123 BAYSIDE DR U'S.DEF'ARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
Federal Emergency Management Agency Expires Februarv 28.2009
National Flood Insurance Program Important: Read the instructions on pages 1-8.
SECTION A-PROPERTY INFORMATION For Insurance Company Use:
A1. Building Owner's Name FELDMAN/SEACOM CORP. Policy Number
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No:)or P.O. Route and Box No. r,nm�anv NAIC Number
123 BAYSIDE DR 123 BAYSIDE DR
City CLEARWATER BEACH State FL ZIP Code 33767
A3. Property Description(Lot and Biock Numbers,Tax Parcel Number,Legal Description,etc.) BCP2004-11455
LOT 5&6-LESS E. 10'LOT 6,BAYSIDE SUB N0.3 NEW SFR
FELDMAN, MARVIN
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) RES Zoning: LMDR a�
A5. Latitude/Longitude:Lat.N27°58.201 Long.W82°49.594 rtonzvrna�va�w�i. L„��.r,.. ,.,�. ,�,,, .JAD 1983
A6. Attach at least 2 photographs of the building if the Cert'rficate is being used to obtain flood insurance.
A7. Buiiding Diagram Number 8
A8. For a building with a crawl space or enclosure(s),provide A9. For a building with an attached garage,provide:
a) Square footage of crawl space or enclosure(s) 6538sq ft a) Square footage of attached garage N/A sq ft
b) No.of permanent flood openings in the crawl space or b) No.of permanent flood openings in the attached garage
enclosure(s)walls within 1.0 foot above adjacent grade 11 walls within 1.0 foot above adjacent grade N/A
c) Total net area of flood openings in A8.b 7843 sq in c) Total net area of flood openings in A9.b N/A sq in
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61. NFIP Community Name&Community Number B2.County Name B3.State
PINELLAS COUNTY 12103 PINELLAS FL
64.Map/Panel Number 65.Suffix B6.FIRM Index B7.FIRM Panel 68.Flood B9.Base Flood Elevation(s)(Zone
Date EffectivelRevised Date 'Zone{5j ° `'`AO,6s�bgse flood"depth)'
12103C0102 G 9l03/2003 9/03/2003 AE 11"
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
❑FIS Profile �FIRM ❑Communiry Determined ❑Other(Describe)
611. Indicate elevation datum used for BFE in Item 69: ❑NGVD 1929 �NAVD 1988 ❑Other(Describe)
B12. ts the buitding�ocated in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area RA) 7` ❑Yes �No
Designation pate ❑CBRS ❑OPA �,J /� '� '��
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SECTION C-BUILDING ELEVATION INFORMATION(SU�2VEY REQUIRED)
C1. Building elevations are based on: ❑Construction Drawings"` ❑Building Under Construction* �Finished Construction
'A new Elevation Certificate will be required when construction of the bui�ding 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-g
below according to the building diagram specified in ttem A7.
Benchmaric Utilized KEATING1 Vertical Datum NGVD'1929 �('' ��_�_ -�-�-��-�----�
Conversion/Comments SUBTRACTED 0.85 FROM FIELD MEASUREMENTS TO GET NAVD'88 ENTRIES i�' �f i.�' �� !� j+ � `;? ��u
Check the measure riE� . ��•-----•--------- i �� �'
�t � 'x
a) Top of bottom floor(including basement,crawl space,or enclosure floor)_ 6.2 �feet ❑meters(Pue ` only}SEP O � ZOO9 �I ��
b) Top of the next higher floor 19.0 �feet ❑meters(Pue �only) ` U :
c) Bottom of the lowest horizontal structural member(V Zones only) NlA. ❑feet ❑meters(Pue o Ric�l�t1._,____ �,�„K� �
d) Attached garage(top of slab) 6.2 �feet ❑meters(Pue o�3��1���";I' a'.!I':, , ';�?S"3
e) Lowest elevation of machinery or equipment servicing the building 12.4 �feet ❑meters(Pue o RicS.dr�f'�fif C°� L,'•_,.����i�/ATL��_�
(Describe type of equipment in Comments) -- ---�-
fl lowest adjacent(finished)grade(LAG) 6.0 �feet ❑meters(Puerto Rico only)
g) Highest adjacent(finished)grade(HAG) 6.2 �feet ❑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 archited authorized by law to certify elevation
infortnation. 1 certify that the information on this Certi�cate 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, Secfion 1001.
� Check here if comments are provided on back of fortn. � ,
Certifiers Name FRANK A.JULIAN License Number 5495 ` „ -
Title PROFESSIONALSURVEYOR&MAPPER Company Name _ �-S���
Address 6438 POLK ST City NEW PORT RICHEY State FL ZIP Code 34653 �,/Z/o�
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Signature Date Telephone 727 845-0389
6 - Z-�-�8 .
•IMPOd2TANT:� 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. Poiicy Number
123 BAYSIDE DR.
Gity CLEARWATER BEACH State FL ZIP Code 33767 Company NAIC Number
SECTION D-SURVEYOR,ENGINEER,OR ARGHITECT CERTIFiCATION(CO
Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agenUcompany,and(3)building ow r�l r� �(j �� � 1 ;i? `�1
Comments C2 e)A/C LOFT � '.�,�'""'""."'""."""""-' �; "
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Signature Date ;� , " ' " ' """ ' �' � •
b- Z-O C ' �heFeif��ta��Tr�rits �
SECTION E-BUI�D 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.
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).
aj Top of bottom floor(including basement,crawl space,or enclosure)is ❑feet ❑meters ❑above or Q below the HAG.
b)Top of bottom floor(including basement,crawl space,or enclosure)is ❑feet ❑meters ❑above or❑ below the LAG.
E2. For Buitding Diagrams 6-8 with permanent flood openings provided in Section A Items 8 andlor 9{see page 8 of Instructions),the next higher floor
(elevation C2.b in the diagrams)of the building is ❑feet ❑meters ❑above or ❑below tfie 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 Q 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 o�cial must certify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIYE)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 ar�e co�rect to the best of my know�dge.
Property Owner's or Owner's Authorized Representative's Name
Address City State ZIP Code
5ignature Date Telephone
Comments
❑Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTtONAL)
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 Certficate. Complete the applicable item(s)and sign below. Chedc the measurement used in Items G8.and G9.
G1.❑ The information in Section C was taken from other documentation that has been signed and seated 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 lssued
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
Local Official's Name Title
Community Name Telephone
Signature Date
Comments
(�l Check here if attachments
• 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. Poiicy Number
123 BAYSIDE DR
Cltj/ CLEARWATER BEACH St2t@ FL ZI P COd@ 33767 Company NAIC Number
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,
following.
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For Insurance Company Use:
Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Poiicy rvumber
123 BAYSIDE DR
Clty NEW PORT RICHEY State FL ZI P COd@ 33767 Company 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 View" and "Rear View"; and, if required, "Right Side View" and "Left Side View."
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