31 MIDWAY ISLAND ELEVATION CERT1FiCATE O.M.B.NO3067•0077
Exp��esMay3�, 7993
FEDEAAL EMERGENCY MANAGEMENT AGENCY
. NATIONAL FLOOD INSURANCE PROGRAM '
A7TENTION:Use of this certificate does not provide a waiver of the tlood insurance purchase requirement. This form is used oniy to
�ovide elevation information necessary to ensure compliance with applicable communiry floodplain management ordinances,to
�termine the proper insurance premium rate,and/or to support a request for a Letter of Map Amendment or Revision(LOMA or IOMR).
Instructtons for completing this form can be found on the following pages.
SECTION A PROPERTY INFORMATION POR INSURANCE COMPANY USE
BUILDING QWNER'S NAME POLICY NUMBER
JEFFREY & DAWN DALMAN
STREET AODRESS(Indudinq Apt.Unit.Suite andlor Bldq.Number)OR P.O.ROUTE AND 80X NUMBER COMPANY NAIC NUMBEA
31 MIDWAY ISLAND
OTHER DESCfiIPT10N(Lot and 81o�c��m�ete�STATES OF CLEARWATER
LOT 21� UNIT 3 .
�C.�EARWATER, FLORIDA STAr� ZIPCODE
SECTION B FLOOD INSURANCE RATE MAP(F1RM)tNFOFiMATION
Provide the followiny from the proper FIRM(See Instructions):
t.COMMUNITY NUMBER 2 PANEI NUMBEN 3.SUFFIX 4.DATE OF fIRM INOEX S.FIRM ZONE 8.BASE FLOOD ELEVATION
(in AO Zon�s,uf�0spt�)
125096 0007 D 8/19/9I AE 11
i
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations(BFE): ❑NGVD'29 ❑�Other(describe on back)
8. For Zones A or V,where no BFE is provided on the F1RM,and the community has established a BFE for this building site,indicate
the community's BFE:�L�.0 feet NGVD(or other FIRM datum—see Section 8, Item'7), �
SECTION C BUILDING ELEVATION INFORMATION
�. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level Z_ .
�!a). FIRM Zones A1•A30,AE.AH,and A(with BFE). The top of the reference level floor from the selected diagram is at an elevation
of� � � � 9 •�feet NGVD (or other FIRM datum—see Section B, Item 7}.
(b). FIRM Zones Vt-V30,VE,and V(with BFE). The bottom of the lowest horizontal structural member of the reference level from
the selected diagram,is at an elevation of��.0 feet NGVD(or other FIRM datum—see Section B, Item 7).
(c). FIRM Zone A(without BFE). The floor used as the reference level from the selected diagram is I I I,1 I feet above� or
below❑ (check one) the highest grade adjacent to the building.
(d). FIRM Zone AO. The floor used as the reference level from the selected diagram is �.0 feet abcve❑ or below i! (check
one)the highest grade adjacent to the building. If no flood depth number is available,is the building's lowest floor(reference
level) elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown
3. Indicate the elevation datum system used in determining the above reference level elevadons:� NGVD'29 ❑ Other(describe
under Comments on Page 2). (NOTE: If the elevation datum used In measuring fhe elevatlons rs diHerent than thaf used on
the FtRM (see Sectlon 8, ltem 7J, then convert the efevatlons to the datum system used on the F1RM and show the conversion
equaiion under Commenfs on Page 2.)
• 4. Elevation reference mark used appears on FIRM: ❑ Yes ❑No (See Instructions on Page 4)
5. The reference level elevation is based on: �actual construction ❑ construction drawings
(NOTE: Use of construcilon drawings is onfy valid if ihe building does nof yet have the re/erencs leve!floor in place, in which
case this certi�cate wil/on/y be vaJid/or the building durrng the course of constructlon. A post-consiructlon Elevation Certi�cate
will be requi�ed once construcfion is comp/ete.)
6.The elevation of the lowest grade immediately adjacent to the building is:� � ' .:.'��eet NGVD(or other FIRM datum-see
Section B, Item�.
SECTION D COMMUNITY INFORMATION
�. If the communiry official responsible for verifying building elevations speciBes that the reference level indicated in Section C, Item 1
� is not the"lowest floor"as defined in the community's floodplain management ordinance,the elevabon ot the building's"lowest
floor"as defined by the ordinance is: �J.0 feet NGVD(or other FIRM datum—see Section B, Item 7).
2. Date of the start of constructfon or substantial improvement •
FEMA Form 81-31�MAY 90 REPlACES All PREVIOUS EDITIONS SEE REVERSE SIDE FOR COPIT�NWTiON