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1315 CLEVELAND ST U.S.DEP�I'RTMENT OF HOMELAND SECURITY ELEVATION CERTIFICA �`D� �p�j� OMB N0. 1660-0008 Fed�ral Emergency ManagementAgency �� 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 Nemishawn Inc, A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. 1315 Cleveland St. " � City Clearwater State FL ZIP Code 33755 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Brookwood Terrace Revised Blk 5,Lots 1 to 20 Incl&N 1/2 of Vac St S of Lots 19&20/ 15-29-15-12276-005-0010 A4. Buiidiny Use(e.g.,Resideniial,Nun-kesidential,Aodition,i+ccessury,etc.)Nun Ftesiuc:n�ial ' . A5. Latitude/Longitude:Lat.27°57'55.65 Long.82°46'S736 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 1A A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: r a) Square footage of crawispace 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 N/A within 1.0 faot 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 flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes ❑ No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 61.NFIP Community Name&Community Number B2.County Name B3.State � Ciry of Clearwated 125096 Pinellas FL 84.Map/Panei Number 65.Su�x B6. FIRM Index 67.FIRM Panel 68.Flood 69. Base Flood Elevation(s)(Zone 12103C 108 H Date Effective/Revised Date Zone(s) AO,use base flood depth) 5/17/05 5/17/05 AE/X ' 20.00 610. 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) B11. Indicate elevation datum used for BFE in ttem 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,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 Utitized NGSBM Seminole WVertical Datum NAVD 1988 Conversion/Comments N/A � Check the measurement used. a) Top of bottom floor(including basement,crawlspace,or enGosure floor)22.12 �feet ❑meters(Pue�to 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) NlA. ❑feet ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 22.2 �feet ❑meters(Puerto Rico only} (Describe type of equipment and location in Comments) fl Lowest adjacent(finished)grade next to building(LAG) 19.8 �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 21.8 �feet ❑meters(Pusrto 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 certi ication 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 Certi�cate represents my best efforts to interpr�t the data available. `,��,,�,�' �a ," �� ., 1 undersfand that any false statement may be punishab/e by fine or impnsonment under 18 U.S. Code, Section 1001. .;'..�,° ', '± u'� . � Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ��''�r "✓j � ''r" licensed land surve or? �� Y � Yes ❑ No 'Y �. ,.�� i - •�� :�,� y- Certifier's Name Dennis J.Eyre License Number 2865 �`- . :,�;, �g',,`�, ° , �' � ,� . ��' �.��,.•. Title Land Surve or Company Name GeoData Services, Inc. � � �� t,�`� �% '. ." '',�s� Address 1822 Dr Street,Suite 8 City Clearwater State FL ZIP Code 33766 ' �� ,`'� • , . . • ``: , ' , ��,�� ;�" Signa r Dat Telephone 727-447-1763 `' ��;a.��,��A�"'� FEMA For 1-31,Ma 9 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section A. ��su��nceGprnpany�tJ�e ��'��a Building Street Address(including Apt.,Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. #�q�cy htttinber 1315 Cleveland St. ' <:� �` �� :;�'`�..�' _.�� Cit ClearwaterState FL ZIP Code 33755 &'.: Y �i�NAIG N�tb�C ;> , �s3 `° �� > .� .��. � � ,�. . �,. ..,�_, SECTtON 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 C2 e)Lowest elevation is the electric meter box.Air condition is on the roof —� , —_ G_ . (p .�bL� — Signature Date ❑ Check here if attachments SECTION E-BUILD G ELEVATI 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 available. 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 beiow 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 community's floodpiain management ordinance? ❑Yes ❑ No ❑ Unknown. The local official must ceRify 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 if attachments SECTION G-COMMUNITY INFORMATION(OPTIONAL) The local o�cial 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(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 Namz Telephone Signature Date Comment� ❑Check here if attachments FEMA Form 81-31,Mar 09 Replaces all previous editions