1855 VENETIAN POINT DR _ _ _ _ _ �
_.
19�/� ��`l— C) / �l/c''
. .r,Y. '�„��t". �'p �`rr,+�•�f FEpERAL EMERGENCY MANAGEMENT AGE YN���'� O.M.B.No.3067-0077
� ••- NATtONAL FLOOD INSURANCE PROGRAM Expires De�Qmt+er�31,2005
. �,-9—�� ;�
� ELEVATION CERTIFICATE
• Importarfi Reaci tt�e in�uctions on 1-7.
SECTION A-PROPERTY OWNER INFOItIIMTION Far trsirance Car�ury Use:
BUILDING OWNER'S NAME Po6c,y Ntxnber
STEVE VOIGHT AND SU L. T -VOIGHT
BUILDING SIREET ADDRESS(1 ,' Apt, nit,Suite,anci/or Bkig.No.)OR P.O.ROIJTE AND BOX NO. Company NAIC Number
1855 VENEIIAN POINT DRIVE
C17Y�� STATE ZfP CADE
CLEARWATE � FL 33755
PROPERTY DESCRIPTION(Lot a umbers,Tax Parcel Number,Legal Desaiptio�,etc.)
LOT 27 VENETIAN POINT SUBDM
BUILDING IJSE(e.g.,Resider�ial.Non-residential,A�ddiBon,Accessory,etc. Use a Commerds area,iF r�eoe.ssary.)
RESIDEN'T1AL
LAl11UDEJLOWGffUDE(OP110NAL) HORIZONTAL DAl11M: SOURCE: GPS CrYPe). .
(�r#°-�-�#.�ar o� �.#ra�r� ❑ww�s2� ❑ww�sss ❑uscs n�,ad nnaP ❑on,e�:
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATIOM
81.NFP COM11�1NITY NANE&COMut1NfTY NUNBER B2 COUNTY NAWE 63.STATE
CLEJ1ftVUATER 125096 PINEWIS ���
B4.MAP MID PANEEl B7.FRM PMEl. B9.BASE ROOD ELEVA?ION(S)
MJII�BER B5.SIJFFDC B6.F mIDEX TE SED QATE B6.ROOD ZONHS) (Za�e A0.use deplh of Aood'ig)
12103C0106 G - 9303 AE 13.0
610.Inc�rate the souroe aF tlie Base Fbod EJevabon(BF� or flood e.ntered in B9.
❑FIS Pr�'ile �FIRM ❑ ❑Other(Desaibe):
811.In�Cate the elevation datum used for the BFE in B9:�N�VD 1929 �NAVD 1988 ❑Other(Desaibe):
B12.Is the bu�ng located in a Coastal Barrier Resources System(CBRS)area a Oft�enMSe Protec�ed Area(OPA)? ❑Yes �No DesignaGon DaOe
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
;1.Budd'ing elevati�ons are based on:�con.str�,ction orawirgs' ❑e�akSrg under C.aistruction• �F'uashed Cor�struction
'A new EJevafion Certificate wiq be required when oonstruction of the buWmg is comple�e.
C2.Btalding Oiagram Number 7(Select the bu�ng�agram most sim�ar�o the bu�ng for wt�ch this oertificate is be�g cariple�ed-see pages 6 and 7. If no diagram
accu►ately represents the buildng,provide a sk�ch or photograph.)
C3.Eleva6ons-Za�es A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(wifh BFE),AR�A,AWAE,ARIA1-A�,AR/AH,AR1A0
Car�plebe Items C3.-a-i bel�w aocading to the bu�din9�agram speafied in ftem C2.Stahe the dalum used.IF the datum is�t fivm the da�um t�ed for 1he BFE in
Section B,oonvert the d�um to tha�used for the BFE Show field measu�ments and�hxn conversion c�ulation. Use the spaoe prrnrided or Uie Canments area of
Sec6on D or Sediai G,as apExopria�e,�o document the datum oonversion. �
DadKn 1988 ConversiorV�Comments NONE
Bevatio�r�erer�ce mark used ON SITE Does the elev�ion rderer�ce m�k used appear on the FIRM? No U '
❑a)Top of bo�om floor(ux�ng basernent or�ure) 5. 9 ft.(m)
❑b)Tap d r�d higher floor �16.35 R(m) �
❑c)Bot6o�n oF lowest horQaital struclural member(V mnes adyj WIA. ft(m) Q �o � :
❑d�Attadted 9arage ttoP of s�b) 5. 89 ft(m) J' c°.� �
❑e)Lowest elevation d madaur�ery andlor equipmart �� ..-- L!��„►`
saviang the bu�7d'ing(Desaibe in a Comments area) 15.3 ft(m) !� �'''' �-
O�Lowest ac$acent(fin��ade�LA�) 5.47 it(m) �I(L� � °° �
�9)�����9����) 5. 77ft(m) �`:� �
❑h)No.of Permanent�penirx,�s(flood verrts)witlun 1 ft�ove ad'�acent g�ade 48 �
❑i)T�al�ea�F all Perr►ranent openings(flood vents)in C3.h 260B sq.in.(sq.an) ��� �"'
SECTION D-SURVEYOR,ENGINEER,OR ARCHR CT TL�1��
.
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.
I certify thaf the information in Sections A,B,and C on this certificate represents my best e�forts to ir�erpret the data available.
1 undersfand that any false statement may be punishable by fine or imprisonme�under 18 U.S.Code,Section 1001.
CERTIFIEIZS NAME JOHN R BEACH LICENSE NUMBER 2984
• TtTLE P.LS. COMPANY NAME JOHN R BEACH&ASSOC.,INC.
ADDRESS CITY STATE ZIP CODE
911 ST.PEfERSBURG DR W. ��R � �
SIGNATURE � , TEIFPHONE
-� 05127105 813-854-1276
F l Form -31,January 2003 See reverse side for continuation. Replaces all previous editions
�G /" ,f G;4- � - c-= � a � �
��". '�,��'" f p ��°�� FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
- • ; �� NATIONAL FLOOD INSURANCE PROGRAM Expires Der�mhe„31, 2005
• ' ' �� ELEVATION CERTIFICATE
importar� Read the instructions on pa es 1-7.
SECTION A-PROPERTY OWNER INFORMATION Fa In�xar�oe Can�ary use.
BUILDING OWNER'S NAME Policy Number
STEVE VOIGHT AND SUSAN L.WHITE VOIGHT
BUILDING STREET ADDRESS(Induding Apt,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
1855 VENETIAN POINT DRIVE
C�-JY STATE ZIP CODE
CLEARWATER � ���
PROPERTY DESCRIPTION(Lot and Blodc Numbers,Tax Parcel Number,Legal Descrip6on,etc.)
LOT 27 VENETIAN POINT SUBDNISION
BUILDING USE(e.g.,Residential,Non-resider�tiai,Addition,Accessory,etc. Use a Commer�is area,if 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 CON1Ml1NfTY NAME&CONtivIUNffY NUNBER 62.COUNTY NAME B3.STATE
CLEARWATER 125096 PINEt1AS RORIDA
B4.MAP AND PANEL B7.FIRM PANEL B9.BASE FLOOD ELEVATION(5)
NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTiVElf2EVISED DATE B8.ROOD ZONE(S) (Zaie A0.use depth af floodig)
12103C0106 G 9/3�03 9f.�13 AE 13.0
610.indicate the source of the Base Flood EJeva�on(BFE)data or base flood depth entered in 69.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Desaibe):
B11.Indicate the elevation datum used for the BFE in 89:�NGVD 1929 �NAVD 1988 ❑Other(Desaibe):
B12.Is the building located in a Coastal Barrier Resources System(CBRS)area a Otherwise Protected Area(OPA)? ❑Yes �No Designation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:❑Construction Dra�vings' ❑Buiiding Under Construdion* �Fnished Construction
• *A new EJevation Certificate will be required when construction of the building is oomplete.
C2.Building Diagram Number 7(Select the building dagram most similar to the building for which this certificate is being completed-see pages 6 and 7. !f no diagram
accurately represents the building,provide a sketch or photograph.)
C3.Eleva6ons—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,ARIAO
rw"�"11M°.�°�.°^'O v..�.-u-i wU.:�'c'^^^.IV'^^y�.^.�'�°.w��Winy ri.1.,�nyr�m�ror�ifiwri in I4om(`7 Cf�o�o�I��m��e� If�ho�I�fi�m���frff�ron�imn�ho ri�im��e�fnr�ho RFG�n
Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion calculation. Use the spaoe provided or the Ccmments area of
Section D or Sec�ion G,as appropriate,to document the datum conversion. j
Datum 1988 ConversioNComments NONE
Elevation r�erence mark used ON SITE Dces the elevahon referer�ce mark used appear on the FIRM?�No � 4�
❑ a)Top of bottom floor(induding baserr�ent or endosure) 5. 9 ft.(m) �
0 b)Top of next higher floor 16.35 ft.(m) �==J � ��
❑�>�o�o�,ot iow�sc r,o�;ZOr,t�Sa�,r�rr,�er(v zo�es or,N) NIA._ft(m) o �.o �„
�J d)Attac�ed garage(top of slab) 5. 89 ft(m) � cv s�� �
❑ e)Lawest elevation of machinery andlor equipment �"�' '^ ��
servidng the buiiding(Desaibe in a Canments area) 15.3 ft.(m) � �'' .
�~ ��
❑f�Lowest adjacent(finished)grade(LAG) 5.47 ft.(m) 1, °� �i
❑ g)Highest�acent(finished)grade(HAG) 5. 77 ft(m) � � �', '
❑ h)No.of permanerrt openings(flood ve�ts)within 1 ft.above adjacent grade 48
� _�
❑ i)Total area�f all perrnanent openings(flood vents)in C3.h 2608 sq.in.(sq.an) ��� �"'
SECTION D-SURVEYOR,ENGINEER,OR ARCHffECT C ICAT�?l��
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.
I carf+fy thaf the information in Sections A,B,and C on this certificate represenfs my best e(forts to interpref the data available.
1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001.
CERTIFIER'S NAME JOHN R.BEACH UCENSE NUMBER 2984
• TITLE P.L.S. COMPANY NAME JOHN R.BEACH&ASSOC.,INC.
ADDRESS CIN STATE ZIP CODE
911 ST.PETERSBURG DR W. OLDSMAR FL 34677
SIGNATURE DATE TELEPHONE
�- ' � 05I27/05 8138.54-1276
FETVIA Form 1-31,January 2003 See reverse side for continuation. Replaces all previous editions
IM��T'ANT: In these spaces,copy the corresponding information from Section A For Ir�surance Company tJse:
cIUILDtivG STREEf AC�RESS Qr�dud'rg Apt,Unrt,Sui�,andlor Bkig.No.)OR P.O.ROUTE AND BOX N0. Po6c,y Number
1855 VEtvETIAN POINT "'' �� � R ,
C�1'� STATE ZJP CODE
CLEARWATER � Can�anY NAIC Nurt�er
33755
SECTION D-SURVEYOR,ENGINEER,OR ARCHffECT CERTIFICATION(CONTINUED) �
Copy both sides af this Elevabon Cer6ficate for(1)community offidal,(2)insur�nce agenUcompany,and(3)building owner.
COMMENTS
2ND LJVING AREA=28.16
❑Chedc 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 BF�,complete Items E1 ihrough E4. ff the Deva6on Certificate is intended for use as supporting infama6on for a LOMA a LOMR-F,
Secfion C must be completed.
E1.Buiiding 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 dagrarn accurately
represents the building,provide a sketch or photograph.)
E2.The top af the bottom floa(induding basement or endosure)of the building is _ft(m)_in.(an)�above or ❑belaw(chedc one)the highest adjacent grade. (Use
natural grade,'rf available).
E3.For Building Diagrams 6-8 with openings(see page 7),the neact higher floor or elevated floor(elevation b)of the building is _ft.(m)_in.(cm)above the highest adacent
grade. Complete items C3.h and C3.i on front of form.
E4.The top aF the platf�orm of machinery and/or equipment servidng the building is _ft.(m)_in.(cm)�above or ❑below(chedc one)the highest adjacent grade. (Use
natural grade,'rf availabie).
E5.Fa Zone AO only: If no flood depth number is av�lable,is the top�the bottan floor elevated in accordance with the communit�/s floodpl�n management ordinance?
❑Yes ❑No ❑Unknown. The loc�affidai must certify this ir�ormation in Sec6on G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTiFiCATION
The property owner or owners authorized representative who completes Secbons A,B,C(Items C3.h and C3.i oniy),and E for Zone A(wilhout a FEMA-issued or communiiy-
issued BFE)or Zone AO must sign here. The statemerr(s in Sections A,B,C,and E are conect to fhe best of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
r
,DDRESS CITY STATE 7JP CODE •
SIGNATURE DATE TELEPHONE
COMMENTS
_1
❑Chedc here if attar,hments
SECTION G-COMMUNfTY INFORMATION(OPTIONAL)
The local offiaal who is autliorized by law or ordinance to administer the communitys floodplain management ordinar�ce can canplete Sections A,B,C(or E),and G af this Elevation
Cer6ficate. Compiete the applicable item(s)and sign below.
G1.�The informa�on in Section C was taken from other documentation that has been signed and embossed by-a licensed surveyor,engineer,or archited who is authaized by state
a locai law to ce�tify elevation ir�ormation. (Indicate the sour�e�d date�the elevation data in the Comments area below.)
G2.�A community offiaal compieted Section E for a buikling located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0.
G3.�The folbwing information(Items G4�G9)is provided for community floodplain management purposes.
G4.PERMfT NUMBER G5. DATE PERMff ISSUED G6.DATE CERTIFICATE OF CONG�LIANCEIOCCIJPANCY ISSUED
G7.This pemiit has been issued for.0 New Construc�ion ❑Substantial Improvement
G8.Elevation of as-built lowest floor(induding basement)of the twilding is: _._ft.(m) Datum:
G9.BFE or(in Zone AO)depth af flooding at the building site is: _ _ft.(m) Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
;OMMENTS •
❑Chedc here if attact�ments
FEMA Form 81-31,January 2003 Replaces ali previous editions
n,xarr
. ��{���OF),yF�`
�e� � '�� C ITY OF C LEARWATER
• N v .� r, �,,
H� -� �Qw
%,—�� c�y DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
�+�+a=-�-.. �
��a�d.�� �����}� POST OFFICE BOX 474H� CLEARWATER� FLO�DA 33758-4748
� �GYY�i"[YH +���.
�q►��,P����„�t��' MUNICIPAL SERVICES BUILDING, lOO SOUTH MYRTLE AVENUE,CI.EARWATER,FLO�uDn 33756
TELEPHONE�7Z� 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 correctnessand 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 sedion(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. 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 B3.STATE
64.MAP AND PANEL g5.SUFFIX 66.FIRM INDEX DATE B�•FIRM PANEL gg,FLOOD ZONE(S) B9�BASE FLOOD ELEVATION(S)
NUMBER H 5/17/2005 EFFECTIVE/REVISED DATE (Zone AO,use depth of flooding)
12103C0106 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 69:� NGVD 1929 ❑ NAVD 1988 ❑Other(Describe)
612. Is the buildin located in a Coastal Barrier Resources S stem(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 all permanent openings(flood vents)in C3.h sq.in.(sq.cm)
Comments:
Date of Review: Community Official:
Al1 e/evation certificates shal/be maintained by the community and copies with the attached memo made availa6le by request
•
F►�wK H�a►innw�,MAYOR
GEORGE N.CRE'I'EKOS,COUNCILMEMAER JOIIN DORAN,COUNCtLMEMBER
PAUL F.GIfiSON,COUNCILMEMAER � CARLEN A.PE7'ERSEN,COUNCILMEMBER
��EQUAL EMPLOYMENT AND AFFIItMAT1VE AC1'ION EMPLOYER��
��1 e'/� :��-��'�°l— � / �l/L'
,' S�"K ` 1�� ��"''�"�" FEDERAL EMERGENCY MANAGEMEM AGENCY O.M.B. No. 3067-0077
� ����� NATIONAL FLOOD INSURANCE PROGRAM Expires DecembeL31,2005
� ELEVATION CERTIFICATE
� Importartt Read the instructions on pa es 1-7.
SECTION A-PROPERTY OWNER INFORMATION Fa�r�aance Cornpeny use:
BUILDING OWNER'S NAME Poficy Number
STEVE VOIGHT AND SUSAN L.WHITE-VOIGHT
BUILDING STREETADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Canpany NAIC Number
1855 VENEfIAN POINT DRIVE
CRy STAlE ZIP CODE
CLEARWATER Fl- ���
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,legal Desaiption,etc.)
LOT 27 VENEfIAN POINT SUBDMSION
BUILDING USE(e.g.,Residential,Non-residential,Addition,Ac�essory,eta Use a Commer�ts area,if neoessary.)
RESIDEIJTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONlTAL DATUM: SOURCE: GPS(fype): •
� #�°-#�r-�#.�ar or ##.#a�#°� ❑nu��s2� ❑n�a��sas ❑us�s Q�ad�nap ❑oa,er.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61.NFIP COMMUNfTY NAME&COMuNNffY NUNBER 62 COUNTY NAIvE B3.STATE
CLEARWATER 125096 PINELLAS RORIDA
B4.MAP AND PAI�L B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUWBER B5.SUFFIX 86.FIRM INDEX DATE EFFECTIVEJREVISED DATE B8.ROOD ZONE(S) (%aie A0,use deplh of floodig)
12103W106 G 9�+03 9+3A3 AE 13.0
B10.Ind�cate the source of the Base Flood Elevafion(BFE)data or base flood depth enter�ed in B9.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Desaibe):
B11.Indicate the elevaation datum used for the BFE in 89:0 NGVD 1929 �NAVD 1988 ❑Olher(Desaibe):
B12.Is the building located in a Coastal Barrier Resources System(CBRS)area a Otherwise Proteded Area(OPA)? ❑Yes �No Designafion Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevatlons are based on:❑Construdion Drawings' ❑Building Under Construdion* �Flnished Construc�ion �
� A new Elevation CerUficate will be required when constnx�ion of the building is canplete.
;2.Building Diagram Number 7(Sdect the building�iagram most similar to the building for which this certificate is being completed-see pages 6 and 7. If no diagram
aa:urately represents the building,pr�vide a sketch or photograph.)
C3.Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AWA,AWAE,AR/A1-A30,AR/AH,ARIAO
Canplete Items C3.�a-i below a000rding to the buikling diagram speafied in ttem C2.State the datum used.lf the dalum is different iran the daRum used for the BFE in
Section B,caivert the datum to that used for the BFE.Show field measurements and datum oonversion calculation. Use the space provided a the Comments area of
Section D or Section G,as appropriate,to document the datum oonversion. s ;
Datum1988 Conversion/CommentsNONE ��q�;�46'fEt�,�$� y
EJevation r�ererxe mark used ON SITE Does the elevahon r�ference mark used appear on the FIRM?�No � ��� �,�
atio
❑ a)Top of bottom floor(indu�ng basernent a endosure) 5. 9 ft.(m) � ���M ,� ,,.'`"°°'"�°�.Q`.F ��
❑ b)Top af next higher floor 16.35 ft.(m) � �� °' ,����, ',�w� '�, �y `'
❑c)Bottan of lowest horizontal struclural member(V za�es ony) WA._ft(m) � N � °m �,• �',a} ;.*r �'`,',`
� � �� �� � !
❑d)Attad�ed 9arage(top aF slab) 5. 89 ft.(m) c� �� -�, �' Yy: ,, �
� � ;
❑e)Lowest eleva6on�machinery andlor equipmerrt � "' �;U � ,,�a�:== s � �r� _�, =
servidng the buil�ing(Desaibe in a Canments area) 15.3 ft(m) � �'''� �� -� �,,,*��,�►,C�; � " ` � : ,�
❑�Lowest adacent(finished)grade(LAG) 5.47 ft(m) (�,,� ?� � :,�, �;�'�^�°',�`�" �":' .° ,: _
❑ Hi hest ad'acer�finish rade HAG 5. 77 ft m `�-� � '�'�°� `'�'��"'e,o.t�"'°�---
9) 9 1 � �9 � ) � ) r �.t,.°^,•� <<
❑ h)No.of perm�ent openirgs(flood venls)wifhin 1 ft.above adjaoent grade 48 ;� `���,� �_�°"° �°`°
❑i)Tot�area of all permanent openings(flood vents)in C3.h 2608 sq.in.(sq.an) �� W ` a�litl�eC�l���� .
SECTION D-SURVEYOR,ENGINEER,OR ARCHR CT ICATI�IJ L�
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 certificate represents my best efforts 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.
CERTIFIER'S NAME JOHN R BEACH LICENSE NUMBER 2984
TITLE P.L.S. COMPANY NAME JOHN R.BEACH 8�ASSOC.,INC.
� ADDRESS CITY STATE ZIP CADE
911 ST.PETERSBURG DR W. OLDSMAR FL 34677
SIGNATURE � DATE TELEPHONE
-�' 05/27ro5 813-854-1276
FE11AA Fortn -31,January 2003 See reverse side for continuation. Replaces all previous editions
, INi�ANT: In these spaces,copy the oorresponding i�ormation from Sedion A Fa in�rar,oe�«nparn t�e:
� �ILDii'�d'i�STREET AC�JRESS(Indud'ng Apt,Uni�SuiOe.ar�dfor Bldg.No.)OR P.O.ROIffE AND BOX N0. Poicy Numbe� ,�
�855 VEI4ETIAN POINT
'CfTY STATE Z1P CODE Canpany NAIC Nim�ber
CIFARWATER FL 33755
- SECTION D-SURVEYOR,ENGINEER,OR ARCHRECT CERTIFICATION(CONTINUED)
Copy both sides of lhis Elevation Certifiqte for(1)oommunity�i'iaal,(2)insurance agenUcompany,and(3)building owner.
COMMENTS
2ND LIVING AREA=28.16
❑Chedc here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(INITHOUT BF�
For Zone AO and Zone A(witha�t BF�,compl�e items E1 through E4. if the Elevabon Certificate is intended fur use as supporting infama6on fa a LOMA a LOMR�,
Secbon C must be oompieted.
E1.Building Diagram Number_(Sele�the twilding diagram rt�st similar to the buikJing fur which this cerbdficate is being oompleted–see pages 6 and 7. If no dagram accur�tely
represents the buil�ng,Provide a sketch a Photo9raph•)
E2.The top of the bottan floor(indu�ng bas�r�ent a endosure)of the buiiding is _ft.(m)_in.(cm)�above a ❑belav(chedc one)the highest adjacent grade. (Use
natural grade,if available).
E3.Fa Buil�ing 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 acfacent
grade. Complete items C3.h and C3.i on frrmt of form.
E4.The top o�ihe plaffam of machinery and/or equipment serviang the building is _ft.(m)_in.(an)❑above a ❑below(chedc one)the highest adjacent grade. (Use
natural grade,if available).
E5.Fa Zone AO only: If no flood depth number is available,is the top oi the bottan floor elevated in accordance with the oommunih/s floodplain m�nagernent adinance?
❑Yes ❑No ❑Unknown. The local offidal must certify this ir�ama6on in Sec.•tion G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFlCATION
The property owner or owners authorized representative who oompletes Sections A,B,C(ftems C3.h and C3.i only),and E for Zone A(wilhart a FEMA-issued or community-
issued BFE)or Zone AO must sign here. The statemerr[s in Sections A,B,C,and E a►e coned to fhe best of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
*
�DDRESS CIlY STATE ZJP CODE
SIGNATURE DATE � TELEPHONE
COMMENTS
_{
❑Chedc here if atta�fiments
SECTION G-COMMUN(TY INFORMATION(OPTIONAL)
The local offiaal who is autha¢ed by law or ordin�oe to adminisstter the community's floodplain management adnance can complete Sections A,B,C(or�,and G of ihis Elevabon
Czrfificate. Complete the applicable item(s)and sign below.
G1.�The informa6ai in Section C was taken from other documentation that has been sgned and embossed by a licensed surveyor,ergineer,a archited who is aufhaized by state
or local law to certify eleva�on ir�orma6on. (Ind�cate the souroe and date of the elevation data in the Comments area bebw.)
G2.❑A communiiy official oompl�ed Secfion E for a building bcated in Zone A(witl�out a FEMA�ssued or community-issued BFE)or Zone A0.
G3.�The folbwing information(Items G4-G9)is provided for oommunity floodplain management purposes.
CPERMff NUWBER G5. DATE PERMfT ISSUED G6.DATE CERTIFICATE OF COWPLIANCEIOCCUPANCY ISSUED
G7.Tfiis permit has been issued fa:�New ConsUuclion ❑Substar�ial Improvement
G8.Elevation of as-buift lowest floor(induding basement)of the building is: _._ft.(m) Datum:
G9.BFE a(in Zone AO)depth of floo�ng at the buil�ng site is: _._ft.(m) D�um:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
OMMENTS
❑Chedc here if atta�ments
FEMA Form 81-31,January 2003 Replaces all previous editions
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������s�s��t���i' POST OFFICE BOX 474H� CLEAEtWATER� FLORIDA 33758"474g
�i qTEP�'� f4¢ MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CI.EARWATER,FLO�unn 33756
rr�lj�Yf TELEPHONE �7Z� S6Z-4S67 F�vc(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 O�cial
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
1.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME 63.STATE
64.MAP AND PANEL g5.SUFFIX B6.FIRM INDEX DATE B�•FIRM PANEL gg.FLOOD ZONE(S) B9•BASE FLOOD ELEVATION(S)
NUMBER H 5/17/2005 EFFECTIVE/REVISED DATE (Zone AO,use depth of flooding)
12103C0106 5/17/2005
610. 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)
B11. Indicate elevation datum used for BFE in 69:� 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 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 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/Ai-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) r
Comments: "
Date of Review: Community Official:
All e/evation certi(�cates shall b maintained by the community and copies with the attached memo made available by request
�
FRANK HIBRARD,MAYOR
GEORGE N.CRE'1'EKOS,COUNCILMEMBER JO[IN DORAN,COUNC[LMEMBER
PAUL F.GIASON,COUNCILMEMAER � CARI.EN A.PE'PERSEN,COUNCILMEMBER
��EQUAL EMPLOYMENT AND AFFIftMATNE ACTION EMYLOYER��