400 MIDWAY ISLAND a
ELEVATIt�N CERTIFICATE o."'.B."°3o�'-°°"
ExprresMay31, 1993
FEDERAL EMERGENCY MANAGEMENT AGENCY
s' NATIONAL FLOOD INSURANCE PROGRAM
,�fTENT10N:Use of tl�is certi(icate does not provide a waiver o1 the flood insurance purchase requfrement. This torm is used only to
provide elevat(on Inlormation necessary to ensure compliance with applicable community(loodplain management ordinances,to
, �rmine the proper lnsurance premium rate,and/or Io supporl a request(or a Letter ol Map Amendment or Revision(LOMA or LOMR).
Instructions for completing this lorm can be found on the toliowing pages.
SECTION A PROPERTY INFORMATION fOR INSURANCE COMPANY USE
BUILOING OWNER'S NAME POLICY NUMBER
Kenneth A. Krauskopf
-------- ----- - - - -------- ---- --- -- - ---- --
STFlEET AODRESS(Includfng Apf.,Unit,Suite and/or B�dg.Number)OR P.O.ROUTE ANO 80X NUMBER COMPANY NAIC NUMBER
400 Midway_Islazid ----------------------
OTHER DESCRIPTION(lot and Block Numbers,elc.)
Lot 67, Unit 3 Island Estates of Clearwater
CITY STATE ZIP CODE
Clearwater Florida
SECTION 8 FLO00 INSURANCE RATE MAP(FIRM)iF1FORfNAT10N �
Provide the tolfowing Irom the proper FIRM(See Instructions): -
1.COMMUNIIY MUMBEH 2.PANEI NVMBER 3.SUFFIX A.DAIE CF�IRM I:JDEX 5.FI/iM ZONE 8.BASE�LOOD EIEVATION
(In AO 2ons�,use dspth)
125096 0007 D 8/19/91 AE 11.00'
7. indicate the elevatlon datum system used on the FIRM for Base Flood Elevalions(BFE): �X)NoVD'29 ❑Other(e4escribe on back)
8. For Zones A or V,where no BFE is provided on the FIRM,and the community has establ(shed a BFE tor thls building s�te,indicate
the community's BFE:I I I I ( I.U Ieet NGVD(or other FIRM datum-see Saction B, Item 7),
SECTION C BUILDING ELEVATION INFORMATION _
t. Using the Elevation Certificale Instructions,indicate the diagram number trom the diagrams found on Pages 5 and 6 tha4 best ' �
describes the subject building's reierence level _.1__ .
21a1. FIRM Zones A1-A30,AE,AH,and A(with BFE). Tf�e top ot the reierence level Iloor trom the selected diagram ts at an elevalion
at U�.�_?.).�1�teet NGVD(or other FIRM datum-see SecUon B, Item 7).
). FIRM Zones V1-V30,VE,and V(with BFE). The battom oi the lowest horixontal structurat member ol the reterence level(►om •
the selecled diagram,is at an elevat►on o!L11J_..1_�,�J tee!NGVD(or other FIRM datum-see Section B, Item 7).;
(c). FIRM Zone A(without BFE). The tloor used as the relerence level irom the selected dlagram is W.t..�feet above❑ or
below❑ (ct�eck one) the highest grade adjacent to the building.
(d). FIRM Zone AO. The(loor used as the reterence level Irom the selected diayram is L_U.0 leet above❑ or below[)(check
one)the highest grade adjacent to the building. It no flood depth number is available,is the buliding's lowest tioor(reference
level)elsvated in accardance with Ihe commu�ity's(loodplain management ordinance? (_] Yes (� No ❑ Unknown
3. Indicate fhe elevation datum system used in delermining the above relerence level�levations:L� NoVO'29 ❑ Other(describe
under Comments on Page 2). (NOTE: !/fhe e/evatlon detum used In messuring Ihe elevafions!s di//erent than Ihef used on
!hA FIRM (soe Seclio�B, ltem 7J, then converi ll�e elevations to the datu►n syslern used on the F/RM and shoiv the converslon
equat/on under Comments on Pege 2.)
4. Elevation reterence mark used appears on FIRM: � � Yes ���No (See Instruclio�s on Page 4)
5.The reterence level elevation is based on: fX� actual construction L� constructlon drawings
(NOTE: Use ol cons(rucllon drawings is only valld i/lhe bui/ding does not yel have the reference/evef/loor Jn p/ace,In whJch
case fhis certi/Icate will on/y be vadd lor Ihe building durJng fhe course o/conslrucfion. A post-construcNon E/evation Certllicate
wlll be required once consfruction!s complefe.)
6.The elevation ol Ihe lowest grade immediately adjacent to the building is:(._�_.I,_1_L6I.�3� feet NGVD(or other FlFiM datum-see _
Section B, llem 7).
SECTION D COMMUNITY 1NFOAMATION
1.it the community olticial responsibie for veritying buiiding elevations specifies that the re(erence level Indicated In Section C, item 1
Is not the`lowest tioor"as de(ined in lhe community's(loodplain management ordinance,the elevation of the building's"lowest
as detined by the ordinance is: LL..L_L_I__I.I..J teet NGVD(or other FIRM datum-see Section B, Item 7).
2. ate ot the slart of construction or substantlal improvement __—_._.______.___ ._.___ .
fEMA Form 81-31�MAY 90 REPLACES ALL PREVIOUS EDIilONS SEE REVERSE S�DE FOR CONIINUATION
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