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107 MIDWAY ISLAND FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 ELEVATION CERTIFICATE Important: Read the instructions on pages 1 -7. �' $rF�JS'� SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use: � ILDING OWNER'S NAME Policy Number Rand Fi ueredo BUILDING STREET ADDRESS(Including Apt., Unit,Suite, and/or Bidg. No.)OR P.O. ROUTE AND BOX NO. Company NAIC Number 107 Midwa Island CITY STATE ZIP CODE Clearwater Beach FL 337 PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number, Legai Description,etc.) 29-15-08-43344-000-0330 BUILDING USE(e.g., Residential, Non-residential,Addition,Accessory,etc. Use Comments section if necessary.) Residential LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Ty • - ( ##°-##'-##.##" Of ##.�°) � NAD 1927 ❑ NAD 1983 � USGS Q � SUCS TY OF CtE�►RWATER SECTION B-FLOOD INSURANCE RATE MAP(FIRM) INFORMATION B1.NFIP COMMUNITY NAM &COMMUNITY NUMBER 62.COUNTY NAME 63.STATE � 125096 L'�-�� ;r��((� ��,,,.�+ Pinellas FL i � - B4.MAP AND PANEL 65.SUFFIX B6.FIRM IND�X B7.FIRM PANEL 68. FLOOD E3�. BASE FLOOD ELEVATION(S) N MBER DATE�'� EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use depth of flooding) '��;{�r,�0007 D 8/1�'� 8/19/91 AE 11 B10. Indicate the source of the Base Flood Elevation (BFE)data or base flood depth entered in 69. ❑ FIS Profile � FIRM ❑ Community Determined ❑ Other(Describe): B11. indicate the elevation datum used for the BFE in B9: � 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 � No Designation Date SECTION C -BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* � Finished Construction new Elevation Certificate will be required when construction of the building is complete. C, . duilding Diagram Number 1 (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.) 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 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. Show 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 1929 Conversion/Comments n/a Elevation reference mark used PCBM Does the elevation reference mark used appear on the FIRM? ❑ Yes � No o a)Top of bottom floor(including basement or enclosure) ��ft.(m) � � �, ,. o b)Top of next higher floor n/a ._ft.(m) `� o c) Bottom of lowest horizontal structural member(V zones only) n/a ._ft.(m) o o ;�-�- �� o d)Attached garage (top of slab) r��._ft.(m) E� � ±�C�^� a o e) Lowest elevation of machinery and/or equipment W� �±� �� . " � servicing the building f�,�... ��Q ��ft.(m) � ' ° �' � ? o fl Lowest adjacent grade (LAG) !._.P �� ft.(m) z'm o g) Highest adjacent grade (HAG) � .yUFt.(m) �� a � o h) No. of permanent openings (flood vents)within 1 ft. above adjacent grade n/a J r o i)Total area of all permanent openings (flood vents) in C3h n/a sq. in. (sq. cm) SECTION D-SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land sunreyor, engineer, or architect authorized by law to certify elevation information. I certify that the information in Sections A, 8, and C on this certificate represents my 6est efforts to interpret the data available. I understand that any fa/se statement may be punishab/e by fine orimprisonment under 18 U.S. Code, Section 1001. CERTIFIER:S NAME Carl M.Smith; Odalys C. Bello-Iznaga LICENSE NUMBER 3762;6169 Professional Surveyor and Mapper COMPANY NAME First Financial Surveyors, Inc. LB 6387 A RESS CITY STATE ZIP CODE 365 Aulin Avenue Suite Ovi do FL 32765 SIGNATURE � D TELEPHONE ' � .��G��'' /4071977-7010 FEMA Form 81-31, AUG 99 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,and/or Bldg. No.)OR P.O.ROUTE AND BOX NO. Policy Number 107 Midwa Isle CITY STATE ZIP CODE Company NAIC Number ClearwaterBeach FL SECTION D-SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) opy both sides of this Elevation Certificate for(1) community official, (2) insurance agenUcompany, and (3) building owner. COMMENTS o-84931 ❑ Check here if attachments SECTION E -BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(1NITHOUT 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 of the bottom floor(including basement or enclosure)of the building is _ft.(m)_in.(cm)❑ above or ❑ below(check one) the highest a�ja�ert�rade. E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor(elevation b) of the building is _ft.(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 the community's floodplain management ordinance?❑ Yes ❑ No ❑ Unknown. The local official must certify this information 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 ,�ESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS ❑ Check here if attachments SECTION G-COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized 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. G1. ❑ The information 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. ❑A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or Zone AO. G3. ❑ The following information (Items G4-G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-built lowest floor(including basement) of the building is: _ft.(m) Datum: G9. BFE or(in Zone AO) depth of flooding at the building site is: _ft.(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SI�URE DATE C� �NTS �EMA Form 81-31,AUG 99 REPLACES ALL PREVIOUS EDITIONS