The URL can be used to link to this page

2703 LAKEBREEZE LN S U.S.DEPA��ENT�F HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal E�:� n_�:y.t*a.�agement Agency Exqires Februarv 28. 2009 National Fi�od Insurance Program Important: Read the instructions on pages 1-8. � SECTION A-PROPERTY INFORMATION For Insurance Company Use: A1. Building Owner's Name ROTTLUND HOMES OF FLORIDA, INC. Policy Number �w._. ..�..�-...__,.��.,....m._.....,_....__.__�-.._._. . Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. 1 ! �t�m� ny f�FAi�f�umbei� ,� 2703 LAKEBREEZE LANE SOUTH � City CLEARWATER State FL ZIP Code 33759 � �;,; i r P"y'i *y � r:';��' ti--�-i- d-3, A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) LOT 13 CHAUTAUQUA LAKE ESTATES PLAT BOOK 128,PAGES 39�3 '; ; � d P.. �; � , t� , •, A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) Residential , ;, T , � r � A5. Latitude/Longitude:Lat. 28d 0' 14.5" N Long. 82d 43'30.0" W Horizot�tal��atcim. �}�1R�3�92#�--��Nl�-�98� 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 crawl space or enclosure(s),provide A9. For a building with an attached garage,provide: a) Square footage of crawl space 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 crawl space or b) No.of permanent flood openings in the attached garage enclosure(s)walls within 1.0 foot above adjacent grade N/A walls 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 SECTION B-FLOOD INSURANCE RATE MAP(FIRM) INFORMATION 61.NFIP Community Name&Community Number B2.County Name 63.State CLEARWATER -125096 Pinellas County Florida 64. Map/Panel Number B5.Suffix B6. FIRM Index B7.FIRM Panel 68.Flood B9.Base Flood Elevation(s)(Zone Date Effective/Revised Date Zone(s) AO,use base flood depth) 12103C 0088 G MAY 17,2005 SEPTEMBER 3,2003 X&A 86 610. 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)Comprehensive Watershed Manaaement Plan for Alliaator Creek Watershed,Vol.1 (1997) B11. Indicate elevation datum used for BFE in Item 69: ❑NGVD 1929 � NAVD 1988 ❑Other(Describe) �� Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No Designation Date N/A ❑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-g below according to the building diagram specified in Item A7. Benchmark Utilized CAMPUS J.ELEVATION 90.47 Vertical Datum NAVD Conversion/Comments N/A Check the measurement used. a) Top of bottom floor(including basement,crawl space,or enclosure floor) 91.2_ �feet ❑meters(Puerto Rico only) b) Top of the next higher floor 101.9 ❑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 91.3_ ❑feet ❑meters(Puerto Rico only) (Describe type of equipment in Comments) f) Lowest adjacent(finished)grade(LAG) 89.8 �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade(HAG) 90.4 �feet ❑meters(Puerto Rico only) 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 interpret the data available. I understand that any false sfatement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ,(17/9��L1� �:s�;a��r2o � Check here if comments are provided on back of form. � ,,� .� Certifier's Name KATHLEEN C.LANZNER License Number 5120 . �.. le LANDSURVEYOR Company Name CUMBEY&FAIR,INC °~'�` � „cti Address 2463 ENTE RISE ROAD City CLEARWATER State FLORIDA ZIP Code 33763 Signatur Date 07/19/ Telephone 727-797-8982 � FEN1.A Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions �c.c�a o o�-, -. d�5S� IMPORTANT: in these spaces, copy the corresponding information from Section A. For Insurance Ccarnpany� e: Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. Policy Number �"`- 2703 IAKEBREEZE LANE SOUTH City CLEARWATER State FL ZIP Code 33759 Company NAIC Numb::_4r� 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 C2.E IS THE A/C PAD NO PORTION OF THE BUILDING IS LOCATED WITHIN FLOOD ZONE"A". Signature Date 07/19/07 ❑ Check here if attachments SEC ION E -BUILDING ELE TION 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,crawl space,or enclosure)is ❑feet ❑meters ❑above or❑below the HAG. b)Top of bottom floor(inciuding basement,crawl space,or enclosure)is ❑feet ❑meters ❑above or❑ below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9(see page 8 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 sfatements 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 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 Local O�cial's Name Title Community Name Telephone Sigriature Date Comments ❑Check here if attachments FEMA Form 81-31, February 2006 Replaces all previous editions ,�,� , , Building Photographs See Instructions for Item A6. • . ,� For Insurance Company Use: Bui,ldin�Street Address(including Apt., Unit,Suite, and/or Bidg. No.)or P.O. Route and Box No. Po�icy Number - 3 LAKEBREEZE LANE SOUTH 'ity CLEARWATER StBte FL ZIP COde 33759 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. _r,.. __...__ _ ,v , /, -;,' ,' ,, ,, �' ��r �{k �r t,�- � } 1,#y�� '�� . . � ._ ��k�� . .. . '� �i� . . :�,�� ,. �i � � u�kg,._`- E x f " yu. `�vy �S . kY �� -� �� r �4, y. . ' ; �,c� � : �.�:�,r �` ., � a � ��. 3�:. ,;'` �s a.t s��,�k ',� � Y r�;`- � .k' :�' '�p,. ,� "41�`�F'3�wv b� ,>.. � � y� , � �' � ��. ��a �', Y-., :� �� L. � � _ _ ._. , r � �'y,y --^--�--�,..�'�.x...,in°"�ss��.�,� r t,...;:,wF , i. .. ,s'J 4�- q . . ; ^• �.- r .. ��:... F ..�'a"' ��i.� � _ 'p" _ r,' �, � : � - :;� 4 � t � - � - .. .. n. d � �, .� � ; ��' _ �V'� ��1W,� . . .� _,: � !? . . '�.,3' .. ,.,�M ,,,� �! .,,' .. ' at� �n .— _. c. �- _.._ � . �.;: ^� � • _ . ..... . .+ . ..��.� �a � • . " .� 4...�.. ,.- }t .^�. -�� . y.. �"�. , �2 .�t .y r'^��.. .`�.�, ' � , .� �a+az`d'S . .•. - �f'��... �� r�-. �« �� '_ ,�'� ..k. �t t� � „�� ,', I� _ s�,_ �'-., ,.m.c: t . �s. �' � 4 � � . g � � L:;' 4 X �` Y,��..-..-'a`"`.'S, . ._. �..�!'n'R. �.� t.. , -+ � +�'� K'� .�._ �..}�w,. � _ _ . . - __ _. _.__.:�-_: ...�...�..north side . �.w...._. . ,,.,_,.. __ --__- ..,..,,� I ..�� ; I_i �' �-� � � i �� J�L 2 7 2007 i �' . �� --. � ��'F'��i'�.� ^ P C �S�'VCE� Jd:.. �'�':'wE"�^ORCi:.'_'ro �L.:� . F . �. ..'". _ .. . . . ��'. .. . .....,._.__....a Y ..��......... ........_,...... .:......._... �,. � y � #��: i Building Photographs � , h• , 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 • 2703 IAKEBREEZE LANE SOUTH City CLEARWATER State FL ZIP COd2 33759 CompanyNAlCNumber 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." �� r�''�-�..,� A • . �5 '� ,� ��``. • �_..... , _ --- ` "_,,,,,.___��- ' . _........:.......__—'--..�,�.,,,�,vc.._. �� .._. -�-' �� . ,,..m�a�^ ^^""°.nu''"� , �°.� � .. �� ' . . � ; ■ , ;;�. . _ � � � _ .. ��. , ,�+�� ,. � _ _ . _ � �M � � � ----�� C ,._... ryr.;� t,}., i'"s s :,� .. .'�, ��' �i Fa�- ., . � . . � '�� , ..._. ___ . . ,i' . ', .$'�{ ��: ... _ _ .____.._ �.� �. -rl� r � �-' - ' . . . " -�--.�-.r� _ _ '.�. ' ': "' . �i..^ r_°:"_'.' .'.. . ._ i,a �^y�� ' , "",.,,,-_..,., �. � �.C"' ..- .. . .._ :.. _�. . nr.�;, .- a':_ . . , _-.a ��+. �"'k ,�..,�.,: -'�4.�'" £°"_` _ _ `-...`,. '�`�:,� ,,,,�,.,si�1.{ ,,,,�,,,, •.- �4.�iiey+G t..� � M .�...: • . ��yy* .,. S ..m,�,�.XI . � °"C'^'�, �.,,�y.. . ' C-.-�'.�" ' _ � ! � Mk'� y �-',�� -.."1*j�IG�I+�� - _ � r .�,� � . � .� ,.. 'C x•�"'`..w ti �:� .. .. � .�.a �.4. � . �.. .�. . � ' . �. ��.. ' 4� k .�.� t ��.. :� �,�s..r+.� ... , ,,j., .*�� y � � - �.�' •�., �. .� .. ,rm�"� � � ... _ . . ry'R�.•� � vi L��i._ _ -�:f� .� ' •,�.�. .�.�- .,,y, :..�-�'_ _v} _._ � ' _ FRONT - , ,� : /'� � � � �,.... ;�x.t � �� -...,.�.-:.=:-�.,_._ ..� -=�,..z.,�.�,.�.�---�� w ,' *� , � � .>. 'I� �- - ��.. �.. � ' , ,P `_ �� - � - .+ �'�`�t :� � =r= �: � _ � '. _ ti ... . .. _. _.... _._ jj�, „�. S K:'.:� ". . ��.. � ' �'N>53' '+,. � ?�-. " .�, "�,^,' ,�y:S� �"`�'� °o 's� �t' . . . ��^e 5�,�c �+k .;�t�e�. �� . - w 4' , . r . i �� I ar...:.� * e� °�� '*"."n. .,. '�., � , . . ,� ,�'.� a }�p ;i�w'dt ;`. -�i�t�t��'��,,, v:� _.....___._ .°� � ,�� i r�,y J- ��'1R. �, z . ��''4�"�� "�y , . � � .«. ... . ��.. ., ... . .,,�e�r ..� .. . . -_. "Ran'. �-w y.�, . ..� _ ..-. _ ._ • `f' j �� t.. Yi . _ "�. . _. �'",?'� a?/ _ . .,�..'�'.�, ._ - . _ � � �« ..,,,,� ... ''�A "h. � � �'� ..i... . .�yM. .:. •+�.�y. .A"t M, � :. '.�v"yrw' ..+ � ' �' .��. � � ,�%� "`�.y ft N -='g." �t� . �'�'"�a" .""�"r.. ' �*R'..,�.;:, .r y"y r"�, ..!� .,++�,._„,�,/^ -�1.�C,�'y� , _ . ��y' , .'•.q�,. '� '�� ^�, 1��;�'�'M1�� ,.. . ... ..- .. .. . �, , , ,... .,.�� r^ ''.;w.."`!�.,;,. yz� .�.;. , .� - .. .. - >. d,��. .P,.e'�„ta..s r� ,,;� s....�� •_--- " .-=. b1 ,`� ,, � � .� .�v �i. .r yy �, . - .,�. . '' .,�►.�..., .�' ,. , �..� �� ' t s�..✓''a .o� ' �. �� ✓. j' J�'r�,.�"ra'4 sn"S "+y ,�'^n..-� ,} a .�,,, °'+� 'f��«+✓ ✓►�� ,./ 1,r "ti � �'. s'hr". w �... w 'M. f".,� .�'4 e�'� �j w�+ y�'a7'"��„r�^��!h'., �`,� � ��,,..',"��'_`.-,�.�.w`_::�._r.J..' y :.� �+ '�`�. �`� ,� .�:.r �:-,:,W y.�` �.> ."� REAR FROM NORTH SIDE �� 4�t��a�Hf�� `�`��; �� CITY OF CLEARWATER � ��, � . � A_ �,=�� y DEVELOPMENT & NEIGHBORHO(�D SERVICES DEPARTMENT ��,f3�:��,��QQ� PosT OFFicE Box 4748, Cti�wn�x, Fio�unn 33758-4748 ��.�i��R��jY MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CLEARWATER,FLORIDA 33�5� TELEPHONE�72� 5�2-4567 Fnx(72� 562-4576 MEMO OF REVIEW FOR CORRECTNESS & COMPLETION In accordance with participation in the NFIP/CRS program, all elevation certificates are required to be reviewed for correctness and completion prior to acceptance by the community. This complete form shall be attached to all elevation certificates maintained on file and provide with requested copies of elevation certificates. The attached elevation certificate requires corrections by the surveyor of section(s) prior to acceptance by the community X The attached elevation certificate is complete and correct Minor corrections have been made in the below marked sections by Community Official SECTION A-PROPERTY INFORMATION For Insurance Company Use: A1. Building Owner's Name Policy Number A2. Building Street Address(including Apt., Unit,Suite,and/or Bidg.No.)or P.O. Route and Box No. Company NAIC Number City State ZIP Code A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) A4. Building Use(e.g.,Residential, Non-Residential,Addition,Accessory,etc.) A5. Latitude/Longitude: Lat. Long. 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 crawl space or enclosure(s), provide A9. For a building with an attached garage,provide: • a) Square footage of crawl space or enclosure(s) sq ft a) Square footage of attached garage sq ft b) No.of permanent flood openings in the crawl space or b) No.of permanent flood openings in the attached garage enclosure(s)walls within 1.0 foot above adjacent grade walls within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in SECTION B-FLOOD INSURANCE RATE MAP(FIRM) INFORMATION B1. NFIP Community Name&Community Number 62.County Name 63.State B4. Map/Panel Number 65.Suffix 66. FIRM Index B7. FIRM Panel 68.Flood 69. Base Flood Elevation(s)(Zone Date Effective/Revised Date Zone(s) A0,use base flood depth) 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) 611. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ❑ NAVD 1988 ❑Other(Describe) 812. 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-g below according to the building diagram specified in Item A7. Benchmark Utilized Vertical Datum Conversion/Comments Check the measurement used. e) Lowest elevation of machinery or equipment servicing the building ❑feet ❑meters(Puerto Rico only) (Describe type of equipment in Comments) Comments: �e of Review: Community Official: All elevation certihcates sha//be maintained b the community and copies with the attached memo made available by request FRANK HIBBARD,MAYOR GEORGE N.CRE7'EKOS,COUNCILMEMBGR JOIIN DORAN,COUNCILMEMBGR PAUL F.GIRSON,COUNCILMEMRER � CARLEN A.PE7'CRSEN,COUNCILMEMBER ��EQUAL EMNLOYMENT AND AFFIRMA'I'IVE AC'1'ION EMPLOYER�� U.S.DEPARTMENT`1F HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Exqires Fe ruarv 28. 2009 Federal E�r M! :n�,�:.a:,iagement Agency Nationai Flood�insurance Program Important: Read the instructions on pages 1-8. SECTION A-PROPERTY INFORMATION or Insurance Company Use: A1. 'Iding Owner's Name ROTTLUND HOMES OF FLORIDA,INC. Policy Number M �� .°.. �.� _. ding Street Address(including Apt., Unit,Suite,and/or Bidg.No.)or P.O. Route and BoxNo. AIC Numbec-. 2Z03 1AKEBREEZE LANE SOUTH ' '' ,...:. _ ..�.. .�....�:_ � ,,. ` City CLEARWATER State FL ZIP Code 33759 A3. Property Description(Lot and Biock Numbers,Tax Parcel Number,Legal Description,etc.) • LOT 13 CHAUTAUQUA LAKE ESTATES PLAT BOOK 128,PAGES 39�3 � ; . �.,r.., A4. Building Use(e.g., Residential,Non-Residential,Addition,Accessory,etc.) Residential ; , , .: � . __ � -, ; A5. Latitude/Longitude:Lat. 28d 0' 14.5" N Long. 82d 43'30.0" W Horizo'ntal•Datam.--[�RIA(�•1927 �K�NA�-1983 A6. Attach at least 2 photographs of the buiiding if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 1 A8. For a building with a crawl space or enclosure(s), provide A9. For a building with an attached garage,provide: a) Square footage of crawl space 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 crawl space or b) No.of permanent flood openings in the attached garage enclosure(s)walls within 1.0 foot above adjacent grade N/A walls 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 SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 61. NFIP Community Name&Community Number 62.County Name 63.State CLEARWATER -125096 Pinellas County Fiorida 64. Map/Panel Number B5.Su�x 66. FIRM Index B7. FIRM Panel B8.Flood 69.Base Flood Elevation(s)(Zone Date Effective/Revised Date Zone(s) AO,use base flood depth) 12103C 0088 G MAY 17,2005 SEPTEMBER 3,2003 X&A 86 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)Comprehensive Watershed Manaqement Plan for Alliqator Creek Watershed.Vol.1 (1997) B11. Indicate elevation datum used for BFE in Item B9: ❑NGVD 1929 �NAVD 1988 ❑Other(Describe) the building located in a Coastai Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No ^ �signation Date N/A ❑ 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 buiiding is complete. C2. Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,ARIA,AR/AE,AR/A1-A30,AR/AH,AR/AO. Complete Items C2.a-g below according to the building diagram specified in Item A7. Benchmark Utilized CAMPUS J.ELEVATION 90.47 Vertical Datum NAVD Conversion/Comments NIA Check the measurement used. a) Top of bottom floor(including basement,crawl space,or enclosure floor) 91.2_ �feet ❑meters(Puerto Rico only) b) Top of the next higher floor 101.9 ❑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 siab) N/A._ ❑feet ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 91.3_ ❑feet ❑meters(Puerto Rico only) (Describe type of equipment in Comments) f) Lowest adjacent(finished)grade(LAG) 89.8 �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade(HAG) 90.4 �feet ❑meters(Puerto Rico only) SECTION D-SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICAT � This certification is to be signed and sealed by a land surveyor,engineer,or architect authonzed by law to certify elevation information. I certify that the information on this Certificate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. 0�/19/07 / ' L.S. #5120 `� � Check here if comments are provided on back of form. /"`�`1 ;��l�� +, � C ' er's Name KATHLEEN C.LANZNER License Number 5120 � : 3 �`` � y ' r� � ,� , D SURVEYOR Company Name CUMBEY&FAIR,INC ��'�� E� �� ;� ��`�� i� � t` ,` Address 2463 ENTE RISE ROAD City CLEARWATER State RORIDA ZIP Code 33763 � n �� ..% •7 7-8982 if �� Si natur : G Date 07/19/ Telephone 727 9 � a 9 ,si ✓ r`' FENt.A Form 81-31, February 2006 V See reverse side for continuation. Replaces all previous editions n .- ,r. •,..�-�r ...., r�-i� IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Campany l�se: Buiiding Street Address(including Apt.,Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Policy Number M 2703 LAKEBREEZE LANE SOUTH ` ' City CLEARWATER State FL ZIP Code 33759 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.E IS THE A/C PAD NO PORTION OF THE BUILDING IS LOCATED WITHIN FLOOD ZONE"A". ,�' ��. .---..� --'' Signature 1 v� f � �'�`' �,.-'" � Date 07/19/07 ' �` (%��;�'']+-,t��—�4�' ❑ Check here if attachments SECTION E -BUILDING ELEVi4TION 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 foilowing 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,crawi space,or enclosure)is ❑feet ❑meters ❑above or�below the HAG. b)Top of bottom floor(including basement,crawl space,or enclosure)is . ❑feet ❑meters ❑above or❑ below the LAG. E2. For Buiiding Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9(see page 8 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 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, 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 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 floodpiain management purposes. G4.Permit Number G5. Date Permit Issued G6. Date Certificate Of Compiiance/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 Locai Official's Name Title Community Neme Telephone Sigr�ature . Date Comments ❑Check here if attachments FEMA Form 81-31, February 2006 Replaces all previous editions M ' + : fi ��:�'.-��, A . � � � ��„�� + ��°`�a" ��4�� C I T Y O F C L E A R W A T E R ��.,� �� . ��°�;�. �� ',�� '�� -��' DEVELOPMF.NT & NEIGH�30RHOOD SERVICFS DEPAKTMF,NT � �. �� „�� v %g,�;��,,��' Posr O�rtc�: Box 4748, C�.F:nRwnz'F:H, I'i.o�nn 337�8-4748 ,� �� -¢,�.'��,�� MUN[CIPAL SF.RVICP•,S�UII.DING, 1��SOU'CH MYRI'I.E f�VENUIi, �I.PARWA"1'IiR,F�I.OEtIDA 3�j756 -��.�",�,�a�w�. Tr:i.r��ioNr (72� 562-45C7 Fnx(727) SC2-4576 MEMO OF REVIEW FOR CORRECTNESS & COMPLETION ' In accordance with participation in the NFIP/CRS program,all elevation certificates are required to be reviewed for correctness and completion prior to acceptance by the community. This complete form shali be attached to all elevation certificates maintained on file and provide with requested copies of elevation certificates. The attached elevation certificate requires corrections by the surveyor of section(s) prior to acceptance by the community X The attached elevation certificate is compiete and correct Minor corrections have been made in the below marked sections by Community Official SECTION A-PROPERTY INFORMATION For Insurance Company Use: A1. Building Owner's Name Policy Number A2. Buiiding Street Address(including Apt., Unit,Suite,and/or Bidg. No.)or P.O. Route and Box No. Company NAIC Number City State ZIP Code A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory,etc.) A5. Latitude/Longitude: Lat. Long. 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 crawl space or enclosure(s), provide A9. For a building with an attached garage, provide: �) Square footage of crawl space or enclosure(s) sq ft a) Square footage of attached garage sq ft ) No.of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage enclosure(s)walls within 1.0 foot above adjacent grade walls within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in SECTION B-FLOOD INSURANCE RATE MAP(FIRM) INFORMATION B1. NFIP Community Name&Community Number 62.County Name B3.State 64. Map/Panel Number B5. Suffix 86. FIRM Index 67.FIRM Panel 68. Flood B9.Base Flood Elevation(s)(Zone Date Effective/Revised Date Zone(s) AO,use base flood depth) 610. 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) B12. 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' ❑ Buiiding Under Construction' ❑ Finished Construction 'A new Elevation Certificate wili 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. Compiete Items C2.a-g below according to the building diagram specified in Item A7. Benchmark Utilized Vertical Datum Conversion/Comments Check the measurement used. e) Lowest elevation of machinery or equipment servicing the building ❑feet ❑meters(Puerto Rico only) (Describe type of equipment in Comments) Comments: Review: Community Official: All elevation cerfi�cates shall be maintained by the community and copies with the attached memo made avai/able by request Fanrrx H�aRnru�,Mnvok GGORGE N.Citii7'i?.KOS,CUUNCILMEMBCR ,�<)IIN DO}tAN,CC)UNCII.MEMAER YAL1L F.C�IHSUN,COUNC1LMf:M[iTR � C,ARLF.N f�. Pti'I'ERtifN,�,UUNCI1.MIiMH6R ��HQUAI.NMPLOYMIiN'P AND f�}'FII�tA77VE A(,"1'ION �:MPI.OY'HR�� i �. Building Photographs ��" � Continuation Page For Insurance Company Use: Building Street Address(inciuding Apt., Unit,Suite, and/or Bldg. No.)or P.O. Route and Box No. Porcy tvumber 2703 LAKEBREEZE LANE SOUTH City CLEARWATER State FL ZIP COd2 33759 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." _ i ��, �`"�.._ . '� �s �`; � � ,, � � . � s -,, .. �� :.;w�"`w� ' � `� ��' � :� ..��m:,.R,. .:-- �,�. ,. , , � ,_., -� � .�..,,;� '"r„ ��e � � .x� . ?"!?�,�, �-....,;=.. i�� ._ -... I � �, �a ��i _ �� ''�'"... "� � � �� .. � � i ��' r., �ky, `�; . 1� �Y�, � � ` . � � ��'... ,��:� � ,� . wvw`+i., ��n�r,.� 4. Y. I`i• . . � „_...�_ • � 3 4 �'�F! i�—'JY�.WW_�� . —T� f , u� , .�k — �_�. _ .�:�. � '�.�� ,.,-� � . -- �:. � ,��a�� - � `—`-�' �s, � ��,�ss�„- -- ;� a �,a�„�. � .:�. �� e�:, --...,_:.:,�„ , -;�,, >., ,.� �, �� `,: � °' =�:..�, ; i ;.:.- _ � „� '"�, ' �;�:'�*�, �� "`' � � ` ,. i , w�L ,. . �� .. _ r" r;2 g 1^� e�. .. ,fa.�. �, l�_F^,,C �. �j�f L: �,,� !��^'� `' � "'�� r � :a, 4�� °m�t, .�' '�� 1 . f. ..,.�-�r ., , � :,yt��''��` 1 � - ,�_' r'• ,va.•.'°' �x��:�v,°e��ww- " � `.�..� �_� _ _ .._ _ �� -`" -� � _. _ ._ _ _ _�_.__ ��FRONT .. a__.. _ _ � ,r``;�r ,�.� , � ` . �._W �.�-�r�� „��.v_._�., �.v l�� , C . �. m .n�.. " ..-�.—.f ... .:+..c- �.,�y ..�,� � _....,- _.r ...__ , .a.. "' "' "` �.� � :.� .1..m.�..^-v.... .�—.�.�,.:.,. ,.' ..f '��. �I �;;�.:; �: �� - m��'t' f � , � .< � � � � ;� 4� � �� rt Y.�5:f � 'mi y x. �.� .�, f:�„ r. ��,�" �� ,yw '^"� '�'Y.�� ivk s�x� �r ' { � ��.�'"-�, -�r � �" � Q-. � '`�,� •.�� i�„F� �r ,,� ;� i�,*' � , ��., •`� , a.� ,, ��: '� w�.�, � ,,., ,u: _ _---- . � t� �.�.'':��a�.'f�F .+G' N�s.� ��t:* . .n��"�: } ��£`! �; 3, t ��._,K:•, . ... . b. �� ' � .4W '�°2r� �,m �'� (.$M1 . .m.-�k^"'."� � � � 4'�:+�' -':..>� "4 ' ," �y t M ,��`� � � � -� �� _ � -�� _ � _ - �- ,,� r ,_. ` "�'�:w :;. � '� ---��,r� �' �- � �r� ;�, I �"'� r ;a�^i - '.�r �, .; ' �r {�, ., r ,� - ��.,ti 'x 'v� � � � �Y �a "4 �4..�. y"'�. .64��h • '� . i+^t .. � � :. Y �,�,� .,.: - N '1 � 'i �� 1 y � r ��S J+ 'ly ..�.1 ..�.`..' T R ��.{Y'W y,,J!� , W � yr -. , j . :. ` J /'i �.t v'y` ✓T ''t`.�X ti'!' � ,�.- ^��w.._...� ' � '�� -..""� ¢ .. `�� n; d s t'.x T dgrrd'+'�',y"Y'!� /� J'� J ,, : . � i y��-��-.:_'''�,��-�.�`.'.��".._.,.�"' '�*-` :�' ` r . �ry . '" ' 'REAR FROM NORTH SIDE .. ...... _ . . . �..� . `�' .�».' .�sd ��.,.+ p_.er".�� .4✓. ..sa.._x,�.,..�°c.....�.,_.z_�_ ,i i � Building Photographs ' ' See Instructions for Item A6. � For Insurance Company Use: Polic Number Building Street Address(inciuding Apt., Unit, Suite, and/or Bidg. No.)or P.O. Route and Box No. Y ""�' EBREEZE LANE SOUTH l�ity CLEARWATER State FL ZIP COd@ 33759 Company NAIC Number If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according t� the instructions for Item A6. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Rigi� . he Continuation Pa e, View." If submittin more photographs than wili fit on this page, use t 9 Side View" and "Left Side 9 following. 0' � - r j ;' ��'' � � , � � ;, , �;.� � , g �; �:, �; !? L ; j` � � ,�i �� tik � f�;'rA�� i �ry � � !�� .. � ° A}r�{ , a^;...�, �.�„i �*�. y �� Y,4�-� � �� - r�� ,..0 x'�., . 4 ,.��t µ?a.�_,�w .�j1�.�`�i _ �'� v" '�"�� h��y^,' � r,:i.. ,��. t � �� ywdetrv �. ,� ., i .� •.y �.� _..,....._. ._. ,_,. a`�'�' ��'� �,"8.,'k"�,:..� t�:i Y� � "S �� . � xL w. . �u..k„ � � x r..= - �`" � . �:?. n�'�""�,''�4a. .f ��"' "a" . c^".'� '� . . . � � . �� ,.n. I;, . . � . . �.�-w�. � � `" - ea., '�8� %a �,-..' , - : �-x.a4AAo".+a'.��c'?�}i� . .i � t ' L' �+:,"` �,t�.�r�.`.��k(µ�wp..�..�"Ef � f . �. D�, �v _ '� _ ,�,r��m+„�� `��.� "�� t� �'�� a. �S .�} ,43ffi F3�L. .A . .• � �" + ' _ �, y,: �._ . .s , . L �1'��''�+f 4 , �� . ,r� . .. ' ha _� �.. P _ , ' 1 �"y ' �i.; s' . ..n r"—.-+. , � . � �% Y k �` ... �.^ �ro!',�'� !y._. { "��a. fi � S: .-...s �:��T ' � �^•+� �M •�+�.: . .',- ' ::�� •�v + �. �� L_ �„��,, Y�,��.�' � .. �.. _..��:_ ,�'�. .:north side . � .N � ,. , - _.. . . � _. . , . . .__ ._� .._ . - �..��.`�.y,,. � , _ _ _ . ._ ._ �..:��,, ��A � !�� I.; i'. ?-� 1 j? i� 4 �� .s.wrw.�.�w...w�,,, .»,«w.�+-+#� �� f i' � �� ;1 ' 1� :' i ,1�JL 2 7 2�07 �; '; ; ' .i; ' _ . .. �F�� ... _ +,�f.:�J�c i,1G'A ''�5 , ',�i .fi ',{�i:. L-C2'� � . . , : , .. , "r' S _,,... . ' .. ..:....�__.A • ....,._,....._. .... .. � Building Photographs . Continuation Page • For insurance Company Use: Iding Street Address(including Apt., Unit, Suite,and/or Bldg. No.)or P.O. Route and Box No. Poiicy Number 2703 LAKEBREEZE LANE SOUTH City CLEARWATER State FL ZIP COde 33759 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." .. _. , �x'^ f : � � �� '� �� .:-� �. - : ; � �- � � �-- ;_. . ,, . �, - ; ; - , . _ �-, _ ��. � �t � f� �, , °�.,.,,� � � � �:: ' _ ;.��,�� -._.,��"� +� � �`"� �� _ � .= � .y �' _ � =-� _--- � � ' � -- � � ; �� — _ - � �� _ � --� ,,�„�� `��` �`�, � . � � �''� �� - . - =.,�;{.- 7 ��` c t -r'�.�_:�S,ltiqt ; » . _.:. � ___---_ " s , . - k..�:. � Y�'�'-��" - � � � ��`.�-�e-^l�1 �, ...„ s., . � ,..- . � "�a,r w. .� ^i. .G=ms. ..,......� .. J . . �'t,"x- 'µ'*_ -r-c-.'�"5'�-c`.`"y f"�: - .x'c "'"'�-+�',,,W;y+s-�- '�w�,� 9:��'kz'z ��... �°'.a,�,� �-:° ��.-�-§ "V�. ... ,z- �_,.,,.,,��,�'e+sH� ��"y�� , y,...�,'s � ,y� �� -�"��.� '!� '"--.'° � � � ....,< �k. � .-;.- zHrc�..,.,,,,,,,,_._ -+-- � . . +:� �� ` �,-,- .�..a..u.+"' ��,_ x ~`"„- �j�g��"'��,� '�'r" a �. . ,�, ,x _. -- - r,� _.. �yxc��"�"�-.. < l��_�.,_� ti. � � ��. .,�� "��, _ �� . �'�" �` , �:.`" 't ,v�' <+_ ��. '.�"- _ _ . �-�,�c��t'�3:s' ,� . -A.. � - �v�:.v ...' �� .arp�..e - .. �4�� 'N . r5 4.0-> .yi's, ��- ,.��` 2r! x t,�.-... .�ra � ,�..�-,".'� � '` � �,,..i -7.. s� � �. "" .i � � �� ` '�y�yJM'r� '1y^�' �� .s R � { '� i '��k � ��`h" '� +✓�'�'41fY� *�y _ri`- �,�. `. f��-� .�'3, :__�.�._�_ _ _�� =- _ - _,�,�--�"`�.�.��._.___ ''� �� _. . .. _�_ry__.a_� �nFRONT ` . ._ ��. ,. �:f_ . �;�,� .. . �� , � �q;� y:,:, i� ,- . � . ,.� �_ �� : ,,�; ,. ___r ____ _ _ ____ , , . , �, ,�. __� �� _ _, ,�, . � .: _ ��` .. ,�- � �;� ?`; �� , r� x ' +° �3� � � � ry ;�«= � ��' �,�, €'� ��,r,� � " �i1.4 iy.,k > �-^r-`'�'�.� q y�,y t' :��,4�" �st . � �'�F �,��,,. $ �„ > , ,y. i Y'�.��' 1 Nr.c.^* � . ._�� .M.-- ,� -j°�r a x C �:r �.5� "�Ir" � h�rt�^�.� ye � �Y� _ _ .,�. ��G�.�=� � .;r �1 �Y"., -�" . � . �i `k K � ;�.4 . . � .�. . � .. ' _.,_..._.. ,. .....,.. .F .i..sd'+ Y9._. � reu...��. �a.� ... �ar � ' . - ,��y,.� _ - -� _ ��-a�. �,'i.�f `-`^'�y��'-,��S�� - �._ � c _ --R_:_ '.-�j' ' _ ^--""'-:,..'t. "r'_.,�� - _ .;: �-. .��. . ,..� ..,_ ;.-,- '° .,.� : . .. - �-:_ � �„ * � " x ~ � ...� �� .f�,?&. "-"'�x �".� A��°`-�'- �. t '.,r.r-w-�c 4/" r,- . a�"" ��'as}.�. �Y..- "' ; ^'":>"""�}4 i�' .^�. -zr. -�;,a.''�� : � �� ....,-..-, �, �,3.t � +�ca�x � `' �i.---" " -�. - ._J`�r`�' '�'rw.�"S� ,�.+ .� ^�`�� r � � h� .y�� . �, . �: � S .�r u � y w 4` '� ;�r e � k` ��,�,5 ''� ._.�.�sr.�C '�'e�. 'a. . �. l ......+Y'^!� W . � � � .,,4!. F,°'.-:..ra+At�,F:Kh..Y�,. � +'4 � �-_ ��;+ �.- . "'! ; .....-.._." Ik� +Ln-i ""r a' +.r .e" �✓ ..r _�._.r. . .+-r�,w Jr . "^e.,,,. „-'�R W,.sv..,„_.�_". 3 3' ,-n. � _� �----- . y �""y�,"'y �y� ry 3x- �r., q � ".r �: r : � r �.�:��.t.+.�g d�T �Yr. '� .O" ^ro'�'�''wl��'e.��.. `xe� `a��w""`w .r :. � �(' '°a. � F'-s .q .,.a,��✓ F •-..x>-y .,� ��`''G' �y�..✓ .�'',-„v �" ��., "�#�.a K- ,yy.: +y�'. w T� t�� . <,ya' l�y�' ryk��a�,�M.� t��.4� a�'�,,`��'°y,.•.�'-�':.s�:°',�'. �`�.��''.s.r ;.?�'_:4�� -y% __,sr y=�� .-�� :, �� ,� :�-....,�_'�'REAR FROM NORTH SIDE �uilding Photographs See Instructions for Item A6. For Insurance Company Use: Building Street Address(including Apt., Unit,Suite, and/or Bldg. No.)or P.O. Route and Box No. Poiicy Number -'�3 LAKEBREEZE IANE SOUTH � l�lty CLEARWATER State FL ZIP COdB 33759 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. r, �r�� „ .. -- f � � �_ , � �t :, f�.:' � �e ,t� ; M r �.� +�` is � � ` ,� \ ..� , 1�� je �� 1� �' �� . � {..a ` � '��` `n'�. ' t��F_� .�k t .' ': �e : � . E '1 �, -. .^�<w L ,��tj�N'ry�Yi�.,}_� � �P . .� �..+I}c� '� ! y`d'1 , �'Y r�`'- >x! ��-",>s�>�..:,T>s �, . . 'ro- � �t Z 3' ''�,�� +' s . � �, . ;+a.: ��..,�x �;��;��s-�.��»_"�'�3"��iM�s.,,'"`:': xt'�`r » I � ;y,;_ L_�� F'�� ' �, "'� .s: � e i _.___—__ ":."----"-`^�� =� s ; -- �,.�'_'�' .�~ °„�*,��`'�-*�'°_� -� � : ': t "r'��"� '�' 'i.�, � � �` -i � „,�� {, �` ^'Y`; "�- � : �.� " � � �� e�� - '"�-�, , T- "`` - �'� ,i i ;" r a. _-.� - _f. - c,-�5- ,,.:�- f �� ~ _ �"r'�* .�� . _ a -��.,,,,� ._d - . > .� � _ - . �..".'4.: �� r...-.,-""-•._, ,�. _^ 'z . T �� > _ �� `"'=„'�'.:�."'.- a�"'�� K �^y,�'�'. -.... � � � � S�`�-. � � ,�a��`� � � °'' r'C.; _ \ _.,;,;.. .��.-� ,.�, ,ca:.. _ � � s� ��"�S" .. .. � . � � � � ��.�..+�.� �— .. .__ .,. . .__ .�� '' ' , _�.`�.. __' ._.�,-,. '� y �- .�A.��north side �! s �.; ` ' � :_; ! � � �I � i �. �. �' `t . � � �� j j�{;y,.,,.,.o..........-..,.,,...-�...»...,.,... _..- i. (.1{ � ;� � 7 � �; i� ��:i�. � � �� ,: � ;i_'r.13 i -- ? ' � �t � t'� _ i ��,K tl�t :.� , � �� E .}r� ` . :._, r�_.�.� � U.S. DEPA:Th1ENT`�F HOMELAND SECURITY ELEVATION C�RTIFI - I OMBNo. 1660-0008 Federal E�: '« �^; `..a.iagement Agency Exqires Februarv 28.2009 National Flood i�surance Program Important: Read the instructions on pages 1-8. SECTION A-PROPERTY INFORMATION For Insurance Company Use: A1. Building Owner's Name ROTTLUND HOMES OF FLORIDA,INC. Policy Number �.,.w__._._,..__. _. Building Street Address(including Apt.,Unit,Suite,and/or Bidg.No.)or P.O.Route and Box No. ; ' Comp�ny;(}tAiC,t�umtie"r- � 2703 LAKEBREEZE LANE SOUTH � �' City CLEARWATER State FL ZIP Code 33759 � ; �� A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) : "''" y"` ` ` ' LOT 13 CHAUTAUQUA LAKE ESTATES PtAT BOOK 128,PAGES 39-43 . S _. ,i.+�: � A4. Buiiding Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) Residential . , �. A5. Latitude/Longitude:Lat. 28d 0'14.5" N Long. 82d 43'30.0" W Horizofitat�flatvmr�-�}-NA�S�•1�927`��NAD-�98� 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 crawl space or enclosure(s),provide A9. For a building with an attached garage,provide: a) Square footage of crawl space or enclosure(s) N/A sq ft a) Square footage of attached garage N/A sq ft b) No.of perrnanent flood openings in the crawl space or b) No.of permanent flood openings in the attached garage enclosure(s)walls within 1.0 foot above adjacent grade N/A walls 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 SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 61.NFIP Communiry Name&Community Number B2.County Name 63.State CLEARWATER -125096 Pinelias County Florida B4.Map/Panel Number 85.Suffix 66.FIRM Index B7.FIRM Panel B8.Flood B9.Base Fiood Elevation(s)(Zone Date Effective/Revised Date Zone(s) AO,use base flood depth) 12103C 0088 G MAY 17,2005 SEPTEMBER 3,2003 X&A 86 610. 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)Comorehensive Watershed Manaqement Plan for Alliaator Creek Watershed.Vol.1 (1997) 611. Indicate elevation datum used for BFE in Item B9: ❑NGVD 1929 �NAVD 1988 ❑Other(Describe) ''?. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No Designation Date N/A ❑CBRS ❑OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: ❑Construction Drawings* ❑Buifding 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-g below according to the building diagram specified in Item A7. Benchmark Utilized CAMPUS J.ELEVATION 90.47 Vertical Datum NAVD Conversion/Comments N/A Check the measurement used. a) Top of bottom floor(including basement,crawl space,or enclosure floor) 91.2_ �feet ❑meters(Puerto Rico only) b) Top of the next higher floor ✓101.9 ❑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 ✓J1.3_ ❑feet ❑meters(Puerto Rico only) (Describe type of equipment in Comments) � Lowest adjacent(finished)grade(LAG) 89.8 �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade(HAG) 90.4 �feet ❑meters(Puerto Rico only) 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 interpret the data available. 1 understand that any fa/se sfatement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001. 07/19/07 ` L.S.#5120 � Check here if comments are provided on back of form. ,.-. ; (' I , .fr �,.�1 t �,�� Certifier's Name KATHLEEN C.LANZNER License Number 5120 , , � ! ' � ,yy, tle L4NDSURVEYOR CompanyName CUMBEY&FAIR,INC ' ` a � ,i �/ ir � [i . ddress 2463 ENTERPRISE ROAD City CLEARWATER State FLORIDA ZIP Code 33763 � �, ,i � _, _ d. sA , .y Signature ' % s ' Date 07/19/QZ-- Telephone 727-797-8982 ` �� ,j � � .. �-�, �,6�L f.� ;��,� ; ,; FEtit4 Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions �u�aoo� -. p�5�� 1 ��Y��"Ad'-t 4r�fit;��'vxl�i F��m, � 4�`��;, �� CITY OF CLEARWATER � ��, � � � ��r�-�4-�==_ `�� DEVELOPMENT & NEIGHBORHOaD SERVICES DEPARTMENT �c�r.y+�---�-- �„� `"T �+��d��1� POST�FFICE BOX 474g� CLEARWATER� FLOa�DA 33758-4748 "' `'`+'si::ri p'Pw�,o�T�� MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CI.EARWATER,Fio�unn 33756 � It''��'�A¢ TEC.ErxoNE(72� 562-4567 Fnx(72� 562-4576 MEMO OF REVIEW FOR CORRECTNESS & COMPLETION In accordance with participation in the NFIP/CRS program,all elevation certificates are required to be reviewed for correctness and completion prior to acceptance by the community. This complete form shall be attached to all elevation certificates maintained on file and provide with requested copies of elevation certificates. The attached elevation certificate requires corrections by the surveyor of section(s) prior to acceptance by the community _X The attached elevation certificate is complete and correct Minor corrections have been made in the below marked sections by Community Official SECTION A-PROPERTY INFORMATION For Insurance Company Use: A1. Building Owner's Name Policy Number A2. Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Company NAIC Number City State ZIP Code A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) A4. Building Use(e.g., Residential,Non-Residential,Addition,Accessory,etc.) A5. Latitude/Longitude: Lat. Long. 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 crawl space or enclosure(s),provide A9. For a building with an attached garage,provide: � a) Square footage of crawl space or enclosure(s) sq ft a) Square footage of attached garage sq ft b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage enclosure(s)walls within 1.0 foot above adjacent grade walls within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in SECTION B-FLOOD INSURANCE RATE MAP(FIRM) INFORMATION 61. NFIP Community Name&Community Number B2. County Name B3.State 64. MaplPanel Number B5.Suffix B6. FIRM Index 67.FIRM Panel 68.Flood B9.Base Flood Elevation(s)(Zone Date Effective/Revised Date Zone(s) AO,use base flood depth) 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 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-g below according to the building diagram specified in Item A7. Benchmark Utilized Vertical Datum Conversion/Comments Check the measurement used. e) Lowest elevation of machinery or equipment servicing the building ❑feet ❑meters(Puerto Rico only) (Describe type of equipment in Comments) Comments: �e of Review: Community Official: All elevafion certi(cates shall be maintained by the community and copies with the attached memo made available by request Fwwx H��+w>,Mnvoa GEORGE N.CRE'1'EKOS,COUNCILMEMABR JOIIN DORAN,COUNCILMEMBER PAUL F.GIBSON,COUNCiLMEMRGR � CARLEN A.PC'fGRSEN,COUNCILMGMBER ��EQUAL EMPLOYMEN7'AND l�FFIRMA'PNE AC7'ION EMPLOYER�� U.S. DEPA�Tti�ENT')F HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federai E�,-�;;; ;n�y r'.�;�agement Agency Ex�ires Februarv 28. 2009 National Fipod I�surance Program Important: Read the instructions on pages 1-8. ' SECTION A-PROPERTY INFORMATION For Insurance Company Use: ' Building Owner's Name ROTTLUND HOMES OF FLORIDA,INC. Policy Number r^-_--- •m ,� _�„� _. Building Street Address(including Apt., Unit,Suite,and/or Bidg.No.)or P.O. Route and Box No. +; C�m ny�f�tAl�y Numb� ` �� 2703 LAKEBREEZE LANE SOUTH �, ; , City CLEARWATER State FL ZIP Code 33759 " � i' ; � � � it E� ,, n, , A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) �- +� .�i�r� i LOT 13 CHAUTAUQUA LAKE ESTATES PLAT BOOK 128,PAGES 39-43 ' '+ _ I A4. Building Use(e.g., Residential,Non-Residential,Addition,Accessory,etc.) Residential ' J ��y '''t � �- � A5. Latitude/Longitude:Lat. 28d 0' 14.5" N Long. 82d 43'30.0" W � �' ' ' � ''" 1 ' ' Horizo1�ta1 Datum,._-�i�lftib�927=�..NA��9E� 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 crawl space or enclosure(s),provide A9. For a building with an attached garage,provide: a) Square footage of crawl space 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 crawl space or b) No.of permanent flood openings in the attached garage enclosure(s)walls within 1.0 foot above adjacent grade N/A walls 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 SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1. NFIP Community Name&Community Number B2.County Name B3.State CLEARWATER -125096 Pinellas County Florida B4.Map/Panel Number B5.Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9.Base Flood Elevation(s)(Zone Date Effective/Revised Date Zone s 12103C 0088 G MAY 17,2005 SEPTEMBER 3,2003 X&A) AO,use base flood depth) 86 B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profiie ❑ FIRM ❑Community Determined �Other(Describe)Comprehensive Watershed Manaqement Plan for Alliqator Creek Watershed Vol 1 (1997) B11. Indicate elevation datum used for BFE in Item B9: ❑NGVD 1929 �NAVD 1988 ❑Other(Describe) �. Is the building located in a Coastal Barrier Resources System(CBRS)area or Othervvise Protected Area(OPA)? ❑Yes Designation Date N/A ❑CBRS �No ❑OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: ❑Construction Drawings" ❑Building Under Construction' 'A new Elevation Certificate will be required when construction of the building is complete. �Finished Construction 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-g below according to the building diagram specified in Item A7. Benchmark Utilized CAMPUS J.ELEVATION 90 47 Verticai Datum NAVD Conversion/Comments N/A Check the measurement used. a) Top of bottom floor(including basement,crawl space,or enclosure floor) 91.2 �feet ❑meters(Puerto Rico only) b) Top of the next higher floor 101.9 ❑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 91.3 ❑feet ❑meters(Puerto Rico only) (Describe type of equipment in Comments) ' f) Lowest adjacent(finished)grade(LAG) 89.8 �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade(HAG) 90.4 �feet ❑meters(Puerto Rico only) 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. I certify that the information on this Certificate represents my best efforts to inte�pret the data available. I undersfand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. 07/1 g/07 � Check here if comments are provided on back of form. L.S.#5120 ;� � , , �Gertifier's Name KATHLEEN C.LANZNER License Number 5120 � �:[le (ANDSURVEYOR � \ CompanyName CUMBEY&FAIR,INC ! I. J Address 2463ENTE RISEROAD City CLEARWATER State FLORIDA ZIP Code 33763 ��J Signatur �- Date 07/19/ Telephone 727-797-8982 � " FEN�.q Form 81-31,_February 2006 _� See reverse side for continuation. -- Replaces all previous editions For Insurance Company l)se: �(VIpORTANT: In these spaces, copy the corresponding information from Section A. Policy Number �� ' � � Building Street Addre�NE SOUTH APt.,Unit,Suite,andlor Bldg.No.)or P.O. Route and Box No. Company NAIC Number 2703 I�.KEBREEZE ' City CLEARWATER State FL ZIP Code 33759 . SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) both sides of this Elevation Certificate for(1)communit official, 2 insurance agenUcompany,and(3)building owner. _ Y � � Copy Comments C2.E IS THE A/C PAD NO PORTION OF THE BUILDING IS LOCATED WITHIN FLOOD ZONE"A". Date 07119/07 � Check here if attachments Signature WITHOUT BFE) SEC ION E-BUILDING ELE TION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZON o p(ete Sections A,B, For Zones AO and A(4 hO e BaSural g adlet f lava lable ECheck the measureme teu ed tln Pperto R co only�entOernm te s, and C. For Items E1 E , E1. Provide elevation information for the followe gLaAG check the appropriate boxes to show whether the elevatios is aabove ob�below the HAGdjacen grade(HAG)and the lowest adjacent grad ( ) ❑feet ❑mete ❑ below the LAG. a)Top of bottom floor(inciuding basement,crawl space,or enclosure)is : (�feet ❑meters ❑above or❑ b)Top of bottom floor(including basement,crawl space,or enclosure)is �Idin is ❑feet ❑meters ❑above or ❑below the HAG. E2. For Building Diagrams 6-8 with permanbuj flood openings provided in Section A Items 8 andlor 9(see page 8 of Instructions),the next higher oor (elevation C2.b in the diagrams)of the 9 • to of slab is ❑feet ❑meters ❑above or ❑below the HAG. E3. Attached garage( p ) ' , ❑feet ❑meters ❑above or 0 betow the HAG. E4. Top of platform of machinery andlor equipment servicing the building is E5. Zone AO only: If no flood depth number is available�locah offi Pal mus bcertify hisrinformat on in Section G With the community's floodplain managemen � Yes ❑ No ❑ Unknown. The ordinance. ❑ SECTION F -PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION e ro ert owner or owner's authorized representative who co d E are corre'�ct t thebest�of my know edgethout a FEMA-issued or community-issued BFE) Th ' r Y � or Zone AO must sign here. The statements in Sections A, B, an Property Owner's or Owner's Authorized Representative's Name State ZIP Code City Address Date Telephone Sinf?atUfe Comments ❑Check here if attachments SECTION G-COMMUNITY INFORMATION (OPTIONAL) ' ble item s and sign below. Check the measurement used in Items G8.and G9. The local official who is authorized by�aw or ordinanclica admini(tjr the community's floodplain management ordinance can complete Sections A,B,C( or E , and G of this Elevation Certificate. Complete the app ation. Indicate the source and date of the elevation data in the Comments area below.) G1. The information in Section C was taken frompother documentation that has been signed and sealed by a licensed surveyor,engineer,or architec w o ❑ is authorized by law to certify elevation info � G2.❑ A community official completed Section E for a building located unit ofloodp aitn management purposesommunity-issued BFE)or Zone AO. G3.❑ The following information(Items G4.-G9.)is provided for comm y G6. Date Certificate Of CompliancelOccupancy Issued G4.Permit Number G5. Date Permit Issued New Construction ❑ S u bsta nti al I m prov e m e nt G7.This permit has been issued for: ❑ ❑feet ❑meters(PR)Datum G8.Elevation of as-built lowest floor(including basement)of the building: �feet ❑meters(PR)Datum Gg.BFE or(in Zone AO)depth of flooding at the building site: Title Local Official's Name Telephone Community Name . Date Signature Comments ❑Check here if attachmen� Replaces all previous editior ��,�„ �„r.,, sz�_�� Februarv2006