300 MIDWAY ISLAND � ' ' �,�p 1,�0�-- �10�;; I. --- _ �, �'n; can a� �S,"-«�cFrw
. u.s.DEPARTMENTOFHOMEUINDSECURtTY ELEVATION CERTIFICATE oMSNa. �sso-000s
Federai Emergency Manaqement Agency Expires MarCh 37,2012
Natlonal Fload lnaurance Propram important: Read the instrudions on pages 1-9.
3ECTION A-PROPERTY INFORMATION For Inaurance Company Ube:
A1. Butlding Ownera Name FERNAID,GARY M.AND KIMBERLY PaUcy Number
A2. Butlding Strest Addnsss(including Apt.,Unit,Suite,andlor Bldg.No.)or P.O.Route end Bon No. Company NAIC Numder
300 MIDWAY ISIAND �
Cky CLF.�IRWATER Stete Fl. ZIP Code 33T8T
A3. Property Desaiption(Ld erd Blodc Numbers.Tax Pareai Number.Legoi Daec�tion,etc.)
LOT 74,UNR 31SlAND ESTATE3 OF CLEARWATER
AA. Bullding Usa(e.g.,Reeiderdisl,Non-Rs:identiai,Add�ion,Acosssory,eta)RESIDENTIAL
A5. L.atttudelLor�Rude:Lat.�,58,49'�, Long.$2_40'45" Horizontal Datum: ❑ NAD 1927 � NAD 1883
AB. Attach at bast 2 photopropha ot the 6ullding tf the Certllipite id bNnp used to obtsin flood insuronca.
A7. Building DiaQr�m Number 1
A8. For a buflding wfth a crawispaoe or enc�oEUre(e): A8. For a buNding with an attached 9sreps:
a) Squ�ra footege of crawlepace or endoaure(a) � sq ft e) Square fodsys of aCached par�e �,g/ aq R
b) No.of permanard floa!opsninys tn the crawlspaoe or b) No.of pertttAnent flood opentnpe in tl�e�ftached ysrage
sncbsuro(i)within 1.0 foot above edjaaM grade within 1.0 foot abovs adjacent grade
c) Totai nst aroa of flood openin9s in AH.b sq in c) Totaf net area of flood openinpe in AB.b sq in
d) En0lneerod Aood opsnings? ❑ Yea ❑ No cn En�ineerod flood Openinps7 ❑ Yes ❑ No
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SECTION B-FLOOD INBURANCE RATE MAP�FIRM)INFORMATION
B1.NFIP Community Name 3 Communfty Number S2.CouMy Name 89.St�te
CLEARWATER 126098 pINELIAS FLORIDA
64.MaplPanel Number B5.3uffoc B6.FIRM Index B7.FIR Panel B8.Flood B9.Baea Flood Elevatlon(s)2one
12103C0102 t3 Dete EMeetivs/Rev(sed Date Zone(a) AO,use base flood depth)
9-03-03 8-03-03 AE 11.0
610. tndicaM the source of ths Bass Fiood Eisvatlon(BF�dah or baea 11ood dspth eMersd In item B9.
Q FIS Proflie 181 ��wN ❑ Community Detertnined ❑ Other(Detcribs)
B11. Indicate abvatlon d�tum u�ed for BfE In Itsm B9: ❑Nt3VD 1928 � NAVD 1988 ❑ dher(Dsecaibe�
812. Is the bulidinp locabed in a Coastrt Bsrrier Resourcer System(CBRS)aroa or Othe�Protecxed Area(OPA)? [] Yes � No
Deei�natlon Dste 1,� ❑ CBi2S ❑ OPA
SECTICN G-BUILDINO ELEVATION INFORMA710N(SURVEY REQUIRED)
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C1. Buffdir�elevatla�s are bsaed on: ❑ ConsVuctlan Dravdnge' ❑ Buitdin�Under Ca�eWc�ion" � Finishsd Conshucdon
'A nsw Htevadon Csttl�cate wiA be roquirod when cor�struGion of the buRdinp is complete.
C2. Elev�tions—Zones A1a430,AE,AH,A(w�h BFE),VE,V1 V30,V(with BFE),AR,AR/A,AR/AE,AR/A1,A30,AR/AH,AR/AO. Compb�a ltame C2.afi
betow acxordfny to d�e butiding diayram apecifled in ltem A7. Use the same daturn as the BFE.
Benchmsdc tltlHzed C�,,�yyAT��.6""Verticai D�lum t�}(��i 7.42
Conversion/Cbmments�
Chsdc the meaaurement uaed.
a) Top of bottom 11oor(tncluding bexn+ent.crawlsP�,or andoaure floor)�•$� �fest ❑msbers(Pusrto Rico,oNY�� , ,
b) Top ot the ns�d hlgher floor �• ❑fest ❑metsrs(Pu�rto Rk6,oniy) `
c) Bottom oi Me Iowest horisonW sUucturel membsr N Zonea only) 1,�/ . ❑test ❑msbrs(Puerto Rk:c ony)
d) Atteched garaye{top of slab) ¢.�,Q �iset ❑msbers(PueRo Rioo only)
e) Lowe:t sievatlon of machinsry or squipment servidnp the bu�ldinp �.,�, �isst ❑meEers(Puerto Rtcn onlj� -
(Dasaibe type of equlpment and tocatlon fn Commerrts) : ,,. `
ry Lowest adJacent(flnished)�rade ne�d to bulldlnp(LAti) �•g �femt ❑mstere(Puerto Rlco ony) :
p) Hfghed adjaceirt(1lnished)grade ne�fp buildin9(HAO) $•Z �fsat ❑mebsrs(Puerto Fdivo only)!
h) Lowsst ad]acant prade at towest alevatton of dedc or stalrs,Indudinp I�,. ❑feet ❑meUsrs(Pusrto Rico oMy)
structural support
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8ECTION b-SURVEYOR,ENOINEER,OR ARCHIt�CT CERTIFlCAT10N '
Thfs certifiCadon Is to be sipned end�ealed by�land aunreyor,englneer,or arohlGsd outhoritad by fnw to osNfy alevAtion
iMoanation. t c�e�rtffy that M�e ir�fomratfon on d�is faertlRcete rep�asar+ta my best eNb�fa 6o intsrp�t Ohs deta avsltsbb.l
underatand that any falae statement may be puMahebh by fine or�mpd�nment under!8 U.S.Coda,Secdon f Ot?f.❑
Chedc here ff oomments are providsd on brdc of fortn. Were latidide end lonpitude in 3ectlon A piovided by a .
Iicensed land surveyor? � Yss ❑ No ,.,.,
CertNler'a N�me WILLIAM C.KEATING Ucense Numka�er 1528 � �
LAND S R Company Name ALtIED 3URVEYlNt3
Addross 1273 N IGHLAND AVE. ity CL ATER Stete FL P ode 33755 ��
Sigrmturo De�e Ot-02-10 Telephone 727-�46-1283
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Building Photographs
See Instructions for item A6.
For tnsvrar�e.�omparry Use:
Building S#reet Address(inctuding Apt.,Unit,Suite,ancUor B�g.No.)or P.O.Route and Box No. Paiey�v�4er
#300 lsAIdWAY iSLAND
City CLEARWATER Stcli6 FL ZIP COd@ 33767 Ca�nYCVAICN�
If using the Elevation Certificate to obtain NFiP flood insurance, affix at least two building photographs below according to
the instructions for Item A6. lde�tify all photographs with:date taken;"Front View"and"Rear View";and, if required, °Right
Side View" and `Left Side View." tf submitting more photographs than will fit on this page, use the Continuation Page,
following.
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PIG'�'UItES TA.KEN: DE C. . 3 0 , 2 0�0 8
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