1021 CHARLES ST U.S.DEP,ARTMEPIT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
Federal Emergency Management Agency Expires March 31,2012
National Flood Insurance Program Important: Read the instructions on pages 1-9.
SECTION A-PROPERTY INFORMATION ' : '
A1. Building Owner's Name Jon D.Hoover 8 Karin Hoover ,��;,r� ',x;
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A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.NoJ or P.O.Route and Box Na � i�^'°
1021 Charles Street „�
City Clearwater State FL ZIP Code 33755
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
E 1/2 of Lot 4,All of Lot 5&W 9ft of Lot 6,Block B,Peale Park
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential
A5. Latltude/Longitude:Lat.27.993392 Long.-82.793973 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 16
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 flood openings in the attached garage
enclosure(s)within 1.0 foot above adjacent grade 0 within 1.0 foot above adjacent grade 0
c) Tota�net area of flood openings in A8.b 0 sq in c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP Community Name&Community Number 62.County Name B3.State
Cfry of Clearvvater 125096 Pinellas FL
64.Map/Panel Number 65.Suffix 66.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone
12103C0106 H Date Effective/Revised Date Zone(s) AO,use base flood depth)
5-18-09 5-17-05 AE 12'
B10. Indicate the source of the Base Fiood Elevation(BFE)data or base flood depth entered in Item 69.
❑ FIS Profile � FIRM ❑ Community Detertnined ❑ Other(Describe)
B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other(Describe)
B12. Is the buiiding located in a Coastal Barrier Resources System(CBRS)area or Othervvise Protected Area(OPA)? ❑ Yes � No
Designation Date N/A ❑ CBRS ❑ OPA
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
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C1. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' � Finished Construction
'A new Elevation Certificate will be required when conshuctfon 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,ARIA1-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 AURAL"B"#114 Vertical Datum ELEV=6.96'(N.A.V.D.I
Conversion/Comments N/A
Check the measurement used.
a) Top of bottom floor(induding basement,crawlspace,or enGosure floor)11.68 �feet ❑meters(Puerto Rico only)
b) Top of the next higher floor IV.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) W.A �feet ❑meters(Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building 11.68 �feet ❑meters(Puerto Rico only)
(Describe type of equipment and location in Comments)
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� Lowest adjacent(finished)grade next to building(LAG) 9.$ �feet ❑meter�(Puerto Rico on�y)
g) Highest adjacent(finished)grade next to building(HAG) 1Q.4 �feet ❑meters(Puerto Rico only)
h) Lowest adjacent grade at lowest elevatlon of deck or stairs,including IV.A �feet ❑meters(Puerto Rico only)
structural support
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION `�����+r� � � r �J
This cerdfication 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 Certl�cate represents my besf elforts to interpret the data available. � ,���.••''r�C •• ` w
I understand that any false statement may be punlshab/e by�ne or imprisonment under 18 U.S. Code,Section 1001. � ���'`.,�z�,,' �r,�.'•,, ��'"
� Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ,,; - � V ~^9;�c-` -�
licensed land surveyor? � Yes ❑ No _ '� � "a�� `, _
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Certifier's Name Philip C.Stock License Number RLS#3035 � .�. ;°g'�r�'���' �a'
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Title President Company Name Target Land Surveying,Inc. ',��l�z)��f� �
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Address 516 Lakeside Place City Largo State FL ZIP Code 33771 °J/y/���,��:
Signature _ �_ �,___..__ Date 9-21-11 Telephone (727)784-0573 " --
FEMA Form 81- 1, Mar 09 See reverse side for continuation. Replaces all previous editions
IMPORTANT: In these spaces,copy the corresponding information from Section A.
Building Street Address(induding Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. � � '�
1021 Cha�les'�treet ' � _���"
Ciry Clearwater State FL ZIP Code 33755 a� 'a'
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SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation.�ertificate for(1)community official,(2)insurance agenUcompany,and(3)building owner.
Comments `t,�� � r,,;,� ,,��^�;%�,,.
Job#11p914.01 �� � ��.f' ',,, , �
C.2.e)=Water�Meate� .:..• ..,r/p �,` =-
According to N��Ir�1I�s 0�8�iP.ro�ertj�Appraiser,this house was built in 1925. At that time,FEMA Flood Maps did not exist.
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Signature � .. :� Sr`, � .�'. *"� ' -_- - Date 9-21-11
� - ❑ Check here if attachments
SECTIOf� , U, ��f�G ELEVA�i , �NFORMATION(SURVEY NOT REf�UIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
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For Zones�O�s�,2Yg�wiflSavf�F�).,oprriplete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B,
and C. For lie�r)s�FA-2�,%i��"�u,�ai grade,if available. Check the measurement used. In Puerto Rico only,enter meters.
E 1. Prowde e(ev�tionlinfoimation for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent
grade(HAG)antf the lowest adjacent grade(LAG).
a)Top of bottom floor(including basement,crawlspace,or endosure)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&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 platfortn 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 REPRESENTATNE)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 Oate 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 infortnation in Secdon C was taken from other documentadon that has been signed and sealed by a licensed surveyor,engineer,or architect who
is authorized by law to certify elevallon information. (Indicate the source and date of the etevation data in the Comments area below.)
G2.❑ A community official completed Section E for a building located in Zone A(wlthout 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 Pertnit Issued G6. Date Certificate Of Compliance/Occupancy Issued
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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 Offlcial's Name Title
Community Name Telephone
Signature Date
Comments
❑Check here if attachments
FEMA Form 81-31, Mar 09 Replaces all previous editions
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. Po�icy rvumber �
1021 Charles Street �
I City Clearvvater State FL ZIP COde 33755 CompenyNAlCNumber
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— _ _ _ _ _ ____ _ __
iIf 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 on the
reverse.
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Continuation Page
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 i
1021 Charles Street ;
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Clty Clearwater State FL ZIP COd@ 33755 Comperry NAIC Number —�
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i If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify ali �
photographs with: date taken; "Front View"and "Rear View"; and, if required, "Right Side View" and "Left Side View."
"Right Side View"— Pictures Taken 9-21-11
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