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511 ISLAND WAY (� '�� i�� !G, � DERAL EMERGENCY MANAGEMENT AGENCY D `= �C NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077 "�� Expires July 31, 2002 ,��;y. t �i ,��;�,. ` �ELEVATION CERTIFICATE 1 portant: Read the instructions on pages 1-7. S 0 EPT SECTION A-PROPERIY OWNER INFORMATION For InsuranceCompany Use: BUIL OV1(,�R+St111�ME � = .,,.,..._. Policy Number BAR &'�f��ROBBINS� BUILDING STREET ADDRESS(Including Apt.,Unit,.Suite,and/or Bidg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number 511 ISLAND WAY CITY STATE ZIP CODE CLEARWATER BEACH FL 33767 PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) LOT 72 ISLAND ESTATES OF CLEARWATER BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,if necessary.) RE5IDENTIAL LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type): ( ##°-##'-##.##" or ##.�� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other: SECTION B-FLOOD INSURANCE RATE MAP(FIRfV�iNFORMATION IB1.NFIP COMMUNITY NAME& NAJNITYiJFJMB€R B2.COUNTY NAME 83.STATE 125096 ��..��r— PINELL4S FL - -- B4.MAP AND PANEL 65.SUFFIX B7.FIRM PANEL B9.BASE FLOOD EI^'"T'^""^' NUMBER 66.FIRM INDEX DATE EFFECTIVEIREVISED DATE B8.FLOOD ZONE(S) (Zone A0,use dept 0007 D &19-91 &1&92 AE 11' B10.Incicate the source of the Base Flood Elevation(BF�data or base flood depth entered in 69. ❑FIS Profile �FIRM ❑Cammunity Detetmined ❑Other(Desaibe}: m � B 11.Inc�cate the elevation datun used for the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Other(Desaibe): N 812.Is the building located in a Coashal Barrier Resources System(CBRS)area or Otherwise ProtectedArea(OPA)? ❑Yes ❑No Designation Date N SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) `—},° m C1.Building elevations are based on:�Construction Drawings* ❑Buikiing Under Construction* �Finished Construction �` � 'A new Elevation Certificate will be required when construction of the building is canplete. Q � Q S?.Building Diagam Number 1(Select the building ciagam most similar to the building for which this certificate is being completed-see pages 6 and 7. If no dagr � N m � accuratey represents the bu�ding,provide a sketch or photograph.) Q C3.Elevations–Zones A1 A30,AE,AH,A(with BFE),VE,V1 V30,V(with BFE),AR,P,RlA,AR/AE,P,R/A1-A30,AR/AH,ARIAO � T � Complete Items C3.-a-i below accading to the building dagram specfied in Item C2.State the datun used.If the datun's different fran the dahm used for the Z � � Section B,cornrext the daUum to that used for the BFE.Show freld measuranents and dahm conversion ca�ulation. Use the space provided or the Carmenls; Q N Q Section D or Section G,as approFxiate,to document the daUum conversion. J � V p Datum Cornrersion�Carmenis �/� � �/� N Uj�W Elevation reference mark used Dces the elevation refe�ence mark used appear on the FIRM? ❑Yes �No � a Z � ❑ a)Top of bottan floor(nclucing basernent or enclosure) 13. 6 ft.(m) � � U m .E ❑ b)Top of next higher flaor N.A ft(m) � r � o ❑c)Bottom of bwest ha¢ontal structural member(V zones only) N.A ft(m) o o � m � N ❑ d}Attached garage(top of slab) 13. 0 ft.(m) E� �,{ ❑ e)Lowest elevation of machinery andlor equipment W� 1 " �`� ��,,_,,� �� ,' "=0" senricing the building(Desaibe in a Canments area) N.A ft.(m) � � �f�-�LCI S ❑ fl Lowest adjacent(6nished)grade(LAG) 10.9 ft.(m) z'� ❑ g)Highest adacent(finished)gade(HAG) 12. 5 ft.(m) � � �� ❑ h)No.of permanent openings(flood venis)within 1 ft.abave adacent grade 0 � ❑ i)Total area of all permanent openings(flood venls)in C3.h 0 sq.in.(sq.an) SECTION D-SURVEYOR,ENGINEER,OR ARCHITEC7 CERTIFICATION This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation informa6on. 1 certify that fhe information in Sections A,8,and C on this cer6ficafe represents my best efforts fo interpret the data available. 1 understand thaf any false sfatemenf may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001. CERTIFIER'S NAME MARCEL G.MAYER LICENSE NUMBER 4495 TITLECEO COMPANY NAME FLOWDA BENCHMARK .�DDRESS CITY STATE ZIP CODE 1298 LAKEVIEW RD CLW FL 33756 S(GNAT� DATE TELEPHONE ��,�'�"�.�c;�� 9-16-02 727-298-0286 FEMA Form 81-31,JUL 00 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT: In these spaces,copy the coResponding information from Section A For�nsurar�ce Com�ary use: BUILDING STREET ADDRESS(Inclu�ng Apt.,Unit,Suite,ancUor Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number �ITl STATE ZIP CODE Comparry NAIC Number SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) • Copy both sides of this Elevation Certificate for(1)canmunihr o�iaal,(2)insur�uice agent/comparry,and(3)building owner. COMMEIVTS ❑Check here'rf attachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(IMTHOUT BFE} For Zone AO and Zone A(wiihout BFE),canplete Iterrs E1 through E4. If the Elevation Certificate is intended for use as supporting infamation for a LOMA or LOMR-F, Section C must be completed. E1.Builcing Diagam N�mber_(Select the builcing diagam most smilar to the building for which this certificate is being completed—see pages 6 and 7. If no diac�am accuratey represenls the building,provide a sketch or photogaph.) E2.The Uop of the bot9�m floor(nclucing baserner�a erxtosure)of the builcing's _ft(m)_in.(an)❑abave or ❑below(chedc one)the highest adacent grade. (Use natural grade,'rf available). E3.For Building Diagams 6-8 with openings(see page�,the next higher floor or elevated floor(elevation b)of the building is _ft.(m)_in.(cm)above the highest ad�acent gade. Canplete items C3.h and C3.i on front of fam. E4.For Zone AO ony: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the canmuniiy's floodplain managemer�orcinance? ❑Yes ❑No ❑Unknown. The local official must certi(y this infamation in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The properly owner or owner's autha¢ed representative who canpletes Se�tions A,B,C(Items C3.h and C3.i ony),and E for Zone A(wiU�out a FEMA-issued or cornmuniiy- issued BFE)or Zone AO must sign here. The statemenls in Sections A,B,C,and E are correct to the best of my knowiedge. PROPERIY 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(OPTIOtVAL) The local official who is authaized by law or ordinance to actninister the canmunitys Boodplain 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 infamation in Section C was taken from other doarnentation that has been signed and embossed by a licensed surveyor,engineer,or ar�hitect who is author¢ed by state or local law to certify elevation infamation. (Indicate the source and date of the elevation data in the Conmenls area below.) G2.❑A communiiy off�ial carpleted Section E for a building located in Zone A(without a FEMA-issued or carmuniiy-issued BFE)or Zone A0. G3.�The following inforrnation(Items G4-G9)is provided for carmuniiy floodplain management purposes. G4.PERMIT NUMBER �G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCEJOCCUPANCY ISSUED G7.This permit has been issued for:❑New Construction ❑Substantial Improvement G8.Elevation of as-buift lowest floa�(including basement)of the builckng is: _._ft(m) Datim: G9.BFE or(n Zore AU)depth of floodng at the builcGng site is: _ _ft.(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNIIY NAME TELEPHONE SIGNATURE DATE CON1MENiS • ❑Check here rf attachments FEMA Form 81-31,JUL 00 REPLACES ALL PREVIOUS ED1710NS