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458 MANDALAY AVE � FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 ; NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 �' �F JUL 0 6 2001 ` � i; ELEVATION CERTIFICATE �, � ��.±: � �; �� -, � •°� ' Im ortant: Read the instructions on a es 1 -7. � ,.: , . , , n _ .. .. � �_°s X _'�" s + Y ,:� t,"��& "? ' SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use: . -. --. _.._.. M DING OWNER'S NAME Policy Number - BUIIDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg. No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number 458 Mandala Avenue STATE ZIP CODE Clearwater Florida 33767 PROP�RTY DESCRIPTION(Lot and Biock Numbers,Tax Parcel Number,Le al Description,etc.) Lot s ) 72-77 Clearwater Beach Park �inellas County PB 10 Pg 42 BUILDING USE(e.g.,Residentiai,Non-residential,Addition,Accessory,etc. Use a Comments area, if necessary.) LATITUDE/IONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ��GPS(Type): ( ##°-##'-##.##" or ##.#####°) L�NAD 1927 LI NAD 1983 �_�USGS Quad Map L�Other: SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 81. NFIP COMMUNITY NAME 8 COMMUNITY NUMBER B2.COUNTY NAME B3.STATE City of Cleawater 125096 Pinellas Florida 84.MAP AND PANEL 65.SUFFIX B6. FIRM INDEX B7.FIRM PANEL B8.FLOOD 89.BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use depth of flooding) 125096 0007 D 8-19-1991 8-19-1991 AE 11 B10. Indicate the source of the Base Flood Elevation (BFE)data or base flood depth entered in B9. �J FIS Profile �X� FIRM �� Community Determined �_� Other(Describe): B11. Indicate the elevation datum used for the BFE in B9: � X� NGVD 1929 �J NAVD 1988 �_J Other(Describe): B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? �_�Yes (J No Designation Date: SECTION C -BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C +ilding 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 1 (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.) 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 NGVD 19 2�onversion/Comments Elevation reference mark used on—s i te BM Does the elevation reference mark used appear on the FIRM? �_) s �X� No ❑ a)Top of bottom floor(including basement or enclosure) *5 .8 ft.(m) � ,`, ❑ b)Top of next higher floor n/a ,_ft.�m� �' r + � ❑ c) Bottom of lowest horizontal structural member(V zones only) n/a ._ft.(m) �o O d)A tt a c h e d g a r a g e(t o p o f sl a b) n�a •_ft_(m) $� ❑ e) Lowest elevation of machinery and/or equipment W,; , �1 i servicing the building(Describe in a Comments area.) n/a ,_ft-�m� E� �'' • _ ., "- '� n� �" ❑ � Lowest adjacent(finished)grade(LAG) *5 � ft.(m) z'� i V � �� O g) Highest adjacent(finished)grade(HAG) *5 .8 ft.(m) � H �; ' . "V ' ❑ h) No.of permanent openings(flood vents)within 1 ft. above adjacent grade�a � , � ❑ i)Total area of all permanent openings(flood vents)in C3.h n�a sq. in. (sq.cm) r;. ,�-.' _ .-,� . , � SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor,engineer,or archited authorized by law to certify elevation information. 1 certify that the informafion in Sections A, 8, and C on this cerfificate represents my best efforts to interpret the data available. I understand that any false sfatement may be punishable by fine or imprisonment under�8 U.S. Code, Section 1001. (' TIFIER'S NAME LICENSE NUMBER _�1 � T R�hPrtG�n 4573 �S�eyor and Mapper ROBERTSON & ASSOCIAT�SNSU�VEYING & MAPPING, INC . A�g�tE�SS Swann Avenue — Suite 200 ��Tampa FlorT�da Z�P��09 SIGNATURE DATE - - TELEPHONE� g 1 3 ) 8 7 9 2 3 2 3 ,�- FEMA Form 81-31,JUL 00� SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT: In these spaces,copy the corresponding information from Section A. For lnsurance Company L)se; .' BUILDING STREET ADDRESS(InGuding Apt.,Unit,Suite,and/or Bidg.No.)OR P.O.ROUTE AND BOX NO. Policy,Number CITY STATE ZIP CODE Company NAIC Number SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUEDj Copy both sides of this Elevation Certificate for(1)community official, (2)insurance agenUcompany, and(3)building owner. �' COMMENTS I—I Check here if attachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zone AO and Zone A(without BFE), complete Items E1.through E4. If the Elevation Certificate is intended for use as supporting 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 enclosure)of the building is �L�ft.(m) LL�in.(cm) L�above or L�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 I_I—I ft.(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 management ordinance? � I Yes � I No � I Unknown. The local official must certify this information in Section G SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owners 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, 8, C, and E are conect to the best of my knowledge. PROPERTY 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 (OPTIONAL) The local 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)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 information. (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. L�The following information (Items G4-G9)is provided for community floodplain management purposes. G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY I ISSUED G7.This permit has been issued for: L� New Construction ��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: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS �— � I Check here if attachments FEMA Form 81-31,JUL 00 REPLACES ALL PREVIOUS EDITIONS