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625 ISLAND WAY � �, .� . � .U.S.DEPARTMENTOF HOMELAND SECURITY ELEVATION CERTIFICATE OMB N0. 1660-0008 Fed�ral Emergency ManagementAgency Expires March 31, 2012 National Flood Insurance Program Important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION A1. Building Owner's Name LE RUBY CONSTRUCTION A2. Buiiding Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. 625 ISLAND WAY City CLEARWATER State FL ZIP Code 33767 A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) LOT 3 ISLAND ESTATES OF CLEARWATER UNIT 8 PB.64,PG.73 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)RESIDENTIAI A5. Latitude/Longitude:Lat.N 27-59-12 Long.W 82-49-09 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 1A 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) sq ft a) Square footage of attached garage 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 B1.NFIP Community Name&Community Number B2.County Name 63.State CITY OF CLEARWATER 125096 PINELLAS FLORIDA 64.Map/Panel Number B5.Suffix 66.FIRM Index 87. FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone 12103C0102 G Date EffectivelRevised Date Zone(s) AO,use base flood depth) 8-18-2009 9-3-2003 AE 12' B10. 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 B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other(Describe) 612. Is the building located in a Coastai 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 PIN.CO.DISK AURAL A Vertical Datum NAV DATUM 198 ELEV=11.82 Conversion/Comments Clteck the measurement used. a) Top of bottom floor(including basement,crawispace,or enclosure floor)9.4 �feet ❑meters(Puerto Rico only) b) Top of the next higher floor N/A. ❑feet ❑meters(Puerto Rico only) c) Bottom of the lowest horizontai structural member(V Zones only) NlA. ❑feet ❑meters(Puerto Rico only) d) Attached garage(top of slab) 9.0 �feet ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 10.2 �feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Comments) � Lowest adjacent(finished)grade next to building(LAG) 8.9 �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 9.2 �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,angineer,or architect authorized by law to certify elevation ,, infonnation. 1 certify that the information on this Certificate represents my best efforts to interpret the data availab/e. �yyp,y - _,,,,,. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 9001. . �, � Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ��'�, ��„�y�> , licensed land surveyor? � Yes ❑ No ° � ��,.°,`°��_`�f '' J Certifier's Name LAUREN R.PENNY License Number #4931 � F� �,' �:� �� 'w.� Title LAND SURVEYOR Company Name L.R. PENNY AND ASSOCIATES, INC. . � `=.� "'�� '`` ' �" 4 "` �`F �, �,� ; Address 10730 102 .AVENUE NORTH City SEMINOLE State Fl ZIP Code 33778 k - � `"�`�'� _ "`''` ..� �. _. -.� . Signature ,f Date 12-28-2010 Telephone 727-398-4360 ?ft'��;�rGrl�v�"`'�hy -..► Q FEMA�Form 81-31, Mar 09 See reverse side for continuation. Replaces all previous edi�ons _ _ _ __ _._ _ � • IMP.'1RTANT: In these spaces,copy the corresponding information from Section A. Bui�ling Street Address(including Apt.,Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. 625 ISLAND WAY 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 agenUcompany,and(3)building owner. Comments LOWEST ELECTRIC IS AN OUTLET AT THE REAR OF THE HOUSE Signature Date 12/28/2010 � 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 naturai 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(IAG). a)Top of bottom floor(including basement,crawispace,or enclosure)is ❑feet ❑meters ❑above or 0 below the HAG. b)Top of bottom floor(inciuding basement,crawispace,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 ❑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 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 ❑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 compiete 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 GS 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 buiiding located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3.❑ The foilowing 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 ❑mete�s(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)Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑Check here if attachments FEMA Form 81-31,Mar 09 Replaces all previous editions