1771 HARBOR DR��
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�`� �" OMB 3067-0077
a�-�Oc �`�s FEDERAL EMERGENCY MANAGEMENT AGENCY ��"'' �""` ���
�`; � .;:�,�, � • NATIONAL FLOOD INSURANCE PROGRAM
�� � ELEVATIDN GERTI FICATE : �
Th(s form ia to be used tor: 1) New/Emergency Program construction in Special Flood Hazard Areaa; 2) Pre-FIRM construction atter
3eptember 30, 1982; 3) Poat-FIRM conatructio�; and, 4) Other buildinga rated aa Poat-FIRM rulea.
Mrs._Martin 1771 Harbor Drive Clearwater, FL
BUII.DING OWIVER'S ADDRESS
NAME . .
PROPERTY LOCATION (Lot and Block numbers and eddreas ii available) ,
LOTS 10, 11 AND WEST 6.0 FEET OF LOT 12 + LAND TO WATER, BLOCK E
1 certliy that the in}o�mation on this certiticate represents my best eftorts to interpret ihe data available. 1 understand that any talse
statement may be punishable by fine or Imprisonment under 18 U.S. code, Section 1001.
SECTION I ELIGIBILITY CERTIFICATION (Complefed by Local Commu�lty Permit O}ficial or a Registered Protessio�al Engineer,
Architect, or Surveyor)
OMMUNITY NO PANEI NO. SUFFI% UAIE OF �=iaiN � FIRWi ZOHe DATE OP COhST.^.. � OA3E Ft0^O E! EY. B!4LbIN(3 1$
(In A e, uas deplh) O New/Emergency
125096 0008 � B 6/1/83 A10 I °l'�'
O Pre-FiRM Reg.
O Post-PIpM Reg.
YES NO �t is intended that the buflding descrfbed above will be constructed in compliance with the community's tlood plafn
❑ O ordinance. The certilier may rely on community records. The lowest floor (including basement) wiil be at an elevation
oi it, NGVD. Failure to construct the building at this etevallon may place the building in violation of
the communily's flood plain management ordinance.
YES NO The building described above has been constructed in compliance with the community's ilood plain management
❑ O ordinance based on elevation data and visual Inspection or other reasonable means.
I( NO is checked, attach copy ot variance issued by the community.
YES NO 7he mobile home located at the address described above has been tied down (anchored) in compliance with the
O O communily's ilood plain management ordinance, or in Compliance with the NFIP Speci(icalions.
MOBiLE HOME MAKE MODEL YR. OF MANUFACTURE SERIAL NO. OIMENSIONS
X
(Community Permit Official or Registered Protessional Engineer, Architect, or Surveyor)
NAME Gordon F. Kl.11iOri ADDRESS 22� Belcher Road North
TITLE Pres.i��nt
SECTION 11 /ELEVATION CERTI
Clearwater
Florida „033575
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TION (Certitied by a local Community Permit Otticial or a Registered Professlonal Engineer,
Architect, or Surveyor.)
FIRM ZONE A1-A30: 1 certify that the building at the property locatlon described above has fhe lowesf lloor (inctudfng basement)
at an elevation ot teet, NGVD (mean aea level) and the average grade at ihe building site Is at
an elevation ol leet, NGVQ.
FIRM ZONES V, V1-V30: I cerNfy that the buUding 1L�he property location described above has the boffom ol fhe lowesl lloor 6eam
at an elevation of I�� . teet, NGVO (mean sea level), and the average grade at the building site
is et an elevation o(l�,. $�� teet, NGVD. Note : Garage elevation 5. 67 Feet
FIRM ZaNES A, A99, AH and EMERGENCY PROGAAM:1 certify fhat the building at the property locetfon described above has the lowest
floor elevation of feet, NGVD. The elevation o( the highest adjacent grade next to the building is � feet, NGVD.
FIRM ZONE AO: 1 certity that the building at the property locatton described above has the lowest fivor e�evation ot
feet, NGVD. The elevation oi the highest adjacenf grade next io the building Is teet, NGVD.
SECTION 111 FLOODPROOFIN(i CERTIFICATiON (Certiiication a Registered Professional Engineer or Architect)
I certity to the best o( my knowledge, intormation, and belfet, that the building is designed so that the building Is waterBght, wilh
walls substantialty impermeable to the passage o( water and structural components having the cepabtlity of resisting hydrostatic
and hydrodynamic loads and eftects oi buoyancy that would be caused by the Ilood depths, pressures velocities, impact, and upiift
lorces associated with the base flood.
YES O NO d In the event oi ilooding, will this degree oi iloodprooffng be achieved with human Intenrentton7
(Huma� intervention mr±nns that water will enter the buiidin� Khen liaods up to ihe base tlood level oc-
cur unless measures are taken prior to the tlood to prevent entry ot wate► (e.g., bolting metal shields over
doors and windows).
YES O NO O Will the building be occupfed as a residence?
If the answer fo bolh questions is YES, the (loodproofing cannot be credited for rating purposes and the actual Iowest tloor must be
completed and certitied instead. Complete both the elevalion and floodprooiing certificates.
FIRM ZONES A, A1,-A30, V1-V30, AO and AN;
THIS CERTIFICATION IS FOR O SECTION II
- CERTIFIER'S NAME
Certified Floodprooted Elevation is feet, (NGVD).
O BOTH SECTIONS II AND III (Check One)
COMPANY NAME
LICENSE NO. (or Atlix Seai)
Go,��tan F. Killion Killion & Associates 3138
TI��E . AUDRESS '
;.� y J, . , 21P
�# ���5�� °�� ": 227 Belcher -Road North � Clearwater 33575
S''TU DATE CITY STATE PHONE
���� 10 2 86 Clearwater Florida n813) 791-1082
f'`The ur ns.e e,ge t should allach Ihe ortginal copy ol Ihe compleled lorm to the flood I�su►a�ce policy applieallon�
'i , !he �econ �opy should be supplled lo the poiicyholder and lhe Ihird copy relai�ed by the egenl
.. ,�;
INSURANCE AGENTS MAY ORDER THIS FORM
FEMA Form 81-31•. SEP 83 0�0� er�e reuw e.�n.. s
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