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NATIONE+L �LOCG 1NSiJRAiVCc rnCGnabl
�TTENTION: Use of this cenificate doPS not orovioe a�?�yP�o�!h?ft���1 �nsurance ourchase requirem'ent. This form�s�used uniy to
. provide elevation infonnation necessary to ensure compliance with applicabie community fioodp�ain management ordinances, to
: determine the proper insurance cremium rate. and/or:o suppert a request for a Letter of Mao Amendment or Revision(IOMA or LOMRI.
Instructions (or completing this form can be found on the following pages.
' SECTION A PROPEATY INFORMATION wa iNSUanNce co��wY use
,
� POIICY NUMBE9 . ,
gV���OWNEA'SNAME • .
� JERRY AND V V N HARRIS �aP,uvyruuc�uMee�
S7REET ADORESS(Induou+9 AP�•�^�w Sw�e a^dior 8idg.Numoer�GR P.O.nCUTE RN�BCX NUMBeR
E 484 I �
� �LC7T E�4�P�UISITC BISLA�I ��e�`�TATES OF CLEARWATER '�
C STATE Z1P CODE
� �� ' FLORIDA
CLEARWATER
SECTION 8 FLOOD INSURANCE RATE MAP(F1RM)INFORMATION
Provide the tollowing from the proper F1RM(See Instructions):
1.COMMUNITY NUMBEA 2 PANEL NUMBER 3.SUFF�X 4,OATE OF FIRM INDEX 5.FIRM ZONE 6.9n AV Z�ne�s u eEoep�j N
125096 0007 D 8 19/91 AE 11
7.Indicate the elevation datum system used on the FIRM for 8ase Flood Elevations(BFE): n NGVD'29 n Other(describe on back)
S.For Zones A or V,where no BFE is provided on the FIRM,and the communiry has established a BFE for this building site;�inc�,ate
the community's BFE:� � ' ' � �.�feet NGVD(or other FIRM datum-see Section B, Item 7), .. ....- ,
SEC'f10N C BUILdING ELEVATION INFORMATION
� � --� �
�1.Using the Elevatlon Certificate Instructions,indicate the diagram number from the diagrams found on Pages 5 and 6 that be$t �
1 _. ,
� describes the subject building's reference level
2(a). F1RM Zones A1-A30,AE,AH,and A(with BFE}. The top of the reference level floor from the selected diagram is at an elevation
of � � 8•8S�feet NGVO (or other F1RM datum-see Section B. Item 7).
(b). FIRM Zones V1-V30,VE,and V(with BFc). The bottom of the lowest horizontal structural member of the reference level from
� ! ','feet NGVD or other FIRM datum-see Section B, Item 7).
the selected diagram,is at an elevation of� ! � '— � —
(c). F1RM Zone A(without BFc). The floor used as the reference level from the selected diagram is ' � �.:._.�feet above',- or
below❑ (chedc one) the highest grade adjacent to the b�ilding.
, . , r- r-
(d). F1RM Zone AO. The floor used as the reference level from the selec;ed diagram is ' '.:._'feet above;_._' or below�.(check
one)the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor(referer.ce
level)elevated in accordance with the community's floodplain management ordinance? � Yes � No ,� Unknawn
3.Indicate the elevation datum system used in determining the above refe�ence level eleva6ons:i�! NGVD'29 �! Other(describe
under Comments on Page 2). (NOTE: !f ihe eleva6on datum used in measuring the elevations is different than that used on
the F1RM (see Secaon 8, Item�, Chen convert the elevations to the datum sys�em used on the F1RM and show ihe conversion
equation under Comments on Page 2.j .
4.Elevation reference ma�fc used appears on FIRM: r Yes J No (See Instruciions an Page 4) •
X a�ual construction !' construction drawings
5.The reference level elevation is based on: ❑ �
{NOTE: Use of co�struction drawings is only valid if the bullding does not yet have the reference ieve/No�r in place.in which
case?his certircate will only be valid for the building dunng the course oi co nsr r u c r i o n. A p o s t-c o n s t r u c t i o n Elevation Ceriilicate
will be required once construcbon is complete.)
6.The elevation of the towest grade immediately adjacent to the building is:� � 8•�Q4� teet NGVO (or other FIRM datum-ses
� Section B,Item,7). '
� SECTION D COMMUNI7Y INFORMATION .
t.if the cammuniry otficial responsible for verifying building e:e��at����s sPac�►es ttiat:h2 refererca level indicated in Sec;ion C,�tem 1
is nat the"lowesi flocr"as detined in the communiry's floodplain man2gement��dinanca,the elevation of the building's"Iowest
� :oo;n�C�;� •!-�� ":�!:t�at�.;m-see Se�:icn B. Item 7).
ticc."as defined by;~e c:ci;.anca is: �— • �' "
2. Date of the start of construction or substantial imFrovemant
ccM4 Fnrm 81-31,MAY 90
RE?LaCE$AL!PREVIOUS EDi'�ONS Sc�REVEASE SIDE FOR CCNTINUA7�CN
SECTION E CcRT1FiCAT10N
'..,: „_';i`.t�a,i�' ._:G �� 5:7'c: .`r;c 1c'i�3:J'VBV6',c'10i�@g! or architeC:Wh0 is authonzed bY S;ate ot. .d�13w';p C�':lf�?l9vdt10r
;::=�.-;a;;;r:w�sn ,tie�ievat�an i�iorr�at�n for Zo�es A1—A30.A=.AH.A!witr. 9��j.V�—V3�.V�. 3!2� V !::'::h�^�� t£.•�,^��:.'°C�.. .
;,;,^T;;:::���;�;c3;5�ti~� :.'6 2L':�1C�:Z2G�5Y��:.2��8�:Cr ordinar,ce te arovide floodplain managemen:tl1f0lfTlZ:io.^.. may also sian the
ce�t�f��at�an �n tne case o�Zones AO and A�w�thout a �=MA or community issued BF=_), a buiiding of!ic:a:. a�ro�eRy owner, or an
Ow(1@'S�°Dr?SC�iBUJe tT'�ay diSG Si9n �he cert'rfica�ion.
Rereren�e ievel diagrarns o.i and 8 - Gisiinowsh�ng Features—If the certifier is unable to certify to breaicawaymon-oreakaway wall,
�-c;o;u;� s;ze;lacat�a� cf servi;,i�g equip„�ent,are�;;se,�:al�openings, or unfinished area Feature(s;,;hen lis�the Feature�s) not
;^�ludsd in:he certific2:i�n u.^.�er Commems 5elow. The diagram number, Section C. Item 1, must still be entere�.
!ceriiiy f.hat the informaiion rn �e�tions a"anJ C on this certi�;ate rspresen:s my besf efforts fo interpret fhe data available. �
!undersrand that any false statement may be punishab/e by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIER'S NAME LICENSE NUMBER�or AHix Seal)
GORDQN F. KILLION PLS# 3138
TITLE COMPANY NAME
OWNER KILLION AND ASSOCIATES
ADDHESS . CT' STATE ZIP
125 — SOUTH HIGHL ND AVENUE CLEARWATER FLROIDA 33756
SIGNATURE 11/25%9�'7 813 443P7067
Copies hou d be made oi thls Certlilcate for:1)community otticlal�2)lnsurance agenUcompany,and 3)bullding owner.
COMMcNTS: BENCH MARK USED CITY OF CLEARWATER I-35 EL. 7. 275
_ �
oN wrrr+ oa v��es.
SLAB BASEME!!T PIERS.OR COLUMNS
A V A A V
29N�S 2rN°_S � ZONES 20N`S ZONES
i � �F��� �
,or_a:;.N1 � �( �y� „�� 'E: ��.{� �R�F-.��1��
� 1 LE�1F. � G�u i�lw �11 I e�.+..�. , �lii � � � :e:e. �
. � ii1' '!P ,I: ' EIEVATION IY� � I
'�1: '!':Ji'i Iw': ^��. Cy,�1� � �`' I 1 �
I' � _ _' �i.)'i ..j�G�'.��. •�:�Jy"`h
, .. ........_.. ... . ... ,•
,.-i::::� .;:�.:.�: . �^' KSF
, �F ��. .� � •ti.Ji4.EbT F� f1�fERSeY! � FLOOD
FLOOD ..:.: •••.:.. 6MDE ''kY,.�,: �� � EtEV�TqH
LIEwTd+ � nEcEaE�+CE •,�W�CE� ... 'id! �
IEVEI Op�DE •ti.. � , ��
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. � .°..+.�! .. � ... �.. .f`irS7�. 3n��f
1
� 'ne d�a,rams above i.E�strate the poir,;s at whicti the elevations should be measured in A Zones a-c�':ones.
i
=._:atio.^.s �o; a��M Zones should be measurec at the to�of the refere�ce ieve� fico:.
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� �'�:' ..�v��. a!� ;.� .'�.v�'p� ..�viJiV �c n�cG�ViCV ni i'c vvuv� v/�h� il7Y�Q��. ^j-i��1r'.G: �'r:s"� - . 7 ...= i
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