1530 MAPLE ST U.S.DEPA�'?�MENT�OF HOMELAND SECURITY ELEVATION 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 ��° ' " '� "� '"``` "
�91:,. ,����.
A1. Building Owner's Name d � �bQ��S� ..
Ben'amin A.Brudnicki&Tina R.Brudnicki �`"'�"w" """'"""`° ""�'"w`" "'
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. � p�, I�hb���"°
1530 Maple Street(AddiGon) ��r��'��� ,s���;��,��,„�� ��w �, ��
City Clearwater State FL ZIP Code 33755
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Lots 105, 106, 109, 110,&the East 1/2 of lot 108,Glenwood Subdivision
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential
A5. Latitude/Longitude:Lat.27.971864 Long.-82.773599 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 1B
A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enGosure(s) sq ft a) Square footage of attached garage 380 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 within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes � No
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1. NFIP Community Name 8 Communiry Number 62.County Name 63.State
Ciry of Clearwater 125096 Pinellas FL
64. Map/Panel Number B5.Suffix 66.FIRM Index B7.FIRM Panel B8.Flood 69. Base Flood Elevation(s)(Zone
12103C0107 H Date Effective/Revised Date Zone(s) AO,use base flood depth)
8-1&09 5-17-05 A 49'
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69.
❑ FIS Profile � FIRM ❑ Community Determined ❑ Other(Describe)
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other(Describe)
612. Is the building located in a 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 G o � � �
"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. Comp � � � W
below according to the building diagram specified in Item A7. Use the same datum as the BFE. r- n N �
Benchmark Utilized P.C.D."BREEZE Y"MAP#1491Vertical Datum ELEV=72.45'(N.A.V.D.) � � O
o -- ° D�
Conversion/Comments � W
Check the measurement used. m �
z � �
a) Top of bottom floor(inGuding basement,crawlspace,or enclosure floor)49.76 �feet ❑meters(Puerto Rico only) p
b) Top of the next higher floor 59.09 �feet ❑meters(Puerto Rico only) O rn
c) Bottom of the lowest horizontal structural member(V Zones only) N.A �feet ❑meters(Puerto Rico only) �
d) Attached garage(top of slab) 49.74 �feet ❑meters(Puerto Rico only) � �
e) Lowest elevation of machinery or equipment servicing the building 56.36 �feet ❑meters(Puerto Rico only) �
(Describe type of equipment and location in Comments)
w
f) Lowest adjacent(finished)grade next to building(LAG) 48.2 �feet ❑meters(Puerto Rico only) y
g) Highest adjacent(finished)grade next to building(HAG) 56.4 �feet ❑meters(Puerto Rico only) �
h) Lowest adjacent grade at lowest elevation of deck or stairs,including IV.A �feet ❑meters(Puerto Rico only) J
structural support
_ cfl
L
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 certi(y that the information on this Certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001. � '' ' f a;, '-
♦ . .Z- ��a .r.��/:�' '/�
� Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a : f �*��
licensed land surveyor? � Yes ❑ No t�:�' �f` '• _
�' � 'rifl.�:�3�±
Certifier's Name Philip C.Stock License Number RLS#3035 -
:• ,! ,�
Title President Company Name Target Land Surveying, Inc. - '� �'/ S i�T��' � =�` `
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��� •. Fl.r>��C',.� �;
Address 516 Lakeside Place City Largo State FL ZIP Code 33771 � '�������:���o`�`
Signature , ; � .�. Date 12-09-09 Tele hone 727 784-0573 � - "`f � � - ----
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FEMA Form 81-31, Mar 09 See reverse side for continuation. Replaces all previous editions
IMPORTANT: In these spaces,copy the corresponding Mformation from Section A. ,�,, ,;?�
Building SVeet Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. 'Ppl � hc,�'���;���;�"�y'" ��
1530 Maple SVeet �,,,q;�,�y,,,;,� ,�,, : ��,�,�„„��,� ��
City Clearwater State FL ZIP Code 33755 ' "' � '
.� �.�A � �p
�°�� v.,�`�����,w��'�.�'�,� �,�,�.�'
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
Job#091208.02
C2.e=A/C Unit
No part of the addition falls in a flood zone.
Signature . , _ Date 12-09-09
�`l'22,;�fs �=/__ ��a-� _�--.-.-- ❑ Chedc here if attachments
SECTION E-BUIL G ELEVATION INFO MATION(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.
E 1. 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(inGuding basement,crawlspace,or endosure)is ❑feet ❑meters ❑above or�below the HAG.
b)Top of bottom floor(including basement,crawlspace,or endosure)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&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 bullding 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 offlcial must cerUfy this infortnation in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owner's autho�ized representaGve who completes Sectlons 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 communiry'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 infortnation in Sectlon C was taken from other documentaGon that has been signed and sealed by a licensed surveyor,engineer,or architect who
is authorized by law to certify elevation infortnation. (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 Official's Name Title
Communiry Name Telephone
Signature Date
Comments
❑Check here if attachments
FEMA Form 81-31, Mar 09 Replaces all previous editions
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IMPORTANT: In these spaces,copy the corresponding information from Section A. �of Insu�Gompany Use" �
Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Rd N�rllbef'
1530 Maple Street
City Clearvvater State FL ZIP Code 33755 40I�1p�lny(1�AIC Nl�llber �
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
Job#091016.01
C2.e=A/C Unit
SignatureG'G� --� Date 10-20-09
� ❑ Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO and A(without BFE),complete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B,
and C. For Items E1-E4,use natural grade,if available. Check the measurement used. In Puerto Rico only,enter meters.
E 1. 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(inGuding 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&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 o�cial 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 communiry-issued BFE)or Zone AO.
G3.❑ The following informadon(Items G4-G9)is provided for communiry floodplain management purposes.
G4.Permit Number G5. Date Pertnit Issued , G6. Date Certificate Of Compliance/Occupancy Issued
G7. This permit has been issued for: ❑New ConsVuction ❑Substantial improvement
G8. Elevation of as-built lowest floor(including basement)of the building: ' ❑}e�t ❑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
U.S.DEPF:RTMENT OF HOMELAND SECURITY ELEVATION 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 For Insurance'Company Use:
A1. Building Owner's Name Pollcy Number
Ben'amin A.Brudnicki&Tina R.Brudnicki
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Carrtipsiny NAIC Number
1530 Maple Street
Ciry Clearwater State FL ZIP Code 33755 1530 MA P L E S T
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Lots 105, 106, 109, 110,&the East 1/2 of lot 108,Glenwood BC P2009-10009
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential
A5. Latitude/Longitude:Lat.27.971864 Long.-82.773599 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 1B
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) sq ft a) Square footage of attached garage 380 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 within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes � No
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61.NFIP Community Name&Community Number B2.County Name 63.State
City of Cleanaater 125096 Pinellas FL
B4.Map/Panel Number 65.Suffix 66.FIRM Index 87.FIRM Panel 68.Flood B9.Base Flood Elevation(s)(Zone
12103C0107 G Date Effective/Revised Date Zone(s) AO,use base flood depth)
8-18-09 5-17-05 AE 49'
610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 89.
❑ 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 ❑ 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 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 It m -h
below according to the building diagram specified in Item A7. Use the same datum as the BF . ^ ��D ��D �����
Benchmark Utilized P.C.D."BREEZE Y"MAP#1491Vertical Datum ELEV=72.45'(N.A.V.D.) vu a C� i�
Conversion/Comments ��� � ��/ c �
Check th r e s .� d-•
a) Top of bottom floor(includjn,g basement,crawispace,or enclosure floor)50.26 ' � eet ❑me rs(Puerto Rico only)
b) Top of the next higher floor 59.09 � eet ❑me rs(P�?t�F�or�
c) Bottom of the lowest horizontal structural member(V Zones only) IV.� � eet ❑me rs(Puerto Rico only)
d) Attached garage(top of slab) 49.74 � eet ❑me
e) Lowest elevation of machinery or equipment servicing the building 56.36 � eet p me@rF(IB�i€rb�da d�Ai�N T &
(Describe type of equipment and location in Comments��.^��� N G H B Q F�!-I U d D S E R V I C E S
f) Lowest adjacent(finished)grade next to building(LAG). ` Y�� 48.2 � eet r��t�rs( �to i�o�r�y�W A T E F�
g) Highest adjacent(finished)grade next to building(HAG`� � 56.4 � .e
h) Lowest adjacent grade at lowest elevation of de or st�ir�i?ciyrJirRaG�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. I certify that the inforrnation 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. .' ,;;�'�: •• y��,: �',
�*� r ••
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� Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a � y `"~�..�,`^
� .� .
licensed land surveyor? � Yes ❑ No _ :�o �,����`" �
Certifier's Name Philip C.Stock License Number RLS#3035 - - •� -
. - �'�:;Tc .'.a-
Title President Company Name Target Land Surveying, Ina ••, �=��;`,,,;,, ,:' ,V;�.•
Address 516 Lakeside Place Ciry Largo State FL ZIP Code 33771 ��'°,'. Z D
_ � ,�'�a�,.,�?
Signature � ...�-.- -Dete 10-20-09 Telephone (727)784-0573
� - �
FEMA Form 81-31, Mar 09 See reverse side for continuation. Replaces all previous editions
North
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c� � �� BRUDNICKI, BEN
W �3 Zoning: LMDR atlas#279,�.
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� � " Curve number 2
Q � --------------
� Radius= UNDEF/NED
� Chord= 132.40(M) M
� `�f Chord Brq. S.8 � 43 0 � E ( �
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FND 5/8"lR `— CITY OF CLE/��:t!'JATLR
NO�
1 dG DEPT.
BY �
DATE � ��
F.�r�l�,�per_ (000�
NOT�NC�UDEp REV/SED:
OFF/CE LOCATION: 516 LAKES/DE PLACE TARGET LAND SURVEY/NG, II V C.
LARGO, FLOR/DA 33771
NOT 1/ALID WITHOUT THE SIGNATURE AND P.O. BOX 663
THE ORlG1NAL RAISED SEAL OF A FLORIDA DUNED/N, FL 34697-0663 PH:(727) 784-0573
LICENSED SURVEYOR AND MAPPER. I hereby certify that this survey was mode under my responsible
PREPARED FOR AND CERTIFIED r0: charge and meets the minimum Technical Standards as sef forth
� BENJAM/N A. BRUDN(CKI & TINA R. BRUDN/CK/ by fhe Flor�da Board of Professiona/ Land Surveyors in Chapter
61 G 17, Florida Administrative Code, pursuant to Section 472.027,
Florida Statutes
' Field Survey 12-9-09
��-� ���-� FB# EFB Pg NA
. Phrlip C. Stock
RLS #3035, LB #5570 Job# 091208.02
������6 Drawn By: J.WALKER
CnPYR/<;F,'TQ`, 9n(15 TARGFT I AN/7 Sl/RVFYING /NC_ nATF nF (`F"RTI�I/`dTl�ln/ Siirvava�-1 Rv• P CTnr`v
LEGEND: TP)IS property lies w;thin Flood Zone A as depicted on F/ood Insurance
BM — Benchmork CB — Goncrete Block CL — Centerline CM — Concrete Atonument
fLEV— Elevation FNO — Found IP — !ron Pipe fR — fron Rod ASP — Asphaft Rote Ma Communit Panei J1 � �i f�f
LS�' — Land Surveyor Regiatmtion Number N/f— Noil k Tcb NdrD — Nail& Disk P Y 7l 2/�3C��l/7H Dated: �—�7—OS
M.K — Manhole P.R.M. — Pormonent Re/ercnce Monument R/W— Right Of Way
CONC — Concrcte P.C. — Point OF Curvoturc P.T, — Poirrt Of Tcnqent BENCHMARK:
P.R.C. — Point 0!Reverse Curvaturo P.C.C. — Point Of Compound Curve Ch. — Chord
P.P. — Powsr Pole W.M. — Woter Meter R.R.S. — Railroad Spike RAO. — Rodius BASE FLOOD ELEI/AT/ON: 49�
R — Record 0 — Deed M — Neasured C — Colculotsd D.B. — Deed Book
P.B. — P)at Book O.R. — Officioi Reco�d Book PC — Poge PVM7 — Pavement SECTION__LL_TOWNSHIP�Z.�.�,_RANG�Z.2`�,_
P.0.8. Point Of Be9inning P.O.C. Potnt Of Commencement CH.B. Chord Bearinq BASlS OF BEARINGS:
R.P. — Radius Poi�t CLF— Choin Link Fence P.C.P. — Petmonent Controf Pomt EAST UNE OF LOTS 1 10 & 106 BE/NG S 1 1'47'37"W
P.l. — Point o(lntersection
G£NERAL N07ES:
7. No instruments of record rof/ecting eosements, nghts—o/—way, ond/or ownership were LEGAL DESCR/PTION:
iumiahed, except os ehown.
�. No foundotions or un0erground improvements locoted except o5 stioW�. LOTS 105 9 06 109 AND � 9 0 AND THE EAST 9/2 OF LOT 1 D8,
3. 1(elevatione aro ehown, sucA elevotions oro boeed on N.G.V.O. 7929 MSL � 0.00',
Except Pinellos �a�My whe�e ���a�w�g oro based on NA.V.D. 1988 MS� = o.00� GLENWDOD SUBD/VISJON, ACCORD/N� TO THE M,4P OR PLAT THEREOF
4. Dec(orotion is made to origina!purohaaer o/the survey. It ia not tranaferob/e to
odditionol;�s�;���;o�s o,9�b5�Q����ow���. AS RECORDED lN PL,4T BOOK 8, AT PAGE 14, OF THE PUBL/C
5. Surveyor hos mode no investigotion or independent eeorch !or eosements o!recoM,
encumbronces, rosttictive covenants, ownershi�tit/e evidence, or ony other/acts RECORDS OF P/NELLAS COUNTY, FLOR/DA.
thot an accurote and eurrent tit/e searth mo OisNose.
6. No water metero located except as shown.
7. This Survey is prepored for the axc�usive use of those parties cartilied heroin and
is vofi0 for ane (i)yeor irom Dats of Certificotion.
EASEMENT NOTE PER PLAT.
EACN GRANTEE TOGETHER AGREES THAT UPON REQUESr aF THE PRESEN7 OWNERS Of
ANY PDRTION OF THiS SUBD/U/SIDN TO GRANT EASEMENT OVER TNE PLAT CON—
UEYED FOUR FEET lN W(DTH ALONG THE REAR OF SAlD PREMlSES FOR rHE
� LAYlNG OF CABLES, ERECT/NG NECESSESARY POLES AND SEWER PIPES FOR
� ' THE PURPOSE OF SUPPLY/NG' TELEPHONES AND ELECTRIC L/GHT SERI/!CE
OR OTHER PUBUC SERV/CE TO RESIDENTS OF THE SUBD/V/S10N OR FOR
� � OTHERS S/MiLAR PURPOSES OF CENTRAL PUBLIC /NTREST.
CORNER NOT FNO
� FALLS /N WATER
' LOT 10
NOT /NCC UpEO
LAKE
7RNER NOT FND
itLS !N WATER
S ��eO" ,S�I ��/�/ FND 5/B"lR
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- �or >os --------------
� Radius= UNDEFiNED
Chord= 6. 60(M)
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ELEVATION SERTIFICATE CHECK LIST
City of Clearwater \��'
FOR O.M.B.No.3067-0077- THAT EXPIRES DECEn�IBER 31,2005 !
SECTION A ✓ YES ✓ NO
A1. Building owner's name � �
A2. Complete building address �
A3. Complete property description
A4. Building use (Resident/Commercial)
A5. Latitude/Longitude
A6. Photographs (for flood insurance only)
A7. Building diagram number
SECTION B '
$1. COI11T11UIllt�/I13Tlle & IlUT11be1" �1'_�i)�)U--(.'ii.��rsz:�lt;,i�',�at�-.•t`� -
B2. Countyname (������l�<as)
B3. State (��'i�i��ar�;�)
B4. Map/Panel# (see map) ,S"t�trr,�le-1?1�1�C;U/0?
B5. Suffix (see map) Su»�>>1��: "C>"
B6. Firm index date (see map) " :�;!i.�C'+i;,��t� - �.�?;'%-�
,>u;�ri�lr::
B7. Firm panel effective/revised date (see map cover) 1-.�-!;.�
B8. Flood zone(s) (see map)
B9. Base flood elevation
810. Sot�rce of base floocl �
B11. Elevation datum �
B12. Located in a CBRS area or OPA area
SECTION C CJ v � e �''��° �
C1. Elevation information base
C2. Attached �ara�e (base on dia�rram #) _
C3. Elevations (crawl spaces or enclosure(s) from diagrain #)
SECTION D
D1. Check comment box (if applicable)
D2. Surveyor, engineer or architect certification & seal
SECOND PAGE
A2. Complete building address
SECTION D
D3. Comments (if applicable)
SECTION E
E1. Elevation information (if applicable)
E2. Building diagram (if applicable)
E3. Attached gara�e (if applicable)
E4. Platform of machinery/equipment (if applicable)
E5. Zone (AO) (if applicable)
SECTION F
Fl. Owners representative information (if applicable)
SECTION G (o tional)
G1-9 Completed all section in section"G"
Miscellaneous:
Elevation certificate is complete and correct
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U,.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB NO. 1660-0008
Feder�l Emergency ManagementAgency Expires March 31,2012
National�lood Insurance Program Important: Read the instructions on pages 1-9.
SECTION A-PROPERTY INFORMATION ° � "' ' `'�r'
t�5�.�<��
A1. Building Owner's Name �,���� �^ a
Ben�amin A.Brudnicki&Tina R.Brudnicki ,,.� ,�,„�„s�„ , �;„ ;
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. �ri�" � �
1530 Maple Street �, �';y�'����}�>; �����x;;
City Clearwater State FL ZIP Code 33755
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) 1530 MA P L E ST
Lots 105, 106, 109, 110,8 the East 1/2 of lot 108,Glenwood BCP2009-10009
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential
A5. Latitude/Longitude:Lat.27. 71864 Long.-82.773599 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 1B
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) sq ft a) Square footage of attached garage 380 sq ft
b) No.of permanent flood openings in the crawlspace or b) No.of pertnanent flood openings in the attached garage
enclosure(s)within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes � No
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP Community Name&Community Number B2.County Name B3.State
City of Clearwater 125096 Pinellas FL
64.Map/Panel Number B5.Suffix B6.FIRM Index B7.FIRM Panel BS.Flood B9,Base Flood Elevatlon(s)(Zone
12103C0107 G Date Effective/Revised Date Zone(s) AO,use base flood depth)
8-1&09 5-17-05 AE 49'
610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69.
❑ FIS Profile � FIRM ❑ Community Detertnined ❑ Other(Describe)
B11. Indicate elevation datum used for BFE in Item 69: ❑ 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-h
below according to the building diagram specified in Item A7. Use the same datum as the BFE.
Benchmark Utilized P.C.D."BREEZE Y"MAP#1491Vertical Datum ELEV=72.45'(N.A.V.D.I
Conversion/Comments heCk�N]����d. ��w��
t"'�a
a) Top of bottom floor(inciuding basement,crawispace,or enclosure floor)�Q.26 �f t ❑me�(�rlp�Ri�or�yv E D
b) Top of the next higher floor 59.0� �f t ❑mete ue
c) Bottom of the lowest horizontal structural member(V Zones only) IV.A �f et ❑mete (P i Qnl i
d) Attached garage(top of slab) 49.74 �f et ❑met (P��i�4n1�
e) Lowest elevation of machinery or equipment servicing the building 56.3¢ �f et ❑met erto Rico onl )
(Describe type of equipment and location in Comments) D���' �p��
f) Lowest adjacent(finished)grade next to building(LAG) 48.2 �f �, �p�g e d'Rif:d N T &
g) Highest adjacent(finished)grade next to building(HAG) ,�.4 �f �c rh���,��c�rl�) S E R V I C E S
h) Lowest adjacent grade at lowest elevation of deck or stairs,including N.A � et e�er�(P�i'�to�3`ido�t)FZ H/�Q T� �
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 certify that the information on this Certi�cate represents my best efforts to interpret the data available. ' ' ' ' `�:; ;
l understand that any false statement may be punishable by�ne or imprisonment under 18 U.S. Code,Section 1001. �`�.<, �,? r , � :,�
,` �3�;�',.....:.�'%rj �i
� Check here if comments are provided on back of fortn. Were latitude and longitude in Section A provided by a : ;.,���,:�`.,••. C!, �,
licensed land surveyor? � Yes ❑ No �� � :'�G� `�'t�.�•
Certifier's Name Philip C.Stock License Number RLS#3035 ' 1�°•�u3� ` .' � --
- v _
Title President Company Name Target Land Surveying,Inc. � �{,�„�GT �
Address 516 Lakeside Place City Largo State FL ZIP Code 33771 p � , ^ .• ��
'��d���� :
Signature ^, � .__-..---0ate 10-20-09 Telephone (727)784-0573 � /� `� -�>
�� i ,
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. �or I�u„ ,4�.C�omp,�r)y, se;.. ,,„.
Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. pp�����J�j�� ,
1530 Maple Street a� �� ��� �
Ciry Clearvvater State FL ZIP Code 33755 Co�lqpenyV�NA�C NUmber
a,x �rts.
. � . . ,.
�_. fle� tu
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner.
Comments
Job#091016.01
C2.e=A/C Unit
Signature ., Date 10-20-09
�� _ . ) ❑ Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO and A(without BFE),complete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B,
and C. For Items E1-E4,use 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 enGosure)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&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 o�cial 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 Ciry State ZIP Code
Signature Date Telephone
Comments •
❑Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The local o�cial 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 Secbon 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 infortnation. (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 Pertnit issued G6. Date Certificate Of Compliance/Occupancy Issued
G7. This permit has been issued for: ❑New Construction ❑Substantial Improvement
G8. Elevation of as-built Iowest 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
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U.S.DEPA'RTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB NO. 1660-0008
��ral Emergency Management Agency Expires March 31,2012
National Flood Insurance Program Important: Read the instructions on pages 1-9.
SECTION A-PROPERTY INFORMATION �'� �`� '� ������ ` ������w,�'
A1. Building Owner's Name � '� •'
����:����• u
Ben'amin A.Brudnicki&Tina R.Brudnicki r�:�'� �1.� E��
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. t�t�^�+��� °
1530MapleStreet �.°,�'� ���x'�,�,��.T,����, : ; �
City Clearwater State FL ZIP Code 33755 '
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) �530 MA P L E S T
Lots 105, 106,109, 110,&the East 1/2 of lot 108,Glenwood BCP2009-10009
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential
A5. Latitude/Longitude:Lat.27.971864 Long.-82.773599 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 1B
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) sq ft a) Square footage of attached garage 380 sq ft
b) No.of pertnanent flood openings in the crawlspace or b) No.of pertnanent flood openings in the attached garage
enclosure(s)within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes � No
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61.NFIP Community Name 8 Community Number B2.County Name 63.State
City of Clearwater 125096 Pinellas FL
64. Map/Panel Number 65.Suffix B6.FIRM Index 67.FIRM Panel 68.Flood 69,Base Flood Elevation(s)(Zone
12103C0107 G Date Effective/Revised Date Zone(s) AO,use base flood depth)
8-18-09 5-17-05 AE 49'
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 B9: � NGVD 1929 � NAVD 1988 ❑ Other(Describe)
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Othervvise Protected Area(OPA)? ❑ Yes � No
Designation Date ❑ CBRS ❑ OPA
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. Building elevaGons 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. -h
below according to the building diagram specified in Item A7. Use the same datum as the BF . ,-.,������ �n �nn(7
Benchmark Utilized P.C.D."BREEZE Y"MAP#1491Vertical Datum ELEV=72.45'(N.A.V.D.I VV �� ��
Conversion/Comments �,,�,� ,� � V E D
Check th r e s d.
a) Top of bottom floor(inGuding basement,crawlspace,or enciosure floor)50.26 � eet ❑met rs(Puerto Rico only)
b) Top of the next higher floor 59.09 � eet ❑met rs(P�rt�17�o�or�
c) Bottom of the lowest horizontal structural member(V Zones oniy) N.A � et ❑met rs(Puerto Rico only)
d) Attached garage(top of slab) 49.74 � et ❑met
e) Lowest elevation of machinery or equipment servicing the building 56.36 � et ❑me�(I�G�1��1�{�T �
(Describe rype of equipment and location in Comments) N G H B O R H U U C� �E R V(C�S
� Lowest adjacent(finished)grade next to building(LAG) 48.2 � et (P �to i�o�@n�����T E Fi
g) Highest adjacent(finished)grade next to building(HAG) 56.4 � et �e ' .onl�r.} ---•.-.�-•�H��
h) Lowest adjacent grade at lowest elevation of deck or stairs,inGuding 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 s t s , 'f
information. I certify that the information on this Certificate represents my best e/forts to interpret the data available. �` *� �', � ,
l understand that any false statement may be punishable by�ne or imprisonment under 18 U.S. Code,Section 1001. ��`t�� •• �'r�;,��,
` � •'��,�IF'n;�•,,'.j- '
� Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a �;,� y�rl�•,
licensed land surveyor? � Yes ❑ No � � � �' '
ldo.3435 `?
Certifier's Name Philip C.Stock License Number RLS#3035 -;� ; �y -
J 1 i4.1 L.[�'(` � .�.��
Title President Company Name Target Land Surveying,Inc. ti
ri
, `�.tZ' ?� .
Address 516 Lakeside Place City Largo State FL ZIP Code 33771 �',�'i�� z��,,,�
., �1vp`r,,,'t,`
Signature -- -Date 10-20-09 Telephone (727)784-0573 � �` '
FEMA Form 81-3 , Mar 09 See reverse side for continuation. Replaces all previous editions
IMPORTANT: In these spaces,copy the corresponding information from Section A. .,t�p��g����R�y�j�p,t
Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. pq��q���y�� �
1530 Maple Street
;�:a�� * w .
Ciry Clearwater State FL ZIP Code 33755 ��p��x�������, ��
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
Job#091016.01
C2.e=A/C Unit
Signature „ Date 10-20-09
��`>___
❑ Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO and A(without BFE),complete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B,
and C. For items E1-E4,use 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 enGosure)is ❑feet ❑meters ❑above or 0 below the HAG.
b)Top of bottom floor(including basement,crawlspace,or enGosure)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&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 platfortn 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 communiry'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,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 GS and G9.
G1.❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who
is authorized by.law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
G2.❑ A communiry 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 Official's Name Title
Community Name Telephone
Signature Date
Comments
❑Check here if attachments
FEMA Form 81-31, Mar 09 Replaces all previous editions
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