648 HARBOR ISLAND --�-
�• U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB NO. 1660-0008
Federal Emergency Management Agency Expires Februarv 28.2009
N�tional Flood Insurance Program Important: Read the instructions on pages 1-8.
SECTION A-PROPERTY INFORMATION For Insurance Company Use:
A1. Building Owner's Name MICHAEL CANNON Policy Number
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. Company NAIC Number
648 HARBOR ISLAND
City CLEARWATER State FL ZIP Code 33767
A3. Property Description (Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) 648 HA R SOR IS LA N D-
05-29-15-43456-073-0910 B C P 2�0 7-0419 3 -
A4. Building Use(e.g., Residential,Non-Residential,Addition,Accessory,etc.) RESIDENTIAL
A5. Latitude/Longitude:Lat.N 82.81655 Long.W 27.9 839 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 crawl space or enclosure(s),provide A9. For a building with an attached garage,provide:
a) Square footage of crawl space or enclosure(s) 3.197 sq ft a) Square footage of attached garage 665 sq ft
b) No.of permanent flood openings in the crawl space or b) No.of permanent flood openings in the attached garage
enclosure(s)walls within 1.0 foot above adjacent grade 17 walls within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b 3.400 sq in c) Total net area of flood openings in A9.b 0 sq in
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61. NFIP Community Name&Community Number B2.County Name B3.State
CITY OF CLEARWATER 125096 PINELLAS FL
B4. Map/Panel Number 65.Suffix B6.FIRM Index B7.FIRM Panel BS.Flood B9.Base Flood Elevation(s)(Zone
Date Effective/Revised Date Zone(s) AO, use base flood depth)
12103C-0102 G 5/17/2005 9/3/2003 AE 11
610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
❑ FIS Profile � FIRM ❑CommunityDetermined ❑Other(Describe)
611. Indicate elevation datum used for BFE in Item B9: ❑ 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 N/A ❑CBRS ❑OPA
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY RE(aUiRED)
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-g
below according to the building diagram specified in Item A7.
Benchmark Utilized CLEARWATER BM I-3.5 Vertical Datum NAVD 88 a �+z
ret �l� �
Conversion/Comments N/A C �,,._--���_...r
Check the measurement used. r� �
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a) Top of bottom floor(including basement,crawl space,or enclosure floor)_ 6.41 �feet ❑meters(Puerto Rico only) � �
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b) Top of the next higher floor 11.83 �feet ❑meters(Puerto Rico only) �,� -�p �
c) Bottom of the lowest horizontal structural member(V Zones only) N.A �feet ❑meters(Puerto Rico only) ��� � ���'�
d) Attached garage(top of slab) 7.98 �feet ❑meters(Puerto Rico only) m � '
e) Lowest elevation of machinery or equipment servicing the building 14.04 �feet ❑meters(Puerto Rico only) � � �, � y
(Describe type of equipment in Comments) o i -��-.: �
f) Lowest adjacent(finished)grade(LAG) 5.91 �feet ❑meters(Puerto Rico only) m °O
g) Highest adjacent(finished)grade(HAG) 6.86 �feet ❑meters(Puerto Rico only) � l�-N
. G
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 besi efforis to interpret the data available.
!understand that any fa/se statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001.
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� Check here if comments are provided on back of form. �� r` � .}`�'
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Certifier's Name GEORGE A.SHIMP III Job No. 070018-I License Number 6137 ���� �.� � �"� '
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Title VICE PRESIDENT Company Name GEORGE A.SHIMP 11&ASSOCIATES, INC. � '`
'�`a., f
Address 3301 DESOTO BLVD.,SUITE D Ci ty PALM HARBOR State FL ZIP Code 34683 ��,��
ture Date 9-8-2008 Teiephone 727-784-5496 #6,�37°DA��y- r 6 �'`
:Qw7'LA�. /J � .�c..,
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FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions
IMPORTANT: In these spaces,copy the corresponding information from Section A. For Insurance Company Use: •
Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. Policy Number
648 HARBOR ISLAND ,
City CLEARWATER State FL ZIP 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 C2.e)GENERATOR
AS.c)TOTAL VENT AREA IS BASED ON EACH SMART VENT BEING ENGINEERED TO EQUAL 200 SQ. INCHES OF VENT AREA
A9)GARAGE CONTAINS 4 SMART VENTS, EACH OVER 1.0 FOOT ABOVE ADJACENT GRADE
��� � ��
Signature Date 9-8-2008
� Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REGIUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO and A(without BFE),complete Items Ei-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,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 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 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 community-issued BFE)
or Zone AO must sign here. The statemenis in Secfions A,8,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 attachmen•
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 ftem(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 whc
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
Local Official's Name Title
Community Name Telephone
Signature Date
Comments
❑Check here if attachm�
FEMA Form 81-31, February 2006 Replaces all previous editi�
� U.S. d�PARTMENT OF HOMEL4ND SECURJTY ELEVATION CERTIFICATE I OMB NO. 1660-0008
rederal Eme.qency Management Agency ' Ex�ires rebruarv 28. 2009
Nationai Flood Insurance Program lmportant: Read the instructions on pages 1-8.
SECTION A-PROPERTY INFORMATION For insurance Company Use:
A1. Building Owner's Name MICHAEL CANNON Policy Number
A2. Buiiding Street Address!including Apt.. Unit,Suite.and/or Bidg. No.1 or P.O. Route and Box Vo. Company NAIC Number
648 HARBOR ISLAND
City CLEARWATER State FL ZIP Code 33767 648 HARB
A3. Property Description (Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.l OR IS LA N D
05-29-15-43456-073-0910 �CP2007-04193
A4. Building Use(e.g., Residential,Non-Residential,Addition,Accessory,etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. N 27.98839 Long.W 82.81655 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 Oiagram Number 7
A8. For a building with a crawl space or enclosure(s), provide A9. For a building with an attached garage, provide:
a) Square footage of crawl space or enclosure(s) NA sq ft a) Square footage of attached garage NA sq ft
b) No.of permanent flood openings in the crawl space or b) No.of permanent flood openings in the attached garage
enclosure(s)walls within 1.0 foot above adjacent grade NA walls within 1.0 foot above adjacent grade NA
c) Total net area of flood openings in AB.b NA sq in c) Total net area of flood openings in A9.b NA sq in
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61. NFIP Community Name&Community Number 62.County Name B3.State
CITY OF CLEARWATER 125096 PINELLAS FL
84. MaplPanel Number B5.Suffix 66. FIRM Index 67. FIRM Panel B8.Flood 69. Base Flood Elevation(s)(Zone
Date EffectivelRevised Date Zone(s) AO,use base flood depth)
12103C-0102 G 5/17/2005 9/3/2003 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)
611 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 N/A ❑CBRS ❑OPA
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REGIUIRED)
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-g
below according to the building diagram specified in Item A7.
Benchmark Utilized CLEARWATER BM I-3.5 Vertical Datum NAVD 88
Conversion/Comments N/A
Check the measurement used.
a) Top of bottom floor(including basement,crawl space,or enclosure floor)_ 8.09 �feet ❑ meters(Puerto 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 �faet ❑meters(Puerto Rico only)
d) Attached garage(top of slab) 7.92 �feet ❑meters(Puerto Rico only)
- s) Lowest eievation of machinery or equipment servicing the building N.A �fset ❑meters(Puerto Rico only)
(Describe type of equipment in Comments)
f) Lowest adjacent(finished)grade(LAG) 5.09 �feet ❑meters(Puerto Rico only)
g) Highest adjacent(finished)grade(HAG) 620 �feet ❑ 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. 1 certity that the information on this Certificate represents my best efforts to interpret.fhe data available.
1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
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� Check here if comments are provided on back of form. f'�",� 4 x
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Certifier's Name GEORGE A.SHIMP III Job No. 070018-E License Number�137 � ���� h ±��
,r. �'k ��rrs
Title VICE PRESIDENT Company Name GEORGE A.SHIMP II&ASSOCIATES,ING �� �•x =
r� ��
Address 3301 DESOTO BLVD.,SUITE D City PALM HARBOR State FL ZIP Code 34683 ��•��N���
i ature � Date 08-31-07 Telephone 727-784-5496 #6.13� �b�t��� � '��� fl7
.GO�4.� � "�
FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions
IMPORTANT: In these spaces, copy the co�responding information from Section A. For msurance Company Use: �
Building Street p,ddress;including Apt.. Unit, Suite,and/or Bldg. No.)or P.O. Route and Box No. Policy Number ` �
648 HARBOR ISLAND
City CLEARWATEFi State FL ZIP 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 agent/company.and (3)building owner.
Comments NO COMMENTS
�,e.c,a,�.�( �.o �
Si nature Date 08-31-07
� Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REGIUIRED)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,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 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 0 below the HAG.
E5. Zone AO only: If no flood depth number is availabie, is the top of the bottom floor elevated in accordance with the community's floodplain management
ordinance? ❑Yes ❑ No ❑ Unknown. The local official must certify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S 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 att�chments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The local officiai 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 applicabie 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
Local Official's Name Title
Community Name Telephone
Signature Date
Comments
❑ Check here if attachments
FEMA Form 81-31, February 2006 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. Poiicy rvumber
648 HARBOR ISLAND
Clty CLEARWATER State 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,
following.
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Continuation Page
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' 648 HARBOR ISLAND
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' If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all
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Bui�c�ing P�otograph�
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