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320 PALM ISLAND NE' U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important Read the instructions on pages 1-9. OMB No. 1660-0008 Expires March 31, 2012 SECTION A - PROPERTY INFORMATION Ftir Insurance Ce 1papyUse: 'Al . Building Owner's Name Ricky L. Johnson )uirj� A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 320 Palm Island S.E. Company .NAiG,Number City Clearwater Beach State FL ZIP Code 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 20, ISLAND ESTATES OF CLEARWATER UNIT 6A A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) A5. Latitude/Longitude: Lat. 27d 59' 02.07" N. Long. 82d 49' QQ,73" W. A6. Attach at least 2 photographs of the building if the Certificate is being used A7. Building Diagram Number 1A A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosures) NA - sq ft b) No. of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade ff c) Total net area of flood openings in A8.b MA sq in d) Engineered flood openings? 0 Yes ® No Residential Horizontal Datum: 0 NAD 1927 In NAD 1983 to obtain flood insurance. A9. For a building with an attached garage: a) Square footage of attached garage 481.7 sq ft b) No. of permanent flood openings in the attached garage within 1.0 foot above adjacent grade NA c) Total net area of flood openings in A9.b Nee► sq in d) Engineered flood openings? 0 Yes ® No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number Clearwater 125096 B2. County Name Pinellas 83. State Florida 84. Map/Panel Number 85. Suffer B6. FIRM Index 87. FIRM Panel 88. Flood 89. Base Flood Elevation(s) (Zone 12103C 0102 G Date Effective/Revised Date Zone(s) AO, use base flood depth) 9/3/03 9/3/03 AE 11.0' 810. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. 0 FIS Profile In FIRM ❑ Community Determined 0 Other (Descxle) B11. Indicate elevation datum used for BFE in Item 89: ❑ NGVD 1929 ® NAVD 1988 0 Other (Describe) 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 0 Yes Designation Date 0 CBRS 0 OPA ® No SECTION C - BUILDING ELEVATION INFORMATION (SURVEX E.Fcct SEP)$Y �J j �( C1. Building elevations are based on: 0 Construction Drawings* 0 Building Under Construction' FmidhBdCohStruclion *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations - Zones A1 -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30 FQ/1i//e.'gomplete items C2.a-h below according to the building diagram specified in item A7. Use the same datum as the BFE. Benchmark Utilized 350/360 Harbor Passaoe Vertical Datum NAVD 1988 PLANNING & DEVELOPMENT Conversion/Comments a) Top of bottom floor (including basement, crawlspace, or enclosure floor) f.$ b) Top of the next higher floor ILA c) Bottom of the lowest horizontal structural member (V Zones only) NA d) Attached garage (top of slab) g.Q e) Lowest elevation of machinery or equipment seiviang the building Z.Q (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to budding (LAG) $.$ 9) Highest adjacent (finished) grade next to building (HAG) $•$ h) Lowest adjacent grade at lowest elevation of deck or stairs, including NA structural support cXWATER ® feet ® feet ® feet ® feet ® feet ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) 0 meters (Puerto Rico only) ® feet 0 meters (Puerto Rico only) ® feet 0 meters (Puerto Rico only) In feet 0 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. 1 certify that the information on this Certificate represents my best efforts to Interpret the data avallable.1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.0 Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a licensed land surveyor? In Yes 0 No Certifier's Name Edward D. Murphy License Number 5333 Title Professional Land Surveyor Company Name Murphy's Land Surveying, Inc. Address 5750 1111 Avenue N. City St. Petersburg Signature FEMA Form 81-31, Mar 09 State FL ZIP Code 33710 Date 9122110 Telephone 7271347-8740 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt, Unit, Suite, and/or BIdg. No.) or P.O. Route and Box No. 320 Palm Island S.E. City Clearwater Beach State FL ZIP Code 33767 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 C2e = A/C Signature Date 9/22/10 0 Check here if attachments SECTION E - BUILDING ELEVA710N IN RMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete s El and C. For Items E1 -E4, use natural grade available. El. Provide elevation information for . following and grade (HAG) and the lowest adja • t grade (LAG). a) Top of bottom floor (including . - _ crawls If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B, the measurement used. In Puerto Rico only, enter meters. • the appropriate boxes to show whether the elevation is above or below the highest adjacent , or endosure) is 0 feet 0 meters 0 above or 0 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 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is 0 feet 0 meters 0 above or 0 below the HAG. E3. Attached garage (top of slab) is 0 feet ❑ meters 0 above or 0 below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is 0 feet 0 meters 0 above or 0 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? 0 Yes 0 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 owners 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 Owners or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments SECTION G - COMMUNITY INFORMATION (OPTIONAL) 51 Check here if attachments 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. 01. ❑ 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 offical 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 G4-09) is provided for community floodplain management purposes. G4. Permit Number 05. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for. 0 New Construction 0 Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: 0 feet 0 meters (PR) Datum 0 feet 0 meters (PR) Datum 0 feet 0 meters (PR) Datum G9. BFE or (in Zone AO) depth of flooding at the building site: G10. Community's design flood elevation Local Official's Name Title Community Name Telephone Signature Date Comments l Check here if attachments FEMA Form 81-31, Mar 09 Replaces all previous editions 1•111111111111\ 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. 320 Palm Island S.E. Policy Number City Clearwater Beach State FL ZIP Code 33767 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. DATE: 9/20/10 FRONT VIEW: REAR VIEW: • U S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood insurance Program ELEVATION CERTIFICATE Important. Read the instructions on pages 1-9. OMB No. 1660-0008 Expires March 31, 2012 SECTION A - PROPERTY INFORMATION Al. Building Owner's Name Ricky L Johnson A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 320 Palm bland S.E. City Clearwater Beach State FL ZIP Code 33767 a;. g 401 a t3 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 20, ISLAND ESTATES OF CLEARWATER UNIT 6A A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory. etc.) A5. Latitude/Longitude: Lat. 27d 59' 02.07" N. Long. 82d 49' 00.73' W. A6. Attach at least 2 photographs of the building lithe Certificate b being used A7. BuiidIng Diagram Number ,i@ A8. For a building with a crawlspace or endosure(s): a) Square footage of crawlspace or endosure(s) N,g sq ft b) No. of permanent flood openings In the aawispace or endosure(s) within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b d) Engineered flood openings? ❑ Yes ® No sq in Residential Horizontal Datum: 0 NAD 1927 ® NAD 1983 to obtain flood insurance. A9. For a building with an attached garage: a) Square footage of attached garage 4811 sq ft b) No. of permanent flood openings in the attached garage within 1.0 foot above adjacent grade f c) Total net area of flood openings in A9.b M9 sq In d) Engineered flood openings? 0 Yes ® No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number Clearwater 125096 62. County Name Pineltas B3. State Florida B4. MaplPanel Number 135. Suffix B6. FIRM Index '. B7. FIRM Panel B& Flood 89. Base FloOd Elevation(s) (Zone 12103C 0102 G Date Effective/Revised Date Zone(s) AO, use base flood depth) 913/03 9/3/03 AE 11.0' 810. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. 0 FIS Profile ® FIRM 0 Community Determined 0 Other (Describe) B11. Indicate elevation datum used for BFE in Item B9: 0 NGVD 1929 ® NAVD 1988 0 Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 0 Yes ® No Designation Date ❑ CBRS 0 OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: 0 Construction Drawings' 0 Budding 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, ARIA, ARAE, 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 ,950/360 Harbor Passage Vertical Datum NAVA 1988 Conversion/Comments a) Top of bottom floor (Including basement, crew lspace, or enclosure floor) 11.$ b) Top of the next higher floor 11.64 c) Bottom of the lowest horizontal structural member (V Zones only) NA d) Attached garage (top of slab) kJ/ e) Lowest elevation of machinery or equipment servicing the budding LQ (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) ,2.5 g) Highest adjacent (finished) grade next to building (HAG) . ti.$ h) Lowest adjacent grade at lowest elevation of deck or stairs, including NA structural support RECEIVED BY: V.J.K Chedc the measurement used. ® feet ❑ meters ® feet ❑ meters (Puerldi r y) 2018 ® feet ❑( . Rico on feet El L. • kS VELOPMENT ® feet ❑ meteliPiftr@Rketr@ARWATER ® feet ❑ meters (Puerto Rico only) ® feet 0 meters (Puerto Rico only) ® feet 0 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 infomtation. I certify that the information on this CertVacate represents my best efforts to Interpret the data avallable.l understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.0 Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a licensed land surveyor? ® Yes 0 No Certlfier's Name Edward D. Murphy License Number 5333 Title Professional Land Surveyor Company Name Murphy's Land Surveying, Inc. Address 575011' Avenue N. City St. Petersburg Signature FEMA Form 81-31, Mar 09 State FL ZIP Code 33710 Date 9/22/10 Telephone 727/347-8740 See reverse side for continuation. Replaces all previous editions ti - 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. 320 Palm Island S.E. City Clearwater Beach State FL ZIP Code 33767 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 C2e = A/C Signature SECTION E - BUILDING ELEVAION IN For Zones AO and A (without BFE), complete and C. For Items E1 -E4, use natural grade, El. Provide elevation information for grade (HAG) and the lowest ad a) Top of bottom floor (including EZ E3. E4. E5. Date 9/22/10 0 Cited( here if attachments RMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) E1 available. following and grade (LAG). crawkipa . If the Certificate Is intended to support a LOMA or LOMR-F request, complete Sections A. B, the measurement used. In Puerto Rico only, enter meters. the appropriate boxes to show whether the elevation is above or below the highest adjacent or enclosure) is 0 feet 0 meters 0 above or 0 below the HAG. b) Top of bottom floor (including basement, crawispace, or enclosure) is . 0 feet 0 meters 0 above or ❑ below the LAG. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is❑ feet 0 meters 0 above or 0 below the HAG. Attached garage (top of stab) is 0 feet 0 meters 0 above or 0 below the HAG. Top of platform of machinery and/or equipment servidng the building is • 0 feet 0 meters 0 above or ❑ below the HAG. 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? 0 Yes 0 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, 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 X( Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local offidal 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. 01. ❑ 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 haw to certify elevation information. (Indicate the source and date of the elevation data In the Comments area below.) G2. ❑ A community offidal completed Sedion 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 connmunity floodplain management purposes. G4. Permit Number 05. Date Pernik Issued G6. Date Certificate OfCompliance/Occupancy Issued G7. This permit has been issued for. 0 New Construction 0 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 budding site: 0 feet 0 meters (PR) Datum 310. Community's design flood elevation 0 feet 0 meters (PR) Datum Local Official's Name The Community Name Telephone Signature Date Comments f1 Check here if attachments FEMA Form 81-31, Mar O9 Replaces all previous editions Building Photographs See Instructions for Item A6. For 1cit4rice..20.MOa.nY.Use:' Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 320 Palm Island S.E. City Clearwater Beach State FL ZIP Code 33767 Company t .4AIC 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. DATE: 9/20/10 FRONT VIEW: REAR VIEW: 3 2 0 P A L M I S L N E FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 BCP2009-01120 NATIONALFLOODINSURANCEPROGRAM Expires December 31, 200: ELEVATION CERTIFICATE ELEVATION CERTIFICATE FUTRAL-ANDERSON, REBECCA �m rtarrt: Readtheinstructionson a es1-7. Zoning: IEOD atlas#258B SECTIONA-PROPERTYOWNERINFORMATION For�nsuranceCanparryuse: BUILDING OWNER'S NAME _ Policy Number S ' Tide VIII Investments BUIlDi1�3 STREET ADDRESS(tnduding Apt.,Unit,Sufte,and/or Bkig.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number 320 Pakn�land NE _ • C�7�' - STATE ZIP C --- Clea�nrdter FL 33767 , � (� � PROPERTY DESCRiP'TION(lot and Blodc Numbers,Tax Parcel Number,Legal Description,etc.) —• .-� Island Estates Of Cleannrater UnR 6-B Lot 76/05/29/15/43434J000/0760 BU�iUSE(e.g.,Residerdial,Non-residerrtial,Addition,Acoessory,etc. Use a Comments area,iF necessary.) FEg Z 6 Zp09 LATRUDEILONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(f ( �-#�-#�.� or �#.� ❑NAD 1927 ❑nu���ss3 ❑usGS .�LOP1� ....R�lt�e� �EPT , SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION -� ..:. .�. � B1.NF� NA�E 8 CONMUN(TY NUM1ABER B2.COUNTY NAME 63.STATE CYyo(G�n�ei1125096 Pa�Ras FL B4•AAAP AND PAt�I 67.FIRM PANEL B9.BASE FLOOD ELEVATION(S) tJl1A�BER � 65.SUFFIX 86.FIRWt INDEX DATE EFFECTIVEIREVISED DATE 88.FLOOD ZONE(S) (Zaie A0,use deptli of floodirg) 12103C 0102 � SC3103 9r03r03 AE 11.00 810,Ir�e 1he saaoe of the Base Fbod Fleyation(BFE�dala a base flood depth entered in B9. . ❑FIS Profile �FIRM ❑Canmunity Determined ❑Other(De.scribe):_ B11.Irx�e ihe elev�on dadam used fa ihe BFE in 89:�NGVD 1929 �NAVD 1988 ❑Other(Desaibe):_ B12.is tlie b�xj located�a Coastal Barrie�Resouroes System(CBRS)area a OU�erwise Proteded Area(OPA)? ❑Yes �No Desi nation Date � SECTION C•BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1.8t�ng ele�rations are based o�: Cor�struction prauuings` ❑Buikling Under Constnxtion' �Finished ConsUucUon "A new Elev�on Ce�ic�te w�.be required when oonstn�dion d the building is oomplete. C2.Bu�ng Diagram�1(Seled the bu�ng�iagram most similar to the buikling fa which this certificate is being completed-see pages 6 and 7. if no tliagram aoaratelY r�fs the bu�ng,prnvide a sketch a pt�tograph.) C3.Elew�a�—Zones A1�13(1,AE,AH,A(with BF�VE,V1-V30,V(with BFE),AR,AWA,AWAE,AWA1-A30,AR/AH,AR/AO Complete Items C3.-a�i befav aoca[�ng to the ng diagram speafied in Item C2.State the datum used.If the datum is different fran the datum used fa the BFE in Sec6on B,oonve�t Ihe dabum�O that used fa tlie BFE.Show field measurements and datum oonversion caiculation. Use the space prrn�ded or the Comments�ea of�_ Secfion D or Secfion G,as appropriate,to document ihe datum oonve�sion. �,�;i a �3�J 3 Da4xn NAVD 1988 ConversioNComments PCED Autal A , �3'��»:3��w., � .�X -- �:,� �, ,;�-. FJeva6on aefe�er�ce mark used Au�l A Does the ele�+a6on refe�ence mark used appear on the FIRM? ❑Yes �No ' •- '�"' � j �� ,.-��f�. � ` a)Top of boltom floa('�baserr�ent a enclosure) 5. 97 ft.(m) �' � i,�� ,�'�L�j(� �' 'f ' . b)Top of next higher floor N/A._ft.(m) � � r ','#�� � d:,, t '', c)Bot�m d low2st haizontal sUudur�mernber(V zones only) N/A._ft.(m) �,, � , :"� °'" °, �7 � :a � � �Attad�ed 9arage(top of siab) 5. 94 ft.(m) �� E�!����. � .:1 V�, , �� ~ e)low�elevaGon of madd�imery and/a equiExnent W.� � , � � . ��' serviang the bu�n9(Descnbe�a Corrunents area) 5.94 ft.(m) E� .,i�,"a'� � �'�r` . "�'� � � � �Lawe�adjaoent������) 5.2 ft.(m) z� .�'�..... ..`�1�1 A� h) d perrna�ent openings(flaod vents)within 1 ft above ad'aoent grade p 5. 7 ft.(m) U ,, ,;�fr j'a�` � �; ������3� � � �.�:� J )Total area of ad permar�ent openirgs(flood v�nts)in C3.h 0 sq.in.(sq.an) 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 that fhe infom►ation in Sections A,B,and C on this cerfificafe 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 Secfion 1001 CERTIFIEf7S I�tAA�E Denros J.Eyre LICENSE NUMBER 2865 T�TIE Profe�onai Land SurveYa COMPANY NAME Geodata Syste,rns Inc. �� CITY STATE ZIP CODE ���� � Clearwater FL 33765 � � DATE TELEPHONE 6/6/05 727-447-1763 FEMA rm 81-31,January 03 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces,copy the corresponding information from Section A. For ir�uranoe com�any use: BUILDING STREET ADDRESS(Ir�lud'mg A�.,Unit,SuiEe,andla Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number 320 Palm Island NE �� STATE ZIP CODE Company NAIC Nurnber �� FL 33767 SECTION D-SURVEYOR,ENGINEER,OR ARCHRECT CERTIFICATION(CONTINUED) Copy both sides o�this Elevation Certificate f&(1)oanmunity official,(2)insur�ce agenUoanpany,and(3)building awn�. COMMEh(TS } a ; ❑Chedc here if attachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) Fa Za�e AO and Zone A(witl�out BFE',oomplete ftems E1 through E4. If the Elevabon Cer6ficate is intended fa use as supporting information for a LOMA a LOMR-F, Section C must be oanpieted. E1.Buikl'uig Diagram Number 8(Se�Ct the buildng�diagrarp most similar to the buil�pg for which this certificate is being completed—see pages 6 and 7. If no diagram aca irately �esents ihe buikfug,pruvide a sketch or ptatograpFr.) ; E2.1�he�op of tlte bottom floor(induding baSerr�ent a endosure)of the building� 0 ft.(m)_in.(an)�above or ❑below(chedc one)tlie highest adjaoent grade. (Use r�nai grade,if available). E3•For Buil�ng Diagr�s 6-8 wifh ope�tings(see page�,the next higher floor a devated floa(elevation b)of the building is _ft.(m)_in.(cm)above the highest adjacent grade. Corr�pi�e iterr�,s C3.h and C3.i on front o�fam. E4.The top of ihe pl�fam of machir�y andlor equipment se�viang the building is 0 ft.(m)_in.(an)�above or ❑below(check a�e)the highest adjacent grade. (Use n�ural grade,if available). E5.Fa Zone AO a�ly: If no flood depfh number is available,is fhe top of the bottan floor devated in accad�ce with the community's fbodplain management ordinanoe? ❑Yes ❑No ❑Unkna�m. The local official must certify this infamabon in Section G. SECTION F-PROPERTY 0�1�VNER(OR OWNER'S REPRESENTATNE)CERTIFICATION The prope�ty oMrt�er a o�'s aufhorized nepresenta�ive who cornpietes Sedions A,B,C(Items C3.h and C3.i only),and E fa Zone A(without a FEMA-issued a canmunity- issued BFEj a Zone AO rrwst sign here. 11 ae statements in Sedrons A,B,C,and E a�a correcect to the best of my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME . �. ��� CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS ❑Chedc here rf attachments SECTION G-COMMUNITY INFORMATION(OPTIONAL) The bcai anaal who is auft�aized hy lauv a adin�e to administer the oanmunit�s floodplain managerr�ent adinance can complete Secfions A,B,C(a E),and G of this Elevation Certifiwte. Cor►�ete tl�e applic�ble it�n(s)and s�Jn L�eluw. �1.�The infam.�on i��Section�was iaken trom otl�er document�ion that has been sic�ed and embossed by a licensed surveyor,engineer,a architect who is authorized by state a bcal law to oefi(y elevatan u�fama�ai. (In�Cate Uie source and date of the devation data in the Canments area below.) G2.0 A ocxzvrr�rriry official�ed Sea`rxi E fior a bu'�d'ing bcated in Zone A(without a FEMA�ssued or community-issued BFE)or Zone A0. G3.�The idlc,�!�aig i�fortt�nn(Itaris G4G9)is provided for carrnunity floodptain managerr�ent purposes, G4.PERMT NUtu�ER � G5. DATE PERMIT ISSUED G6.DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7.This permit has been issued fa: ❑New Constn�Uion ❑Substan6al Improvement G8•FJeva�on of as�uilt loavest floa(indu�ing basernent)of the building is: _._ft.(m) Datum:_ G9.BFE or(in Zone AO)depth of flooding at the building site is: _._ft.(m) Datum:_ LOCAL OFFICIAL'S NAME TITIE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS ❑Check here if attachments FEMA Form 81-31,January 2003 Replaces all previous editions