2767 DIANE TERRACE�:������`�-(`.�37
FEDERAL EMERGENCY MANAGEMENT AGENCY
''� NATIONAL FLOOD INSURANCE PROGRAM
;�
��� ELEVATION CERTIFICATE
Read the instructions on pages 1- 7.
SECTION A- PRQPERTY OWNER INFORMATION
DONALD R. & CHERYL A. MCCARTHY
BUILDING STREET ADDRESS (InGuding Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
2767 DIANE TERR
O. M. B. No. 3067-0077
Expires December 31, �!005
CITY
CLEARWATER F�AT� ZIP CODE
Pr�OPERTY DESCRi�TION ��ot and Bfocic Numbers, Tax Parcel Number, Legai Dsscripticn, etc.; 33759
LOT 2, DIANE HEIGHTS REPLAT
BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory•, etc. Use a Cornments area, if necessary.)
RESIDENTIAL
Fa Insurance Comparn Use:
�� w� ,���v^�� nurtiGUNTAL DATUM: SOURCE. ❑ GPS (Type):
( ##° - ##' - ##.##" or #fk.�k� � NAD 1927 ❑ NAp 1983 ❑ USGS Quad Map ❑ Other:
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
61. NFIP COMMUNITY NAME & COMMUNITY NUMBER 82. COUNTY NAME 63. STATE
CLW 125096 I PINELLAS FL �
64. MAP ANO PANEL 67. FIRM PANEL 69. BASE FLOOD ELEVATION(S)
NUMBER B5. SUFFIX B6. FIRM INDEX DATE EFFECTIVElREVISEO DATE 68. FLOOD ZONE S
125096-0126 � g�3 9�3 () (Zone A0, use depih of flooclirg)
AE �,5
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9.
� ❑ FIS Profile � FIRM ❑ Community Determined ❑ Other (Describe): _
611. Indicate the elevation datum used for the BFE in B9: � NGVD 1929 � NAVD 1988 ❑ Other (Describe):
B12. Is the building located in a Coastal Bamer Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes � No Designation Date
SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are basetl on: � Construction Drawings" ❑ Building Under Construc�ion' � Finished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
C2. Building Diagram Number 1(Select the bui!ding dagram most similar to the building for which this cerUfificate 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, AWA, AR/AE, AWA1-A30, AR/AH, AR/AO
r�,.na��so Items C3.-a-i below acc�r�in� to G;e b;.�ilding �agram specifizd in (tem C2. Sta'te fne datum used. If tne datum is di�rerent from the datum used ror 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 1988 ConversioNComments
Elevation reference mark used Does the elevation reference mark used appear on the FIRM? ❑ Yes � No
o a) Top of bottom floor (induding basement or enclasure) �. 7 ft,�m� � °��C.�C�S
o b) Top of next higher floor N. A ft.(m) �
o c) Bottom of lowest horizontal structural member (V zones only) N. A ft,(m) y�
o d) Attached garage (top of slab) 56 3 ft�m� �°
o e) L�vest elevation of machinery and/or equipment ` �
servicing the building (Describe in a Comments area) 56 . 0 ft.(m) � ,�.
o� Lowest adjacent (finished) grade (LAG) 56 . 3 ft.(m) Z�,
o g) Highest �acent (finished) grade (HAG) 56. 3 ft.(m) �`�
o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 0 � � _<
o i) Totai area of all permanent openings (flood vents) in C3.h 0 sq. in. (sq, cm) J
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 certi(y that fhe information in Secfions A, B, and C on fhis certi�cate represents my best efforfs to interpret fhe data available.
1 understand thaf any false stafement may be punishab(e by frne or im risonment under 18 U. S. Code, Secfion 1001.
CERTIFIER'S NAME M.G. MAYER LICENSE NUMBER4495
TITLECEO COMPAM( NAME FLORIDA BENCHMARK
l`� `� ADDRESS
il� 1298 LAKEVIEW RD.
C SIGNATURE
FEMA Form 81-31, January 2003
CITY STATE ZIP CODE
CLEARWATER FL 33756
DATE
06-01-04
See reverse side for continuation.
TELEPHONE
727-298-0286
Replaces ail previous editions
, IMPC3�?TANT: In these spaces, co�
BUILDih�� STkEET ADDRESS (induding Apt.,
2767 DIANE TERR
CITY
CLEARWATER
the
Suite, and/or BkJg. No.)
information from Section A.
OR P.O. ROUTE AND BOX N0.
STATE
FL
Ftlr ir�surance Comparry Use_�
Po6cy Number
ZIP CODE Crxnparry NAIC Number �
33759
SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) J
Copy both sides of this Elevation Certificate for (1 } community official, (2) insurance agenticompany, and (3) building owner.
COMMENTS
AC 56.0
❑ Check here if attachments
SECTION E- BUlLDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE)
Fa Zone AO and Zone A(without BFE), complete Items E1 through E4. If the Elevation Certificate is iMended for use as supporting information for a LOMA or LOMR-F,
Section C must be completed.
E1. 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 accuralely
represents the building, provide a sketch or photograph.)
E2. The top of the bottom floor (including basement or enclosure) of the building is _ ft.(m) _in.(cm) � above or ❑ below (check one) the highest adjacent grade. (Use
natural grade, if available).
E3. For Building 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 adjacent
grade. Complete items C3.h and C3.i on front af form.
E4. The top of the platform of machinery and/or equipment senriang the building is _ ft.(m) _in.(cm) � above or ❑ below (chedc one) the highest adjacent grade. (Use
natural grade, if available).
E5. For Zone AO only: If no flood depth number is available, is the top of the bottom floor efevated in accordance with the community's floodplain management ordinance?
❑ Yes ❑ No ❑ Unknown. The local officiai must ceRify this informa�on in Section G.
SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owne�s authorized represenkative who completes Sections A, B, C(Items C3.h and C3.i oniy), and E for Zone A(without a FEMA-issued or community-
issued BFE) or Zone AO must sign h�re. The statements in Sections A, B, C, and E are correcf to the best of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME —
ADDRESS
JiCil�la I U�rt�
COM
CITY
STATE ZIP CODE
DATE TELEPHONE --
!"`�, �
�
' ❑ Check here if attachments
SECTION G - COMMUNffY INFORMATION (OPTIONAL)
The locai official who is authorized by law or ord;�ance to administer the community's floodplain management orciinance can compiete Sections A, B, C(or E), and G of this El�avation
Certificate. Complete the applicable item(s) and sign below.
G1. � The information in Sec6on C was taken from other documertation that has been signed and errbossed by a licensed surveyor, engineer, or architectwho is authorizai by state
or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below. j
G2. � A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or Zone A0.
G3, � The following informa6on (Items G4-G9) is provided for community floodplain management purposes.
G7. This permit has been issued for: ❑ New Construdion ❑ Substantial Improvement
G8. Elevafion of as-built lowest floor (induding basement) of the building is:
G9, BFE or (in Zone AO) depth of flooding at the building site is:
LOCAL OFFICIAI'S NAME
COMMUNITY NAME TELEPHONE
SICiNA I UKt
COMMENTS
_. _ft.(m) Datum:
_. _ ft.(m) Datum:
❑ Check here if aitachments
FEMA Form 81-31, January 2003 Repiaces all previous editions