817 MARK DR ------�---.__ . _
PL"UEIt/AL I=fV1L'12GLPJl:Y PV'IAI��\GLfdiElJl' '�aGL=f�ICY U.M.L3. NU. JUli1-U11T7
NAl IUNsAL PWUU IWSURANCE N130C:1�.AN1 Expires July 31, 2UU2
L LL='Ve�"9'I O tv �IEfZTi(=1�A�1'� —
In>>o�lant: l2ca� tl�e iiislructiuus on �a es 1 - r'.
SECl lUN A-PROPGRTY OWNER INFORMATION For Insuiance Conipairy Use:
L3UI' �UWNLIt'S NAML Policy Nwnber "
.__.�- _
" G �"�� �, F'LLY�`�_.---�--
UUILDI�Jti Sl(�EET ADDRESS(Includiny ANt.,Unil,Suite,�i1i1/ur Ul�y.No.)UR P.O.ROUfE ANU BUX NO. Cu�n{�aiiy NAIC Nwii�ei
�'�7 ��1�2K � ��v�
C;I I Y ,,,_,_ STAI E Zlf'�UUE
C1,.FARwA � ��2 � __rt-o��oia .3 3"7S� -
PI2UI'EI21 Y UESI;RIF'I IUN(L t and L31oi;k Nuni�eis, 1`ax 1'a�cel IJuiii�ei,Leya1 UesuipGon,elc.)
�� ��--:����_.__�s�.�-�,��__`�r��'� �r���" ��� ------
E3UILUIIJ`U5E(e.y.,ResidenUal,Non-tesidenG�l,Ad�iGon,Ac;c;essory,elc. Use a Coirnrienls aroa,i nec;essaty.)
-•----,��5�,���/,7"�.f�L.. ---•------�-----�-- ---------
Ll�IIIUI.)E/LONI�IIUU�(OP�IIUNAL) IIUItIZ�)NInLUnIUM: :30UI10E: (_(GPS(tYUu).---.—.—_-.---_---------- _
� uri°-ruR�-�ru.urt° �� i�u.�uiuriiF") - 1_I���u ��z� �_�t�nu i�us �_I uscs uu��nndu I—I uu���:_------ _ .
SECIIUN D-PLOOU INSUft�IJCE ItA'fE MAP(FIRM)INFORMATION _
(----lS 1.NI IP(,OMMUNI IY NAME 8�COMMUNI IY NUMUER Li2.CUU JlY IJAME F33.S I A I E
---/�150�l o ��--�.,�/1l�L L/� S" ,�-��.0 l��,Of� ___
L1�I.tvU�P AIJU PANLL 1�5.SUI'FIX Ei6.FIRM II�ULX til.FIRM PANEL BH.FLOUD k�9.k1ASE f-LUUU E:LEVnI IUIJ(Sj
NUMI3ER D DAIE EI=FL=CIIVFJREVISEUUAIE ��ZUNE(S) �,� (Zon�AU,usedepU�ollluucliiiy)
I___ o i �RI � � I �y a5
f3 f U_ IncJicate lhe sowce of tlie Base FIooJ Elevation(13F[)dala ur base Ilood deplh enlered in B9.
�_�FIS Profile �FIRM �_�Cunununily Uelenuine� �_�Otlier(Uescribe): � ' • _ —_--_
611. li��iic:alo U�e elevalion dalwn used(or tlie BFE in B9: (�)NGVD 1929 �_�NAVD 19E38 �+�011ier(Uescribe):_ _
!i 12.Is llie builcliny localed in a Coastal Bairier Resowces Sysleiu(CBRS)area or OU►erwiso Prulecled Area(UPA)? �_�Yes ��1Ju
Desiynalion Uale:__ ____—__—_
SECTION C-BUILUIfJG ELEVAIION IWFOI2MAl lUN (SURVEY REQUIREU)
C 1.kluileliny elevalions are based on: �_�Consliuclion Diawinys' �_�Duilcllny Under Cunsliuction" � Pinislied Constiucliun
w Elevalion Ceiti(icale will be reyui�ed wlien cunstiucliun of Uie buildiny is coniplete.
C2. • my Uiayrain Nwnber�_(Selecl lho buil�iny cliayiain inost siinilar lo lho buil�iny(vrwhicli lliis ceililicale is�eiiiy cuu�ulete�-see
s G and 7. If no diayrani accuralely represents llie�uileliny,provicJe a slcetch or ptiotoyrapli.)
C3. Elevalions-Zones A1-A30,AE,AH,A(willi BF�),V[,V 1-V3U,V(wilh BFE),AR,AR/A,AR/AE,AWA I-A3U,AWAI-I,AWAU
Coiuplele Iteins C3.a-i below accordiny lo tlie buil�iny cliayiain sNecilied in Ileiu C2.Slale the Jatuni usecJ.I(llia�atuui is�i((�ient fiuni
tlie cJaluni used for llie B1=E in Seclion B,wnverl llie dalun�lu ll�al used(or ll�e BFE.Sl�ow(ield nieasuren�enls ancJ claluni wnvcrsiun
calculaliQn. Use lho space provide�or tlie Cununents area of Seclioi�U or Seclion G,as approNtiale,to clocunierd tlie daluni cunveisiun.
Uatuni-`��- Conversion/Conuuenls _ ----
Elevation reference mark useJ Does ll�e elevation re(erence inark used appearon thQ FIRM7 �__�Yes �__�!Jv
U a)l op of�oltom Iloor(includiny basenienl or enclvsure) • ___ a s •���.����) �v ."'
U �)�I u�of next liiyl�er floor _ N�—�•--fL(in) � ��;`
iJ c)Bollon►o(lowesl horizonlal slructwal iueni�er(V zunes only) ____�_ � «•(���) o �
U cl) Altacliecl yaiaye(lop of slab) ------�.�' (L(in) F � �j� �;_, ,''. �6 .
w � � �. ;�
U e)Lowesl ele"valion of machinery andlvr eyui�iuent � - �; � • - y
serviciny the buildiny(Describe in a Conunenls.area.) �--�a5-�. 5 (t.(iii) E o �� ��(�Q,/ '��% �'�
rade LAG �• C1 fL(in) z' .�� Q �, V'� ,
U f)Lowest adjacent(tirnshed)y ( ) �;
U y)I-liyliesl adjacent((iiiished)yrade(I-IAG) ------��. �3 IL(ni) � ' ` � ��••,
U li)Na of pennanerzt openiiiys(Iloucl venls)witliin 1 Il.a�uve aeljacent yracle /�A _ J �.�
U i)�I atal aiea of all pern�anenl oNei�inys(floo�venls)in C3.1�_�A'_sy.in.(sy.cin) _
SECl ION U-SURVEYUR,ENGINEER,OR ARCHf�ECT CERTIFICA'lION
Tliis cerlilication is lo be siyned and sealecl�y a land surveyor,enyiiieer,or arct�itect authorized by law to ceilify olevatiun in(urniatiun.
!cerli�y tliat[he ir�formc�lior�in Secfions A,B,and C ai lliis certilica(e reprusents n�y best eltoiis to interp�el Ihe data available.
1 unders(and lhot arty false slafernent n�ay be�unishable by lii�c or iiii�risonrnent under 1 A U.S. Codv, Seclion 1 UU 1.
!(;Efll IFIER'S NAME UCENSE NUMBER �
Oc.�NA�.t7 W L►-►-inN1�;�� 5b4 I --
I.UMPAIVY NAME
►�-��� p�z�;s z�EN-r wr�.�zA►v�so�� �' .�s �� -r�5.�._ --�rv�:.
��uui��ss l ��� . tJ A�.C Ivl G 1 � I- 4J� . c.i iY--�Il i'v1 PF� �l..�RY 17t1 zi�c�u� 3��� I�.�
-�• ���- UA I E I ELEPIIUNE �'` •
� U�z) "�l Cr) ' /.ri ��C)
�'I G.n:. Fr�rn,lll_31 .11II Illt . - - •! .' 1F Ff1R f:f1NfIN1IA71C1N RFPI Af:hC A1 I P{I{F\/IOI I.^.FI�I I Ir�W�:
� � MAY 2 8 2002
,
�f,.��VNING SVCS
CITY OF CLEAR ATER
�.__.__ ____ _g�.�.._�.__� �___�_.__ _ .,. :.. .u ._ ..____��__�__�.�_...._ ._ _..,.._.,
itV�POf2TA��i l': 6+� i�I4JFI S�SC$�.E.U�c:opy thcs co�eesp.+vEi�.s � ,,:�c, c�.-��: jE_sa� , s' i�or ir�suiaiicu c;ui���� i� �!c;,i: !
[3UILDING STREGT ADURESS(Includiny Apt.,Unit Suite,ai d/or E11dy.No.)OR P.O.ROUTE AND BOX NO.�� Policy Nurnber .�
,R�'7 f�AR/� �J 11� �i't:
CI lY S fAl E r ` ZIP COUE Company NAIC Nuniber
��.,C�I��'�ni�i 7 F/� L �.�:.��� 3'1
SECTIOPd D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)' ' °
Copy bolh sides of this Elevalion Ce�tificate for(1)conununily of(icial,(2)insurance agenUcompany,and(3)building owner.
-
COMMENI S _ -
�
�__� Check here i(attachinents
SECTION E-BUILDING ELEVATIQN INFORMATION (SURVEY NOT REQUIREU)FOR ZONE AO AND ZONE A(WITHOlJ'T fiFE)
=or Zone AO and Zone A(wilhout BFE),complele Iterns E1.lhrouyh E4. If tha ElevaUon Certificate is intended for use as supportiny
nfonnation for a LOMA or LOMR-F,5eclioc�C must be complelod. " ' "% ' �' � � � •
c1.Building Diagram Number � (Selsct the building diag�am niost similar to the buildi�y for which this cerUficalo is being completed–
see pages 6 and 7. I(no diagrarn accurately represents the building,provide a sketch or photograph.) �
E2.l�tio top of the bottom floor(includiny basement or enclosure)of tl�e building is ` I_�_)ft.(m)I—I—I�n.(crn) (._�above or �_�below •
(cl�ock one)thQ hiyhest adjacent gradc�. (Uso nalural yrade,if avallablo.) ` `
E3.For Buildiny Diayrams 6-8 with openinys(see pago 7),the nex[hiyher tloor or elevated floor(elevalion b)of lhe buildiny is
�—�—�(4(m)�—�,�in.(cm)above ttio highest adjacent grade. Complele Items C3.h and C3.i on front oF form. '' '
E4. For Zono AO only. If no ilood depth nurnber is available,is the top of the bottorn iloor olevaled in accordance wilh Uie cc�mmunily's
Noodplain manayement ordinance?� �Yes � �No � �Unknown. The local offlcial must certify this information in Section G. _
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESEN7ATIVE)CEitTIFICATION
7he proNeriy owner or owner's aulhorized represeniaUve who conipleles SecUons 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 rnust sign here..The statements in SecGon,s A,.B, C,and E are correct to
ihe best of m knowled e.
'PROPER'fY�R'S OR WNER'S AU HO ZED REPRESEN� fA1I�E'S NAM .. , _, . .. . ...... .
AuDRESS , . CI ; , , S Al E ZIP COU
SIGNAIUF� pq E .. E�EPI-TONE
COMMENI"S ' , .. , ,;, ,, .:- , , -
� . � �_� Check here if allachn�ents
� � . 'SECTION G-COMMUNITY INFORMATION(OPTIONAL) �
The local o(ficial who is authorized by law or ordinance to administer the community's(loodplain 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 informaUon in Soction C was taken irom other documentalion that has beon sic�ned and ombossed by a licansed surveyor,
enyineer,or architect who is authorized by stalo or local law to cerGfy.elavaGon informalion.'(Indicato tha sourco ai7c1 dalo of tlie
elevation cJata in tha Comments area below.)
G2. �_�A community official completed Section E for a buildiny loc;aled in Zone A(wilhout a FEMA-issued or conununity-issued BFE)or
Zone AO. , ,
G3.�_�Ttj�foilowing infonnation(Itams G4-G9)is providc�cl for coirnnunity iloodplain manayement purpuses.
G4. PLRMIT NUMF�ER G5. DATE PERMIT tSSUED G6. DATE CERTIFICAiE OF,GOMPLIANCEJOCCUPANCY I
ISSUED , ,
��
G7.This permit has been issued for. �_�New Construclion �_�Substantial lmprovement , ;,
G8. Elevalion of as-built lowest floor(including basement)of the building is: ' _ �fL(rn)Datum:
G9. ElFE or(in Zone AO)depth of flooding at the building site is: _ . _ �ft.(rn)Dalum:
LUCAL OFFICIA�LS E TITLE ; _�. . . :
COMMUNIN NAME - , , TELEPHONE , .
SIGNATURE • DATE � , , .
CU�o1h1E1J(S . �
� � Check here if attachrnents
F=F�;i�1 Fnrm fi1-R1 .II II (lfl RFPI A(:F�A1 I PRFVICII IR Ff1f�IC1NC
, yA