605 POINSETTIA AVE #5 !J.�•. �E�,/`�RTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
Exaires Februarv 28.2009
FPderal Emergency Management Agency
National Plood Insurance Program Important: Read the instructions on pages 1-8. �� � __ ���c� �
SEC'CION A-PROPERTY INFORMATION For Insurance Company Use:
�1. Building Owner's Name Florence Enterprise,LLC Policy Number
Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Campany NAIC Number
605 Pointsetta Avenue, Unit 5 ��<%�n ��t�iQ
City Ciearwater State FL ZIP Code 33767
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Parcel ID No.05/29/15/66377/000/0010
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) Residentival
A5. Latitude/Longitude:Lat.82^49'32" Long.27^59'09" Horizontal Datum: ❑ NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 7
A8. For a building with a crawl space or enclosure(s),provide A9. For a building with an attached garage, provide:
a) Square footage of crawl space or enclosure(s) N/A sq ft a) Square footage of attached garage 509 sq ft
b) No.of permanent flood openings in the crawl space or b) No.of permanent flood openings in the attached garage
enclosure(s)walis within 1.0 foot above adjacent grade N/A walls within 1.0 foot above adjacent grade 8
c) Total net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b 912 sq in
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1. NFIP Community Name&Community Number B2.County Name B3.State
125U960102G C:ye,q_n�{{-�_ Pinellas Fiorida
B4. Map/Panel Number B5.Suffix B6.FIRM Index B7.FIRM Panel 68. Fiood B9. Base Flood Elevation(s)(Zone
Date Effective/Revised Date Zone(s) AO,use base flood depth)
12103C0102G G September 03, September 03,2003 AE EL.11.0
2003
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)
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other(Describe)
��. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No
Designation Date ❑ CBRS ❑ OPA
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. 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 C2.a-g
below according to the building diagram specified in Item A7.
Benchmark Utilized Labins EI.4.191 VeRical Datum NAVD 1988
�'onversion/Comments N/A
Check the measurement used.
a) Top of bottom floor(including basement,crawl space,or enclosure floor)_ 6.60 �feet ❑ meters(Puerto Rico only)
b) Top of the next higher floor 16.60 �feet ❑ meters(Puerto Rico only)
c) Bottom of the lowest horizontal structural member(V Zones only) N/A. ❑feet ❑ meters(Puerto Rico only)
d) Attached garage(top of slab) 6.00 �feet ❑ meters(Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building 11.00 �feet ❑ meters(Puerto Rico only)
(Describe type of equipment in Comments)
f) Lowest adjacent(finished)grade(LAG) 5.0 �feet ❑ meters(Puerto Rico only)
g) Highest adjacent(finished)grade(HAG) 5.8 �feet ❑ meters(Puerto Rico only)
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. 1 certify that the information on this Certificate represents my best efforts to interpret the data available. �
I understand that any false statement may be punishable by fine orimprisonment under 18 U.S. Code, Section 1001. �v�,� �,�� �,`�
�
� Check here if comments are provided on back of form. � � �;i�.
�.,� �:. -
Certifier's Name Bruce A.Klein License Number PLS No.5052 -� ` :��- � ��
s; . .�,.• -_..
President Company Name Klein&Staub Surveying, Inc. � -� � `� `Y -`
- �:;, ;�
Address 8016 OI Cou ty oad No.54 City New Port Richey State FL ZIP Code 34653 �a;,���.��F��.�� 'i
��,a+
" �.� . • c.�� �
Signature � Date 03/14/07 Telephone 727-834-8140 '�,��� ' . , �.,r,�='
�.
FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions
IkII�OR7',4NT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use:
Building Street Ad�iress(including Apt., Unit,Suite,and/or Bidg. No.)or P.O. Route and Box No. Policy Number
605 Pointsetta Avenue Unit 5
City Clearwater State FL ZIP Code 33767 Company NAIC Number
SECTION D -SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
opy both sides of this Elevation Certificate for(1)communiry official,(2)insurance agenUcompany,and(3)buiiding owner.
Comments Ail A/C Units are on the roof
Elevator equipment is on or above EI. 11.00
Signature � Date 03/14/07
❑ Check here if attachments
SECTION E-BUILDIN EVATION INFORMATION (SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO and A(without BFE),complete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B,
and C. For Items E1-E4,use naturai grade,if available. Check the measurement used. In Puerto Rico only,enter meters.
E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent
grade(HAG)and the lowest adjacent grade(LAG).
a)Top of bottom floor(including basement,crawl space,or enclosure)is _ ❑feet ❑ meters ❑above or�below the HAG.
b)Top of bottom floor(including basement,crawl space,or enclosure)is ❑feet ❑ meters ❑above or❑ below the LAG.
E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9(see page 8 of Instructions),the next higher floor
(elevation C2.b in the diagrams)of the building is ❑feet ❑ meters ❑above or ❑ below the HAG.
E3. Attached garage(top of slab)is __.___ ❑feet ❑ meters ❑above or ❑ below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is ❑feet ❑ meters ❑above or❑ below the HAG.
E5. 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. The statements in Sections A,8, and E are correct to the best of my knowledge.
perty Owner's or Owner's Authorized Representative's Name
ddress City State ZIP Code
Signature Date Telephone
Comments
� ❑ Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The local o�cial 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. Check the measurement used in Items G8.and G9.
G1.❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who
is authorized by 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-buiit lowest floor(including basement)of the building: _❑feet ❑ meters(PR)Datum
G9.BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑ meters(PR)Datum
Local Official's Name Title
Community Name Telephone
ignature Date
�ments
❑Check here if attachments
FEMA Form 81-31, February 2006 Replaces all previous editions
..�'
• .
Building Photographs
See Instructions for Item A6.
For Insurance Company Use:
ilding Street Address(including Apt., Unit, Suite,and/or Bldg. No.)or P.O. Route and Box No. Poiicy Number
Pointsetta Avenue,Unit 5
Clty Clearwater St8t2 FL ZIP COd2 33767 Company NAIC Number
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least finro building photographs below according to
the instructions for Item A6. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right
Side View" and "Left Side View." If submitting more photographs than will fit on this page, use the Continuation Page,
following.
Front View
Rear View
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!J.S.DE�ARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB NO. 1660-0008
Exoires Februarv 28.2009
Federal E;°�ergency Management Agency
Nationai Fiood msurance Pro9ram Important: Read the instructions on pages 1-8. �j � __ ���y �
y SECTION A-PROPERTY INFORMATION For Insurance Company Use:
1. Building Owner's Name Florence Enterprise,LLC Policy Number
. Building Street Address(including Apt., Unit,Suite,and/or Bidg.No.)or P.O.Route and Box No. Campany NAIC Number
605 Pointsetta Avenue, Unit 5
City Ciearwater State FL ZIP Code 33767
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legai Description,etc.)
Parcel ID No.05/29/15/66377/000/0010
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) Residentival
A5. Latitude/Longitude:Lat.82^49'32" Long.27^59'09" Horizontal Datum: ❑ NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 7
A8. For a building with a crawl space or enclosure(s),provide A9. For a building with an attached garage,provide:
a) Square footage of crawl space or enclosure(s) N/A sq ft a) Square footage of attached garage 509 sq ft
b) No.of permanent flood openings in the crawl space or b) No.of permanent flood openings in the attached garage
enclosure(s)walls within 1.0 foot above adjacent grade N/A walls within 1.0 foot above adjacent grade 8
c) Total net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b 912 sq in
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1. NFIP Commu it� me omm ber ,n B2.County Name B3.State
125096�" �,q_qs,,�i�'z� `�`�-- Pinellas Florida
B4.Map/Panel Number s B5.Suffix B6. FIRM Index B7.FIRM Panel B8.Flood 69.Base Flood Elevation(s)(Zone
Date rj'�(^�,,� Effective/Revised Date Zone(s) AO,use base flood depth)
12103C0102� G Ca�ber-Q3, September 03,2003 AE EL.11.0
ti��
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)
B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑Other(Describe)
B . Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No
Designation Date ❑CBRS ❑ OPA
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIREDj
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. 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 C2.a-g
below according to the building diagram specified in Item A7.
Benchmark Utilized Labins EI.4.191 Vertical Datum NAVD 1988
Conversion/Comments N/A
Check the measurement used.
a) Top of bottom floor(including basement,crawl space,or enclosure floor)_ 6.60 �feet ❑ meters(Puerto Rico only)
b) Top of the next higher floor 16.60 �feet ❑ meters(Puerto Rico only)
c) Bottom of the lowest horizontal structural member(V Zones only) N/A. ❑feet ❑meters(Puerto Rico only)
d) Attached garage(top of slab) 6.00 �feet ❑ meters(Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building 11.00 �feet ❑meters(Puerto Rico only)
(Describe type of equipment in Comments)
f) Lowest adjacent(finished)grade(LAG) 5.0 �feet ❑ meters(Puerto Rico only)
g) Highest adjacent(finished)grade(HAG) 5.8 �feet ❑ meters(Puerto Rico only)
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. I certify that the information on this Certificate represents my best efforts to interpret the data available.
l understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
� Check here if comments are provided on back of form. `
Certifier's Name Bruce A.Klein License Number PLS No.5052 �
� ,'
President Company Name Klein&Staub Surveying, Inc.
ss 8016 OI Cou ty oad No.54 City New Port Richey State FL ZIP Code 34653 �� �G�.Z
Signature Date 03/14/07 Telephone 727-834-8140 '� ��
FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions
111APO��TANT: In these spaces,copy the corresponding information from Section A. For Insurance Company Use:
Buildinc�Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number
60F Pointsetta Avenue Unit 5
City Cleanvater State FL ZIP Code 33767 Company NAIC Number
SECTION D-SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION(CONTINUED)
y both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner.
Comments All A/C Units are on the roof
Elevator equipment is on or above EI. 11.00
Signature Date 03/14/07
❑ Check here if attachments
SECTION E-BUILDI EVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO and A(without BFE),complete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B,
and C. For Items E1-E4,use natural grade,if available. Check the measurement used. In Puerto Rico only,enter meters.
E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent
grade(HAG)and the lowest adjacent grade(LAG).
a)Top of bottom floor(including basement,crawl space,or enclosure)is ❑feet ❑ meters ❑ above or❑ below the HAG.
b)Top of bottom floor(including basement,crawl space,or enclosure)is ❑feet ❑ meters ❑ above or❑ below the LAG.
E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9(see page 8 of Instructions),the next higher floor
(elevation C2.b in the diagrams)of the building is ❑feet ❑ meters ❑above or ❑ below the HAG.
E3. Attached garage(top of slab)is ❑feet ❑meters ❑above or ❑below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is ❑feet ❑ meters ❑above or❑ below the HAG.
E5. 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. The statements in Sections A,8,and E are correct to the best of my knowledge.
erty Owner's orDwner'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. Check the measurement used in Items G8.and G9.
G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who
is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
G2. ❑ A community o�cial 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: _�feet ❑ meters(PR)Datum
G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑ meters(PR)Datum
Local Official's Name Title
Community Name Telephone
Si nature Date
ients
❑ Check here if attachments
FEMA Form 81-31, February 2006 Replaces all previous editions
• � Building Photographs
See Instructions for Item A6.
For Insurance Company Use:
'Iding Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Poiicy Number
Pointsetta Avenue,Unit 5
Clty Clearwater StBte FL ZIP COd2 33767 CompanyNAlCNumber
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to
the instructions for Item A6. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right
Side Viev�' and "Left Side View." If submitting more photographs than will fit on this page, use the Continuation Page,
following.
Front View Rear View
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���`���`��'��������j C I T Y O F C L E A R W A T E R
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��' �j y�==� DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
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��,.�3 � r- ��*������'' Posr OFFicE Box 4748, C►.e,nawn�a, Ftio�u�n 33758-4748
~"'<,�.��� ������ MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CI.FARWATER,FLORIDA 3375�
'�`�`-"`���� TELEPxoNE (72� 562-4567 Fa,x(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
The attached elevation certificate is complete and correct
X 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. Buiiding Use(e.g.,Residential, Non-Residential,Addition,Accessory,etc.)
A5. Latitude/Longitude: Lat. Long. Horizontal Datum: ❑ NAD 1927 ❑ NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Buiiding Diagram Number
A8. For a building with a crawl space or enclosure(s),provide A9. For a building with an attached garage, provide:
. a) Square footage of crawl space or enclosure(s) sq ft a) Square footage of attached garage sq ft
b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage
enclosure(s)walls within 1.0 foot above adjacent grade walls within 1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in
SECTION B-FLOOD INSURANCE RATE MAP(FIRM) INFORMATION
61. NFIP Community Name&Community Number 62.County Name B3.State
CLEARWATER-125096
64. Map/Panel Number 65.Suffix 66. FIRM Index 67. FIRM Panel 68.Flood 69.Base Flood Elevation(s)(Zone
Date Effective/Revised Date Zone(s) AO, use base flood depth)
12103C-0102 5/17/2005
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69.
❑ FIS Profile ❑ FIRM ❑Community Determined ❑Other(Describe)
611. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ❑ NAVD 1988 ❑Other(Describe)
612. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes ❑No
Designation Date ❑CBRS ❑OPA
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. 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 C2.a-g
below according to the building diagram specified in Item A7.
Benchmark Utilized Vertical Datum
Conversion/Comments Check the measurement used.
e) Lowest elevation of machinery or equipment servicing the building ❑feet ❑meters(Puerto Rico only)
(Describe type of equipment in Comments)
Comments:
�of Review: Community O�cial:
A,�e/evation certificates shall be maintained by fhe community and copies with the aftached memo made availab/e by request
FRANK HIftBARD,MAYOR
GEORGE N.CRE7'EKOS,COUNCILMEMB�R JOIIN DORAN,COUNCILMEMBER
PAUL F.GIRSON,COUNCILMEMBBR � CARI.EN A.PE7'ERSEN,COUNCILMEMBER
��EQUAL EMYLOYMENT AND I�FFIRMATIVE ACTION EMYLOYER��
� � � �c�o - O�D4�
� rtUtKAL tMtK(itN(:T MANAtitMtN I AlitNl;T
. NAFIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077
� Expires December 31, 2005
' �LEVAT�(;�N CERTIFICATE
Important: �te.3�tt :i^,s':�uc.tions crn pages 1-7. JOB No.050132.2
� � ;:'.�''i�'aN A-PRUPERTY OWNER INFORMATION Forinsurance Company Use:
BUILDING OWNER'S NAME � ''" .�.�. W_,. Policy Number
Park Place Townhomes, LLC Unit No. 5
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldq.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
605 Poinsettia Avenue
CITY STATE ZIP CODE
CLEARWATER FLORIDA 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Lot 5,Park Place P.B.133,Pgs.30-32
BUILDING USE(e.g.,Residential,Non-residentiai,Addition,Accessory,etc. Use a Comments area,if necessary.)
RESIDENTIAL
LATITUDEILONGITUDE(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&COMMUNITY NUMBER B2.COUNTY NAME B3.STATE
City of Clearwater 12103C0102G PINELLAS FLORIDA
64.MAP AND PANEL 67.FIRM PANEL 69.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVFJREVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depih of flooding)
125096-0102 G SEPTEMBER 03,2003 SEPTEMBER 03,2003 AE EL.11.0
B10.Indicate the source of the Base Floal Elevation(BFE)data or base flood depth enteretl in B9.
❑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 Bamer Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No Designation Date_
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
1.Building elevations are based on:❑Construction Drawings' �Building Under Construcfion' ❑Finishetl Construction
'A new Elevation Certificate will be required when construction of the building is complete.
2.Builtling Diagram Number 7 (Select the building diagram most similar to the building for which this certificate is being completed-see pages 6 antl 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,ARIA,AR/AE,AWA1-A30,AR/AH,AR/AO
Complete Items C3.-a�below according to the building diagram specifed in Item C2.State the datum used.If the datum is different from the datum usetl for the BFE in
Section B,convert the datum to that usetl 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 appropnate,to document the datum conversion. F . � , q
Datum NAVD 1988 ConversionlComments N/A , °,.. '�-" ��';'.
Elevation reference mark used LABINS EL.=4.191 Does the elevation reference mark used appear on the FIRM? D Yes ���> W •
o a)Top of bottom floor(induding basement or enclosure) 5.60 . F=f ft.(m) � "� Y �� '�
o b)Top of next higher floor 16.60 FT ft.(m) "' " A�' ,��r � � ,
� �
a�^. � �- u W
o c)Bottom of lowest horizontal structural member(V zones only) N/A . FT ft.(m) �� "�, y_ �,.� •
o d)attached garage(top of block) 5.60 . Ff ft.(m) �� ° �=
o e)Lowest elevation of machinery and/or equipment W� �' � , ~ `� ` �
serviang the building(Descnbe in a Comments area) 11,00 FT ft.(m) E��, , �''' „g � ^' �
o �Lowest adjacent(finished)grade(LAG) 5.0 . FT ft.(m) z�' `� ; �a �{'y:f�Q52 r
s�~�-
o g)Highest adjacent(fnished)grade(HAG) 5.1 FT ft.(m) � _`'_� :�d��10%06
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 3 � -
o i)Total area of all permanent openings(flood vents)in C3.h 384 sq.in. "
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.
1 certify that the information in Sections A,B, and C on this cerfificate represents my best efforts to inferpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIER'S NAME LICENSE NUMBER
BRUCE A.KLEIN PLS 5052
TITLE COMPANY NAME
PRESIDENT KLEIN&STAUB SURVEYING,INC.
ADDRESS CITY STATE ZIP CODE
8016 Old County ad 54 New Port Richey FL 34653
SIGNATURE DATE TELEPHONE
03/10/06 (727)834�140
FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces ail previous editions
IMPORTANT: In these spaces,copy the corresponding information from Section A. Forinsurance com�any use: ,
BUILDING STREET ADDRESS(Induding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX N0. � Policy Number
605 Poinsetta Avenue Unit No.5 .
- l�
CIIY STATE ZIP CODE Company NAIC Number
CLEARWATER FLORIDA 3376?
SECTION D-SI.R��=l�,,FNGlNK'�R,ORAkt;�i:t=�.'' � i:�''1"IFI`,aTION(CQNTiI�UEY��j
Copy both sides of this Elevation Certificate for(1)commu���ty offcial,(2)insurance agent'ccrr��an;,�� c,�.��'���i'd'ng owner.
COMMENTS
N/A
❑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 intendetl 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 completetl—see pages 6 and 7. If no diagram accurately
represents the building,provide a sketch or photograph.)
E2.The top of the bottom floor(induding basement or enclosure)of the building is _ft.(m)_in.(cm)�above or ❑below(check one)the highest adjacent grade. (Use
natural grade,if available).
E3.For Builtling 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. Complete items C3.h and C3.i on front of form.
E4.The top of the platform of machinery and/or equipment servicing the building is _ft.(m)_in.(cm)❑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 local official 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 sfatements in Sections A,8,C,and E are correct to the best of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
❑Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The local offcial who is autt�crized by law or�rdinance to administer the community's floodplain management ortlinance can complete Sections A,B,C(or E),and G of this Elevation
Certificate. Compiete the applicable item(s)and sign below.
Gt�The information in S�ction C was taken fi,�m other documentation that has been signetl and embossed by a licensed suroeyor,engineer,or architect who is authonzed by state
or local law to certify elevation inforr�ation. (Indicate the source and date of the elevation data in the Comments area below.)
G2.�A community afficial ctimpleted SE�,�tion E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0.
G3.0 The following information(Items G4-G9)is provitled for community floaJplain 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 Flootling 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,January 2003 Replaces all previous editions