42 MIDWAY ISLAND FEDERAL EMERGENCY MANACGEMENT A(�tN(:Y O.M.B. No. 3067-0077
NATIONAL FL•OOD INSURANCE PROGRAM Expires July 31, 2002
� . � :. ELEVATION CERTIFICATE
T Im ortant: Read the ins�n�ctions on a es 1 -7.
SECTION A-PROPERTY OWNER INFORMATION 6or Insu�anoe Company Uss:�a��''�'����k
BUILDING OVIMER'S NAME PolicyNumber�!�'�f��""r";'�7 �:�^.,°
ERNEST H. McDOWELL � " ' ''" �' '""��'�"��
BUILDING STREET ADDRESS(InGuding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC.,Numbe[,; '�� .�,;.;:�,'a:
42 MIDWAY ISLAND '
CLEARWATER F�TE �4��8E
PROPERTY DESCRIPTtON Lot and Block Numbers,Tax Par 1 Number,Leyal Description,etc.)
LOT 8 UNIT 3 ISLA�D ESTATES OF CLEARWA�ER
BUILDIN(3 USE(s.�.,ResfdenUal,Non-rosidentfal,Additfon,Aooessory,etc. Use a Comments area,N necesaary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAI DATUM: SOURCE: L)GPS(Type):
( AqqK"-�N'-�.irtl►' or �N.�IqWlqlql�� �,_J NAD 1927 U NAO 1983 U USGS Cluad Map LJ Other:
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME 3 COMMUNITY NUMBER B2.COUNTY NAME B3.STATE
C1TY OF CLEARWATER 125096 PINELLAS FLORIDA
B4.MAP AND PANEL B5.SUFFIX B6.FIRM INDEX 67.FIRM PANEL B8.FLOOD B9.BASE FLOOD ELEVATION(S)
NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use depth oi floodin�)
125096-0007 D 8-19-91 8-19-91 AE 11
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in 89.
LJ FIS Profile LJ FIRM ��Community Determined LJ Other(Describe):
B11. Indicate the elevation datum used for the BFE in B9: U NGVD 1929 �� NAVD 1988 �J Other(Describe):
B12. Is the building located in a Coastai Bamer Resources System(CBRS)area or Othervvise Protected Area(OPA)? LJ Yes �,J No
Designation Date:
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. Building elevations are based o�: uConstruction Drawings' LJBuilding Under Construction' �,JFinished Construction
•A new Elevation Certificate will be required when construction of the building is complete.
C2. Building Diagram Number 7 (Select the building diagram most similar to the building for which this certificate is being completed-see
pages 6 and 7. If no diagram accucately 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.Ii the datum is different irom
the datum used for the BFE in Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion
cakulaUon. Use the space provided or the Comments area oi Seclion D or Section G,as appropriate,to document the datum conversion.
Datum M.S.L. Conversion/Comments
Elevation referenoe mark used G-3.5 EL=7. Does the elevation reference mark used appear on the FIRM? ,�Yes ��No
, ❑ a)Top of bottom floo�(including basement or enclosure) 4 , 89 ft. m � t�����
O _ ,
O b)Top of next higher floor 11 41 ft,�m� � tl ,,r ,;, � �.�,,,,��„ «�i;
O c)Bottom of lowest horizontal structural member(V zones only) 0 _�,�m� ,,., ._ - �
O d)Attached gerage(top of sleb) 4 . 89 ft.(m) �° : �,5^ fr' f' -r
O e)L o w e s t e leva t bn o f ma c hinery an d/or equipment W�` ' �- -°; F Y ; � �.
servicing the building(Describe in a Comments area.) 24 36 ft.(mj �� ' �. ;M
O ��owest adjacent(finished)grade(LAG) . 5 ft.(m) z's "� �/ .�; ..{'�� '
O g)Hlghest adjacent(finishe�grade(HAG) � �" " � r
ft.(m) � ..
O h)No.of pertnanent openings(flood vents)within 1 ft. above adjacent grade�,_ � '
O i)Total area of all pertnanent openings(flood vents)in C3.h 18]4 sq,in.(sq.cm) #2512 5-1-02 .
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION
This certiflcation is to be signed and sealed by a land surveyor,engine�r,or arohitect authorized by law to certiy elevation infortnation.
►ceitily that the inlon»ation in Sections A, 8, and C on this certi�cate rapresents my best eRorts to interpret the deta evailable.
I understend thef any false statement may 6e punishable by bne or imprisonment under 18 U S Code Sec6on 1001
GERTIFIER S NAME LI ENSE NUMBER
GEO�,GE A. SHIMP II �512
��Tt DENT GEORGE A SHIMP II & ASSOCIATES INC.
3�� E��SOTO BLVD. ��I�I HARBOR �S�ArE z�4���E
SIG
J B 'OZOZ83 DATE ;��P�
FEMA Form 81•31,JUl 00 SEE REVERSE SIDE FOR CONTINUATION REPLACES All PREVIOUS EDITIONS
IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use:
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,andlor Bldg. No.)OR P.O.ROUTE AND BOX NO. Policy Number
42 MIDWAY ISLAND
C�N STATE ZIP CODE Company NAIC�Number :
CLEARWATER FL. 34630 ,
°•" SECTION D-SURVEYOR,ENGINEER,OiZ ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community official, (2)insurance agent/company,and(3)building owner.
COMMENTS
- � Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REGIUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zone AO and Zone A(without BFE),complete Items E1.through E4. If the Elevation Certificate is intended for use as supporting
information for 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.The top oi the bottom floor(including basement or enGosure)of the building is L(�ft.(m) LUin.(cm) u above or LJ below
(check one)the highest adjacent grade. (Use natural grade,if available.)
E3. For Building Diagrams 6-8 with openings(see page 7),the next highe�floor or elevated floor(elevation b)of the building is
I I 1 ft.(m) �Uin.(cm)above the highest adjacent grade. Complete Items C3.h and C3.i on front of form.
E4. For Zone AO ony: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's
floodplain management ordinancel�Yes � I No I Unknown The local official must certify this infonnation 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,C(Items C3.h and C3.i only),and E fo�Zone A
(without a FEMA-issued or community-issued BFE)or Zone AO must sign here. The statements in Sections A, 8, C, and E ere conect to
the best o/my knowledge.
PFiVPERTY OWNER S OR OWNER S AUTHORIZED REPRESENTAT�VE S NAME
AODRESS CITY STATE ZIP CODE
1 NA URE DATE TELEPHONE
MMEN
Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The local officc�al who is authorized by law o�ordinance to edminister the community's floodplain management ordinance can complete
Sectlons A, B,C(or E),and G of this Elevation Certificate. Complete the applicable item(s)and sign below.
G1. Lj The infonnation in Section 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 elevation information. (Indicate the source and date of the
elevation data in the Comments area below.)
G2• LI A community official completed Section E for a buitding located in Zone A(without a FEMA-issued or community-issued BF�or
Zone AO.
G3. L)The following information(Items G4-G9)is provided for comrnunity floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY '
ISSUED ;
G7.This pennit has been issued for: L�New Constn�ction L�Substantial Improvement �
G8. Elevation of as-built lowest floor(including basement)of the building is:
G9. BFE or(in Zone AO)depth of flooding at the buitding site is: —ft•(m)Datum:
_,ft.(m)Datum:
L L OFFICIAL'S NAME TITLE
COMMUNI NAME TELEPHONE
� NAT R
DATE
COMMENTS
Check here if attachrr�ents
FEMA Form 81-31,JUL 00
REPLACES ALL PREVIOUS EDITIONS
� �1i a��u. . �G _...� �
. ✓
_ � -
' ' Na1�E: No instruments of record reflecting easemen��, ���:hts-nt-way� and/or M �
t owndrship were fumisheci this Surveyo�� except as show�►. , ' . ,
� as de icted on Flooc� Insurance
This property lies within Flood Zone �2 P
- Rate Map Communiry Panel ��5�6 0007H p�ed: June 1, 1983 � • _
(Aase F]�ood Sl: 11.00') �
GENERAL N()TES: If elevations a�e shown, such elevations are based on N(3�I.D.
1929 (MSL=0:00').
0 0 BENCHMARK:
gC,q�; ��� :��; BASIS OF BEARINGS: Record Plat '
I
BOlIND11RZ SURVEY: Lot 23, UNIT 3 ISIAND ESTATES OF CIFARWATEft, according t.o
the p].a►t thereo! se recorded in Plat Book lt7� Pagea 62 and 63, �-
publia Rscorda of Pinellae CountYs Florida. �•� -�
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' -FROM . CITY OF CLEARWATER -
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�� IR)aFd. IROi�� , a N ROD, (CM)=CONC. iui�NUiViEi�T
suav�r Nar v�u.in uN�ESS . � � TARGET LAND �URVEYING INC.
EMBOSSEO WITH SURVEY�RS SEAL. 3665 EAST BAY DRIVE, SUITE 204-143
PREPARED F'-OR AND CERTIFIEO TO: tARGO, FLORIDA 34641 PH: (813) 4461846
• Heins J. & Slisabeth Raeshink 1 here5y cenify that the survey represe�ted he�eon meets
Meri,cau SuretT Title the minimum requirements of Chapter 21 HH-6, Florida
An�erican Title qdrninisirative Code �
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Fortu _ a �� I � , �, - Field Survey ? 9��90
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� Phiiip C..Stock, RLS �3035 FB# 65`A P¢ 21
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