914 NARCISSUS AVE .
FEDERAL EMERG�NCY MANAGEMENT AGEIVCY
. NATIONAI.F�Ci4Q INSURANCE RR�GRAM
ELEVATION �ERTIFICATE o•M.B. �vQ. 306�-0077
Expires Tu ly 31, 24(?2
� Im rtant: Read the instruations an a es 1 -7,
SECTION A-PROPERTf OWNER INFORMATiON :;��iC��4���::'.:::;.;;':;:;;::
BUILOING OWNER'S NAME :?:,.,!�.;�::.>:.:;.::::.:;::::<.-:::�:::::`:::>:z::z;'''�:;:�~.<':::�::�:::>:::>::::>::�'.
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s,a�..v,a roRE' s��� E' .>.:,::::::::::::::::::::::::
BUILDING S7REET ADORE53 Including Apt,Unit,Suke,anc!!or eldg.No.}OR P.O.ROIJTE AND BOX NO. ::.:::::xk.:�;:.;;;;;;:„<;;;.;
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914 NA RCISS S A YE'NUE "`�°
::::: �..,:::...........
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CLE`ARWATER FLUf?I�A 3.3 ?'
PROPERT'Y pESCRIPTION(Lot and Block Mumbers,Tax Parcel Number,Legal DescripUon,etc.}
BUIl.01 115 e.g., es dentia,Noo-residential,Addition,Accessory,etc. llse a omments area,' aecessary.
R�`.SI�1E'NT/AL , _
_- -- . _
LA717UDElLONGITUDS(OPTIONAL) HaRIZONTAL DATUM: SdU�F : � GPS(Type�,�_� _,__
( ##°-##'-##.##" or ##.##�##°} �_�NAD 1927 �� NAD 1983 ��USGS Quad MaP L�Other.___
SEGTIQht B-FLOOn 1NSURANCE RATE MAP(FIRM)INFORMATtON
B4.NFIP COMMUNETY NAAAE&CaMMUNITY NUMBER 82.COUMY NAME 93.STA7E
;�,CLEARWATER r25o9s PINELLAS ��-��-�'r FL4RID.4
� E34.MAP ANO PANEL B5.5UF IX B6.FIRM IND B . I BS.FLOOD 69.BASE F O EL A ION y
a NUMBER DATE EFFECTIVFJFiEVI 0 DATE ZONE(S) (Zone AD,use depth oftiooding)
�r2soss000 oaiy sis2 -e"s� a E r r
81(l.[ndicate the source of the 8ase Flood Ele�ation{BFE;data or bese flood depth entered in B9.
� ._�FI8 Profile J,x�FIRM J__�Gommunity Dstermined j_..�Qther�Describe):,._^_____, .___ __ ____
611.Indicate the ele�atiqn datum used for the BFE in 89:�NGVD 1929 �_� t�AV01988 �__�Qther(Qescribe}:Y_�._�___—_. _
B 7 2. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area{OPA)? �_�Yes �No
�esignation Daie:_ ,_._______,.
�� SECTIbN C-BUILOING EL�VATION INFORMATtON (SURVEY REQEJIRED)
C7.Building elevations are hased on: �__�Canstruction Drawings` � ..jBuiiding Under Canstructian' J,j�Finished ConsWcGon
`A new Elevation Certificate will be required when ccrostructiort�f the building is complete.
'2.Building Oiagram Number.....r__(Seiect the building diagram most simiiar to the buitding for whioh this certificate is being compteted-see
pages 6 anti 7. [f no diegram accurately reprasents the buitding,pro�ide a sketch or photogr�ph.)
C3. Elevatians–Zones A1 A3Q,AE,AH,A(with BFE),VE,V1-V30,V{with BFE),AR,ARtA,ARlAE,ARIA1-A30,ARIAH,ARIAO
Complete Items C3.a-i below according to the building diagram specified in Itern C2.State the datum used. If the datum is different irom
the datum usecf Tor the gFE in Section 6,can�ert the daturrt to that used fo�the BFE.Show fielcf ineasurertlents and daium Corneraion
calculation. Use the spaca provided or the Comments area of Section D or 5e�tion G,as appropriate,to do�ument the datum conversion.
Datum ,_____ ConversioNCamments_..
Elevation reference martc used___. .._ ____.__ aoes the eie�ation reference mark used appear on the FIRM? �__�Yes �No
LI a}Top of bottom floor(incluciing basement or snclosure) ______. _.__J_'�.�_�i.{m) � �., .. .
�l b)Top of next higher floor ------.. -- ---ft.(m) `� ;,s' ?�.�.,...
a �'." ,
::1 a?Bottom af lowest horiiontaE structurel member(V zones only) _______ ___ft.(rn} � � !' ��` '� �
. ,�,.,
!i d}Attached garage(top of slab} .___ft.(m) � � ' `�.• y -
U e}Lowest ele�aGon af machinery and/or equipment � � �� � __
servicing the huilding(Describe in a Comments area.) �._�__ft.(m} -� �
----�- �— � , �,(� .^ r � ,..:'s� ` �:. �a". ..
l� f}Lowest adjacent(finished)grade(�AG) � � � � p,.�
�.a_ft.{m) z � �}
CJ g)Highest adjacent(finished)grade{HAG} �,$_. ft,(m) � y �r'��
U h}No,of permanent openings(flood�ants}within 1 ft.above adjacent grade_ � -, %1 . �
❑ i}7otal arsa of all permanent openings{ifood vents)in G3.h_A_�sq,in.(sq.cm} J
SEC710N D-SURVEYOR,ENGINEER,DR ARCHITECT CERTIFICATIO[�
This certification is to be signed and sealed by a land survayor,engineer,or arahitect authorized by law to certify elevation informatiorr.
I ceriify that the informatron in Sections A, 8,and C on this certiFcate represents my besf eh`orfs ta rnterpret fhe data availa6Je,
!understand that an false stafernent ma be unishable b frne orim »soRmenf under 78 U,S. Code,Section 1 DQZ.
CERTIFIER'S E
R�Q_B.E.1�T__,�_-
LEH�,R,�_� LICEN�ut.��
.S��R VEYOR C�MPANY iV�pE ND SUR VEY ~
.��95 X G T LN C E�'�4 WA TER T ,4 z1P s
SIGNATURE 7� T _ E H NE
7 9
FFAnA Fnrm A1_�1 II 11 (1f1 CFF RFV R.^ti �IIIF�f]R[�f1AITINI IATICIN RFPI AC;F�A1 1 PRF�(��I.0 FfS1TIC�A[�
- _ �— _
IMPORi'ANF: [n the�e spaces,�poy the co�responding ir�t'amation irom Sectian A =;�:;��.::. ,<:�;:,:;� •
�BUILDING STREET AD�RESS Q+rJuan9 Apt,Uni�Sute,andla Bldg.Na.J oR P.D.ROl!(E At+D 60X N0. ;.;.:.:. _:;:t�x�..„>:::::::
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914 NA RCI5SU5 A YENUE `r>%%�• :: Y%����::.o-::>::>:::»::::»:
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CITY STATE ZIPCODE , " :::::�:'.�
CLEARWATE`R F �RlDA 3.�767 ii;�; �`«"';':�"'k..: `:��:`:�"
fr�i'/`.'N:•`
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SECiION D-SURIf�YOR,ENGINEER,OR AitCHITECT CER�iFICATION�CUNf INUED) �� •
Copy both sides of this Elevabon Certifi�e i�r t1)[xnmu�y ol6aal,(2�irr�ua�ir.e a9entloonpanY,and(3�txulc�g tr�ner.
COMlvIEMS
C-3-�' AIR CC7N�IT14N!►1(G _CaMPRL�SSOR
❑Chedc hena if a�acM�eNs
SECTION E-BULflING ELEYAiIOM INFORMATION{SURVEY[�lOT REQURED)FORZC�+E A�0 AND ZOGE A(W�I'HdUT�
�or Zoroe AO and Zone A(witl�aut BFE},canple�iherr�s E1 thr�ugh E4. If the Elevation Cer6ficate is ir�nded for use as suppadng i�tiat fa a LOMA ar LoN1R-F,
Se�tion G must be compl�d.
E1.Buiking Di�qrarn Numbe�'_{Setect the b�dk�t�g r�a�arn mostsimilar'in the buil�ing for wt�ich this certifx�te s being ccxnpl�ed-see pages 6 and 7.lf na cGa�am aax�atety
re�xesenls#he bui�ing,pravide a ske�h a photagaph.)
E2.The�p af ihe boibm 11�oar(inclucing 3�nent or eridosu�e)a�tlie buiking is _1E[m)_in.{cm}O abate or ❑bebw(check one}the t�es�a�ac�t 9ad� Nse
natural grade,if aw�lahle).
E3.For Building Diagarns 6�wii�openings(see page 7�.the next I�gher Aoor ar elevat�ed 1k�or(ele�ration b}d the buiding is ,_ft�n}_in.�anJ abn�e 1he highest a�er�t
gade. Complete it�ts p.h and C3i an Tront at farm.
E4.�or Zone A�ody: IF no flood depih nunher is avaih�bl�is#he top oFthe bot6am flflor deva�ed i�aocordawe with the car�m�il�ls 1loodplain maamgdnent acirrarxe?
❑Yes ❑No ❑UnEmanm. The bcal ofiaal must ' Uws infortna�an in Section G.
SECTION�-PROPERTY Q1M�ER(OR O1�VlVEF�S REPRESENTA'I1VE)CER7IFlCATIQN
The pro�erty owne�or�rt�'s aulhor¢ed repr�sentatiue who canpletes Sections A,B,C(Ihems C3.h and C3.i any),and E�or ZateA(wilhout a F�tu4A�'�sued a oar�ttttat►�ty-
issued BFE)a Zme AO must sgn here. The slatanents in Sections 1�B,C,a¢sd E ar�e oarrectto the best of my knowledc�e.
ARaPEfz7Y OWNERR'S OF2 OWNER'S AtJ�liORI�D REI�FZESENtA71VE5 NAME
ADDRESS C�'Y STATE ZIPCODE •
51GNATURE UA7E TELEP{-iONE
COMMENTS
❑Chedt E�ena if attachrnents
SECTION G-COMMUIWTY INFORMA710N(OPTIQN�U�
The local olficFaf who is aulhaasd by#awar ordinanoe�o adnir�'ster the communil�/s Aoot�laiit m&t�es'neM or�nance can oomplete Sec�ons A,B,C{or E},ar�d G of th's ElevaUat�
c�rtific�. canp�e ihe applicab�e itar,{s)and sigi below �
G i.�The intamation in Section C was faken fram oiher da:u neMation tltat has been signed mtd err�OS.9ed by a fice�ed surv�yo�,engneer.or a�ltihect who is auU�a¢ed b�
sia�e or local lawfio certidy eleva�on�nfom�6ort. (Inck�tl�e soutr.e at�d date oi�`ele+�iion data in the Commer�s area qelow.)
G2.�A cmmunihr otfi�iai oarplet�i Section E i�r a huiding I�in Zone A(wiUbuf a FEMr1-issu�ci��x;muriiy-is�d�FE}a Zar�AO.
Ci-[]The foWwing it�orrrretion(I�ns G4G9y is prcNided far�mmunily flon�lan managerr�ent ptrposes. '
Gd.PERMIT NUMBER - � Cd5. DATE PERMIT ISSUED _-- Gfi. D,4TE CERTIFICATE OF COMPLIRNCF�CxCUPANCY 15SUED
G7.This perrrit has heen'ssued fa:❑New Corstruction ❑Substantial Impravett�ent
G8.�fEVation of�-buift bwESt floa�i�du�ng basemerrt�of ifie huil�ing is ____.�R(m� Daiun.
G9.BFE or(n Zo�AD)dep�of floair�q at 1�e buiking site is: ,____.�tt�rn} Datrm;
___..__.__._____._._______�_------- ________________�_._._..____--------___ _w_---__ --------- ------
LOCAL CfFICIAL'S NAME Til"i.,E
�COMMUNITY NAME � �TELEPHC�JE
SIGNA7URE qATE
COMMEf�lrS
_....._ .,,. _ -
___..-------------------- _..___.._________..__ ------_.._ ------- �Checst hena iFa�ac�unents
FEMA�orm 81-31,JUI.UO REPLACES ALL PFi�VI0U5 EDITI�NS