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818 LANTANA AVE � FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM Expfres July 31,2002 � ELEVATION CERTIFICATE . � Im ortant: Read the Instructlons on a es 1 - 7. SECTION A-PROPERTY,OWNER INFORMATION ':::pqr l��ry��• BUILDiNG OWNER'S NAME ICy Mumbp� $ i�3f � R A N D Y L-. R 0 B I N S 0 N <:::s>a?><::;<:::>:::::;:::»::>:::::::::s.::a�ssaaa>:;;<::<::<;>::;s>:: BUILDING STREET ADORESS(InGuding Apt,UMt,Suke,andJor Bldg.No,)OR P.O.ROUTE AND BOX NO. ��ppr. 818 LANTANA .AVENUE ' � . c'TM srAre ::'.:<: o°.. CLEARWATER BEACH FLORIDA PROPERTY DESCRIPTION(Lot and Blodc Numbers,Tax Parcel Number,Leqal Desaipdon,etc.) LOT 8 , BLOCK °23" , MANDALA�Y R E S I D E N e�I�,I,� nti , on-resident�a, Uon, ssory,etc. se a ments area, necessary. LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: S ype: ( ##°-##'-#I!.##' or #lt.�°) QL�NAD 1927 �I—I NAD 1983 u USGS Quad Map �—�Other SECTION B-FLOOD INSURANCE RATE MAP(FlRM)INFORMATION B1.NFIP COMMUNITY NAME 8 COMMUNITY NUMBER B2.COUNTY NAME 63.STATE CLEARWATER-125096 - _ , PINELLAS FLORIDA • . Afi�tSER".�i.�_..:��: ` � , NUMBER UATE � i��P�aT:C11VF-J�tFVIS�D DATE ZONE(S) (Zone AO,use depth oiflooNntg) � 125096-0007 B 8-19-91 ��AE" 11 .0 .�1....._.,_�-� -- 810.Indicate the source of the Base Flood Elevgdon(BFE)data ur bau��'rlc+��l��pui an!ored in 89. ��FIS Profile ��FIRM �_�Community Determined �_�Other(Describe): B 11.Indicate the elevatlon datum used for the BFE in B9:��NGVD 1929 (_�NAVD 1988 �_�Other(Describe): 812.Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)7 ��Yes ,�No Designat�on Date: � SEC710N C-BUILDING ELEVATION INFORMATION�(SURVEY REQUIRED) � 1.Building elevations are based on: �,�Construction Drawings' �,_�Building Under ConstrucUon` �Fintshed Co�sWction �i 'A new Elevation Certificate will be required when construction of the building is complete. � C2.Building Diagram Number 1 (Select the building diagram most similar to the building for which this certificate is betng 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(wifh"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�Sectlon 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. a� Datum _ ConversioNComments Elevation reference mark used_ Does the elevation referenoe mark used appear on the FIRM? Yes-. No � O a)Top of bottom floor(including basement or enclosure) 4 •9�} ft,�m� ; �'� ��—� ❑ b)Top of next higher floor ��m� � : �°,;�'�T'�� , Q, O c)Bottom of lowest horizontal structural member(V zones only) . ft.(m) � � �� "*�,� � �� '� � �q � O d)Attached garage(top of stab) --�. ?b-ft�m� E° . �• � �^f °�•V 0 e)Lowest elevaUon of machinery a�d/or equipment W " ` . +: '� o - . .� servicing the building(Describe in a Comments area.) ft.(m) � � " � �.'^ °� ` 0 �Lowest adjacent(finished)grade(LAG) �� -,�n,�m� Z � -' � '` ❑ g)Highest adjacent(finished)grade(HAG) 4.4_n,�m� O h)No.of permanent openings(flood vents)wlthin 1 ft,above ad)acent grade �''`�� ` " � ❑ I)Total area of all permanent openings(flood vents}in C3.h sq,in.(sq.cm) � G. S Ot'�`�#152 � SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION �. This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information. I certily that the in(onnation in Sections A,B,and C on th/s certificate represents my best efforts to inte�pret the data availaWe. I understand that any false statement may be punisha6le by fine or imprisonment under 18 U S Code Sect/on 1001 l�.tK1�I�F�ItKJ 1�'�ilflMt WILLIAM C. KFATING NQ. 1528 TIT E REGISTERED SURVEYOR OMPANYr�M E Al�ied Surve in ORESS CITY STATE ZIP CODE � i . �sTA 33765 11-07-02 � � �"`r"�".` �- � � �� CFF RF\/FRCF CIf1F Fl1R(:f1NTINl IATI(1N RFPI ArFC QI I PRFVI(111C Ff11Tl(1NC � IMPORTANT: In these spaces,copy the corresponding information from Section A. Fcx.:insur�nce�txs�pan�r Us�,: : BUILDING STREET ADDRESS(Including Apt,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. PaHHcy Numher . :< 818 LANTANA AVENUE , , CITY STATE 7JP CODH ontpany N�11G Nqmber ,,;; � CLEARWATER BEACH FLORIDA SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) ... Copy both sides of this Elevation Certificate for(1)community official,(2"J insurance agent/company,and(3)buiiding owner. COMMENTS . � � I I Check here if attachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR 20NE AO AND ZONE A(WITHOUT BFE) For Zone AO and Zone A(wilhout BFE),complete Items E 1,through E4. If the Elevation Certiflcate is intended for use as supporting information for a LOMA or LOMR-F,Section C must be c�mpleted. E1.Building Diagram Number (Select the buiiding diagram most similar tn the building for which this certificate is being oompleted- eee pegea 8 and 7. if no diagrem aocurately represents the buildfng,provide a aketch or photograph.) . E2.The top of the bottom floor(including basement or endosure)of the building is I—I—I�•(m)I__I—Iin.(cm) �Y�above or �_�below (check one)the highest adjacent grade. (Use natural grade,if available.) E3.For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is � �-_�--�n•(m)��in.(cm)above the highest adjacent grade. Complete Items C3.h and C3.i on front of form. , E4.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?�_�Yes �__�No �__�Unknown. The local official must certify this information in Section G SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFlCATION The property owner or ownePs authorized representative who completes Sections A,B,C(Items C3.h and C3.i only),and E for Zone A (without a FEMA-issued or community-issued BFE)or Zone AO must sign here. The statements in Sections A,B,C,and E are correct to �he best o(my knowledqe. ' PROPERTY OWNER S OR OWNER S AUTHORIZED REPRESENTATIVE S NAME ADDRESS C S ZIP COD SIGNATURE DATE TELEPHONE COMMENTS � � I Check here if attachments SECTION G-COMMUNITY INFORMATION jOPT10NAL) The locai 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)a�d sign below. � G 1.�_�The informaGon 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 infortnation. (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 BFE)or - Zone AO. � G3.(_�Ths following infortnation(Items G4-G9)is provided for community floodplain management purposes. � G4.PERMIT PJUMBER GS.�DAT P IT ISSU . A RT I A O COMPLIANC � ISSUED G7.This permit has been issued for: �__�New Construction �N�Substantial Improvement G8.Elevation of as-built lowest floor(including basement)of the building is: _ _ ___ft.(m)Datum:_ �__ G9.BFE or(in Zone AO)depth of flooding at the building site is: ____ ___ft.(m)Datum:_ ____ LO O I IAL S M � COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS I I Check here if attachments FF�AA F�mi R1_'t1 .II It fltl RFPI ArFR AI 1 PRF\/I(lll.0 Ff11Tl(1NC