475 EAST SHORE DR Y
u.s.o°���o��wNO�R n�ELEVATION CERTIFICATE OMB No. 1660-0008
Federal Emergenc;y Management Agency E x D i r e s F C b r u a N 2 8.2 0 0 8
Nation�l Flood Insurance Program Important Read the instructions on pages 1-8.
SECTION A-PROPERTY INFORMATION For Insurance Company Use:
Building Owne�'s Name Belleair Harbor,LLC Policy Number
. Building Street Address(including Apt.,Unit,Suite,andlor Bldg.No.)or P.O.Route and Box No. Company NAIC Number
475 East Shore Drive
Ciry Clearwater Beach State FL ZtP Code 33767
A3. Property Description(Lot and Blodc Numbers,Tax Paroel Number,Legal Description,etc.)
Lot 5 Blodc C of replat of Blodc A,8 Lots 1-15 Block B Cleaiwater Beach Park 1�Addition,Plat Book 21,Page 21
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Acoessory,etc.) Residential
A5. LatkudelLongitude:Lat.27°58.887 N Long.082°49.529 W Horizontal Datum: ❑NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of the building ff the Certficate is being used to obtain flood ir�surance.
A7. Building Diagram Number 8
A8. For a building with a crawl space or enG�ure(s),provide A9. For a building with an attached garage,provide:
a) 5quare footage of crawl space or enclosure(s) UNKsq ft a) Square footage of attached garage UNK sq ft
b) No.of permanent flood openings in the crawl space or b) No.of permanent flood openings in the attached garage
enctosure(s)walls within 1.0 foot above adjacent grade UNK walls withi�1.0 foot above adjacent grade I�NK
c) Total net area of flood openings in AB.b UNK sq in c) Total net area of flood openings in A9.b �NK sq in
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP Community Name&Community Number 62.County Name B3.State
Pinellas 12103C Pinellas FL
B4.Map/Panel Number B5.Suffix B6.FIRM Index 67.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone
Date Effective/Revised Date Zone(s) AO,use base flood depth)
12103C 0102 G 09-03-03 09-03-03 AE 11'
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in ftem 69.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Describe)
811. 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 Othervvise Proteded Area(OPA)? DYes �No
�Designation Date N/A ❑CBRS ❑OPA
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. Building elevations are based on: ❑Construdion Drawings" �Building Under Construction* ❑Finished Co�strudion
*A new Elevation Cefificate will be required when construdion of the building is compfete. v
C2. Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A7-A30,AR/AH,AR/AO. Compt�e Items C2.a-g
below according to the building diagram specified in Item A7. �. ,
Benchmartc Utilized Local Vertical Datum NAVD 1988 �`� > �
ConversionlComments Add 0.86 to convert to NGVD 1929. o � �
Check the measurement used. V 3 O �
�.°; cc �_ !
a) Top of bottom floor(induding basement,crawl space,or enclosure floor)_ �.QQ {�feet ❑meters(Puerto Rico only) o ¢ U �
b) Top of the ne�higher floor W.A ❑feet ❑meters(Puerto Rico only) C.� � �
c) Bottom of the lowest horizontal strudural membe�(V Zones only) N/.A ❑feet ❑meters(Puerto Rico only) o u. Z �
d) Attached garage(top of slab) N/A ❑feet ❑meters(Puerto Rico only) �p "
e) Lowest elevation of machinery or equipmerrt servicing the building N/.A ❑feet ❑meters(Puerto Rico only) � � � u� �
(Describe type o f equipment in Comments) °� - �� �
fl Lowest adjacent(finished)grade(LAG) 4.2 �feet ❑meters(Puerto Rico onty) a, � �� �
g) Highest adjacent(finished)grade(HAG) 4.6 �feet ❑meters(Puerto Rico only) �r,
o,�
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION �
This certification is ta be signed and sealed by a land surveyor,engineer,or archited authorized by law to oertify elevation
information. 1 certify that the info►mation on this Certificate represents my best efforts to interp►et 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 badc of form.
Certifier's Name Jadc W.Smith License Number 6140
� Project Surveyor Company Name Klein&Staub Surveying,Inc.
dress 8016 Old County Road 54 Ciry New Port Richey State FL ZIP Code 34653
Signature Date 03-13-08 Telephone 727 834-8140
'� �� Building Photographs
� Continuation Page
For Insurance Company Use:
�ing Street Address(including Apt., Unit,Suite, and/or Bldg. No.)or P.O. Route and Box No. Poiicy Number ',
ast Shore Drive
City Clearwater Beach State FL ZIP Code 33767 Company NAIC Number
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all
photographs with: date taken; "Front View"and "Rear View"; and, if required, "Right Side View"and "Left Side View."
REAR VIEW
Photograph taken 03-12-08
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� Building Photographs
See Instructions for Item A6.
For Insurance Company Use:
ding Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Poiicy Number
475 East Shore Drive
Clty Clearwater Beach State FL ZIP COdA 33767 Company NAIC Number
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two buifding 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,
following.
FRONT VIEW
Photograph taken 03-12-08
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IMPORTA�IT: In these spaces,copy the corresponding information from Section A. For Insurance Company Use:
Building S reeZ Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. Policy Number
475 East Shore Drive
City Clearwater Beach State FL Z�P 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 Item A7:Unsure as to the final building designation.
Item A8&A9:At this time building is concrete blodc outline only.
Item C2a:Elevation was shot on top of concrete blodc outline.
Signature Date 03-13-08
❑ 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 Cert�cate is intended to support a LOMA or LOMR-F request,complete Sections A,B,
and C. For Items E1-E4,use natural grade,ff available. Chedc the measurement used. In Puerto Rioo only,enter meters.
E1. Provide elevation information 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(inctuding basement,crawl space,or enclosure)is ❑feet ❑meters ❑above or�below the HAG.
b)Top of bottom floor(including basement,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 Instrudions),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 andlor equipment servicing the building is ❑feet ❑meters ❑above or 0 below the HAG.
E5. 2one 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 Iocal official must cert'rfy 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 canmunity-issued BFE)
or Zone AO must sign here. The statements in Sections A,8,and E aie oonect to the best of my knowledge.
�rty Owners or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
❑Chedc 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 compte#e Sedions A,B,C(or E),
and G of this Elevation Certficate. Complete the appticable item(s)and sign below. Chedc the measurement used in It�ns G8.and G9.
G1.❑ The information in Section C was taken from other documeMation that has been signed and sealed by a licensed surveyor,engineer,o�arChitect who
is authorized by law to certify elevation infortnation. (Indicate the source and date of the elevation data in the Canments area below.)
G2.❑ A communiry official completed Section E for a building tocated 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.Pertnit 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
Local Official's Name Title
Community Name Telephone
Signature Date
ments
❑Chedc here if attachments
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