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738 HARBOR ISLAND U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB NO. 1660-0008 Federal Er�ergen�y Management Agency Expires MarCh 31,2012 Nation�l Flood Insurance Program Important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION � ' �`'� �,�_ �� A1. Building Owner's Name STEVEN B.CARROLL ��y " ��,�� , �� ',��, a�; �r � �. 'u��x� A2. Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. �� r�u 738 HARBOR ISLAND ,��J�'s ��F ��'� �„�'� �a�'�� . � � ��, �_ City CLEARWATER State FL ZIP Code 33767 A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) LOT 76,ISLAND ESTATES OF CLEARWATER UNIT 6D,7A,7C, PARCEL ID.05-29-15-43456-073-0760 A4. Buiiding Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)RESIDENTIAL A5. Latitude/Longitude:Lat.27°59'29.8" Long.82°49'02.3" Horizontat 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 1B 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) 0 sq ft a) Square footage of attached garage 462 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) Total net area of flood openings in AS.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 61. NFIP Community Name&Community Number 62.County Name 63.State CITY OF CLEARWATER/125096 PINELLAS FL B4.Map/Panel Number 65.Suffix 66.FIRM Index 67.FIRM Panel 68.Flood 69. Base Flood Elevation(s)(Zone 12103C0102 G Date Effective/Revised Date Zone(s) AO,use base flood depth) 8/18/2009 09/03/2003 AE 11 610. 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) B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes � No Designation Date ❑ CBRS ❑ OPA SECTION C-BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction` � Finished Construction "A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO. Complete Items C2.a-h below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized CITY OF CLEARWATER I-03.5Vertical Datum 6.491'NAVD 1988 DATUM � Conversion/Comments NONE �� W Check the measurement used. � a) Top of bottom floor(including basement,crawlspace,or enclosure floor) 7.79 �feet ❑meters(Puerto Rico only) �� N �Q b) Top of the next higher floor N/A._ ❑feet ❑meters(Puerto Rico only) � O a c) Bottom of the lowest horizontal structural member(V Zones only) N/A._ ❑feet ❑meters(Puerto Rico only) �� N O d) Attached garage(top of slab) 7.29 �feet ❑meters(Puerto Rico only) �y� � o �U e) Lowest elevation of machinery or equipment servicing the building 7.19 �feet ❑meters(Puerto Rico only) `-�' p u, (Describe type of equipment and location in Comments) �� W .a O � Lowest adjacent(finished)grade next to building(LAG) 7.1 �feet ❑meters(Puerto Rico only) W z� g) Highest adjacent(finished)grade next to building(HAG) 7.5 �feet ❑meters(Puerto Rico only) � Z U h) Lowest adjacent grade at lowest elevation of deck or stairs,including N/A._ ❑feet ❑meters(Puerto Rico only) � g structural su ort p. SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation ` "* information. 1 certify that the information on this Certificate represents my best efforts to interpret the data available. „ ��,��'��'^.,�� '� 1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ��4��,��,�,.�� .'�� Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a y,,`"�,�,� `�� '°9 �'��°` licensed land surveyor? � Yes ❑ No �` � ,:� ��`':'�� "°- ;.w' ��' . ��.� Certifier's Name GUY HALE LAND SURVEYING License Number 4626 `" � -� Title PROFESSIONAL LAND SURVEYOR Company Name GUY HALE LAND SURVEYING � � :.� ��-�-�� ; ' Address 111 FOR LAKES BLVD City OLDSMAR State FL ZIP Code 34698 '`^� �''��'��'��rt';: ``y'`` '�/�.�a,� •... , �..��,,�r, Signature Date 01/25/2012 Telephone 727-734-4266 r�°�r �'f�;jRV�jai '',��;� ��: , , FEMA Form 81-31, ar 09 See reverse side for continuation. Replaces all previaus editions ___ _ _ IMPORTANT: In these spaces, copy the corresponding information from Section A. �', ��g� � ��,y�,�� Building 3treet Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O. Route and Box Na �±'q�j� ��, h�„��,�'y��'3 ' 738 HARBOR ISLAND � �E ,��i� ,�� `� � �t�,"� � y,� ,k City CLEARWATERState FL ZIP Code 33767 �#�mR��,��`�`�U�� , r,'�` g"` 4 �. ,.�!f � „ ,.'� SECTtON 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 THE LOWEST MACHINERY IS THE AIR CONDITIONER. Signature Date 01/25/2012 � 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 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 below the highest adjacent grade(HAG)and the lowest adjacent grade(LAG). a)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or�below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or❑ below the LAG. E2. For Building Diagrams 6-9 with 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 plattorm 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 floodplain management ordinance? ❑Yes ❑ No ❑ Unknown. The local o�cial 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,B, and E are correct to the best of my know/edge. 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) fhe 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. �1. ❑ 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.) 32. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. 33.❑ The following information(Items G4-G9)is provided for community floodplain management purposes. G4.Permit Number G5. Date Permit Issued G6. Date Cert�cate Of Compliance/Occupancy Issued �7. This permit has been issued for: ❑New Construction ❑Substantial Improvement �8. Elevation of as-built lowest floor(including basement)of the building: ❑feet ❑meters(PR)Datum �9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters(PR)Datum �10.Community's design flood elevation ❑feet ❑meters(PR)Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑Check here if attachments EMA Form 81-31, Mar 09 Replaces all previous editions , . Building Photographs See Instructions for Item A6. , For Insurance Gompany Use: I Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Poiicy Number' 738 HARBOR ISLAND Clty CLEARWATER St2t@ FL ZIP COde 33767 CompanyNAlCNumber 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. `�!C�:'r{i ��(c�C�"1'r"K1t-' FRONT EAST VIEW(DATE TAKEN 01/25/2012) � ' �. � .y��y� , 7 _ � ,�:1, � 4 ;�t�Y� ", `. .. � �° t � ,r� �w•�, ��,:� �v _ {f th t�ti,� � ;t�' ...;;:�. �. � � � I �,•. ,� . ,. . C. _�?..- *,q.'. �� ` ,,i r �` � r M1 , .�� I �. � — �,w ,. '" , �a y.,'..�4. � � . .� ��,� ��,. � �• � ^ _ '`� , „ ��;. .��, � .. rr.' � ,r .� -T : � �.,r;,�--^::?�J,�` . " �r�.r�'��It y��-�� .. .,... , � �,.-. 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