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3155 OYSTER BAYOU WAY • � 1��'` � � FEDERAL EMERGENCY MANAGEMENT AGENCY p.M.B. No. 3067-0077 �� , D�� NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 ELEVATION CERTIFICATE Im ortant: Read the instructions on a es 1 -7. SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number BUIIDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number 3155 OYSTER BAYOU WAY ZIP CODE C��, STATE CLEARWATER FL 33759 PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) LOT#43 BAYSHORE TOW NHOUSES BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use Comments section if 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 61.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME 63.STATE 125096 PINELLAS COUNTY FL 64.MAP AND PANEL B5.SUFFIX 66.FIRM INDEX B7.FIRM PANEL 68.FLOOD 69.BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZOAE(S) (Zone AO,use d�epth of flooding) 0018 D 08-19-91 610. Indicate the source of the Base Flood Elevation (BFE)data or base flood depth entered in B9. ❑ FIS Profile ❑ FIRM ❑Community Determined ❑ Other(Describe): 611. Indicate the elevation datum used for the BFE in 69:� NGVD 1929 ❑ NAVD 1988 ❑ Other(Describe): B12. Is the buiiding located in a Coastal Barrier Resources System (CBRS)area or Otherwise Protected Area(OPA)? ❑Yes ❑ No Designation Date SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REGIUIRED) C1. Bui�ding 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 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 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 caiculation. Use the space provided or the Comments area of Section D or Section G,as appropriate,to document the datum conversion. Datum Conversion/Comments E�evation reference mark used Does the elevation reference mark used appear on the FIRM? ❑Yes � No ❑ a)Top of bottom floor(including basement or enclosure) 19.41 ft.(m) � 0 b)Top of next higher floor 28.91 ft.(m) � � , � ':; ��; ❑ c) Bottom of lowest horizontal structural member(V zones only) ._ft.(m) o o �,,� '� � 4 �r,�� .. ❑ d)Attached garage(top of slab) 9.41ft.(m) E� .;',;,G�, � �' e -. W � � F�! . +'*oi {, .� i � �t., : ❑ e) Lowest elevation of machinery and/or equipment �;� ' "`=3 ' .�y ,,, , servicing the building 10 .91ft.(m) E� �� .,y ❑ f) Lowest adjacent grade(LAG) 8 .97ft.(m) �u,' '�'.'r° °"• '��. ;.� ❑ g) Highest adjacent grade(HAG) 9.36ft.(m) � ;' � � �`^�<�}��' ❑ h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 4 � ":� '� ^�' �, ❑ i)Total area of all permanent openings(flood vents)in C3h 514 sq. in.(sq.cm) '�`l�/"�'e;�+� i��`�5'�� 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 elevation information. l certify that the information in Sections A, 8, and C on this certificate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishable by fine or imprisonment undLlC NS NUMBER 572p n 1001. CERTIFIER'S NAME MICHAEL E.JENKINS TITLE: SURVEY MANAGER COMPANY NAME American Consulting Engineers,PLC ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE FEMA Form 81-31,AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPJRTANT: 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 3155 OYSTER BAYOU WAY ��N STATE ZIP CODE Company NAIC Number CLEARWATER FL 33759 SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official, (2)insurance agent/company,and (3)building owner. COMMENTS ELEVATIONS FOR:A/C PAD=10.91'; WATER HEATER=11.61' ❑ 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 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 adjacent grade. 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 communiry'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 ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TEIEPHONE 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 SIGNATURE DATE COMMENTS ❑ Check here if attachments FEMA Form 81-31,AUG 99 REPLACES ALL PREVIOUS EDITIONS