61 WINDWARD IS ___ _______.__
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U.S. DEPARTMEMT OF HOMELAND SECURIIY ELEVATION CERTIFICATE OMB No. 1660-0008
Federal Emergency Management Agency Ex�ires FebruaN 28. 2009
National Flood Insurance Program Important: Read the instructions on pages 1-8.
• -= SECTION A-PROPERTY INFORMATION Forinsurance Company Use:
uilding Owner's Name DAVID AND LORI NADER Policy Number
A2. Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Company NAIC Number
61 WINDWARD ISLAND
City CLEARWATER State FL ZIP Code 33767
A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.)
LOT 28 UNIT 4 ISLAND ESTATES OF CLEARWATER
A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory,etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat.27.97562 N Long.08i.81076 W 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 buiiding 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) NA sq ft a) Square footage of attached garage 668 sq ft
b) No.of permanent flood openings in the crawi space or b) No. of permanent flood openings in the attached garage
enclosure(s)walls within 1.0 foot above adjacent grade NA walls within 1.0 foot above adjacent grade 5
c) Total net area of flood openings in AB.b NA sq in c) Total net area of flood openings in A9.b 1273.61 sq in
SECTION B -FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61. NFIP Community Name 8�Community Number 82. County Name 63.State
CITY OF CLEARWATER 125096 PINELLAS FL
B4. Map/Panel Number 65.Suffix B6. FIRM index 67. FIRM Panei B8. Flood B9. Base Flood Elevation(s)(Zone
Date Effective/Revised Date Zone(s) AO, use base flood depth)
12103C0106 H 09/03/03 05/17/05 AE 11
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)
611. Indicate elevation datum used for BFE in Item B9: ❑NGVD 1929 � NAVD 1988 ❑Other(Describe)
• ':the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No
esignation Date NA ❑CBRS ❑OPA
SECTION C -BUILDING E�EVATION 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,ARlA,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 F=3 Vertical Datum NAVD 88
Conversion/Comments NA
Check the measurement used.
a) Top of bottom floor(including basement,crawl space,or enclosure floor)_ 5.25 �feet ❑meters(Puerto Rico only)
b) Top of the next higher Floor 11.51 �feet ❑meters(Puerto Rico only)
c) Bottom of the lowest horizontal structural member(V Zones only) NA. �feet ❑meters(Puerto Rico only)
d) Attached garage(top of slab) 5.25 �feet ❑meters(Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building 11.37 �feet ❑meters(Puerto Rico only)
(Describe type of equipment in Comments)
� Lowest adjacent(finished)grade(LAG) 4.64 �feet ❑meters(Puerto Rico only)
g) Highest adjacent(finished)grade(HAG) 5.09 �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 ce�tify that the information on fhis Certificate represents my best efforfs to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
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� Check here if comments are;pro4ided�o.n back of form. ~ z^��,�� �, '-, -
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rt�fier's Name GEORGE A. SHIMP III License Number 6137 JOB#050528A '
E�,�1:. '..' f,., � � ,
�. VICE PRESIDENT w` �
Company Name GEORGE A.SHIMP II&ASSOCIATES, INC. ' �'' � '�:. �
,�!!�:: y�;��.f., � � .
Address 3301 DESOTO BLVD.SUITE D � �ity PALM HARBOR State FL ZIP Code 34683 ���� - �x �` '
� � � .�, :a:�,_ �
S� ,J��;e�, /� ,.�.-�-- Date���� Telephone 727-784-5496 l, � -
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IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance.Company Use: •
Building Street Address(including Apt., Unit,Suite,and/or Bidg. No.)or P.O. Route and Box No. Policy Numbe�
61 WINDWARD ISLAND
City CLEARWATER State FL ZIP Code 33767 Company NAIC Number
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for(1)community official, (2)insurance agenUcompany,and(3)building owner.
Comments SECTION C2.e)AIR CONDITIONER PAD
�- �?c�� .,� d.�� �L�.
Signature Date 05/02106
❑ Check here if attachments
SECTION E-BUILDING ELEVATION 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 Q 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 owners authorized representative who completes Sections A, B,and E for Zone A(without a FEMA-issued or community-issued BF�
or Zone AO must sign here. The stafemenfs in Sections A, B, and E are correct fo 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 official who is authorized by law or ordinance to administer the community's fioodplain management ordinance can complete Sections A, B,C(or E),
and G of this Elevation Ce�tificate. 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-built lowest floor(including basement)of the building: _Q 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 O
Community Name Telephone
Signature Date M�Y � ,� �S�f1S
G. :f
c°m„e"ts - DEVEL�PfUIENT SVC�
CITY 6�IF �;t._�,qRUV�,T��
❑Check here if attachments
U.S. DEPARTMENT OF fiOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
Federal Emergency Management Agency
Exnires Februarv 28.2009
Nationa!Flood in5urance Program Important: Read the instructions on pages 1-8.
__ SECTION A-PROPERTY INFORMATION For Insurance Company Use:
F uilding Owner's Name DAVID AND LORI NADER Policy Number
. Building Street Address(including Apt., Unit,Suite,andlor Bldg. No.)or P.O. Route and Box No. Company NAIC Number
61 WINDWARD ISLAND
City CLEARWATER State FL ZIP Code 33767
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
LOT 28 UNIT 4 ISLAND ESTATES OF CIEARWATER
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) RESIDENTIAL
A5. Latitude/longitude: Lat.27.97562 N Long.08�.81076 W 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) NA sq ft a) Square footage of attached garage 668 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 NA walls within 1.0 foot above adjacent grade 5
c) Total net area of flood openings in AB.b IVA sq in c) Total net area of flood openings in A9.b 1273.61 sq in
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1. NFIP Community Name 8 Community Number _ 82.County Name B3.State �
CITY OF CLEARWATER 125096 PINELLAS FL
B4. Map/Panel Number B5.Su�x B6.FIRM Index 67. FIRM Panel B8.Flood 89. Base Flood Elevation(s)(Zone
--I rve/ e Zone(s) AO,use base flood depth)
12103C0106 H 0 3/0 �l/ 05/17/05 AE 11
810. Indicate the source of the Base Flood Eleva on(BFE)data or base 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)
B1" ':the building located in a Coastal Barcier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No
esignation Date NA ❑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 F_3 Vertical Datum NAVD 88
ConversioNComments NA
Check the measurement used.
a) Top of bottom floor(including basement,crawl space,or enclosure floor)_ 5.25 �feet ❑meters(Puerto Rico only)
b) Top of the next higher floor 11.51 �feet ❑meters(Puerto Rico only)
c) Bottom of the lowest horizontal structural member(V Zones only) IVA. �feet ❑meters(Puerto Rico only)
d) Attached garage(top of slab) 5.25 �feet ❑meters(Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building 11.37 �feet ❑meters(Puerto Rico only)
(Describe type of equipment in Comments)
� Lowest adjacent(finished)grade(LAG) 4.64 �feet ❑meters(Puerto Rico only)
g) Highest adjacent(finished)grade(HAG) 5.09 �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 cefify elevation
information. 1 certify that the infom►ation on this Certificate represents my best efforts to interpret the data available.
1 understand fhat any false sfatemenf may be punishable by�ne or imprisonment under 18 U.S. Code, Section 1001.
� Check here if comments are provided Qn back of form. _ ��=� � �, ����'� "
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Cert�fier's Name GEORGE A.SHIMP III License Number 6137 JOB#050528A � �- � '
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_ s•.^y v � �` Y,_.�.�
VICE PRESIDENT Company Name GEORGE A.SHIMP II&ASSOCIATES,INC. ' � -
dress 3301 DESOTO BLVD.SUITE D :! Ci PA 1 . ` "
ty � R State FL ZIP Code 34683
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5 �ure ' Date - � Telephone 727-784-5496
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�/9�� �`Q1�� POST OFFICE BOX 4748� CLEARWATER� FLO�DA 33758-4748
♦ z�JI MUNICIPAL SERVICES BOILDING, ZOO SOUTH MYRTLE AVENUE,CI.EARWATER,Fr.o�unn 33756
�`�E� TELEPHONE�72� 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 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 Poiicy Number
A2. Building Street Address(including Apt., Unit,Suite,and/or Bidg.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: 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. Building 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
B1. NFIP Community Name&Community Number B2.County Name 63.State
64. Map/Panel Number B5.Suffix B6.FIRM Index 67.FIRM Panel 68.Flood B9.Base Flood Elevation(s)(Zone
Date Effective/Revised Date Zone(s) AO,use base flood depth)
5/17/05
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)
611. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ❑NAVD 1988 ❑Other(Describe)
B12. 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 Official:
All e/evation certificates shall be maintained by the community and copies wifh the attached memo made availa6le by request
FRANK HIRRARI),MAYOR
GEORGE N,CRE'1'EKOS,COUNCILMEMRGR JO[IN DORAN,COUNCtLM8MA8R
PAUL F.GIBSON,COUNCILMEMRER � CARLEN A.PE7'ERSEN,COUNCILMBMBER
��EQUAL EMYLOYAfENT AND AFFIRMATIVE AC1'ION EMPLOYER��
i
1
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1.S..DEPARTMENTOFHOMELANDSECURITY ELEVATION CERTIFICATE OMBNo. 1660-0008
FGderal Emergency Management Agency ExDires FebruaN 28. 2009
National Flood Insurance Program Important: Read the instructions on pages 1-8.
_- SECTION A-PROPERTY INFORMATION Fortnsurance Company Use:
uilding Owners Name DAVID AND LORI NADER Policy Number
A2. Buiiding Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Company NAIC Number
61 WINDWARD ISLAND
City CLEARWATER State FL ZIP Code 33767
A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.)
LOT 28 UNIT 4 ISLAND ESTATES OF CLEARWATER
A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory,etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat.27.97562 N Long. 08�.81076 W Horizontal Datum: ❑ NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of the building if the CeRificate 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) NA sq ft a) Square footage of attached garage 668 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 NA walls within 1.0 foot above adjacent grade 5
c) Total net area of Flood openings in A8.b NA sq in c) Total net area of flood openings in A9.b 1273.61 sq in
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61. NFIP Community Name&Community Number _ 62.County Name 63.State
CITY OF CLEARWATER 125096 PINELLAS FL
64. Map/Panel Number 85.Suffix 86. FIRM Index 67. FIRM Panel 68.Flood B9.Base Flood Elevation(s)(Zone
Date Effective/Revised Date Zone(s) AO,use base flood depth)
12103C0106 H 09/03/03 05/17/05 AE 11
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)
811. Indicate elevation datum used for BFE in Item 69: ❑NGVD 1929 � NAVD 1988 ❑Other(Describe)
61' the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No
signation Date NA ❑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 F=3 Vertical Datum NAVD 88
Conversion/Comments NA
Check the measurement used.
a) Top of bottom floor(including basement,crawl space,or enclosure floor)_ 5.25 �feet ❑meters(Puerto Rico only)
b) Top of the next higher floor 11.51 �feet ❑meters(Puerto Rico only)
c) Bottom of the towest horizontal structural member(V Zones only) NA. �feet ❑meters(Puerto Rico only)
d) Attached garage(top of slab) 5.25 �feet ❑meters(Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building 11.37 �feet ❑meters(Puerto Rico only)
(Describe type of equipment in Comments)
� Lowest adjacent(finished)grade(LAG) 4.64 �feet ❑meters(Puerto Rico only)
g) Highest adjacent(finished)grade(HAG) 5.09 �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 effo�fs to interpret the data available.
1 understand that any false statement may be punishable by fine or impnsonment under 18 U.S. Code, Section 1001.
� Check here if comments are provided an back of form. ' r �-�•'z�£ � �? _ "
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C�er's Name GEORGE A.SHIMP III License Number 6137 JOB#050528A _3 �^^ ;�, `� ` `
� ' z� a�'.-��
T� ICE PRESIDENT � Company Name GEORGE A.SHIMP II&ASSOCIATES, INC. �:: ��` � �
'4R.. C.fi 1�:�' . `
' ..'a n`�' .
Address 3301 DESOTO BLVD. SUITE D ity PALM HARBOR State FL ZIP Code 34683 5 .{y.�y� y� • ,
S ure � Date���, /� Telephone 727-784-5496 �
7
_FF�AA Fnrm R1_�1 Fchnioni�nna c..................:.a,,t,..,.,._�:_.._.:-- ^--'---- ' ._ _�:.:---
-" ---...--
ORTANT; �� these s
Bui�din Paces, copy the corres
g Street Address including qPt., Unit ►'°ndin "
61 WINDWqRD ISLqND , Suite 9 jnf��ation fro p
City CLEAR ,and/or BId9. No.)or P.O. m SeCtlOr1 q, •
WATER State F� Route and Bo Fo�Insurance Co
z�P Code 33767 X No. .
Polic !nPany�se:
y Number
SECTIpN D-SURVEYO
Copy both sides of this Elevation R� ENGINEER Compa�y��C
Comments Certificate for 1 , OR qRCHITEC7 CERTlFIC Nu�ber
SECTION C2.e ( )communiry official A710N(CONTINUED
)AIR CONDITIONER Pqp � (2)insurance a �
genVcompa�y,and(3)building owner,
�' � � �
Signature �
SECTION E-BUILDING Date
ELEVqr�p 05�o2�os
For Zones AO and q N�NFORMqTIpN(gURVEY NOT Q
and C, For Items �W�thout BFE�, com i RE U�RED)FpR ❑ Check here if
E�-E4, use natural � p ete Items E1_E5, Z�NE AO qNp Z�NE A a�tachments
E1, Provide elevation inforrriation for�the followlnl�able. If the Certificate is intended to su �W�rHOUT gpE
grade Check the measurement used. ►�p ppO�a LOMA or LO �
(HAG)and the lowest adjacent grade g and check the uerto MR-F re
a)Top of bottom floor(includin ��G) appfOp�'ate boxes to show R�co only, enter qUest, complete S
g base meters, ections q, g,
)7op of bottom floor(includin ment,crawi s whether the elevation is above or below the hi
E2- For Buildin 9 basement,crawl Space,or enciosure)is
g Diagrams 6-8 with Pace,or enclosure)is�— ❑feet 9hest adjacent
(elevation C2.b in the diagrams permanent flood o ❑ineters
E3. Attached )of the building�S penings provided in ---- ❑feet �above or�below the
E4. To p 9arage(top of slab)is Section q Items 8 �meters �above or HAG,
p of latform of machine �f�� ❑meters and/or 9(see paye 8 of Instruction❑ below the LqG,
E5. Zo�e ry and/o e -- ❑feet ❑meters ❑above or ),the ne
A�o��Y If no Flood de q��pment seroicin ❑above ❑below the HqG �higher floor
ordinance? Pth number is availabie, is hehtobuilding�S or ❑below the HAG.
❑Yes � No p of the botto o-' �feet ❑meters
❑ Unknown. The local official must certi e1eVated in accordance wi�the co or
❑below the HqG
SECTION F_ �Y this inforrnation in Section G. mmuni
PROPER�-�. tY's floodplain management
1e p�OpertY owner or owner's authorized representative OW omR
Zone AO (�R OWNER'S REPRES
must sig�here, The statements in Sections q, B, ENrArivE
°perh'Owner's P etes Sections q, g )CERTIFICqT�pN
or Owner's quthorized and E a��omect fo the and E for Zone A
Representative's Name best of m �''��thout a FEMq_�ssued or co
dress y know/edge, mmunity-fssued BFF
nature C�ty
iments State ZIp Code
Date
Telephone
-al official who fs authorized b SECTIO(�G-
?f this y law or ordinance to administe�rMMU�NII'Y INFOIZIy�qr�ON
Elevation Certificate. Complete the a
The information in S (�Pr�ONq�� ❑Chec_ k�e�f attac��_
Pplicable item mmunity�s flood lain
is authorized b �t�on C �S)and sig�below, p management ordinance
was taken from other docu �heck the measurement used in Items
y law to certi(y elevation inform �1entation that has been sl � �n complete Sections q, g
A community official completed Section E for a t�on. (Indicate the source and G8•and�g, � C(o�E),
9 ed and sealed by a licensed surve
The followin buildin �o date of the elevation data in the Co
g inforrnation(Items G4.- 9 �ted in Zone q yor,engi�eer,or architect�,yho
rmit Number G9'��S p�OVided for co �'^'�thout a FE mments area below.)
mmuni MA-issued or community_issued BFE
G5. Date Pe ry Floodplain rrianagement purposes.
rmit Issued �o�Zone AO.
aermit has been issued for: Gs. Date C
❑New C e��f�cate Of Compliance/Occupancy Issued
tion of as-built lowest floor(includin onstruction
�r in 9 basement)of the building❑�_tantial Irnprovement
( Zone Ap�depth of floodin
9 at the building site: -- -�feet
icial's Name ❑meters(PR�Datum
--� ❑feet ❑meters(pR�patum
�Y Na�_ �_
Title
Telephone
_ Date
�ar � 4 z��s .
�E�E�'�p��NT
CITy ,�1�F �_. SVC�,
81-31, February 2006 �� ��R�✓.Ar��
. ���rNA/
�� ��� �� CITY OF CLEARWATER
� . ,
�� � a DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
~��� ---- I`O�1 POST OFFICE BOX 474H� CLEARWATER� FLO�DA 33758-4748
�QjER`�v1� MUNICIPAL SERVICES BUILDING, lOO SOUTH MYRTLE AVENUE,CI.FARWATER,Fio�unn 33756
�'r'� TELEPHONE�7Z� 562-4567 FAx(72� 562-4576
MEMO OF REVIEW FOR CORRECTNESS 8� 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. Building 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. Building 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 63.State
B4. Map/Panel Number B5.Suffix 66.FIRM Index B7.FIRM Panel 68.Flood 69.Base Flood Elevation(s)(Zone
Date Effective/Revised Date Zone(s) AO,use base flood depth)
5/17/05
610. 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)
611. Indicate elevation datum used for BFE in Item 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
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 Official: �
All elevation certificates shall be maintained by the community and copies with the attached memo made available by request
FRANK HIRRARD,MAYOR
GEORGE N.CRE'I'EKOS,COUNCILMEMBER JOIIN DORAN,COUNC[LMEMBER
PAUL F.GIASON,COUNCILMEMRER � CARI.GN A.PE7'ERSEN,COUNCILMEMBER
��EQUAL EMPLOYMENT AND AFFIItMATIVE ACTION EMPLOYER��