525 MANDALAY BLDG 3 #31-36 � � FEDERALEMERGENCY MANAGEMENT AGENCY
� C����_._ Q�I � O.M,B. No. 3067-0077
� � NATIONAL FLOOD INSURANCE PROGRAM Expires IJecember 31,2005
j �`"� M�`'`�`'��Y ELEVATION CERTIFIGATE --�—
C��d y 3 Un��s�31-36 Important: Read the instructions on pages 1-7.
SECTION A-PROPERTY OWNER INFORMATION Eor Insurance Company Use:
UILDING OWNER'S NAME Policy Number''
_J.M.C.Design&Development Corp.
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Numbef
501-525 Mandalay Avenue(Belle Harbor)
����' STATE ZIP CODE
Clearwater FL 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Lot 1"Belle Haibor'as recorded in Plat Book 125,Page 15 of the Public Records of Pineilas Couniy,Florida
BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,if necessary.)
hilulti-story residential
LATITUDEJLONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type}:
( ##°-�I#'-##.#tK' or ##.##�#°) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other:
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61.NFIP COMMUNITY NAME&COMMUNITY NUMBER 82.COUNTY NAME B3.STATE �
Ciry of Clearwaier,Fbrida 125(XJ6 Pinellas FL
B4.MAP AND PANEL B7.fIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER 65.SUFFIX B6.FIRM INDEX DATE FFFECTIVEIREVISED DATE B8.FLOOD ZONE(S) (7.one A0,use depth of flooding)
1250960007 D 0811911991 0811911991 AE 10&11
B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in 69.
❑FIS Profile �FIRM ❑Canmunity Determined ❑Other(Describe):�
B11.Indicate the elevation datum used for the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Other(Describe):_._
B12.Is he buiiding located in a Coastal Barrier Resources Sysiem(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes ❑No Designation Date_
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Builtling elevations are based on:❑Construction Drawings" ❑Buiidiny Under Construction' �Finished Constructian �
`A new Elevation Certificate will be required when construction of the building is complete.
�.Building Diagram Number 7(Select the building diagram most similar to the building fa which this certific;ate is being campleted-see pages 6 and 7. If no diagram
accurately represents the building,provide a sketch or photograph.)
C:.Elevaiions–Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,ARIA,ARIAE,AR/A1-A30,AR/AH,AR/AO
Complete Items C3.-a-i below according to lhe building diagram spec�fied in Item C2,State the datum used.lf the datum is different from the datum used for the BFE in
Section B,convert the datum to that used fa the BFE.Show field measurements and datum conversion calculaUon. Use the space provided or the Comments area of
Secfion D or Secfion G,as appropriate,to document the datum conversion.
Daium Conversion/Canments
Elevation reference mark used 51 Does the elevaGon reference mark used appear on the FIRM? ❑Yes �No —
o a)Top of boflom floor(induding basement or endosure) 7. 1 ft.(m) � � a.,
o b)Top of next higher floor 11.1 ft.(m) �
o c)Bottom of lowest horizontal sUuctural member(V zones oniy) _ft.(m) °' °' � �
o d)Attached garage(top of slab) l, 1 ft.(m) �� ��
o e)Lowest elevation of machinery andlor equipment W`0 � �
� j �.�� �
servicing the building(Describe in a Canments area) 2.0 fl.(m) �a `�
o fl Lowest adjacent(finished)grade(LAG) 6.7 ft.(m) z.� �,,,�
o g)Highest adjacent(finished)grade(HAG) 7. 4 ft.(m) �� `h� �
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 12 J .
o i I Totai area of all permanent openings(flood vents)in C3.h 108.288 sq.in.(sq.cm) �—i�_
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.
1 ce�tify fhat the information in Secfions A,B,and C on this certificate represents my best efforts to interpret the data available.
1 understand that any false statement may be punishable by fine or imprisonmenf under 18 U S Code Section 1001
C:ERTIFIER'S NAME Samuel Mark Beach LICENSE NUMBER LS 6261
TITLE Professional Surveyor and Mapper COMPANY NAME Florida Design Consultants,Inc.
-DDRESS CITY STATE ZIPCODE
3�30 Starkey Boulevard New Pat Richey FL 34655
;IGNlaTURE DATE TELEPHONE
K.. 03/1012005 (727)849=1588
FE114A Form 81-31,January 2003 See reverse side for continuation. Replaces ali previous editions
IMPOR?ANT: In these spaces,copy the corresponding information from Section A. �� Forinsurance Company Use:
B�ILDIN�STCEET ADDRESS(Induding Apt,Uni�Suite,ancior Bkig.No.)OR P.O.ROUTE AND BOX N0. Policy Nuitiber
501-525 Mandalay Avenue(Belle Harbor) _
CITY • STATE ZIP CUDE Company NAIC Number '
Ciearwater FL 33767
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) ���
py both sides of this Elevation Certificate for(1)community offiaal,(2)insurance agenUoompany,and(3)building owner.
CC MMENTS
C3 a-Elevation given is lowest garage floor elevation. ___
C3 e-Efevation given is the botom of ihe elevata shaft.
See atta�ed Architects plan for calculations and flood vent IocaUons. �Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE�(WITHOUT BFE)
For�one AO and Zone A(without BFE),complete Items E1 through E4. If the Elevation Cerfificate is intended fa use as supporting infamation for��LOMA or LOMR-F,
Secti�n C must be completed.
E1.Buiiding Diagram Number_(Select the building diagram most similar to the building for which this certificate is being oompleted—see pages 6 and 7. If no diagram accurately
represents the building,provide a sketch or photograph.)
E2.The tcp of the bottom floor(including basement or enclosure)of the buiiding is _ft.(m)_in.(cm)0 above or ❑below(chedc one)the highest adjacent grade. (Use
natural grade,'rf available).
E3.Fa Building Diagrams 6-8 with openings(see page 7),the next higher floor a elevated floor(eleva�on b)of the building is _ft.(m)_in.(an)at�ve the highest adjacent
grade. Complete items C3.h and C3.i on front of form.
E4.The tcp of the platform of machinery andla equipment serviang the building is _fl.(m)_in.(cm)❑above a ❑below(check one)the highest adjacent grade. (Use
natural grade,'rf 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 manageinent ordinance?
]Yes ❑No ❑Unknown. The local official must oerfify ihis information in Secfion G. ��
SECTION F•PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION �
The property owner a owne�'s authorized representative who completes Sections A,B,C(Items C3.h and C3.i only),and E fa Zone A(wiU�out a f=EMA-issued or oommunity-
iss aed BFE)or Zone AO must sign here. The statements in Sections A,B,C,and E are correct to the best of my knowledge.
P�.OPERIY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAMI=
�DRESS CIIY STATE ZIP CODE
SIGNATURE DATE 1ELEPNONE
COMMENTS
❑Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAI_)
The local�fliaal who is authaized by law a ordinance to administer the community's floodplain management ordinance can complete Sec,�tions A,E3,C(�r E),and G of this Elevation
Cert�icate. Complete the applicable item(s)and sign below.
G1.]The information in Section C was taken from other doaamenta6on that has been signed and embossed by a licensed surveyor,engirieer,or architect who is authorized by state
or local law to oertify eleva6on informa6on. (Indicate the source and date of the eleva6on data in the Comments area below.)
G2.�A community offiaal completed Section E for a buiiding located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0.
G3.]The foliowing informaUon(Items G4-G9)is provided for community floodplain managerrient purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCFJOCCUPANCY ISSUEQ�
G7.This permit has been issued fa: ❑New Construclion ❑Substan6al Improvement
G8.=levation of as�uilt lowest floor(including basement)of the building is: !._ft.(m) Daiurn:__
G9.3FE�x(in Zone AO)depth of flooding at the building site is: _,_ft,(m) Datum;_
LC�CAL OFFICIAL'S NAME TITLE
COMMI�NITY NAME TELEPHONE
SI��NATURE DATE
MMENTS
❑Check here if attachments
FEMA Form 81-31,January 2003 Replaces ail previous editions
��r
C i�--a��;� _ ��I `� FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.E3. �Jo. 3067-U077
�� � NATIONAL FLOOD INSURANCE PROGRAM Expires Dec,ember 31,2005
�����`'`�'`�`�/``y ELEVATION CERTIFIGATE --
(31�� � �1nt�5�`31-36 Important: Read the instructions on pages 1-7.
SECTION A-PROPERTY OWNER INFORMATION For insurance Company Use:
dUILDWG OWNER'S NAME Policy Number
J.M.C.Design 8�Development Corp.
BUILDING STREET ADDRESS(Induding Apt. Unit,Suite,and/or Bid .N )Oq P�,.•O.ROUTE AND NO. Company NAIC Number
arbor) C,( .t.L�t/;
CITY ATE ZIP CODE
Clearwater L 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Lot 1"Beile Hart�or'as recorded in Plat Book 125,Page 15 of the Public Records of Pinellas County,Florida
BUILDING USE(e.g.,Residential,Non-residentiai,Addition,Accessory,etc. Use a Comments area,if necessary.)
Wlulti-story residentiai
LATITUDFJLONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):
( ##°-#1#'-##.##" or ##.####i#°) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑01her:
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNIY NAME B3.STATE
City of Clearwater,Fbrida 125096 Pinellas FL
B4.MAP AND PANEL B7.FIRM PANEL 69.BAS�FLOOD ELEVATION(S)
NUMBER B5.SUfFIX B6.FIRM INDE ATE EFFECTIVE/REVISED DATE a8.FLOOD ZONE(S) (Zone A0,use depth of flooding)
125096 0007 D 08119/ 1 l" OS/19/1991 AE 10&11
610.Indicate the source of the Base Flood ElevaGon(BFE)da or base depth entered in B9.
❑FIS Profile �FIRM ❑Canmunity Delermined ❑Other(Describe):_
B11.Indicate the eleva6on datum used for the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Other(Describe):__
B12.Is he building located in a Coastal Bamer Resources Syslem(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes ❑No Designation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:�Construdion Drawings' ❑Buildiny Under Construcfion' �Finished Construclion � �
� *A new Elevation Ce�ificate will be required when consUuclion of the building is complete.
:.Building Diagram Number 7(Select the building diagram most similar to the building for which this certific;ate is being completed-see pages 6 and 7. If no dia�ram
acc�rately represents the building,provide a sketch or photograph,)
C�.Elevalions–Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR1A,AR/AE,AR/A1-A30,AR/AH,ARlAO
Canplete Items C3:a-i below according to the builefing�ia�ram snerrfiari in Itam�?.Sr?tP thP�a±��m����.if±ho,�ah im jg ujffo�°^�ffClTl uh8�u�uf�i uS`c'�Ivf u c�vc�ii i
Seclion B,convert the datum to that used fa the BFE.Show field measurements and datum conversion calculafion. Use the space provitled or the Comments area of
Section D or Section G,as appropriate,to document the datum conversion.
Daium ConversionlComments
ElevaGon reference mark used 5_1 Does the elevaUon reference marlc used appear on the FIRM? ❑Yes �No — ��
o a)Top of boflom Boor(including basement or enclosure) 7. 1 ft.(m) � ���.,
o b)Top of ne�higher floor 11.1 ft.(m) �' ��
o c)Bottom of lowest horiza�tal sUudural member(V zones only) _ft.(m) °°' � � -
o d)Attached garage(top of slab) 7. 1 ft.(m} �� ���/ ��
o e)Lowest elevation of machinery ancUor equipment W� ��',`3` ��
servicing the building(Describe in a Comments area) 2.0 fl.(m) °' � ��,��.. , �
o f1 Lowest adjacent(finished)grade(LAG) 6.7 ft.(m) z.m ��►,.1� l�a
� 1 ��
o g)Highest adjacent(finished)grade(HAG) 7. 4 ft.(m) � `�`
o h)No.of permanent openings(Bood vents)within 1 ft.above atljacent grade 12 ;
o i I Total area of all permanent openings(flood vents)in C3.h 108,288 sq.in.(sq.an) �
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.� �
1 cerfify that the information in Sections A,8,and C on this certificate represents my best efforfs to interpret fhe dafa available.
1 understand thaf any false statement may be punishable by fine or imprisonment under 18 U.S. Code Section 1001.
C;ERTIFIER'S NAME Samuel Mark Beach LICENSE NUMBER LS 6261
11TLE Professional Surveyor and Mapper COMPANY NAME Florida Design Consultants,Inc;
•�!DDRESS CITY STA7E ZIP CODE
3�30 Starkey Boulevard New Port Richey FL 34655
�IGN/�TURE DATE TELEPHONE
� 03/10/2005 (727)849-7588
FE�4A Form 81-31,January 2003 See reverse side for continuation. Replaces all previous editions
IMPQRTANT:Jn these spaces,copy the corresponding information from Section A. ��� For Insurance Company Use:
BUiLDINC.STREET ADDRESS Qndudirg Apt,Uni�Suite,andlor Bk7g.No.)OR P.O.ROIfTE AND BOX N0. Policy Nurr�ber �
F�i-525 Mandalay Avenue(Belle Harbor)
CITY STATE ZIP CODE Company NAIC Number
Clearwater FL 33767 �_
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) �
.,opy both sides of this ElevaUon Certificate for(1)communiry offiaal,(2)insurance agenf/company,and(3)building owner. _
CCMMENTS
C3 a-Elevation given is lowest garage floor elevation. _
C3 e-E4evation given is the botom of the elevator shaft.
See attayhed Archiiects plan fa calculaGons and flood vent locations. �Check here if attachments_
SECTION E•BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE�(WITHOUT BFE)
Fa�one AO and Zone A(without BFE�,complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting infamation for a IOMA or LOMR-F,
Secti�n C must be completed.
E1.6uilding Diagram Number_(Select the building diagram mosl similar to the building for which this ce�ificate is being completed—see payes 6 and 7. If no diagram acc�irately
represents ihe building,provide a sketch a photograph.)
E2.The tcp of the bottom Floor(induding basement or enclosure)of the building is _ft.(m)_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 ne�higher floor or elevated floor(eleva6on b)of the building is _fl.(m)_in.(cm)at�ve ihe highest adjacent
grade. Compiete items C3.h and C3.i on front of form.
E4.The top of the platform of machinery anc�a equipment serviang the building is _ft.(m)_in.(cm)�above a ❑below(chedc one)the hiyhest adjacent grade. (Use
natural grade,rf available).
E5.For Zone AO only: If no flood depth number is available,is the top of the boflom floor elevated in accordance with the cornrnunity's floodplain management ordinance?
]Yes ❑No ❑Unknown. The local official must certify this information in Seclion G. ��
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION �
The property owner a ownei's authorized representative who completes Seclions A,8,C(Items C3.h and C3.i only),and E for Zone A(without a f=EMA�ssu�d or community-
iss�ed BFE)a Zone AO must sign here. The statemenfs in Sections A,B,C,and E are correct to the best of my knowledye.
PF.OPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAMF
.DRESS CITY STATE ZIPCODE
SIGNATURE DATE TELEPHONE
COMMENTS
❑Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAt_)
The local�ffiaal who is aulhorized by law a ordinance to administer the communit�s floodplain management ordinance can�mplete See,-tions A,E3,C(or E),and G of this Elevation
Cert�icate. Complete the applicable item(s)and sign below.
G1.�The information in Secfion 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 eleva6on information. (Indicate the source and date of the elevation data in the Comments area below.)
G2.]A community offiaal completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)a Zone A0.
G3.�The following informa6on(Items G4-G9)is provided for communiry floodplain managerrient purposes.
G4.PERMIT NUMBER G5.DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANGEIOCCUPANCY ISSUEU
G7.This permit has been issued for. ❑New Construclion ❑SubstanGal Improveinent
G8.=1eva6on of as-built lowest floor(induding basement)of the building is: _._ft.(m) 1�aturn:
G9.3FE�x(in Zone AO)depth of flooding at ihe building site is: ._ft.(m) Daium:
LOCAL OFFICIAL'S NAME TITLE
COMMUNIIY NAME TELEPHONE
SI��NATURE DATE
OMMENTS
❑Check here if attachments
FEMA Form 81-31,January 2003 Repiac�s all previous editions
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�`g��`�Y-� ���� C I T Y O F C L E A R W A T E R
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��. ����� "`�•< .s DEVELOPMENT & NEIGHBORHO(�D SERVICES DEPARTMENT
�� : ���� °
�,�s, i- a ��„ ' -° POST OFFICE BOX 474H� CLFARWATER� FLOa�DA 33758-4748
� x,: L .,
�"`���k�. ��.,b MUNICIPAL SERVICES BUILDING, ZOO SOUTH MYRTLE AVENUE,CLEARWATER,FLO�unn 33756
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TFi.ErxoNE(72� 562-4567 Fnx(72� 562-4576
MEMO OF REVIEW FOR CORRECTNESS 8� 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
The attached elevation certificate is complete and correct
X 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
525 MANDALAY AVE (BLDG 3 UNITS 31 -36)
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
NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME B3.STATE
B4.MAP AND PANEL 67.FIRM PANEL 69.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX 86.FIRM INDEX DATE EFFECTIVE/REVISED DATE B8�FLOOD ZONE(S) �Zane A0,use depth of flooding)
8/19/1992
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69.
❑ FIS Profile ❑ FIRM ❑ Community Determined ❑Other(Describe)
B11. 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 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 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 fieid 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)
COfTIITI@I1tS: One siqned and sealed elevation cerfificafe submitted for oroiect bv the survevor Raised seal attached to main certificate for address 501-to 525 Manda/av Ave.
Date of Review: Community Official:
�vation certificates shall be maintained by fhe community and copies wifh the attached memo made available by request
F[u�[c H�s�,vu�,Mnvoa
GEORGE N.CRE'fEK05,COUNCILMEMRCR JOIIN DORAN,COUNCILMEMB[R
PAUL F.GBSON,COUNCILMEMAER � CARLGN A.PE1'GRSEN,COUNCILMEMRER
��EQUAL EMPLOYMEN'I'AND AFFI1tMATIVE ACTION EMYLOYER�
.
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��� . .��° � DEVELOPMENT & NEIGHBORHO(�D SERVICES DEPARTMENT
��°� ��' ''�~ POST QFFICE BOX 474g� CLEAftWATER� FLOa�DA 33758-4748
� y��`�S Y �� °~A MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUF,CI.EARWATER,FLO�uDn 33756
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TELEPHONE�7Z� 5�2-4S��I Fnx(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
The attached elevation certificate is complete and correct
X 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
509 MANDALAY AVE
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:0 GPS(Type):
��°_��_�.��� or ##.#####°) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map❑Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
,.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME 63.STATE
B4.MAP AND PANEL g5.SUFFIX B6.FIRM INDEX DATE B�•FIRM PANEL gg.FLOOD ZONE(S) B9•BASE FLOOD ELEVATION(S)
NUMBER $�19�1992 EFFECTIVEJREVISED DATE (Zone AO,use depth offlooding)
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69.
❑ FIS Profile ❑ FIRM ❑Community Determined ❑Other(Describe)
B11. Indicate elevation datum used for BFE in 69:� NGVD 1929 ❑ NAVD 1988 ❑Other(Describe)
612. 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* ❑ F�nished Construction
*A new Elevation Certificate wiil be required when construction of the building is compiete.
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 accurately represents the buiiding,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)
C01T1171@I1tS:_One signed and sealed /evatio certi ate sub ft�for project by the surveyor. Raised sea/attached to mai ate for address 1 25 Mandal9y ve.
Date of Review: Community O�cial:
�vation certificates sha//be ntained by the community and copies with the attached memo made availab/e by request
FRANK HIBBARD,MAYOR
GEORGE N.CRE7'EKOS,COUNCILMEMBHR JOIIN DORAN,COUNCILMEMBER
Pnui F.G[ssotv,COUNCILMEMAER � CARI.EN A.PE"1'ERSEN,COUNCILMLMBER
��EQUAL EMYLOYMENT AND AFFIRMATIVE ACTION EMPLOYER��