330 PALM ISLAND SE U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
Federa?Emerge�cy ManagementAgency Explres MarCh 31,2012
National Flood Insurance Program Important: Read the instructions on pages 1-9.
SECTION A-PROPERTY INFORMATION C�ti�r��'i;�rlp�ny Ulee:
A1. Building Owner's Name Donna Eliason Revocable Trust ���fb�l" `
A2. Buitding Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. w �'�IpBfly f+LA C NUmbBC
330 Palm Island SE
Ciry Clearwater State FL ZIP Code 33767
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Parcel ID#05-29-15-4341&000-0210
A4. Building Use(e.g.,Residential,Non-Residential,AddiBon,Accessory,etc.)Residential
A5. Latitude/Longitude:Lat.27.9836635 Long.-82.816985 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) N/A sq ft a) Square footage of attached garage 320 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 0 within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b 0 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 Community Number B2.County Name B3.State
City of Clearvvater 125096 Pinellas FL
B4.Map/Panel Number 65.Suffix 66.FIRM tndex 67.FIRM Panel B8.Flood B9.Base Fiood Etevation(s)(Zone
12103C0102 G Date Effective/Revised Date Zone(s) AO,use base flood depth)
&1&09 9-3-03 AE 11'
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)
611. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other ' ��� �� (� ��
812. Is the building located in a Coastal Barrier Resources System(CBRS)area or Othervvise Protected Area( c{°„�,�
Designation Date N/A ❑ CBRS ❑ OPA � � � � � �
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY QUIRE
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C1. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Constructi n' Fiid�4cd�ons e� n
'A new Elevation Certificate will be required when c;onstruction 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-A3 ,AR/AH, . Complete Items C2.a-h
below according to the building diagram specified in Item A7. Use the same datum as the BFE. P�NNrN�$���v��,o���N'('[��PT
Benchmark Utilized CITY CLWT H-4 Vertical Datum 4.499T(N.A.V.D.I ���d�������j0�'���j
Conversion/Comments N/A
Check the m .
a) Top of bottom floor(inGuding basement,crawlspace,or enclosure floor)7.56 �feet ❑meters(Puerto Rico only)
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)
d) Attached garage(top of slab) f.8 �feet ❑meters(Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building 8.24 �feet ❑meters(Puerto Rico only)
(Describe type of equipment and location in Comments) s
fl Lowest adjacent(finished)grade next to building(LAG) 6.7 �feet ❑meters�'(Puerto Rico only)
g) Highest adjacent(finished)grade next to building(HAG) ¢.� �feet ❑meters(Puerto Rico only)
h) Lowest adjacent grade at lowest elevation of dedc 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
infortnation. I certify that the information on this Ce�cate represents my best e�fats to interpret the data available.
I understand that any false statement may be punishable by�ne or imprisonment under 18 U.S.Code,Section 1001. � �,"� �i'; , �
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� Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a � <:i`,.•��c;r!r•„�� . `f
licensed land surveyor? � Yes ❑ No ` �r�' , . �,; �
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Certifier's Name Philip C.Stock License Number RLS#3035 � '`''``'"
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Title President Company Name Target Land Surveying,Inc. �, - �-��-
Address 516 Lakeside Place City Largo State FL ZIP Code 33771 ���3`������ _
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Signature r Date 12-23-11 Telephone (727)784-0573 ..�.�--�`~ ,
FEMA Form 8 -31, Mar 09 See reverse side for continuation. Replaces all previous editions
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330 PALM ISLAND
BCP2011-12242
RESPONSE TO COMMErdTS
ELIASON, DONNA
Zoning: Island Estates Neighbor Atlas#: 258B
IMPORTANT: In these spaces,copy the corresponding information from Section A. `F�°It�lfit�l�ofnpany We:
Buildirtg Street ddress(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. a � Nilfiirf�dl`",
330 Palm Island SE '"�I;;i � x,s �� "
City Clearwater State FL ZIP Code 33767 �Ct11'�l�t; IC�IUfMbelr''
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SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community offlcial,(2)insurance agenUcompany,and(3)building owner.
Comments
Job# 111220.03
C.2.e)=AJC Unit
According to the Pinellas Counry Property Appraiser,this house was built in 1968. At that time,FEMA Flood Maps did not exist.
Signature � Date 12-23-11
� �L ❑ Chedc 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 infortnatfon for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent
grade(HAG)and the towest adjacent grade(LAG).
a)Top of bottom floor(including basement,crawlspace,or endosure)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 communiry's floodplain management
ordinance? ❑Yes ❑ No ❑ Unknown. The local official must certify this informabon in Sectlon 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 carect 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 INFORMA�'ION(OPTIONAL)
The local official who is authorized by taw or ordfnance 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. Chedc 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 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 pertnit has been issued for: ❑New Construction ❑Substantfal Improvement
G8. Elevation of as-built lowest floor(including basement)of the buflding: ❑feet ❑meters(PR)Datum
G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters(PR)Datum
G10.Communiry'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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Building Photographs
See Instructions for Item A6.
For Insurance Company Use:
! Building Street Address(inciuding Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Poiicy Number
` 330 Palm Island SE
Clty Clearwater State FL ZIP CQd@ 33767 ComparryNAlCNumber
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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.
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For Insurance Company Use:
r Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Poiicy Number
' 330 Palm Island SE �
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F Clty Clearwater State FL ZIP Code 33767 Compeny NAIC Number
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' 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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"Right Side View"— Pictures Taken 12-23-11
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