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���-�-�=�� � FEDERAL EMERGENCY MANAGEMENT AGENCY
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E� 4I ��! ' ��' ��� �,.�. NATIONAL FLOOD INSURANCE PROGRAM
��T =� �A�'�"��EVATION CERTI FICATE
OMB 3067-0077
F,'xpirex: Feb. 1987
This form 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.
Dr William Stafford 824 Harbor Island Drive. Clearwater. FL
BUILDING OWNER'S ADDRESS
NAME
Lot 64 "Island Estates of Clearwater, Unit 6D, 7A & 7C"
PROPERTY LOCATION (Lot and Block numbers and address if available)
I 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 I ELIGIBILITY CERTIFICATION (Completed by Local Community Permit Official or a Registered Professional Engineer,
Architect, or Surveyor)
COMMUNITY NO. PANEL NO. SUFFIX DATE OF FIRM FIRM ZONE DATE OF CONSTR. BAS D ELEV. BUILDING IS
(In A ne, e depth) New/Emergency
125096 0007 B June 1, A-12 12 � Pre-FIRMReg.
1983 ❑ Post-FIRM Reg.
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) will be at an elevation
of ft, NGVD. Failure to construct the building at this elevation may place the building 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
❑ ❑ community's flood plain management ordinance, or in compliance with the NFIP Specifications.
MOBILE HOME MAKE MODEL YR. OF MANUFACTURE SERIAL NO. DIMENSIONS
X
N/A
(Community Permit Official or Registered Professional Engineer, Architect, or Surveyor)
NAME Ronald L. Hughes ADDRESS 2433 Gulf to Bay Blvd., Suite E.
TITLE President
Clearvaater_,
�r �
STATE Florida ZiP 33575
799-1763
SECTION II ELEVATION CERTIFICQTION (Certified by a Local Community Permit Official or a Registered Professional Engineer,
Architect, or Surveyor.)
FIRM ZONE A1-A30: I certify that the building at the property location described above has the lowest floor (including basement)
at an elevation of 11 .45 feet, NGVD (mean sea level) and the average grade at the building site is at
an elevation of %. 5 feet, NGVD.
FIRM ZONES V, V1-V30: I certify that the building at the property location described above has the bottom of the lowest floor beam
at an elevation of feet, NGVD (mean sea level), and the average grade at the building site
is at an elevation of feet, NGVD.
FIRM ZONES A, A99, AH and EMERGENCY PROGRAM: I 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 nextto the building is feet, NGVD.
FIRM ZONE AO: I 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 velocities, impact and uplift
forces associated with the base flood.
YES ❑ NO ❑ In the event of flooding, will this degree of 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 unless 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?
If the answer to both questions is YES, the floodproofing cannot be credited for rating purposes and the actual lowest floor must be
completed and certified instead. Complete both the elevation and floodproofing certificates.
FIRM ZONES A, A1,-A30, V1-V30, AO and AH;
Certified Floodproofed Elevation is feet, (NGVD).
THIS CERTIFICATION IS FOR C}� SECTION II ❑ BOTH SECTIONS II AND III (Check One)
CERTIFIER'S NAME
COMPANY NAME
LICENSE NO. (or Affix Seal)
Ronald L. Hughes Plumley Engineers & Assoc., Inc. 3747
TITLE ADDRESS ZIP
President
SIGNATURE
2433 Gulf to Bay Blvd,
DATE , , CITY
Clearwater,
33575
STATE PHONE
Florida 799-1763
The ins`urance agent(hould attach�he akiginal copy of the completed form to the flood insurance policy application,
the second copy should be supplied to the policyholder and the third copy retained by the agent
FEMA Form 81-31, SEP 83
INSURANCE AGENTS MAY ORDER THIS FORM
REPLACES FEMA FORM 81-31, APR 82, WHICH IS OBSOLETE.
593-117
N2w; Emer�ency Proqram Canstructron:
Fer the purp�sFS of determining insuranca rates, hui!�ir7�s for �vP;iCh the �siart �f cunstrurticr; or st,t,,t<. ��.!al�iir�proti.,,Te�.�.
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