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843 ISLAND WAY U.S:DEPARfMENTOFHOMELANDSECURITY ELEVATION CERTIFICATE oMBNo. 1660-0008 Fede;al Emergency Management Agency Expires March 31,2012 National Flood Insurance Program Important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION ��r��i�(�i`iF��9�iparty��s�,., A1. Building Owner's Name LINDA L.SCHLICK and Z-BEST CONST.(CONTRACTOR) Y �' ��w:f= S � ��`��'�,�'e,3sk�.,p'+3 u»'"'�i�4.,,�...8��h��:;r�.' A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. ��t ��l��+��`��,a �'� 843 ISLAND WAY (SW ADDITION) �� ,��,�`��;��„ ��„''�'. City CLEARWATER State FL ZIP Code 33767 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) �� c� �L'�f 1 � �� LOT 40,UNIT 8,ISLAND ESTATES OF CLEARWATER,PLAT BOOK 64,PAGES 73&74. P' O A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)ADDITION c A5. LatitudelLongitude: Lat.27°59'42"N Long.82°49'11"W Horizontal Datum: ❑ NAD 1927 � NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used io obtain flood insurance. A7. Building Diagram Number 1 A8. For a building with a crawispace or enclosure(s): A9. For a buiiding 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 crawispace 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 AB.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 8�Community Number 62.County Name 63.State CITY OF CLEARWATER 125096 PINELLAS FLORIDA 64.Map/Panel Number 65.Suffix B6.FIRM Index 67.FIRM Panel B8.Flood 69.Base Fiood Elevation(s)(Zone 12103C0102 G Date Effective/Revised Date Zone(s) AO,use base flood depth) MAY 17,2005 SEPT.3,2003 AE 11 &12 B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile � FIRM ❑ Community Determined ❑ Other(Describe) B11. 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)7 ❑ Yes � No Designation Date NONE ❑ 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 SEE COMMENTSVertical Datum NGVD29 Conversion/Comments NGVD29-0.86'=NAVD88 Check the measurement used. a) Top of bottom floor(including basement,craw�space,or enclosure floor)10.9 �feet ❑meters(Puerto Rico only) /, b) Top of the next higher floor N/A.T ❑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) J�owest elevation of machinery or equipment servicing the building N/A. ❑feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Comments) � Lowest adjacent(flnished)grade next to building(LAG) 8.4 �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 suppoR SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION .�'. ��„�p Y�. .-_!�.�r '�� 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 best efforts to interpret the data availab/e. � r"= '�� / /'� `- - I understand that any fa/se statement may be punishable by fine or imprisonment undar 18 U.S. Code,Section 1001. ^� 4� �, �a �= � Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a licensed land surveyor7 ❑ Yes � No �, �� ' !� � ; Certifier's Name MICHAEL J.BAKER License Number LS 4086 .�r/ .�» - _ ,�,�d � Title� LAND SURVEYOR Company Name MICHAEL BAKER ASSOCIATES '�t� f�`r��-Y," �'� ;Ws�. ., Address 220 S.SAFFORD AVENUE City TARPON SPRINGS State FL ZIP Code 34689 �� ..:.. -- Signature � _i Date FEB.20,2009 Telephone 727-938-5026 FEMA orm 81-31, M 09 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces,copy the corresponding information from Section A. �or�ns��anc+aGo��q�€:..�,,"' Building Street Address(induding Apt., Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. P#�licy Nut�bet' ,•; ' `` 843 ISLAND WAY(SW ADDITION) City CLEARWATERState FL ZIP Code 33767 ��p�X �� ,x; : -.,d,_ , ,... �.�� >. _. SECTION D-SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)communiry official,(2)insurance agenUcompany,and(3)building owner. Comments C2. ELEVATIONS REFERENCED TO CLEARWATER BENCHMARK"1-3.5"-ELEVATION=7.275'NGVD29. ,�' Signatur � � , o� Date 02/20/2009 - �'��' �� ❑ 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),compiete 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,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 ❑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 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 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 authoriied tiy law,to certify elevation infoRnation. (Indicate the source and date of the elevation data in the Comments area below.) G2.❑ A communii�i'o�icjal completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3.❑ tt�'f011ov�tg ir�formation(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 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 Building Photographs See Instructions for Item A6. �or insurance Gompany Use: Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Poiicy Number 843 ISLAND WAY Clty CLEARWATER State FL ZIP COd@ 33767 CompanyNAiCNumber ', 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 on the reverse. �Y e�!';/� � '' e� �F,i 4 �� '��F`��" <' �u�� ;,�� F. �_,l�+ba , _„ �'4 �.r ": � �';� �" � _ A l d��,�.?f'S et� .�� ' �� .y ,�: �� i� ~ 'a. �R � `ti'.y � l`-�.��. � 1 �. `� , � . � �,�. � �� , , , � � � �, ,` �__�� _ . ��r,�� .��,��. •��_ � �"�a �� ` � ��`�.. 337 �937 � ri�.� � A.��i P� Rp-`� � ' .� � i.� ...-_. ..� .. 4 �I . ,. " �,��{+ �y±�.�. w`^+} � ..r.. 1W�'°�� (y ' ,j -,,.i: I . �.:_.� �. ;�s;y� . �. �i I - � `�+ _ j . "*,,,4�--"'.`'. � �,t s` . ' , . . , x �3*' � � , � �"�v '- �'=' s• � ,�,,�,,��1lL�,' . � . � yr.., }��y�c�,� �-�� . � ^ R!' � t ��• ;/ a F i'f J-. ?'� '' �` � �s'' . . �' ,i } .._� � � ��,. � ��' . ��'�* � `��- _ ; �-� � � �l j ZU/1lJUy _ �� _,.. . , � , . -- . ,� � �; 1 �/� ��✓',= ,%'f'f'A '`r,,�'-�� T�' _ �� -�� ---� ,/ l �. � �� , � ;�, �� s .:� � �n; "`_�� :,��' .*L'` � ,�, . =t . • U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATtON 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 ,��r.��a�vc�apan�l.►s� . �,,'` ; A1. Building Owner's Name LINDA L.SCHIICK and Z-BEST CONST.(CONTRACTOR) �ll�lt��fi s" ��,. �,��.� ..,�#. �,��.�'»�.A`� � A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. ,�'"r�ti'�p��titrt��c� �� r 843 ISLAND WAY (SW ADDITION) ��: � ,n� '� � � r ��:- p.F. k�ux�.: "�: r�,y n City CLEARWATER State FL ZIP Code 33767 �� A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) �C]�� t^'" LOT 40,UNIT 8, ISLAND ESTATES OF CLEARWATER,PLAT BOOK 64,PAGES 73&74. �(�1J A4. Buiiding Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)ADDITION v A5. Latitude/Longitude:Lat.27°59'42"N Long.82°49'11"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 1 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) Totai 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 62.County Name 63.State CITY OF CLEARWATER 125096 PINELLAS FLORIDA 64.Map/Panel Number B5.Suffix 66.FIRM Index 67.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone 12103C0102 G Date Effective/Revised Date Zone(s) AO,use base flood depth) MAY 17,2005 SEPT.3,2003 AE 11 &12 610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ 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 Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes � No Designation Date NONE ❑ 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 SEE COMMENTSVertical Datum NGVD29 Conversion/Comments NGVD29-0.86'=NAVD88 Check the measurement used. a) Top of bottom floor(including basement,crawlspace,or enclosure floor)10.9 �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 structurat 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) �owest e►evation of machinery or equipment servicing the building N/A. ❑feet ❑meters(Pue�to Rico only) �� (Describe type of equipment and location in Comments) � Lowest adjacent(finished)grade next to building(LAG) 8.4 �feet �meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) �.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,engineer,or architect authorized by law to certify elevation information. 1 certify that the information on this Certificate represents my best efforts to interprot the data available. >w�.�".�' " �;�:�)`-��s 1 understand that any fa/se statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001. f ` �,�� ' ,t" ,�. �� . � Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a . .v�� : °- licensed land surveyor? ❑ Yes � No ��'� � Certifier's Name MICHAEL J.BAKER License Number LS 4086 '��i-�� /�' �A�� ,��. � Titl� LAND SURVEYOR Company Name MICHAEL BAKER ASSOCIATES f��I f`�y Address 220 S.SAFFORB AVENUE City TARPON SPRINGS State FL ZIP Code 34689 (j-�?, L�� ,a , � t ; _ ,_ . . .. Signature / Date FEB.20,2009 Telephone 727-938-5026 � �2 e FEMA Form 81-31, Mar 09 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section A. �'��e�nsur�nce,��;�i�a��;�.ise . � Building Street Address(inciuding Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. „Ppl[cy�iutsaber, ;;,,' i ' 843 ISLAND WAY(SW ADDITION) City CLEARWATERState FL ZIP Code 33767 �',fl�y�g��E SECTION D-SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION CONTI � � ( NUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agenUcompany,and(3)building owner. Comments C2. ELEVATIONS REFERENCED TO CLEARWATER BENCHMARK"7-3.5"-ELEVATION=7.275'NGVD29. Signature - f Date 02/20/2009 ❑ Check here if attachments SECTI N E-BUI 1NG 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 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,crawlspace,or enclosure)is ❑feet ❑meters ❑above or 0 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 andlor 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 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 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 authoriz�d,by leu�to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2..�, A communtty�dfficial completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3. 04y T�fqllowing inf4rmation(Items G4-G9)is provided for community floodplain management purposes. ,„ G4.PermiYNumber " 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 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 . • Building Photographs See Instructions for Item A6. '`For Insurance Gompa�y Use: � Building Street Address(including Apt, Unit,Suite, and/or Bldg. No.)or P.O. Route and Box No. Poiicy Number 843 ISLAND WAY Clty CLEARWATER State FL ZIP COd2 33767 Company NAIC Number 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 on the reverse. ��,h'�'�� ;� �� r° ., . �� , � � �' � , , Ts � ��U ��:".,�:i� ,��, �: � . � � ; i, � � ��''�'! "�� F yA � ,� ' r• . , „ �� Y' � ' ._ ., '� » -��. �„ �� r_ � �� . ___ 4,�1� ; � , � _.., , , -�"�;; '� I � �� ' � �I �� «�- . � ��—� , �, � �� . yr�. • � a � . , �_ , �' , � �t�;� . �� . `� � � . �'�( �a�s� 5�_„ �. Ijy ry�,..,�';� �i �_�. '.2�-, � �.q�t �.. �4r�'i�� . r ' ��! �� - . � �, , i � � F'., tiy�� . '�,�Ir--".�..r *�'«. ` ' ' � ��3 t,��'t :»'U��,�i ; �-� - .� �`��' " _ � .e l��i;n i,�s 1 � � L �'� � � � ,y� r d"�+y N` ��'�C,r��F''^xl*.I��'tS:.,:.�i'�'r... -d �ti�,�i_�i� ."f ��'�;_ �_n:i .�.': �"l�� -G�-'r' 'r,; `�,� �� /�• , . . - � %�l. "n "t"t 1/l/'1 L+ � ��z .�:��..J �4�' �;, �\ �,��~, �`%a'' ' , r .�; t�� , � _. ' x� +t "�k' •a +K Q � ' � �_ 4. � er"�� ' . , �� {�/'* . d �;. r �/ /7 //�`J� /�yA/]/'�//y' - / � ,, �i�'A,(y ``—" ,1 / �'�'�.� �" . lt ! . l • � U.S.DEPARTMENT OF HOMELANO S�CURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal�mergency Management Agency Expires March 31,2012 National FI4od Insurance Program Important: Read the instructions on pages 1-9. SECTION A-.PROPERTY INFORMATION For Insurance Company Use: A1. Building Owner's Name LINDA L.SCHLICK and Z-BEST CONST. (CONTRACTOR) Policy Number A2. Bui�ding Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Company NAIC Number 843 ISLAND WAY (SW ADDITION) City CLEARWATER State FL ZIP Code 33767 A3. Property Descnption(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) LOT 40, UNIT 8, ISLAND ESTATES OF CLEARWATER,PLAT BOOK 64,PAGES 73&74. A4. Building Use(e.g.,Residential,Non-Residential,Addition,Acc�ssory,etc.)ADDITION A5. Latitude/Longitude:Lat.27°59'42"N Long.82°49'11"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 1 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 AB.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 61. NFIP Community Name 8 Community Number 82. County Name ^ . 63.State CITY OF CLEARWATER 125096 PINELLAS FLORIDA 64.Map/Panel Number 65.Suffix 66.FIRM Index B7. FIRM Panel B8.Flood 69. Base Flood Elevation(s)(Zone 12103C0102 G Date Effective/Revised Date Zone(s) AO,use base flood depth) MAY 17,2005 SEPT.3,2003 AE 11 8�12 B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ 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 NONE ❑ CBRS ❑ OPA ' SECTION C-BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Buiiding 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/A0. Complete Items C2.a-h below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized SEE COMMENTSVertical Datum NGVD29 Conversion/Comments NGVD29-0.86'=NAVD88 • Check the measurement used. a) Top of bottom floor(including basement,crawlspace,or enclosure floor)10.9 �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) fl Lowest adjacent(finished)grade next to building(LAG) 9.1 �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 10.5 �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,engineer,or architect authorized by law to certify elevation information. l ce�fify that the information on this Certificate represents my best efforfs to interpret the data available. ' *%"�- ' . I understand that any fa/se statement may be punishab/e by fine or imprisonment under 18 U.S. Code, Section 1001. �' �.`�� f /��,, �� - ' ,,,� � t;+. •, _ � Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ,,� -. , - licensed land surveyor? ❑ Yes � No . Certifler's Name MICHAEL J. BAKER License Number LS 4086 � � �i� ;�� ; Title LAND SURVEYOR Company Name MICHAEL BAKER ASSOCIATES /��j �� .4 "^f� _ .; ✓ +J t a:�^`. Address 220 S.SAFFORD ENUE City TARPON SPRINGS State FL ZIP Code 34689 ;✓`'��; , .�:,��:�1 � Signature '��' Date SEPT.3,2010 Telephone 727-938-5026 FEMA Form 81-31, Mar 9 See reverse side for continuation. Replaces all previous editions l • • R 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 � 843 ISLAND WAY(SW ADDITION) City CLEARWATERState 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 officiai,(2)insurance agenUcompany,and(3)building owner. Comments C2. ELEVATIONS REFERENCED TO CLEARWATER BENCHMARK"1-3.5"-ELEVATION=7.275'NGVD29. Signature �,,; Date 09/03/2010 i ❑ Check here if attachments SECTION E-B DING 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 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,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 andlor equipment servicing the building is ❑feet ❑meters ❑above or 0 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 officiai 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 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 G10. Community's design flood elevation ❑feet ❑meters(PR)Datum Local O�cial's Name Title Community Narr�e Telephone Signature Date Comments ❑Check here if attachments FEMA Form 81-31, Mar 09 Replaces ali previous editions . . - � � . 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 843 ISLAND WAY Clty CLEARWATER State FL ZIP COd@ 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." 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