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14 MIDWAY ISLAND _ . , �P 2z�G�-055�2 " FCDCRAL CMERGCNCY MANAGCIUICNT AGGNCY O.M.D. No. 30G7-0077 NATIONAI. FLOOD INSURANCI:. PROGRAIUI � , �xpires July 31, ?_002 r�` ���Oi�`�"I()6� ��9�1'I�I�/�T'� — � _ Impor�ant: Rcad the instructions on ��ac�es 1 -7. � `��� S[CTION A-PROPERTY�OWNER INFORMATION 1'or insurnnco Compnny Usu: DUILDING OWNCR'S NAML f'olicy Number ;; WILLIAM R. .JACOBSES �, .. , ' • ' 13UIl,f)ING STRCLT/.1DDR�^S(Inr,luclinr�/1�t.,Unit,Suile,ond/or fticl�.No.)OR P,O. IZOU'fF nNU f30X NO Company)VAIC Number � 14 MIDWAY ISLAND � , �--- ' _._--�-------__...---- �---�— . -----------�-----�--------�--------_ ( __._.___ _. "�/ _._�. CI��EARWATER FL '�T � - o1 .�: ,---.—_---� -- --------..------ � � 'rS��DA ���� � ;: . , ` l� �",,,,,�',,,.,•..::....`..��..'=,.w..—.r* �j i> � LUTt.��Y1�C�CI:UNIT �y�t.�ISL�ANDn�iESfiAT���uiN'�,rnGi�rL�`��Wt1�� -------------- -� }� ___ _ � � � .i � U �Kn,elc.) - --.�.------------- l i � -- --�� �` 1 I�UICDING US�(e.g.,Residential,IJan-residr,ntial,nddition,/lccessory,etc: Use Comments section if necessary.) � REBIDENTIAL � L/�'fl`I'UU�/I.ONGITUUG(Of''f10NnL) NORILON7AL UAl'UM: SOURCL: �_�GPS('fy{�e): ------°�;r^r•�-'-"""';�,r�.�5 ( llil"-f111'=�Ill.fll!" or JlIEJIIIII/f!I") �.j:��N/1D 197.7 I�I N/1D i�tt3 �_�USG�Cluad M;t{ � ��� -- �'-��e���---�..m. SI�CI'ION l3-fLOOD INSURANCE RA'fE MAP(PIRM)INFOI�MATION �111.N1=1P COMMUNITY NnML&COMMUNI'fY NUMCSGR ti2.COUN'IY NAM� � ` F3J,;;17�TF_ � ^ LEARWATER _ 1 2 5 0 9 6__,,_--_--� _ PINELLAS ,_ FLORI DA k14.MAPAND I'ANLL 13!i. ;UFfIX 13G.PIRM INU� 13%.1=112M I'AN�L D0,fLOOD L39.LiASE 1=LOQD 1=l.GVA��ION(S) NUME3�R 1'° f.:FPI'cCTIV�/RGVISCb IjA'fC: 7_ONC(.^>) (7onc!10 u.o deplh of Iloodin�) 1 25b96-0007 B �'"����' 8-1 9-91 AE 1 1 . b a10. Indicalo the source of the 13ase I�lood Elevation(F��C)data or base.floocl�depth entered in D9. � � , I_I �IS f'rofilc ��� 1=1RM �_� Community Delermined �_� Other(Describe):� 11�11. Indicate lhe elevation dalum usecl fur the DF�in D9: �:� NGVD 1 J2�1 �_� Nl1VD 1�JtiA ��� Olher(Describr); . � f3'12. Ic;lhe buiidinc�loc�tecl in a Coast:.�l l3arrier f:esources ;;yslei>> (CI]RS)are�or Olherwise Protecled nrea (OPl1)'� �__�Yes �,}SJ No Designation D�itc:- - -- SCCTIOtd C-E3UILDING �L�VATION WPORMATION (SURVC`(RCQUIF:I:D) C1.�inc�elevations are I�ased on: �._�Construclion Drawin�s" �_�l3uilding Under Conslruction'' �`_C}Finisl�ed Construclion "'/1 new 6levation Cerlificate will be rr.quired when construction of tl�ie building is completa C2. l3iiiiding Dir.ic�ram Number 1 _ (Sclect ihr buiiding diar�r�m ntost::imilar to llic buildin�far whic;h thi:ccrlilic.:�te is being complcl��d- sec pa�es G�nd%. If no dir��rr�m .�ccu�.ilely repmsents lhe buildinc�, provide:� :kclr.h or photogr���h.) C3. 1=levalions—Iones/�1-/130,/��,/�i-1,/1 (with (3F�),VL,V1-V;10, V(wilh t3PL),nR,AR/A,n�tinc,nr�in i-n3U,nr.ini i,nrlino C:omplete Ilems C3�-i betow;�ccorciinc� to the I�uildin�dinqram speciliecl in Ile�n C2.. State lhc:d�iluiri u�ed. If Ihe cl,ilum is differenl(roin tl�e tlalum used for the DFL= in Section L�,converl the datwn to that usecl for the Df-E.Show field measuremenls c�ncl clatum eonversion cnlculation. Use the;pace provided or lhe Comments area of�ection I�or Section G, as approprinte, lo dacument the datum conversion. Datum Convcrsion/Commenfs Clevation reference mark�.ised__ Uoes lhe elevation reicrence mark used appear on the FIRM? �_�Yes �_� No U a)Top of boltom iloor(including basr.ment or enclosurc) 7_�5 (t.(m) �,; CI•b)Top of next hic�lier Ooor �_^—_.---_— —ft.(m) T; � . �,'`�'�,. �' . .����� � ••'` Ct c) 13ottom of lowest horizontal :truclur�l membcr(V zon�s only) —•-----_—.^fl.(rn) <��i' • ,- ;�,5� F CJ d Att�ched ara e to of;Inb ° �-' � .a ° % ) �J 9 � P ) ---•------ —ft.(m) j';� � �.';°�-. .�, ,R; ,� ,: U e l_owest elevalion oF inachiner ��� �° �y r " ) y�ncUor equipnicnt . •• m p.. "' ,�,, {� scrvicing thc building . it.(ni) ��' ' �, c� �° . ,'� ` Cl � 4owest adjacent�rade(Ll1G) �i 6. 2 (t. rn � u �� � CI I•lic he�t ad'�cenl radc I-InG •— �+_ ! ( ) .:, '' �l ��' ,�. r �J) J 1 �J ( ) _(L(ru) �_U '�i/�,�/�t . CI h) No.o(permanent openings(Oood vents)within 1 ft.above adjacent gradr_ ��.;�;�L!'` `'',` � U i)1'olal arca of all perm�.inent opening:.(flood venls}in C�h _ ,q,i�, (,��,�;��� NO. 1 5 2 .✓ 0�` 0 2—2 0 0 0 , ��CTION D-SURVGYOR, HNGIN�CR, OR ARCI-117�CT CCRTIrICATION This certilication is lo be signecl ar�c! scaled by a land surveyor,enc�ineer,or architect aulhorized by law to cerlify elevalion information. !cartlfy tlaat the in(om���tion in Seclion;/1, B, and C on fhis certircatc rcE�rescnls my Lesl ef(orls fo inlc�prr.f fhc da(�avai/abla 1 crndr,rstond ihat�nY f�lsa slaleaicnt mny bc punish�ble t�fine or imp�isonment under 9tt U.S. Code, Scction 1009. � • CI-r" �IER'S NAM�-- � NO. ,� J 2� lIC[NSL=NUMlsl:lt ----^.! �.����.��g`Z'.I I�LC�--�--- ' •� 'I'I'I i.- ^ COMI�/1NY NAML '�-------------------•::.---- _ ftCG. SURVL;Y01:__+_ � ALL:CrD SURVFXZ,NG , n�necr_ss �– —_._ crrv— `si.nii=_._.__--.--zi��coui=_—��`— 211II �,,,., ;.,i�r�a Sz�Rr�T CL�ARW��I� .�r�41�1��---------3.JJG5 �sicNn'ru�� � • � �� - ,- ` pnTr_ . 4 �ri:�.r.:r�i�ioNr_ ----- �f _ .��.��'�,-,l_. ------� 0-0 2-_2 0 0 Q—_.`—_,..J?7_4 2G_-:1_Z_G.3------�. .�__.__-------- =� A -o n t3'1-3 /11 G �� ��=- S1=F :f= _ �- � - - -, -� ,_ _ ., , , ,.....,, � r .vi_r, c �II�F I-Of2 CONI lt�ll.)n(ION Rf I I .�1CF"';nl.L l'f�l-.VInU'; I-(IITICIN� II'v71'Of:T!\N7: lii thc:sc spacce„ co��y lhe corresponclin� infor�riaGon(r�m JCCI.IOII A. (-OY II1SUf:1f1CC C:OfT}�)7��y USO: IlUILOING S"1"ItL"LT ADDItLSS(hicluclin�/\pt., Unit, Suite, and/or 131dg. No.)OI�P.O. ROUTG AND DUX NU. Policy Number 14 MIDWAY ISLAND • , � — -------------------- ,' `: CI7Y 51"AT[=. 7_II'CODL= Company NAIC Numbcr. CLEARWATER FLORIDA .. SLC'CION U-;,URVCYOR, GNGINEER, OR ARCWITGCT CERTI�ICATION (CON7INUED) _Co�.�y bc�lh sicles of Ihis(:Ievalion Certific7te for('I�communily o(fir,i�il, (2)insur,�nce a�enf/company, �ir�� 3 buildin owner. �r , � ) �J --------------_----------- ----..- ..__—.-----�------ � - ��� _--�-�- ....-___. ,___.._. (,c.1Ul I.:N'I:, ---- I__.I Checic here if atlachments � ��CTIUN L-[3UILUING f=LLVl1l'ION IWFORMA710N (SUR�IGY NOT RLQUIi�CD) FOR"LONE/10 l�NU 7_ONE A(WI7HOUT CirE)! Por`l_une/�O and Zonc/�(wilhout C3f-I�), complele Ite►ns L1 lhrouyi� L=4. If ihc Elev._�r;o��c�rr�r�<�<<�i::in(c>ncicrl for u:e as suppo�ting information/a�n LOM/l or!_OMR-F, Scction C nttist br, cvniplclecl. l=l, I]uilclin� Uiac�ram N�imber (Sclecl ihe building di�c�rani most similar to thc building for which this ce�lificate i:being completed- see pac�e;G and 7. If no diac�ram accuralely renresents the buildinc�, provide a slcetch or photoqrapfi.) G�. '1"he lop of lhe bottom iloor(includinc� basemenl or enclosure)of lhe biiildin� i;; �_�_� ft.(m) ���_�in.(citi) ���above or �_�below (checic one) the hic�liest adjacent�7rade. L=3. f'or(luildinc� Diac�rams G-a with o�enings(see pac�e 7), the next hiyl7rr iloor or clevated iloor(elcvalion U)of lhe buildin� is �_�__� «���») �-���in.(cm) above the highest acljacent c�rade. , _ L�. 1=or Zonc:n0 only: If no Iloocl de��lh iunnl.�er i;,availal.�lc, is lhc lop o(lhe bollon�floor cicv.ilcd in��cc:ordancc willi lhc conununily': _ tloodplain manac�ement ordinancc;'? �. -s�Yes ��� No �_..�'Unlcnowr�. 1"he local official mus�certifylhis inFormation in Section G. SGC710N F-PROPCRTY OWNGR(OR OWNCR'S RCPt2CS[NTA7IVG)C[f271FICATION Thr, property owncr or owncr's authorized representativc who completes Scclions/1, B,and G for 7_one n(vrilhout a P�MA-issucd or coinnwnity-issucd 13f=�)or 7_one AO must si�n hcre. -- _____.._._.,----- --------------------------------- - ---�-------�-------- f'I2UPkR�TY UWNCf2'S Ofi OWNI_li'.�AUl"1-IURILL=D I�EPRL=SLN'I'AllVl:'S NAML � __ _� �__ ----- -- l�DURLSS CI IY �_i--- --- ;`I I\I l --- LII'C01�f= � �. , --_ _- -- -- -- ------- ---------------- - ------- - _ ----- - ----- - . SIC�N/11 U12E_ D!�I G - ff L LI'FIONI. ----...._.....--------....____ COMMI:IJI.; - ----_._.----_ ...__------_-_---_ -------------- __ _____ • �_.� Checl< here if altachmenls � .�CC710N G-COMMUtvI7Y INI=ORMATION (OPTIONAL) 1'he loc�rl official who is authorixed by law or ordinance l0 7dminister the comm'Unity's(loodplain manac�ement ordinance can complele Sections A, L3, C (or C), and G of this C:levalion Certificate. C6mplete lhe.applicable ilem(s)and sign below. ' G�I. �__�The iniormation in Section C was lalcen from other documentation that has been signed and embossccl uy a licenseci surveyor, � enc�ineer,or architect who is aulhorized by state or local law to cerlify elevation informafion. (Indir,ale thc source and dato of the elevation data in the Comments area bclowJ ;� : V�'-• I._I n comnwnily o(ficial completed Section L (or a building located in lone A(witliout a f=I_MA-i::sued or co�rnii��nity-issued l3FE)or . lonc 110. G:l. �._���he following in(ormalion (Items G�4-G9) is providcd for conimunily flooclplain m.inac�emenl E�urpo;es. CG4. f'1:12MIT NUMD�ii U:,. DnTL=PL=12M17 IS6UED � GG. Un"I�C Cl�l2�fll'ICn'ft_UF COMPLInNC[/OCCUPANCY _"_"__"__ +_—��`'` __�__ - � IJJUIcD `__._____�._ � . , G7.�I�his ��crmit has been issucd for. ��� New Construction �___� Subslantial Improvcrnent ---1 G13. f._Icvr.ilion o(as-bi�ilt lowast iloor(includiii� basement)of lhc building'is: _,T,v fl.(n�)Dalum: ' G9. Ctf=r or(i�i 7_on�AO) dcpth o(11oc�cling al lhc buildirig;:ile'i:: -`-�--- ----fL(m)D�lum: r „'. " ` . tUC/1L 01=1=1CI11L'S N�ML -�----------- --- .I.ITLL -�+��—__.___.:_. ; CC)MMUNI'fY NAMC --_-------- -- ---=f�L1=P1-10N1= �----------- ---....___---------r-- —-- - - .�.��._ -------- ----- , ' �I(_;f�!/171JRL- uAl'L: ;,,•; ... _......---•--___._.....__._.--------- .. �, • �CONiMLN'I'; ._____. ._�_..__.._._.._.�__ � .. -----------__._��-----...�__._.____.._�_._.. _____.._------_•_.___.-----�-�_ . . 4 ----------------------- -.�_-��.-----.�_����_ ., ",�-,,—;-- . _____�__---•- ------.__.___..�-.-- _- - -- ,--- �-- '--�-'`�Check here if att�chments FLM/1�orm fl1-:s�,nU� ;�s �• . r;ri��.ncr-_s ni_t,i�r.r_viot�s F=Di'fIO1J5�