700 OSCEOLA AVE • r� ' ��v � dsc,�o�A�
. Rc p - oZ�"a�-/>.f88
Ro�� �. ►��,���.,�y
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` FEDERALEMERGENCY MANAGEMENTAGENCY O.M.B. No. 3067-0077
- � NATIONAL FLOOQtNSURANCE PRQGRAN� Expires December 31, 2005
�-L�V�4�'IO�1-�E�TaFaC�T�
SECTION A-PROPERTY OWNER INFORMATION For Insurance Company use:
BUILDING OWNERS NAME Policy Number
BAWIEW CLEARWATER,LLC
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bidg. No.)OR P.O. ROUTE AND BOX NO. Company NAIC Number
�oo rroR�oscEOLa a�.
CITY STATE ZIP CODE
CLEARWATER FL 33762
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.)
PARCEL ID#Q9-29-15-00000-4Z0-0400
e.g., esi en ia, on-resi en ia, i ion, ccessory,e c. se a ommen s area,i necessary.
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS T e:
� YP )
(##-##-##_##or##.####. ) �NAD 1927 �NAD 1983 �USGS Quad Map �Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM) INFORMATION
61.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME B3.STATE
CITY OF CLEARA�ATER 12509fi P�LL�S FLOR�!� �
64.MAP AND PANEL B7,FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6,ffRM INDEX DATE �ELTfVE7REVISED DATE B8.fLOCiD�OiVE
0008 D 8/19/92 8/19/91 VE,AE&X) ��VE 12 dep�thofl�l ding)
� ) � )
810,indiCate the source of the Base Flood ElevBtion(BFE)data or base flootl depth entered in B9.
❑FIS Profile �FIRM �Community Determined ❑Other(Describe):
B1 t.Indicate the elevation datum used for the BfE irt 69:��GUD i828 ��q�/}D1�J88 �Other(Describe):
892.Is the building located in a Coastal Barrier Resources System(CBRS)area or Othenvise Protected Area(OPA)? ❑Yes �No Designation Date
SECTION C-BUILDING ELEVATfON INFORMATION(SURVEY REQUIRED)
C1.Building e�evation5 are based on:Q Construction Drawings* �Building Under Construction* �Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2.Building Diagram Number 2 (Select the building diagram most similarto the building for which this certificate is being completed-seepages 6 and 7.If no diagram
accurately represents the building,provide a sketch or photograph.)
C3.Elevations-Zones AI-A30,AE,AH,A(With BFE),VE,V1430,V(With BFE),AR,ARA,ARAE,AR/AI-A30,AR/AH,ARAO
Complete Items C3:a-i below according to the building diagram specrfied in Item C2.State the datum used.If the datum is different from the datum used for the BFE in
Secton B,convert the datum to that used for the BFE.Show fieid measurements and datum conversion calculation,Use the space provided or the Comments area of
Section D or Sedion G,as appropriate,to document the datum conversion. -.
Datum NGV�19z9 Conversion(Comments o�R 4\ �w,�,9'11@��vlai�,�9 :
�leva;ion refererc2 mark used o� Does the elevation reference mark used a�pear an the FlRM? ❑Yes �No ���r As � tJ
a)Top of bottom floor{including basement or enGosure) . 19.0 ft.(m) �. �' .�'� '' �� po '�'<
cn �" �`. ° -�
b)Top of next higher floor 29.1 ft.�m� N �, Q� ��,^��, �" � r� °=�
c)Bottom of lowest horizontal struciural member{uzor�es only) -12:0 _{{{m) �� ��°"� �'� �:;.; ,�,a F �'-
d}Attached garage(top Of slab) 19.0 ft.(m) w � � �� `�;> �`?� o ^ �.
e)Lowest elevation of machineryandtorequipmeni- � � ' ` A . , �� ,�° � m
� �
servicing the building(Descri6e in a Comments area) 28.2 ft.(m) � " ` � ,�-
� � � �
Lowest ad acent fimshed rade LAG 199 Z� /T� `°
�l J (� )9 ( ) ft.(m) �� , ,:
g)Highest adjacent(finished)grade(HAG) 28.6 ft.�m� � "�; �'-�-�� �.. � '���
� � �:` ;�c ��-
h)No.of permanent openings(floodvents)within tft:above adjacent grade N/A {{,(m) '�4 Y�'�2/26/;(� ,�09
i)Totai area Of all permanent openings(flood vents)in C3.h NiA sq.in,(sq.cm) �'.;�,_< -���,?�<"
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certification is#o be sianed and sealed by a land surveyor;engineer;or architect authorized by law to certify elevatian information,
/certify that the infiormation in Sections A,B,and C on this certificate represents my best efforts to interpret the data available.
/understand that any false statement may be punishable by fine or imprisonment under 18_U,.S. Code,Section 1DD1,
CERTlFIERS NAME LICENSE NUMBER
CI�ARI,ES H.FOGELSONGER LS4148-2/25/04
TITLE COMPANY NAME
VICE-PRESIDENT HAMILTON ENGINEERING&SURVEYING
CITY STATE ZIP CODE
311 N.Newport Ave,Suite 100 Tampa FL 33606
SIGNAT DATE TELEPHONE
2/26/04 813-250-3535
IMPORTANT: In these spaces,copy the corresponding information from Section A ' '
For Insurance Company Us
BUILDING STREET ADDRESS(Including Apt,Unit,andlor Bldg.No.)OR P.O:ROUTE AND BOX NQ Policy Number
700 NORTH OSCEOLA AVENL7E
CITY STATE ZIP CODE Company NAIC Number
CLEARWATER FL 33767 �
SECTION D=SURVEYOR;ENGINEER;QK ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community official,(2)iosurance agenUcompany,and(3)building owner.
COMMENTS
Items C3: d-first and second levels are for parking;e-is an electric box attached to structure. Elevations are based on a site
benchmark having a reported elevation of 24.48 feet.(NGVD 1929) Not valid with out the signature and original seal of a Florida
Licensed Surveyor and Mapper.
❑Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFF.�
For Zone AO and Zone A(without BFE),complete Items EI through E4.If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F,
Section C must be eompleted.
EI.Building Diagram Number-(Select the building diagram most similar to the building for which this cert'rficate is being completed-see pages 6 and 7.If no diagram accurately
represents',he building,provideas#etch or photograph.)
E9.The top of the bottom floor(including basement or enclosure)of the building is_ft.(m) in.(cm)Q above or ❑Wow(check one)the highest adjacent grade,(Use
natural grade,ff av2ilable):
E3.For Building Diagrams 6-8 with openings(seepage 7),the ne�R higher fioor or elevated floor(elevation b)of the building is ft.(m)_in.(cm)above the highest adjacent
grade.Complete it�ms E31�and C3.i on front oi form.
E4.The top of the platform of machinery andlor equipment servicing the buiiding is ft.(m) in.(cm)Q above or❑below(check one)the highest adjacerrt grade.(Use
natoral grade,if available). —
E5.For Zone AO only:If nq flood depth number is available,is the top of the bottom floor elevafed 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 REPRESENTA7IVE)CERTIFICATION
The property owner or owner's authorized representative who completes Sections A,B,C(Nems C3.h and C3.i only),and E for Zone A(without a FEMA-issued or community-
issued BFE)or Zone AO must sign here.The statemants i�Sections A,B,C,�nd_E are coRect to fhQ bestnf my knawl�dge
PROPERTY OWNERS OR OWNERS AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
--- ❑Check here if attachments
�_,� SECTION G-COMMUNITY INFORMATION(OPTIONAL)
i he local official who is authoriz�d h�;law or ordinance to atlminister the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of ihis Elevation
Certif?;zte.Complefe the appiicanle item(s)and sign below.
G1.Q The information in Sectian C was faken from other documentation that has been signed and embossed by a licensed surveyor,engineer,or architect who is authorized by state
or lucal lan�to cert�i� eievation;nformation,(Indicate the source and date of the elevation data in the Comments area below.)
G2.[]A community officiai compietEd Section E for a building located in Zone A(without a FEMA-issued or community issued BFE)or Zone A0.
:3.[�The follo�ring irdonnation;iiems G4-G9)is provided for community floodplain managemerrt purposes.
� G4.PERMIT NUMBER G5.DATE PERMIT ISSUED 6. !
I
G7.This permit has been issued for: ❑New Construction ❑Substantial Improvement
c�t�(�v3!!^:1�f 25_IJUlM buue�fi.��\f^���d',^,y b�3Q^�E^,)Ci uh2���ld-^^y� . N r.,,� a�„ .
�„�� �T�.
G9.BFE or(in Zone AO)depth of fiooding at the building site is: ft.(m) Datum:_
LOCAL OFFICiAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
nrtio..�tio.e:s�rt�..ti...o..��
�G����'� ��-S �� FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
, NATIONAL F100D INSURANCE PROGRAM Expires December 31, 2005
ELI�VAT90N CERTIF9CATE
SECTION A-PROPERTY OWNER INFORMATION For Insurance Company use:
• BUILDING OWNERS NAME Policy Number
BAYVIEW CLEARWATER,LLC
BUILDlNG STREET ADDRESS(including Apt.,Unit,Suite,and/or Hldg.No.)Ofd P.O.RdUTE AND BOX NO. Campany PlAIC f�umber
700 NORTH OSCEOLA AVENLJE
CITY STATE ZIP CODE
CLEARWATER �LORII�A 33762
PROPERTY DESCRIPTION(Lot and Block idumbers,Tax Parcel Number,Legai Description,etc.)
PARCEL#09-29-15-00000-420-0400
e.g., esi e ia, on-resi n ia, i ion, ccessory,e c. se a ommen s area,i ecessary.
RESIDENTIAL
LATITUDElLONGITUDE(OPTIONAL) HQRIZONTAt DATUM: SOURCE: GPS(Type):
(##-##-##.##or##.####.) �NAD 1927 �NAD 1983 �USl3S Quad Map �Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
Bt.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME B3.STATE
CLEARWATER,CITY OF 125096 PINELLAS FLORIDA
64.MAP AND PANEL B7.fIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6. R IND X DAT EFFECTIVEIREVISED DATE 68.FLOOD ZONE(S) (Zone AD,use depth of flooding)
12103C0106 G 09/03/03 09/03/03 X,AE,VE AE(EL 12),vE(EL 14),vE(EL15)
810,Indicate the source of ihe Base Flood Elevation(BFE)data or base flaod depth entered in 69.
❑fIS Pr�le �FIRM ❑Community Determined ❑Other(Describe):
61 1.Indcate the elevation datum used for the BFE in 69:Q NGVD 1929 �NAVID 1968 ❑Other(bescribe):
612.Is the building Iocated in a Coastat Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No Designation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Buiiding elevations are based on:Q Construction Drawings` �Buildi4g Under Construc6on' �Finished Construction
*A new Elevation Certificate will be required whGn construction of the buiiding is complete.
..2.Building Diagram Number 3 (Select the building diagram most similar to the building for which this cer4ificate is being completed-seepages 6 and 7.If no diagram
accurateiy represents the building,provide a sketch w photograph.j
C3.Elevations•Zones AI-A30,AE,AH,A(With BFE),VE,V1430,V(With BFE),AR,ARA,ARAE,ARIAI-A30,AR/AH,ARAO
Complete Items C3.-a-i bebw 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
Secton B,wnvert the datum to that used for the BFE.Shaw fieid measurements and datum conversion calculation,Use the space provided or the Comments area of
Section D or Sedion G,as appropriate,to document the datum conversion.
Datum NAVn�9ss ConversionlComments o�
� �,
Elevation reference mark used o� Does the elevation reference mark used appear on the fIRM? ❑Yes �No ,w°`lr#� h � A=,,�
a)Top of bottom floor(including basement or enclosure) 18.1 ft.(m) d �;�",,�,,;-� „' `
b)Top of next higher floor 2g.2 ft.(m) a�°i w, x'��R +��„a""�o o a:� ��9 ,-.
c)Bottom of bwest horizontal structural member(V zones only) 20.4 ft.(m) n 4 �=�a p�"�'�l�� �� �p ;�
f P.I't'.
d)Attached garage(top Of slab) 18.1 ft.(m) w� �� °��°' ���
e)Lowest elevation of machinery and/or equipment a� � � �f° "' � '°
servicing the building(Describe in a Comments area) 20.8 ft.(m) ; � ;:� 4�� ' �" '
fl Lowest adjacent(finished)grade(LAG) 5.6 ft.(m) �`� �r;.�," �
g)Highest adjacent(finished)grade(HAG) 26.5 ft.(m) � ` ,°�. �'
. . .;�'.s4�
h)No.of permanent openings(flood vents)within i ft.above adjacent grade N/A ft.(m) J �` �=�1/O 1/04"
i)Total area Of all p�manent openings(flood vents)in C3.h NiA sq.in,(sq.an) �r���,r��i'` �e���,;<``
SECTION D-SURVEYOR,ENGINEER,OR ARCNITECT CERTIFICATION
This certification is tv be signed and sealed by a land surveyor,engineer,or architect author+zed by law to certify elevation information.
/certify that the information in Sections A,B,and C on thiS certificate represents my best efforts to interpret the data availabie.
/understand that any false statement may be punishable by fine or imprisonment under 18 U,S.Code,Section 1001,
CERTIFIERS NAME LICENSE NUMBER
CHARLBS H.FOGELSONGER,PLS LS4148
TITLE COMPANY NAME
�VICE-PRESIDENT HAMII.TON ENGINEERING&SURVEYING
CITY STATE ZIP ODE
311 N.Newport Ave, Suite 100 Tampa FL 33606
SIGNATUR �� �. DATE TELEPHONE
_.. .����-����_I�.�. 11/O1/04 813-250-3535
f�..,-
{��'��T,0.EdT:is�th�se����es,e¢�y 4he c�re�s�ao�adiaag inffar�atia�fao�SecBeon�4 For Insurance Company Use
BUII.DlhlG STREET ADDRESS(including Apt,Unit,andlor Bldg.No.)OR P.O.ROUTE FaN�BOX�0. Folicy tdumber
7d0��€�'�'�-i OS����l����I�N6J� � .
CIT�d � ST�TE � ZdF COD[ Com��ny V�P,EC Plumlicr
C�,�f�.��F�•r`�:�'�,�'� ���J��1� 33762
����'B�E��-��EP��.R�"�`�R,�����C����,t3@�����1�'�����€�'�P�'E�'�,�`�������B�T¢£�&�l�8]� � .
�Jji��uDlil,.���5 GT(�ua��:'i.._J�l 4..G-'-I"�i�t^u".l��S}i�1%Gfi.�`s;l?Utlf y�GT��.;����,��1�ll„��..i?., -��t.,G.`.Ftl�,�i V�211d��}�111�C���p��e.�i.;1'. �
Gr�fl•�!4"E�;'C�
Iter�s C3:o.ieweet lioiimiitsl a,em�er is 11a�t of the patio decic. B,�eed�n FE;.�iH R�zp anc i'snei;�'.am�er t2 iO3C O10E�,�.ed O9,'OiI03 ti�e�-�one crocses ihe patio araa aud rot The m�in uitildia�c$rsE ind s�d�nd 1rve1_s
are fer p�sFEng,e-�owest elevation ef;;�achinery and(�r er,�;iipment scnn.cing the bulring is rep:esented Uy tl�e ccxrete 2ir conditio�i.r,g p�d I�*.eo at tYe NorLhwest comer of tFee hui[3ing. Elevaticns are base.i on a siu:
bench�nark having a report=d eievatinn oi 24.48 ieet(1VGVD 1929).NGVI?1929 to NAVD 1 Ss&=-O.II"o feet.PIo2 valid wid�out tkte si�ature zrd ociginal sea(of a Flo�ida Licensed Sucveyor and P�r�per. �
❑Check here if attachments
S�CT643Pd E-�l1iLD6�(i E.�E�f�91Pl�Bd 6P����NE.ATl0�1�S�RV�EI°B�'�T€�EG4U€Pq��3)FOFt�C1t��AA AtVP3�0l�E A(q�iPRFB-EOUT t�FE)
For Zone AO and Zone A(without BFE),complete B4ems EI througfi E4.If th�Elevafion Certificate{s intended fior use as supporting information for a LOiUL4 or LO�iR-F,
Section C must be completed.
EI.Bwil�,ing�iagram Number-(Select the building diagram mosi similar to th�buiiding for which this ce�ificate is being compieted-see pages 6 and 7.If no diagram accura�ely
represerrts the buiitling,provide a sketch or photograph.)
E9.The top of the bottom floor(including basement or endosure)of the building is_ft.(m) in.(cm)Q above or ❑Wow(check one)the high�st adjacent grade,(Use
natUral grade,If availabie).
E3.�or Building piagfams&8 with openings(seepage 7),the ne�hi�her floor or elevated floor(elevation 6)o€the 6uilding is ft.(m) in.(cm)above the highest adjacent
grade.Complete items C3.h and C3.i on front of form.
E4.The top of the platform of machinery andlor equipment senrieing the buiiding is ft.(m) in.(cm)�above or�below(chec.k one)the highest adjacent grade.(Use
natural grade,if available).
E5.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 floodpla;n management ordinance?
❑Yes ❑No ❑Unknown,The local official must cerfrfy this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owner's authorized repsesentative who completes Sections A,B,C(Items C3.h and C3.i only),and E for Zone A(without a FEMA-issued or community-
issued BFE)or Zone AO must sign here.The s?afements in Sections A,B,C,and E are coRect to the best of my kno�ledge
PR�PERTY OWNERS OR OWNERS AUTHORIZED REPRESENTATIVE'S NAME
ADQRESS CITY STATE ZIP CODE •
51Gt�ATEJRE DATE TEL�PHONE
COMMENTS
❑Check here if attachments
SECTION G-COMN1UPdIrtY IhEFflRk9ATiON(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�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 archiiect who is au4horized by state
or local law lo certity elevation information,(Indicate the source and date oi the elevation data in the Comments area below.)
G2[]A community official completed Section E for a buiiding located in Zone A(wi4hout a FEMA-issued or community issued BFE)or Zone A0.
G3.[]The foNowing information ptems G4�9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5.DATE PEftM1T ISSUED �
G7.This permit has been issued for: ❑New Construction 0 Substantial Imp�ovement
G8.Elevaiion of as-built lowest floor(including basement)of the building is: ft.(m) Datum:
G9.BFE or(in Zone AO)d2pth of�looding at the building site is: ft.(m) Datum:
LOCAL OFFIGIAL'S NAME TITLE
COMMUNITY NAME TELEPHOhIE '
SIGNA7URE ! DATE
CQMMENTS ,
f j�lieiii r@�e ii wi�m�eiiii8i�e5
_
� C ITY OF C LEARWATER
• DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
POST�FFICE BOX 4/4g� CLEARWATER� FLO►�DA 33758-4748
MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CLEARWATER,FLO�uDn 33756
TELEPHONE�72� 562-4567 Fn�c(72� 562-4576
MEMO OF REVIEW FOR CORRECTNESS & COMPLETION
In accordance with participation in the NFIP/CRS program,all elevation certificates are required to be reviewed for correctness and completion prior to
acceptance by the community. This complete form shall be attached to all elevation certificates maintained on file and provide with requested copies of
elevation certificates.
The attached elevation certificate requires corrections by the surveyor of section(s) prior to acceptance by the community
X The attached elevation certificate is complete and correct
Minor corrections have been made in the below marked sections by Community Official
SECTION A-PROPERTY INFORMATION For Insurance Company Use:
A1. BUILDING OWNER'S NAME Policy Number
A2.BUILDING STREET ADDRESS(including Apt.,Unit,Suite,and/or Bidg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
CITY STATE ZIP CODE
A3. PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
A4. BUILDING USE(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)
A5. LATITUDE/LONGITUDE(OPTIONAL): HORIZONTAL DATUM: SOURCE:❑GPS(Type):
(##°-##'-##.##" or ##.###�{#°) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map❑Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME 63.STATE
B4.MAP AND PANEL g5.SUFFIX 66.FIRM INDEX DATE B��FIRM PANEL gg,FLOOD ZONE(S) B9•BASE FLOOD ELEVATION(S)
NUMBER EFFECTIVE/REVISED DATE (Zone AO,use depth of flooding)
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
❑ FIS Profile ❑ FIRM ❑ Community Determined ❑Other(Describe)
611. Indicate elevation datum used for BFE in B9: 0 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
'A new Elevation Certificate will be required when construction of the building is complete.
C2. 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.)
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.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 Conversion/Comments
Elevation reference mark used Does the elevation reference mark used appear on the FIRM? ❑Yes ❑No
e) Lowest elevation of machinery or equipment servicing the building(Describe in Comments area) ft.(m)
h) No.of permanent openings(flood vents)1ft.above adjencent grade
i) Total area of ali permanent openings(flood vents)in C3.h sq.in.(sq.cm)
Comments: , �
/
Date of Review: Community Official:
�levation cerfificates shall be maintained by the community and copies with the attached memo made availab/e by request
FRANK HIBBARD,MAYOR
GEORGE N.CRE"1'EKOS,COUNCILMEMBGR JOIIN DORAN,COUNC[LMEMRER
PAUL F.GIBSON,COUNCILMEMBER � CARLEN A.PE1'ERSEN,COUNCILMGMBER
��EQUAL EMYLOYMEN"I'AND AI�FIItMATIVE ACTION EMPLOYER�
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S�- d,� ►�� �, � -
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� I
�C- ? ����� �✓2--�`v�� FEDERA.L ENERGENCY MANAGEft�EI�T AGENCY —� �-- � �'"'
• NA i IflNAL FLOOD INSURANCE PROGRAM O.�`�.�. �o. 3067-0077
Expires December 31, 20Q5
, �@�,��������� ��������a��� a
�
- ��"",. . �,�n,..��-_�,,�_�� .
SECTION A-PROP�RTY OVt!NER INFORMA I ION For Insurance Comp2ny Use:
SUfLGlNG 04J�cRS NAAQE Folicy fi'umb�r
Bf�YVii:t�✓�CLFARW�?"i'ER,LLC
2UILD!h1G S i P.EE i A�JDRESS Qncluding Apt., Un�E,���ii�.enclor c�!dg.R!o.)OR P.O.ROUTE AND LOX P!O. Cempany P.Alr t�unber
700 NO�t"�H C3SCEOLA�VENUE
��TY S-iATE ZiP CODE
c�,���wE��p��p �t���p�� �����
PROPERTY pESCR1P i ION(Lot and Block t�umbers,Tax P2rce1 P�umber, Legal Desaiption,etc.)
PARCEL#09-29-15-00000-420-0400 I
e.g., esi en ia, on-resi en ia, i on, ccessory,etc. se a ommen s area,i necessary. �'
RESIDF,NTIAL !
LATITUDE/LONGITUDE(OPTIONAL) HORIZONiAL DATUM: SOURCE: GPS(Type):
(�#-�-�#.�or�;'#.�. ) �NAD 1927 �t�AD 19&3 �USGS Quad Niap �Other.
, SEC i ION B-FLOOD INSURANCE RATE PJiAP (FIRM) INFORA�ATION
B1.NFIP COMMUNITY�AME&COMMUNITY NUM.BER B2.COUNTY NAME 63.STATE
CLEARWATER,CITY OF 125096 PINELLAS �LORIDA
64.MAP AND PANEL B7.FIRM PANEL 69.BASE FLOOD ELEVATION(S)
NUMBER B5.SUfFIX 66.FIRM INDEX DATE EFfECTIVE/REVISED DATE B8.FLOOD 20NE(S) (Zone AD,use depth of flooding)
12103CO106 G 09/03/03 09/03/03 X,A:E,VE nE(EL i2),vt;(FI. 1a),vF(�:1,15)
810,indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in 69.
❑F!S Profile �FIRM ❑Communiiy Determined ❑Other(Describe):
61 1.Indicate the elevation datum used ior Yhe BFE in B9:❑NGVD 1929 �NAVID 1988 ❑Other(Describe):
612.IS the building located in a Coastai Barrier Resources System(CBRS)area or Othervvise Protected Area(OPA)? ❑Yes �No D�signation Date
— — --- - — -- - - ---------._._..__._....—_-- .... ___.__...
SECTION C-BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1.Buiiding elevations are b2sed on:Q Construction Dr2wings` �Building Under Construction' �Finished Construction
.A new Elevation Certificate will be required when construc�ion of the buiitling is complete. '
6uiiding Diagram Number � (Select the bui(ding diagram most similar to the building for�Krich this ce��cate is being completed-seepages 6 and 7.I�no�i2gram
accurately represents ihe b;ciiding,provide a sketch or photograph.)
C3.Eievations-�ones AI-A3d,AE,AH,A(With BFE),VE,V1430,V(Wifh 3FE),AR,ARA,F,RAE,ARlAI-A30,ARlAN,ARAO
Complete Items C3.-z-i below according to the building diagram specified in item;C2.Sfate the tlatum used.!f t�e da�um is dif�erent from the datum used for t1�e 6Fr in
Secton B,con�ert the daium to that used for the BFE.Show fieid measurements and datum conversion calculation,Use the space previded or±he Cemnenis area of
Section D or Section G,as appropriate,to document the datu�converson.
Datum NAw 198s Conversion/Comments ovcx
Elevation reference mark used ov�.R Does the eievation reference mark used appear on the FIRM? ❑Yes �t�lo i
a)Top of bottom floor(inciuding basement or enclosure) 18.1 ft.(m) a �
�
b)Top of next higher floor 28.2 ft.(m) � �, � . ,
c)Bottom of lowest horizontal structural mem6er(V zones only) 20.4 ft.(m) ��:� ' .
d)Attached garage(top Of slab) 18.1 ft.(m) w m
e)Lowest elevation of machinery and/or equipment �,�' '
� , �
servicing the building(Describe in a Comments area) 20.8 ft.(m) � =
�Lowest adjacent(finished)grade(LAG) 5.6 ft.(m) �"� ��
g)H i g h e s t a d j a c e n t(f i n i s h e d)g r a d e(H A G) 2 6.5 $,(m) � ' /������
h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade N/A ft.(m) J G'� LS4148=11/O1/04
i)Total area Of ali permanent openings(flood vents)in C3.h wn sq.in,(sq.cm)
SECTIOPJ D-SUR1/EY�R,�RlGi�lEER,0�2 AE�CHITECT CERi'{FICATEON
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to c2riify eleva5on information.
/certify that the information in Sections A,B,and C on this certificate represents my besf efforts 4o interpret the dafa available.
/understand that any false statement may be punishable by fine or imprisonment under 18 U, S. Code,Section 1001,
CERTIFIERS NAME LICENSE PJUMBER i
C�IA.RLES H. FOGELSONGER,PLS LS4I48
T�TLE COMPANY NAME
:E-PRESIDFNT Hf1MILTON ENGINEERIIVG c�c SURV�YING
^� CITY STATE ZIP CODE
311 N.Newport Ave, Suite 10t? i ampa FL 33606
SIGNATURFi�'�% �, DATE TELEPHONE
___����i�ii4��!�s.-�--- 11/O1/04 813-250-353�
. '�av /1/. Ds cPo�.
unique identifier assigned by the maintainer of the benchmark. Also provide the vertical datum for the benchmark elevation.
' S'�nw the conversion from the ficld survcy datum used if it differs from the datum used for the BFE entered in Item B9 and
•itc thc conversion soitware used. Ali eievations for the certificate, including the elevations for Iteins C2.a-g, must be
enced to the datum on which the BFE is based. Sh�w the datum conversion, if applicablc, in this section or in the
C;omments area of Scction D. For property cxperiencing ground subsidence, thc most recent referencc mark cicvations must be
used for dctcrmining building elevations. However, when subsidence is involved, the BFE should not be adjusted. Enter
clevations in Items C2.a-g to the nearest tenth of a foot(nearest tenth of a meter, in Puerto Rico).
Items C2.a-d Enter the building elevations (excluding the attached garage) indicated by the selected building diab ain (Itein
A7.) in Items C2.a-c. If thcre is an attached garage, enter the elevation for top of attached garage slab in Item C2.d. (Because
clevation for top of attached garage slab is self-explanatory, attached garages are not illustrated in the diagrams.) If thc
building is located in a V zone on the FIRM, complete Item C2.c. If the flood zone cannot be determined, enter elevations for
all of Items C2.a-g. For buildings in A zones, elevations a,b, d,and e should be measured at the top of the floor. For buildings
in V zones, elevation c must bc measured at the bottom of the lowest horizontal structural member of the floor (see drawing
below). For buildings elevated on a crawl space, Diagram 8, enter the clevation of the top of the crawl space floor in Iteii,C2.a,
whether or not the crawl space has perinanent flood openings (flood vents). If'any item� does not apply to the hc�ilding, enter
, "N/A",f'or not applicuble.
BUILDING ON BUILDING WITH BUILDING ON PILES,�
SLAB BASEMENT PIERS,OR CpLUMNS
��I CZ.a A ZONES V ZONES C2.a A ZONES V ZONES
\���� �\�
1 '� -`-�-_-��.----�
A ZONES / 'J''�-
i%,�i yi%�i 5�%/,. !�i' _ �1�.' ,�
— �
C2.8 j
. j .� C2.c
BASE FLOOD � �
ELEVATION CZ.0 BASE FLOOp:','..` \
ADJACENT ELEVATION ' ' /� \
GRADE � \ DJA'CENT
``...'•;..�".,.:'!:;•,.'':;':.;'� :'.<.'•,..
GE2P,DE
Item C2.e Enter the lowest platform elevation of at least one of the following inachinery and equipinent items: elevators and
their associated equipmcnt, furnaccs, hot water heaters, heat puinps, and air eonditioners in an attached garage or enclosurc or
on an open utility platform that provides utility scrvices for the building. Note that elevations for thcsc speci�c machinery and
equipment iteins arc rcquired in ordcr to rate the building for flood insurance. Local floodplain inanagement officials are
requircd to ensure that all machinery and equipment servicing the building are protected from flooding. Thus, local officials
may rcquirc that elcvation information for all machinery and equipment, including ductwork, be documented on the Elevation
Certificate. If thc machinery and/or cquipment is mounted to a wall, pile, etc., enter the platforin elevation of the machincry
and/or equipment. Indicate machinery/equipment type in the Comments arca of Section D or Scction G, as appropriatc. If this
item c�oes not apply to the huilding, enter "N/A"f'or not applicable. �
Items C2.f-g Adjacent b ade is defined as the elevation of the ground, sidewalk, patio slab, or deck s'�pport immediately next
to the building. If the certificate is to be used to support a request for a I.OMA ar LOMR-F, providc in thc Comincnts area the
lowest adjacent grade clevation measured at the deck support or stairs if that elevation is lower than the building's lowcst
adjacent grade. For Zone AO, use the natural grade elevation, if availablc. This mcasurement must bc to the nearest tenth of a
foot (nearest tenth of a inetcr, in Puerto Rico) if this certifcate is bcing used to support a rcquest fo:a LOMA ar LOn�R-F.
SECTION D-SURVEYOR,ENGINEER, OR ARCHITECT CERTIFICATION
Complete as indicated. This section of the Elcvatiori Certificate may be signed by only a land surveyor, engineer, or architect
who is authorized by law to ccrtify elevation information. Place your license number, your seal (as allowed by the State
licensinb board), your signature, and the date in the box in Section D. You are certifying that the information on this certificatc
�sents your best efforts to interpret the data available and that you understand that any false statement may be punishable
Instructions—Page 4
. ��� � OSceoC�
I3iJILDING DIAGI2AMS
'I'he following cigl�t diagrams illustrate various typcs. of buildings. Co�i�ipare the features of tlie builditig beiug
• certi(ied with the features shown in the diagrams and select tl�c diagram most applicable. Enter the diagram
number in ltem A7., the square I-ootage of�crawi space or enclosure(s) and ttie area of flood openings in square
inches in ltems A8.a-c, the square footage of attached garage and the area of flood openings in syuare inches in
Items A9.a-c, and the elevations in �ltems C2.a-g.
In A zones, the floor clevation is taken at the top finished surface of the floor indicated; in V zones, the floor
elevation is taken at the bottom of the ]owest horizontal structural member (see drawing in instructions for
Section C).
DIAGRAM 1 DIAGRAM 2
All stab-on-grade single-and multiple-floor buildings All single-and multiple-floor buildings with basement
(other than split-level)and high-rise buildings,either (other than split-level) and high-rise buildings with
detached or row type(e.g.,townhouses);with or basement,either detached or row type(e.g.,
without attached ara e. townhouses •with or without attached ara e.
Distinguishing Feature—The bottom floor(basement or underground
Distinguishi�g Feature—The bottom floor is at or above yround level qarage)is below yround level(grade)on all sides. Buildings constructed
(yrade)on at least one side.' above crawl spaces that are below grade on all sides should also use this ,
diagram.'
C2.b
C2.a � NEXT HIGHER � C2.a � i
i FLOOR _
' ' C2.b
NEXT HIGHER
FLOOR
GRADE BOTTOM FLOOR
\ GRADE
80TTOMFLOOR
1 (BASEMENT)
,: -
;:. , ;.. {. :'.i•.
_
. .
, _ ;. � , i ::r.
• C2 f g. edesti g��eadej. . `C2 f g; Edes ngige de),`.. .
DIAGRAM 3 DIAGRAM 4
All split-level buildings that are slab-on-grade,either All split-level buildings(other than slab-on-grade),
detached or row type(e.g.,townhouses);with or either detached or row type(e.g.,townhouses);with or
without attached garage. without attached garage.
Distinguishing Feature—The bottom floor(excluding garage)is at or Distinguishing Feature—The bottom Ooor(basement or underground
above qround level(,yrade)on at least one side.' garage)is below yround level(grade)on all sides. Buildings constructed
above crawl spaces that are below grade on all sides should also use this
diagram.'
C2. /g'/ � '
� �
' a$', Z C2.b C2.a C2.b
HIGHER i
FLOORS i HIGHER
NEXT HIGHER GRADE FLOORS
FLOOR NEXT HIGHER
RADE gOTTOM oOTTOM FLOOR f LUOR
\ LOOR _ (BASEMENT)_
y` .. ., ���� �
, ,
�
..�. . ..:.� . "_..-�_---,, ..::� . .����.'��, � .�. �'- ' �� ��� �..;.1'.
�:. ..� _.�: .. �, .�,...� ��� �'�� . . . .
��. .r. ?..: .-..-.~�� , i �. �:. . � � . . ..
�� (d�teri�imed bX (deteTmined by`:
G2:f g eXisting grade)' " ' ' � C2•f"g existing grade)
•* A (loor that is bclow ground level (grade)on all sides is considered a basemcn[even if thc floor is uscd for living pumoscs,or as an officc,
garage,workshop,etc.
lnstructions--PaSc 7
. . . .
. ' ROWE & NEWBERRY� �NC. TELEPHONE 727/323-1900—FAX 727/323-1323
GENERAL CONTRACTORS 2728 20T"AVENUE NORTH,ST.PETERSBURG,FLORIDA 33713
T0: City of Clearwater Date: March 15, 2004
RE: Bayview Condominiums
700 North Osceola Avenue
Clearwater, Florida 33755
Attention:
WE ARE SENDING YOU (x) ATTACHED ( ) UNDER SEPARATE COVER VIA
COPIES RETURN Descri t1011
1 Of the signed and sealed elevation certificate from Hamilton Engineering.
Received By:
Date Received:
cc: P.A.C. Land Develo ment
THESE ARE BEING TRANSMITTED AS MARKED BELOW
FOR APPROVAL COORDINATION EXECUTION &RETURN
xxx FOR YOUR USE FOR YOUR INFORMATION PRICE QUOTATION
xxx FOR YOU FILES FOR FURTHER PROCESSING FOR DISTRIBUTION
YOUR REVIEW&COMMENTS OTHER—
APPROVED APPROVED AS NOTED NOT APPROVED
RESPONSE REQUESTED For Payment RESUBMIT COPIES
Remarks:
xxx File:PT Delivered
xxx Superintendent:Phil Tyler 3-5-04
Other-
�aMCaa 7JlG. �a.,�caaalt. �i./'!�t'1/
James M.Zumwalt,Jr.
President
��%/"':�'-G�� � �✓�S �� FEDERAL EMERGENCY MANAGEMENT AGENCY
O.M.B. hJo. 3067-0077
NATIONAL FLOOD INSURANCE PROGRAM Expires Qecember 31, 20Q5
� EL��ATE��1 �ERT�����AT�
�
. e ' SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use:
BUILDlNG C�b'Vt�ERS NAME Policy Number
BAYVIEi7aT CLEARVVATER,LLC
BUl�D(NG S�REET ADDRESS(lnduding Apt.,Urit,Suite,and/or Bldg.No.)QR P.O.ROUTE A�!D�OX fsO. Company RA�G Rumher
7�0 NOR'i'�-Z OSCEQLA AVENt_TE
CITY STF�TE ZiP CQQE
CI,��Ri��f',TER FI.�RI�3� .i3762
PR�PERTY DtSCRfP i iON(Lot and 81ock Numbers,Tar.Parce!Plurnber,Leqai Qe,cription,eicJ
PARCEL#09-29-15-00000-420-0400
e.g., esi en ia, on-resi en ia, i on, ccessory,e c. se a ommen s area,i necessary.
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS(Type):
(##-�l#-##.##or##.####.} �NAD 1927 �NAD 1983 �USGS Quad Map �Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
81.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME 63.STATE
CLEARWATER,CITY OF 125096 PINELLAS FLORIDA
B4.MAP AND PANEL B7.FIRM PANEL 69.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX 86.fIRM INDEX DATE EFFECTIVE/REVISED DATE 68.FLOOD ZONE(S) (Zone AD,use depth of flooding)
12103C0106 G 09/03/03 09/03/03 X,AE,VE aE(Et,12),vE(EL 1a),vE(EL15)
810,lndicate the source of the Base Fiood Elevation(BFE)data or base flood depth entered in B9.
❑FIS Praiile �FIRM ❑Community Oetermined ❑Other(Describe):_
61 1.Indicate the efevation datum used for the BFE in B9:Q NGVD 1929 �NAVID 1988 ❑Other(Describe):
612.ls the building located in a Coastal Barrier Resources System(CBRS)area or Othenvise Protected Area(OPA)? ❑Yes �No Designation Date_
SECTIOM C-BUILDING ELEVATION(NFORMATION(SURVEY REQUIRED)
C1.Builc�ing elevations are based on:Q Construction Drawings* �Buildirlg Under Constructlon* �Finished Construction
*A new Elevation Certificate will be required when constn�ction of the building is compiete.
� :2.Building Diagram Number 3 (Select 4he building diagram most simila�to the building for which this cert�cate is being completed-seepages 6 and 7.If no diagram
accurateiy represents the building,provide a sketch or photograph.)
C3.Elevations-Eones AI-A30,AE,AH,A(With BFE),VE,V1430,V(With BFE),AR,ARA,ARAE,AR/AI-A30,ARfAH,ARAO
Complete Items C3.-a-i bebw according to the building diagram specified in Item C2.Sfate the datum used.If the datum is different from the datum used for the dFF in
Secton B,convert the datum to that used for the BfE.Show fieid measurements and datum conversion calculation,Use the space provided or the Commenis area of
Section D or Section G,as appropriate,to document the daium conversion.
Datum NAV��9ss Conversion/Comments o�
Elevation reference mark used o� Ooes the elevation reference mark used appear on the FIRM? ❑Yes �No
a)Top of bottom floor(including basement or enclosure) 18.1 ft.(m) N fl,.
b)Top of next higher floor 28.2 ft.(m) a m . •,'6�"
c)Bottom of bwest horizontal structurai member(V zones only) 20.4 ft.(m) �4 ". � ,
d�Attached garage(top Of slab) 18.1 ft.(m) W m �+- �`'
e)Lowest elevation of machinery and/or equipment � � `
servicing the building(Describe in a Comments area) 20.8 ft.(m) � 6 ' �
fl Lowest adjacent(finished)grade(LAG) 5.6 ft.(m) �; -� /' � �
g)Highest adjacent(finished)grade(HAG) 26.5 ft.(m) g� �����v
h)No.of permanent openings(flood vents)within I ft.above adjacent grade N/A ft.(m) �' ��LS41�8=11/O1/04
i)Total area Of all permanent openings(flood vents)in C3.h NiA sq.in,(sq.an) '
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer,or archi#eCt authorized by law to certify elevation information.
/certiiy that the information in Sections A,B,and C on this certificate represents my best efforts to+nterpret the data available.
/understand that any false statement may be punishable by fine or imprisonment under 18 U,S.Code,Section 1001,
CERTIFIERS NAME LICENSE NUMBER
CHARLES H.FOGEL50NGER,PLS LS4148
TITLE COMPANY NAME
• VICE-PRESIDENT HAMII.,TON ENGINEERiNG&SURVEYlNG
CITY STATE ZIP ODE
311 N.Newport Ave,Suite 100 Tampa FL 33606
SIGNATUR ��,� DATE TELEPHONE
_��;�� /T���'�.-�..�-�..._. 11/01/04 813-250-3535
�
IF�K'f��tTFcP�'�:1r�dh�se��aees,capy�he��re���oediaag E�ffoerr�at'smn�ao�SeraE�,�� For Insurance Company flse
BUILDIh�G STPEET ADDRESS(includino Apt,Unit,andlar Bidg.i�o.�QR P.O.P,OUTE AND BOX iv0. Folicy fcumber
7C�Q�T��.�'��5���'s�,R_A�I�?J'UE
CI I Y ST.�,TE � =�IP CODE Compeny f��,fC h�umber _
��.�'��s�'��"r'f�fi�s�J_'.� F�`L���/'$ 2.3%�32
����'8�E'a E'r°�`t€i�'e�'C6�,�E'���«��E'�,�,^°r,����;;�'�<V���:s�Ef��€E�;`a��€�4�fiEs"'�m��"��
���:�uvtii Sv�S u�.i:.i4S�;�<<.:-��.i�i vG:�.;>:,.:�_:Gi(1�C�-i�,"�"�lry�., �.."� ;i;..is��. ,.x� �G�Pt��, .i,`;e_�;�;al' � _ ., .t.. t �
C��E�ria�:�=Cc
Iterns�C;.c�ov.-�i h�z�cnt_1 m�rr:�e�.s�isat o`:hz pzna deck. �-�en„,F�,�_4 1:� .. �ai . __.. _, �Ol r��s,u�c�0>:C�iG',d�e�i�,�e r.^•�ses t�c*+•.�o nrzc e��Z i�ot�he r,e:r.L^,,.'.o'.�,d-`.�:��z�se�.,,u In-zis
are fo:p�;k�ag;e-L,wes?c-;evation of�ach_�nery and/or✓.�;irn.en[sc:v!cir.g:he b��1�:,�is represe,-,tca oy u�e eescrete��r con�doir.g psd lrn;�ta;�i;;:eh�orLh�,'CSS C01T°C GCS.h?haitdir.�. ELvzficss acc bse'on a siw
bencF.n:zrk hav;n�z-�Ported e?evavon e:4.4.48 feet(NGVD 1929j.IQG'���3929 to TdqVD 1SES=-0_IIo feet Not e•alid wiih out tie siepa!tre z:�d originr�sezl cf a Flai;a Licer,ced Sucveyor and hQeuper.
❑Check here if attachments
�EL'TIG`P�9 E-�'�3iLC3eR.P`s EL��,�A.�6�r9 EPd��B�',�fffATB��(5l1�.��`�`€V�!r°T�.��9.��P•.E�)��R�Qty"�690 AIV6]�Z�B14E e�Q�€d@Y!-lQJ7[$F�p
For'cone AO and Zcne A(v�i4hou4 BFE),complete Ifems EI throuyh E4.I�th�Elevatiu�Certificaie is inter�ded ror use as supporfing infiorma°.ion for a LOF�J�or LQhhR-F,
Section C must be completed.
EI.Buiiding Diagram Number-(Select ihe building dia�ram most similar to the building for which this ce�tific�te is bcing completed-see pages 6 ancl 7.If no dizgram accurately
represerrts the building,p��ovide a sketch or phatograph.)
E9.The top of the bottom floor(including basement or endosure)of the building is_ft.(m) in.(cm)Q above or ❑Wow{check one)the highest adjacent grade,(Use
nat�ral grade,If avail8hie).
E3.For Building Diagfams&8 with openings(seepage 7),the next higher floor or elevated floor(elevatian 6)of the 6uilding is ft.(m) in.(cm)abave ihe highest adjace�t
grade.Complete items C3.h and C3.i on front of form.
E4.The fop of the platform of maehinery andlor equipment servicing the buifding is ft.(m) in.(cm)Q above or�belaw(chec,k one)the highesf adjacent grade.(Use
naturai grade,if available).
E5.For Zone AO oniy:If no flocd depth number is available,is the top of the bottom floor elevated in accordance with the community's floodp!ain management ordinance?
❑Yes ❑Mo ❑Unknown,The local official must cetfrfy this information in Section G.
SECTIQP!F-PRQPERl'Y�IMNER(OR OWPdER'S REPRSSENTATIVE)C�itTIFIGA710N
?�� .+....W c �a�+I,...��e.1 b e��±;,re�.h�� m lofo�Cor±,�n�A R r.n+�m�r3 h�,,,�r.3�,�,iv� anrl F fnr 7nna A Iwrfhn��t a FFMA-i55i�P�1�t Cpmi?lUfllfV-
�propC„r ,.�erGr,.,.,.,,..�� ,.u,..,,�v,.,,.N,es., ,,
„ ., , ..o„^ . ..,..,..�....... . . ...,,,-
issu�d BFt)ar�on�AO must sign hcre.7he s±atements in Sections A,B,C,and E are correcf to the best of my knowiedge
PR�PERTY OWNERS OR OWNERS AUTHORIZED REPRESENTATIVE'S NAtJIE
A�QRESS CITY STATE ZIP CODE �
SIGN?TURE DATE TELcPHONE
COMN(ENTS
❑Check here if attachments
SECTI�PI G-GORAlI�UPdItY Ih6FORRAATIOP!(OPTIONAL)
The local officia!who is authorized by law or ordinance io administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation
Certificate.Complele the applicabie item(s)and sign below.
G1.Q The information in Section C was taken from other documentation that has been signed and em4ossed by a licensed surveyor,engineer,or architect who is au4horized by s�ate
or local lav�fo cetify elevafion informafion,(indicate the source antl date oi the elevation data in the Comments area be�ow.)
G2.Q A community ofiicial completed 5ection E for a building locaied in Zone A(without a FEMA-issued or community issued BFE)or Zone A0.
G3.[�The�ollowing inform2tion(Items G4�9)is provided for community floodpiain management purposes.
G4.PERMIT NUMBER G5.�ATE PERMIT ISSWED 6. I A A Y
G7.This permit has been issued for: ❑New Construction Q Substantiai Improvement
G8.Elevaiion of as-built lowest floor(induding basement)of the bui�ding is ft.(m) Datum:
G9.BFE or(in Zone AO)depth of flooding at the building siYe is: ft.(m) Datum:
LOCAL OFFICIAL'S NAME TiTLE
COMMUNITY NAME TELEPHONE
S�GhEATURE � DATE
CQM1AMENTS
L._�_
� �liliCi:Il IICiC 11 QL6ifl1.PlitICIfIJ
�G��L�-�' — �.� 5 ��� FEDERAL EMERGENCY MANAGEMENT AGENCY
O.M.B. No. 3067-0077
, NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
EL���TIAN CERT�F9�AT�
, �
SECTION A-PROPERTY OWNER INFORMATION for Insurance Company Use:
BUILDING OV'dNERS NAlVIE Rolicy Number
BAYVIEW CLEARWATER,LLC
BUILDING STREET ADDRESS(Including Apt., Urif,Suite,and/or Bldg.Mo.)QR P.O.ROUTE AMD EOX MO. Cem�any haEC f�umber
700 NORTH OSCEOLA AVENUE
CITY STATE ZIP CODE
CLEARWATER FLORI3?A 3376�
PROPERTY DESCRiPTION(Lot and Block Numbers,Tax Parcel�lumber,Legal Qescription,etc.)
PARCEL#09-29-15-00000-420-0400
, esi e a, on-r si n ia, i o , ssory,e c. a ommen area, sary.
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS(Type):
(##-##-##.##or##.####.) �NAD 1927 �NAD 1983 �US�S Ouad Map �Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
Bt.NFIP COMMUNITY NAME d COMMUNITY NUMBER 62.COUNTY NAME 83.STATE
CLEARWATER,CITY OF 125096 PINELLAS FLORIDA
84.MAP AND PANEL 87.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
N M ER B5.SUfF 6. EFFECTIVElREVISED DAT 68.FLOOD ZONE(S) (Zone AD,use depth of flooding)
12103C0106 09/03/03 -�f93�6�3� X,AE,VE AE(EL 12),VE(EL 14),vE(ELIS)
SfO,Indica�the source of the Base Flood ElevaHon(BFE)data w base flood depth entered in B9.
❑FIS Profde �FlRM �Community Determined �Other(Describe):
81 1.Indicate the elevation tlatum used for the BFE in B9:Q NGVD 1929 �►�AVID 1988 ❑Other(Describe):
612.Is the bu�ding located in a Coastat Bartier Resources System(CBRS)area or Otherwise Protected Area(OPA)7 ❑Yes �No Designation Date
SECT101d�-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
1 Bulkiing elevations are based on:❑Conswction�rawings� �Buildirig Under Construc6on` �Fm�ghed Construction
� 'A new Elevation Certifu�te will requireed when constnidion of the buifd'mg is complete.
d
.2.Bw'Iding Diagtam Number 3 Select the buiiding diagr�n most similar to the building for which this ceRificate is being completed-seepages 6 and 7.H no diagram
acauately repre�nts the bulding,provide a sketch a photograph.)
C3.Elevations•Zones AI-A30,AE,AH,A(With BFE),VE,V1430,V(With BFE),AR,ARA,ARAE,AR/AI-A30,AR1AH,ARAO
Canplete ftems C3.-a-i bebw according to the build+ng diagram specified in Item C2.State the datum used.If the datum is d'rfferent from the datum used for the BFE in
Sedon B,convert the datum to that used for the BFE.Show field measurements and datum conversion ca�ulatia�,Use the space provided or fhe Comments area of
Section D or Sedron G,as appropriate,to documeM the datum conversion.
Datum xnvv i9ss Conversion/Comments o�
Elevatan reference mark used o� Does the elevation reference mark used appear on the FIRM? ❑Yes �No
a)Top af bottom floor(induding basement or encbsure) 18.1 ft.(m) N
b)Top of next higher floor �8.2 ft.{m) �m
c)Bottom of lowest horizontal structural member(V zones only) 20.4 ft.(m) o�
��9�9e nop Of slab) . 18.1 ft.(m) w�
e)Lowest elevation of machinery andlor equfpment m �
serviang the building(Describe in a Commer�s arna) ✓�0.8 ft.(m) ��
�Lnwest adjaceM(finished)grade(LAG) 5.6 ft.(m) �`� , ! ��
9)Hi�e�adJaceM(finished)grade(HAG) 26.5 R.(m) � i'"
h)No.of pemiane�openings(flood vents)with�I ft.above adjacerrt grare N/A ft.(m) '� � LS414E-11/O1/04
)Total area Of all perrrianent openings(flood verds)�C3.h �p sq.m,(sq•an)
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This cerbfication is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certiiy elevation information.
/cerdfy ttrat the information in Sections A,B,and C on this certificate represents my best efforts to irrterpret the data available.
/understand that any false statement may be punishable by fine or imprisonment under 18 U,S.Code,Sectiw�1001,
ERTIFI RS NAME LICENSE NUMBER
CHARLES H.FOGELSONGER,PLS LS4148
TLE COMPANY NAME
CE-PRESIDENT HAMILTON ENGIl�IEERING&SURVEYING
CITY STATE IP ODE
311 N.Newport Ave,Suite 100 Tampa FL 33606
SIGNATU �`� �� TELEPHONE
�/���''i .��—�-�---_----- 1/01/04 ' 813-250-3535
`t s`rp,r�,R,ri
•e`�.��'°'�IL�`Nf�r�°� C I T Y O F C L E A R W A T E R
• ��1 �`!/� " �n
a� a
�°,��` L -_ �� DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
��,���W;;,,�`���w� PosT OFF�cE BoX 4748, C��WA�R, FLOa�DA 33758-4748
���ryTE��U�� MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CLEARWATER,FLO�uDn 33756
� �
,a���'�4� TEI.F.PHONE�72� 562-4567 Fnx(72� 562-4576
MEMO OF REVIEW FOR CORRECTNESS & COMPLETION
In accordance with participation in the NFIP/CRS program,all elevation certificates are required to be reviewed for correctness and completion prior to
acceptance by the community. This complete form shall be attached to all elevation certificates maintained on file and provide with requested copies of
elevation certificates.
The attached elevation certificate requires corrections by the surveyor of section(s) prior to acceptance by the community
X The attached elevation certificate is complete and correct
Minor corrections have been made in the below marked sections by Community Official
SECTION A-PROPERTY INFORMATION For Insurance Company Use:
A1. BUILDING OWNER'S NAME Policy Number
A2.BUILDING STREET ADDRESS(including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
CITY STATE ZIP CODE
A3. PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
A4. BUILDING USE(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)
A5. LATITUDE/LONGITUDE(OPTIONAL): HORIZONTAL DATUM: SOURCE:�GPS(Type):
(##°-##'-##.##" or ##.###�{#°) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map❑Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
NFIP COMMUNITY NAME&COMMUNITY NUMBER 82.COUNTY NAME 63.STATE
64.MAP AND PANEL 67.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER 85.SUFFIX B6.FIRM INDEX DATE EFFECTIVE/REVISED DATE B8�FLOOD ZONE(S) �Zone AO,use depth of flooding)
610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
❑ FIS Profile ❑ FIRM ❑Community Determined ❑Other(Describe)
B11. Indicate elevation datum used for BFE in 69:� NGVD 1929 ❑ NAVD 1988 ❑Other(Describe)
B12. Is the buiiding located in a Coastal Barrier Resources S stem(CBRS)area or Otherwise Protected Area(OPA? ❑Yes ❑No Desi nation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction� ❑ Finished Construction
`A new Elevation Certificate will be required when construction of the building is complete.
C2. Building Diagram Number (Select the building diagram most similar to the building for which this ceRificate 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 C3.-a-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 Conversion/Comments
Elevation reference mark used Does the elevation reference mark used appear on the FIRM? ❑Yes ❑No
e) Lowest elevation of machinery or equipment servicing the building(Describe in Comments area) ft.(m)
h) No.of permanent openings(flood vents)1ft.above adjencent grade
i) Total area of all permanent openings(flood vents)in C3.h sq.in.(sq.cm)
Comments:
Date of Review: Community O�cial:
�levafion certificates shal!be maintained by the community and copies with the attached memo made availab/e by request
FRANK HIRRARI),MAYOR
GEORGE N.CRE'1'EKOS,COUNCILMGMRGR J011N DORAN,COUNCILMBMBER
PAUL F.GIHSON,COUNCILMEMR@R � CARI.CN A. PE'fERSEN,COUNCII.MGMBER
��EQUAL EMYLOYMEN"1'AND E�FIItMATIVE AC7'ION EMPLOYEH��
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
ELEVATION CERTIFICATE
SECTION A-PROPERTY OWNER INFORMATION Forinsurance Company Use:
BUILDING OWNERS NAME Policy Number
BAYVIEW CLEARWATER,LLC
BUILDING STREET ADDRESS(including Apt., Unit,Suite,and/or Bidg. No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
700 NORTH OSCEOLA AVENUE
CITY STATE ZIP CODE
CLEARWATER FLORIDA 33762
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
PARCEL#09-29-15-00000-420-0400
e.g., esi en ia, on-resi en ia, i ion, ccessory,e c. se a ommen s area,i necessary.
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS(Type):
(##-##-##.##or##.�.) �NAD 1927 �NAD 1983 �USGS Quad Map �Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME 8 COMMUNITY NUMBER 62.COUNTY NAME B3.STATE
CLEARWATER,CITY OF 125096 PINELLAS FLORIDA
B4.MAP AND PANEL 67.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER 85.SUFFIX B6.FIRM INDEX DATE EFFECTIVE/REVISED DATE B8.FLOOD ZONE(S) (Zone AD,use depth of flooding)
12103C0106 G 09/03/03 09/03/03 X,AE,VE ��EL 12),VE(EL 14),VE(EL15)
870,Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9.
❑FIS Profile �FIRM �Community Determined ❑Other(Describe):
61 1.Indicate the eleva6on datum used for the BFE in B9:Q NGVD 1929 �NqVID 1988 ❑Other(Describe):
612.Is the building located in a Coastal Barrier Resources System(CBRS)area or Othenvise Proteded Area(OPA)? ❑Yes �No Designation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:❑Construction Drawings' �Building Under Construc6on" �Finished Construction
`A new Elevation Cert�cate will be required when constniction of the building is complete.
C2.Building Diagram Number 3 (Select the building diagram most similar to the building for which this certificate is being completed-seepages 6 and 7.if no diagram
accurately represeMs the building,provide a sketch or photograph.) .
C3.Elevations-Zones AI-A30,AE,AH,A(With BFE),VE,V1430,V(With BFE),AR,ARA,ARAE,AR/AI-A30,AR/AH,ARAO
Complete Items C3:a-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
Sedon B,convert the datum to that used for the BFE.Show field measurements and datum conversion caiculation,Use the space provided or the Comments area of
Section D or Section G,as appropriate,to document the datum conversion.
Datum NAV�lvsa ConversioNComments o�R �^.�a
�,�� �t��= ..a.,,;•
Elevation reference mark used o� Does the elevation reference mark used appear on the FIRM? ❑Yes �No .gA�,;
a)Top of bottom fbor(including basement or enclosure) 18.1 ft.(m) � ' �
v> > � °� '
b To of next hi her floor 20.2 F '' �"''
) P 9 ft.(m) ��,. M'"g '<
��' , '
c)Bottom of lowest horizontal structural member(V zones only) 11.1 ry.�m) �o �� °�; � � a
d)Attached garage(top Of slab) 18.1 ft.(m) w� r f '^ ,�4
� � �
e)Lowest elevation of machinery and/or equipment �� ; � ;�
servicing the building(Describe in a Comments area) 20.8 ft.(m) � �: '� �,,`� ,a.
°' �e�;�.
z -. ,�` �
�Lowest adjacent(finished)grade(LAG) 5.6 ft.(m) N`� ` �,�, �'`ry:r�
g)Highest adjacer�(finished)grade(HAG) 26.5 ft.(m) g ' �..;,, � , 4`5
h)No.of permanent openings(flood vents)within I ft.above adjacent grade N/A ft.(m) J - �'` LS41��-1��01�/04 .°
i)Total area Of all permanent openings(flood vents)in C3.h N�A sq.in,(sq.an) f�� '_ , ,� .•
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION+
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevati ion.
/certify that the information in Sections A,B,and C on this certificate represents my best efforts to interpret the data ava� le. N�v Q 1 Z004
/understand that any false statement may be punishable by fine or imprisonment under 18 U, S.Code,Section 1001, ;
CERTIFIERS NAME LICENSE NUMB�R
CHARLES H.FOGELSONGER,PLS LS4148 ; ���� �` � ��-��f �NT SUC�
TITLE COMPANY NAME � (�RT
VICE-PRESIDENT HAMILTON ENGINEERING�' EYING
A CITY STATE ZIP CODE
311 N.Newport Ave, Suite 100 Tampa FL 33606
� . URE � ��.�/- DATE TELEPHONE
�. � ,'�='� ��,,.���u��—�.�r-- 11/O1/04 813-250-3535
�
FEMA Form 81-31,January 2003 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,andlor Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number
700 NORTH OSCEOLA AVENUE
CITY STATE ZIP CODE Company NAIC Number .
CLEARWATER FLORIDA 33762
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agenUcompany,and(3)building owner.
COMMENTS
Items C3:c.lowest horizontal member is that of the pool suppoR.d-first and second levels are for pazking;e-Lowest elevation of machinery and/or equipment servicing the building is
represented by the concrete air conditioning pad loca[ed at the Northwest comer of the building. Elevations are based on a site benchmazk having a repoded elevation of 24.48 feet(NGVD
1929). NGVD 1929 to NA VD 1988=-0.88 feet Not valid with out the signature and original seal of a Florida Licensed Surveyor and Mapper.
❑Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zone AO and Zone A(without BFE),complete Items EI through E4.If the Elevation Cert�cate is intended for use as supporting information for a LOMA or LOMR-F,
Section C must be completed.
EI.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.)
E9.The top of the bottom floor(including basement or enclosure)of the building is_ft.(m) in.(cm)❑above or ❑Wow(check one)the highest adjacent grade,(Use
natural grade,If available).
E3.For Building Diagrams fr8 with openings(seepage 7),the ne�higher floor or elevated floor(elevation b)of the building is ft.(m) in.(cm)above the highest adjacent
grade.Complete items C3.h and C3.i on front of form.
E4.The top of the platform of machinery andlor equipment servicing the building is_ft.(m) in.(cm)❑ above or❑below(check one)the highest adjacent grade.(Use
natural grade,'rf available).
E5.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 o�cial must certify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owners authorized representative who completes Sections A,B,C(Items C3.h and C3.i only),and E for Zone A(without a FEMA-issued or community-
issued BFE)or Zone AO must sign here.The staiements in Sections A,B,C,and E are corred to the best of my knowledge
PROPERTY OWNERS OR OWNERS AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS 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 communitys floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation
Certificate.Complete the applicable ite��n(s)and sign below.
G1.Q The information in Secticn C was t�ken from other documentation that has been signed and embossed by a licensed surveyor,engineer,or architect who is authorized by state
or locai law to certify elevation information,(Indicate the source and date of the elevation data in the Comments area below.)
62.❑A community official comple;ed Section E for a building located in Zone A(without a FEMA-issued or community issued BFE)or Zone A0.
G3.❑The following information(Items G4G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5.DATE PERMIT ISSUED • TI I IA I
G7.This permit has been issued for: ❑New Construction ❑Substantial Improvement
G8.Elevation of as-buift lowest floor(including basement)of the building is: ft.(m) Datum:
G9.BFE o�(in Zone AO)depth of flooding at the building site is: fl.(m) Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
❑Check here if attachments
FEMA Form 81-31, January 2003 Replaces all previous editions
�,�,�,��y—�_-�� � s� _ __
��y�, ° -� � � .. FEDERAL EMERGENCY MANAGEMENT AGENCY O.I�I.B. No. 3067-0077
' NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
�L��JATI��d CERT��ICAT�
SECTION A-PROPERTY OWNER INFORMATION For Insurance Company use:
BUILDIh1G OWNERS NAME Policy Number
Bf�YVIE°11V CLEARWf�TER,LL,C
BUILDING STREET ADDRESS Qncluding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company PfAlC V�umber
700 NORTH OSCEOLA AVENUE
CITY S7ATE ZIP CODE
CLEARWATER FLORIDA 33762
PROPERTY DESCR�PTIOPI(Lot and Block Idumbers,Tax Parcel Fiumber,Legaf Description,etc.)
PARCEL#09-29-15-00000-420-Q400
e.g., esi en ia, on-res� n ia, i on, ccessory,e c. se a ommen s area,i ecessary.
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAt DATUM: SOURCE: GPS(Type):
(##-##-##.##or##.####.) �NAD 1927 �NAD 1983 �US(3S Quad Map �Other.
SECTION B-FLOOD It�SURANCE RATE MAP(FIRM)INFORMATION
B7.NFIP COMMUNITY NAME&COMMUNITY NUMBER 82.COUNTY NAME 83.STATE
CLEARWA'TER,CITY OF 125096 PINELLAS FLORIDA
B4.MAP AND PANEL 87.FIRM PANEL 69.BASE FLOOD ELEVATION(S)
NUMBER 85.SUFFIX B6.fIR TE EFFECTIVElREVISED DATE 88.FLOOD ZONE(S) (ZoneAD,use depth offlooding)
12103C0106 G 09/03/03 09/03/03 X,AE,VE ,�(EL 12),VE(EL 14),vE(EL15)
810,Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Describe):
61 1.In�cate the elevation tlatum used for the BF�in 69:Q NGVD 1929 �NAVID 1988 ❑Other(Desaibej:
612.is the building(ocated in a Coastat Barrier Resources System(CBRS)area or Othenvise Protected Area(OPA)? ❑Yes �No Designation Date
SECTION C-BUILDING�LEVATION INFORMATION(SURVEY f�EQUiRED)
C7.Building elevations are based on:0 Canstruction Drawings• �Buiidir�g Under ConstrucBon' �Finished Construction
'A new Elevation Cert�cate will 6e required when constn�ction of the buiiding is complete.
C2.Building Diagram Number 3 (Select the buikling diagram r�st sim�ar to the building for which this ce�4�cate is being completed-seepages 6 and 7.If no diagram
accuratety represenis the building,provide a sketch or photograph.)
C3.Elevations•Zones AI-A30,AE,AH,A(With BFE),VE,V1430,V(With BFE),AR,ARA,ARAE,AR/AI-A30,AR/AH,ARAO
Complete Items C3.-a-i bebw according to the building diagram specified in Item G2.State the datum used.If the datum is different from the datum used for the BFE in
Secton B,convert the datum to that used for the BFE.Show field measurements and datum conversion caMulation,Use the space provided or the Commenis area of
Section D or Section G,as appropriate,to document the datum conversion.
Datum NaVD lsss ConverSionlComments o�
Elevation reference mark used o� Dces the elevation reference mark used appear on the FIRM? ❑Yes �No
a)Top of bottom floor(including basement or enclosure) 18.1 ft.(m) y
b)Top of next higher floor 28.2 ft.(m) a�
c)Bottom of lowest horizontal structural member(V zones only) 20.4 ft.(m) �q
d)Attached garage(top of slab) 18.1 ft.(m) w�
e)Lowest elevation of machinery andlor equipment ��
servicing the building(Describe in a CommeMs area) 20.8 ft.(m) � �
za
fl Lowest adjaCent(finished)grade(LAG) 5.6 ft.(m) �`� ��%
g)Highest adjacent(finished)grade(HAG) 26.5 fl.(m) �
h)No.of permanent openings(flood vents)wrthm I ft.above ad�acent grade N/A ft.(m) J � LS4148-11/O1/04
i)Total area Of all pertnaneM openings(flood vents)in C3.h xiA sq.in,(sq.cm)
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer,or architeet author+zed by law to certify elevation information.
/ceRify that the information in Sections A,8,and C on this certificate represents my best effoRs to interpret the data available.
1 understand that any false statement may be punishable by fine or imprisonment under 18 U,S.Code,Section 1001,
CERTIFIERS NAME LICENSE NUMBER
CHARLES H.FOGELSONGER,PLS LS4148
TITLE COMPANY NAME
VICE-PRESIDENT HAMILTON ENGINEERING&SURVEYING
CITY STATE ZiP ODE
311 N.Newport Ave,Suite 100 T'ampa FL 33606
SIGNATU �� �. DATE TELEPHONE
�����,�,�''�. 11/O1/U4 813-250-3535
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JILDIFlG STREET RDDRESS(includina Rpt,Unit,andlor Bldg.�lo.)QR P.O.ROUTE f�ND BOX�d0. Polir,y Pdum��r .
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Ifems C3:c.levr�st 6o:izo;3Ll B�emSec is Lta2 o:`e6e p-tio deck. S��ed cr.F�,h%A.P,`ezp and'c'=�e.i?d�.ie;:�er 1_iC_C OIGc Ci,�.cd OS;C'siO3 tF�e V zone crn;ses il�e pstio ere�az:d irot the rr.air ctildia?d-`rt-,_n�sec�ad IFVeia
are fer p2rF-�rg;e-'=.owest eleva�oa af maclunery and/or equipment serv'�cir.a:he buld%n�is rep:eser.tctl by tlie cc�crete��r con2utiozing pad lxated at�e NorLhwest comer af the bui[�ing. Elevatiens are base'on a si�
bench,�;�k having a reporLed e!evation af 24.48 f et(NGVD 1929).1VGVD 1929 to NAVD 14fi8=-0.IIo feet Not valid witli out the si�ature znd orignal seal of a Fto�ida Licensed Surveyor and&Srypec �
❑Check here if attachments
��CTIGN E-�UiLDIfi?G ELEVATI�rd 6td�O�P�6ATlOF�;SURVEY PfAT�EQU6REE3)FOR ZOAlE AO Afdf�Z�NE A(ir�lTH�UT[iFE)
for Zone AO and Zone A(without&FE),complete Items EI through E4.I�the Elevafion Certificate fs intended fior use as supporting information for a LONEA or LQNIR-F,
Section C must be completed.
EI.Buil�ing Diagram Number-(Select the building diagram most similar to the buiiding for which this ce:tificate is being completed-ses pages 6 and 7.If no diagram accurately
represerrts the building,provide a sketch or photograph.)
E9.The top of the bottom floor(including basement or endosure)of the building is_ft.(m) in.(cm)Q above or ❑Wow{check one)the highest adjacent grade,(Use
natUral grade,If availabie).
E3.�or Building Diagfams&B with openings(seepage 7),the next higher floor or elevated floor(elevation b)oi fhe 6uilding is ft.(m) in.(cm)ahave the highest adjacent
grade.Complete items C3.h and C3.i on front of form.
E4.The top of ihe platform of machinery andlor equipment servieing the buiiding is ft.(m) in.(cm)Q above or�below(check one)the highest adjacent grade.(Use
natural grade,if available).
E5.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 locaf ofBcial must cerfrfy this information in Section G.
SECTIQN F-PROPER'fY OWNEPt(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owner's authorized representaiive who completes Sections A,B,C(Items C3.h and C3.i only),and E for Zone A(without a FEIUTA-issued or community-
issued BFE)or�one AO must sign here.The statements in Sections A,B,C,and E are correct to the best of my knowiedge
PR�PERTY OWNERS OR OWNERS AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS �
❑Check here if attachments
SECTION G-GQRAMUPd17Y IWFORMATION(OPTIONAL)
The local official who is authorized by law or ordinance to administer tMe communitys floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation
Certificate.Complete the applicable iiem(s)and sign belouv.
G1.Q The information in Section C was taken from other documentation that has been signed and em6ossed by a licensed surveyor,engineer,�r archiiect who is author¢ed by state
or local law to certify elevation information,(Indicate ths source and date ot the elevation data in the Comments area be�ow.)
G2.[]A comm�niiy official completed Section E for a building located in Zone A(without a FEMA-issued or community issued BFE)or 2one A0.
G3.[]The following inform�tiorl(Items G4-�9)is provided for community floodpiain management purposes.
G4.PERMIT NUMBER G5.�ATE PEftM171SSUED • �
�7.This permit has been issued for: ❑New Construction 0 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 OFFIGIAL'S NAME TITLE
COMMUNITY NAME TELEpHONE
SIGNATURE l DATE
COMNiENTS
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