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837 HARBOR ISLAND`U.$. DEFy,ARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY OMB NO. 1660-0008 Natronal Flood Insurance Program Important: Read the instructions on pages 1-9. Expiration Date: July 31, 2015 SECTION A - PROPERTY INFORMATION A1. Building Owner's Name MARC RUTENBERG HOMES, INC. �;; A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 837 HARBOR ISLAND =�:: �, City CLEARWATER State FL ZIP Code 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 42, BLOCK UNIT 7C, OF UNITS 6D, 7A, 7C, ISLAND ESTATES OF CLEARWATER - PARCEL # 05-29-15-43456-073-0420 A4. A5. A6. A7. A8. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL Latitude/Longitude: Lat. 27.9948°N Long. 82.8176°W Horizontal Datum: ❑ NAD 1927 � NAD 1983 Attach at least 2 photographs of the building if the Cert�cate is being used to obtain flood insurance. Building Diagram Number 1 B 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) N/A sq ft a) Square footage of attached garage 907 sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s) within 1.0 foot above adjacent grade N/A within 1.0 foot above adjacent grade 9 C) Total net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b 2450 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 62. County Name I CITY OF CLEARWATER 125096 PINELLAS B4. Map/Panel Number 65. Suffix B6. FIRM Index Date 67. FIRM Panel 68. Flood Zone(s) Effective/Revised Date 12103C0102 G 8-18-09 9-3-03 AE 610. IndiCate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile � FIRM ❑ Community Determined ❑ OthedSource: 611. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: 612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? Designation Date: N/A ❑ CBRS ❑ OPA 83. State FLORIDA B9. Base Flood Elevation(s) (Zone AO, use base flood depth) 11' ❑ Yes � No 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. In Puerto Rico only, enter meters. Benchmark Utilized: WAUCHULA CORS Vertical Datum: NAVD 1988 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 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) fl 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 stairs, including structural support 11.23 22.80 N/A 7.82 11.70 7.2 7.5 N/A � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters 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'� ;, infomration. 1 certify that the information on this Certificate represents my best efforts to interpret the data availab/e. ` � - 1 understand that any fa/se statement may be punishable by �ne or imprisonment under 18 U. S. Code, Section 1001. r� �. °�r o� � Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ;��p�; �� �,�t��;� �%,o ,' � Check here if attachments. licensed land surveyor? � Yes ❑ No n- C� :�';� _ �'�,,, ;�_ .� Certifier's Name GEORGE A. SHIMP III Job Number 150005 License Number 6137 -, : v taA` �'��� � '; � "- Title VICE PRESIDENT Company Name GEORGE A. SHIMP II & ASSOCIATES, INC. Address 3301 DeSOTO BLVD., SUITE D City PALM HARBOR State FL ZIP Code 34683 FEMA Form 086-0-33 (7/12) Date 1-20-2015 Telephone 727-784-5496 G � � •�fa�E iQ tii' . �,". � � u� ., FlL�A�C�., ' �' ' � #6%T �afe.'� , rr,Vc � r �,.. .,�� See reverse side for continuation. Replaces all previous editions. ELEVATION CERTIFICATE, page 2 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. 837 HARBOR ISLAND 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 agenVcompany, and (3) building owner. Comments SEE PAGE 5 FOR SURVEYOR'S COMMENTS (THIS DOCUMENT IS NOT VALID WITHOUT ALL 5 PAGES) Signature Date 1-20-2015 SECTION E— BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND 20NE 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 infortnation for the following and check the appropriate boxes to show whether the @I@v8ti0n iS BbOV@ Of b210W th@ hl9h@St 8dJ8C2f1t grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or � below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑ f@et ❑ 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 statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments. SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local 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—G10. In Puerto Rico only, enter meters. 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—G10) 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 G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet G10. Community's design flood elevation: Local Official's Name Community Name Signature Comments FEMA Form 086-0-33 (7/12) ❑ feet Title Telephone Date ❑ meters Datum ❑ meters Datum ❑ meters Datum Check here if attachments. Replaces all previous editions. ♦ ' ELE'aATION CERTIFICATE, page 3 guilding Photographs See Instructions for Item A6. 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. 837 HARBOR ISLAND City CLEARWATER State FL ZIP Code 33767 FOR INSURANCE COMPANY USE Policy Number: Company NAIC Number: If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 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." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. � :� -.. _ ��- � ;`���� , _, �,_.. FEMA Form 086-0-33 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 4 guilding Photographs Continuation Page 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. 837 HARBOR ISLAND City CLEARWATER State FL ZIP Code 33767 4 • � , FOR INSURANCE COMPANY USE Policy Number: Company NAIC Number: If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View° and "Rear View'; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. �� FEMA Form 086-0-33 (7/12) Replaces all previous editions. . . `,� ELEVATION CERTIFICATE, page 5 IMPORTANT: In these spaces, copy the Surveyor's Notes Continuation Page ing information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 837 HARBOR ISLAND City CLEARWATER State FL ZIP Code 33767 SECTION D— SURVEYOR'S CERTIFICATION (CONTINUED FROM PAGE 2) A1. ) THIS ELEVATION CERTIFICATE WAS PREPARED EXCLUSIVELY FOR THE USE AND BENEFIT OF THE PARTY SPECIFIED IN SECTION A, ITEM 1, FOR THE SPECIFIC PURPOSE OF OBTAINING FLOOD INSURANCE AND/OR VERIFYING FLOOD ZONE COMPLIANCE WITH THE LOCAL GOVERNING AUTHORITY. THIS DOCUMENT SHALL NOT BE VALID AND BINDING AGAINST THE SIGNING SURVEYOR WITHOUT THE ORIGINAL RAISED SEAL AND SIGNATURE OF THE FLORIDA LICENSED SURVEYOR AND MAPPER. USE OF THIS DOCUMENT BY ANY OTHER PARTY OR FOR ANY OTHER PURPOSES IS STRICTLY PROHIBITED AND SHALL RENDER THIS DOCUMENT INVALID FOR THOSE PURPOSES. UNAUTHORIZED COPIES ARE STRICTLY PROHIBITED AND SHALL NOT BE VALID. REQUESTS FOR ANY ADDITIONAL OFFICIAL SIGNED AND SEALED COPIES MUST BE DIRECTED TO GEORGE A. SHIMP II & ASSOCIATES, INC. A4.) THE BUILDING USE WAS DETERMINED BY PHYSICAL OBSERVATIONS MADE ON THE DATE OF SURVEY. A5.) THE LATITUDE AND LONGITUDE COORDINATES WERE OBTAINED USING A HAND HELD G.P.S. UNIT WHICH MEETS OR EXCEEDS FEMA'S REQUIRED ACCURACY OF 66 FEET. A7.) THE BUILDING DIAGRAM NUMBER WAS DETERMINED BY PHYSICAL OBSERVATIONS MADE ON THE DATE OF SURVEY. CERTAIN STRUCTURAL FEATURES NOT VISIBLE TO THE SURVEYOR (PILINGS, GRADE BEAMS, ETC.) CAN AFFECT THIS DETERMINATION. A8.) FOR THE PURPOSE OF THIS DOCUMENT, A BUILDING ENCLOSURE IS DEFINED AS THAT PORTION OF AN ELEVATED BUILDING, BELOW THE LOWEST ELEVATED FLOOR, THAT IS EITHER PARTIALLY OR FULLY SHUT IN BY RIGID WALLS. A GARAGE BELOW OR ATTACHED TO AN ELEVATED BUILDING IS CONSIDERED AN ENCLOSURE. SUCH AREAS SHALL NOT CONTAIN MORE THAN 20 LINEAR FEET OF FINISHED INTERIOR WALLS (PANELING, ETC.) OR IT WILL BE CONSIDERED A FINISHED (HABITABLE) AREA. IF APPLICABLE, THE STRUCTURE CONTAINS: ❑ CRAWLSPACE ❑ ENCLOSURE � N/A IF APPLICABLE, THE CRAWLSPACE CONTAINS N/A SMART VENT(S) CERTIFIED TO COVER N/A SQ. FT. PER VENT. IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAINS N/A SMART VENT(S) CERTIFIED TO COVER N/A SQ. FT. PER VENT. IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAINS: N/A IF APPLICABLE, DOES THE BOTTOM FLOOR ENCLOSURE APPEAR TO CONTAIN BREAK-AWAY WALLS? ❑ YES ❑ NO � N/A A9.) IF APPLICABLE, THE ATTACHED GARAGE CONTAINS N/A SMART VENT(S) CERTIFIED TO COVER N/A SQ. FT. PER VENT. A8. & A9.) FOR THE PURPOSE OF THIS DOCUMENT, A FLOOD OPENING IS DEFINED AS A PERMANENT OPENING IN AN EXTERIOR WALL THAT IS NO HIGHER THAN 1.0 FOOT ABOVE THE HIGHER OF THE EXTERIOR OR INTERIOR GRADE OR FLOOR IMMEDIATELY BELOW THE OPENING. 68.) UNLESS OTHERWISE NOTED IN SECTION B, ITEM 10, THE FLOOD ZONE WAS DETERMINED BASED ON THE FLOOD INSURANCE RATE MAP. IN CERTAIN CASES WHERE AN ACCURATE DETERMINATION COULD NOT BE MADE FROM THE MAP, THE COUNTY'S G.I.S. OVERLAY MAY HAVE BEEN UTILIZED TO DETERMINE THE FLOOD ZONE. NO SEARCH OF THE PUBLIC RECORDS WAS PERFORMED FOR LOMA'S, LOMR'S, ETC. WHICH MAY AFFECT THE SITE. C2.a) BOTTOM OF ELEVATOR PIT ELEVATION= 10.13'; WINE CELLAR FLOOR ELEVATION= 1.82' C2.e) BOTTOM OF THE MAIN BUS OF THE BREAKER PANEL LOCATED IN GARAGE. U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal Emergency Mar�mer�t Ag�cy FJCpires March 31, 2012 Nationai Fbod Insurance Program important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION :::�':::1�:����""�""".�:�:;:::::;`::;:�;»::>:;:� ..:..::.:.::.:..:......:..:::.:.:.�: ...... ........... A1. Buildi Owner's Name ICAT SERVICES FOR THE OPAI TRUST �9 nit Suite and/or BI .No. or P.O.Route and Box No. '..::�:i::::;:;::::�::'::�:`::::;`:::;::>:; ;::: A2. Buiiding Street Address(irxluding Apt.,U , � d9 ) '.�»>;;;:.;;:.;:.;:.;.;:.::>:.;:.::.;;;:;;;:;;.;;:-;;;:.:.;:...;:.;. 837 HARBOR ISLAND Ci1y CLEARWATER State FL ZIP Code 33767 ; ;�, :. ��L�... E � , , ,, '� `,:.:: i c"�� J J�° �1: , ( "r f � �._,i v �._7�- A3. Property Descriptan(Lat and Block Numbers,Tax Parcel Number,L¢gai Description,etc.) r t-.: '� ,, . r j ; i: . .. .,, _ , LOT 42,UNITS 6D,7A,7C,ISLAND ESTATES OF CLEARWATEf2 � ._. :..,, ,; � , A4. Building Use(e.g.,Residerdial,Non-Re,siderrtial,Addition,AcxRSSOry,�c.) RESIDENTIAL A5. Latlh�de/Longitude:Lat.27.9948°N Long.82.8176°W Horizw�tal�)� �1�AD 1927 � NAD 1983 A6. Attach at least 2 Photo�aPhs of the buikting if the CeRificate is being used to obtain flood ir�surance.. � U"t A7. Building Diagram Number 4 ;-i v: _... c.-� 1l1 __._ _.. __ __. A8. For a buildir�with a crav�lspace or enclosure(s): A9. For a building w�tfi an attached garage: • �A �v a) Square footage of crav►�ace or encbsure(s) N/ sq ft a) Sq�id�ape.a�a�kached garage_.. _ -.._931-.� ,.,_��-_....� b) No.of permanent flood openings in the cra�Mspace or b) No.of permanent flood c�penings in the attached garage enclosur�s)within 1.0 foot above ad'�acent grade WA within 1.0 foot above adjacent grade 9 c) Totai net area of flood openings in A8.b N/A sq in c) Total r�et ar�of flood openings in A9b 31�0 sq in d) Engineered f�od openings? ❑ Yes � No d) Engineered flood openir�gs? ❑ Yes � No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name 8 Community Number B2.CouMy Name B3.State CLEARWATER-12°'.,O�J6 PINELLAS FLORIDA B4.MaplPanel Number 85.Suffa 66.FIRM Irxie�c B7.FIRM Panel B8.Flood 69.Base Fbod Elevation(s)(Za�e 12103C0102 G Date Effective/Revised Date Zone(s) AO,use base flood depth) 5/17lOS 9/3/03 AE 11' 810. Ind"�cate the source of the Base Flood Elevation(BFE)daNa or base flood depth er�tered in item 69. ❑ FIS Profile � FIRM ❑ Community Ddermined ❑ Other(Describe) � Bt 1. I�ipte elevatia�datum used for BFE in item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other(D�cribe) � � B12 is the building located in a Coestal Barrier Resources System(CBRS)are�a or Othervuise Protected A�(OPA)? ❑ Yes � No n Designation Date ❑ CBRS ❑ OPA � ~ N = SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) O D C1. Bulding elevations are based on: ❑ Construction Drawings' � Building Under Construction' ❑ Finished Construction ~ � 'A new Elevation Certificate will be required when constn�ction of the building is canplete. � � C2. Elevations-Zones A1-A30,AE,AH,A(writh BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO. Complebe ttems C2.a-h O below acx.ording M Uie building diagram specified in Item A7. Use the same dffium as tl�e BFE. � � � Benchma�ic Utit¢ed #249B�CLEARWATER)Vertical Datum 1988 � ��_�� CornersioNComments NAV[7 Checic the m�suremeM used. c?Z �� r .���,� D D a) Top of batom floor(induding basement,crawlspace,or encbsure floor)1.�.Ci �feet ❑meters(Puerto Rico on �� � �; b) Top of the ne�d higher floor 1L•-� �feet ❑meters(Puerto Ftico on � Z c} Bottom of the bwest horizordal structural member(V Zones only) N.A ❑feet ❑meters(Puerto Rico on < � �It Q cn Athact�ed garage(top of slab) 7.5� �fe� ❑meders(Puerto Rico on r � � e) Lowest elevation of machinery or equipment servicing the building 10.�9 �fcet ❑meters(Puerto Rico on '�a Q Q {Describe type of equipmerrt and locatioFf in CommeMs) a�`'^.=Vr, c,do � Lowest adjacent(finished)grade next to building(LAG) 5.4 �feet ❑meters(Puerto Rico onl�� � 9) Highest adjacent(finished)grade next to building(HAG) �.4 �feet ❑meteFs(Puerto Rico onh�) v� h) Lawest adjacent grade at bwest elevation of deck or stairs,including N.A ❑feet ❑meters(Puerto Rico onl�) � e"� structural su SECTION D-SURVEYOR, ENC3INEER,OR ARCHITECT CERTIFICATION This certification is to be signed and s�led by a land surveyor,engineer,or archite�t authorized by law to certify elevatan ` � � �forrr�ation. 1 cerGfy that the information on tfiis C+e�6licate represents my best eflro�ts fo inte�piet the data avadab/e. ,� w�'' ° a�9�p �,,,}""� °�4¢ 1 unde�stand that any fa/se statement may be punishable by fine orimp�onmenf under 18 U.S.Coahe,Seclion 1001, n � . _ �� 4�� �� , • . � Check here if comments are provided on badc of form. Were latitude and bngitude in Section A provided by a '` � �� � �a ` � , � �. Q licensed land surveyor? � Yes ❑ No p �'� c:� ,_ � . � T �� Certifier's N JOHN C.BRENDLA Licer�se Number 1269 �. 4 �,�.�' * '� o �, . Q .t EGIS RE LAN�SURVEYOR Company Name OHN C.BRENDLA&ASSOCIATES,INC. , f .` �'�'�k " � Address 15 AVENUE NORTH City PINEL 5 PARK State FL ZIP Code 33781 �-��° ����' 'ti'�� '�"�;. Signatu Dffie 07131/09 Telephone 727-57Cr7546 � V = *���w>r,,��� �"� � _ ^ ,; • IMPORTANT: In these spaces,copy the corresponding information from Sec�tion A. '::��;.�.�`�`"":�,;.:.;;:;::;;;;;;:;,;. Building Street Address{including A�.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. � :: .:::�'>>;;::;,:;;>::;::;;;.;::<:::;;;>;>:::>>;:"'"'''>"; 837 HARBOR ISLAND ' CL EAR WAT ER State F L �Y ZIP C ode 33767 ....::::.:.::.:..:::>;:;;::;:.:; ; .... : ::::Ci�xi�;i�l#T�::�1t�YE�' :: .:..:::.;>:<•:.::::::.:::::.>;<::;•:::;:: _::> _:;::: ..>.;;;:.:�;:;;;>:.::,:-..:.: . ..............:..:._:.:::::;:..;;:<:: SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy b�h sides of this Elevation Certificate fw(1)community official,(2)insura agenUcompany,and(3)building owner. C s c2e:PO R BOX NCH RK 49 B-CLEARW TER ELEV.7.275'NGVD A TED TO ELEV.6.395'NAVD-MSL=0.00 S u Date 07/31/09 ❑ Check here if attachments SEC ION E-BUILDING EC.EYATIO INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zon�s AO andA(without BFE),complete Items E1-E5. If the Cefificate is irrtended to su�ort a LOMA or LOMR-F request,c�nplete Sedions A,B, and C. �or Items E1-E4,use natural grade,if availabie. Ct�eck the m�surement used. In Puerto Rico only,errter meters. E1. Provide elevation information for the folbwing and check the appropriate boxes to show whether the ekvatlon is above w below the high�t adjacerrt grade(HAG)and the lowest adjacerd grade(LAG). a)Top of bottom floor C�luding basement,ctawlspace,or enclosure)is ❑feet ❑meters ❑above or Q below the HAG. b)Top of bottom floor(inciuding basemerrt,cravWspace,or enclosure)is ❑feet ❑meters ❑above or❑ below tl�e LAG. E2. For Building Diagrams 8�9 with perrnaneM flood openings provided in Section A ftems 8 and/or 9(see p�es&9 of Instructi�s),the next higher floor (elevation C2.b in the diagrams)of the building is ❑feet ❑meRers ❑above or ❑below the HAG. E3. Attached garage(top of slab)is ❑fee# ❑meters ❑above or ❑below the HAG. E4. Top of platform of machinery andlor equipmer�t servicing the building is ❑feet ❑meters ❑above or 0 below the NAG. E5. Zone AO only: If no flood depth number is avaiMable,is the top of the b�tom floor elevated in acc�rdance with the community's floodplain mar�agement ordinance? ❑Yes ❑ No ❑ Unimown. The locai officiai must cerGfy this infwmation in Sectiorn G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or ow�er's authorized repre�MatNe 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 ststements in Sections A,8,and E ar�s correct to the best of my know/edge. Property Owner's o�OvmePs Authorized RepreseMative's Narr� Address City State ZIP Code Signature Date Telephone Comments ❑Check here if attachrr�nts SECTION l3-COMMUNITY INFORMATION(OPTIONAL) The bcal officiai who is author¢ed by law or ordinance to adminlster the community's floodpiain managemerrt ordinance can compk�te Sections A,B,C(w E), and G of this Elevation Certificate. Comptete the applicat�e item(s)and sign below. Check the m�suremeM used in Nems G8 and G9. G1.❑ The information in Sectior►C was taken from other document�ron that t�as been signed and s�led by a Ikensed surveyor,engineer,or architect who is author¢ed by law to certify elevation information. pndicate the source and date of the elevation data in the Commerrts ar�below.} G2.❑ A community official cornpleted Section E fw a building located in 2one A(wiGwut a FEMA-issued or community-issued BFE)or Zaie AO. G3.❑ The follovving information(kems G4-G9)is provided for community floodplain managemeM purposes. G4.Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliancel0ccupancy Issued G7_ This Pe►mit h�been issued for: ❑Nevv Caistruction ❑Substantial Improvemerrt G8. Elevation of as-buift law�est floor(including basement)of the building: ❑feet ❑meters(PR)Datum G9. BFE or(in Zor�AO)depth of fboding at the building site: ❑feet ❑meters(PR)Datum G10.Community's design flood elevation ❑feet ❑meters(PR)Datum Loc:al Offici�l's Name Title Community Name Telephone S� Date Canntents �l Check here if attachmeMs