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7 LEEWARD ISLAND v.nr�.�. .., 2002 � FEDERAL EMERGENCY MANAGEM ' NATIONAL FL•O�D INSURANCE PROGRAM Expires July 31, ELEVA�'ION CER.TIFIGATE lmportant: Read fihe instrucfiions on pa �s '� '7. For lnsuranGe ComPany Use: SECTION A-PROPERTY OWN�f�INFORMATION Po��Y�umbef g�, NG OWNER'S NAME Compa[�Y t�lAlG Numher nk and Ann Mongelluzzi . BUILDING STREET ADDRESS (Including Apt., Unit, Suite,and/or Bldg. No.)OR P.O. ROUTE AND ROX NO. ��P CODE 7 Leeward STATE C 1TY Clearwater PROPERTY DESCRIPTION (Lot and elocK Numbers,Tax Parcel Number,Legal Description,etc. LOt 1 1 Of Unit 1 Island EStateS Of C eeausa a Commants area, if necessary.) BUILDING USE(e.g., Residentiai, Non-residential,Addition,Accessory, ReS1C�eritldl GPS (Type): Other: LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: I._.I USGS Quad M I �^� NAD 'I 927 I—I NAD 1983 I_.I � �°_�t'-##.##" or ##.��) _ SECTION B -FLOOD WSURANCE RATE MAP (FIRM) INFORMATI ' g1. NFIP CONIMUNITY NAME 8�COMMUNITY NUMBER B2.CCJUNTY NAME Florida P1rie11aS �g,gqSE FLOOD ELEVATIUN(S) Clty Of Clearwater 1 87.FIRM 68. FLOOD use depth of flooding) IND ��5� (Zone AO, g4, MAp AND PANEL B5. SUFFIX • pAT� FFGCTIVE/REVISEQ DA?E � � NUMBER Au USt 1 1 2 5 0 9 6 • � BFE) data or base fload depth e � • 810. Indicate the source of the Base Floo — — Other(Describe): �`J FIS Profile jX � FIRM I_I Community Determined I._._.I NAVQ 1988 I�I Other(Describe): X NGVD '1929 �_._,� YES �X � No g1'i. Indicate the elevation datum used for the BFE in B9; I._I B12. !s the building lacated in a Coastal Barriar Rasourcas System (CBRS) areianor Otherwise Protected Area (OPA)? I.__ ter Ter Designation Date: - SEC7IQN C -BUIL,DING ELEVATION INFORMATION (SURVEY REQUIRED X Finished Construction C1. Building elevations are based on: �_�Construction Drawings" �� Duilding Under Construction" I—I x nerv Elevation Certificate will be required when construction of the building is complete. C2 ding I�iagram Number 1 (Select the building diagram most similar to the b oi�dihotograph� this certificatE is being complsted - see VE, V1-V30,V(with BFE),AR,AR/A,ARIAE,AR/A1-A 3 0,A R/A M,A R/A O ges 6 and 7. !f no diagram accurately represen ts t he b u i l d i n g, p r o v i d e a s e c G3. Elevations-Zones A1-A30,AE,AH, A(with BFE), �F� Show field measurements and datum conversion Complete Item s C3.a-i below accarding to the building diagram specifiad in 1{he C2• State the datum used. If the datum is different rom ro riate, to document the datum convers�on_ the datum used for the BFE in Section B, convert the datum ta that used for calculation. Use the space provided or the Comments area of Section D or Section G, as app p ear on the�1�!N��'�`�`.=''�"Xes, �X� No DatumNGV___ D �929 ConversionlComments _ , ,'. - Elevation refarence mark usedsee comments Does tha elevation reference mark used app 6 .8 ft.(m) N '` �� '' �.�,, ,� :l - � ` � � �1 a) Top of bottom floor (including basement or enclosure) � .p ft.(m) � � �'�^ } , � ,,'�, : � `�,%,_,_ ❑ b) Top of next higher floor N/A ____ft.(m) o Q �' " �,`�� . � '� ❑ c) Bot[om of lawest horizontal structural member(V zones only) 6 .4 ft,(m) w� "�, J % � ,� � � rs ❑ d) Attached garage (top of slab) w v . „ �,� -,. cr p e) Lowest elevation of machinery and/or equipment , 6 ,��.(m) =e '• ,��, ��t..J .. �Q servicing the building (Describe in a C o m ments area.) 5 ,� ft.(m) ��, ' `' 2a-� �� ,��y .,� ❑ f� Lawest adjacent(finished) grade (�G) � ,�{t,(m) G �"��',.,, '>:' rade (HAG) � �w� ❑ g) Highest adjacent(finished) g �.�j�`��"�y �l h) No. of permanent openings (flood vents)within 1 ft. above adjacent grade�� a r�,�✓ _ 0 sq. in. (sq. cm) ❑ i)Total area of all permanent openings (flood vents) in C3.h_________. , , , ,_ :;;;;,,;, EGTION D -SURVEYOR, ENGINEER, OR ARCMITGCT CERTIFICATIOK , `�- aled by a land surveyor, engineer, or architect authori�dtoYnt rpretthe datavavallabJEOrmation. This certification�4s'�o-k�.si' d',��'� ! certify that tha i�f ,, i�r�! r.Se�JOns''�1, B� and C on this certificato repr�sents my best effo 1 under�tand th�,��a��lse s�2f�tent�na �ba punish�ble by fine orimpnsonment undLICENSE NUMBER ection 1009. C�RTIFIER'S ��a � _ V GOMPANY NAME - � �-� �• ^^ � '�� Michael ]3alcer Associates zlP CODE TITLE - - � - � STATE and;= Surv^�� o •D�,� �' CITY Florida _ ,,� =::. � r i n s � A� ,�s =- , - �,.,��, . ,_ Tar on S TELEPHONE SIGNATU � . .� ' �� + '�` � FebAT26 2002 ^ `"-�r>' �,' �-s`� �' REPLACES AL�. PREVIOUS EDITI�I' -EN1A Form 8'1 31;J?'1L 00 �' K`' SEE REVEF�SE SIDE FOR CONTINUATION i �a� � d4e5, copy the corresponding information from Section A. BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND 80X NQ. For lnsurance Uompany us�: 7 Leeward Island Poucy rv�ar,,ber CITY C123r'Water STAI"E. ZIP COD� Company NA1C Number Florida 33767 S�CT10N D -SURVEYQR, ENG1NEEf2, OR ARCFi1'TECT CEF:TIFICATION (CQNTINUED) Copy both sides of this Elevation Certificate for{1) community official, (2) insurance agent/company, and (3) building awner. CON1fv1ENTS C3e= air conditioner .— . E evations Referenced to Pinellas County Benchmark "Aural - A" Elevation=12, 61 - SEC�'l, F„_ �.(��N�a ELEVATION 1NFQf�MATION (SURVEY NOT R�QUIRED) FOR ZONE AO ANDIZONE A (WITHOUT g��nts For Zone' � ri�l�o � '(without BFE), cpmplete Items G1. throuc�h E4. If the Elev�tion Certificate is intended for use as su information for a LOMA or LOMR-F, Section C must be com�leted. pp°��g E'1. Building Diagram Number (Select the builciinc� diac�r�m most similar to the buildinc� for which this certificate is being complated— s�e pages 6 and 7. If no diagram accurately r�presents the building,�provide a sketch or photoc�raph.) E2. The top of the bottom floor (includinc� basement or enclosure) of the buliding is ��^I ft• m in. cm above or (check one) the highest adjacent grade. (Use natural grade, if av�ilable.) � � �^�—'� � � �—� I_...I below E3. For 6uilding Diagrams 6-8 with openings (see pac�e 7), the next higher floor or elevated floor(elevation b) of the building is I_I__.I ft.(m} I_I_.I�n.(cm) above the hic�hest adjacent grade. Complete Items C3.h and C3.i on front of form. E4. For Zone AO oniy: If no flood depth number is available, is tho top of tha bottom floor elevated in accordance with the community's floodplain management ordinance? �_� Y�5 No lJnknown. Tha local official must certify this information in Section G. S�CTION F -AROPERTY OWNkR (OR OWNER'S R�PR�S�NTATIVE) CERTIFICATION -- - The property ov,rner ar ov,rner's authorized represent�tive who completes 5ections A, 6, 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 h�re. The st�tements in Sections A, B, C, and E are corr�cf to the best of�ny knowledge. PROPERTY OWMER'S OR OWNER'S AUTHORIZED REARESENTATIVC'S NAME ADDRESS C1TY STATE ZIP CODE SIGNATURE DATC TELEPHONE COMMENTS • SECTION G -COMMUNITY 1NFORMATION (OPTIONAL) �� Check here if attachments ie Jocal o�cial �rho is authorized by law or ordin�nce to administer the community's floodplain management ordinance can complete :ctions A, 6, C (or E), and G of ihis Elevation Certificate. Complete the applicable item(s) and sign below. 1� �_f The informatian in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, eng;naer, or a;chitect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the �levation data in the Comments area below.) '• I_!a commu�;ty officiaJ completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or Zon�q0. �- �_J The following infor;r,aticn (ftems G4-G�J) is provided for community floodplain management purposes. 4. PERMIT NUlvIBER— G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF CQMPLIANCE/OCCUPANCY ISSUED . This permi�has been issued for; �_� New Construction �_� Substantial lmprovement . Elevation of as-built lowest floor (including basement) af the building is: BFE or (in Zone AO) depth of flooding at tha building site is: _.ft.(m) Datum: �CAL OFFICIAL'S NAN1E �ft,(m)Datum: TITL� �[v1MUN1TY NAME � TELEPHONE — �NATIJRE DATE MMENTS I_I Check here if attachment: A Form 89-3�, .1UL 00 REPLACES ALL PREVIOUS EDITIONS