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��"��� �''�3 FEDERAL EMERGENCY MANAC3EMENT AGENCY
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��'�'f � Z NATIONAL FLOOD INSURANCE PROGRAM
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�y ° ELEVATION CERT! FICATE
OMB 3067-0077
Exyirea: June ] 984
This torm is to be used for: 1) New/Emergency Program construction in Special Flood Hazard Areas; 2) Pre-FIRM construction after
September 30, 1982: 3) Post-FIRM construction; and, 4) Other buildings rated as Post-FIRM rules.
BUILDING OWNER'S ADDRESS
NAME
Lot 42, Island Estates, Unit 7B, Plat Book 64, Page 70, Pinellas County, Florida
PROPERTY LOCATION (Lot and Block numbers and address if available)
#800 Snug Island, Clearwater, Florida
1 certify that the information on this certificate represents my best efforts 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.
SECTION 1 ELIGIBILITY CERTIFICATION (Completed by Local Comrnunity Permit Official or a Registered Professional Engineer,
ArChitect, or Sun;eyor)
YES NO It is intended that the building described above will be constructed in compliance with the community's flood plain
❑ ❑ ordinance. The certifier may rely on community records. The lowest floor (including basement) witl be at an elevation
oi ft, NGVD. Failure to construct the building at this elevation may place the buitding in violation of
the community's flood plain management ordinance.
YES NO The building described above has been constructed in compliance with the community's flood plain management
❑ ❑ ordinance based on elevation data and visual inspection or other reasonable means.
If NO is checked, attach copy of variance issued by the community.
YES NO The mobile home located at the address described above has been tied down (anchored} in compliance with the
❑ O community's flood plain management ordinance, or in compliance with the NFIP Specifications.
MOBILE HOME MAKE MODEL YR. OF MANUFACTURE SERIAL NO. DIMENSIONS
X
(Community Permit Official or Registered Professional Engineer, Architect, or Surveyor)
� AODRESS
TITLE CITY STATE ZIP
SIGNATURE DATE PHQNF
SECTION 11 ELEVATION CERTIFICATION (Certified by a Local Community Permit Official or a Registered Professional Engineer,
Architect, or Surveyor.)
FIRM ZONE At-A30: 1 certify that the buil i g the property location described above has the lowest lloor (including basement)
at an elevation of feet, NGVD (mean sea level) and the average grade at the building site is at
an elevation of 4. 2 feel, NGVD.
FIRM 20NES V, V1-V30: I certify that the building at the property location described above has the bottom ol the fowest lloor beam
at an elevation of feet, NGVD (mean sea level), and the average grade at the building site
is at an elevation ot feet, NGVD.
FIRM ZONES A, A99, AH and EMERGENCY PROGRAM: 1 certify that the building at the property location described above has the luwest
floor elevation of feet, NGVD. The elevation of tfie highest adjacent grade next to the building is feet, NGVD.
FIRM ZONE AO: 1 certify that the building at the property location described above has the lowest floor elevation of
feet, NGVD. The elevation of the highest adjacent grade next to the building is feet, NGVD.
SECTION III FLOODPROOFING CERTIFICATION (Certification by a Registered Professional Engineer or Architect)
I certify to the best of my knowledge, information, and belief, that the building is designed so that the building is watertight, with
walls substantially impermeable to the passage of water and structural components having the capability of resisting hydrostatic
and hydrodynamic loads and effects of buoyancy that would be caused by the flood depths, pressures vetocities, impact and uplift
forces associated with the base flood.
YES � NO O In the event of ftooding, will this degree oi floodproofing be achieved with human intervention?
(Human intervention means that water will enter the building when floods up to the base flood level oC-
cur unleas measures are taken prior to the flood to prevent entry of water (e.g., bolting metal shields over
doors and windows).
YES ❑ NO ❑ Will the building be occupied as a residence?
It the answer to both questions is YES, the floodproof�ng cannot be credited for rating purposes and the actual lowest floor must be
completed and certified instead. Complete both the elevat�on and floodproofing cert�ficates.
FIRM ZONES A, A7-A30. Vt-V30. AO and AH:
Certified Floodproofed Elevation is feet, (NGVD).
THIS CERTIFICATION IS FOR � SECTION II ❑ BOTH SECTIONS II AND I11 (Check One)
CERTIFIER'S NAME COMPANY NAME
Bobb J. Goodman King Engineering Associates, Inc.
TITLE ADDRESS
Land Surv
IGNPT,�IRE �
3250 U.S. 19 North, Suite 105
DATE CITY
3 �9_t� Clearwater,
STATE
Fl ori da
LICENSE N0. (or Affix Seal)
4055
ZIP
33575
PHONE
(813)785-2556
ince agent should attach the original copy ol the completed form to the flood insurance policy application,
the second copy should be supplied to the po�i�Yholder and the third copy retained by ihe agent
INSURANCE AGENTS MAY ORDER THIS FORM
FEMA Form 81-31, SEP 83
REPLACES FEMA FORM 8�"3�• APR 82, WHICH IS OBSOLE 1 t.
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