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910 LANTANA AVE •U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Expires March 31,2012 Federal Emergency Management Agency Nationai Flood Ir►surance Program important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION For Insurance Company Use: A1. Building Owne�s Name Thomas Lee Policy Number A2. Buiiding Street Address(inGuding Apt.,Unit,Suite,and/or Bidg.No.)or P.O.Route and Box No. Company hWtC Number 910 Lantana Avenue City Clearwater State FL ZIP Code 33767 A3. Property Description(Lot and Blodc Numbers,Tax Parcel Number,Legal Description,etc.) Mandafay Subdivision,Blodc 46A,Portion of Lois 7,8.Folio#05-29-15-54666-461-0070 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)residen ial A5. Latitude/Longitude:Lat.27-5 -52.9 Long.82-49-30.7 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 8 A8. For a building wiM a c,�awlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawispace or enGosure(s) 1054 sq ft a) Square footage of attached garage n/a sq ft b) No.of pertnanent 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 19 within 1.Q foot above adjacent grade Na c) Tota�net area of flood openings in A8.b .�36, sq in c) Total net area af flood openings in A9.b Na 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 B2.County Name B3.State City of Ciearwater/125096 Pinellas FL B4.MaplPanel Number B5.Suffix B6.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone 12103C/0102 G Date Ef�ective/Revis�Date Zone(s) AO,use base flood depth) 8-18-09 9-3-03 AE 11.0' 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) 811. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other(Describe) B12. Is the building tocated in a Coastal Barrier Resources System(CBRS)area or Othervvise Proteded Area(OPA)? ❑ Yes � No Designation Date n/a ❑ CBRS ❑ OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: ❑ Constnaction Drawings" ❑ Building Under Construction* � Finished Construction "A new Elevation Certificate will be required when construetion of the building is complete. C2. Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),Aft,AR/A,AR/AE,AR/A1-A30,AR/AH,ARlAO. Complete Items C2.a-h below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized F-03 Vertical Datum NAVD 1988 Conversion/Comments n/a Check the measurement used. a) Top of bottom floor(induding basement,crawlspace,or enclosure floor)C.2 �feet ❑meters(Puerto Rico onty) b) Top of the next higher floor n/a. �feet ❑meters(Puerto Rico only) c) Bottom of the lowest horizonta!structural member(V Zones only) n/a. ❑feet ❑meters(Puerto Rico only) d) Attached garage(top of slab) Na. []feet ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 4.9 �feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Comments) f� Lowest adjacent(finished)grade next to buitding(LAG) 3.7 �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 4.4 �feet ❑meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of dedc or stairs,induding 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 archited authorized by law to certify elavation information. l certify that!he i�rfiarmation on this Ce�tificaGe represents my best efforts to inte►pnet the data available. 'n" " '��'r l understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001. '��f � � Check here if comments are provided on badc of form. Were latitude and longitude in Section A provid�by a ``�' ;..,�+�n��; � licensed land surueyor? � Yes ❑ No '�f �- °' G� ��,. � �= Certifier's Name Alex Thompson,Jr. License Number 5318 '��o�� " _ t' y Title Professional Surveyor Company Name Extreme Surveying of Florida,�nc. 'j y "' G . r C�l °e eo� , �. Address 29340 R od' lace City Wesley Chapel State F� ZIP Code 33545 f��i�,'� �J�°'°'��e�`-.�°� . y yy� ��,•' Signature � Date _� 6,� Telephone 813-973-2092 '*�°l'�I1tt10811N1�� 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. For Insurance Company Use: Buiiding Street Address(including Apt.,Unit,Suite,and/or Bldg.NoJ or P.O.Route and Box Na Policy Number 910 Lantana Avenue City Clearvvater State FL ZIP Code 33767 Gompany NAIC Number . SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agentJcompany,and(3)building owner. Comments Lowest machinery is a/c pad. �^,,. Signature r� / Date / �J ( c+ ' �� w� ❑ Chedc here if attachments SECTION E-BUILDING EL N 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 Cert�cate is intended to support a LOMA or LOMR-F request,complete Sections A,B, and C. For Items E1-E4,use natural g�ade,if available. Check the measurement used. In Puerto Rico only,enter meters. E1. Provide elavation information for the following and chedc 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�betow 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 Instruetions),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 tocal 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 Secfions A,8,and E are coirect to the best of my knowledge. Property Owner's or Owne�s Authorized Representative's Name Extreme Surveying of Florida,Inc. Address 29340 Rhodin Pla City Wesley Chapel State FL ZIP Code 33545 Signature � � Date �� _�� Telephone 813-973-2092 Comments ❑Chedc here if attachments SECTION G-COMMUNITY INFORMATION (OPTIONALy 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)o�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 Certficate Of Compliance/Occupancy Issued G7. This perrnit has been issued for: ❑New Construction ❑Substantial Improvement G8. Elevation of as-built lowest floor(inGuding 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 fiood elevation ❑feet ❑meters(PR)Datum Local�fficial's Name Title Community Name Telephone Signature Date Comments ❑Check here if attachments FEMA Form 81-31, Mar 09 Replaces all previous editions , OMB No. 1660-0008 U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE Expires March 31,2012 Federai Emergency Management Agency National'Fiood insurance Program Important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION For lnsurance Ca»pany Us�. Poficy Nurnber A1. Building OwnePs Name Thomas Lee A2. Building Street Address(inGuding Apt..Unit,Suite,and/or Bidg.NoJ or P.O.Route and Box No. GoMpany NAtC Number 910 Lantana Avenue City Ciearvvater State FL ZIP Code 33767 A3. Property Description(Lot and Blodc Numbers,Tax Parcei Number,Legal Description,etc.) Mandalay Subdrvision,Biodc 46A,Fortion of Lots 7,8•Fo�io#05-29-1 f�-54666�461-0070 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)residential Horizontal Datum: ❑ NA�1927 � NAD 1983 A5. Latitude/Longftude:Lat.27- - 2.9 Long.8 -4,3.9-30.7_ A6. Attach at least 2 photographs of the buiiding if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 8 A9. For a buiiding with an attach�i 9arage: A8. For a buiiding with a crawispace or enciosure(s): 1 O� Sq� a� Square footage of attached garage n/a s4� a) Square footage of crawlspace or enclosure(s) b� No.of permanent flood openings in the attached garage b) No.of permanent flood openings in the craw�sPace or y��.p�e��jac�ent grade n!a enclosure(s)within 1.0 foot above adjacent grade $� �i� �� Total net area of flood oPenings in A9.b n/a sq�� c) Total net area of flood openings in AS.b d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B2.Coun Name �'�e B1.NFIP Community Name&Community Number Pinellas ty FL City of Clearvvater I 125096 B4.MaplPanel Number B5.Suffix 66.FIRM Index 67.FIRM Panel 68.Flood B9'AO use base flood depth)one 12103C/0102 G Date Effedive/Revised Date Z�S� 11.0' 8-18-09 9-3-03 B10. Indicate the source of the Base Flood Etevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile � FIRM ❑ Community Determined ❑ Other(Describe) NAVD 1988 ❑ Other(Describe) 611. lndicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � No B12. Is the building located in a Coastat Barrier Resources System(CBRS)area or Othervvise Protected Area(OPA)? ❑ Y� � Designation Date nla ❑ CBRS ❑ OPA SECTtOtd C-BUILDING ELEVA710N INFORMATION(SURVEY REQUIRED} G1. Building elevations are based on: ❑ Construdion Drawings" ❑ Building Under Construction* � Finished Construction 'A new Elevation Certificate will be required when construction of the building is camP�ete. C2. Elevations�'n��e�ing dia�qram(�specified i Ite�n A7�se thehsa►�e datv�g�'AwA1-A30,AR/AH,AR/AO. Complete Items C2.a-h below acco 9 Benchmark Utilized F-03 Vertical Datum NAVD 1988 Conversion/Comments n/a Check the measurement used. feet meters(Puerto R'�co only) a) Top of bottom floor(including basement,crawlspaoe,or enclosure floor)6 2 ��t ❑mete►s(Puerto R'�co onty) b) Top of the next higher floor feet ❑meters(Puerto Rico only) c) 8ottom of the lowest horizontai structural member(V Zones only) Na. ❑{�et ❑meters(Puerto Rico only) d} Attached 9ara9e(top of slab) - {�t meters(Puerto Riccw only) e) Lowest elevafron of machinery or equipment servicing the building 4.9 � � (Describe type of equipment and location in Comments) 3� �feet ❑meters(Puerto Rico only) fl Lowest adjacent(finished)grade next to building(LAG) 4 4 �{Bet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) -- �t �m�Q��puerto Rico,�only) 5..;�„��,li&]+)�,�� h) Lowest adjacent grade at lowest elevation of dedc or stairs,including n/a. ❑ � structural su ort * '•• � � �of�i SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION R -'�i ;o• •••°•°• ; � This certification is to be signed and sealed by a land surveyor,engineer,or archited authorized b�w��ti�vation :(J c�,` �. information. 1 cefifY U�at the ir►�wrnetio►►ort this Cer6ficate represenfs my best efforts iv u►te►pre ; _ W _ _ 1001. !understand that any false staterr�rrt maY be Pmrishabfe by fine or imprisonment under 98 U.S. Code,Se�on r � o • � Chedc here'rf c�mments are provided on badc of form. Were latitude and longitude in Section A provided by a � •.',�..,��'j� a; licensed land surveyor? � Yes ❑ Na •' 'fl.°`�. ' .`'' `ii' r ° r..,,`��`, License Number 5318 �l��r�°••� •��"�°�1`�� Certifier's Name Alex Thompson,Jr. �� •• �� rf�f�r�rNt�t11��! Title Professional Surveyor Company Name Extreme Surveying of Florida,Inc. Address 29340 R in Place Ci{y WQSIey Chapel State Fl ZIP Code 33545 / Telephone 813-973-2092 Signature 2 �a� i-zyF-�( �'' Replaces all previous editions �Gnea Fnnn 81-31.Mar 09 See reverse side for continuation. IMPORTANT: In these spaces,copy the corresponding information from Section A. Far Insurance Gompany Use: �, Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Poticy Number 910 Lantana Avenue City Clearwater State 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 official,(2)insurance agent/company,and(3j building owner. Comments Lowest machinery is a/c pad. Signature Date ,f . � � �`�7 � ❑ Chedc here if attachments SECTION E-BUILDING EL ION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND Z�NE A(WITHOUT BFE) For Zones AO and A(without BFE),complete ftems E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,cornplete Sections A,B, and C. For Items E1-E4,use natural grade,'rf 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 enGosure)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 platforrn 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 infoRnation in Seetio�G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owners authorized representative who completes Sections A,B,and E for Zane A(without a FEMA-issued or community-issued BFE) or Zone AO must sign here. The staiements in Sections A,8,and E are co�rect to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Extreme Surveying of Florida,Inc. Address 29340 Rhodin Place City Westey Chapel State FL ZIP Code 33545 Signature � � Date �� .�,.!�/ Telephone 813-973-2092 �x � Comments ❑Chedc here if attachmeMs 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 inforrnation. (Indicate the source and date of the etevation 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.Pertnit Number G5. Date Permit Issued G6. Date Certfiqte Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑New Construction ❑Substantial Improvement G8. Elevation of as-buiR lowest floor(inGuding basement)of the building: ❑�eet ❑meters(PR)Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters(PR)Datum G70.Community's design flood elevation ❑feet ❑meters(PR)Datum Local Official's Plame Title Community Name Telephone Signature Date Comments ❑Check here if attachments FEMA Form 81-39,Mar 09 Replaces all previous editions • - Building 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 910 Lantana Avenue Clty Clearwater State FL ZIP COd@ 33767 Company NAIC Number If using the Elevation Certificate to obtain NFIP flood insurance, affix at least finro 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. ��a�:� . ��.��,` r ��'� - , ti t,- /-�, /n-'_' Y r. � _. � ' - "- �" � a._ ' ' r : �� _ '.r �: --_ — _: . �� ` - — � . �y�+� Ra° 9 �`-'"R �..�` S �'` . .. � �fw � �:.. � ' p � � z � �� . `y,.. 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Route and Box No. Poi�cy Number 910 Lantana Avenue Clty Clearwater State FL ZI P COd@ 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. �� ` i �: t�� '�" `;�:� r�� s � �� '� •. � � .. . R�- .�< '' '� � T� " ..?. . __.. _ . -,.,, r,.. z-, . p- �, b,� . _. ,.� .. . . , °"i..n'�'.C.�,'�: .� �; 1 ,...__ •_� ... :�., � ..._� �, _ .,_._ _ � �� ,�... _ k�� ,�, fi �l° r#. �� vj r•`^: `M; �� ,� � "��' � . � ' i �% . •_ ��r��. "t'',.i+ ��`i�_� �.1! ��WT�,�i �r ��`,�:. r('� �k'.� 4 ��k �: ... � } t�a. P�'�.11 ,.{'r 1'�w P' .;.�,, /d . _ • " - . �., n ,� . � .: , � : �+ . ��. '... ��. . . ... .. "�: . �.' � 1 v�....., 'a. . .., . ] ' i: , ; ,... . '. _,v � �a ;;�� .' . . . Y .� �r> . ' . . ' _' . �r. ' .c._ . . S�✓ \:.J. �:.�y 3 . �.TTMALf.T�✓'" . ++� .�ri.iAlR6l � Front View �:� � � �,-�� ;+�'�� <�'� a� h�'"7�, t r� r �`-4f� --__ - -- - --- � �b ",, k �!� . r �- � � ..�._' 3�► � � � :� i�i !� � ,�� : � � - � �.�� . vff_. � Z. - a � I��T , i� .�.; :J ��- - -- ��P _� � � : y.. r - �.. , � � �e i Y �"� � :n� �i � }. " ��'". �!-�V7'�'f ,"�F.k��rry'� ��✓}�y : :�. 5'+sr"�:. �,y� ,.g � Aµ rA`C�n a�w#��`k�t�,+ i# �.f�i � '+` � S " �°' 'f w i . . , �.�>:rye'.. , _._ 'i > •``, . . k*,,��` �x?�;�,'�� y , Rear View