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755 BAY ESPLANADEU.S. DEPARTMENT OF HOMELAND SECURITY ' Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important: Read the instructions on pages 1-9. OMB No. 1660-0008 Expires March 31, 2012 SECTION A - PROPERTY INFORMATION For Insurance Company Use: Al. Building Owner's Name ROGER ROBERDS A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 755 BAY ESPLANADE JOB No.: 11-001 PoitoY Nt fiber Coinpary NAIC Number City CLEARWATER State FL ZIP Code 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOTS 1 AND 2 AND THE SOUTH 30 FEET OF LOT 3, BLOCK 38, MANDALAY, PB 14 PAGES 32-35, PINELLAS COUNTY, FLORIDA A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) A5. Latitude/Longitude: Lat. 27°59'30.8' Long. 82°49'26.9' A6. Attach at least 2 photographs of the building if the Certificate is being used A7. Building Diagram Number $ A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) 2789 sq ft b) No. of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 28 c) Total net area of flood openings in A8.b 2.627 sq in d) Engineered flood openings? ❑ Yes ® No RESIDENTIAL to obtain flood insurance. Horizontal Datum: 0 NAD 1927 ® NAD 1983 A9. For a building with an attached garage: a) Square footage of attached garage $2Z sq ft b) No. of permanent flood openings in the attached garage within 1.0 foot above adjacent grade § c) Total net area of flood openings in A9.b 470' sq in d) Engineered flood openings? ❑ Yes ® No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 51. NFIP Community Name & Community Number CLEARWATER, CITY OF 125096 0102 B2. County Name PINELLAS COUNTY B3. State FLORIDA B4. Map/Panel Number B5. Suffix 86. FIRM Index B7. FIRM Panel 88. Flood 89. Base Flood Elevation(s) (Zone 12103C0102 G Date Effective/Revised Date Zone(s) AO, use base flood depth) 8-18-2009 9-3-2003 AE 11 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. 0 FIS Profile ® FIRM 0 Community Determined 0 Other (Describe) B11. Indicate elevation datum used for BFE in Item B9: 0 NGVD 1929 ® NAVD 1988 0 Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes Designation Date LILA 0 CBRS ❑ OPA ® No SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: 0 Construction Drawings' ® Building Under Construction* 0 Finished Construction -A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations - Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/A0. Complete Items C2.a-h below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized NGS 'F 3' Vertical Datum NAVD1988 Conversion/Comments N/A a) b) c) d) e) f) 9) h) Top of bottom floor (including basement, crawlspace, or enclosure floor) 11 Top of the next higher floor 11.2 Bottom of the lowest horizontal structural member (V Zones only) N/A. Attached garage (top of slab) 7.2 Lowest elevation of machinery or equipment servicing the building. (Describe type of equipment and location in Comments) Lowest adjacent (finished) grade next to building (LAG) 2.9 Highest adjacent (finished) grade next to building (HAG) 4.2 Lowest adjacent grade at lowest elevation of deck or stairs, including N/A. structural support Check the measurement used. ® feet ® feet ❑ feet ® feet ❑ feet ® feet ® feet 0 feet ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) 0 meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. / 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. ® Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a licensed land surveyor? ® Yes 0 No Certifier's Name CHARLES H. FOGELSONGER License Number 4148 Title SURVEYOR AND MAPPER Company Name ROBERTSON&ASSOC. SURVEYING&MAPPING, INC. Address 10126 WOODBERRY ROAD City TAMPA State FL ZIP Code 33619 FEMA Form 81-31, Mar0911° See reverse side for continuation. Date 2-26-11 Telephone 813-662-3434 Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 755 BAY ESPLANADE For Insurance Company Use - • Policy Number City CLEARWATER State FL ZIP Code 33767 Company NAIC Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments SECTION "C" (C2). NGS (NATIONAL GEODETIC SURVEY) BENCHMARK "F 3" HAVING A REPORTED ELEVATION OF 2.72 FEET (NORTH AMERICAN VERTICAL DATUM OF 1988). N/A = NOT APPLICABLE. NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER.' Signature Date 2.26-11 ® Check here if attachments SECTION E - BUIL G ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items E1 -E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For Items E1 -E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is 0 feet 0 meters 0 above or 0 below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters 0 above or 0 below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet 0 meters 0 above or 0 below the HAG. E3. Attached garage (top of slab) is ❑ feet ❑ meters 0 above or 0 below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is 0 feet 0 meters ❑ above or ❑ below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? 0 Yes 0 No 0 Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA -issued or community -issued BFE) or Zone AO must sign here. The statements in Sections A, 6, and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments 0 Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8 and G9. G1. 0 The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. 0 A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. G3. 0 The following information (Items G4 -G9) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: 0 New Construction 0 Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: 0 feet 0 meters (PR) Datum G9. BFE or (in Zone AO) depth of flooding at the building site: 0 feet 0 meters (PR) Datum G10. Community's design flood elevation 0 feet 0 meters (PR) Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑ Check here if attachments FEMA Form 81-31, Mar 09 Replaces all previous editions Building Photographs See Instructions for Item A6. For Insurance Company U Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 755 BAY ESPLANADE Policy Number City CLEARWATER State FL ZIP Code 33767 Co pang NAIC Nurnberg If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to the instructions for Item A6. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." If submitting more photographs than will fit on this page, use the Continuation Page on the reverse. FRONT VIEW 2-26-11 REAR VIEW 2-26-11 7,47 -/b3 - /R027 U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 ' Federal Emergency Management Agency Expires March 31,2012 �National Flood Insurance Program Important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION ` Far fr�arcar�e Gompany Use: A1. Building Owner's Name ROGER ROBERDS ��Y��f ' A2. Building Street Address(including Apt.,Unft,Suite,and/or Bidg.No.)or P.O. Route and Box No. Gom{�any NAtC Ntxnbsr 755 BAY ESPLANADE JOB No.:11-001 City CLEARWATER State FL ZIP Code 33767 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) �OTS 1 AND 2 AND THE SOUTH 30 FEET OF LOT 3,BLOCK 38,MANDALAY,PB 14 PAGES 32-35,PINELLAS COUNTY,FLORIDA A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)RESIDENTIAL A5. Latitude/Longitude:Lat.27°59'30.8" Long.82°49'26.9" Horizontal Datum: ❑ NAD 1927 � NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 8 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) 2789 sq ft a) Square footage of attached garage 837 sq ft b) No.of permanent flood openings in the crawlspace or b) No.of permanent flood openings in the attached garage enclosure(s)within 1.0 foot above adjacent grade 28 within 1.0 foot above adjacent grade 6 c) Total net area of flood openings in A8.b 5627 sq in c) Total net area of flood openings in A9.b 470' sq in d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No ` SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name&Community Number B2.County Name 83.State CLEARWATER,CITY OF 125096 0102 PIN�LLAS COUNTY FLORIDA B4.Map/Panel Number B5.Suffix B6.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone 12103C0102 G Date Effective/Revised Date Zone(s) AO,use base flood depth) 8-18-2009 9-3-2003 AE 11 B10. Indicate the source of the Base Flood Elevation(BFE)data or base fiood depth entered in Item 69. ❑ FIS Profile � FIRM ❑ Community Determined ❑ Other(Describe) B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other(Describe) 612. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes � No Designation Date N/A ❑ CBRS ❑ OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Ci. Building elevations are based on: ❑ Construction Drawings' � Building Under Construction' ❑ Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO. Complete Items C2.a-h below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized NGS'F 3'Vertical Datum NAVD1988 Conversion/Comments WA Check the measurement used. a) Top of bottom floor(including basement,crawlspace,or enclosure floor)5.1 �feet ❑meters(Puerto Rico only) b) Top of the next higher floor 11.2 �feet ❑meters(Puerto Rico only) c) Bottom of the lowest horizontal structural member(V Zones only) N/A. ❑feet ❑meters(Puerto Rico only) d) Attached garage(top of slab) 7.2 �feet ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building N/A. ❑feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Comments) fi) Lowest adjacent(finished)grade next to building(LAG) 3.9 �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 4.3 �feet ❑meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs,including N/A. ❑feet ❑meters(Puerto Rico only) structural support SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION _,��,��=�- : s -..�a� This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information. l certify thaf the information on this Certificate represents my best efforts to interpret the data available. `9 8��; I understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001. Qo g-° °o� � Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a °' o � . . . , - 4 - .. _..- , '-.' :.._ �. . . . .. ; .�. ... . .. licensed land surveyor? � Yes ❑ No �, ::; . -, < = Certifier's Name CHARLES H.FOGELSONGER License Number 4148 '° 1 � ' Title SURVEYOR AND MAPPER Company Name ROBERTSON&ASSOC.SURVEYING&MAPPING,INC. '' � � '� � Address 10126 WOODBERRY ROAD City TAMPA State FL ZIP Code 33619 � °,�q c ��<.,; Signature l Date 2-26-11 Telephone 813-662-3434 �°�, , - ^��}��, a - FEMA Form 81-31, M 09 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces,copy the corresponding information from Section A. For I�urance Company Use: - .Building Street Address(induding Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Pd�y Number ` 755 BAY ESPLANADE . City CLEARWATER State FL ZIP Code 33767 C�nparry'NAIC Nurnber SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agenUcompany,and(3)building owner. Comments SECTION"C"(C2).NGS(NATIONAL GEODETIC SURVEY) BENCHMARK'F 3" HAVING A REPORTED ELEVATION OF 2.72 FEET(NORTH AMERICAN VERTICAL DATUM OF 1988). N/A=NOT APPLICABLE. "NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER." Signature Date 2-26-11 w— � Check here if attachments SECTION E-BUIL G ELEVATION INFORMATION(SURVEY NOT RE(,IUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),complete Items Ei-E5. if the Certificate is intended to support a IOMA or LOMR-F request,complete Sections A,B, and C. For Items E1-E4,use natural grade,if available. Check the measurement used. In Puerto Rico only,enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG)and the lowest adjacent grade(LAG). a)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑teet ❑meters ❑above or❑below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions),the next higher floor (elevation C2.b in the diagrams)of the building is ❑feet ❑meters ❑above or ❑below the HAG. E3. Attached garage(top of slab)is ❑feet ❑meters ❑above or ❑below the HAG. E4. Top of platform of machinery and/or equipment servicing the buitding is ❑feet ❑meters ❑above or❑below the HAG. E5. Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owner's authorized representative who completes Sections A,B,and E for Zone A(without a FEMA-issued or community-issued BFE) or Zone AO must sign here. The statements in Sections A,B,and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑Check here if attachments SECTION G-COMMUNITY INFORMATION(OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E), and G of this Elevation Certificate. Complete the applicable item(s)and sign below. Check the measurement used in Items G8 and G9. G1.❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2.❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3.❑ The following information(Items G4-G9)is provided for community floodplain management purposes. G4.Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑Substantial Improvement G8. Elevation of as-built lowest floor(including basement)of the building: ❑feet ❑meters(PR)Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters(PR)Datum G10.Community's design flood elevation ❑feet ❑meters(PR)Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑Check here if attachments FEMA Form 81-31, Mar 09 Replaces all previous editions *� . Building Photographs See Instructions for Item A6. For Insurance Company Use: Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Poi�cy rvumber 755 BAY ESPLANADE Clty CLEARWATER Stat2 FL ZIP COde 33767 CompanyNAlCNumber If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to the instructions for Item A6. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." If submitting more photographs than will fit on this page, use the Continuation Page on the reverse. FRONT VIEW 2-26-11 �,� .�,� �' �; ,� �� =�� .�,;� ��ry �� r , r� , ,� �.'�'� ts ��k�&� -�+r �,.�- �-- ' s �— .,#� . �• �:,�^ � � �.� � � � E �� .:� F* ,�r ;� � b� _ � � '� � �+ .� • �y,� ' � �� i� t 1 a�i$! � . , �+ ^ . :� """:�:,.� -- _ . -.- � � �- - " ,: � . a � � . _ ��, ,�� x.. ' '"-`� . : a . ..<.` „ . , ,.. y . . ��^ � �;. . -� -u�, �, �.�� i � :.��. �' , ._. . .�� REAR VIEW 2-26-11 � ��f,, ,�" � :�, �� ,�" � �`� '�,,. , ,;��.. :�,. �.,� ,',�.�,'� �� ,�. �`�'•�� :� , � , � � ��° � � �; �,� _'�� r � -�� . �fi i�..�z;%�'; ! � .� ;�� i��¢��; �,�,# �t . ' .� a� _:_ �` �- �- - ` ��m_. � ,: it... —�e - --' _�- `� Y-�� - +aRr',rpqw,�S"ie� �:. ... _ ,� �_ _ � �.,� .,-� �. ._ .. � ��. � �� . . .. � M ^ � �-�R , � — - -i — � M� . . -4._ . .. -,,, - � ' � �� z " ` ..� ,� . � �.�.. : , r �� '/DJ�-��' �� . �� J ��7 ��.J/��'� � �� s�� Sc�. n � � �� z �I ��1 U I� � ��`� ,-��, � , ; 1 _ ,. ; � ; �� <. DEPARTMENT OF FiOMELliND SECURITY Federal Emergency Management Agency National Flood Insurance Program A1. Buiiding Owners Name ROGER O. EL�V=�TIOfV C�RT'IFICAT'E (mportant: Read the instructions on pages 1-9. SECTION A - PROPERTY ItJFORfIRAT10N 5 AND ELEAN(1R cznnGC�nc A2. 8uilding Street Address (inciuding Apt., Unit, Suite, and/or 81dg. No.) or P.O. Route and 8ox No_ 755 BAY-ESPLANADE JOB No.: 11-001 City CLEARWATER State FL ZIP Code 33 i 67 — __ --- _ C�MB No. 1660-0008 ' E;rpires March 31, 2012 For Insurance Company Use: Policy Number Gompany A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.j LOTS 1 AND 2 AND THE SOUTH 30 FEET OF LOT 3, BLOCK 38, MANDALAY, PB 14 PAGES 32-35, PINELLAS COUNTY, FLORIDA A4. Building Use (e.g., Residentiai, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. LatitudetLongitude: Lat. 27°�g'30_8" Long, 82°49'20.9" - A6. Attach at Ieast 2 photographs oi the building if the Cert�cate is being used to obtain flood insura cenZOntaf Datum: ❑ NAD 1927 � NAD 1983 A7. Building Diagram Number 8 A8. For a-buiiding-with-a erawlspace-or enclosure(s): - - - - a) Square footage of crawlspace or enGosure(s) 2789 s fr A9. For a building with an attached garage: 4 a} Square footage of attached garage 881 sq ft b) No. of permanent flood openings in the crawispace or b) No. of permanent flood openings in the attached garage enclosure(s) within 1.0 foot above adjacent grade 27 cj Totai net area of flood openings in A8.b within 1.0 foot above adjacent grade 6 5400 sq in c) Total net area of flood openings in A9.b 1200 sq in d) Engineered flood openings? � Yes ❑ No d) Ertgineered flood openings? � Yes ❑ No SECTION B- FLOOD INSURANCE RATE MAP (FIRM} INFORMATION B1. NFIP Community Name & Community Number a� r,.,..,.., ,,�....._ 611. 612. LIFIS Profite -- �--- -..,.... ,..,.�,�u �� .C�� na. � FIRM ❑ Community Determined Q Other (Describe) indicate elevation datum used for BFE in Item 89: ❑ NGVD �929 � NAVD 1988 ❑ Other (Describe) Is the building Iocated in a Coastal Barrier Resources System (CBRS) area or Othenvise Protected Area (OPA)? Designation Date N/A ❑ CBRS ❑ OPA ❑ Yes � NQ SECTION C- BUILDING ELEVATION INFORMATION {SURVEY REQUIRED) C1. 8uilding elevaiions are based on: ❑ Construction Drawin s` *R new Elevation Certificate wiil be required when construction ofihe building fs❑complete. Under Construction• � Finished Constniction C2. ElevaUons -Zones A1-A30, AE, AH, A(with BFE}, VE, V1-V30, V(with BFE), AR, AR/q, AR/AE, AR/A1-A30, ARIAH, AR/AO. Complete Items C2.a-h below according to the building diagram speeified in Item A7. Use the same datum as the BFE. Benchmark Utiiized NGS "F 3" Vertical Dafum NAVD1988 ConversioNComments N/A Check the measurement used. a) Top of bottom floor (ncluding basement, crawlspace, or enclosure floor) 5.1 � feet b) Top of the next higher floor ❑ meters (Puerto Rico oniy) � �•? � feet ❑ meters (Puerto Rico oniyJ c) Bottom of the lowest horizontal structural member (V Zones only) N/A, ❑ feet d) Attached garage (top of stab) ❑ meters (Puerto Rico only) ?•? � feet ❑ meters (Puerto Rico only) e) Lowest efevation of machinery or equipment servicing the building 11.5 � feei (Describe type of equipment and location in Comments) ❑ meters (Puerto Rico only) fl Lowest adjacent (finished) grade next to building (LAG) 4.0 � feet g) Highest adjacent (fi�ished ❑ meters (Puerto Rico oniy) ) grade next to buitding (HAG) 4.3 � feet ❑ meters (Puerto Rico oniy) h) lowest adjacent grade at lowest elevation of deck or stairs, inciuding 4.3 � feet structural su ort ❑ meters (Puerto Rico only) SECTION D- SURVEYOR, EMGINEER, OR ARCHITECT CE(2TIFICATION This ceRification is to be signed and sealed by a land surveyor, engineer, or archited authorized 6y law to certify elevation information. ! certify that the information on this Certifrcate represents my best efforts to rnteipiet the dafa available. I understand that any false statement may be punishable by fine or imprrsonment under 18 U. S. Code, Section i00L �_ —1 � Check here if comments are provided on back of fortn. Were Iatitude and longitude in Section A provided by a licensed land surveyor? � Yes ❑ No Certifier's Name CHARLES H. FOGELSONGER License Number 4148 'fitle SURVEYOR AND MAPPER Campany Name ROBERTSON&ASSOC. SURVEYING&MAPPING, INC. Address 10126 WOODBCRRY ROAD City TAMPA _ State FL ZIP Code 33619 c�,,,,�t..�a-- - _ � ��'%�°"�'� : ii-" .� FEMA Form 81-3 i, i6ic,-•pg Date 8-7-12 OcSez resats�aes e1Ne Ierr eer�.Ur'ueUUS+. ,� `7�f��•.!� �� t i2 'i � , `� �1,3. [?FrNIRt+&a 9!! H1�&,�SIHNd 2sNiHliHC� . INr?ORTQ,i; T-�---�-_._..�,o..� � Itt these spaces, c,:_ the curra�For_,;�r,y i,itom�,��;c;;; ro-oR� 5ection A. Bu;lding Street Address (includ ny Ap:.., Unit, Suite, and/or Bidg. No.; or P.C. Route and Box No. 755 BAY ESPLAnADE City CLEARWATER Siate FL ZIP Code 33767 For (nsurarce Company i;se: Policy NumtAr �ompany NAIC Number SECTION D- SURVEYOR, ENG(NEER, OR ARCHiTECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation CeRificate for (1) community offcial� (2) insurance agenUcompany, a�d (3) building owner. Comments "SECTION "C" (C2). NGS (NATIONAL GEODETIC SURVEY) BENCHMARK "F 3" HAVING A REPORTED ELEVAiION OF 2.72 FEET (NORTH AMERfCAN VERTICAL DATUM 01= 1 ggg), A8d & A9d - ENGINEERED FLUOD VENTS ARE SMAR NENT MODEL 1540-5� 0 HAVING A�cEPORTED FLOW AREA OF 200 SQUARE INCHES EACH. C2d = AIR CONDITIONER P�ATFORM N/A = NOT APPLICABLE. "NOT VALID WI7HOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER." /� _..�`�?'.��/(i�>.•-�ic�'i�..�._-c,_-----. uate 8-7-12 -. SECTION E-�N LEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND 20NE A(WITHOUT 8FE ents For Zones AO an_d A(without B.F�), compie4e ltems-El=Efi, -if the Certifieate is intended to support a LOMA ortaMR-F requesf, cofnplefe Sections A, 8, ) and C. For Items E1-E4, use natural grade, if available. Check the measurement used. In Puerto Rico oniy, enter meters. Ei. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAGj a�d the fowest adjace�t grade (LAG). b) Top of bottom floor (including basement, crawispace, or endosure) is ❑ feet ❑ meters ❑ above or �] below the HAG. E2. For Building Oiagrams 6-9 with permanent flood openings provided in Section A Items 8 and�/or 9(se�e pages 8-9�of nstructio❑ns)bth next h gherfloor (elevation C2.b in fhe diagrams) of the building is . ❑ feet E3. Atta c h e d g a r a g e ( t o p o f s ia b) is ❑ meters ❑ above o r ❑ b e l o w t h e H A G. ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4_ Top of platfoRn of machinery a�dlor equipment servicing the buiiding is E5. Zone AO oniy: If no fiood depth number is available, is the top of the boriom floor elevat�ed fn a ardance wit❑h he comm�unty's flo dp e n management orciinance? ❑ Yes ❑ No ❑ Unknown. The Iocal oificiai must certify this information in Section G. SECTION F- PROPERTY OWNER (OR OtNNER'S REPRESENTATIVE) CERTIFICATION The property owner or owners authorized representative who compietes Sections A, 8, and E for Zo�e A(without a FEMA-issued or community-issued BFE) or Zone AO must sign here_ The statements in Sections A, B, and E are correct to the 6est of my knowledge. Prope�ty Owner's or Owners Authorized Representative's Name Address Sig�ature Comments City Date State Z1P Code Telephone SECTION G- COMMUNITY INFORMATlON (OPTIONAL) � Check here if attachments The local o�cial who is auihorized by law or ordinance to administer the community's floodp(ain management ordinance can compiete Sections A, 8, C(or E), and G of this Elevation Certificate. Complete the applicabie item(s) and sign below. Check the measurement used in Items GS and G9. G1. ❑ The intormation in Section C was taken trom other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who rs authorized by law to certity elevation information. (indicate the source and date of the elevation data in the Comments area below.j G2. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or Zone AO, G3. ❑ The following information (Items G4-G9) is provided for community floodpiain manaqement oumosec G4. Permit Number G7. This permit has been issued for: G5. Oate Permit Issued ❑ New Construciion G6. Date Certificate Of Compliance/Occupancy Issued ❑ Subsiantiai Improvement G8. Elevation of as-built lowest floor (including basement) of the building: G9. BFE or (in Zone AO) depth of flooding at the buifding site: ❑ feet ❑ meters (PR) Datum ❑ feet ❑ meters {PR) Datum G90. Communit�rs design ftood elevation ❑ feet ❑ meters (PR) Datum Local O�cial's Name Title Community Name - ----- Telephone Signature Date Comments FEMA Form $1-31. Mar 09 ._0 Check here if attachments Replaces all previous editions � �udid��s� �ho�ograph� See Instructions for Item A6. iBuiiding Street Address (including Apt., Unit; Suite, and/or Bldg. No,) or P.O_ Route and Box No. _755 BAY ESP�ANADc I Clty CLEFRWATER State Fl. ZIP Code 33767 For Insurance Policy Numbe _ -� If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to the instructions for Item A6. (dentify al! photographs with: date t�ken; "rront Vievd' and "Rear Viev✓'; and, if requirec,', "Right 5ide Vie�rl' and "Left Side View." If submitting more phatographs than witl fit on this page, use the Continuation Page on the reverse. I _ __ FRONT VIEW 8-7-12 � �, ��,� y, �� - �� . , s �� .:- _ _ ., .. ,<�� REAR VIEW 8-7-12 � �h i��t�t{ t!,:, :... � ' ' �.,'. i � a � � I� �a< : ".��:.': �..: �� ; � � �j � � �' � t � N i l�.t1ii � :� 4 k f,Z�' s3 __ '^ ,.d � �� y� � � _ a j ,. t� rr,� � �� ,1�1 ii,l �� , � _ - - - - -- �� `; � � � : � � � �g.�o � E � �`�� _ � �> ,�.: a � - --� E' � , _ : ". 3 F �r w ° �� € ` ° -- -. � , �u��dir�g Pho�og��h� Continuation Page Building Street Address (including Apt: Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 755 BAY ESPLANADE City CLEARWA7ER State FL ZIP COde 33767 insurance Company Use: Comparry NAIC Number if submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front Viev�' and "Rear View"; and, if required, "Right Side Viev�' and "Left Side View.° LEFT SIDE VIEW 8-7-12 RIGHT SIDE VIEW 8-7-12