: ❑ NAD 1927 � NAD 1983 A6. Attach at least 2 photographs of the building ff the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 1A A8. For a building with a crawlspace or enctosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or endosure(s) 0 sq ft a) Square footage of attached garage 0 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 0 within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b 0 sq in c) Total net area of flood openings in A9.b 0 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 82.County Name B3.State CITY OF CLEARWATER,125096 PINELLAS FL 64.Map/Panel Number 65.Suffix B6.FIRM Index 67.FIRM Panel B8.Flood 69.Base Flood Elevation(s)(Zone 12103C0109 H Date Effective/Revised Date Zone(s) AO,use base flood depth) 5-17-05 8-18-09 AE,X 31.5 B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile � FIRM ❑ Community Determined ❑ Other(Describe) 611. Indicate elevation datum used for BFE in Item 89: ❑ 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 N!A ❑ 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 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 BFE. Benchmark Utilized D-07Vertical Datum 1988 Conversion/Comments WA Check the measurement used. a) Top of bottom floor(including basement,crawlspace,or enclosure floor)35.7 �feet ❑meters(Puerto Rico only) b) Top of the�ext higher floor N/A. ❑feet ❑meters(Puerto Rico only) c) Bottom of the lowest horizontal structural 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) f� Lowest adjacent(finished)grade next to building(LAG) 31.0 �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 34.5 �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 This certification is to be signed and sealed by a land surveyor,engineer,or archited authorized by law to certify elevation information. 1 ceitify that the information on this Certifrcafe�presents my best e(forts to inteipref the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001. �J,�3 � Check here if comments are provided on badc of form. Were latitude and longitude in Section A provided by a licensed land surveyor? � Yes ❑ No � Certifiers Name JOHN O.DIEHL License Number 4053 Title PROFESSIONAL LAND SURVEYOR Company Name POLARIS ASSOCIATES,INC. Address 2165 SUNNYDALE BLVD. City CLEARWATER State FL ZIP Code 33765 � �/3 r!� Signature Date 1-13-11 Telephone 727-461-6113 FEMA Form 81-31, Mar 09 See reverse side for continuation. Replaces afl previous editions ' � IMPORTANT: in these spaces, copy the corresponding information from Section A. For Insurance Company Use: Building Street Address(including Apt.,Unit,Sufte,and/or Bldg.No.)or P.O. Route and Box Na Policy Number 1225 SOUTH HIGHLAND AVENUE City CLEARWATERState FL ZIP Code 33756 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)building owner. Comments 1.SURVEY MAP AND REPORT OR THE COPIES THEREOF ARE NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER.ADDITIONS OR DELETIONS TO SURVEY MAPS OR REPORTS BY OTHER THAN THE SIGNING PARTY OR PARTIES IS PROHIBITED. 3945 NEW BLDG Signature .9 Date 1-13-11 ❑ Check here if attachments SECTI 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,'rf 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(see pages 8-9 of Instructions),the�ext higher floor (elevation C2.b in the diagrams)of the building is ❑feet ❑meters ❑above or ❑below the HAG. E3. Attached garage(top of siab)is . ❑feet ❑meters ❑above or ❑below the HAG. E4. Top of platform of machinery andlor equipment servicing the building is ❑feet ❑meters ❑above or�below the HAG. E5. Zone AO oniy: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodpiain 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,and E for Zone A(without a FEMA-issued or community-issued BFE) or Zone AO must sign here. The stafements in Sections A,8,and E a�e comect to the best of my knowledge. Property Owners 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. Check the measurement used in Items G8 and G9. G1.❑ The information in Section C was taken from other documentation that has been signed and seaied 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 compteted Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)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 Certficate 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: ❑feet ❑meters(PR)Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters(PR)Datum G10.Community's design flood elevation ❑feet ❑meters(PR)Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑Check here ff attachments FEMA Form 81-31,Mar 09 Replaces all previous editions r Glllf COaSt C011Sllltlllg� Il1C. Land Development Consulting • Engineering • Planning • Tranaportation • Permitting ICOT Center 13825 ICOT Boulevard.Suite 605 Clearwater.FL 33760 Phone:(727)524-1818 Fax:(727)524-6090 February 21, 2011 Mr. Elliot Shoberg, P. E., Stormwater Manager City of Clearwater Public Works Department 100 S. Myrtle Avenue, 2nd Floor Clearwater, Florida 33756 Re: Pine Berry Limited Partnership Pine Berry Senior Apartments 1225 South Highland Avenue Clearwater,Fl City of Clearwater,Florida LOMR-F Submittal Dear Mr. Shoberg: The newly constructed Pine Berry Senior Apartments which lies within Flood Zone AE has been constructed above the 100-year base floodplain elevation of 31. The approximate Flood Zone "AE" limit is defined by the FIRM Community Panel No 12103C0109H, dated May 17, 2005, as detailed on the 8-1/2"x 11"FIRM panel E�chibit(Item 5 listed below). We have removed the structure from Flood Zone AE with the Base Flood Elevation (BFE) of elevation 31, with the addition of fill, stem wall construction for the building and constructing the finished floor elevation of the structure to elevation 35.7 as noted on the Certified Elevation Certificate(See Item 6 listed below). Please sign the MT-1 Form 3 — Communitv Acknowled�ement Form and forward the executed form to our attention for submittal to FEMA for the LOMR-F. The following documents have been provided for your review as part of this LOMR-F submittal request: 1. One(1)DHS-FEMA Form 81-87 MT-1 Form 1 —Property Information Form; 2. One(1)DHS-FEMA Form 81-87 MT-1 Form 2—Elevation Form; 3. One(1)DHS-FEMA Form 81-87 MT-1 Form 3—Community Acknowledgement Form to be executed; 4. One(1)FEMA Form 81-107—Payment Information Form; 5. One(1) 8-1/2" z 11" copy of the effective FIRM panel with the property boundary overlaid; 6. One(1) copy of the Certified Elevation Certificate; 7. One(1) copy of the Drainage Design Report as previously submitted and approved by the City of Clearwater for this development. February 21,2011 Page 2 of 2 Please call me if you have any questions or if you need any additional information to facilitate your review and approval of this Letter of Map Revision based on Fill request. Sincerely, 7 Sean P. Cashen, P.E., LEED AP Principal Encl. cc: Dusan Peric -Beneficial Communities John Luther-Beneficial Communities File 09-014 U.S. DEPARTMENT OF HOMELAND SECURITY-FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.NO. 1660-0015 PROPERTY INFORMATION FORM EzpiresDecember3l,zo�o PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this form is estimated to average 1.63 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources,gathering and maintaining the needed data, and completing, reviewing, and submitting the form. You are not required to respond to this collection of information unless a valid OMB control number appears in the upper right corner of this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to: Information Collections Management, U.S. Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington DC 20472, Paperwork Reduction Project(1660-0015). Submission of the form is required to obtain or retain benefits under the Nationai Flood insurance Program. Please do not send your completed survey to the above address. This form may be completed by the property owner,property owner's agent,licensed land surveyor,or registered professional engineer to support a request for a Letter of Map Amendment(LOMA),Conditional Letter of Map Amendment(CLOMA),Letter of Map Revision Based on Fill(LOMR-F),or Conditional Letter of Map Revision Based on Fill(CLOMR-F)for existing or proposed,single or multipie lots/structures. In order to process your request, all information on this form must be completed in its entirety. Incomplete submissions may result in processing delays. Please check the item below that describes our re uest: ❑ LOMA A letter from DHS-FEMA stating that an existing structure or parcel of land that has not been elevated b fill natural rade would not be inundated b the base flood. ❑ CLOMA A letter from DHS-FEMA stating that a proposed structure that is not to be elevated by fili(natural rade would not be inundated b the base flood if buiit as ro osed. � LOMR-F A letter from DHS-FEMA stating that an existing structure or parcel of land that has been elevated by fill would not be inundated b the base flood. A letter from DHS-FEMA stating that a parcel of land or proposed structure that will be elevated by ❑ CLOMR-F fiil would not be inundated by the base flood if fiil is placed on the parcel as proposed or the structure is built as ro osed. Fill is defined as material from any source(including the subject property)placed that raises the ground to or above the Base Flood Elevation(BFE). The common construction practice of removing unsuitable existing materiai(topsoil)and backfilling with select structural material is not considered the placement of fili if the practice does not alter the existing(natural grade)elevation,which is at or above the BFE. Fill that is placed before the date of the first National Flood Insurance Program(NFIP)map showing the area in a Special Flood Hazard Area(SFHA)is considered natural grade. Has fill been placed on your property to raise ground that was previousiy below the BFE? � Yes ❑ No If yes,when was flll placed? 10/2010 month/year Will fill be placed on your propertyto raise ground that is below the BFE? ❑ Yes ❑ No If yes,when will fill be placed? / month/ ear 1. Street Address of the Property(if request is for multiple structures,please attach additional sheet): 1225 South Highland Avenue Clearwater,FI 33756 2. legal description of Property(Lot,Block,Subdivision)(complete description as it appears in the Deed is not necessary): Portion of Lots 4,5 and 6,Forrest Hill Estates,Unit 5 3. Are you requesting that the SFHA designation be removed from(check one): ❑ the entire legally recorded property? ❑ a portion of land within the bounds of the property?(A certified metes and bounds description and map of the area to be removed, certified by a licensed land surveyor or registered professional engineer,are required.For the preferred format of inetes and bounds descriptions,please refer to the MT-1 Form 1 Instructions.) � structures on the property? What are the dates of construction? 5/2010-11/2010 4. Is this request for a(check one): � single structure ❑ single lot ❑ multiple structures(How many structures are involved in your request?l.ist the number: ) ❑ multiple lots(How many lots are involved in your request?List the number: ) DHS-FEMA Form 81-87,DEC 07 Property Information Form MT-1 Form 1 Page 1 of 2 • Copy of the Plat Map for the property(with recordation data and stamp of the Recorder's O�ce) � OR • Copy of the property Deed(with recordation data and stamp of the Recorder's Office),accompanied by a tax assessor's map or other certified . map showing the surveyed location of the property relative to local streets and watercourses . Form 2—Elevation Form. if the request is to remove the structure,and an Elevation Certificate has already been completed for this property, it may be submitted in lieu of Form 2. If the request is to remove the entire legally recorded property,or a portion thereof,the lowest lot eievation must be provided on Fortn 2. Please include a map scale and North arrow on all maps submitted. For LOMR-Fs and CLOMR-Fs,the following must be submitted in addition to the items listed above: • Form 3—Community Acknowledgment Form Processina Fee(see instructions for appropriate mailing address;or,visit http:l/www.fema.gov/fhm/frm_fees.shtm for the most current fee schedule) Revised fee schedules are published periodically,but no more than once annually,as noted in the Federal Reaister. Please note: single/multiple lot(s)/structure(s)LOMAs are fee exempt. The current review and processing fees are listed below: Check the fee that applies to your request: ❑ $325(single IoUstructure LOMR-F following a CLOMR-F) � $425(single lot/structure LOMR-F) ❑ $500(single IoUstructure CLOMA or CLOMR-F) ❑ $700(multiple IoUstructure LOMR-F following a CLOMR-F,or multiple IoUstructure CLOMA) ❑ $800(multiple IoUstructure LOMR-F or CLOMR-F) Please submit the Payment Information Form for remittance of applicable fees. Please make your check or money order payable to:National Flood Insurance Proaram. All documents submitted in support of this request are correct to the best of my knowledge. I understand that any false statement may be punishable by fine or imprisonment under Title 18 of the United States Code,Section 1001. . Applicant's Name: John E. Luther, Director of Development Company: Pine Berry Limited Partnership Please Print or Type Mailing Address: 2205 Jo-An Drive Daytime Telephone No.: (941)929-1270 Sarasota, FI 34231 E-Mail Address: Dusan Peric,(dperic@beneficialcom.com) Fax No.: 941)929-1271 (optional) �/�y � Date �j� Sign re of App t(requ'ed) If you have any questions concerning DHS-FEMA policy,or the NFIP in general,please contact the F[MA Map Assistance Center toll free at 1-877- FFMA MAP(1-R77-33R-?R971 nr vicit tha Finnd Ha�ard Manninn wPhcitP at httoJ/www_fama.nov/fhmL U.S. DEPARTMENT OF HOMELAND SECURITY-FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.NO. 1660-0015 ELEVATION FORM ExpiresDecember3l,aoio PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this form is estimated to average 1.25 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources,gathering and maintaining the needed data,and completing, reviewing,and submitting the form. You are not required to respond to this collection of information unless a valid OMB control number appears in the upper right corner of this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to:Information Collections Management, U.S.Department of Homeland Security,Federal Emergency Management Agency,500 C Street,SW,Washington DC 20472, Papervvork Reduction Project(1660-0015). Submission of the form is required to obtain or retain benefits under the National Flood Insurance Program. Please do not send your completed surve to the above address. This form must be completed for requests and must be completed and signed by a registered professional engineer or licensed land surveyor. A DHS- FEMA National Flood Insurance Program(NFIP)Elevation Certificate may be submitted in lieu of this form for single structure requests. For requests to remove a structure on natural grade OR on engineered fill from the Special Fiood Hazard Area(SFHA),submit the lowest adjacent grade(the lowest ground touching the structure),inciuding an attached deck or garage.For requests to remove an entire parcel of land from the SFHA, provide the lowest lot elevation;or,if the request involves an area described by metes and bounds,provide the lowest elevation within the metes and bounds description.In order to process your request,all information on this form must be completed in its entirety. Incomplete submissions may result in processing delays. 1. NFIP Community Number: 125096 Property Name orAddress: 1225 South Highland Avenue Clearwater,FI 33756 2. Are the elevations listed below based on �existina or ❑ proposed conditions? (Check one) 3. What is the elevation datum?❑NGVD 29 � NAVD 88 ❑ Other(explain) If any of the elevations listed below were computed using a datum different than the datum used for the effective Flood Insurance Rate Map(FIRM)(e.g.,NGVD 29 or NAVD 88),what was the conversion factor? Local Elevation+/.ft.=FIRM Datum 4. Piease provide the Latitude and Longitude of the most upstream edge of the structure(in decimal degrees): Indicate Datum: � NAD83 ❑ NAD27 27.9524 Lat. -82.7731 Long. Please provide the Latitude and Longitude of the most upstream edge of the property(in decimai degrees): Indicate Datum: ❑ NAD83 ❑ NAD27 . Lat. . Long. 5. For the existing or proposed structures listed below,what are the types of construction? (check all that apply) ❑ crawl space �slab on grade ❑basemenUenclosure ❑other(explain) 6. Has DHS-FEMA identified this area as subject to land subsidence or uplift?(see instructions) ❑ Yes � No If yes,what is the date of the current releveling? / (month/year) Lowest Block Lowest Lot Adjacent Base Flood Lot Number Number Elevation* Grade To BFE Source For QHS-FEMA Use Only Structure Elevation Bid 1A 31.00 31.00 Jeffords St Tributa This certification is to be signed and sealed by a licensed land surveyor, registered professional engineer, or architect authorized by law to certify elevation information. Ail documents submitted in support of this request are correct to the best of my knowledge. I understand that any false statement may be punishable by fine or imprisonment under Title 18 of the United States Code,Section 1001. Certifier's Name: Sean P.Cashen,P.E,LEED AP License No.: 42505 Expiration Date: 2/28/2011 Company Name: Gulf Coast Telephone No.: (727)524-1818 Fax No.: (727)524-6090 Signature� Date: 'For requests involving a portion of property,include the lowest ground elevation within the metes and bounds description. Please note:If ihe Lowest Adjacent Grade to Structure is the only elevation provided,a determination will be issued forthestructureonly. S@8I (OptlOfla�� DHS-FEMA Form 81-87A, DEC 07 Elevation Form MT-1 Form 2 Page 1 of 2 Continued from Page 1. Block Lowest Lot Lowest gase Flood Lot Number Number Elevation Adjacent Grade Elevation BFE Source For DHS-FEMA Use Only To Structure This certification is to be signed and sealed by a licensed land surveyor, registered professional engineer, or architect authorized by law to certify elevation information. All documents submitted in support of this request are correct to the best of my knowledge. I understand that any false statement ma be unishable b fine or im risonment under Title 18 of the United States Code,Section 1001. Certifier's Name: License No.: Expiration Date: Company Name: Telephone No.: Fax No.: Signature: Date: Seal (optional) DHS-FEMA Form 81-87A, DEC 07 Elevation Form MT-1 Form 2 Page 2 of 2 U.S. DEPARTMENT OF HOMELAND SECURITY-FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.NO. ]660-0015 � COMMUNITY ACKNOWLEDGMENT FORM ExpiresDecember31,2o10 PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this form is estimated to average 1.38 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources,gathering and maintaining the needed data, and completing, reviewing,and submitting the form. You are not required to respond to this collection of information unless a valid OMB control number appears in the upper right corner of this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to: information Collections Management, U.S. Department of Homeland Security, Federat Emergency Management Agency, 500 C Street, SW,Washington DC 20472, Paperwork Reduction Project (1660-0015). Submission of the form is required to obtain or retain benefits under the National Flood insurance Program. Ptease do not send your completed survey to the above address. This form must be completed for requests involving the existing or proposed placement of fill (complete Section A) OR to provide acknowledgment of this request to remove a property from the SFHA which was previously located within the regulatory floodway(complete Section B). This form must be completed and signed by the o�cial responsibfe for floodplain management in the community. The six digit NFIP community number and the subject property address must appear in the spaces provided below. Incomplete submissions may result in processing delays. Community Number: 125096 Property Name or Address: 1225 South Highland Avenue Clearwater,FI 33756 A. REQUESTS INVOLVING THE PLACEMENT OF FILL As the communiry official responsible for floodplain management, I hereby acknowledge that we have received and reviewed this Letter of Map Revision Based on Fill(LOMR-F)or Conditional LOMR-F request. Based upon the community's review,we find the completed or proposed project meets or is designed to meet all of the community floodplain management requirements,including the requirement that no fill be placed in the regulatory floodway, and that all necessary Federal,State,and local permits have been,or in the case of a Conditional LOMR-F,will be obtained. in addition,we have determined that the land and any existing or proposed structures to be removed from the SFHA are or will be reasonably safe from flooding as defined in 44CFR 65.2(c),and that we have available upon request by DHS-FEMA,all analyses and documentation used to make this determination. For LOMR-F requests,we understand that this request is being forwarded to DHS-FEMA for a possible map revision. For LOMR-F or Conditional LOMR-F requests that have the potential to impact an endangered species,documentation wili be submitted to show that we have complied with Sections 9 and 10 of the Endangered Species Act(ESA). Section 9 of the ESA prohibits anyone from"taking"or harming an endangered species. If an action might hann an endangered species,a permit is required from U.S. Fish and Wildlife Service or National Marine Fisheries Service under Section 10 of the ESA. For actions authorized,funded,or being carried out by Federaf or State agencies,documentation from the agency showing its compliance with Section 7(a)(2)of the ESA will be submitted. Community Comments: Community Official's Name and Title: (P/ease P�nt or Type) Telephone No.: Elliot Shober P.E.,Stormwater Mana er 727 562-4748 Community Name: Community Official's Signature: (required) Date: City of Clearwater �J�� 9� f/ ! f''`�/ B. PROPERTY LOCATED WITHIN THE REGULATORY FLOODWAY As the community official responsible for floodplain management,I hereby acknowledge that we have received and reviewed this request for a LOMA. We understand that this request is being forwarded to DHS-FEMA to determine if this property has been inadvertently included in the regulatory floodway. We acknowledge that no fill on this property has been or will be placed within the designated regulatory floodway. We find that the completed or proposed project meets or is designed to meet all of the community floodplain management requirements. Community Comments: Community Official's Name and Title: (Please Print or Type) Telephone No.: Community Name: Community Official's Signature(required): Date: DHS-FEMA Form 81-876,DEC 07 Community Acknowledgment Form MT-1 Form 3 Page 1 of 1 FEDERAL EMERGENCY MANAGEMENT AGENCY PAYMENT INFORMATION FORM Community Name: 125096 Project Identifier: 1225 South Highland Avenue Clearwater,FI 33756 THIS FORM MUST BE MAILED,ALONG WITH THE APPROPRIATE FEE,TO THE ADDRESS BELOW OR FAXED TO THE FAX NUMBER BELOW. Type of Request: FEMA � MT-1 application � Fee Charge System Administrator ❑ MT-2 application 6730 Santa Barbara Court Elkridge,MD 21075 � FEMA Project Library ❑ EDR application 847 South Pickett St. Alexandria,VA 22304 FAX(703)212-4090 Request No.: (if known) Amount: 425.00 ❑ INITIAL FEE* ❑ FINAL FEE ❑ FEE BALANCE'`" ❑ MASTER CARD ❑ VISA � CHECK ❑ MONEY ORDER '`Note: Check only for EDR and/or Alluvial Fan requests(as appropriate). *'Note:Check only if submitting a corrected fee for an ongoing request. COMPLETE THIS SECTION ONLY IF PAYING BY CREDIT CARD CARD NUMBER EXP.DATE — — — m � 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Month Year Date Signature NAME(AS ITAPPEARS ON CARD): (please print or type) ADDRESS: (for your credit card receipt-p/ease print or rype) DAYTIME PHONE: FEMA Form 81-107 Payment Information Form _ _ � �� ■ ��I� ■111 111� I��!,�.��a�p rY. , , � �� ■�I■ ■�� '11.N ■II� ■ �� ■ �� 11� �� ~ �� -. � : ��.!�!� � � �� '_..---_' � , . . . - �G��a�� `'� � � ' � ' � '� ��■ �r� �� ■�� ■� �� ■��r �,�,� „ .. ■� �� . �. , -- ■�i��i�■ .� �•''�� . �. �Illllfllllllll � �� . . ■��r��■ � �� ''' ��r, : . � � . .r :■ r�. ,��► �� , • .•. � � .,� �:{,, �r. ��, ■��i.��■ � �I�:.3 � :�/t�� .�� ,+� ��tb,� � � �§�' ' � i � i �'��h2� .,�d�aX.S�GS�'//�. 1�,�.�.�@� �� b"�. . �. L'Fd'� L . PM X�ms31 ��.rG.a`it�T$"'eL��Y'A�t2��`�`:PM� T��.J �t�°-.�� }�'�"i i,..�. 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