585 SKY HARBOR DR �r,r�,��� ,r� ( �•� FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
y-�c.� NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 200:
• ELEVATION CERTIFICATE
� Important: Read the instructions on pa es 1•7.
SECTION A-PROPERTY OWNER 1NFORMATION For Insuranoe Canpany Use:
BUILDING OWNER'S NAME Policy Number
Richard Sima
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
585 Sky Harbor Dr.#101
CITY STATE ZIP CODE
Clearwater FL 33759
PROPERTY DESCRIPTION(Lot and Bbck Numbers,Tax Parcel Number,Legal Description,etc.)
Lot 101,Sky Hart�or Estates Corporation Condo/17/29/16/82690/000/1010
BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,ff necessary.) .
Residential
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS(fype):
( ##°-##'-##.##" or ##.�°) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME&COMMUNITY NUIv�ER B2.CWNTY NAME 63.STATE
Ciry of Ckaruva�ed125039 Pir�6as F[:`" �,_ ,_,_ ,� �__`
64.MAP AND PANEL B7.FIRM PANEL !� .�,��L�EI:€VA�I �
NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVEIREVISED DATE 68.FLOOD ZONE(S)f, ; ��or�e A0,use depih o�i�`� ���i j {
12103C 0128 G 9/3J03 913�U3 X °< ;� � j
t
B10.Indicate the source of the Base Flood Elevation(BFE)data a base flood depth entered in B9. � �
❑FIS Profile �FIRM ❑Communi�Determined ❑Other(Desaibe):_ °` `—°-F ;
811.Indicate the elevation datum used fa the BFE in B9:0 NGVD 1929 �NAVD 1988 ❑Ofher(Desaibe)��t, "° ° ' _ ,._ �
612.Is the building located in a Coastal B�rier Resources System(CBRS)area a Otherwise Protected Area(OPA)? ❑Yes �No' Design��pate;• : -
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) ���������},�, _" '
C1.Building elevations are based on:❑Caistruction Drawings' ❑Building Under Construction* �Finished ConsUuction
'A new Elevation Cefificate will be�equired when construction of the building is complete.
.2.BuikJing Diagram Number 8(Select the building diagram most simlar to the building for which this oertificate is being oompleted-see pages 6 and 7. If no diagram
accurately re�resents the buiiding,provide a sketch a photograph•)
C3.Elevations—Zones A4-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BF�,AR,ARIA,AWAE,AWA1-A30,AWAH,AR/AO
Complete Iterns C3.-a-i below accading to the Iwil�ng diagram speafied in Item C2.State the datum used.If the datum is different from the datum u�d fa the BFE in
Sedion B,convert the datum to that used for the BFE.Shaw field measuranents and datum conversion calcula6on. Use the space provided a the�Comrt�ts area of
Section D a Section G,as appropriate,to document the dafum conversion. ,. �3°°�' 4��� ''A a e� ::,
Datum NAVD 1988 ConversionlCanments PCBM Courtnev V ;,'�� � ���'1t `;�r
Elevation refer�ce mark used CouMev V Does the�evation reference mark used appear on fhe FIRM? ❑Yes �No
��+ 4.1� ? ..�; .�,,,� <
a)Top of bottan floa(induding basement a endosure) 22. 11 ft.(m) @ '��,� .
b)Top of next higher floa WA._ft.(m) �' d �^��^ `�'", `=Y�:
'� a � , r'
c)Bottan of bwest haizontal sUudural member(V zones only) N/A._ft.(m) y,� "� : �' , � �r: �f
d)AttaChed 9arage(top of slab) WA._ft.(m) '��a �')� � a� `�, s =
e)La�uest elevation of machinery andla equiPment �'_� y��''•'� j, �'" �.:•�, ° _ �
servicing ihe building(Desaibe in a Comments area) ��. 20.11 ft.(m) �'�� �,, ;,� , � � t� � `�`�� '
�Lowest�acent(finishec�grade(IAG) 19.9 ft.(m) �,°'t �'��i�, '', . . ,-��,��+�o��
9)Highest adjacent(finished)grade(HAG) 20. 3 ft.(m) � , 4��m; � �' ��, ,,.,�s
h)No.of permanent openings(flood vents)within 1 ft.�ove adjaoent grade 0 � ��°N���f�(1��'
i)Total area of all perrrianent openings(flood vents)in C3.h 0 sq.in.(sq.an)
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land suNeyor,engineer,or architect authorized by law to certify elevation information.
1 certify that the information in Sections A,8,and C on this certificate represents my best efforts to interpret the data avaifable.
1 understand that any false statemenf may be punisha6le by�ne or imprisonment under 98 U.S.Code,Secfion 1001.
CERTIFIER'S NAME DENNIS J.EYRE LICENSE NUMBER 2865
<
TITLE PROFESSIONAL LAND SURVEYOR COMPANY NAME GEODATA SYSTEMS,INC.
•ADDRESS CITY STATE ZIP CODE
1822 D ST.,S TE 8 CLEARWATER FL 33765
SIGNA . DATE TELEPHONE
8/15/05 727-047-1763
FEMA Form 81-37,Jan ry 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 STREEf ADDRESS(Induding Apt,Uni�Suite,ancUor BkJg.No.)OR P.O.ROUTE AND BOX N0. Policy Number ,
585 Sk Harfior Dr.#101
CITY STATE 21P CODE Company NAIC Number
Ciearwater FL 33759 `
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) �
Copy both sides of this Elevation Certificate fa(1)oommunity offiaal,(2)insurance agenUoanpany,and(3)buildng owner. �
COMMENTS
❑Chedc here if attachments
SECTION E-BU(LDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
Fa Zone AO and Zone A(without BFE),oomplete items E1 through E4. If the Elevation Cer6ficate is intended for use as suppating infamation for a LOMA a LOMR-F,
Sedion C must be oompleted.
E1.Buildng Diagr�n Number 8(Seled the building diagram most similar to the twilding fa which this oertificate is being completed—see pages 6 and 7. If no diagram accurately
represents the bui�ing,provide a sketch a photograph.)
E2.The top of the bottan floa(indudng basement or endosure)of the building is 0 ft.(m)_in,(an)❑above a ❑below(chedc one)the highest adjacent grade. (Use
natur�grade,'rf available). �
E3.Fa Building Diagra�ns 6-8 with openings(see page 7),the next higher floa a elevated floor(elevation b)of the buiiding is _ft.(m)_in.(cm)above the highest adjacent
grade. Complete items C3.h�d C3.i on front of fam.
E4.The top of the pla�am of machinery andlor equipment serviang the building is 0 ft.(m)_in.(an)Q above or ❑belou�r(check one)the highest adjacent grade. (Use
natural grade,ii avail�le). ,�
E5.Fa Zone AO only: If�fbod depth number is available,is the top of the bottan fba elevated in acmrdance with the communit�s floodplain management ordinance?
❑Yes ❑No ❑Unkncr,m. The local�f'iaal must certify this infamation in Sedion G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property oHmer a oMmei's authaized representative who oompletes Sections A,B,C(Items C3.h and C3.i only),and E fa Zone A(withart a FEMA-issued or oommunity-
issued BFE)a Zone AO must sign here. The statements in Sections A,B,C,and E a�e carect to the best of my knowledge.
PROPERIY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP CODE •
SIGNATURE DATE TELEPHONE
CAMMENTS
❑Check here if attachments
' SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The I�a o�iaal-who is authorize�ci by law�r ordir�ance to administer the oanmunit�s floodpl�n management adinance can oanplete Sections A,B,C(or E),and G of this Elevation
Ce�tificate. Can�lete the appliCd�e item(s)and sign belauv.
G1.0 Tt��e ir�or�a6on in Sedi�C was taker fom other documentation ihat has been sigr�ed and embossed by a licensed surveyor,engincer,a architect who is authorized by state
or kx�l law to oertify elevation informaticx�. (Indicate the source�d date of the elevaGon data in the Comments area below.)
G2.�A c�ommunity offiaal oompieted�.,a.�tian E fa a building located in 7_one A(without a FEMA�ssued or wmmunity-issued BFE�or Zone A0.
G3.�The fdlouving inf�rma6on(It�ms G4-G9)is provided fa commwity floodplain managerr�ent purposes.
G4.PERMIT NUMBER � G5. DATE PERMIT ISSUED G6.DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED
G7.This permit has bcen issued fa: ❑New Construction ❑Substantiai Improvement
G8.Elevation of as-lwilt lowest floa(induding basement)�the building is: _._ft.(m) Datum:
G9.BFE a(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 •
❑Chedc here if attachments
FEMA Form 81-31,January 2003 Replaces all previous editions
i d ���� ,r j I �•--� r•, rtutKAL tMtKGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
'd.J � t '1—}� NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 200;
, .
� ELEVATION CERTIFICATE
• Important: Read the instructions on pages 1•7.
SECTION A-PROPERTY OWNER INFORMATION For Insurance Car�pany Use:
BUILDING OWNER'S NAME Policy Number
Richard Sima
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bklg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
585 Sky Harbor Dr.#101
GTY STATE ZIP CODE
Clearwater FL 33759
PROPERN DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Lot 101,Sky Harbor Estates Corporation Condd 1729/16/82690/000/1010
BUILDING USE(e.g.,Residentiai,Non-residential,Addition,Accessory,etc. Use a Comments area,if necessary.) .
Residential
LATITUDFJLONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):
( ##°-##'-#tk.#tf" or ##.�� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME&COIWNUNRY NUN�ER 62.COUNTY NAME B3.STATE
City of Cleann�ated}�5B`35' Pine�s FL ~ "-__ -� �.^°� :_:.:
, -
64.MAP AND PANEL 87.FIRM PANEL �: Bg_�4�FL0C3D EI�VA�ION ��
NUN�ER 65.SUFFIX B6.FIRM DEX DATE EFFECTIVEIf2EVISED DATE 68.FLOOD ZONE(S)E' '��(Zone AO use depth o��`uig�f u� �;
12103C 0128 G 9/3ro3 X ;; �� `' '
B10.Indicate the source of the Base Flood Elevation(BF� a base flood depth entered in B9. �
❑FIS Profile �FIRM ❑Community Detertnined ❑Other(Desaibe):_ � �—
B11.Indicate the eleva6on datum used for the BFE in B9:�NGVD 1929 �NAVD 1988 ❑Other(Desaibe). — � .�,r ,""" " �
����,..�
612.Is the building bcated'm a Coastal Barrier Resources System(CBRS)area or Othenvise Proteded Area(OPA)? ❑Yes �No Desigraatipp pate.; ,
_ - - �r��.s
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) �
C1.Buildng elevations are based on:❑Construction Drawings' ❑Building Under Construdion* �Finished ConsUudia�
'A netiv Elevation CertiFicate will be required when oonstruction of the buildng is canplete.
�C2.Buikling Diagram Number 8(Select the building�iagram most simlar to the building fa which this ce�tificate is being oanpleted-see pages 6 and 7. If no diagram
accurately represents the buii�ing,provide a sketch or photograph.)
C3.Elevations—Zaies A1-A30,AE,AH,A(with BFE),VE,V1-V30,V{w'rfh BF�,AR,AR/A,AR/AE,AWA1 A30,ARIAH,AWAO
Complete Items C3.-a-i below aocording to the building dagram spedfied in Item C2 State the datum used.If the datum is different from the datum u�ed fa the BFE in
Section B,convert the datum to that used fa the BFE.Shotiv fiekJ measurements and datum oonversion calculation. Use the space prov�ded a the�Canrraents area of
SeUion D a Section G,as ap�xopriate,to document the datum conversion. � �:°
�
Datum NAVD 1988 ConversioNCanments PCBM Courfnev V
Elevation referenoe mark used Courfnev V Does the eleva6on reference marlc used appear on the FIRM? ❑Yes �No
a)Top of bottom floor(induding bas�nent a endosure) 22. 11 ft.(m) � p;e� � � � �/�
b)Top of next higher floor WA._ft(m) � - ��
c)Bottan of lowest haizontal strudur�member(V zones only) WA._ft.(m) y� �, � ,;,,
c�Attached 9arage(top of slab) WA._ft.(m) ,�� '.� �, ;
e)Lowest elevation of machinery andlor equipment s"' � � � " .� .
saviang ihe building(Desaibe in a Comments area) ��. 20.11 ft.(m) t�'` E „5: -,;
�Lowest�acent(finishedj grade(LAG) 19.9 ft.(m) ;z'�: ^ ;w,"J
9)Highest adjacent(finished)grade(HAG) 20. 3 ft.(m) ' � ,; ` ~
hj No.of perrnanent openings(flood vents)within 1 ft.above adjacent grade 0 � V r !� �l���
i)Total area of all permanent openings(flood vents)in C3.h 0 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 architect au(horized by law to ceRify elevation information.
1 certify that the information in Secfions A,8,and C on this certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable 6y�ne or imprisonment under 18 U.S.Code Secfion 1001.
CERTIFIER'S NAME DENNIS J.EYRE LICENSE NUMBER 2865
TITLE PROFESSIONAL LAND SURVEYOR COMPANY NAME GEODATA SYSTEMS,INC.
• ADDRESS CITY STATE ZIP CODE
'1822 D ST.,S TE 8 CLF�R , ER FL 33765
SIGNA . ' DATE ' `�� TELEPHONE
8/15/05 727-447-1763
e.�1-- ,
FEMA Form 81-31,Jan ry 2003 See reverse side for continuation. Replaces all previous editions
imrurt i AN i: in tnese spaces,copy the corresponding information from Section A. For Insurance Canpany Use:
BUILDING STREET ADDRESS(Indudirg Apt,Unn Suite,and�or Bkig.No.)OR P.O.ROUTE AND BOX N0. Poficy Number �
585 Sk Harbor Dr.#101
CIiY STATE ZIP CODE Company NAIC Number
Cleanvater FL 33759 '
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate fa(1)community official,(2)insurance agenUcanpany,and(3)Iwildng awner. �
COMMENTS
❑Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
Fa Zone AO and Zone A(without BFE�,compiete Items E1 fhrough E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F,
Sedion C must be completed.
E1.Build'�ng Diagr�n Number 8(Seled the twilding diagram most similar to the building fawhich this certificate is being oompleted—see pages 6 and 7. If no diagram accurately
rep�esents the building,provide a sketch or photograph.)
E2.The top of the bottan floor(induding basement or endosure)of the building is 0 ft.(m)_in.(an)�above a ❑below(chedc one)the highest adjacent grade. (Use
naturai grade,'rf avalat�le). �
E3.For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevatiai b)of the buiiding is _ft.(m)_in.(cm)above the highest adjacent
grade. Complete items C3.h and C3.i on front�fam.
E4.The top of the pla�am of machinery andlor equiExnent servidng the building is 0 ft.(m)_in.(an)�above or ❑below(chedc one)the highest atljacent grade. (Use
natural grade,'rf available).
E5.Fa Zone AO only: If no flood depth number is available,is the top of the bottom floa elevated in accordance with the communitys floodplain manage,ment ordinance?
❑Yes ❑No ❑UnknoHm. The local oifiaal must oertify this infamation in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The properry owner or own�s authaized representative who compietes Sec�ons A,B,C(items C3.h and C3.i only),and E for Zone A(without a FEMA-issued or canmunity-
issued BFE)or Zaie AO must sign here. The statements in Sectiars A,B,C,and E a�e carect to the best of my knowledge.
PROPERIY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP CODE �
SIGNATURE DATE TELEPHONE
COMMENTS
❑Chedc here if attachments
' SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The I�a!offidal who is�thorized by law ur ordir�ance to administer the canmunit�s floodplan management ordinance qn oomplete Sedions A,B,C(or E),and G of this Elevation
Certificate. Com�lete ths�plir,d�e item(s)and sign below.
Gi.C Th�ir�arna6on in Sedir��C w�s taker,firom other documentation ihat has been signed and embossed by a li�surveya,engineer,or architect who is authaized by state
or loc�law to oertify elevaGon infarr,aticxi. (Indicate the source�d date of the elevaation data in the Comments area below.)
G2.0 A oanm�nity official compieted�on E for a building la:ated in Zaie A(without a FEMA-issued a community-issued BF�or Zone A0.
G3.�The fdlo�uing int�rrn�ion(It�ms G4-G9)is provided for canmuniry floodplain managerrient purposes.
G4.PERMIT NUtvIBER G5.DATE PERMIT ISSUED G6.DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED
G7.This permit has been issued fa: ❑New Construction ❑Substantiai improvement
G8.Etevation of as-built bw�st floor(induding basernent)of the building is: _._ft(m) Datum:_
G9.BFE a(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,January 2003 Replaces all previous editions