913 METTO STU.S. DE''ARTMEIJT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
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ELEVATION CERTIFICATE
Important: Read the instructions on pages 1-8.
OMB No. 1660-0008
Expires February 28. 2009
Policy Number
A2. Building Street Address (including Apt.. Unit, Suite. and/or Bldg. No.) or P O. Route and Box No.
913 METTO STREET
City CLEARWATER State FL ZIP Code 33755
Company NAIC Number
A3. Property Description (Lot and Block Numbers. Tax Parcel Number. Legal Description. etc.)
10-29-15-68346-000-0110
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory. etc.)
A5. Latitude/Longitude: Lat. N 27.97605 Long. W 82.79385
A6. Attach at least 2 photographs of the building if the Certificate is being used
A7. Building Diagram Number 1
A8. For a building with a crawl space or enclosure(s), provide
a) Square footage of crawl space or enclosure(s) N/A sq ft
b) No. of permanent flood openings in the crawl space or
enclosure(s) walls within 1.0 foot above adjacent grade N/A
c) Total net area of flood openings in A8.b N/A sq in
'RESIDENTIAL
to obtain flood insurance
Horizontal Datum: ❑ NAD 1927 (E NAD 1983
A9. For a building with an attached garage. provide:
a) Square footage of attached garage N/A sq ft
b) No. of permanent flood openings in the attached garage
walls within 1.0 foot above adjacent grade N/A
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
82. County Name
B3. State
CITY OF CLEARWATER 125096
PINELLAS COUNTY
FL
84. Map/Panel Number
B5. Suffix
86. FIRM Index
87. FIRM Panel
88. Flood
89. Base Flood Elevation(s) (Zone
Date
Effective/Revised Date
Zone(s)
AO, use base flood depth)
12103C-0106
H
5-17-05
5-17-05
AE
21'
610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9.
❑ FIS Profile ® FIRM 0 Community Determined 0 Other (Describe)
811. Indicate elevation datum used for BFE in Item B9: 0 NGVD 1929 ® NAVD 1988 0 Other (Describe)
402. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑Yes ®No
Designation Date NA 0 CBRS 0 OPA
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings' 0 Building Under 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
below according to the building diagram specified in Item A7.
Benchmark Utilized SRD BRASS 015K B.M. #430 Vertical Datum NAVD88
Conversion/Comments NA
(ZI Finished Construction
a) Top of bottom floor (including basement, crawl space, or enclosure floor)_
b) Top of the next higher floor
c) Bottom of the lowest horizontal structural member (V Zones only)
d) Attached garage (top of slab)
e) Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment in Comments)
Lowest adjacent (finished) grade (LAG)
Highest adjacent (finished) grade (HAG)
f)
g)
N.A
N.A
22.58
23.16
Check the measurement used.
® feet
® feet
® feet
® feet
® feet
Complete Items C2.a-g
❑ meters (Puerto Rico only)
0 meters (Puerto Rico only)
0 meters (Puerto Rico only)
0 meters (Puerto Rico only)
❑ meters (Puerto Rico only)
19.E ® feet 0 meters (Puerto Rico only)
22.24 ® feet 0 meters (Puerto Rico only)
-v
0 77
mm
M
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. / certify 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.
Check here if comments are provided on back of form.
ertifier's Name GEORGE A. SHIMP III
ii
JOB# 070132C License Number 6137
le VICE PRESIDENT Company Name GEORGE A. SHIMP 11 & ASSOCIATES, INC.
Address 3301 DESOTO BLVD. SUITE D
tatiic
4 p
City PALM HARBOR State FL ZIP Code 34683
Date 6-12-08 Telephone 727-784-5496
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IMPORTANT: In these spaces, copy the corresponding information from Section A.
Building Street Address (including Apt.. Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
913 METTO STREET
City CLEARWATER State FL ZIP Code 33755
For Insurance Company`Use:
Policy Number
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 (3) building owner.
Comments C2.e) AIR CONDITIONER
Sig ature
t
Date 6-12-08
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 El -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.
El. 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 0 feet ❑ meters ❑ above or ❑ below the HAG.
b) Top of bottom floor (including basement, crawl space, or enclosure) is ❑ feet ❑ meters ❑ above or 0 below the LAG.
E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9 (seeage 8 of Instructions), the next higher floor
(elevation C2.b in the diagrams) of the building is ❑ feet 0 meters ❑ above or [below the HAG.
E3. Attached garage (top of slab) is ❑ feet 0 meters ❑ above or 0 below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is 0 feet ❑ meters 0 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 0 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, 6, 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.
31. 0 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. 0 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. 0 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: 0 feet 0 meters (PR) Datum
G9. BFE or (in Zone AO) depth of flooding at the building site:
❑ feet 0 meters (PR) Datum
Local Official's Name
Title
Community Name
Telephone
Signature
Date
•
Comments
0 Check here if attachments
FEMA Form 81-31, February 2006
Replaces all previous editions
•
CITY OF CLEARWATER
DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
POST OFFICE Box 4748, CLEARWATER, FLORIDA 33758-4748
MUNICIPAL SERVICES BUILDING, 100 SOUTH MYRTLE AVENUE, CLEARWATER, FLORIDA 33756
TELEPHONE (727) 562-4567 FAx (727) 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
Al. 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.
A6. Attach at least 2 photographs of the building if the Certificate is being used
A7. Building Diagram Number
A8. For a building with a crawl space or enclosure(s), provide
a) Square footage of crawl space or enclosure(s)
b) No. of permanent flood openings in the crawl space or
enclosure(s) walls within 1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b
•
Horizontal Datum: 0 NAD 1927 ❑ NAD 1983
to obtain flood insurance.
sq ft
sq in
A9. For a building with an attached garage, provide:
a) Square footage of attached garage sq ft
b) No. of permanent flood openings in the attached garage
walls within 1.0 foot above adjacent grade
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
62. County Name
B3. State
B4. Map/Panel Number
B5. Suffix
B6. FIRM Index
Date
B7. FIRM Panel
Effective/Revised Date
B8. Flood
Zone(s)
B9. Base Flood Elevation(s) (Zone
AO, use base flood depth)
B10. Indicate the source of he Base Flood Elevation (BFE) data or base flood depth entered in Item 69.
0 FIS Profile ❑ FIRM ❑ Community Determined
0 Other (Describe)
B11. Indicate elevation datum used for BFE in Item B9: 0 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 0 N
Designation Date ❑ CBRS 0 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.
C2. Elevations — Zones A1 -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, ARAE, AR/A1-A30, AR/AH, AR/A0.
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 0 feet ❑ meters (Puerto Rico only)
(Describe type of equipment in Comments)
0 Finished Construction
Complete Items C2.a-g
Comments:
.11evation certificates shall be maintained by the community and copies
e of Review: Community Official:
th the attached memo made available by request
FRANK HIBBARD, MAYOR
GEORGE N. CRETEKOS, COUNCILMEMBER
PAUL F. GIBSON, COUNCILMEMRER
i
JOHN DORAN, COUNCILMEMBER
CARLEN A. PETERSEN, COUNCILMEMBER
"EQUAL EMPLOYMENT AND AFFIRMATIVE ACTION EMPLOYER"
•
Building Photographs
See Instructions for Item A6.
For Insurance Company Use:
Building Street Address (including Apt., Unit, Suite. andior Bldg. No.) or P.O. Route and Box No,
913 METTO STREET
Policy Number
City CLEARWATER State FL ZIP Code 33755
CompanyNAC 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.
following,
• - ,
MOR471,.•: .
.111-
411
FRONT VIEW
PICTURE TAKEN 6-10-08
Building Photographs
Continuation Page
,rt
Building Street Address (including Apt., Unit, Suite. and/or Bldg. No.) or P.O. Route and Box No.
• 913 METTO STREET
For Insurance Company Use.
Policy Number
City CLEARWATER State FL ZIP Code 33755
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."
REAR VIEW
PICTURE TAKEN 6-10-08
•
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� OMB No. 1660-0008
U.S. DE�rARTMEf3T OF HOMELAND SECURITY ELEVATION CERTIFICATE Expires Februarv 28.2009
Federal Emergency Management Agency
National Flood Insurance Program Important: Read the instructions on pages 1-8.
SECTION A-PROPERTY INFORMATION For Insurance Company Use:
��1. Building Owner's Name PINELLAS HABITAT FOR HUMANITY, INC. Policy Number
A2. Building Street Address(including Apt., Unit, Suite,and/or Bldg. No.)or P.O. Route and Box No. Company NAIC Number
913 METTO STREET
City CLEARWATER State FL ZIP Code 33755
A3. Property Description (Lot and Block Numbers.Tax Parcel Number. Legal Description.etc.)
10-29-15-68346-000-0110
A4. Building Use(e.g.. Residential,Non-Residential,Addition,Accessory,etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. N 27.97605 Long.W 82.79385 Horizontal Datum: ❑ NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 1
A8. For a building with a crawl space or enclosure(s),provide A9. For a building with an attached garage, pravide:
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 AB.b N/A sq in c) Total net area of flood openings in A9.b N/A sq in
SECTION B-FLOOO INSURANCE RATE MAP(FIRM)INFORMATION
B1. NFIP Community Name&Community Number 62.County Name 63.State
CITY OF CLEARWATER 125096 PINELLAS COUNTY FL
64. Map/Panel Number 65.Suffix 66. FIRM Index 67. FIRM Panel 88. Flood 69. Base Flood Elevation(s) (Zone
Date Effective/Revised Date Zone(s) AO, use base flood depth)
12103C-0106 H 5-17-05 5-17-05 AE 21'
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 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 NA ❑ CBRS ❑OPA
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY RE�UIRED)
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. Com�lete Items C2.a-g
below according to the building diagram specified in Item A7. (7 �
Benchmark Utilized SRD BRASS DISK B.M.#430 Vertical Datum NAVD88 � m �'°�''s
Conversion/Comments NA � �
Check the measurement used. � �„ �
a) Top of bottom floor(including basement,crawl space,or enclosure floor)_ 23.16 �feet ❑meters(Puerto Rico only) � `s Z �
b) Top of the next higher floor N.A �feet ❑ meters(Puerto Rico only) � � �� �
c) Bottom of the lowest horizontal structural member(V Zones only) N.A �feet ❑meters(Puerto Rico only) �„� � w �
d) Attached garage(top of slab) 22.58 �feet ❑meters(Puerto Rico only) � /'j
"� .0 C� II_�'C'"_,
e) Lowest elevation of machinery or equipment servicing the building 23.16 �feet ❑meters(Puerto Rico only) � .,,.� � ��
(Describe type of equipment in Comments) � �
f) Lowest adjacent(finished)grade(LAG) 19.80 �feet ❑meters(Puerto Rico only) � �
g) Highest adjacent(finished)grade(HAG) 22.24 �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 certily that the information on this Certificate represents my best efforts to interpret the data availab/e.
I understand that any false statement may be punishab/e by fine or imprisonment under 18 U.S. Code, Secfion 1001.
� � ;'r��''y�;,
� Check here if comments are provided on back of form. '�„.���`r fi,,i,'-
� `n, K� rt':
�ertifier's Name GEORGE A.SHIMP III JOB#070132C License Number 6137 � , �'r�,� �s�� "'
le VICE PRESIDENT Company Name GEORGE A.SHIMP II&ASSOCIATES, INC. �� •"
.�+�'t 3'� r,T .��'
Address 3301 DESOTO BLVD.SUITE D City PALM HARBOR State FL ZIP Code 34683 �J��,�; j 4'� '��,�
�v
i atun���� � Date 6-12-08 Teiephone 727-784-5496 ��0��'��D��b�
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. - '
IMPORTANT: In these spaces, copy the corresponding information from Section A. For msurance�;ompany'�Jse:
Building Street Address(including Apt.. Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Policy Number
913 METTO STREET
City CLEARWATER State FL ZIP Code 33755 Company NAIC Number
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)AIR CONDITIONER
Sig ature Date 6-12-08 ,
� Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REGIUIRED)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(including 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 m ust sign here. The statements in Sections A,8, and E are correct to ihe 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 Official's Name Title
Community Name Telephone
Signature Date •
Comments
❑Check here if attachments
FEMA Form 81-31, February 2006 Replaces all previous editions
.w��.��,� �7 "�` '
�° �� "` C ITY OF C LEARWATER
�.
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• ��� ��
8�.4� DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
' POST�FFICE BOX 474g� CLEARWATER� FLO�DA 33758-4748
rt `' �y' MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CLEARWATER,FLO�unn 33756
TELErxoNE(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 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
61. NFIP Community Name&Community Number 62.County Name 63.State
B4. Map/Panel Number 65.Suffix 66. FIRM Index B7. FIRM Panel 68.Flood B9. Base Fiood 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 buiiding ❑feet ❑ meters(Puerto Rico only)
(Describe type of equipment in Comments)
Comments:
�e of Review: Community O�cial:
levafion certificates shall be maintained by the community and copies with the attached memo made availab/e by request
FRANK HIAAARD,M.4YOR
GEORGE N.CRE7'EKOS,COUNCILMEMAER JOIIN DORAN,COUNCILMEMBER
PAUL F.GIBSON,COUNCILMEMBGR � CARI.EN A.PE7'ERSEN,COUNCILMEMBER
��EQUAL EMPLOYMENT AND AFFIRMATIVE ACTION EMPLOYER��
� / T
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 rvumber
913 METTO STREET
Clty CLEARWATER State FL ZI P COde 33755 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,
following.
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� FRONT VIEW
PICTURE TAKEN 6-10-08
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Building Photographs
Continuation Page
For insurance Company UsP
i Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Poi�cy rvumber
913 METTO STREET
�
IClty CLEARWATER State FL ZIP Code 33755 Company NAIC Number
I� 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."
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PICTURE TAKEN 6-10-08
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