321 PALM IS NEDEPARTMENT OF HOMELAND SECURITY - FEDERAL EMERGENCY MANAGEMENT AGENCY
COMMUNITY ACKNOWLEDGMENT FORM
O.M.B. NO. 1660-0015
Expires February 28, 2014
PAPERWORK BURDEN DISCLOSURE NOTICE
Public reporting burden for this data collection is estimated to average 1.38 hours per response. The burden estimate includes the time for reviewing instructions,
searching existing data sources, gathering and maintaining the needed data, and completing and submitting the form. This collection is required to obtain or retain
benefits. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding
the accuracy of the burden estimate and any suggestions for reducing this burden to: Information Collections Management, Department of Homeland Security,
Federal Emergency Management Agency, 1800 South Bell Street, Arlington, VA 20598-3005, Paperwork Reduction Project (1660-0015). NOTE: Do not send your
completed form to this address.
This form must be completed for requests involving the existing or proposed placement of fill (complete Section A) OR to provide acknowledgment of this request to
remove a property from the SFHA which was previously located within the regulatory floodway (complete Section B).
This form must be completed and signed by the official responsible for floodplain management in the community. The six digit NFIP community number and the
subject property address must appear in the spaces provided below. Incomplete submissions will result in processing delays. Please refer to the MT -1 instructions
for additional information about this form.
125096 25096 Property Name or Address: 321 Palm Island NE
Community Number:
A. REQUESTS INVOLVING THE PLACEMENT OF FILL
I hereby acknowledge that we have received and reviewed this Letter of Map
request. Based upon the community's review, we find the completed or proposed project
management requirements, including the requirement that no fill be placed in the
and local permits have been, or in the case of a Conditional LOMR-F, will be obtained.
will document Endangered Species Act (ESA) compliance to FEMA prior to issuance of the
I acknowledge that compliance with Sections 9 and 10 of the ESA has been achieved
prohibits anyone from "taking" or harming an endangered species. If an action might harm
Fish and Wildlife Service or National Marine Fisheries Service under Section 10 of the ESA.
Federal or State agencies, documentation from the agency showing its compliance with
we have determined that the land and any existing or proposed structures to be removed
as defined in 44CFR 65.2(c), and that we have available upon request by DHS -FEMA, all
For LOMR-F requests, we understand that this request is being forwarded to DHS -
floor above base flood elevation. No fill to remainder of site outside of foundation walls.
As the community official responsible for floodplain management,
Revision Based on Fill (LOMR-F) or Conditional LOMR-F
meets or is designed to meet all of the community floodplain
regulatory floodway, and that all necessary Federal, State,
For Conditional LOMR-F requests, the applicant has or
Conditional LOMR-F determination. For LOMR-F requests,
independently of FEMA's process. Section 9 of the ESA
an endangered species, a permit is required from U.S.
For actions authorized, funded, or being carried out by
Section 7(a)(2) of the ESA will be submitted. In addition,
from the SFHA are or will be reasonably safe from flooding
analyses and documentation used to make this determination.
FEMA for a possible map revision.
Community Comments:
Plans show raised slab with compacted fill. Finished
Community Official's Name and Title: (Please Print or Type)
Gina L. Clayton, Planning and Development Director
Telephone No.:
727-562-4587
Community Name:
City of Clearwater, FL
5 l , munity Offici Si a re: quired)
4
Date:
(fi - I L - Z I
B. PROPERTY LOCATED WITHIN THE REGULATORY FLOODWAY
As the community official responsible for floodplain management, I hereby acknowledge that we have received and reviewed this request for a
LOMA. We understand that this request is being forwarded to DHS -FEMA to determine if this property has been inadvertently included in the
regulatory floodway. We acknowledge that no fill on this property has been or will be placed within the designated regulatory floodway. We find
that the completed or proposed project meets or is designed to meet all of the community floodplain management requirements.
Community Comments:
Plans show raised slab with compacted fill. Finished floor above base flood elevation. No fill to remainder of site outside of foundation walls.
Community Official's Name and Title: (Please Print or Type)
Telephone No.:
Community Name:
Community Official's Signature (required):
Date:
DHS - FEMA Form 086-0-26B, FEB 11
Community Acknowledgment Form
MT -1 Form 3 Page 1 of 1
1
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
Important Reed theinstructicelis on pave 1.- T.
G.M.13: No. 3067-0077
Eq3ires.July 31. 2002
SECTION A- PROPERTY OWNERINFORMATION
BUILDING CANNER'S NAME
Denis A. & Cher 1 White
• ForintruiencertorteneS WO:
preicyNumber
IIVIIIINGSTREEr AINIRESs (includes] Act. Un( Sete. eloVorado.No.) ORP.Q. ROUTE.AND BOX NO:
321 Pala Island. NE .
CITYSTATE
.
Clearwater VL
PrOPITOr %ITV 6B- ISLAND ESTATES OF -CLEARWATER
Itoiene Black Number% Tax PerastNenexa Legal OiciariptIon. de)
BUILDING USE(e.g.. Residatebd, NOn-aMideettal, AreilUon. Accessary, etc..1.15sCammaatasectio. Ifterceapa30
Residential
LATTTUDELOPIGITUDE(OFDONAL) . HORIZONTAL DATUM SOURCE:.. U GPS MOO
( if - err -11tir or WNW) LI MAD 1927 _LI Op tap
Campers NAIC Ifterber
ZIP CODE
31767-4931
LJ U.SGS-Orrett Map
SECTION B - FLOOD INSURANCE RATE MAP (FM) INFORMATION
91. NFIPOONIMUNITY NAME & COMMUNITY NUMBER
City of Clearwater 5996
02.-COUrr NAM
Pinellas•
133. STATE
FL
E14.1APP NA) PANEL.
BS:SUFFIX
BS. FIRM INDEX
07. FIRM PANEL
Btk FLOOD
99. BASE FLpoD et.evAnows)
NUMBER
DATE
EFFECTIVE/REVISED DATE
ZONE(S)
17.one AA =seep& of eroding)
125096 0007
.D
7/2/92
8/19/91
_ AE
11.0'
BitelheisOurcelof the Base -Flood.BsIrstkm-(13F14 data or -brise Stood depth-onlesed in
LJFIS.PioNe LX1FIRM• LJ Coronas* Detemoined LjOlivr (Describe* -
131t Indk:NteIie elevation datum 10db:ribs BFE1n B9: J NGVD 1929 LJ NAVD 1980 LI Other (Desonbs):
812. is the budding located in -a Coastal Barrier Resources System (PERS) area or Othervise Protected Area (00A3? U Yes LI No
Designadon Date:
SECTION C - WILDING ELEVATION INFORMATION (SURVEY REQUIRED).
C1. Building elwastionseis baisadeit LiConstrucdon Drirsings- USuildIng !hider Construction* arinished Crinsitudon
*Ansi' Devatkerr Certificate Will be required WhehconstructiOn Otte building. is complete..
C2. Building.Diagrarn Number 1 ..(Seksembebulkling diagram most similar tithe building for efidtthis certificate -is -being completed see
pages 6 and 7 lfno diagram ace:milady representethe building..provideatheich-or pbotograpit,)
C3. Semitone—Zones Al -A30. AE.AH. A erethSFE), VE. VI -V30, V (vsithSFE). AFti ARIA. AWAE. AR/A1-A30. ARIAN, MAO
Compkte Isms C34-1. below according kr the bedding *gram specilledimiteM CZ Slabs cloture Used. if the rheum is.diffenint:from
the datum used for the BFE In Section 6. corieNt the datum to that used for the BFE. Shur Odd meadurements and.ditum conversion
nalculedoe. Use the *ace provided orthe Comments wee of.Sedionti or 'Sectixt G: se apprOprIsIkto document the :datum cmynseicin.
orn NGVD 1929 tonierskinicorninents
Betatian reference markUsed CityBM 7.275 Does the elevation reference asark-used on the FIRM?. LJ 'e L No
0 re)Top of bodomsloor (induding-basementer enciosure) 11..Lt
• b) Top/Abed higherfoor
q c)Sollorn of Icerest hodzentst structural member (Vzonse oNy) t(m)
o d) Attached garage (top of stab) --el •
• e) Lessestelevation of araihinery anew equipment
seNicina Ihetudding II_ 0 t(n)
O I) Lowastriciacentgrade.(LAG) 6.9
o g) ROM adjacert grade (HAG} 10.9 tOS)
O It) No. of permanent openings (Ilood venbj-vrithin-1 ft. above adjacent grade
-0 Toed arse ohbl permanent openings flood aerie) in Ch 818 lq-• am)
.sEcztoyet....SDRVEYOR. ENGINEEILOR ARCHITECT cernFicAmot;
This cerirmaion be ,be signed sod.epslad by abinttstireeYor, engineer, dr =Mee sulhotited W Wain =dry etervallon.infainiettoiL
1 cagier earth klarmaion In SetbonsA BandC an this- esdhlais topless& My hestellimft biderptetthe-dlia-taitalabhx.
undatitand *if at* Noe statenxiiiinaylie punishabii brialprisoninsat einderlitiLS. Code, Saida; 100lb
UCENSE MONIER
.3983
c911119191/14146E
Edward C. Elliott.
Professional Snrvevor & Mapper
089 ADCRESS
-Roosevelt Blvd
1 --
FEMA Form AUG29._
COMPANY NNE
Overbeck & Elliott. Inc.
CITY STATEMPOCOE
Clearvater FL 33760
DATE TELEPHONE
3/20/01 (727) 524-9666
SEE fiedERSESIM FOR PgralmUATION REPtACES ALLY SIMONS