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720 BRUCE AVE U.S.D�F;�,RTMEN,T OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Expires Februarv 28.2009 Federal Em,ergency Management Agency N�`.?.;"'al Flood Insurance Program Impo�tant: Read the instructions on pages 1-$. . SECTION A-PROPERTY INFORMATION For Insurance Company Use: '. Building Owner's Name Gregg C.Johnson Policy Number . Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number 720 Bruce Avenue City Clearwater State FL ZIP Code 33767 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Lot 10,Block 13,MANDALAY A4. Building Use(e.c�.,Residential,Non-Residential,Addition,Accessory,etc.) Residential A5, Latitude/Longitude:Lat.27d 59'27.04"N. Long.82d 49'33.83"W. 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 1 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) I�A sq ft a) Square footage of attached garage NA 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 7.0 foot above adjacent grade NA walls within 1.0 foat above adjacent grade NA c) Total net area of flood openings in A8.b NA sq in c) Total net area of flood openings in A9.b WA sq in SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 61.NFIP Community Name 8�Community Number B2.County Name B3.State Clearwater eeach 125096 Pinellas Florida B4.Map/Panel Number 65.Suffa 66.FIRM Index 67.FIRM Panel 68.Flood B9.Base Flood Elevation(s)(Zone Date Effective/Revised Date Zone(s) AO,use base flood depth) 12103C 0102 G 9/3/03 9/3/03 AE 11.0' B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑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 ❑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 Items C2.a-g below according to the building diagram spec�ed in Item A7. � Benchmark Utilized Aural RM-3 Vertical Datum NAVD 1988 .� ConversionlComments � Check the measurement used. a) Top of bottom floor(including�basement,crawl space,or enclosure floor)_ 4.f �feet ❑meters(Puerto Rico only) '�" b) Top of the next higher floor N.A �feet ❑meters(Puerto Rico only) � c) Bottom of the lowest horizontal structural member(V Zones only) IV.A �feet ❑meters(Puerto Rico only) � d) Attached garage(top of slab) N.A ¢�feet ❑meters(Puerto Rico only) � e) Lowest elevation of machinery or equipment seroicing the building g.F �feet ❑meters(Puerto Rico only) �O (Describe type of equipment in Comments) � Lowest adjacent(flnished)grade(LAG) 4.Q �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade(HAG) 4.2 �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 architect authorized by law to certify elevation information. I ce�tify that the information on this Cert�cate rep�sents my best efforts to interpret the data available. 1 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. ;`°YZE, R.4�P� �'�., �, ,�»�,�r d �� o �� y �n."I�O 11�Yi'fR..�,! s/i""f � Certifier's Name Edward D.Murphy License Number 5333 `�R� t �y,°,' �p , sl � pn � e �� 'le Professional Land Surveyor Company Name Murphy's Land Surveying,Ina T .,{��;= a,..,�, - dress 575011 Avenue N. Ciry St.Petersburg State FL ZIP Code 33710 �4 Signature ate 7/23/07 Telephone (727)347-8740 � FEMA Form 81-31, February 20 See reverse side for continuation. Replaces all previous editions IMPORT,ANT: !n these spaces,copy the corresponding information from Section A. For Insurance Company Use: Buildinc�:treet Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number ; �20 Bruce Avenue Giry 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 agenUcompany,and(3)building owner. Comments C2e=Finished Fioor Signature Date 7/23/07 ❑ Check here if attachments SECTION E-BUILDING ELEV ION IN RMATION(SURVEY NOT REf.lUIRED)FOR ZONE AO AND 20NE A(WITHOUT BFE) For Zones AO and A(without BF ,complete Items E1 5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B, and C. For Items E1-E4,use na ral grade,if available. heck the measurement used. In Puerto Rico only,enter meters. E1. Provide elevation informatio for the following and heck the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG)and the lowest jacent grade(LA . a)Top of bottom floor(includin asement, I space,or enclosure)is ❑feet ❑meters ❑above or�below the HAG. b)Top of bottom floor(including basemen,crawl space,or enclosure)is ❑feet ❑meters ❑above or❑ below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 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 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❑befow 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 campletes 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 a�correct to the best of my knowfed9e• �perty 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 ftem(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 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: _0 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 mments ❑Check here if attachments FEMA Form 81-31, February 2006 Replaces all previous editions � . � Building Photographs See Instructions for Item A6. For Insurance Company Use: ilding Street Address(including Apt, Unit, Suite,and/or Bldg. No.)or P.O. Route and Box No. Poiicy N�mber 720 Bruce Avenue Clty Clearwater St3t@ FL ZIP 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 �n this page, use the Continuation Page, following. . . � k�. .s.. Y -- �"'�'�� . . . d� r�.r�bif�'�r�S" 71n.. �# tw��T k �i A� �! r'� �"-��¢:�M-w . �ie':,b4 4/� � . a�� '��r, �.�x f � � . . � ' z„5 �. f {; . , . .. � .,{�� s`� �..«� I �" �,^. Date: 7/19/07 �,�f� t � � -:�. ��,�"� °. 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'�va"na�.s,n...aan.,..-.:_ f ....�.nk�',`,.kua?is as., ?�� y,�t- �a"��.;� F'� � ,�-''s� r" ;�, I �- � �.. � y �a ` ",�d+c��"':a�.+i.�w�-:�. i ��ri+�".. ___,...�"'.� � U.S.DEPA�tTMENT QF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Expires Februarv 28.2009 Federal Emergency Management Agency Natw�;al Flood Insurance Program important: Read the instructions on pages 1-8. SECTION A-PROPERTY INFORMATION For Insurance Company Use: A Building Owners Name Gregg C.Johnson Policy Number uilding Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number 720 Bruce Avenue City Clearwater State FL ZIP Code 33767 A3. Property Descrip6on(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Lot 10,Block 13,MANDALAY A4. Building Use(e.c�.,Residential,Non-Residential,Addition,Accessory,etc.) Residential A5. Latitude/Longitude:Lat.27d 59'27.04"N. Long.82d 49'33.83"W. Horizontal Datum: ❑NAD 1927 � NAD 1983 A6. Attach at least 2 photographs of the building ff the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 1 AS. 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) NA sq ft a) Square footage of attached garage tJA sq ft b) No.of pertnanent flood openings in the crawl space or b) No.of permanent flood openings in the attached garage enGosure(s)walls within 1.0 foot above adjacent grade NA walls within 1.0 foot above adjacent grade tJA c) Total net area of flood openings in AS.b NA sq in c) Total net area of flood openings in A9.b NA sq in SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name 8�Community Number 62.County Name B3.State Clearwater Beach 125096 Pinellas Florida B4.MaplPanel Number B5.Suffix B6.FIRM Index B7.FIRM Panel B8.Flood 69.Base Flood Elevation(s)(Zone : Date Effective/Revised Date Zone(s) AO,use base flood depth) 12103C 0102 G 9!3/03 AE 11.0' 610. Indicate the source of the Base Flood Elevation(BF )data or base flood depth entered in Item B9. ❑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 Othervvise Protected Area(OPA)? ❑Yes �No Designation Date ❑CBRS ❑OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: ❑Construction Drawings* ❑Building Under Construction' �Finished Construdion *A..yw GI�yY±;�n�or4;£r,�fg will he�wnuirari whpn:nng4�v:finn nf tha hi�jlrlin�is rmm�lPtP_ .� ..y_..... - 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 Item A7. � Benchmark Utilized Aural RM-3 Vertical Datum NAVD 1988 CornersioNComments � Check the measurement used. a) Top of bottom floor(including�basement,crawl space,or enclosure floor)_ 4.6 �feet ❑meters(Puerto Rico only) '6' b) Top of the next higher floor N.A �feet ❑meters(Puerto Rico only) � c) Bottom of the lowest horizontaf structural member(V Zones only) N.A �feet ❑meters(Puerto Rico only) � d) Attached garage(top of slab) N.A �feet ❑meters(Puerto Rico only) �. e) Lowest elevation of machinery or equipment servicing the building 4.6 �feet ❑meters(Puerto Rico only) OC (Describe type of equipment in Comments) � Lowest adjacent(finished)grade(LAG) 4.0 �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade(HAG) 4.2 �feet ❑meters(Puerto Rico only) SECTION D-SURYEYOR, ENGINEER,OR ARCHITECT CERTIFICATION Th's.certifiqtion 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 Ce�cate represents my 6est efforts to interpret the data available. 1 understand that any false statement may be punisha6le by fine or imprisonment under 18 U.S.Code,SecUon 1001. ❑ Check here if comments are provided on badc of form. Certifier's Name Edward D.Murphy License Number 5333 - Title Professional Land Surveyor Company Name Murphy's Land Surveying,Inc. _ e _ ress 5750 11 Avenue N. City St.Petersburg State FL ZIP Code 33710 . ature ate 7/23/07 Telephone (727)347-8740 FEMA Form 81-31, February 200 See reverse side for continuation. Replaces all previous editions IMPORT,ANT: In these spaces,copy the corresponding information from Section A. For Insurance Company U'se: Buildinq�treet Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number �?20 Bruce Avenue City Clearvvater 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 agenUcompany,and(3)buiiding owner. Comments C2e=Finished Floor Signature Date 7/23/07 ❑ Check here if attachments SECTION E-BUILDING ELEV ION IN RMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BF ,compiete Items E1 5. �f the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B, and C. For Items E1-E4,use na ral grade,if available. heck the measurement used. In Puerto Rico only,enter meters. E1. Provide elevation informatio for the following and ck the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG)and the lowest jacent grade(lA . a)Top of bottom floor(includin asement,c I space,or enclosure)is ❑feet ❑meters ❑above or�below the HAG. b)Top of bottom floor(including basemen,crawl space,or enclosure)is ❑feet ❑meters ❑above or� below the LAG. E2. For Building 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 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 o�cial 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 co�rect to the best of my knowtedge. Property Owner's or Owners Authorized Representative's Name Address City State ZIP Code • Signature Date Tefephone 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 qn complete Sections A,B,C(or E), and G of this Elevation Certficate. Complete the appliqble item(s)and sign below. Check the measurement used in Items G8.and G9. G1.❑ The information in Section C was taken from ofher documentation that has been signed and sealed by a IiCensed 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 communiry-issued BFE)or Zone AO. G3.❑ The following information(ttems 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 tor: ❑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 OfficiaPs Name T��e Community Name Telephone Signature Date Comments � ❑Check here if attachments FEMA Form 81-31,February 2006 Replaces all previous editions — Builclin� Photograpl�� See Instructions for Item A6. _ For Insurance Company Use: �ng Street Address(including Apt, Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Poiicy Number 720 Bruce Avenue City Clearwater Stat@ FL ZIP COd@ 33767 Company NAIC Number if using the Elevation Certificate to obtain NFIP flood insurance, affix at least finio 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. � �`� � � n � d�`t��, �y�� . �- - Y. � 7, I '�r� it;:=..e� .`i��'�YS� . ..3, `q't �..� r -. �'l ;��h sy* � s-� �,._'2�, ��,n . � _-. ..__ . s _ r�'r.� ?tE�:��- *.. ._ �v _ . _ _ . ,. .. '�� q"je;� �� .a.. :l . . . . . .. . . .. .. �:, �.h �ate: 7/19/07 � f _ _ ;,�=�-- ��:' r `�� :��s,r - - ;.�`.�=" i � `�`' � �� . ?�` : -- - - - � �r. �- 3 t�'�i�l�• , �+„+y f I _ __ � � �. # �.`,`' � � €� ��. � �_ $�;. � ..a��,�. ir �➢ ��;�f js�•�� i � t . s r �. is ., ' y3s ,� : '� r �; . ' , s , �. �� , , �. a . , � � �.. 4� �ONT V1EW: .�� d`°- - , . �� , �.��'� �{ r .,. ' _ h r 1 "'�.: • �1 �� T .`�-'t__ ._.e__._...,w�. �` \ A kE�.d" al` , -. f �� ,�' �� '�e i � < , � . . . --•. . . ._. .�K�" �� ,� �� _:,� �'- s { .. . . ....� . � .:�� `��e� ..f � i ,� , . . . . 1�. '?�!�iE��. � �{q .y`V�.V� �M +L�... �j C '� .. � �� .�i.J 'rl� � ..�.,a�iY��'i -�Yi ' , � � � _ _ 3_..3„ �Ca..�_�a� . ,..�v::�.,,..�_. ...i_. _ _ �� VPI� � �y�..� ��, , 3 �: � _ — - - - _�_�_- _ - �_- f �_ _ �� ' � � �e � -- — - _-- - -- _ - -_-_ _ � --__ _- - --- _ ! _ � . _ = - -___— �_ - � .-- - _ � � - - � � � _ - -- -_- ---- -- -- - � _ �z,� 1 i �� _� _==-,-_----__-- - ,- ; _ �� _ , :AR VIEW: =�__ -;,'=;�__=_ . i ; �� ,_� =—_ _ �-_.�- =—"''_='--=-'---_,- � _ -��- '�-�-.�.Y"-_.�__�T�'—=— _'_�- '� ---_� , _ — �`�------_.____,_�___s_ �-----�,i . �"-;�., _ ��—�.--�_� . ?�r`� �.s� � ,� �{ '" —�_---» �� '7 ';��`��,-�� s ____�_�------r.._�.-.�..,�r.__.x,�,��ti �� r' :� •r ,�. _' � . �-, � _ � . - ` _ a , � �, — �.". � .,- -r�['� °�'r'�` .. ..�- , .__..,. .....—.�.� . ��-.�� --Y �... :� y -ya '- S. � �;� � �. .�'�l � `^�s �� j 3� j �,:� pw` ; , "� 'a � �i y��. ;� a � , ., _ � �:, t` ' ;� � . . � • ° ---_ _ .. � �.,, , . .. v ___._ . _ �, � �" � � , . _ , . ; :<.'' '- '^ .:_ _ ,.�'..�1 . . . ,,, . .;�, :; � ,_. � .., � � - ,,. I;;�, � , . : ., '��_, �� - . � ti" �`_�� "�� A � CITY OF CLEARWATER � � �� s ,�x ry�-�,, DEVELOPMENT & NEIGHBORHOGD SERVICES DEPARTMENT �� ,`,..= POST�FFICE BOX 474g� Ct.EARWATER� FLO�DA 33758-4748 MUNICIPAL SERVICES BUILDING, ZOO SOUTH MYRTLE AVENUE,CLEARWATER,FLO�unn 33756 TECEPxotvE (72� 562-4567 Fnx(72� 562-4576 MEMO OF REVIEW FOR CORRECTNESS & COMPLETION In accordance with participation in the NFIP/CRS program,all elevation certificates are required to be reviewed for correctness and compietion prior to acceptance by the community. This compiete form shall be attached to all elevation certificates maintained on file and provide with requested copies of elevation certificates. The attached elevation certificate requires corrections by the surveyor of section(s) prior to acceptance by the community The attached elevation certificate is complete and correct X Minor corrections have been made in the below marked sections by Community Official SECTION A-PROPERTY INFORMATION For Insurance Company Use: A1. Buiiding Owner's Name Policy Number A2. Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Company NAIC Number City State ZIP Code A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) A5. Latitude/Longitude: Lat. Long. 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 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) sq ft a) Square footage of attached garage 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 walls within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in SECTION B-FLOOD INSURANCE RATE MAP(FIRM) INFORMATION B1. NFIP Community Name&Community Number B2. County Name B3.State 64. Map/Panel Number B5.Suffix B6. FIRM Index 67.FIRM Panel 68. Flood B9. Base Flood Elevation(s)(Zone Date Effective/Revised Date Zone(s) AO, use base flood depth) 5/17/2005 610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ 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 ❑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 Items C2.a-g below according to the building diagram specified in Item A7. Benchmark Utilized Verticat Datum Conversion/Comments Check the measurement used. e) Lowest elevation of machinery or equipment servicing the buiiding ❑feet ❑meters(Puerto Rico only) (Describe type of equipment in Comments) Comments: �of Review: Community Official: vation certificates shall be maintained by the community and copies with the attachedmemo made availab/e by request FRANK HIRRARD,MAYOR GEORGE N.CRE'1'EKOS,COUNCILMEMAHR JOIIN DORAN,COUNCILMEMB@R PAUL F.GIASON,COUNCILMEMAER � CARLEN A.PE7'ERSEN,COUNCIL'�fGMBER ��EQUAL EMPLOYMENT AND AFFIRMATIVE ACTION EMPLOYER�� • � � FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 . NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 ELEVATION CERTIFICATE Im ortant: Read the instructions on a es 1 -7. SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Number re C. Johnson and Lillian I. Jo�nson BUILDING STREET ADDRESS(including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number 720 Bruce Avenue CITY STATE ZIP CODE FL 33767 PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Descnption,etc.) Lot 10. Block 13 MANDALAY BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use Comments section if necessary.) R251CIE'.Tlt.ldl LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: �_�GPS(Type): � � ��"� "�•�� °� �•�°) LI NAD 1927 L�NAD 1983 L�USGS Quad Map �_�Other: �� SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION l rl B1.NFIP COMMUNITY NAME 8 COMMUNITY NUMBER B2.COUNTY NAME 63.STATE � 125 6 Pinellas Florida ' B4.MAP AND PANEL B5.SUFFIX B6.FIRM INDEX 67.FIRM PANEL B8.FLOOD B9.BASE FLOOD ELEVATION(S) r � NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use depth of flooding) `iJ D 08 19 91 08 19 91 AE 11.0' r 610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in 69. � I—I FIS Profile �x� FIRM �_� Community Determined �_�Other(Describe): ' B11. Indicate the elevation datum used for the BFE in 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 �x� No Designation Date: � SECTION C-BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C�wlding elev�tions are based on. L�Construction Drawmgs' �_�Bwlding Under Construction" �x�Finished 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 7. If no diagram accurately represents the building, provide a sketch or photograph.) , � C3. 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 C3a-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 area of Section D or Section G,as appropriate,to document the datum conversion. Datum Conversion/Comments Elevation reference mark used_ SE� C(�+'!QV'I'S Does the elevation reference mark used appear on the FIRM? �_�Yes �x� No ❑ a)Top of bottom floor(including basement or enclosure) ,�n.�m� � ❑ b)Top of next higher floor N .�ft.(m) � ❑ c) Bottom of lowest horizontal structural member(V zones only) N .�ft.(m) �� `<'�` . ❑ d)Attached garage(top of slab) N . A ft. m �� ~ ~�� '" .� ❑ e) Lowest elevation of machinery and/or equipment � � E ` � '�. servicing the building E� ` Q 5 . 4 ft.(m) �'�� -�� . ❑ � Lowest adjacent grade(LAG) 4 . 6 ft.(m) z'.� �j� ❑ g)Highest adjacent grade(HAG) �' "'"' � _ 5 . 0 ft.(m) � � .� `' ,(��. ❑ h) No.of permanent openings(flood vents)within 1 ft.above adjacent grade_�_ � ' ?�, � � ❑ i)Total area of all permanent openings(flood vents)in C3h_ 0 sq.in.(sq. cm) J ' �� "�`"` 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 informa6on in Sec6ons A, e, and C on this certificate repr�sents my best e(forts to interpret the data available. 1 understand that any false statement may be punishable by fine orimprisonment under 18 U S Code Section 1001 —.�IFIER Sa DME h R L S LICENSE NUMBER TITLE I,B-6960 President COMPANY NAME ADDRESS P�i h 's I�nc1 Surve in Inc. 5760 llth Avenue rT. STATE ZIP COD � St. Petersbur P'L 33�710 SIGNATUR � DATE TELEPHONE O1 04 02 727 347-�740 FEMA Form 81-31,AUG 99 S _ RF FRSF SI(1F FnR C:f1NTIN1 IATInN RFf'I Af'FR AI I PRF\ilftl IS F(11TI�1MS _ , � � IMPORTANT: In these spaces,copy the corresponding information from Section A. For Insurance Company Use: �UILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Policy Number 720 Bruce Avenue ITY STATE ZIP CODE Company NAIC Number learwater FL 33767 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 Elevations Based on P.C.E.D. Ber_chmark (Aural RNi-3) Elevation = 6.193' Elevations Based on N.G.��.D. 1929 I—I Check here if attachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zone AO and Zone A(without BFE),complete Items E1 through E4. If the Elevation Certificafe is intended tor use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. Building Diagram Number (Select the building diagram most similar to the building for which this cerlificate is being completed– see pages 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.) E2.The top of the bottom floor(including basement or enclosure)of the building is I—I—I ft.(m) ��_�in.(cm) L�above or �_�below (check one)the highest adjacent grade. E3.For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is LLI ft•(m) LL�in.(cm)above the highest adjacent grade. E4.For 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 � I No � I 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. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME �iRESS 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. G1. L�The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer,or architect who is authorized by state or local 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 A0. G3.U 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 is: _ft.(m)Datum: G9. BFE or(in Zone AO)depth of flooding at the building site is: _ft.(m)Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SI NATURE DATE �fdMENTS • I I Check here if attachments FEMA Form 81-31,AUG 99 REPLACES AI L PREVIOUS EDITInNS