Loading...
934 ELDORADO AVEU.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program Important: Read the instructions on pages 1-9. ELEVATION CERTIFICATE SECTION A - PROPERTY INFORMATION Al. Building Owner's Name Henry J. Bohinic k A2. Building Street Address (Including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 934 Eldorado Avenue City Clearwater State FL ZIP Code 33767 OMB No. 1660-0008 Expires March 31, 2012 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description. etc.) Lot 5, Block 52, Mandalay The Isle of a Thousand Palms A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential A5. Latitude/Longitude: Lal. 27.9992731 Long. -82.827486 Horizontal Datum: A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood Insurance. A7. Building Diagram Number j} A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) b) No. of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade c) Total net area of flood openings In A8.b d) Engineered flood openings? 0 Yes ® No QQQ sq ft Q Q sq In 0 NAD 1927 ® NAD 1983 A9. For a building with en attached garage: a) Square footage of attached garage $$¢ sq ft b) No. of permanent flood openings In the attached garage within 1.0 foot above adjacent grade Q c) Total net area of flood openings in A9.b Q sq in d) Engineered flood openings? 0 Yes ® No SECTION B B. FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NFIP Community Name & Community Number 82. County Name 83. State City of Clearwater 125096 Plneflas FL 84. Map/Panel Number 65. Suffix 86. FIRM Index B7. FIRM Panel 88. Flood 69. Base Flood Elevation(s) (Zone 12103C0102 G Date Effective/Revised Date Zone(s) AO, use base flood depth) 8-18-09 9-3-03 VE 13' 610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. 0 FIS Profile ® FIRM 0 Community Determined 0 Other (Describe) B11. Indicate elevation datum used for BFE in Item B9: 0 NGVD 1929 ® NAVD 1988 ❑ Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)7 0 Yes Designation Date to 0 CBRS 0 OPA ® No SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings' 0 Building Under Construction' 0 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/A0. Complete Items C2.a-h below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized AUREL Vertical Datum ELEV..; 5.40' (N.A.V.D.) Conversion/Comments EVA. a) Top of bottom floor (Including basement, crawlspace, or enclosure floor) L b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) g) Highest adjacent (finished) grade next to building (HAG) h) Lowest adjacent grade at lowest elevation of deck or stains, including structural support Check the measurement used. 0 feet 0 meters (Puerto Rico only) 0 feet 0 meters (Puerto Rico only) ® feet 0 meters (Puerto Rico only) 0 feet 0 meters (Puerto Rico only) ® feet 0 meters (Puerto Rico onty) 0 feet 0 meters (Puerto Rico only) feet 0 meters (Puerto Rico only) 0 feet 0 meters (Puerto Rico only) SECTION D • SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification Is to be signed and sealed by a lend 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 dela 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 back of form. Were latitude and longitude In Section A provided by a licensed land surveyor? 0 Yea 0 No Certifier's Name Philip C. Stock License Number RLS#3035 TiUe President Company Name Target Land Surveying, Inc. Address 516 Lakeside Place City Largo State FL ZIP Code 33771 Date 10-2412 Telephone (727) 784-0573 ar 09 See reverse side for continuation. \�roC.,��r�4 3035 Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding Information from Section A. Building Street Address (Including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route arid Box No. 934 Eldorado Avenue City Clearwater State FL ZIP Code 33767 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED Copy both sides of this Elevation Certificate for (1) community official, (2) Insurance agent/company, and (3) building owner. Comments Job # 121022.02 This structure has breake y wpll C2.e)=Electrl4Odter ... Signature Date 10-24-12 SECTI � I L VATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) •,:> n w ,1 For Zones /NO and A (without Ff), complete Items E1 -E5. If the Certificate Is Intended to support a LOMA or LOMR-F request, complete Sections A, B, and C. F r: Items 81;E4, pse'natural grade, If available. Check the measurement used. In Puerto Rico only, enter meters. E1. Provide-eleaatIon-Infot nation for the following and check the appropriate boxes to show whether the elevation Is above or below the highest adjacent grade'(F1AGyand the lowest adJacent g'Yede (LAG). a) Top of bottom floor (Including basement, crawlspece, or enclosure) Is 0 feet 0 meters 0 above or 0 below the HAG. b) Top of bottom floor (Including basement, crawispace, or enclosure) Is 0 feet 0 meters 0 above or 0 below the LAG. E2. For Building Diagrams 6r9 with permanent flood openings provided In Section A Items 8 and/or 9 (see ages 8-9 of Instructions), the next higher floor (elevation C2.b In the diagrams) of the building Is 0 feet 0 meters 0 above or d below the HAG. E3. Attached garage (top of slab) is 0 feet 0 meters 0 above or 0 below the HAG. E4. Top of platform of machinery and/or equipment servicing the building Is 0 feet 0 meters 0 above or 0 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? 0 Yes 0 No 0 Unknown. The local official must certify this Information In Section G. 0 Check here If attachments 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 1n 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 0 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. 01. 0 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.) 02. 0 A community official completed Section E for a building located In Zone A (without a FEMA -Issued or community -Issued 8FE) or Zone AO. 03. 0 The following Information (Items 64-09) Is provided for community floodplaln management purposes. G4. Permit Number G5. Date Permlt Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for. 0 New Construction 0 Substantial Improvement G8. Elevation of as -built lowest floor (Including basement) of the building: 0 feet ❑ meters (PR) Datum G9. BFE or (in Zone AO) depth of flooding at the building site: 0 feet 0 meters (PR) Datum G10. Community's design flood elevation 0 feet 0 meters (PR) Datum Local Official's Name Title Community Name Telephone Signature Date Comments 0 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. 934 Eldorado Avenue Policy Number City Clearwater State FL ZIP Code 33767 Company NAIC Number If 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. Front View 10-23-12 Rear View 10-23-12 Building Photographs Continuation Page Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 934 Eldorado Avenue City Clearwater State FL ZIP Code 33767 For Insurance Company Use: Policy Number Company NAIC Numb©r 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." Ri• ht Side View 10-23-12 Left Side View 10-23-12 U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program Al. Building Owner's Name Henry J. Bohinidc ELEVATION CERTIFICATE Important: Read the instructions on pages 1-9. SECTION A • PROPERTY INFORMATION A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 934 Eldorado Avenue City Clearwater State FL ZIP Code 33767 OMB No. 1660-0008 Expires March 31, 2012 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Descrlptlon, etc.) Lot 5, Block 52. Mandalay The Isle of a Thousand Palms A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) A5. Latitude/Longitude: Lat. 27,9992731 Long. -82.827486 A6. Attach at least 2 photographs of the building If the Certificate is being used A7. Building Diagram Number j} A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) 1Q9 sq ft b) No. of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade Q c) Total net area of flood openings in A8.b Q sq in d) Engineered flood openings? 0 Yes ® No Residential Horizontal Datum: to obtain flood Insurance. 0 NAD 1927 ® NAD 1983 A9. For a building with an attached garage: a) Square footage of attached garage IN sq ft b) No. of permanent flood openings in the attached garage within 1.0 foot above adjacent grade Q c) Total net area of flood openings In A9.b Q sq in d) Engineered flood openings? 0 Yes it No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NFIP Community Name & Community Number City of Clearwater 125096 B2. County Name Pinellas B3. State FL B4. Map/Panel Number 12103C0102 B5. Sufflx 0 B6. FIRM Index Date 8-18-09 B7. FIRM Panel Effective/Revised Date 9-3-03 B8. Flood Zone(s) VE 59. Base Flood Elevation(s) (Zone AO, use base flood depth) 13' 810. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered In Item 69. 0 FIS Profile ® FIRM 0 Community Determined 0 Other (Describe) 811. Indicate elevation datum used for BFE in Item 89: 0 NGVD 1929 ® NAVD 1988 0 Other (Describe) B12. Is the building located In a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 0 Yes _4 No Designation Date DILL 0 CBRS 0 OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: 0 Constructlon Drawings* 0 Building Under Construction' ® Finished Construction A new Elevation Certlflcate 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. Comple" below according to the building diagram spedfled In Item A7, Use the same datum as the BFE. Benchmark Utilized AUREL Vertical Datum ELEV. at 5.40' (N.A.V.D.) Conversion/Comments NA a) b) c) d) e) 1) 9) h) Top of bottom floor (Including basement. crawlspaoe, or enclosure floor) Z.`122 Top of the next higher floor Bottom of the lowest horizontal structural member (V Zones only) Attached garage (top of slab) Lowest elevation of machinery or equipment servidng the building (Describe type of equipment and location In Comments) Lowest adjacent (finished) grade next to building (LAG) Highest adjacent (finished) grade next to building (HAG) Lowest adjacent grade at lowest elevation of deck or stairs, Including structural support Check the measurement used. feet ® feet ® feet ® feet ® feet ® feet ® feet ® feet ❑ meters (Puerto Rico only) ❑ meters (Puerto Rio only) 0 meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ metete (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) 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. / certify that the information on this Certificate represents my best efforts to Interpret the date available. I understand that any false statement may be punishable by line 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 licensed land surveyor? ® Yes 0 No Certlfier's Name Philip C. Stock License Number RLS#3035 Title President Company Name Target Land Surveying, Inc. Address 516 Lakeside Place Signature City Largo State FL ZIP Code 33771 Date 10-24-12 Telephone (727) 784-057 FEMA Form 81 , Mar 09 See reverse side for continuation. / 62/z.,.//i z_ ��- Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding Information from Section A. Building Street Address (Including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 934 Eldorado Avenue City Clearwater State FL ZIP Code 33767 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community offidal, (2) Insurance agent/company, and (3) building owner. Comments Job # 121022.02 This structure has breakaway walls. C2.e) = Electrical Meter Signature Date 10-24-12 0 Check here if attachments SECTION E UILDING 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 El -E4. use natural grade, If available. Check the measurement used. In Puerto Rico only, enter meters. E 1. 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 (Including basement, crawlspace, or enclosure) Is 0 feet 0 meters 0 above or 0 below the HAG. b) Top of bottom floor (including basement, crawispaoe, or endosure) Is 0 feet 0 meters 0 above or 0 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 0 feet 0 meters 0 above or 0 below the HAG. E3. Attached garage (top of slab) Is 0 feet 0 meters 0 above or 0 below the HAG. E4. Top of platform of machinery and/or equipment servldng the building Is • 0 feet 0 meters 0 above or 0 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? 0 Yes 0 No 0 Unknown. The local offldal 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, 9, 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 fhe best of my knowlekige. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments 0 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, 8. 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. 01. ❑ 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. 0 A community offidai completed Section E for a building located In Zone A (without a FEMA -issued or community -Issued BFE) or Zone AO. G3. 0 The following Information (Items G4-09) Is provided for community floodplain management purposes. G4. Pernit Number 05. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued Z G7. This permit has been Issued for G8. Elevation of as-bulit lowest floor (Including G9. BFE or (In Zone AO) depth of flooding G10. Community's design flood elevation 0 New Construction 0 Substantial Improvement basement) of the building; 0 feet 0 meters (PR) Datum at the building site: • 0 feet 0 meters (PR) Datum • 0 feel 0 meters (PR) Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑ Check here If attachments FEMA Form 81-31, Mar09 Replaces all previous editions Building Photographs See !nstructjons for Item A6. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 934 Eldorado Avenue City Cloarwator State FL ZIP Code 33767 For I Company Policy Num conpmnymmC Number'' If using the Elevation Certificate to obtain NFIP flood inovnonoe, affix atleast 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 Pnge on thereverse | Front View 10-23-12 L. Rear View 10-23-12 Building Photographs Continuation Page Bu1dnq Street Address{inc|vdingAp , ()nit, Suite, and/or Bldg '`�'`' P.O. Route -and Box No, 9:34 Eldorado Avenue : Clearwater State FL ZIP Code 33767 For insurance Company Use: nsubmitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify o'h"^"y."v.^"vo, date taken; "Front View" and "Rear Vlow~:and, ifrequired, "Right Side View" /,d " Side e"U^ --�--- — --- -- ! Ri h Side Vie 10-23-12 Left Side View 10-23-12 R:0 U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program Important: Read the instructions on pages 1-9. ELEVATION CERTIFICATE SECTION A - PROPERTY INFORMATION Al. Building Owner's Name Henry J. Bohini A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 934 Eldorado Avenue OMB No. 1660-0008 Expires March 31, 2012 City Clearwater State FL ZIP Code 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 5, Block 52, Mandalay The Isle of a Thousand Palms [5:P5- - 2 9 - - y 512_ - A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential A5. Latitude/Longitude: Lat. 27.9992731 Long. -82.827486 Horizontal Datum: A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood Insurance. A7. Building Diagram Number 7 A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) b) No. of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade c) Total net area of flood openings In A8.b d) Engineered flood openings? 0 Yes E No 2704 sq ft Q 4 sq in 0 NAD 1927 E NAD 1983 A9. For a building with an attached garage: a) Square footage of attached garage N/6 sq ft b) No. of permanent flood openings in the attached garage within 1.0 foot above adjacent grade Q c) Total net area of flood openings in A9.b Q d) Engineered flood openings? 0 Yes sq in No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name 8 Community Number City of Clearwater 125096 B2. County Name Pinellas B3. State FL 84. Map/Panel Number B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone 12103C0102 G Date Effective/Revised Date Zone(s) AO, use base flood depth) 8-18-09 9-3-03 VE 13' B10. Indicate the source of he Base Flood Elevation (BFE) data or base flood depth entered In Item 89. 0 FIS Profile ® FIRM 0 Community Determined 0 Other (Describe) B11. Indicate elevation datum used for BFE in Item 89: 0 NGVD 1929 ® NAVD 1988 0 Other (Describe) B12. Is the building located In a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 0 Yes Designation Date N/A [J CBRS 0 0PA E No SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: 0 Construction Drawings' ® Building Under Construction' 0 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, ARAE, 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 AUREL Vertical Datum gLEV. = 5.40' (N.A.V.D.) Conversion/Comments N� a) b) c) d) e) 1) 9) h) Top of bottom floor (Including basement, crawlspace, or enclosure floor) 7.11 Top of the next higher floor 17.17 14,77 Q•92 N•9 Bottom of the lowest horizontal structural member (V Zones only) Attached garage (top of slab) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location In Comments) Lowest adjacent (finished) grade next to building (LAG) Highest adjacent (finished) grade next to building (HAG) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 4.Q N.@ Check the measurement used. feet 0 meters (Puerto Rico only) E feet 0 meters (Puerto Rico only) ® feet 0 meters (Puerto Rico only) E feet 0 meters (Puerto Rico only) feet 0 meters (Puerto Rico only) ® feet 0 metersPuerto Rico oni'y) ® feet 0 meters (Puerto Rico only) ® feet 0 meters (Puerto Rico only) 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. / certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. E Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a licensed land surveyor? E Yes 0 No Certifier's Name Philip C. Stock Lioense Number RLSit3035 Title President Company Name Target Land Surveying, Inc. Address 516 Lakeside Place City Largo State FL ZIP Code 33771 SignatureDate 11-18-11 Telephone (727) 784-0573 FEMA Form 81-31, Mar 09 See reverse side for continuation. Replaces all previous editions IMPORTANT:, In these spaces, copy the corresponding Information from Section Building Street Address (Including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 934 Eldorado Avenue City Clearwater State FL ZIP Code 33767 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments Job # 111115.01 Signature •�,l" '� S '`• �� Date 11-18-11 SEC 0 Check here if attachments EVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) ✓. r, For Zones AQaridA (without B.F) ).'rzirriplete gems E1 -E5. If the Certlflcate Is Intended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For-Iterrls E•1 E4, use natUr$L'grade, If available. Check the measurement used. In Puerto Rico only, enter meters. El. Provide elafeiign'inTdfmaUort #orthe,following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) prdtlie.Iokrtast.adJacent grade (LAG). a) Top of bottom flb rt(Iriciuding basement, crawlspace, or enclosure) is ❑ feet 0 meters 0 above or 0 below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is 0 feet 0 meters 0 above or 0 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 0 feet ❑ meters 0 above or 0 below the HAG. E3. Attached garage (top of slab) is 0 feet 0 meters 0 above or 0 below the HAG. E4. Top of platform of machinery and/or equipment servicing the building Is 0 feet 0 meters 0 above or 0 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? 0 Yes 0 No 0 Unknown. The local official 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, 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 Date Telephone Comments 0 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. 0 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 author `co and date of the elevation data in the Comments area below.) G2. 0 A commie A (without a FEMA -Issued or community -Issued BFE) or Zone AO. G3. 0 The folie 1 odplaln management purposes. G4. Permit Numt G7. This permit h G8. Elevation of r G9. BFE or (In Zr G10. Community's Local Official's N Community Nam PLAtvMNG u 01'; iwi_=) Pnfii:NT DEPT CITY CF CL: AR'.f1ATER Signature Comments GB. Date Certificate Of Compliance/Occupancy Issued tantial Improvement • 0 feet 0 meters (PR) Datum ❑ feet 0 meters (PR) Datum • ❑ feet 0 meters (PR) Datum Tide Telephone Date 0 Check here If attachments FEMA Form 81-31, Mar 09 Replaces all previous editions Building Photographs See Instructions for Item A6. Building Street Address (including Apt.. Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 934 Eldorado Avenue City Clearwater State FL ZIP Code 33767 ForInsurance Company Use: 1, Policy Number Corpparry NAIC Number If 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 I reverse. Front View 11-17-11 044 to4ti!, t;11 ] I, "1 "' • ri5t°°' ° r tr`'`' 4:;.,4•rrA. Rear View 11-17-1 Building Photographs Continuation Page For Insurance Company Use: Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 1934 Eldorado Avenue Policy Number City Clearwater State FL ZIP Code 33767 Company NAJC Number i 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." Right Side View 11-17-11 U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal Emergency Management Agency Expires March 31,2012 National Fiood Insurance Program Important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION �: . ,� .,� A1. Building Owner's Name Henry J.Bohinidc 'f� �? P�.;:�.Mr'� A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. �''"M `"� 934 Eldorado Avenue �":' '�` ,'.��� City Cleanvater State FL ZIP Code 33767 A3. Property DescripGon(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Lot 5,Block 52,Mandalay The Isle of a Thousand Palms A4. Building Use(e.g.,Residential,Non-Residentlal,Addition,Accessory,etc.)Residential A5. Latitude/Longitude:Lat.27.9992731 Long. . 274 Ho�izontal Datum: ❑ NAD 1927 � NAD 1983 A6. Attach at least 2 photographs of the buitding if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number � 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) 6Q0 sq ft a) Square footage of attached garage 996 sq ft b) No.of permanent flood openings in the crawlspace or b) No.of pertnanent flood openings in the attached garage enclosure(s)within 1.0 foot above adJacent grade Q within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b Q 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 B2.County Name 83.State City of Clearvvater 125096 Pinellas FL 64.Map/Panel Number 65.Suffix B6.FIRM Index B7.FIRM Panel B8.Flood 69.Base Flood Elevation(s)(Zone 12103C0102 G Date EffecUve/Revised Date Zone(s) AO,use base flood depth) &18-09 9-3-03 VE 13' B10. Indicate the source of the Base Flood Elevatlon(BFE)data or base flood depth entered in Item 69. ❑ FIS Profile � FIRM ❑ Community Detertnined ❑ Other(Describe) 611. Indicate elevation datum used for BFE in item 69: ❑ NGVD 1928 � 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 Construcdon' � Finished Construction 'A new Elevation Certiflcate will be required when construotion 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 AUREL Vertical Datum ELEV.= 5.40'(N.A.V.D.) Conversion/Comments N/A � Check the measurement used. a) Top of bottom floor(inGuding basement,crawlspace,or enclosure floor)�.� �feet ❑meters(Puerto Rico only) b) Top of the next higher floor 17.17 �feet ❑meters(Puerto Rico oniy) c) Bottom of the lowest horizontal structural member(V Zones only) 1¢.Q1 �feet ❑meters(Puerto Rico only) d) Attached garage(top of slab) ¢.� �feet ❑meters(Puerto Rico only) e) Lowest elevatfon of machinery or equipment servicing the butlding L.�7 �feet ❑meters(Puerto Rico only) (Describe type of equipment and bcatlon in Comments) � � Lowest adjacent(finished)grade next to building(LAG) 4.Q �feet ❑metel�s(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) �.� �feet ❑meters(Puerto Rico only) h) Lowest adjacent grade at iowest elevation of dedc or stairs,including N.� �feet ❑meters(Puerto Rico only) structurat support SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION This cerdfication is to be signed and sealed by a land surveyor,engineer,or arGhitect autFwrized by law to certify elevation ,T._,.,_ inforrnation. l certify that the Infamatlon on this Cert/f/cete represents my best eflats to lnterpret the data avaflable. ,,' ` ' ' ' ' `> ` I understand fhat any false statement may be punishable by ilne or imprisonment under 18 U.S. Code,Sectlon 1001. , `� � , �' l:, v f ° ,,,,\' ... �J,�,�' � Check here if comments are provided on badc of form. Were latitude and longitude in Section A provided by a , .,' '?`,• c-���-}�k .`�y� �;n licensed land surveyor? � Yes ❑ No - � ;'�;<-, . f;�'•. Certifier's Name Philip C.Stodc License Number RLS#3035 ' u �'°�'°��3zi ' Title PresiQent Company Name Target Land Surveying,Inc. �r��Z�;,�C�--,;� Address 516 Lakeside Place City Largo State FL ZIP Code 33771 . �`f����j�,�� , , i 'v„ � , ', `:� ,:' -,. :A`�=---_ Signature r � �-•-�� -- DBte 10-2412 Telephone (727)784-0573 ' � r FEMA Form 81- , 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(including Apt.,Unit,Suite,and/or Bidg.No.)or P.O.Route and Box No. 934 Eldorado Avenue City Clearwater State FL ZIP Code 33767 ° ��. �3r`ei.��.�,�'��.� SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevatlon Certificate for(1)community offidal,(2)insurance agenUcompany,and(3)building owner. Comments Job#121022.02 . - This structure hagdxealt�vZ�y w�lls�" C2.e)=Electri�(r�ldter � '� " _ ' '"�y��'.! . . , •, Signature;? ' _ ,. <`�. •. � ' _.._. .. Date 10-2412 � . . tr+ - ❑ Chedc here if attachments SEC�10 �I�IN - I�VATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) .. `r} � M :`�; _+ For Zon�s/��O�aqd A(withou���&�,cwnplete'Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B, and C. FdF It�ms 81:�4�1,ise nafUral grade,if availabie. Check the measurement used. In Puerto Ric�o only,enter meters. E1. Provide�e�i8tjon�infof�r"nat�on for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG)+aqd ths loaiest adjacent g'Yade(LAG). a)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or�below the HAG. b)Top of bottam floor(including basement,crawlspace,or endosure)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 buiiding 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 aocordance with the communiry's floodplain management ordinance? ❑Yes ❑ No ❑ Unknown. The local offidal must certlfy this iMormatlon in Sectlon G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATNE)CERTIFICATION The property owner or owner's authorized representadve who completes SecUons A,B,and E for Zone A(without a FEMA-issued or community-issued BFE) or Zone AO must sign here. The sfatements in SecNons A,B,and E are correct fo 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 offiGal who is authorized by law or orclinance to administer the c�mmunity's floodplain management ordinance can compiete SecUons A,B,C(or E), and G of this Elevation Certiflcate. 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 documentadon that has been signed and sealed by a licensed surveyor,engineer,or architect who is authorized by law to certify elevation infortnation. (Indicate the source and date of the elevaHon 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.Pertnit Number G5. Date Pertnit Issued G6. Date Certificate Of Compliance/Occupancy Issued � G7. This permit has been issued for: ❑New Constructlon ❑Substantial Improvement G8. Elevatlon 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 buiiding 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 Insurence Company Use: Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Poncy ruumber , 934 Eldorado Avenue Clty Clearwater StBt@ FL ZIP COde 33767 Company NAIC Number � If 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 j � Side View" and "Left Side View." If submitting more photographs than will fit on this a e, use the Continuation Pa e on the ' reverse. p 9 g I Frant View 10-23-12 \ �1.�11�""", ,` , .. y _ I - . , , _. , _ � -_ � _. , , , y �^-�r. - , �" � ����� , �., � , 7r►rnv � �.1 __.�...:.._�. �i�� ug.aa . .ii I. �__.:. F CqpN EW�011lp1,} 7;;SY�..i :ii'.> �' ^ r � '��'��'" '�F; � �'J,_L,�.yJ,,'�'�":..... :,��� :'1 ��S .„.b` �....,.,._ . ... . .. .. r, �• �.. . , .....,�'A ,.:..... . ... . .. . d � �.:.. .. . � ,�...,.. �.. . .w ' "+iI' .n��_ , .. .... . (�F1��'�,`IC'VV '�-2��—1�;r _,s. � .. i �,d I �ar.z �� . . > �,F.� �, � �.�.+. _" t�� .�.9� � ��..�b''�M ( A} ;..i ._u. i. 4 �J�,.�`4'�p � g� � � :� �. l.y � � ,�(� i. .«...:.'�I���r'� . � ��:V: . .. .. _�R�`...: � . " �_� �� � . . �. . � :„�,,. ,,, . .... �, -��� _ , a Building Photographs Continuation Page For Insurance Company Use: Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Poiicy rvumber 934 Eldorado Avenue Clty Clearwater StBte FL ZIP COde 33767 Company NAIC Nimber c 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." Ri ht Side View 10-23-12 �� `�,, , 1 ,x;;;: � , ;,�-': Gt�z� ^ '� 1 ,�-� � ; g ,: '::` '11 ,,, ,T.7z ..� ! � � ��� �,:. fl �. �' �\ h� I�I,�, � � I 1� � '� i J , ' #,;� ,l� . �?.� - � ,.�.__..Yd / ' =�1 . . ' . � . . . . . .� ' _ -,(f :>!QjF� _�`rCW "f f-Z f-'� �^ � � � � /���� � :� J ,«x, N Y �,^�y�'3��� � ���� l '��.„++s . �,}�: �` : ,?��r �r� �� �'' ��.���.... �< U.S.DEPARTMENT OF HOMEUWD 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. Bui�ding Owner's Name Henry J.Bohinidc . ��._, � ;- A2. Buflding Street Address(inGuding Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. � 934 Eldorado Avenue �/F, f, City Clearwater State FL ZIP Code 33767 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Lot 5,Block 52,Mandalay The Isle of a Thousand Palms A4. Building Use(e.g.,Reside�tial,Non-ResidenHal,AddiNon,Accessory,etc.)Residentlal A5. Latitude/Longitude:Lat.27.9992731 long. ,82748 Ho�izontal Datum: ❑ NAD 1927 � NAD 1983 A6. Attach at least 2 photographs of the buiiding if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number � A8. For a building with a cxawlspace or endosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) 6Q0 sq ft a) Square footage of attached garage 996 sq R b) No.of permanent flood openings in the cxawlspace or b) No.of permanent flood openings in the attached garage enclosure(s)within 1.0 foot above adjacent grade Q withtn 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b 0 sq in c) Totai net area of flood openings in A9.b 0 sq in d) Engineered flood openings? ❑ Yes � No d) Engineered flood openi�gs? ❑ Yes � No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 61.NFIP Community Name&Community Number 62.County Name 63.State City of Ciearwater 125096 Pinellas FL B4.Map/Panel Number 85.Sufflx 66.FIRM Index 87.FIRM Panel B8.Flood 69.Base Flood ElevaBon(s)(Zone 12103C0102 G Date Effective/Revised Date Zone(s) AO,use base flood depth) &18-09 9-3-03 VE 13' 610. �ndicate the source of the Base Flood ElevaUon(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile � FIRM ❑ Community Determined ❑ Other(pesc.�ibe) 611. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other(Describe) 812. Is the building located in a Coastal Barr(er Resour�ces System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes � No Designation Date N/A ❑ CBRS ❑ OPA SECTION C-BUILDING ELEVATION INFORMATtON(SURVEY REQUIRED) C1. Building elevadons are based on: ❑ Construction Drawings' ❑ Building Under ConstrucNon' � Finished ConstrucGon "A new Elevation Certificate will be required when construction of the bufiding is complete. C2. Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,W-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO. Comple*-"----^'--� below according to the butiding diagram spec�fled in Item A7. Use the same datum as the BFE. ���� � Benchmaric Utilized AUREI Verticai Datum ELEV.= 5.40'(N.A.V.D) � Conversion/Comments N/A ' � Z D Check the measurement used. � � 0� m a) Top of bottom floor(induding basement,c,�awls pace,or enclosur e fl o o r)7.5„� �f e e t ❑m e t e r s(P u e rt o R i c o o n i y) � Z�1 b) Top of the next higher floor 17.17 �feet ❑meters(Puerto Rico only) � f/) '�j� c) Bottom of the lowest horizontat s t n i c t u r a l m e m b e r(V Z o n e s o n l y j 1 S i.� �fee t ❑me ters(Puerto Rico only) �j d) Attached garage(top of slab) ¢.� �feet ❑meters(Puerto Rico only) � Z �� e) Lowes t e leva Bon o f machinery or equipment servicing the building 17.�7, �feet ❑meters(Puerto Rico only) �j � (Desc,�Ibe type of equipment and bcatlon in Comments) J � Lowest adjacent(flnished)grade next to building(LAG) 4.� �feet ❑mete�s(Puerto Rico only) � g) Highest adJacent(finished)grade next to building(HAG) ¢,� �feet ❑meters(Puerto Rico only) � h) Lowest adjacent grade at lowest elevation of dedc or stairs,inGuding N.A �feet ❑meters(Puerto Rico only) � � StruCtural support SECTION D-SURVEYOR, ��"� ENGINEER,OR ARCHITECT CERTIFICATION � rn This certlfication is to be signed and sealed by a land surveyor,engineer,or archttect authorized by law to certify elevation � � informallon. 1 certify that the lnfamation o»thls Ce�HB'cate repre�nts my best eBorts to lnterpret the data avallable. J understand that any/alse statement may be punlshab/e by Sne or impNsonment under 18 U.S.Code,Sectlon 1001. � Check here if comments are provided on badc of form. Were latitude and longitude in SecUon A provided by a licensed land surveyor? � Yes ❑ No Certifier's Name Philip C.Stodc License Number RLS#3035 Title President Company Name Target Land Suroeying,Inc. ���Z`���Z- Address 516 Lakeside Place City Largo State FL ZIP Code 33771 v��j .r'/�j Signature � --- ---- -Date 10-2412 Telephone (727)784-0573 �'�`� i FEMA Fonn 81- , Mar 09 See reverse side for continuation. Repiaces atl previous editions IMPORTANT: In these spaces,copy the corresponding information from Section A. Building Street Address(including Apt.,Unit,Suite,andlor Bldg.No.)or P.O.Route and Box No. 934 Eldorado Avenue City Clearwater State FL ZIP Code 33767 SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUEDj Copy both sides of this Elevation CeRificate for(1)community official,(2)insurance agent/company,and(3)building owner. Comments Job#121022.02 This structure has breakaway walls. C2.e)=Elecfical Meter Signature -�_ _ _. Date 10-2412 �� ❑ Chedc here if attachments SECTION E- UILDING ELEVATION INFORMATION(SURVEY NOT REf�UIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),complete Items E1-E5. If the Certiflcate 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 Rioo only,enter meters. E 1. Provide elevatfon infortnation for the following and check the approp�iate 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(InGuding basement,crawlspace,or endosure)is ❑feet ❑meters ❑above or Q below the HAG. b)Top of bottom floor(induding basement,crawlspace,or endosure)is ❑feet ❑meters ❑above or❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Secdon A Items 8 and/or 9(see pages 8-9 of Instructions),the next higher floor (elevatlon C2.b in the diagrams)of the building fs ❑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 servidng the building is ❑feet ❑meters ❑above or❑below the HAG. E5. Zone AO only: If�o 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 locai oflidal must ce►Ufy this informa8on in Secdon G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owner's authorized representadve who completes Sections A,B,and E for Zone A(wlthout a FEMA-issued or communiry-issued BFE) or Zone AO must sign here. The statements in SecNons A,8,and E are carect to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address Cfty State ZIP Code Signature Date Telephone Comments ❑Check here if attachments SECTION G-COMMUNITY INFORMATION(OPTIONAL) The local offlcial 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. Compiete the appilcable item(s)and sign below. Chedc the measurement used in Items G8 and G9. G1.❑ The information in SecHon 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 infortnatlon. (Indicate the source and date of the elevatlon data in the Comments area below.) G2.❑ A community offlcial completed Section E for a building Iocated In Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3.❑ The following infortnation(Items G4-G9)is provided for community floodplain management purposes. G4.Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued 4 G7. This permit has been issued for: ❑New ConstrucUon ❑Substan8al Improvement G8. Elevation of as-built lowest floor(inGuding 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)Oatum Local Official's Name Tide Community Name Telephone Signature Date Comments ❑Check here if attachments FEMA Form 81-31, Mar 09 Replaces ail previous editions Building Photographs See Instructions for Item A6. For Insurance Competty se: Building Street Address(including Apt., Unit,Suite,and/or Bidg. No.)or P.O. Route and Box No. poucy Number 934 Eldorado Avenue ! City Clearvvater StBtG FL ZIP Code 33767 CanpanyNAlGNunber � � ------ � If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two buildina 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. i ' ----. __) Front View 10-23-12 ,�` �I,1ily'�'�mr:: � � ti � � 'a � � i� ' �. � � � � � `,�. �. � ��-� . k; y � ��� � 1f s ���=��'s,�� �;,� 1I� ��- ��,�i � �RII z`g �• �'(L � �'s i ` , �►W n1- �.- �""'�" �,�. �,-���, �� �,�;����1 � -�, ;�: # .� � �����:., F r- � � ` � � �� ' ��IGI� � � .x' aa-� f !{�1' � �� -�-;� , ' n � , ,. ,. .b. � _ � . , - k Rear View 10-23-12 ; , ���. � ; ,. + . ' ��� � _ � , ;� i • • � • • • . • • . • �.�' • ♦' • •' • • ��• • • � • '� • • i •• • • � � �• • i• • '� • •• � •• .�• � •�' � �: �: • • • • ' • • •• .• � ' • ' '• • •.�' .�• • � • •• .• •' • •' i • •• .• •. • • • '• '• • •' • •• � • •' � S .. . . � �y', � ' . 1 � t � . }� �:< }�", ,A')1�`i� ` � '� . ' .� �«�,,•r �R V, . ! �'* �. '. i-af' .�.>.•' r -�.�- �� �r3� � y � . ., ' � � �y�(`- ,qe� >/� .1;���.1�.. . � ��� f�;�y . . y = r}' .. � � � � �i�'��. Y:. �� 9 � �F'� � • . ,. _,,�"'�1'�P4.����,..�1eti l 'Y • , � f"; ""�� �$� �� L� . . y �� �f . �- ti ,. .. �i; . � , R �. . . � �'� ' �'?�,!/ *'k\�' ��� , � L:'''�� h '-''`V'�� a"� e :�!°'r '., � ,��'� ' �� '� f`,r.5k����7�y.� ti �. � � ,y� z� � � �s_ — `�+�;¢ �,�'� � ;�' � �' .{`j�',`�,i. 5�`, �a,'�'�'�' � „y,d�'[ i� `��/ttr �a � W �F� 1 � �' �s.. � . �. , . � �. , ... •' i�Y!,��.�s 11�.fi' � ♦'�i� A�„"..� t � ., �� . a„� ,, � . f� �� ' �, �.�` � �,y ;,� �'� � ��''�����5` , , .��: ;` : �r ,,�t�-�.�` s� . ° ; } ' r �� ��,-�3k�,'���!�~�� ✓ � Y � < ' r�'��,�'� �-� ,� 'I +�-��S....�.r���h,�'� �� �ri � r .! \ 3 �. J5� ...'s" i, `�:. � ���- ;t. - ��i� . :� . r.�. 4 : � < � � c,ti .: ;. � , , , � . , _ . � _, : � �';` ,ra�� .- � , � '��` � � � . ,, i . . �, i ( .E ; i � f � i _ . - � - -� U.S.DEPARTM�NT 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 °�'gg; A1. Building Owner's Name Henry J.Bohinick ���,: �;�� � , A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. � �N ,(�*y �y�q�}�r: - 934 Eldorado Avenue �A: City Clearwater State FL ZIP Code 33767 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Lot 5,Block 52,Mandalay The Isle of a Thousand Palms �9 -2 S -i� S�f�G 61 S Z �� �p� A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential A5. Latitude/Longitude:Lat.27.9992731 Long.-82.827486 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 7 A8. For a building with a crawispace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) 2704 sq ft a) Square footage of attached garage N/A sq ft b) No.of permanent flood openings in the crawispace 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) Total 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 8 Community Number B2.County Name B3.State City of Clearvvater 125096 Pinellas FL 64.Map/Panel Number 65.Suffix 66.FIRM Index 67.FIRM Panel 68.Flood B9.Base Flood Elevation(s)(Zone 12103C0102 G Date Effective/Revised Date Zone(s) AO,use base flood depth) &18-09 9-3-03 VE 13' 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 Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other(Describe) 612. Is the building 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) 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. Benchmaric Utilized AUREL Vertical Datum ELEV.= 5.40'(N.A.V.D.) Conversion/Comments N/A � Check the measurement used. a) Top of bottom floor(induding basement,crawlspace,or enclosure floor)7.53 �feet ❑meters(Puerto Rico only) b) Top of the next higher floor 17.17 �feet ❑meters(Puerto Rico only) c) Bottom of the lowest horizontal structural member(V Zones only) 14.77 �feet ❑meters(Puerto Rico only) d) Attached garage(top of slab) 6.92 �feet ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building IV.A �feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Comments) s � Lowest adjacent(finished)grade next to building(lAG) 4.9 �feet ❑meters�Puerto Rico on�) g) Highest adjacent(finished)grade next to building(HAG) 5.3 �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. I 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. ��� tr��'�, ,,�.; �, � Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a <s`` ,; �;,"f� � .✓r ,�' licensed land surveyor? � Yes ❑ No ;,•'r�%'` �� •. .� ' � ' _. Certifier's Name Philip C.Stock License Number RLS#3035 � � � j'° �� '� Titie President Company Name Target Land Surveying,Inc. • '� �"''��' ;'S ,,-,�,-- ,- Address 516 Lakeside Place Ci Lar o � ��" �� tY 9 State FL ZIP Code 33771 J� / '��f''�' Signature . ____�__.----- Date 11-18-11 Telephone (727)7840573 �F � ���` Ju.�',��--�--«--y�C'� ��.%�'.�''t..� FEMA Form 81-31, Mar 09 See reverse side for continuation. Replaces all'previous editions IMPO�tTAIdTr In these spaces,copy the corresponding information from Section A. � . Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. r 934 Eldorado Avenue ��� , �p� t;���;a��,,�� ,x�� � �: . Ciry Cleanvater State FL ZIP Code 33767 ,.., �, 1� �;k� , �, ��; � � 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 Job#111115.01 ; . , ,`s 2 s�,r r�! i�r. r !�t� � Y�gjS(§ L.: �� , �� ,j `i: Signature ` " ` Y'�. i� � Date 11-1&11 � r � ' " ❑ Chedc here if attachments SEC #�E o:7 _ IL ,, G EYATlON INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) . , � _ � «, . For Zones A(�,ancJ�A�witho�t BF�)�r�m�3lefe�`tems E 1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B, and C. For It�rras��;E4,use n�tUr,�t,�yrade,if available. Check the measurement used. In Puerto Rico only,enter meters. E1. Provide e1�a�i�n`in�oim�or��ar�the,following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG�,��f�t�e lovtr�st�fidjacent grade(LAG). a)Top of bottom fl6dr�(4ricluding bas,ement,crawlspace,or enGosure)is ❑feet ❑meters ❑above or�below the HAG. b)Top of bottom floor(including bassment,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 S and/or 9(see pages S-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 communiry's floodplain management ordinance? ❑Yes ❑ No ❑ Unknown. The local official 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 communiry-issued BFE) or Zone AO must sign here. The statements in Sections A,B,and E are comect 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 INFORMA�ION(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 author .ce and date of the elevation data in the Comments area below.) G2.❑ A comm� `� ;/�� /;� ie A(without a FEMA-issued or community-issued BFE)or Zone AO. G3.❑ The follo i%�� �v� � �odplain management purposes. G4.Permit Numt G6. Date Certificate Of Compliance/Occupancy Issued x �, � G7. This permit h tantial Improvement G8. Elevation of a � � ' � { _ ❑feet ❑meters(PR)Datum r G9. BFE or(in Zc � � � � LI �� �!-, � — � �� ❑feet ❑meters(PR)Datum G10.Community's � �. ¢ j ❑feet ❑meters(PR)Datum �� NO�I212011 ¢ � Local OfficiaPs N � � � Title Community Nam pl_P,ivP�i�4C��;,±: ,�1_;1;%;�;,;:�-�pFp i Telephone C!T'�CF t,!_�r�,�;r,!Art�. Signature �� " Date Comments ❑Check here if attachments FEMA Form 81-31, Mar 09 Replaces ail 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 Number � R34 Eldorado Avenue � Clty Clearwater State FL ZIP COd2 33767 CompenyNAlCNumber ' If 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. Front View 11-17-11 . �, , ,m ., �+ ,. ,,_ , ,. .._ �_ i C � _ � � � �� ' ,( I' f, . � j ,� ' i i!; � ., — i�I � a � �i,��i I � � . � �I��y� �. �.. ,r— I 4 �s—,r�iiF"'_p,` .�--� —r-q r � "� ! � ����. �II"" �a. � ., ��� ..�' y 4� � �W�yj_ ��+n.e � � �.� 1 .r��,• . �`!� �T�_'� �� �, . �� �>r. t ' « — °i I 1 m �� 1• �Akt I � . �.�� 'a�.�:. � ..� ��■ w� � ;r:':0� �, ." ,.. �� �.` ,. . ...�' � � ��. ;,�:� ., � �� .... . ,. . �. , . ,,. u..�. .. � '-. . ..,. . � . ��::�.. .. .,., .,s. Ma: - '-ws ��• ' - � F +^ . M^';. .. ...,.. .,., �.S'k'x ' - . ^ �,.���y ' -. r ..��:'# ` 4.. a ,,,� ..;.., .: . ,:�"",,,�q': �, `�' ,. . � , ,. �..�"�� � . .� � .. Rear V'�aw 11�-17-11 � � �� ' f , I i�p � II�, � y _ r ; ° '� ( I i , ,; � : . �. � •, =�� _ ��,. � �\� �4� �„ :_ �� �� . � ' � ik �. .. �y r,� ' � "�n'�y . [� f� , , ��� -�T � �, � �:: ,' �� ,�. f ��� �L � � �Y I�� ��,_ !� ;. 'r � '�. ... _,� , � • • � • • � . • • • .�' • • •. C • • • �• • • ` • - • • C •• • • ' • '• • C• • '• +- •• .•• - •�� . r .•• .: • • • - • • •• .� • • - -• • •.�- .�• � • • •• .• �- • •- • • •• .• •. • • • -• -• • •- • •- ' • •- �'. „ �� _ � � s 5 // �' '' � �` � �i� ; l :.:�._.- ,� !S �, y�^�;�.,i,�i.�. _..... ''Y",�.r� I��gr ��ae��""e�' �;. '� '�' � ���« �� ,..�� . S r ' � �� I �1 � �` � i�{ X����t '`'���Y .(�q��R� �� � � � ;�,1+� �`.�wl�,�.e �, ��, '.5"'�„T"'1`��e,%�`,� ` ��., �.,� F�+� _ �� , y�. � � s: j. .:q�¢'. yt � k �; �s t'� � �'�C • � ���i .. . ..� �- .. f��� �� ` �' ` 1 ; , '. r � ,,,s,,,��1,,!����`�y���1 �•.4�.���,;'..{ ,.Nt-�'� ��':%• �'`(�� , , � � �I ' '. ` �..�..��� ., � .�(a �-�H f � . . . F� 'R' 7!� - t�,���� � • p t �, � . � �� � .1.,{� p���`i~f�✓�}��P������,, � \ , � A , q f. . q • ' . k.-.�m 2�.n�:��� . �; u � ,... � �� ,, ��, 1; � _ � /�:. , � � �. � , � : , ��..'�� � h ,�,,1` � �� -,,,.�� � , / , � �' �`�. � ���i�� ' ���� J1 k � �r��a. ,` pp�� �1 1�,1�y� Y . . {1 . Q ! fl�� 5 I t� �1.4������S � �4 t � � � �� ��t+ � ` ,A. � �: �� ����� � .a�a. , r, �, ,,t'„ � E , �� l ti��. � � �.__ � , �, , `�' �(�'±!� � ��y � 4. '] �,. . ��� f't��,,,,"� '��wr T4' �.���' . r "� � ,i� w : ,� � � � �, ,��t �� t�,��rr` '*��F ���������6,` �(���, ". " .3��7t �N dtc,' EV ,�ru sY �a°� � '.� � � ,. '�""� � ��Ypf i �..}^���"�✓"i�::we��Y ,.�.�,�,,� .�w�, ,� `"!l.} � � �l�/. ,�'�`��.y ,r'� . s �� , f,,. ^ ` �' y�,� �, � ',� "53 + �r a�;,w�4k�.��{ f�i �eS� y�Yr d .��f" � Tk r�,7•��� a. ��' �����ab L"�-;r. tfl,�':* �r ,, .� ' ,r,. ,s ., , � •_., -> . . . , ..x�,yr.. ,. . . , � � .a_ , ,.- M,..,, � V ZONE DESIGN CERTIFICATE .Name (-�?�~�.,<<c.�. r�.�,aL ,S- Policy Number (lnsurance Co. Use) Building Address or Other Descrsption �3`� C.���o,2.,tJ� �i,�,T Permit No. �CPZdf%—G'yZyjCity _ State � Zip Code �� �% SECTiON i: Flood Insurance Rate Map (FIRM) Information Community No. _ t ZS G`�� Panel No. ZlO�L'�lQ�u�x FIRM Date $/�FIRM Zone(s) L'G� SECTION II: Eievation Information Used for Design jIUOTE: This section documents e/evations used in the design — it does not substitute for an Elevation Certificate.J ". Elevation of the Bottom of Lowest Horizontal Structural Member ......... ...... ............. .... l� feet (NAVD88) 2. Base Flood Efevation (BFE) .................... ................................. .........................�feet (NAVD88) 3. Elevation of Lowest Adjacent Grade ...... ...... ... ..... .. ,�.5'feet (NAVD88) . ............................. ............... 4. A.pproximate Depth of Anticipated Scour/Erosion used for Foundation Design ...... .........�^�feet (NAVD88) 5. Embedmert Depth of Pilings or Foundation Below Lowest Adjacent Grade ................ -��feet (NAVD88) SECTION III: V 2one Design Certification Statement (NOTE. This section must be certified by a registered engineer or architect.] I certify that: (1 } I have developed or reviewed the structural design, plans, and specifications for construction and (2) that the design and methods of construction to be used are in accordance with accepted standards of practice for meeting the following provisions: • The bottom of the lowest horizontal structural member of the lowest floor (excluding piles and columns) is elevated ic or above the BFE; and • The pile and column foundation arid structure attached thereto is anchored to resist flotation, collapse, and lateral • movement due to the effects of the wind and water loads acting simultaneously on all building components. Water loading values used are those associated with the base flood. Wind loading values used are those required by the applicaale State or local building code. The potential for scour and erosion at the foundation has been anticipated for condi!;ors associated with the base flood. including wave action. SECTION IV: Breakaway Wall Oesign Certification Statement j_�'OT£. This section mtrst also be certif ed bv a registerec� engineer or ai•chitect u•ir�r� breakcnrm• u alls exceecl a design sufe loadnig resisrance oJ ZO po:mds per syt�are 1oor.,1 t certify that (1) I have developed or reviewed the structural design, plans, and specifications for construction and (2) that the design and methods of construction to be used for the breakaway walls are in accordance with accepted standards of practice for meeting the following provisions: • Breakaway watl collapse shall result from a water load less than that which would occur during the base flood; and • The eievated portion of the building and supporting foundation system shall not be subject to collapse. displacemeni. or other structural damage due to the effects of wind and water loads acting simultaneously on all buiiding �o^�ponents jwind and water loading values to be used are defined in Section III). SECTION V: Certification and Seal Tnis certification is to be signed and sealed by a re structural designs. l certify the V Zone Design Cer Certificatior+ Sfatemenf in Section IV (if applicab/e). � iz-� h,� r'-#� f Ce�rt�ifier s Namey� �-/ i 1GC�Li.7 1 l+.�:a�t+i1- I 1� t��4Q.9rh�. � Tit{e �a��i1. _ _ .__ Company r� ic i C J/ MAY 16 2011 Telephone o(�itect authorized by law to certify '111�� he Breaka`,��I(I(py��sign '� � � S. � i ; � i i t� ,���` ��PN..... tiS/ ���i i: � �� � �. � F � ,� r!_� ♦ : � 8 •• �� .� . : o.; �44. • .*. -. . ,. ., - — ZI�� . � , � . . ' � E • : � � . i � Q• : ,�� ,��` ' � •.��...•' ,,� ��i�is`S�O N A�-���� ��111l1111��