496 ISLAND WAY . ���`;:���. � ' �
u , � 'ATION CERTIFICATE onne No. �sso-000s �
F � �� �^ ��d � ' � Expires March 31,2012
N, �j � �� Read the instructions on pages 1-9.;
I �N A-PROPERTY INFORMATION 'For Irtsu�anc�Ca4►tp�AY�lt�"�.�� '��
� !�r 1, l.� � S � � n �Olk�y�il�m�10 ,�'����� � �� �";.
� :., .. �'�:.v�K 'N;:a� $ d�'
q p.No.)or P.O.Route and Box No. Qm !r �° `
� � � ,�n ����"��,�€��.�-,�.��
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9 ,�� �� "� • � (J I DA s�� 3 3 7 6 7 ziP code
V\/ __
A; '�����'���8�7�i I T 6-C `
��'� f��`��'�� ` RESIDENTIAL
qq issory,etC.)
A5 8 2.4 9 0 5 Hcrizontel Datum: ❑NAD 1927 [�NAD 1983
qg beinp used to obtain flood insurance.
A7
qg, �._....o wo«�apace or enclosure(s): A9. For a building wfih��attached yarage:
a) Square footage of crewispace or endosure(a) N�p' sq fl a) Square footage of attached garage N A eq ft
b) No.of permaneM flood openinga In the crewispace or b) No,ot permanenl flood openinpa in the attached garape
enclosure(s)within 1.D fool above,adjacent grade within 1.0 foot aGove adjacent yrade
c) Total net erea of tlood openinps in AB.b sq in c) Totaf net area cf flood openin8s in A9b sq in
d) Engineered flood openinps? �Yes �No , d) Engineered flo�d openfnys7 []Yes �No
SECTION B•FLOOD INSURANCE RATE MAP(FIRM)INFORP�+ATION '
B1.NFIP�i�r�l�r��or�m����nber 82.County Name p i n e 11 a s B3��� F 1 or i d a
84.Map/Panel Number B5.Suffuc 88.FIRM Index 87.FIRM Panel 88.Flood 89:Base Fbod ElevaUon(s)(Zone
p Effectiv�R i d Data • Zon�(s) ,�.u�e bace 11ood depth)
12103C1 02 G 9-U�03 9-��03 AE
81 D. Indicate the source ot the Base Flood Elevatlon(BFE)data or base flood depth entered in Item 89. '
�FIS Profile []FIRM CommuNty Determined �Other(Desaibe)
B11. Indicate elevatfon datum used for BFE in Item B9: ❑ NGVD 1929 NAVD 1988 ❑Other(Des:ribe)
812. Is the building located In e Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(�?A)? []Yes � No
pesignadon Date []CBRS �OPA
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REDUIRED)
C1. Building elevations are based on: ❑Construction Drawinps' ❑ Building Undar Constructfon' �Flniehed ConsWction
•A new Elevation Cerliflcale will be requirod when conetrucNon of tha buildin9 is complete.
C2. ElevaGons-Zones A1=A30,AE,AH,A(wfth BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A�O,AR/AH,AR/AO. Complete Items C2.8-h
below according to the buf�dinQ dlagrem s�eafled in Itam A7. Use the same daWm aa the BFE.
Benchmark Utliized CLEARWATER G-03 .5 **** Verticel Detum NAVD' 88� **** ELEV_ 7 _4�
ConversionlComments N A _
Check the i�sasurement used.
a) Top of botlom flow(Including baseme�t,crawlspace,or enclosure floor)_Z�feet meters(PueAo Rico only)
b) Top of the next hfgher floor �/�U faet B meten(PueAo Rico ony)
'�c) Bottom of the lowest horizontal struc,turel member(1A Zones cnly);, : : _��,I,�❑feet . ❑! meters.(PueAo Riao only)
d) Attached garage(lop of slab) _�_� feSt t�meters(PueRo Rico only)
e) Lowest elevatlon M machinery or equipment servicfng the building .�feet ❑meters(Puarto Rlco only)
(Describe type of equipment and IocaUon in Commanta) -
� Lowest adjacent(flnishad)grade next to building(LAG) 6.��teet ❑meters(PueAo Rico only)
g) Highest adjacent(finished)grade next to building(HAG) �—_A__,�]feet a(neters(Puerto Rico only)
h) Lowest adJecenf grade at lowest elevaUon of deck or stai�s,includinq `� Q feel meters(Pue�to Rim onty)
structufel support
^ SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTI:;CATION
This certification is to be signed and sealed by a land surveyor,enpineer,or erchdect authorized by law to cert y elevation .--A-�----.�-
information. I ceRify that ihe Information on this CeRlficate represents my besf effoRs to lnterpret the data avarl3bfe. , ` �,,.r., ' , ��
1 undarstend that any/alse statemenf may be punlshable by�ne orlmpdsonment under 18 U.S.Code,Sectfor, 1001. .,;�'°; ,••••„a, ;�� �
�
(�Check here if commenls are provided on back of form. Were IsUtude and longitude in Section A ro��ded by a ' ��� �;, �
licensed land surveyor7 �Yes g t'� � ,� ��,�,��` � .r �' =
CeNtier's Nem Uce um = �,:�.���!^ �, ,�, _
�1ILLIAM C. KEATING ��. ��528 - ,:> ;*.. �� �- �; '
Title Compan Name ` '•���' �
LAND S� �R ALLIED SURVEYING � ���'�•.
Address � 2�5 ',-: G � CLEARWATER State FLA. Z�3����5 �' t S�{
Sienature ' �a�8 9 2 3-1 0 TB��4 4 6-1 2 6 3
��
FEN��4 Fo 81-31, r 0 � See reverse side for continuation. � � Replaces,. I iou -editions �
U.S.qEPARTMENT OF HOMELAND SECURI7Y ELEVATION CERTIFICATE onns No. �sso-0008 �
Federal Emergency Managemant Agency Expires March 31,2012
Nationel Flood Insurance Propram Important: Read the instructions on pages 1-9..
SECTION A-PROPERTY INFORMATION " `Fo�Irtsuiar�ca,�;'�►paa�tl�et�� ��'.
A1. Buildi POIny��ik�6�;������+�-� �� ,�;
�L1����`"e A. KOTTMEIER , � �,,,., � ,..
A2. Buildin�,$tceet Addcesa�i[uJudingAnt.YUnil,Suke,and/or BIdQ.No.)or P.O.Route and Boz No. �f�any,I��tfa,1�C� �" �s
ti b 1.5"L 1V ll W P, a �;. t�."'Nl,t�' s'�„ , �'A` t�„r�,
,.�. ,... ..
Ciry CLEARWATER FLORIDA S�e�e 3 3 7 6 7 ZIP Code
A3. Prope��scr��on�Lot�d���C�� �J'1'FI`i'��Ur C:1.�P,EI��KeTJiVIT 6—C
A4. Building Use(e.g.,Residentiel,Non-Rasidendal,Addition,Accessory,etc.) RES IDENTIAL
A5. Latitude/Longitude:Lat. 2 7 .5 9 � �5�� Lonp. 8 2.4 9 0 5 Horizontal Datum: ❑NAD 7927 � NAD 1983
A6. Attach at least 2 photographa of the building'rf the Certfficate is beinp used to obtain flood insurance.
A7. Buiiding Diagrem Number,�,_
A8. For a buildinq with e crawlspace or enclosure(s): A9. For a building wfih��attached yarage:
a) Square footage of crawl�pace or endosure(a) N�p' sq fl a) Square footage of attached garape N A sq ft
b} No.of parmanent flood openinps in the crewlspace or b) No.of permanent flood openinps in the atlsched parepe
enclosure(s)within 1.0 foot above.adjacent prade within 1.0 toot above adjacent prade
cj Total net erea of tlood openinpa In ABb sq in c) Total nat area cf Aood openinps in A9b sq in
d) Engineered flood openinps? �Yes �No , d) Engineerad tlo�d openfnpa7 �Yes �No
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORP�iATiON
B1.NFIP CLa��t��l�r��or�rt�p�ll���mber B2.Counry Name p i n e 11 a s B3��� F 1 or i da
B4.MaplPanel Numher B5.Suffix B8.FIRM Index 87.FIRM Panel 88.Flood 88:Baae Fbod EbvaUon(s)(2ono
EHecGv�t�vt�d Data • Zon�(t) ,�.u�e base tlood depth)
12103C102 G 9-8�03 9-03-03 AE
B70. Indicete the source of the Base Fload Elevatfon(BFE)data or base flood dapth entered in Item 89. '
[]FIS Profile ❑FIRM Community Detarmined �Othar(Describe)
B11. Indicate elevetion datum used for BFE in Item B9: ❑ NGVD 1829 NAVD 19B8 ❑Other(Des:r(ba)
B12. fs the building located In e Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(��A)9 �Yes � No
Designatlon Dale �CBRS �OPA
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
Ct. Building eleveti�s are based on: ❑ConstrucUon Drewinps' ❑ Buildinp Under Consttuctlon' �Flnished ConsWction
•A new Elevatfon Caniiicata will be required when construction of tha buildin8 is complale.
C2. Elevations—Zones A1=A90,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,ARIA1-AzO,AR/AH,AR/AO. Complete Items C2.a-h
below according to the bul in dlagrem s ctifled in Itam A7, Use ihe sam�daWm es the BFE.
Benchmark Utllized C�E�RWAT�R G-03 .5 **** Verticel Datum NAVD' 88 **** ELEV_ 7 _ d�
ConversionlComments N A _ �
Chedc the ir3asuremeM used.
a) Top oi bottom floor(Including basemsnt,crawlspzce,or encloaure floor) 7�feot meters(Puerto Rico only)
'' b) Top of the nexl hfghar floor �/nTLJ feet 8 meters(Puarto Rico only)
'�c) Bottom of the lowest horizontal stnactural tnember(u.zonea-only)-;r;�r : _�ry/_t�feet . ❑mstera.fl'uerto Rico only)
d) Atteched garage(!op of slab) _c�: feet ❑maters(PueAo Rico only)
e) Lowest elevatlon of machinery or equipment servicfng the buflding .�feet ❑maters(Puarto Rlco only)
(Describe type of equipment and location in Commenta)
� Lowest adjacent(Mished)prade next to building(LAG) 6.��feet ❑meters(Puerto Rico anly)
g) Highest adjacent(finlahed)grade next to building(HAG) �—�[�feet �Ineters(Puerto Riw onty)
h) Lowast adJecenf grede et lowest eleveUon of deck or stair�,includinp �� �feel meters(PueRo Rico only)
structufel SuppOrt
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTI;�CATION
This certification is to be signed and sealed by a land sunreyor,enpineer,or architect authorized by law to cert y elevation
information. 1 ceRify that fhe In/ormetion on fhis Cert!/icate repreaents my besf e//o�ts to lntarpret the date ava:l361e. '�, ��
1 und9tstand that an /else sMfement ma be unisbable b flne or! risonment under!8 U.S.Code,Sectlor, 1001. �� '�°''°�'�•�•-�. `-� �">
Y Y P Y mP ,�,• .•• �b, -,
r :
�Check here(f commenta are provided on badc of form. Were IaUtude end Iongitude fn Sedion A ror;ded by a � ' r��S� c�, �
licensed land surveyor7 �Yes �t� s`,;� ,�. �r' �: c:'-
��.�. �
Certifler'sNam Uce um r - - t ���t� r, .'- -
�IILLIAM C. KEATING ��. �528 � `� � ~ �- ��
'.�_o.: E� '" ��
Title LAND Sji� �jR Compan Name ALLIED SURVEYING �
;,�.,
Address 1 2 7 5 G � CLEARWATER S�1e FLA. Z�3��,:�5 V *, -�
' �dt�
Sieneture Date 9 2 3-1 0 Te��°�4 4 6-1 2 6 3
�;
FEN�4 Fo 81-31, �r 0 See reverse sfde for conUnuatfon. � Replacas� I �ou �editions �