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1915 CALUMET ST U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB NO. 1660-0008 Federal Emergency Management Agency Expires March 31, 2012 National F►ood Insurance Program Important: Read the inStruCtions On p8ges 1-9. SECTION A-PROPERTY INFORMATION � For Insnrance Company lJse �;y;,° A1. Buiiding Owners Name ROBERT I.SMITH JR. .Rolicg-Number ` s�'?�"�z� , �;.,� �.>.s�` A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. �Company'NAIC N�ber ��,�,�� .� 1916 CALUMET STREET �.�;.�: -�.'. Ciry CLEARWATER State FL ZIP Code 33765 A3. Property Descnption(Lot and Blodc Numbers,Tax Parcel Number,legal Description,etc.) PARCEL ID#01-29-15-00000-340-1300 A4. Building Use(e.g., Residential,Non-Residential,Addition,Accessory,etc.)NON-RESIDENTIAL A5. Latitude/Longitude:Lat.N 27°59'09.6" long.W 82°45'27.5" Horizor+tal 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 1A 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 N/A sq ft b) No.of permanent flood openings in the crawlspace or b) No.of permanent Aood openings in the attached garage enclosure(s)within 1.0 foot above adjacent grade N/A wRhin 1.0 foot above adjacent grade N/A c) Total net area of flood openings in AB.b N/A sq in c) Total net area of flood openings in A9.b N/A sq in d) Engineered 800d openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name&Community Number B2.County Name B3.State CITY OF CLEARWATER 125096 PINELLAS FL 64.Map/Panel Number 65.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-0107 H 8-1&2009 5-17-2005 AE 52' 610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69. ❑ FIS Profile � FIRM ❑ Community DeteRnined ❑ Other(Describe) B1 t Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other(Describe) 812. 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 Items C2.a-h below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized CIEARWATER I-11 Vertical Datum NAVD 88 Conversion/Comments N/A Check the measurement used. a) Tap of bottom floor(including basement,crawlspace,or enclosure floor)51.30 �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) N/A �feet ❑meters(Puerto Rico only) . e) Lowest elevation of machinery or equipment servicing the building 51.33 �feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Comments) � Lowest adjacent(finished)grade next to building(LAG) 50.68 �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 51.06 �feet ❑meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of dedc 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 cerrtiffy that the information on this Certif�ate represents my best efforts to interpnst the data available. 1 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 form. Were latitude and longitude in Se�tion A provided by a licensed land surveyor? � Kes ❑ No Certifiers Name GEORGE A.SHIMP III Job Number 060784A License Number 6137 Title VICE PRESIDENT Company Name GEORGE A.SHIMP II 8�ASSOCIATES,INC. n„b, LL � f�v�jc "V Address 3301 DESOTO BLVD.,SUITE D City PALM HARBOR State FL ZIP Code 34683 #6137 DATE: � i re A1 � /r_ - Date 6-9-2011 Telephone 727-784-5496 ��T /,�L� . f r11AA f�� O� �1� \/..�A!� [�� ......�..� ..:.1..i...-w..w�ir�•.wL:w.. 19....1........ ..11.......:...... ...1:1:...... IMPORTANT: In these spaces,copy the corresponding information from Section A. ;For t�suia�►ce Cornpany�,Use:, Building Street Address(inGuding Apt., Unit,Suite,and/or Bidg.No.)or P.O. Route and Box Na ,PoHcqc��Nurnber 1916 CALUMET STREET City CLEARWATER State FL ZIP Code 33765 �n�i-NAI�NymbeG ' SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for(1)communiry official, (2)insurance agenUcompany,and(3)building owner. Comments C2.e)AIR CONDITIONER ON CONCRETE PAD Signature G ORGE A.SHIMP III Date 6-9-2011 � Chedc 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 suppari 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 infortnation 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 pertnanent 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 ❑fest ❑meters ❑above or❑ below the HAG. E5. Zone AO only: If no flood depfh 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 infortnation 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�nowledge. 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 communiry'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 infoRnation(Items G4-G9)is provided for community floodplain management purposes. G4.Permit Number G5. Date Permit Issued G6. Date Certficate 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 bui�ding: ❑feet ❑meters(PR)Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters(PR)Datum G10.Communiry's design flood elevation ❑feet ❑meters(PR)Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑Check here if attachments FFMA Fnrm R1_.41 Mar(1Q Ronla�ac all nrraviniic aili}innc