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256 BAYSIDE DR (3) _ . � . �U � DEPARTMENTOF HOMELAND SECURITY �LEi�A71�N CERTiFiC�TE OMB NO. 1e�60-4008 ��ederal Emergency Management Agency Expires March 31, 2012 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 CHRISTIAN AND CHRISTINE RUPPEL Policy Number A2 Buiiding Street Address;including Apt.. Unit, Suite. and/or Bldg. No)or P 0 Route and Box No Company NAIC Number 256 BAYSIDE DRIVE City CLEARWATER State FL ZIP Code 33767 A3 Property Description (Lot and Block Numbers.Tax Parcel Number, Legal Description,etc.) LOT K, BLOCK 1 BAYSIDE SUBDIVISION NO 4, UNIT"A° (PARCEL ID 08-29-15-04986-001-0'10j A4 Building Use(e.g.. Residential, Non-Residential,Addition,Accessory,etc)RESIDENTIAL A5. latitude/Longitude: Lat. N 27.96957° Long.W 82.82133° Horizontal L�atum: ❑ 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�uiiding with an attached garage: a) Square footage of crawlspace or enclosure(s) 2156.4 sq ft a) Scuare footage of attached garage 954 7 sq ft bj 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 305 witt�in 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b 4512.9 sq in c) Tctal net area of flood openings in A9.b 0 sq in d) Engineered flood openings? ❑ Yes � No d) Er.gineered flood openings� ❑ Yes � No SECTION B-FLOOD INSURANCE RATE MAP(FIRM) INFORMATION ; B1. NFIP Community Name&Community Number 62. County Name 63 State i CITY OF CLEARWATER 125096 PINELLAS FL ; 64 Map/Panel Number B5. Suffix 66. FIRM Index � 67. FIRM Panel 68. Flood 69. Base Flood Elevation(s)(Zone I � '� Date Effective/Revised Date Zone(s) AO, use base flood depth) I 12103C-0102 � G I 8-18-09 9-3-03 AE I 11' B10 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� 61 1 Indicate elevation datum used for BFE in Item 69 ❑ 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) C1 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 ttems C2.a-h below according to the building diagram specified in Item A7 Use the same datum as the BFE. Benchmark Utilized CITY OF CLEARWATER BNl D-2 Vertical Datum NAVD 88 Conversion/Comments N/A ;heck the measurement used. a) Top of bottom floor(including basement, crawlspace, or enclosure floor)4.71 �feet ❑meters(Puerto Rico only) b) Top of the next higher floor 6.52 �feet ❑ meters(PueRo Rico only) c1 Bottom of the lowest horizontal structural member(V Zones only) N/A �fe�t ❑meters(Puerto Rico only) d) Attached garage(top of slab) 4.84 �fe:�t ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the buiiding 5.65 �feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Commentsj fl Lowest adjacent(finished)grade ne�to building (LAG) 4.55 �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 4.95 �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 This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by'aw to certify elevation information I certify that the information on this Certificate represents my best efforts to interpret tF�data available. ,,,r I understand that any false statement may be punishable by fine or imprisonment under 18 U S. Cca:e. Sectron 1001 �. , � Check here if comments are provided on back of form Were latitude and longitude in Sec±ion A provided by a �� licensed land surveyor7 � Yas ❑ No . .C`��_-�i1'�i � Certifier's Name GEORGE A. SHIMP III Job IVumber 100176A License Number .!37 ' Tltle VICE PRESIDENT Company Vame GEORGE 4 SHINIP ii &ASSOCIA-�S INC � �� ` � ��:.� �' Address 3�01 DE�OTO 3L`✓D SUITc D City PALiLI HARQOR Siate FL Z9P Code 34633 � �6 �7, ��,�� .�,� IC` . .h —_.— I � . 3igr�atur� �--� Date 1 J-13-�� Talephone ?2'-�?4-�496 � .. � 1�C";�t,( �fl`"�� ==1�1d F��r�n 3',-;? \�1ar�19 ��a r=�r�rsa :i�1e t�r ��niin�.aPior ��n+ar.es all nr��nous editiors - • � . 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 J or P 0 Route and Box No. Policy Number ' 256 BAYSIDE DRIVE , 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 agenbcompany, and (3)building owner. Comments C2.e)AIR CONDITIONER ON CONCRETE BLOCKS � Signa ure ORGE A.SHIMP III Date 10-18-10 � Check here if attachments SECTION E-BUILDING 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 CeRificate is intended to suppert 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 foliowing 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 Buiiding 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 ❑befow 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 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 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 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 Qtems G4-G9)is provided for community floodplain management purposes. IG4 Permit Number I G5. Date Perrnit 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 Locai Official's Name Title Community Name T�lephone Signature Date Comments ❑ Check here If attachments ==itilA �orm �?-.i' Ular u9 Ra��ac�s ail �revious editions