437 LEEWARD IS• FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
Important Read the instructions on ptges 1 - 7.
SECTION A PROPERTY OWNER INFORMATION
O.M.B. No. 3067-0077
Expires December 31, 2005
BUILDING OWNER'S NAME
MICHAEL R. KLIfGLER
BI/4G ITHialyESSI(Ligicept., Unit, Suite, andior EVEN. No.) OR P.O. ROUTE AND BOX NO.
Poky Number
7Cernpupy.NAIC Number
CLEARWATER FLORIDA
STATE
ZIP CODE
PtRYFRYA'Esc,RwM +Ix rdi3gratengirkiVki5r.
BtafirititilatiganicIentlaL Non-residential, Addition, Accessory, etc. Use a Comments area. If necassary.)
LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM:'
• SOURCE:Li GPS (Type):
( - - *LW or lg. 1_1 NAD 1927 Li NAD 1983
LJ USGS Quad Map LJ Other
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
91. NFIP COMMUNITY NAME & COMMUNITY NUMBER
CLEARWATER-125096
COU NAME
PINELLAS
B3. STATE
FLORIDA
B4. MAP AND PANEL
NUMBER
125096-0101
B5. SUFFIX
138. FIRM INDEX
DATE
8-19-91
B7. FIRM PANEL
EFFECTNFJREVISED DATE
9-03-03
B8. FLOOD
ZONE(S)
AE
B9. BASE FLOOD ELEVATION(S)
(Zone AO, use depth of flooding)
11 0 •
810. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9.
LJ FIS Profile Lj FIRM LJ Community Determined L j Other (Descnbe):
811. Indicate the elevation datum used for the BFE in B9: 11 NGVD 1929 •11 NAVD 1988OJC Other(Describe):
B12. Is thehuilding located in a Coastal BarrierResourcesSystem (CBRS) area or Otherwise Protected Area (OPA)? 11 Ves J No
Designation Date:
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: L__IConstruction Drawings* LABuilding Under Construction` K_IFinished Construction
`A new Elevation Certificate will be required when construction of the building is complete.
C2. Building Diagram Number 1 (Select the building diagram most similar to the building for which this certificate is being completed - see
pages 6 and T. If ncidiagram accurately represents the buDding, provide a sketch or photograph.)
C3. Elevations - Zones7>1-A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, ARIA, AR/AE, AR/A1-A30, ARJAH, AR/AO
Complete Items C3.a-i below according to the building diagram specified in Item C2. State the datum used. if the datum is different from
the datum used' for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion
calculation: Use the space provided or the Comments anaa of Section D or Section G, as appropriate, to document the datum conversion.
Datum Conversion/Comments
Elevation reference mark used Does the elevation reference mark used appear on the FIRM?
O a) Top of bottom floor (including basement or enclosure) ' 6 - 7 MITI) 1
U b) Top of next higher floor . ft(m) .2w
O c) Bottom of lowest horizontal structural member (V zones only) . fi(m) "
O d) Attached garage (top of slab) 6 22....ft(m) 13
O e) Lowest elevation of machinery and/or equipment g 0,
servicing the building (Describe in a Comments area.).(m) 2 a
O f) Lowest adjacent (finished) grade (LAG) b .1— ft(m) t sg
5 _ 9 ft(m)
O g) Highest adjacent (finished) grade (HAP)
O h) No. of permanent openings (flood vents) within 1 ft above adjacent grade
• i) Total area of all permanent openings (flood vents) in C3.h sq. in. (sq. cm)
J Yes
LJ No
SECTION - SURVEYOR, ENGINEER, OR ARCHITECT CE FICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elev • • information.
1 certify that the information in Sections A, 8, and C 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.
CERTIFIER'SwNAmiLLIAM C C. KEATING ri1994sfV2,8BER
TITLE
LAND SURVEYOR
COMPANY NAME ALLIED SURVEYING
ADDRESS
-t275 NO
GHLAND AVENUE
CITY CLEARWATER STATE FLA. Zjp3%095
SIGNATURE
DATE
APRIL 7 200
7 272:51TerIn 26
FEMA Form 91-3 .40.41r- 'de for continuation. Replaces all previous editions
)
437 LEEWARD ISL
BCP2018-0700590
STORAGE ROOM ADDITION ipir-
JOHN W THIEL
Zoning: Island Estates Atlas #: 267B