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877 BAY ESPLANADE U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Expires March 31,2012 Federal Emergency Management Agency National Flood Insurance Program Important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION For Insurance Company Use: A1. Building Owner's Name CHERIE J.TROYEN Policy Number A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg. No.)or P.O.Route and Box No. Company NAIC Number 877 BAY ESPLANADE City CLEARWATER State FL ZIP Code 34601 A3. Property Description (Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) LOT 3&THE S 10;OF LOT 4&THE N 10'OF LOT 2, MANDALAY REPLAT A4. Building Use(e.g., Residential,Non-Residential,Addition,Accessory,etc.) RESIDENTIAL A5. Latitude/Longitude: Lat.27.59'49.41"N Long. 82.49'23.82"W Horizontat 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) 1738 sq ft a) Square footage of attached garage 300 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 18 within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b 1101.56 sq in c) Total net area of flood openings in A9.b 0 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 62. County Name B3.State 125096 CLEARWATER PINELLAS FLORIDA 64. Map/Panel Number 65.Suffix B6. FIRM Index B7. FIRM Panel 68.Flood 69 Base Flood Elevation(s)(Zone 12103C0102 G Date Effective/Revised Date Zone(s) AO, use base flood depth) 9/3/03 9/3/03 AE 11' 610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69. ❑ FIS Profile � FIRM ❑ Community Determined ❑ Other(Describe) B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other(Describe) B12. 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) C1. Buiiding elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction* � Finished Construction *A new Elevation Certificate witl 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 CLEARWATER 238A Vertical Datum NAVD 1988 Conversion/Comments NONE Check the measurement used. a) Top of bottom floor(including basement,crawispace,or enclosure floor)4.5 �feet ❑meters(Puerto Rico only) b) Top of the next higher floor 6.05 �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 stab) 4.5 �feet ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 4.42 �feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Comments) fl Lowest adjacent(finished)grade next to building(LAG) 4.0 �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 5.0 �feet ❑meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs, including 4.8 �feet ❑meters(Puerto Rico only) structural support 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. I certify that the information on this Certificate represents my best efforts to interpret the data available.l �° � '• understand that any false statement may be punishabie 6y 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 `. -� ��`4 p,�� _ V li c e n s e d l a n d s u r v e y o r? � Y e s ❑ N o �< " y. �k/ '�:, �� Certifier's Name JONN R.BEACH License Number 2984 � Title P.L.S. Company Name JOHN R. BEACH&ASSOC., INC. i'��� � � Address 911 ST. PETERSBURG DR W City OLDSMAR State FL ZIP Code 34677 ,, Signatur Date 7/20/2011 Telephone 813-854-1276 ' r�w�, FE A Form 81- 1, Mar 09 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: � Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No_ Policy Number 877 BAY ESPLANADE City CLEARWATER State FL ZIP Code 34601 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 C2(e)=A/C ELEV;GARAGE AND BASE SQUARE FOOTAGES TAKEN FROM PUBLIC RECORD Signature Date 7/20/2011 ❑ Check here if attachments S TION E- ILDING ELEVATION INFORMATI (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) For ones AO a (without BFE),complete Items E1-E5. f the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A, B, an ems 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 ❑feet ❑ 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 andJor equipment servicing the buiiding is ❑feet ❑ meters ❑above or�below the HAG. E5. Zone AO only: �f 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 ceRify 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, 8, 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 iocal 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 o�ciai completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3. ❑ The foilowing information(Items G4-G9)is provided for community floodplain management purposes. G4. Permit Number G5. Date Pertnit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑Substantiai Improvement G8. Elevation of as-built�owest floor(including basement)of the buiiding: ❑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 U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE oMB No. 1660-0008 Federal Emergency ManagementAgency Expires March 31,2012 National Flood Insurance Program Important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION Fo`Ir�urance Gumpany Use: A1. Building Owner's Name CHERIE J.TROYEN Ptlt�y Number' A2. Building Street Address(including Apt.,Unit,Suite,and/or Bidg.No.)or P.O.Route and Box No. Company NAIC Nt�mber 877 BAY ESPLANADE Cfty CLEARWATER State FL ZIP Code 34601 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) LOT 3 8 THE S 10;OF LOT 4&THE N 10'OF LOT 2,MANDALAY REPLAT A4. Building Use(e.g., Residential,Non-Residential,Addition,Accessory,etc.) RESIDENTIAL A5. Latitude/Longitude: Lat.27.59'49.41"N Long.82.49'23.82'YV 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) 1738 sq ft a) Square footage of attached garage 300 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 18 within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in AB.b 1101.56 sq in c) Total net area of flood openings in A9.b 0 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 8�Community Number 62.County Name B3.State 125096 CLEARWATER PINELLAS FLORIDA 64.Map/Panel Number B5.Suffix 66.FIRM Index 67.FIRM Panel B8. Flood B9. Base Flood Elevation(s)(Zone 12103C0102 G Date Effective/Revised Date Zone(s) AO,use base flood depth) 9/3/03 9/3/03 AE 11' 610. Indicate the source of the Base Flood Elevation(BFE)data or base flood 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) B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes � No Designation Date WA ❑ CBRS ❑ OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construdion 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 CLEARWATER 238A Vertical Datum NAVD 1988 Conversion/Comments NONE Check the measurement used. a) Top of bottom floor{inGuding basement,crawlspace,or enclosure floor)4.5 �feet ❑meters(Puerto Rico only) b) Top of the next higher floor 6.05 �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) 4.5 �feet ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 4.42 �feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Comments) � Lowest adjacent(finished)grade next to building(LAG) 4.0 �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 5.0 �feet ❑meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs,including 4.8 �feet ❑meters(Puerto Rico only) structural su ort 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. 1 certify that the infortnation on this Ce�cate�epresenfs my best eiforts to interpret the data availabJe.l �, �. •¢9q '�`,� .,.� understand that any false statement may be punishable by fine or impnsonment under 18 U.S.Code,Sec6on 1001.� � _' A� �' % Check here if comments are provided on back of form. Were latitude and longdude in Section A provided by a s s���' \I�►q,,. licensed land surve or? Yes No �r °� ` � � "° ♦ Y � ❑ ,� �� ;.�, �,. < Certifier's Name JOHN R.BEACH License Number 2984 � � \ �. t� �.. � S, 2.�= 'n Q �y I / Title P.L.S. Company Name JOHN R.BEACH�ASSOC_,INC. � �-. Address 911 ST.PETERSBURG DR W City OLDSMAR State FL ZIP Code 34677 ._f 4 f '• � � � . ' r,�0� u�aa*.` � : Signatur Date 7/20/2011 Telephone 813-854-1276 . , _ FE A Form 81- , Mar 09 See reverse side for continuation. Replaces all previo�s editions IMPORTANT: In these spaces,copy the corresponding information from Secfion A. For trasuranc�Campany Use: Building Street Address(inGuding Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Podcy Num6er 877 BAY ESPLANADE City CLEARWATER State FL ZIP Code 34601 Company iVAIC Number SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certficate for(1)community official,(2)insurance agenUcompany,and(3)building owner. Comments C2(e)=A/C ELEV;GARAGE AND BASE SQUARE FOOTAGES TAKEN FROM PUBLIC RECORD Signature Date 7/20/2011 ❑ Check here if attachments S TION E- ILDING ELEVATION INFORMATI (SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For ones AO a without BFE),complete Items E1-E5. f the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B, an ems 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 ❑feet ❑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 building 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,8, and E are correct to the best of my know/edge. 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 CeRficate 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 Communitv Name Telephone Signature Date Commants ❑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 StreetAddress(including Apt, Unit,Suite, and/or Bldg. No.)or P.O. Route and Box No. Poiicy Number 877 Ba Es lanade City State Zip Company NAIC N�unber CLEARWATER, FL 33767 If using the Elevation Certificate to obtain NFIP flood insurance, affix at least finro building photographs below according to the instructions for Item A6. Identify all photographs with: date taken; "Front View" and "Rear Viev�'; and, if required, "Right Side View" and"Left Side View." If submitting more photographs than will fit on this page, use the Continuation Page, following. 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