60 MIDWAY ISLAND � U,S.w�EPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
Federal Emergency ManagementAgency Expires Ma�Ch 31,2012
National Flood insurance Program Important: Read the instructions on pages 1-9.
SECTION A-PROPERTY INFORMATION For Insurance Company Use:
A1. Buiiding Owner's Name GEORGOPOULOS,JONAS S.�MARIA E. Policy Number
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bidg. No.)or P.O.Route and Box No. Company NAIC Number
60 MIDWAY ISLAND
City CLEARWATER State FL ZIP Code 33767
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
LOT 5,ISLAND ESTATES OF CLEARWATER UNIT 3
A4. Buitding Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)RESIDENTIAL
A5. Latftude/Longitude:Lat.27 5 ' 2" Long. 28 .48�38„ Horizontal Datum: ❑ NAD 1827 � 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 buitding with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) N/A sq ft a) Square footage of attached garage � sq ft
b) No.of permanent flood openings in the crawlspace or b) No.of peRnanent flood openings in the attached garage
enclosure(s)within 1.0 foot above adjacent grade 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
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 62.County Name 63.State
CLF�IRWATER 125096 PINELLAS FLORIDA
B4.Map/Panel Number 65.Suffix B6.FIRM Index 67.FIRM Panel B8.Flood 69. Base Flood Elevation(s)(Zone
12103C0102 G Date Effective/Revised Date Zone(s) AO,use base flood depth)
9-�3-03 9-03-03 AE 11.0
610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
❑ FIS Profile � FIRM ❑ Community Determined ❑ Other(Describe)
B11. Indicate elevation datum used for BFE in Item 89: ❑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 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-2ones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFEj,AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO. Compfete Items C2.a-h
below according to the building diagram specified in Item A7. Use the same datum as the BFE.
Benchmark Utilized CLEARWATER G-03.5 "*"'Vertical Datum NAVD'88 *"ELEV.7.42
Conversion/Comments N/A
Check the measurement used.
a) Top of bottom floor(inGuding basement,crawlspace,or enclosure floor)5.56 �feet ❑meters(Puerto Rico only)
b) Top of the next higher floor 14.�0 �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) 4.�7 �feet ❑meters(Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building 4.86 �feet ❑meters(Puerto Rico only)
(Describe type of equipment and location in Comments)
� Lowest adjacent(finished)grade ne�ct to building(LAG) 4.1 �feet ❑meters(Puerto Rico only)
g) Highest adjacent(finished)grade next to building(HAG) 5.1 �feet ❑meters(Puerto Rico onty)
h) Lowest adjacent grade at lowest elevation of deck or stairs,including N/A. ❑feet ❑meters(Puerto Rico only)
structural support
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation
information. 1 certify thet the inbrmatron on this Certificete represents my best efl`orts to interpret tha dsta available.! r
.. ,
understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.❑ • �`��'��:.�;- °' a
Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ,' � «���1' �
licensed land surveyor? � Yes ❑ No •�' f.,
.�.r.��� •• ;
CertifiePs Name WILLIAM C.KEATING License Number 1528 r
''Fa` �i�t.:.. 3 ��
Title LAND SURVEYOR Company Name ALLIED SURVEYfNG ' '.� `��,�,� � �-
a. , ca.
Address 1275 NO.H ND AVE City CLEARWATER State FL ZIP Code 33755 � ��'�
Signature ,�' Date 12-30-10 Telephone 727-446-1263 f�!, �
W,�t�
.� ._ �/
,•
' � ' g�i�iding Photogra�phs
See Instructions for Itsm':A6.
�or lisuranoe Gompany,Use:
.Building Stre�tAddress�(inciudin9 Apt�U+vk�uibe,G.►idlor Bklg.No.)or P.O.Route and Boac Ncf. �P.:aicy�_N�rnbei�. .� � .
# 60 MIDWAY ISLAND .
City State F� �IP Code �y��,�„�,.r
CLEARWATER FLORIDA 33767 �
�If using the Elevation Certificate to abtain NF!t' flood insurance, affi�c at least two huil,�ing photographs below according_to
the instructions for ItQm A6. Identify all pk�pto�r�phs with: date taken; "Front View° an�"Reac View'; and, if required, "Right.
Side View" and "Lef[ Side View.' lf SUl�rpitti��, more photographs than wiN fit on thi� page, use ihe Continuation Page,
following.
FRONT REAR
-- _- .
" �-��, ��i�"����o-,�` ';_ #+��. , x -,.-,-_—__—____---� � _-
' � L�� � ��' ir1 , '� �F � �
�
-�.
. r � f "�' � � � �` �..,. �-
_
, �,. <
� ��:�r � � I - � �-
�
� - _ a5 �''
N- _� . , . _ ,. ;
- �,. . z
�
.-
,,.... ��... . �.. '� .
` � �+ ._
`� -:� . .-
�"z -:.._. , . ,�:�.
.r
� --- - -�' ,:... � ....
„. ..... �•..ri.. -. . . . ,
,ww"��` ��7"' :.r�°� �' �� � � -
r � , . � �. . . :;� �,a '.
`.,_.� i:; . . �.�.. �` -s.
. .L v�a ... "'• . ' �y,_.
: .. ,..... .
.:. ' .� ,'.•;�; ,. :;v,- , r,:•�::....,.. , -' �" ,. ' .
�j�.:.. , .�.; �:.ii,�.. �_�...� .� ' � - � ' �
. i. �
� �,S � ��,� �„f� . y � � � �.�
� ,�,����`� Y�t'' �'L-�'�` �w.r :,f �,.
z� ^e5�,.�r ''��.:
� u .,ae: 2:, 3=, '�` �' .c',,�` ��S .
... .._ . . . . .... . .....�+...__ .. _.._ ..t,r,^'�.,. .
�°
.
.
PIC'�'URF��TA][�N : DEC. 3 0 , 2 010