The URL can be used to link to this page

824 ISLAND WAY , '� . ��Y TS``r"'� �J'�Y �� a� s- a 9�.�a P �oT C,,,,,,�o��.,�� y,LT �r� 78 6/6 d� � + � ` ` F�DERA4 EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 �� NATIfJrNAL FLOOD INSURANGE PROGRAM Expires December 31, 2005 � ELEVATION CERTIFICATE Im ortant: Read the instructions on a es 1 -7. .......................:._................................................................................................. SECTION A-PROPERTY OWNER INFORMATION Fo:r;;.f�:s:li'r�i:h��:�Qjtipain:';;:Uss:;�::::::.::.:.::::.::s BUILDING OWNER'S NAME PRIIGY,Numb�,c...:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: Mk�-K M Go N� �M�S o M I� G. :::::::::::::::.:�:�.::>,:-:.::::::::::-::_:::.::::-:::::::::::..::.�.::::-:::: .....:..................................:...:.................................... ......... :..... .......................................................................... BUILpING STREET ADQRESS(including Apt.,Unit,3uite,andlor Bldg. oJ OR P.O.ROUTE AND BOX NO. :::i�o� s�..::NAi ::"ur�i�r:::::::::::::::::::: ::::::::: G��• ��a(� µ/ .�_�::.y::::::,:::.�:.:::::::::::::::::::::-::::::::::-:::::::::::::::::::-:::-: � ................................_.............................._:............:..:..::.:...............:....:. :-::,:::::::::::::::::::::::::::::::::::::::::::::::-:::;::::::::;::,::�:::::::::::::::;::: . ......... . .. . . .: CIG�Ea��T�� STATE � ZIPCODE 337�7 PROPERTY DESCRIP�'ION(Lo�and Block Numbers,Tax Parcel Number,Legal Description,etc.) , Lc�7' L�I , LE55 50• I� ' )N I'' � IS�r�D E.57°•4Tl�S o� CLEf�{�'1�JQTE('� BUILDING USE(e.g.,Resldential,Non-reside tlal,Additfon,Acoessory,eto. Use a Comrrtents area,If necesssry.) _ RES�p�T�A l. LATITUDEILONGITUD�(OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS(Type):__,_ ( ##°-##'-##.#i�" or ##.##�#°) �_�NAD 1927 �`�NAD 1983 �—! _..._ � ` �- �,._I U5Ca5 Quad Map �_�Other _�___ SECTION B-FLOOD INSURANCE RATE MAP(�IRM)INFORMATION B1.NFIP COMMUNITY NAME&COMMUNITY NUMBER g2.COUNTY NAME B3.STATE C i-�-A��/�T��,. / I 2 5 p� (� P�ti Eu-!�5 �L� B4.MAP AND PANEL 65.SU FIX 66.FIRM INDEX B7.FIRM PANEL B8.FLOOD B9.BASE FLOOD ELEVATION(S) NUMBER DATE EFFECT�E/RQ�S��ATE ZONE(S) (Zone A�use depth of flooding) IZI a3 C o l�z U g-p3-�3 �� , 810.Indicate the source of the Base Flood E►evation(BFEj data or base flaod depth entered in B9. �__�FIS Profile ��C(.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)7 �_�Yes ��)No Qesignation Date:_______________�__ SECTION C-BUILDING ELEVATION tNFORMATiON(SURVEY REQUIR�D) C1.Building elevations are based on: �__�Constructlon Drawings' ��Building Und�r Construction" �__�Finished Constructi�on "A new Elevation Certificate will be required when construation of the building is complete. C2. Building Diagram Number_��(Select the liullding diagram most similar tq the building for which this certificate is be(ng 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,AWAH,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 far'�the BFE in Section B,convert the datum to that used for khe BFE.Show fieldmeasurements and datum conversion calculation, Use the space provided or the Comments area of Section D qr Section G,as appra riate,to document the datum conversion. Datum,�lsV17 I�� ConversionlComments___ _�Ze NCTVD I Z �"o J��/�_�Q�____,__`T __ . � �------�--�— Elevation reference mark used_��N of c�R.,�3.5 Does the elevation reference mark used appear on the FIRM7 �__�Yes � �No ❑ a)Top of bottorri floor(including basement or enclosure) I2 .�_ft.(m) W • ❑ b)Top of next higher floor UND�E.R Co�S"[._ft.(m) � ❑ c)Bottom of lowest horizontal structural member(V zones only) ___��__.__ft.(m) �o L.S. �� 93 7� ❑ d)Attached garage(top of siab) UN fl Ef�G?�J.�T_tt.(m) �� ,��' 0 e)Lowest elevation of machinery and/or equipment � servicing the building(4escribe in a Comments area.) ____�f __ __ft.(m) �� Z_Z�_�� ❑ fl Lowest adjacent(finishecl)grade(LAO) ____ " ____ __ft.(m) z� ❑ g)Highest adjacent(finished)grade(HAG) _�__"____ __ft.(m) � ❑ h)No.of permanent openings(flood vents)v�rithin 1 ft.above adjacent grade_ ". __ � ❑ i)Total area of all permanent openings(flood vents)in C3.h__�!_sq.in.(sq.cm) 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 c�rtify elevation information. 1 certify that the information in Sections A,B, and C on this certificate represents my best efforts to interpiiet the data avaifable. !undersfand fhaf any false statemenf may be punishable by fine or imprisonment under 18 U.5. C&de, Section 1001. CERTIFIER'S NAME �LI�SE NUMBER Larry L. Evans L.S. �� 2937 TITLE surveyor COMPANY NAME Evans Land Surveying, Inc. � ADDRESS 1460 Beltrees Street Ste. 9 ��N Dunedin, 3TATE F . ZIPCOpE 34698 SIGNATUR� r -- DATE �ZR��_�� TELEPHONE ��Z�� 734-3821 " MA Fdrm 81-31, �nu 2003 See reverse side for continuation. Replaces all previous editions w � ' A 111'�PI�RTANT: In these spaces, �opy the corresponding information from Sectian A. '�ar fnsurane�Cornpany Us� :: BUILDI G ST ' p!ol(c:':::Nurnb'ee::::::_:-::::::::::::::::::::::::;!::::::.;::::::;.:. . REET ADDRESS(Including Apt..Unit,Swte,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. ,::.::_..........Y__....................................................................................................... . :::::_:::::::-:::::::::::::::::::::::::::::::::::::::::::::::-::::::::::::::::::::::::::::::::::::::::::::::, Z S l.. J�1,� :::::::::::.:::::::::::::::::::::-:::::::•::::::::,:::::::-::,:::::::::::::::::::: STATE ZIP CODE Ct51'I�p�Yty IV1�11C�IUtYt15�C ��.w,�-��.�. f� . �� . _ . SECTION D-SURVEYOR,ENGINEER,bR ARCHITECT CERTIFICA�'ION(CONTINUED) Copy both sides of this Elevation CertifiCate for(1)community official,(2)insu�ance agenticompany,and(3)building owner: COMMENTS , • �_�Check here if attechments SECTION E-BUILDING ELEVAtION INFORMATION(SURVEY NOT f2EQUIRED)FOR�ON�AO AND ZONE A►(WITFlOUT BFE) For Zone AO and Zone A(without BFE),complete Items E1.through E5. If ihe Elevation Ce�tiflcate is intended for use as support(ng information for a LOMA or LOMR-F,Seclion C must be compieted. E1.Building Diagr�m 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 enclosura)of the building is �__�—�ft,(m)�--�-_�in.(cm)�__�above or�_�below (check one)ihe highest adjacent grade. (Use natural grade,if available.) E3.For Buiiding Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is �__�__�ft.(m)�__�_�in.(cm)above the highest adjacent grade: Complete Items C3.h and C3.i on front of form. E�4.The top of the piatform of machinery andlor equipment serviCing lhe 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,(s the top of the bottom floor elevated in accordance with the c4mmunity's flood�lain mena9ement ordinance7�_�Yes I__I No I__I Unknpwn. The local official must certify this information in Section Ci. SECtiON F-PROPERTY OWNER(OR OWNER'S RHPRESENTATIVE)CERTIFICATION The property owner or owner's authorizAd representative who completes Sections A,B,C(Items C3.h�nd C3.i only),and E far Zone.A (without a FEMA-issued or community-issued BF�)or Zone AO must sign here. The sfatements!n Sections A,B,C,and E are correct to the best of my knowledpe. PROPERTY OWNER'8 OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STAtE ZIP CODE SIGNATURE DATE TELEPHONE COMMEN7S ' �,�Check here If attachments . � SECTION G-COMMUNITY INFORMATION(OPTIONAL) The Iqcal official who is aWthorized 6y law or ordinanae to administer the comrhunity's floodplain management ordinance can complete Sections A,B,C(or E),a�d G of this Elevaiion Certificate. Complete the applicable item(s)and sign below. G1.�__�The info�m�ti�n,i�Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer,or arctjitect who is authorized by state o�Iocal law to certify elevation information. (Indicate the source and date of the elevation c�ata in;the�omments area below.) G2.�__�A community offi�ial corrapleted Section E for a building located in Zone A(without a.FEMA-issued or community-issued 6FE)or Zone AO. G3.{__)The following inforrnatiqn(Items G4-G9)is provided for community floodplain management purposes. G4.PERMIT N�AABER G5. DATE PERMIT ISSUED �. G8. DATE CERTIFICAtE OF COMPLIANC�/OCCUPANCY - ISSUED G7.Thia permit has been issued for: 4�1 New Construction �__�Substantial Improvement G8.Elevat+on of as-built lowast floor(including basement)of the building is: ________ _ ft.(m) Datum: G9.BFE or(irt Zona AQj dbpth of flooding at the building site is: ___�___ �._ft.(m) Datum: LOCAL OFFICIAL'S NAME TITLE GOMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS I I Check here if attachments FEMA Form 81-31,January 2003 Replaces all previous editions F�DERAG EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 , �� NATIf�NAL ELOOD INSURANCE PROGRAM Expires December 31,2005 ELEVATION CERTIFICATE Im ortant: Read the instructions on a es 1 -7. SECTION A-PROPERTY OWNER INFORMATION Fpr:l�i&i��hc��pnnpan Wa�� : BUILDING OWNER�S NAME Palic�+l�lumibRr M�4f�K M Go�� ti��S a n�► 1� G . BU��NG ST��T�DDRESS(1n�ding Apt.,Unit,3uite,and/or Bidg. o.)OR P.O.ROUTE AND BOX NO. �ornpany N�li Number , ; , ,.: , ... .::::: c�GLEA��_.�._E� STATE � ZIPCODE 337� PROPHRTY DESCRIPTION(Lo and Block Numbers,Tax Parcel Number,Legal Description,etc.) , Lv7' L�1� L E5 5 So� I� ' . U N I T 3 �S t-A N D EST.�'k"f'!E S o-� CLE,41?�A�TE f� BUILDING USE(e.g.,Residentlal,Non reside tial,Addition,A cessory,eta. Use e Comments area,If necessary.) _ i�ESi��T�AI. LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: ( #/�°-##'-##.##" or �!#.#!#�#°) I—I NAD 1927 �_�NAD 1983 SOURCE: �_I GPS(TyPe):-------------_—_- �_�USGS Quad Map �_�Other _�____ SECTION B-FLOOD INSURANCE F2ATE MAP(FIRM�INFORMATION B7.NFIP COMMUNITY NAME&COMMUNITY NUMBER g2.COUNN NAME B3.STATE C�-�EP��W/�TE�Z., / ►z 5 a� (a P�N E t�,-�:� �1.,� 64.MAP AND PANEL 65.SU FIX B8.FIRM INDEX B7.FIRM PANEL B8.FLOOD B9.BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use depth of flaoding) 121�3 G o IvZ G �-��-�� _��_�,3 �,� 12 , B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9. I—I ��S Profile �,x,�FIRM �__� Community Detertnined �__�Other(Describe):______ 811.Indicate the elevation datum used for the BFE in B9:�__�NGVD 1929 ��NAVD 19$8 �__�Other(Describe):___�__ �___ 812,Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)7 �_�Yes (,�J No Designation Date:_______________�__ SECTION C-BUILDING ELEVATIOIV LNFORMATION(5URVEY REQUIRED) C1. Building elevations are based on: �__�Construction Drawings"" ��Building Und�r Construction* �__�Finished Construction "A new Elevation Certificate will be required when construction of the building ia complete. C2.Building Diagram Number 0�(Select the building diagram most similar tq the building for which this certificate is being completed-sea pages 6 and 7, if no diagram accurately represents the building,provide a sketch or photograph.) C3.Elevations-Zones A1-A�O,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AWAH,AR/AO Complete Items C3.a-i below according to the building diagram specified in Item C2.5tate 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 khe BFE.Show fieldmeasurements and datum conversion calculation. Use the space provided or the Comments area of Section D qr Section G,as apprapriate,to dncument the datum conversion. Datum j�lsVD I�� Conversion/Comments___ _ �1B NGVD l Z "ro J� �/ I 6 �� ' - -�------�-=J-----L�--�--�--�?-- Elevation reference mark used_��N�C�1R.��3.5 Does the elevation reference mark used appear on the FIR ,-� _�Yes � �No ❑ a)Top of bottom floor(inciuding basement or enclosure) I 2 ,Z_ft.(m) � , �,p�' �. ❑ b)Top of next higher floor UNDER Cp,.?ST__ft.(m) `� " �Y � '� 3��"� `� � ^_ �� , c,,p ^ sl�; _ FF'...d��x ❑ c)Bottom of lowest horizontal structural member(V zones only) ____��__.__ft.(m) �� ;�,�;�`5.�� 7 �� w ❑ d)Attached garage(top of slabj UN D E(Z C.C>/�,�"T. {{,(m) � �,,^ � �� r 0 e)Lowest elevation of machinery and/or equipment `� � `� �' �� servicing the building(Describe in a Comments area.) �+ _ft.(m) �� , =, �� d��2�Z ,�� ,�` � ❑ fl Lowest adjacent(finished)grade(LAO) '' � _ft.(m) z.� , - � ,,;° � k a,� ❑ g)Highest adjacent(finished)grade(HAG) " _{�,(m) ��' , � „ ' �," �� `�° ❑ h)No.of perrnanent openings(flood vents)within 1 ft.above adjacent grade_T"____ _ � � � �� ❑ i)Total area of all permanent openings(flood vents)in C3.h__►J _sq.in.(sq.cmj � �, ' `5<�„,�.�� ,.n�;: ,.. . SECTION D-SURVEYOR,ENGINEER,OR ARCHI7�CT CERtIFICATION This certification is to be signed and sealed by a land surveyor,engineer,pr architeet authorized by law to cartify elevation information. I certify that the informafion in Sections A,B, and C on fhis certificafe represents my best efforts fo in,terpret the data available. 1 undersfand fhat any false statement may be punishable by fine orimprisonment under 18 U.S. C�qde, Section 1001. CERTIFIER'S NAME LICENSE NUMBER Larry L. Evans L.S. �� 2937 TITLE surveyor � COMPANYNAME �vans Land Surveying, Inc. ADDRESS 1460 Beltrees Street, Ste. 9 ��N Dunedin, 3TATE . 21P COpE 34698 SIGNATURE DATE 1'ELEPHONE F 12•-L2-�� (727) 734-3821 FEMA�orm 81-31, anu 2003 See reverse side for continuation. Replaces all previous editiona IMPORTANT: In these s aces,copy the corresponding informativn from 5ection A. Far tnsurarice C�mpany Use:: , BUILDIyG STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. F�olfoy Number ' • 8Z4 ZSI.�,i�►.l� A,� • C G��1r.��+.°°�'"�.�„ STATE r` . ��ZI�ODE Ct�l'Yip�wiy�Nd11C Nut'r11s�1� �j-- ..:..... .......:...::..............._..._. .._ SEGTION D-3URVEYOR,ENGINEER,bR ARCHITECT CERTIFICAt10N(CONTINUED) Copy both sides of this Elevation Ce�tificate for(1)community official,(2j insu�ance agenUcompany,and(3)building owner. COMMENTS I I Check here if attachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT I�EQUIRED)FOR ZON�AO AND ZONE A(WITHOUT BFE) For Zone AO and Zone A(without BFE),compiete Items E1,through E5. If ihe Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F,Section C must be completed. E1. Building Diagr�m Number____(Select the building diagram most similar to the buiiding 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 basament or enclosure)of the building is �-_�—�ft,(m)I--I--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 flqor or elevated floor(elevation b)of the building is �--�_-�ft.(m)�__�__�in.(cm)above the highest adjacent grade. Complete Items C3.h and C3.i on front of fc�rm. E4.The top of the platform of machinery and/or equipment servicing the buiiding is I--I--I 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 floodpiain manaqement ordinance7 I I Yes � � No � � Unknqwn 7he local official must ce�rtify this information in Seckion Ci � SECTION F-PROPERTY OWNER(OR QWNER'S REPRESENTATIVE)CE,RTIFICATION 1'he property owner or owner's authorized representative who completes Sections A,B,C(Items C3.h and C3.i o�ly),end E for Zone A (without a FEMA-issued or community-issued BF�)or Zone AO must sign here. The statements in Sections A,B, C,and E are correct to the besf of my knowled e. PROPERTY OWNER'3 OR OWNER'S AUTHORIZ�D REPRESENTATIVE'S NAME � � ADDRESS CITY STA7E ZIP CODE SIGNATURE DATE TELEPHONE COMMEN7S � jheck here If attachmerits SECTION G-COMMUNITY INFORMATION(OPTIONAL) � � The iqcal official who is aWthorized by law or ordinance to administer the community's floodplain management ordlnance can complete Sections A,B,C(or E),and G of this Elevation Certiflcate. Complete the applicable item(s)and sign below. G1.�__�The inform�tian in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer,or arcNi:ect who is authorized by state or local law to certify elevation infomtation. (Indicate the sour�ce and date of the elevation e�fa inlhe Comments area below.) G2. �__�A community o�'icial cornpleted Section E for a building Iocated in Zone A{without a FEMA-issued or community-issued BFE)or Zone AO. G3.�__�The following inforr.,ation(Items G4-G9)is provided for community floodplain management purposes. G4.PERMIT Nl!6+RBER G5. DATE PERMIT ISSUED �. G8. DATE GERTIFICATE OF COMPLIANCE/OCCUPANCY I5SUED G7.Thia permit has been issued for: �__�New Construction �__� Substantial Improvement G8.Elevation of as-built fowesk floor(including basement)of the building is: ______`_ ft.(m) Datum: G9. BFE or(in Z�na AOj aepth of flooding at the building site is: _�_�,___ T_ft.(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS I_I Check here if attachments FEMA Form 81-31,danuary 2003 Replaces all ptevious editions _ � �� A�. �� ,�►_...��...,e 1� �A S'�w�`-- �;� F,�,�.�. �'_�g_�►� � , JAN 2 7 2005 '�LI I' F�DERA4 EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM � � Expires December 31, 2005 ��,,�-��,��ek�u��;��;c�s ��►T ELEVATION CERTIFICATE ��y p€ EL�AI�WAi`E�f� Im ortant: Read the instructions on a es 1 -7. SECTION A-PROPERTY OWNER INFORMATION !:Fwr i��i�anc�C4:nnp�n`Us� BUILDING OWNER'S NAME P41icy I�urrlb�P Mk�K M Co�r �n�«S a �n� i� G . , BUILDING STREET ADDRESS(tncluding Apt.,Unft,3uite,andlor Bldg. o.)OR P.O.ROUTE AND BOX NO. Grlmp�ny Nhi��tum P ,. ��- :��l�A,�1� W�� ` , ,, cin ,; ,;;; GL� a �- � STATE f� ZIPCODE 33 � A/=,r✓/� ,E.. 1_ � 7 PROPERTY DESCRIPTION(Lo and Biock Numbers,Tax Parcel Number,Legal Descriptlon,etc.) t_.r�'I- Col � LE.SS So• I� ' , UNIT �3 I54�►JD E57°`.��`E.j �'�" CLE�d+�'ttiJq7'�,2 BUILDING USE(e.g.,Residential,Non reside tial,Addition,Accessory,eta. Use a Comments area,if necessary.) �5 i D��Ti.� l.. LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: • ( ##°-##'-##.##" or ##.#�#!#°) �—�NAD 1927 �_�NAD 1983 SOURCE: ��I GPS(Type):-----._T_�----_—__ �_�USGS Quad Map �_�Other ___�__ SECTION B-FLOOD iNSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME B3.STATE G�P��w�T��,. / �2�n� � Pi�E�,c.�5 ,�L, 64.MAP AND PANEL B5.SUFFIX B6.FIRM INDEX B7,PIRM PANEL BS.FLOOD B9.BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVEIREVISED DATE ZONE 5 IZ��?, c O 1 b,Z � �-n3-c��, � o�� G ) (Zone A�use depth of floodln9) 810. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in 9 ' �--�FIS Profile ��FIRM �__�Community Determined �__�Other(Describe):______ B11.Indicate the elevation datum used for the BFE in B9:�__�NGVD 1929 ��NAVD 19$8 �__�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� �C . Building elevations are based on: �__�Construction Drawings* �__�Building Und�r CqnStruction* � �Finished Construction A new Elevation Certificate will be required when oonstruction of the building is complete. uilding Diagram Number�_I�(Select the building diagram most similar tq the buiiding for which this certificate is be(ng 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,AWAH,AR/AO Complete Items C3.a-i below according to the building diagram specified in Item C2.5tate 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 qr Section G,as apprapriate,to document the datum conversion. Datum��VD IQ� Converaion/Comments___ _ U 1� NCsVD l Z To � 1� � �' - -�------�-.�----�-�-`!�--�--�-------- -- Elevation reference mark used_��N�_C L►�JjZ,�3�j Does the elevation reference mark used appear on the FIRM7 �_��Yes. � �No O a)Top of bottom floor(including basement or enclosure) _ 00,� �,�m� � � b)Top of next higher floor J � �)Z.�_ft.(m) � a f +� ❑ c)Bottom of lowest horizontal structural member(V zones only) ___��/�1 ft.(m) � jf,S. � 937 ��> 4 d)Attached garage(top of slab) ______ 1 b_,�ft.(m) �� r ° `�,��9 ne "� ❑ e)Lowest elevation of machinery and/or equipment �� P'�`�,;. servicin the buildin Describe in a Comments �2 .� � `° 9 , g( area.) ------- _.�_ft.(m) �� 12-22-� �. ❑ fl Lowest adjacent(finishetl)grade(LAG) ___(�+ ,�_ft,�m� Z,� ' -� ,, ❑ g)Highest adjacent(finished)grade(HAG) __�, 2 ft,�m� �`� ��!1�' � ��Fb�-a.� ^" ❑ h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade��.�✓"�.__ � /�� 01-'2�-� ❑ i)Total area of all permanent openings(flood vents)in C3.h_�I ZO sq,in.(sq,cm) SECTION D-SURVEYOR,ENGINEER,OR ARCHITEC7 CERtIFiCATION This ce�tification is to be signed and sealed by a land surveyor,engineer,ar architect authorized by law to certify elevation inforrnation. I certify fhat fhe informafion in Sections A,8,and C on fhis certificate represents my best efforis to interp�f the data available. 1 understand fhat any false stafemenf may be punishable by fine or imprfsonment under 98 U S Code, Section 1001 CERTIFIERS NAME �I.ICENSE NUMBER ' Larry L. Evans L.S. �� 2937 TITLE surveyor ' ' COMPANYNAME Evans Land Surveying, Inc. ��RESS 1460 Beltrees Street Ste. 9 ��T�' Dunedin, 3TA7E ZIPCOpE, 34698 NATURE DATE '� . .�_� TEL�PHONE• _ - r � (727) 734 3821 FEMA Form 81-31, anu 2003 See reverse side for continuation. Replaces all previous editions ��d�p� .— �� S�, _ _ _ IMPORTANT: In these s aces,copy the corresponding iniormatioh from Section A For Insuranca Comp�ny Usea i • BUILDI G STREET ADDRESS(Including Apt.,Unit,5uite,andlor Bldg.No.)OR P.O.ROUTE AND BOX NO. f�ol(ay Numbec : Z 5 l.- 1J j� � - CITY STATE ZIP CODE Cbl'ripBYiy Nd11C NUf'i'tb�l" ;: �.��.��.�.Tr�� f� , �� - � _ , . SECTION D-SURVEYOR,ENGINEER,bR ARCHITECT CERTIFICAtION(CQNTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insu�ance agent/company,and(3)building owner. COMMENTS 2�� -�� .l�.� z�v�„ - 2�, 3 ' Check here if attachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT kEQU1RED)FOR ZON�AO AND ZONE A(WITHOUT BFE) For 2one 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. euilding Diagram Number____(Select the building diagram most similar to khe 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 enciosure)of the building is �--�_�ft•(m)I--I---I��•(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 flqor or elevated floor(elevation b)of the building is �__�__�ft.(m)�__�__�in.(cm)above the highest adjacent grade. Complete Items C3.h and C3.i on front of fcrrm. 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 availabie.) 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 I Yes � � No � �Unknawn The local official must cert_fv_this information in Seckion�_ SEC710N 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 G3.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 fo the best of my knawledqe. PROPERTY OWNER'3 OR OWNER'S AUTHORIZ�D REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE • SIGNATURE DATE TELEPHONE COMMENTS � � I �Check here if attachments SECTION G-COMMUNITY iNFORMATION(OPTIONAL) The Iqcal qfficial 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 Certiflcate. Complete the applicable item(s)and sign below. G1.�__�The infoRnation in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer,or arciiitect 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 beiow.) G2.�__�A community official completed Section E for a building Iocated 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 floodpiain management purposes. G4.PERMIT NUMBER G5. DATE PERMIT ISSUED �. G8. DATE CERTIFICA7E 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 buildi�g is: ________ _ ft.(m) Datum: G9. BFE or(in Zone AO)depth of flooding at the building site is: _�_a,___ __ft.(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPNONE SIGNATURE DATE COMMENTS i I—I Check here if attachments FEMA Form 81-31,January 2003 Replaces all previous editions � �'xxr�a.� � ,�`�� CITY OF CLEARWATER � ��a,,��`_ � �� ;r-�-'? � �y� DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT „��.� s� ��,;�� a� Posr OFFicE Box 4748, Ci�wnrER, Fcoa�nA 33758-4748 V��A��,�.�� MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CI.EARWATER,FLO�unn 33756 �'�'�"�� TEtEPxoNE (72� 562-4567 Fax(72� 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 Number 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 Q Other SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME 63.STATE 64.MAP AND PANEL g5.SUFFIX 66.FIRM INDEX DATE B��FIRM PANEL gg.FLOOD ZONE(S) B9•BASE FLOOD ELEVATION(S) NUMBER EFFECTIVE/REVISED DATE (Zone AO,use depth of flooding) 610. 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 B9:❑ NGVD 1929 ❑ NAVD 1988 ❑Other(Describe) 612. Is the building located in a Coastal Barrier Resources S stem(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 simiiar 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. Efevations—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 ail permanent openings(flood vents)in C3.h sq.in.(sq.cm) Comments: , � Date of Review: Community O�cial: �evation certificates shall be maintained by the community and copies with the attached memo made availab/e by requesf FRANK HIBBARI),MAYOR GEORGE N.CRE'1'EKOS,COUNCILMEMBER JOIIN DORAN,COUNC[LMEMBER PAUL F.GIRSON,COUNCILMEMRER � CARI.GN A.PE'PERSEN,COUNCILMEMAER ��EQUAL EMYLOYMENT AND AFFIRMAI7VE ACTION EMYLOYER�� v a � J CN' ' �..-. i-rFr.a- xs-'��'�a.a� ,�� y� y��;�� ;� F�DERA4 EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077 3� • Expires December 31,2005 ,�,_..N_...�.�_..�. ��,,��py;k�u; ��.��.j.�� LEVATION CERTIFICATE �� fi�� Im ortant: Read the instructions on a es 1 -7. SECTION A-PROPERTY OWNER INFORMATION For Ins'urance Company Use BUILDING OWNER'S NAME Po1lcyNumber MI��K M co�� H�ti��S a n�p U SNG . BUILpING STREET ADDRESS{Including Apt.,Unit,5uite,andlor Bldg. o.)OR P.O.ROUTE AND BOX NO. G�mpeny NAIC Number. : �'�. ..��..r�,!'�J.,' 1!a�f�,' ciG�.��,t��:n/�-��.�.. STATE �.C. , .ZIPCODE �3�� PROPERTY DESCRIPTION(Lo and Block Numbers,Tax Parcel Number,Legal Descnption,etc.) L..�'T" Lc:l � LE55 50• �� ' , lJN IT �3 2St�r�D E..�T��'�,� o-� CLEA+��nJ,qTE� BUILDING USE(e.g.,Resfdentlal,Non•reside tial,Addition,Accessory,eta Use a Comments area,if necessary.) �E 5 i��Ti�4 l. LATITUDE/LONGI7UD�(OPTIONAL) HORIZONTAL DATUM: ( ##°-##'-##.##" or ##.###f##°) �—I NAD 1927 �`�NAD 1983 SOURCE: I—I GPS(TYPe):--------------- �—�USGS Quad Map �_�Other _________ SECTION B-FLOOD INSURANCE F2�TE MAP(I�IRM�iNFORMATION B1.NFIP COMMUNITY NAME 8�COMMUNITY NUMBER g2.COUNTY NAME 83.STATE C�!��.�/�'�°��.,, / �2�o� (P P��E L�,fl 5 .�L� B4.MAP AND PANEL B5.SUFFIX 66.FIRM INDEX B7.FIRM PANEL B8.�LOOD 69.BASE FLOOD ELEVATION(S) �2� 3UC Q��Z � DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use depth of flood(ng) ° � -a,,-�? > -�,3_„? ,� E IZ ' B10. indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9. �__� FtS Profile ��(FIRM (__�Community Determined �__�Other(Describe):________ _� B11. Indicate the elevation datum used for the BFE in B9: �__�NGVD 1929 �� NAVD 1988 �__�Other(Describe):______ ___ B 12, Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? �_�Yes ��J No Qesignation Date:__________________ SECTION C-BUILDING ELEVATIOIV INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: �__�Construction Drawings' �__�Building Und�r Construction' � �Finished Construction � A new Elevation Certificate will be required when construction of the building is complete. �. Building Diagram Number�_��(Select the building diagram most similar to the building for which this certificate is being compieted-see pages 6 and 7. If no diagram accurately represents the building,provide a sketch or phatograph.) 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 Completa 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 khe BFE.Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D qr Section G,as apprap�iate,to document the datum conversion. Datum�(��D�� ConversionlComments___�_v 18�_ NCsVD l�� TA��V�1 _��'i______ Elevation reference mark used_��N�_C.L�,JjZ,�3,5 Does the elevation reference mark used appear on the FIRM? �__�Yes. 1 � No ❑ a)Top of bottorri floor(including basement or enclosure) 60,4 ft,(m) � � b}Top of next higher flaor _)Z.�_ft.(m) `� f � ❑ c)Bottom of lowest horizontal structural member(V zones only) ___��/� ft. m �� `� ( ) �o �.S. .�� 937� � O d)Attached garage(top of slab) f fj_.�-�.(m) E� ,�,�� ❑ e)Lowest elevation of machinery and/or equipment W " � ��`6 '�' 2 �;�; t ,fdf .� ', servicing the building(Describe in a Comments area.) _____�_� _, �_ft.(m) �°� ' � )2 •Z2-� ❑ fl Lowest adjacent{finishetl)grade(LAGj ___ ____�.�_ft.(m) z� t , p ` b7 �� - ❑ g)Highest adjacent(finished)grade(HAG) _______�. 2 ft.(m) � '�� ' � ( ^ � ' ❑ h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade_�5 __ � �� 0 L-�2�-'� ❑ i)Total area of all permanent openings(flood vents)in C3.h_�LzQ sq.in.(sq.cm) ` 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. !cerfify fhat fhe informatipn in 5ections A,8, ar�d C on this certificate�presents my best efforts fo interpref the data available. 1 understand fhaf any false sfatement may be punishab/e by fine or imprisonment under 18 U.S. C'ode, Section 1001. CERTIFIER'S NAME Larry L. Evans L�CENSE NUMBER L.S. �� 2937 TITLE surveyor � COMPANYNAME Evans Land Surveying, Inc. �'�RESS 1460 Beltrees Street, Ste. 9 �►T�' Dunedin, 3TATE F . zlPCOpE 34698 ,�NATURE � F - �,, DATE �? ��M� TEL�PHONE �72�� 34-3821 FEMA Form 81-31, anu 2003 5ee reverse side for continuation. Replaces all previous editions ��:��UC � ,— �c� � �� 9/1 O�r -� � C�U �;' � l��j ___ IMPORTANT: In these spaces,copy the corresponding informatioh from Section A. � : ! For(nsu�ance Cornpany Use BUILDI G STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Po)foy Number : � Z �5 l,. )...1.G> �C',,t ; CITYG��,�� STATE �4 , ZIP CODE ConSpany NAIC:NUYYiber. . , _ �:� (�"' ; . SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT�ERTIFICAtION(CONTINUED) � Copy both sides of this Elevation Certificate for(1)community official,(2)insu�ance agenUcompany,and(3)building owner. COMMENTS Z vi� �d�-i �'�.f�,'�+/�...��'C�y�„ - 2(�. �1 � _ Check here if attachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT ftEQUIRED)FOR ZON�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 support(ng 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 enciosure)of the building is �__�_�ft.(m)�__�__�in.(cm)�_�above or�_�below (check one)the highest adjacent grade. (Use natural grade,if availabie.) E3. For Building Diagrams 6-8 with openings(see page 7),the next higher flqor or elevated floor(elevation b)of the building is �__�__�ft.(m)�__�__�in. (cm)above the highest adjacent grade, Complete Items C3.h and C3.i on front of f�rm. EA.The top of the platform of machinery and/or equipment servicing the building is �__�__�ft.(mj I--I--I�n.(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 management ordinance7� �Yes � � No � � Unknown The local officiai must certifv this information in Section Ci 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�nd 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 fo the best of mv knaw/edae. PROPERTY OWNER'3 OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE • SIGNATURE DATE TELEPHONE COMMENTS — � I Check here if attachments SECTION G-COMMUNITY INFORMATION(OPTIONAL) �r The Iqcal qfficial who is aWthorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this ElavaUon 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 infomtation. (Indicate the source 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 8FE)or Zone AO. G3. �__�The foliowing infoRnaGqn(Items G4-G9)is provided for community floodplain management purposes. G4.PERMIT NUMBER G5. DATE PERMIT ISSUED �. G6. bATE CERTIFICAtE OF COMPLIANC6/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. 6FE 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 � �_�CheCk here if attachments FEMA Form 81-31,January 2003 Replaces all previous editions ;s _—� _ �s a� !� __ _: _,�_ __: _ _ __.__ _ , � __ ' '' );"��,; � '� ?(�,`E� e' f E !� FEDERAL EMERGENCY MANAGEMENT AGENCY ° �; � --�� NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077 ° ' Expires December 31,2005 � `�"* T w � �� Fy�� : ELEVATION CERTIFICATE � �t; a .:.�Ur,�r ; ' t;+f�� ' ti�.�.J�#�ti'd�/�4�� .�,r� _ • Im ortant: Rsad the Instructions on a es 1 -7. SECTION A-PROPERTY OWNER INFORMATION ,.-. _...._..__......_._._.._..._....._.._..............._.__.._.__. BUILOtNGOWNER�S NAME -�r`�� -��:--•==� * MkKI/� M Co�l1 c�A�t�S o M �,; G, �:Pii�i��r:=:`-"�-��=��:;�=:Y_: _:::::::::..�_......:::::_�................::.:::„�:_:=_�_=�_----�=� ::�:�::-::::::::::_:::-��:��:.:::::_::::::::::_:�::��__-----=--�. ��ST��ADDR�S(I�ding Apt.,Unit,3u(te,and/or Bidg. o.)OR P.O.ROUTE AND BOX NO. �i�j�tpg�r:ii�1�(��j__,�.:.:��!�: CITY � :.....:::::::::�:-__:,�....:..::::::::--::_...._:.�.--:.:�-��_:_�:_. ,.,...._-:::::::::::::::::::::::::::::.:::::-:_::--�::--....�.�.--W:�:-� GLE/�,�qn//�TE�. STATE f, ZIPCODE 33 � PR�PERTY DESCRIPTION(L and Block f�mbers Tax Parcel Number,Legal Descnptton,etc.) j�+ , 7 7 ��T La l , LE55 So• I�` N IT �3 ISt.,p�N D E.57"�T�,S o f CLE,d��q-TEJZ BUILDING U8�(e g Resfdentiai Naweside tial,AddiGon,Ac:cessory,etc, Use a Comments area,if necessary,) E 5►�E��T�A t� LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM. ( #1�°-�l#'-##.�!#" or ##.###!1#°) ��NqD 1927 �_�NAD 1983 SOURCE: (��GPS(TYpe): �_ USGS Quad Map �_�Other 3ECTfON B-FLOOD IN3URANCE RATE MAP�FIRM)INFORMA'fION B1.NFIP COMMUNITY NAME S COMMUNITY NUMBER 62.COUNTY NAME 83.STATE C��zt�/�TE�. / 125 0�t� Pr�vEU.�t 5 .�l.,, 64.MAP AND PANEL B5.SUFFIX B8.FIRM INDEX B7.FIRM PANE B8.FLOOD B9.BASE FLOOD ELEVATION(S) NUMBER �-D��E�� EFFECTIVEfR�EVIS Q DATE ZONE(S) (Za�e A0,use depth of flooc�ng) 121�3 G o ►oZ � � _ 3 �E « �2 B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9. �__�FIS Profite ��FIRM ��Community DeteRnined �__�Other(Describe): B11.Indicate the elevation datum used for the BFE in 89:�_�NGVD 1929 ��NAVD 1988 �__�Other(Describe):_ � 812,Is the build'mg located in a Coastal Barrier Resources System(CBRSj area or Otherwise Protected Area(OPA)? �_�Yes �.�No Designation pate:_`__�_ SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIREDj C1.Buildtng elevations are based on: �_�Construcdon Drawings' �__�Building Und9r Construction" � �Finished Construction 'A new Elevation Certificate will be required when construction of the building is compiete. t,�.Building Diagram Number 0_I!��t the building diagram most similar to the building for which this certiflcate fs betng completed-see pages 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.) 3.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 d�tum 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 a ro iate, Datum bV.i7 1 Z PP P� to document the datum conversion. � Q� Conversion/Comments__ �U. B I�(sVD�� 7"a ��{VD �Q�i Elevation reference mark used_CIT/o C 1�,Jjt�3 5 Does the elevation reference mark used appear on the FlRM? (__�Yes_ � �No O a)Top of bottom floor(including basement or enclosure) ,__ �,� ft,tm� � . • ❑ b)Top of next higher floor '�Z.�_ft.(m) � .� ❑ c)Bottom of lowest horizontal structural member(V zones only) __ ��/�1 ft.(mj � ' S. �� 937 �, ❑ d)Attached garage(top of slab) ___ I b .�ft.(m) � �� - � ❑ e)Lowest elevation of machinery and/or equipment � �� ; �2. � n. ° � servicing the building(Describe in a Comments area.) __�_ �m� �� Z�ZZ-��.. �°�' 'Y ❑ fl Lowest adjacent(finished)grade(LAO) � �.�_ft.(m) z + �, ❑ g)Highest adjacent(finished)grade(HAG) ^�, Z �,�m� �" ��i/� � �{�p 7-p�j �,�: O h)No.of perrnanent openings(flood vents)within 1 ft.above adjacent grade r✓- � K�V� :01,-�25'� ❑ i)Total area of all permanent openings(flood vents}in C3.h I I ZO sq,in.(sq.cm) 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 infoRnaqon. i certify that the informa6on in Sections A,B,and C on this cerfiflcafe represents my best e�►ts to interpriet the data available. I understand fhaf any false statemenf may be punishab/e by�ne or imprisonment under 18 U S Code, Section t 00i CERTIFlER S NAME L�CENSE NUMBER " Larry L. Evans L.S. # 2937 TITLE surveyor COMPANYNAME Evans Land Surveying, Inc. '�RESS 1460 Beltrees Street Ste. 9 CIn Dunedin, srArE . z�PCOpE. 34698 .,.�NATURE DATE TELEPHONE F I"1_-L7_--Q (727) 734-3821 MA Form 81-31, anu 2003 See reverse side for continuation. Replaces all previous editions ��O r� �-- �'�� J�' . � , , � ' �`$��'�� `` �� CITY OF CLEARWATER �4�,��I�, �� • � r y��=�_� �� DEVELOPMENT & NEIGHBORHOGD SERVICES DEPARTMENT ,,�e��r�� 1 POST OFFICE BOX 474H� CLEARWATER� FLO�DA 33758-4748 ��++�AT��7 jj4y MUNICIPAL SERVICES BUILDING, lOO SOUTH MYRTLE AVENUE,CLEARWATER,FLOa�Dn 33756 �"'�A'ffi TELEPxoNE (72� 562-4567 F�ix(72� 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 Number 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 t.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME 63.STATE 64.MAP AND PANEL g5.SUFFIX B6.FIRM INDEX DATE B�•FIRM PANEL gg.FLOOD ZONE(S) B9•BASE FLOOD ELEVATION(S) NUMBER EFFECTIVE/REVISED DATE (Zone AO,use depth of flooding) 610. 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 69:� 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 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 accuratety 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 Official: �levation certificates shall be maintained by the community and copies with the attached memo made available by request FRANK HIRRARI),MAYOR GEORGE N.CRE"1'EKOS,COUNCILMEMBER JOI W DORAN,COUNCILMEMBER PAUL F.GIASON,COUNCILMEMBER � CARI.GN A.PE'I'ERSEN,COUNCILMGMBER ��EQUAL EMYLOYMENI'AND AFFIItMA7'IVE AC170N EMPLOYER�