1495 HIGHLAND AVE � U.S.GEPARTMENT OF HOMELAND 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 `Fc�r I€��cti�r�c���,�pany 11s�;
A1. Building Owner's Name Lazzara Oil Company `F�t�ticy�lurrtper '
A2. Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. �#r»pany.�lAl�t�uti�laer '
1495 Highland Ave.
City Clearwater State FL ZIP Code 33756
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Lots 43,44 and North 60 of Lot 45,Clearvuater Heights
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Non-Residential(Gas Stationl
A5. Latitude/Longitude:Lat.27°56'16"N Long.82°46'29'W 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
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) N/A sq ft a) Square footage of attached garage N/A 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 N/A within 1.0 foot above adjacent grade N/A
c) Total net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b N/A 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 B3.State
Pinellas County 125096 Clearwater-Pinellas Florida
64. Map/Panel Number B5.Suffix 66.FIRM Index B7.FIRM Panel 68.Flood B9.Base Flood Elevation(s)(Zone
12103C0109 H Date Effective/Revised Date Zone(s) AO,use base flood depth)
05/17/2005 05/17/2005 AE47 47.0
810. 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 B9: ❑ NGVD 1929 � 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 ❑ 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 Breeze C-AG0372 Vertical Datum NAVD 88
Conversion/Comments Converted to NGVD 29 DATUM Usina Vertcon
Check the measurement used.
a) Top of bottom floor(including basement,crawlspace,or enclosure floor) 50.20 �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 . ❑feet ❑meters(Puerto Rico only)
d) Attached garage(top of slab) N/A . ❑feet ❑meters(Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building N/A . ❑feet ❑meters(Puerto Rico only)
(Describe type of equipment and location in Comments)
f) Lowest adjacent(finished)grade next to building(LAG) N/A . ❑feet
❑meters(Puerto Rico only)
g) Highest adjacent(finished)grade next to building(HAG) N/A . ❑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 certiflcation is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation
� r.r�
information. I certify that the information on this Certificate represents my best efforts to interpret the data availab/e.l s „�� rt
understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001.❑ ',�� ��� '���°s���e
Check e if comments are provided on back of form. Were latitude and longitude in Section A provided by a r'`� ���i � � � �"
;.�_ .t�.� , �, `�a.,,,
licensed land surveyor? � Yes ❑ No 4F t r���- �' ' �0
�y�,�°��'� '��.% �,�.
Certifier's N m James Winter P ,PLS License Number 3181 �;����,,r.�...E�„ C^� r
'"wre� +..�t�.pj�� G k�;.�� ��: .
.� +- y�� -� af6� [.
Title Engomeer and Surveyor Company Name Progressve Development Group,Inc. �;�„ �,�- ��+� ��'
'"'. �" ���`r�• �# ..,
Address 5205 S.Lois Ave. City Tampa State FL ZIP Code 33611 ;�� ��': � ' ���. �"
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Signature Date 11/28/11 Telephone 813-805-0512 ,' �F��� ���,�'�:�"
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FEMA Form 81-31, Mar 09 See reverse side for continuation. Replaces all previous editions
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Building Photographs
See Instructions for Item A6.
For Insurance Company Use:
Building Street Address(including Apt., Unit,Suite,and/or Bidg. No.)or P.O. Route and Box No. Poiicy Number
1495 Highland Ave.
Clty Clearwater St8t2 FL ZIP COde 33756 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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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 Number
1495 Highland Ave.
Clty Clearwater State FL ZIP COdG' 33756 CompanyNAlCNumber
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all
I photographs with: date taken; "Front View"and "Rear Viev�'; and, if required, "Right Side View" and "Left Side View."
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