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959 MANDALAY AVE � _ �' 2.�ot- D`?� � FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 � NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 • ELEVATION CERTIFICATE Im ortant: Read the instructions on a es 1 - 7. SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number � B ian D h BUIIDING STREET ADDRESS(including Apt.,Unil,Suite,and/or E31dg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number 959 Mandala Avenue CITY STATE Clearwater Beach FL PROPERTY DESCRIPTION Lot and Block Numbers,Tax Parcel Number,Legal Uescription,etc.) Lot 5 Block 5� �Y BUILDING USE(e.g.,Residenlial,Non-residenlial,Addition,Accessory,etc. Use Comments section i(necessary.) qUG 2 1 2001 �S1.CZ�E',Tl�ld�. LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: �_�GPS(Type): ( ##°-##'-##•#l#" o� ##.##ttN#°) ��NAD 1927 (_�NAD 1983 �_�USGS Quad M �_ pther. NT SERVICES DEPT SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATIO CITY O B1.NFIP COMMUNITY NAME 8 COMMUNITY NUMBER 82.COUNTY NAME ^ 83.STATE � 125096 P'lorid B4.MAP AND PANEL 85.SUFFIX B6.FIRM INDEX B7.FIRM PANEL 88.FLOOD B9.BASE FLOOD ELEVF�TION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use depth of flooding) 0007 D 8/19/91 8/19/91 A-E 11.0' B10.Indicate the source of the Base Flootl�levation(BFE)data or base flood depth entered in 89. �__�FIS Profile ��FIRM �__�Community Determined �_�Other(Describe):_____ B11.Indicale the elevation datum used(orthe 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 �X�No Designation Date:__________ SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) �1.Building elevations are based on: �__�Construction Drawings' �__�Building Under Construction' �X�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 beiny compleled-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 E3FE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO Complete Items C3a-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.Shov✓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 _ ConversioNComments Elevation reference mark used_ SEE C��]'I'S Ooes the elevation reference mark used appear on the FIRM7 �_�Yes ��No ❑ a)Top of bottom floor(including basemertt or enclosure) _ $ 5 ft. m b � ) „ f'��i� •�. �i ❑ b)Top of next higher floor N , p,_n�m� `� a ,_ , ', ' ❑ c)Bottom of lowest horizontal structural member(V zones only) Y _NA.A ft.(m) „ � , �°y �� 0 0 ,'f� `.', � �r.., �'7 .. ❑ d)Attached garage(top of slab) • 5 . 8 ft.(m) E g ,; ;. � ❑ e)Lowest elevation of machinery and/qr equipment W " �` �'�» '" ,�`.•" �'• � servicing the building ______ B _ 5 ft.(m) � ? �; ��"� '� �"� •� ` ❑ Q Lowest adjacent grade(LAG) 5 . 6 ft.(m) z� ``;�y A' Mp � � +.; ' ❑ g)Highest adjacent grade(HAG) , ____�__.�ft.(m) �� `' ❑ h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade__Q___ � ` ❑ i)Total area of all permanent openings((lood vents)in C3h__ 0 sq.in.(sq.cm) J 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 te certify elevation information. 1 certify fhat lhe information in Seclions A,8,and C on this certilicate represents my best ef(oris to inferpret tlie dafa availa6le. 1 undersfand that any(alse statement may be punishable by fine orlmprisonment under 18 U S Code Section 1001 CERTIFIERS NAME LICENSE NUMf3ER Er3ward D_ t�� z T S #LB-G9G0 TITLE COMPANY NAME President P �h 's Iand Surve in Inc. DDRESS CITY STATE ZIP CO 5760 llth l�venue N. St. Petersb PL ��3710 SIGNATURE�� DATE TELEPHQ � 4 30 O1 �7 347-87a0 FEMA Form 81-31,AUG 99 E EVERSE SIDE FOR CONT�NUATION REPLACES ALL PREVIOUS EDITIONS . . . . IMPORTANT: In these spaces,copy the corresponding Info�mation from Section A. For Insurance Company Use� BUILDI��STREET ADDRESS(Including Apt.,Unit,Suile,and/o�Bldg.No.)OR P.O.ROUTE AND BOX NO. Policy Number ITY STATE ZIP CODE Company NAIC Number Clearwater Beach FL 33767 SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate(or(1)community official,(2)insurance agent/company,and(3)building owner. ' COMMENTS Elevations Based on P.C.F.D. BencYIInark (Aural RM-3) Elevation = 6.193' . . . . �__� 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(wilhout BFE),complete Items E1 through E4. If the Elevation Certificafe is intended for use as supporling information(or 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."fhe top of the bottom floor(inciuding basement or enclosure)of lhe building is �_�--�ft•(m)�—�—�in.(cm) �__�above or �__�below (check one)the highest adjacent grade. E3.For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated fioor(elevation b)of the building is �_�_�h•(m)�_�__�in.(cm)above the highest adjacent grade. E4.For Zone AO only. If no flood depth number is available,is the top of the bottom floor elevated in accordance with tfie community's floodpiain managemenl ordinance?�_�Yes �_�No �__�Unknown. The local official must certify this iniormation in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owner's authorized representative who completes Sections A,B,and E for Zone A(without a FEMA-issued or community-issued BFE)or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME -ADDRESS CITY STATE ZIP CODE SIGNA7URE DATE TELEPHONE COMMENTS �_� Check here if attachments SECTION G-COMMUNITY INFORMATION(OPTIONAL) The local official who is aulhorized 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. G 1.�_�The information in Section C was taken irom other documentation lhat has been signed and embossed by a licensed surveyor, engineer,or architect who is authorized b�y state or local law to cenify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2.�__�A cammunity officlal completed Section E for a building localed in Zone A(without a F[MA-issued or community-issued BFE)or Zone AO. G3.�_�The following information(Ilems G4-G9)is provided for community floodplain management purposes. G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPUANCFJOCCUPANCY ISSUED G7.This permit has been issued for: �__�New Construction�' ��Substantial Imp�ovement G8.Elevation of as-built lowest floor(including basement)of ihe building is: _ft.(m)Datum:_____ G9.BFE or(in Zone AO)depth of flooding at the building site is: u • LOCAL OFFICIAL'S NAME TITLE COMMUNIIY NAME TEIEPHONE SIGNATURE DATE COMMENTS DEVELOPMENT SERNICES DEPT � I__I Check here if attachments FEMA Form 81-31,AUG 99 REPLACES ALL PREVIOUS EDITIONS