1754 SUNSET DR ► �
ELEVATION CERTIFICATE O.M.B. No. 3067-0077
` FEDERAL EMERGENCY MANAGEMENT AGENCY �p�res July 31, 1999
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of this certificate does not provide a waivar of the flood insurance purchase requirement.This form is used only to pro-
� vide elevation information necessary to ensure compliance with applicable communiry fioodplain management ordinances,to determine
th�oroper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision(LOMA or LOMR).You are not
�-ed to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form.
Instructions for completing this form can be found on the following pages.
SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE
BUILDING OWNER'S NAME POLICY NUMBER
David P. & Gail M. WADE
STREET ADDRESS(Including Apt.,Unit,Suite and/or Bldg.Number)OR P.O.ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
1754 Sunset Drive
OTHER DESCRIPTION(Lot and Block Numbers,etc.)
Lot 4, Block 11, NORTH SHORE PARR SUBDMSION Plat Book 3, pg 10, Pinellas Co. , FL
CITY'", STATE ZIP CODE
Clearwater FL 34615
SECTION B FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
Provide the following from the proper FIRM (See Instructions):
1.COMMUNITY IJUMBER 2.PANEL NUMBER 3.SUFFIX 4.DATE OF FIRM INDEX 5.FIRM ZONE 6.BASE FLOOD ELEVATION
m AO Zones,use depth)
125096 0008 D 8/19/91 VE,V�' 1�.0, 13.0
� 7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations(BFE): �NGVD'29 ❑Other(describe on back)
8. For Zones A or V,where no BFE is provided on the FIRM,and the community has established a BFE for this building site,indicate
the community's BFE:��.I_feet NGVD(or other FIRM datum—see Section B, Item 7),
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Certificate Instructions,indicate�the diagram number from the diagrams found on Pages 5 and 6 that best
�'�scribes the subject building's reference level .
•FIRM Zones A1-A30,AE,AH,and A(with BFE). The top of the reference level floor from the selected diagram is at an elevation
of I I I I '.0 feet NGVD(or other FIRM datum—see Section B, Item 7).
(b). FIRM Zones V1-V30,VE,and V(with BFE). The bottom of the lowest horizontal structural member of the reference level from
the selected diagram, is at an elevation of�J.0 feet NGVD(or other FIRM datum—see Section B, Item 7).
(c). FIRM Zone A(without BFE). The floor used as the reference level from the selected diagram is !�.�feet above❑ or
below� (check one) the highest grade adjacent to the building.
(d). FIRM Zone AO. The floor used as the reference level from the selected diagram is �.0 feet above❑ or below�(check
one)the highest grade adjacent to the building. If no flood depth number is available,is the building's lowest floor(reference
level)elevated in accordance with the community's floodptain management ordinance? ❑ Yes ❑ No ❑ Unknown
3. Ind�cate!hp ele�atio�da!um system Gsed:n deterr*m�ning!he above reference!eve!elev2t:�ns:n NU'VD'29 ❑ Othsr(descriCs
. under Comments on Page 2). (NOTE: If ihe elevation datum used in measuring the elevations is different than that used on
the FIAM �see Section 8, Item 7], then convert ihe elevafions to ihe datum system used on the FlRM and show the conversion
equation under Comments on Page 2.)
4. Elevation reference mark used appears on FIRM: ❑ Yes �i No (See Instructions on Page 4)
5.The reference level elevation is based on: � actual construction ❑ construction drawings
(NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which
case this certificate wil!only be valid for the building during the course of consiruction. A post-construction Elevation Certificate
will be required once construction is complete.)
6.The elevation of the lowest grade immediately adjacent to the building is: � 6 .� feet NGVD(or other FIRM datum-see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
�the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1
not the"lowest floor"as defined in the community's floodplain management ordinance,the elevation of the building's"lowest
ffoor"as defined by the ordinance is ���.�i feet NGVD (or other FIRM datum—see Section B, Item 7).
2. Date of the start of construction or substantial improvement •
FEMA Form 81-31, AUG 96 REPIACES ALL PREVIOUS EDITtONS SEE REVERSE SIDE FOR CONTINUA110N
',, � SECTION E CERTIFICATION
. This certification is to be signed by a land surveyor,engineer,or architect who is authorized by state or local law to certify elevation
information when the elevation information for Zones A1—A30,AE,AH,A(with BFE),V1—V30,VE,and V(with BFE) is required.
Community officials who are authorized by local law or ordinance to provide ffoodplain management information, may also sign the
ertification. In the case of Zones AO and A(without a FEMA or community issued BFE),a buiiding official,a property owner,or an
wner's representative may also sign the certification.
Reference levei diagrams 6, 7 and 8- Distinguishing Features—If the certifier is unable to certify to breakaway/non-breakaway wall,
enclosure size, location of servicing equipment,area use,wall openings,or unfinished area Feature(s),then list the Feature(s) not
included in the certification under Comments below. The diagram number,Section C, Item 1,must still be entered.
/ceKify that the information in Sections B and C on this certificate represents my best efforts to interpret the data availab/e.
I understand that any fa/se statement may be punishab/e by fine or imprisonment under 18 U.S. Code, Section 1001. _
CERTIFIER'S NAME LICENSE NUMBER(or Affix Seal)
C. Boyd Allen 3932
TITLE COMPANY NAME
Professional Land Surveyor Allen Land Surveying .
ADDRESS CITY STATE Z�p
2753 S.R. 580 Ste. 20i Clearwater FL 33761
SIGNATURE --
� 3 1�A�8 813H799-2260
Copies should be de of this Certificate for: 1)community official,2)insurance agent/company,and 3)building owner.
COMMENTS: The finished floor elevation of the structure is at 8.2 feet AMSL
•
ON WITH ON PILES,
SLAB BASEMENT PIERS,OR COLUMNS
, A V A A V .
ZONES ZONES ZONES ZONES ZONES
FEFEqENCE
REFERENCE BASE LEVEL REFERENCE
lEVEI
• FLOOD LEVEL
ELEVATION
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.. ,... � � ,- ; . �' '
BASE �'�'�����'��'� BASE
F�OOD .::�::��'�':�': ADJACENT�:'�.� REFERENCE F1000
ELEVATION REFERENGE ADJACENT GRAOE � LEVEL ELEVATION
LEVEL GRADE �
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.:,i;" 1.
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Gi7ADE
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The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones.
Elevations for all A Zones should be measured at the top of the reference levei floor.
Elevations for all V Zones should be measured at the bottom of the lowest horizontai structural member.
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