125 WINDWARD IS L`LL`VH1 IVIV VCR 1 II"IVH1 C ExpiresMay31, 1993
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION:Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is Used only t�
provide elevation information necessary to ensure compliance with applicable community fioodplain management ordinances,to
determine the proper insurance premium rate,and/or to support a request for a Letter of Map Amendment or Revision(LOMA or LOMR).
Instructions for compieting this form can be found on the following pages.
SECTtON A PROPERTY INFORMATION FoR wsuRnNCe coMPnNV use
BUILDING OWNER'S NAME POIICY NUMBER
Stanley F. & Waldtraut A. Tavanese _ ___ _,
STREET AODRESS(Including Apt.,Unif,Suite and/or Bidg.Number)OR P.O.ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
125 Windward Island
OTHER DESCRIPTION(Lot and Block Numbers,etc.)
Lot 39, Unit 4 Island Estates of Clearwater
CITY STATE ZIP COOE
Clearwater Florida
SECTION B FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
Provide the tollowing from the proper FIRM (See Instructions):
1.COMMUNITY NUMBER 2.PANEL NUMBER 3.SUFFIX 4.DATE OF FIRM INDEX 5.FIRM ZONE 8.BASE FIOOD ELEVATION
(In AO 2onea,use depih)
125096 0008 D 8/19/91 AE 11 .00'
7. Indicate the elevation datum system used on the FIRM tor Base Flood Elevat(ons(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:��.0 leet 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 '
describes the subject building's reference level � .
2(a). FIRM Zones A1-A30,AE,AH,and A(with BFE). The top of the reference level iloor from the selected diagram is at an elevation
of�W.�feet NGVD(or other FIRM datum—see Section B, Item 7).
�) 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� I I � � I.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 L�.0 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 ��.U feet above❑ or below 0(check
one)the h'sghest grade adjacent to the b�+iding. If no flood depth number is available, is ihe building's(owest floor(reference
Ievei)etevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown
3. Indicate the elevation datum system used in determining the above reference level elevations:� NGVD'29 ❑ Other(describe
under Commenis on Page 2). (NOTE: If the elevation datum used in measuring the elevations is di/ferent than fhat used on
the FIf�M (see Sectfon B, Item 7J, then convert the elevations to the datum system used on the FIRM and show the conversion
equation under Comments on Page 2.)
4. Elevation reference mark used appears on FIRM: � � Yes ��No (See Instructions on Page 4)
5. The reference level elevation is based on: �X, 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 certilicate will only be valid for ihe building during the course of construction. A post-constructfon Elevation Certilicate
will be required once construction is complete.)
6.The elevation o(the lowest grade immediately adjacent to the building is:�_�—L_I_15�.L2� feet NGVD(or other FIRM datum-see
Section 8, �ter��).
SECTION D COMMUNITY INFORMATION
1. If the community officia�responsibie for verifying building elevations specifies that the reference level indicated in Section C, Item 1
is not the"lowest floor"as defined in the community's floodplain management ordinance,the elevation of the building's"lowest
iloor"as defined by the ordinance is: �ll�.0 feet NGVD(or other FIRM datum—see Section B, Item 7).
? Date of the start of construction or substantial improvement __ __--.___.
�A Form 81-31�MAY 90 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE F�R CONTINUATION
.7C1i11V1YC VG�711�'1liAlIV1V �
�
This certification is to be signed by a iand surveyor,engineer,or architect who is auttiorized 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 otiicia�s who are authorized by local law or ordinance to provide floodplain management information, may also sign the
ceriification. In the case of Zones AO and A(without e FEMA or community issued BFE),a building official, a property owner,or an
owner's representative may also sign the certification.
Reierence level 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.
I certily that the inlormation in Sections B and C on this certificate represents my best efforts to interpret the data available.
1 understand that any lalse statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIER'S NAME LICENSE NUMBER(or A(tix Seat)
Philip C. Stock R.L.S. #3035
TITLE COMPANY NAME
President Target Land Surveying Inc.
ADDRESS CITY STATE ZIP
� P.O. Box 663 Dunedin Florida 34697
SIGNATURE 11%10/98 784E0573
�n ,•�-�%�"�
Coples should be made of thts Certificate ior: 1)community officlal,2)Insurance agent/company,and 3)bullding owner.
COMMENTS: #981104-02 Benchmark= BMD "AWL USCE 1941", Map# 145, Elev.= 7.985'
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ON WITH ON PILES,
SLAB BASEMENT PIER3,OR COLUMNS
A 'V A A V
ZONES ZONES ZONES ZONES 20NES
REFERENCE
REFE�ENCE � BI1SE �E�E� REPERENCE
IEVEL FLppp LEVEL
ELEVATION
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z' EIEVATION
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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 level floor. �
Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member.
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