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1460 BYRAM DR 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 Fbr Insurance Company Use: A1. Building Owner's Name OSCAR AND CELSA SEGnvIA f�oliCy Number' A2. �uilding Street Address(inclu� � �� S��- � ✓��+ r P.O. Route and Box No. CofnpailY NAIC Number 1460 BYRAM DRIVE City CLEARWATER State �� ; - �,�Z`t 7 A3. Property Description(Lot and �� • � L, ial Description,etc.) PARCEL I.D.#02-29-15-87768-00 ��`[� C (�\�\� �RS U N ✓�i�.G L V A4. Building Use(e.g.,Residential � �tc.)RESIDENTIAL A5. Latitude/Longitude:Lat.27°59 �j�� Ly(„( �� Horizontal Datum: ❑ NAD 1927 � NAD 1983 A6. Attach at least 2 photographs _ _ sed to obtain flood insurance. A7. Building Diagram Number 1 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawispace or enclosure(s) N/A sq ft a) Square footage of attached garage 484 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 N/A within 1.0 foot above adjacent gra�P N/A c) Totai net area of flood openings in A8.b N/A sq in c) Total net area of flo�+�'- N/A sq in d) Engineered flood openings? ❑ Yes � No d) Ena��^� , � No SECTION B-FLOOD INSURANC� " B1. NFIP Community Name 8 Community Number B2.County t � b C��,,�r`� t C�`� PINELLAS COUNTY 12103 PINELIAS J �' � A ��.� B4. Map/Panel Number 65.Suffix 66.FIRM Index 67. ��, �� {',1 � �i �` �vation(s)(Zone 12103C0107 H Date Effecti� `L� � 9ood depth) 5/17/2005 5 ;�"`4\ B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood de � �\ �� ❑ t=i5 Nronie 1251 riKivi �j Communi'ry ueiermined � B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 �S 812. Is the building located in a Coastal Barrier Resources System(CBRS)area or No Designation Date N!A ❑ CBRS SECT�^" " ELEVATION INFC ^l\ / _ V x�� C1. Buildinq P�P•"'� awings' ❑ - �n of the building is cc C2. ��r� i0,V(with BFE),AR,. .,..��e items C2.a-h C�_" `�l, � Use the same datum E ^ G Check the measurement used. a� � ;losure floor)16.66 �feet ❑meters(Puerto Rico only) b) s N/A. ❑feet ❑meters(Puerto Rico only) �� , �nly) N/A. ❑feet ❑meters(Puerto Rico only) d� . � C �� 13.24 �feet ❑meters(Puerto Rico onlY) e� , ding 16.46 �feet ❑meters(Puerto Rico only) l � C. � � 13.0 �feet ❑meters(Puerto Rico only) 9� H 13.3 �feet ❑meters(Puerto Rico only) h) Lc `- iding N/A. ❑feet ❑meters(Puerto Rico only) str `` _..viNEER,OR ARCHITECT CERTIFICATION This certifica �,,\� ...,��surveyor,engineer,or archited authorized by law to certify elevation information. ....«vn on this Certificate r�epresents my best effo�ts to interpret the data availab/e.l understand tf , .�,��e stafement may be punishable by fine orimprisonment under 18 U.S. Code, Section 1001.❑ Chedc here if comments are provided on badc of form. Were latitude and longitude in Section A provided by a licensed land surveyor? � Yes ❑ No Certifier's Name MICHAEL D.CROW License Number PSM#5761 �s�,��6� Title PRESIDENT Company Name CROW LAND SURVEYING,INC. OC/Z3/�// ,7 Address 2444 NICHOLS ROAD City LITHIA State FL ZIP Code 33547 Signature Date 05/23/2011 Telephone 813-754-0505 U.S. DEPARTMENTOF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal Emergency ManagementAgency Expires March 31, 2012 National Flood Insurance Program tmportant: Read the instructions on pages 1-9. ' SECTION A-PROPERTY INFORMATION F�r Insurance Gompany Use: A1. Building Owner's Name OSCAR AND CELSA SEGOVIA �'�u�Y�1��[ A2. �uilding Street Address(including Apt.,Unit,Suite,and/or Bidg.No.)or P.O.Route and Box Na Ci�mpany NAlC NumbeC 1460 BYRAM DRIVE City CLEARWATER State FL ZIP Code 33755 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) PARCEL I.D.#02-29-15-87768-000-0970 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)RESIDENTIAL A5. Latitude/Longitude: Lat.27°59'35.9"N Long.82°46'38.8"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 crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) N/A sq ft a) Square footage of attached garage 484 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 N/A within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 61. NFIP Community Name 8�Community Number B2.County Name 63.State PINELLAS COUNTY 12103 PINELLAS FLORIDA 64.Map/Panel Number 65.Su�x B6.FIRM Index 67.FIRM Panel B8.Flood 69.Base Flood Elevation(s)(Zone 12103C0107 H Date Effective/Revised Date Zone(s) AO,use base flood depth) 5/17/2005 5/17/2005 AE 16 610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69. ❑ f=iS rronie 1251 r=ittnn ❑ Communiiy ueiermined u viner(uescribej 611. 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) 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,ARlAE,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 FDOT BMVertical Datum NAVD 1988 ConversioNComments N/A Check the measurement used. a) Top of bottom floor(including basement,crawlspace,or enclosure floor)16.66 �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) N/A. ❑feet ❑meters(Puerto Rico only) d) Attached garage(top of slab) 13.24 �feet ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 16.46 �feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Comments) � Lowest adjacent(finished)grade next to building(LAG) 13.0 �feet ❑meters(Puerto Rico o�ly) g) Highest adjacent(finished)grade next to building(HAG) 13.3 �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 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 information on this Certificate represents my best efforts to interpret the data available.l � 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 III licensed land surveyof? � Yes ❑ No � ' Certifier's Name MICHAEL D.CROW License Number PSM#5761 �s��6/ Title PRESIDENT Company Name CROW LAND SURVEYING,INC. D�/��/�// Address 2444 NICHOLS ROAD City LITHIA State Fl ZIP Code 33547 Signature Date 05/23/2011 Telephone 813-754-0505 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 Na Policy Number 1460 BYRAM DRIVE City CLFrARWATERState FL ZIP Code 33755 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 SECTION C2e.IS THE ELEVATION OF THE AIR CONDITIONER PAD. Signature Date 05/23/2011 ❑ 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 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 availabie. 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 be�ow 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 communit�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 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'rf 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. 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 sou�ce and date of the elevation data in the Comments area below.) G2. ❑ A commu�ity 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 (-1 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. Poi�cy Number 1460 BYRAM DRIVE City CLEARWATER State FL ZIP COd@ 33755 CompanyNAlCNumber If using the Elevation Certificate to obtain NFIP flood insurance, affix at Ieast finro building photographs below according to the instructions for Item A6. Identify all photographs with: date taken; "Front View" and "Rear VievW'; and, if re uired, "Ri ht Side View" n " . Q 9 a d Left Side View. If submitting more photographs than will fit on this page, use the Continuation Page, following. 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