331 PALM ISLAND SEu.s.�,��rroF�w�r,�s�c�nr ��„�1iAT�Cihf CEE�T��IC,�1�E
FEOERAL E�Y3E�itCY AtAM11CiEMEIWT A6ENCY
�N`unoioal FJt�a�ef Jr�wwm�Jhn,�rane �f[#[�iOFtdlit: Read t(�e i�strwctioas on #�ages 9 9.
SECT�N A — PRCfP�RTY' INFCfftMATld�f
At. BuNdi� Owr►eR's P�ame Kee�hh P. Maarrisor►
+0.2. 8uil�g Stneei lt+ddt�e88 (i�uling Aptr Un�r S�t�. 8ndlof Btd�: NO. j 4r fx.Q. ROUte 8tld BC% NO.
331 i'artm tsiarn# tVE
City ClesrvMate�' Sta6e FL ZI�' Cade 33T67
Nuctlb�s,
Lot'iU3, Ut�2 66: tsf8tld EstEt6e� E
csn�e r�o. �sau-cr�a
Eacptraiion Dat,�: Jul�t 3'�. 2�t�
f14, 8e�r►� Use (e.a.. R�esftJcMlai. Nanr�esidenfliaif, ,4�ddi�or�. Avicessan,�. e�c.j es�
AS. Latk��gll�fe: Lai.27:984�B+t N t.nt►g. 82.�i7!}�3 WV Hori�orttal Daturn: 0 NAa 4327 � NAt) i983
AS. At#�ch � teast 2 ptw�r'sphs af the buieling it the Ga�iificaba is brsin� t�asd ta c3biain flood ir�su�ance_
A7. B+�tldin�g E3fagram I�rnbar 1a
AB: Por a a,+�d�►g w� a crawtsPs�e or enc�os�re�s):. n9i. Par a�uikiinB,rriih an sttaeE�ed gacaee=
�1 ��9� �f erawlspace oe eneasure(s} Na sq tl �� Sq�Ne botage af �taehad ge�8pe 588 sq tt
bj Numbe�r oi permar�nt Roo�d apeni�gs in ft� cra+M�p�ce b� Hunfber at pan►tiarient Aood operrin� ��a aEtachad 9acages
ar sndasure($j w�it� 1 A foot aba�ve adjacertt grade nl� within t_fl foofifi ahove �soent grade 0
c) 7a� ne# sir+ea of f�od openings irt AS.b Na sq iR cj TWai raet sres cN �Oad op�s a2 /k�.ts tu�a � in
di Eragineera�t ilood+�en�gs? � Yes � No dj ErMB�arad"ftood �? []' Yes @,� hicr
SEGT��1 B- FLOOD INSUR�tNCE RATE i4�AP {f�dj:lNFQRM�At�KN�
Bf. NfIP Gomrr�rtity Name 8� Ccrnmtmity Ncimber 62. Caunty hiame 63. State
Gty ot �leatwater.125�198 PineNaa FL.
sa. lt�fav� �c�e! Number Bs. 5uf�x Bs. FlRM hxiex t�a�e ' a7. FtRM Pae�l ea, .�tood ss, e�se flaod: Hevak�e�t�ifzene
��'�co�n2 +� o�ro3ros �,ra�� a �ate �s� ��, �a �� aa �P�h�
Bio. Md� ttte scsr� c,f ihe sase flaad Eieva�wn �BFEj ciata or Uase twod aepcn en� m ttem e9.
❑ FFS Rro�le � FtfiM ❑ Cammut�ty Determined p+DtMrfSou�e: _____
Ba 1. Indicate akvatlo� tlatcu�s t�s�d �orBFE in item^ 89: ��l+�VQ 9�29 (� NA1►D 1988 0 t�er/Saur�e:
Bt 2. Is �� 1oca6e+3 �t a CoasEat, Saxder Resaurces Syst�rn (C���BRSj :are� or t?�nwise t'notncted ltrea �+�'A�? � Yas � Na
Des3gnation �ta:.�„_, [j CBRS C� 0PA
S�CTltil�t C- B!!lLdtNG ELEVATION :tMFE)R�1iATiaN {SiiRYEY 1tE4U1R€13�
C7. Be��dk+g ete+�ations are bsrs�ed an: � Construdbn Orawings' Q 8u�rlf� iJnder Eanstr�on` � FJn�shed GarsWc�iqn
•A new Elev� Ger1i� w� be req�re�d when corssUt�ctGort of !t►e buifcifr�p ls carn�ete.
G2; Ete3r�ions - Zex�as A1-��c30, AE, A�[. A(�!h BFEj. 4�E, Vi-1t30, V{w� BFEj, AR, AR1A, AIxEAE: ARtA4-+430� ARf,�HR ARIAD. Compiete �ams C2:�i-fi
bebw �ex�di�9 bO tha 6� d�r�r� s�d i� Etem A7.1rt Pusrtrs ftico aaly. s2rt�er m+�srs. _
B�'IGt�rrf�EklJ1il�Ed: LOCAL VE�tliiCei, [)BttJfrf: 1�FAV[!9$
ind"rcate ekwatian e�r► u�ed for #he ellewat� fa !!en►� a} through h} txe�w. LI N(3Vt)1929 �1 NAV"D 1988 � 03Aer15o�e:
t7atum useet ior buitd'et� el�+,setior►s ma�st be !he sa�rne as lhst t�ett !'a' ihe B�E.
Ct�ddc #he measutameai c�d:
�� Tc�p of bottorn flo�or (indud'xzg baisemen#, cr$wtsPace, ex enclasure lfoaj
b} TOp ai tfle fi�ext hi�ser fkia'
c) sot�n ot tne lowest tfw�izorst�t �ru�#urat meRS►ber (v zones onlY�
�y �� g�� � �r ��
e� Lovirr,at ek+u�a#iKxra�xerau�M►exy;+x+nqu�ttiseMcf� tha buNdi�g
{�esanbe type a[ equiprt�ent and ta�tian in ComrneMs�
ri ����,� i���� �� �,r�►9 n.�G}
9} }.�9hest sdjaasnt �4RNstr�i� gcade riext ta buitding �HAG)
h} t.o�we�t 8d�acetrt gCB�de a! lawrest Netrestat oi deCk Gt 3ta�s. �tdruling s4�Irai sup�soit
8.6T
t�i'8.
nta.
s.s�
6.08
s,a
s.1
nt�._
� t�t Q meters
0� 0�
Q fse! ❑ meters
� te�t p rnebers
f� te+nt C7 rr�atefs
�� o��
i� f�et ❑ me�ers
D fe�t p naeters
SfCTtQN D_�URVEYOR; ENG��IEER, QR ARCHiTECT �ER?IFIC�4TitltV
7"!►is ce[lilica�iar is tes t�e s�sd and s�sai�d by a tand su�veyor, engineer, or s�chite�ct ac�harmad by iaw t� e�rtffy elevation
inf�sstian. t r�r;Fy �hst �re;�ai�n i� rh�s �cate rap,a��2s my eesi e�s !o s�r�re� rt�e +� 8,►ar7s�fe ���,i�•��, ►���,,,`f
1 tmderstarr� �ret 8t�y faise ste�arne�at triay be ptr�habie by fjne ot trr�ris�ment ur►d'sr° t8lJ,S Code, See�icut t�lOt. +'`���,�� �r�W�„�''�*�f�
!� �`•....
�-E:Iteck heta #f taotnmer►ts aara provi<!ed tat� ba�# of �orrrt. t�VerG iatitud+e �cf iongl�ude in Sretiot� J� ptow�ided bya z+ �;;.
: ; Ma. �srs . ••
[J Ct�ck heta N att�ehmer�f$: li�nsed (and surv�epa? � Yes ❑ No -.r �., i=
CetCifier'S t+fatttie J�epdt _E. Wi1N�on� PLS Lit�rtSe t�huntbet 85'i3
� !
c.a.arrss cvi� a.a:n E ea��c.ny r., �a�a s.
�MPfiRT`;Al�i'i: �f9 thSSB Sj?8kC@S, CO�1' �B Cdt`l�5�f011���1� �i1}i}�'�tl�Cl fi'd!i'1 S@'�b1t �.
�,ikiirpg stree3 a�ddress (atiduding n�t., tinet, suite, are�lror ewg. �io.j or P.o. Rcxite ana Box Nv.
331 Ps1m 9stand NE
City Cieatw�aber 8tate PL Z1P C�e 33?B7
SECTI�N �- SURVEYOR, ENGi1riE�R, �!t ARGIfC€ECT GERT#FI�CAT14Nt �CONTiNUED)
Capy bath sides a€ this �i�avatian C�cate for (� } c+amm�r►ity offidat, �2i re�surer�s agenttcomParnj►, and �3j #auikling awrter.
Co�nments ltem C2e was la�e+d on tha {t�� Ccndi�ic�ner Pad
`��
C�T�
SEC"f10N �%— St�tLdlt�G ELE1l,�lTION IHi�4R1Yt�7'i0N (BURVEY I�OT REt�tiIREDj FO�R ZONE AfJ AND ZONf A(WtTMOUT BFE)
FarZcnest AO and A(wilhout BFE}. oom�le� i�ems E1-�5� If �e GeR�ir.ate is ir�rt� fa suppor! a t+Q1+ufA or Lt1tJf}�-F reqcrest, compl�'be Sec�rxts �4, B,
and C. Far 43ems E#-E4, uss natuoa! gracfe, it av�Hahte. Ch+ec�c the measurernent used. tn Puer�o Riccs ontiy!. enter rneters.
E 3. Pravide e�eua�on infc�rnati+oor+ �or �he foUoa�r&tg atuf cheak ihe approprtate �es to shnw whethea� the eleva�on is a6t�ve ar betaw fhe highest ac�acenC
gracle (�iAfa} �d tlte lo4vest �acxni gro�ie (Ut�).
a� Top ot boaam flor�r (nduciing t�semsnt, fxsvAspace. af endosuna) is ,__„^,. ��et C1 me3ers ❑ sbave or Q belaw rt►e HAG.
bj Top oE boltom floov i�tctudin9 bas�etr�ettt, crav�etsp�ice. ar ertdasurej is 0 i�et CC� meaers C� a�ov� cr Q�ao�w n,e u;�.
Ez. For suad�g t7iagrams s-s wta, perrnanent nood opanir�gs provid�d in sedian A� lba� 8 sndtor s(sae ;pages B-� at rnsln,ctions}, tne next higher 800r
�etevation C2.h in tt�e �sy ai the buliding is ❑�eet D met�ers � above or � koelaw ifte HAG:
E3. Af�chsd garagia {fop of s�b) is ____,,;.,___�_ Q teet Q r�ecers t7 $�o�e a p��a �,e Ha�.
EA. Top of pls�ffiorrn af maci�inery andlnr e�uipnrent s�g iha buiid"mg is CI fes2 p me�s C� �� c,r O�w tt,$ r�ac.
E5. Za�e Afl ordy. If r� ttc� tleplh �eu�er is avaiaWe, is ##►a to� of the �m �loar elevgted in moao�ri8rias sv� ttee eaore�munity�s fkwdphain tnan��ent
ordinatat:e? ❑ Yes Q No ❑ Unkncrrm. The b�ca€ �fiCial must cett9fy !f� ir�atma�ori En SeCiton G.
SECi'Kitr1 F- Pi20FERTY ttWNER (OR flWNE1t'S REPRESENTATtYEj GERT#FICA'i't�iN
rne propa�r owr�r o► cwners author�e�d roprasa�Eaii�e wno+eorapr�les sec�na A. a, :ar�d E toR za�e A{witt�oe�t a FEA�Pc-is�uea or. r,orr►�tt�ni�y�rd�d s�Ej
at �t�e At? must si� i�e. Th� a�stemants � Sec�ona A. S. and E are ccne�! Eo th� b�st of my kna++,tedge.
Prope�e#y OwnePs or Ownet's AuUwcizad Re�re�e�tira`s Name
A,ddtess Cily Stafia iiP +Gpde
Si�natttr� ifabe 7e#ephone
C�rntne�ts
❑ Ch�edt. here if attachmettts.
SECTKlN G - Ct?1�IiYi1JNITY t#�t?i�lATit�N �OPTKKlNALj
at tt�ila �IeMadon Ger#fka�e. Go�rapte� !he a�+lic�le �GarKs} antf sign b�ela+w: Clredc tFua mea�eenant
Gi. � litie iirto�ma�ion in Sec�ar� C was takert trr,m a�er dac�meertauan tt� has bean s�gned and seated by � aoensed swv�ya; eng�i�►�aer. ar sri;hitsct wk�o
is aWlsorized by taw aa �fjr Nevarlbn ir�maban. #lnd3r,�ate !he sourco and da�e a� tha e{avatia► da�s M ihe Com�e�#'s ar�a bebw.) '
C2. p a oo�mr�ityr onkial cor�pk�ed s�on E tbr a twu�qng wcated in zone A{v+�houl a FEi�f�a,-issuea a comnaur�ity-irawed BFEj cr zone �4a.
G3. 0 The ��ormaticn (Items`G�-G i 0� is pFO+�tded ia oarnmuNl�r ltoodplain m�agement Purposas,
G4. Perrn�t N�xr►bes Ga. Os�e Petr+�t Isatred C8; Dale Cettl�r,�t� +Df: Compli�ncelt3catp�r�cy lsstied
G7. 1'his pertnit t�.s t�t issued �os: 0 N�W Cot�ttud[ort � Sub�tentlet E�ttpro�emettt
G8, des+ratfon of as-bt� i�wesf tbdr �hduding b�mertt� of the bt�ifding: ❑ feet Q rr�te�^s E)a�tum
t39. B�E tx (irt 24r� Adj tiepth at'llood�g at ttue buiiding s�te: _ Q� 0 rr�eters Q�tum
CfQ. Cc�mm�ttiun�yt`s design Acod elevErtion: ❑ fe�t C'I metets O�rs
Locad Ofllala!'s Eiarrte Title
Cexerr��nity Nsrne Teteptwne
Signatute DaEe
Cornments
_._...�.�.. .,.. _ �,�...��.. �C� Cl3edc ne�iianscnmBnts_
FEMA Form �i86�-D-33 �7112) Repfaves ai# previous edi�c�ns,
EL�VA�'dUN C€�RTiEICATE� �aage 3
TMPCiRTANT. ln these spaces, +�opy the
Build�ng Photflgraphs
See 1�siructions for Ite�m AC.
Infcsrrnation ira� Seotion A.
Suiding SheeE Ad�ess (ins�uding Apl.. Un�E, 8uite, andlar Bidg, P�Eo.� ar P.U. Ro�u#e and 8ox Nc.
S3i Palm isiaad NE
Glty Gle�ter S'tate FL ZlP Code 33767
f4R ftJSUfiANCE GOMP,4N4' USE
Pa�cy N�mber.
Company N1tIC t�umb�r:
tf usir�g �re ENevation Cerrtiffi�aie ta abtair� NF1P flo+ad �surar�ce, afiix at teast 2 buiEding photographs below ac�ording to Che insiructions
tor I#em A6. I�Eentity aMi y�hctographs vratf�► dste taken; "Froni View' and "Rear V�ew": and. if requirett. "Righ�t S�de View" and "Left Side
Vi�w." YV�en applieable. pEtoUa9r�phs must shaw the fQetrttisfiort witlt tepresentative ez��tpEes of #he flood openit�gs or vettts, as
indicated in Section A8. If submitting mo�e �o�agraphs ihan wiff �it on this page, use the Ganti�uataon Page.
r�
Ft�nt of House
FEE�AA �arm U6�-0-33 (7112� RepEar.e�s a�! prevaou� editicans.
Buiic��r�g Ph+ot+�gt�a�►h�
contanuatian Page
1MPORTANT: tn fhese spac�s, copy the corresponding infiormaiion fron� Section A.
Bu�ding Street A�Ic�e�s �inciud�ng Apt.. Un�k, SuNte, and!'ar Sldg. No.j cr P.O. Rau#e and Bax Na.
331 P$im Istand NE
City Cieanvater Sf�Ce FE. ZIP Code 33767
FtOR iNSIlt2AN�E COPAPAN4' tlS�
P'olicy A�um3r�r,
Coa�raparay FF�AAIC �1�mber:
H submi�ting mare photographs #ta� wilE t�t on tt�e precetiin9 Pa�e. a�x the �dditianat p�►c>togwaphs beiow. id�entify al! photagr�phs
with: date #�icen; `Frant �ew`° and 'Rear �eu�'; and, if �equired, `Right S�ie �ew" and `Left Side V'iew.' When applica3�le,
{�hatograph& must show !he fa��dafian with rep�esentative examples of it�e fiood openi�rgs or �ents, as indica%d ir� Sectioc� A8.
Rear of House
�EMA Form 086-0-33 {7f'! 2) Reptace� a!I prev�+c►t+ts edititans.
k1.S.CEPARTMENTOFHOMEUWDSECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
Federal Emergency Manageme�t Agency Ex�ires Februarv 28.2009
National Ftood Insurance Program Important: Read the instructions on pages 1-8.
` SECTION A-PROPERTY INFORMATION For insurance Company Use:
A1. Building Owners Name SUSAN WALTER Policy Number
A2. Building Street Address(induding Apt.,Unit,SuRe,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number
331 PALM ISLAND SOUTHEAST
City CLEARWATER State FL ZIP Code 33767
A3. Property Description(Lot and Blodc N�nbers,Tax Paroel Number,legal Description,et�., 3 31 P A L M I S LA N D S E
LOT 47,UNIT 6A ISLAND ESTATES OF CLEARWATER PLAT BOOK 60,PAGE 90
BCP2009-02435
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) RESIDENTIAL
A5. Latitude/Longitude:Lat.27 59'0•8" Long.82 48'59.3" Horizontal Datum: ❑ NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of Me buildu�g if tt�e CeRificate is being used to obtain flood insurance.
A7. Building Diagram Number 1
A8. For a building wRh a crawl spaoe or endosure(s),provide A9. For a building with an attached garage,provide:
a) Square t�ooffige of cxawl space or enc�osure(s) sq ft a) Squa�footage of aBached garage 5.25 sq g
b) No.of permaneM flood openings in the aawl space or b) No.af pertnanerrt flood openings in the attad�ed garage
endosure(s)walls witfiin 1.0 foot above adjacent grade walls within 1.0 fooR above adjaoent grade 0
c) Total net area of flood openings in A8.b sq in c) ToRal net area af flood openir�s in A9.b 0 sq in
SECTION B-FLOOD[NSURANCE RATE MAP(FlRllln INFORMA'EION
B1.NFIP Community Name�Communily Nixnber B2.CouMy Name gg.g}�
CITY OF CLEARWATER 8125096 PINELLAS FL
84.Map/Panel Number 65.Suffa 66.FIRM Index B7.FIRM Panel 68.Flood B9.Base Flood Elevation(s)(Zone
Date Etfedive/Revised Date Zone(s) AO,use base ftood depth)
12103C0102 G 5/17/05 9/3/03 AE 11
610. Indicate the souroe of the Base Flood Elevation(BFE)data or base flood depth entered in ttem 69.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Describe)
611. Indicate elevation datum used for BFE in Item 69: ❑NGVD 1929 �NAVD 1988 ❑Other(Describe)
612. Is the building located in a Coastal Barrier Resouroes System(CBRS)area or Otherwise Proteded 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 Construdion
'A new Elevation Ce�cate will be required when construdion of the building is complete.
C2. Elevations-Zones A1-A3Q,AE,AH,A(with BFE),VE,V7-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO. Comp m �
below according to the building diagram specified in Item A7. �
Benchmark Utilized H-04 CITY OF CLEARWATER Vertical Datum NAVD88 n �
Conversion/Comments � �
Check the measuremeM used. �' ^
0 � V C!
a) Top of bottom floor(induding basement,crawl space,or endosure floor)_ 5.6 �feet ❑meters(Puerto Rico only) �
b) Top of the next higher floor wA: D t�et ❑meters(Puerto Rico only) �Am" � ,v �
c) Bottom of the lowest horizontal structural member(V Zones only) _._ ❑feet ❑meters(Puerto Rico only) > m �
d) Attached garage(top of slab) 5.1 �feet ❑meters(Puerto Rico only) � �
e) Lowest elevation of machinery or equipment servicing the building 6.1 �feet ❑meters(Puerto Rico only) � �
(Describe type of equipment in Comments) m� �
� Lowest adjacent(finished)grade(LAG) 5.6 �feet ❑meters(Puerto Rico only) � �j
g) Highest adjacent(finished)grade(HAG) ¢.0 �feet ❑meters(Puerto Rico only) � ���,�
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This oertification is M be signed and sealed by a land sunreyor,er►gir�er,or archRed authorized by law to certify elevation
infortnation. I ce�tify that H►e ir►iormation on this Ce►tificate represents my best eflorfs to inteipiet d►e deta avai7'ab/e.
I u�and that any false stafement may be punishable by fine or imprisonment under 18 U S. Code,Section 1001.
� Chedc here if comments are provided on badc of fortn. -
Certfier's Name VINCENT E_CORBITT License Number 4608
Tdle PRESIDENT Company Name LAND PREClSION CORPORATION + ''', a ,�x�
�. r""'p.s�; ��a�_�
Address 2683 E R City CLEARWA7ER State FL ZIP Code 33759 � ; =..yr����� '''.' �
Sign Date 422/09 Telephone 727-796-2737
FE 81-31, February 2006 See reverse side for oontinuation. Replaces all previous edifions
IMPORTANT: In these spaces,copy the corresponding information from Section A. For Insurance Company Us�e:�
Building Street Address(including Apt.,Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Policy Number
331 PALM ISLAND SOUTHEAST
City CLEARWATER State FL ZIP Code 33767 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 LPC#09071 -N/A-NOT APPLICABLE.A/C UNIT IS THE LOWEST MACHINERY SERVICING THE BUILDING.PIN.CO.W.S.STANDS FOR
PINELLAS COUNTY WEB SITE.GRF-G RAGE FINISHED&BAS-BASEMENT/FiRST FLOOR LEVEL LATITUDE&LONGITUDE FROM LABINS.GOV
WEBSITE.NEW ADDITI LFtfl3TH M FLO ELEVATION AS THE ENTIRE HOUSE.SEE PHOTOS.
Signature -- Date 4l22/09
� Check here if attachments
SECTIO -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.
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 o�cial 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,8, 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
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s �o�nments : �
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❑Check here if attachments
�, i ��" ` - '�� SECTION G -COMMUNITY INFORMATION (OPTIONAL)
..r^f'�.—�_� _. i
� The�ocal offi�iai�fvhQ is authonzed by law or ordinance to admirnster the commurnty's floodplain management ordinance can complete Sections A,B,C(or E),
; �-�nd 6r°di this��levataon Certificate. Complete the applicable item(s)and sign below. Check the measurement used in Items G8.and G9.
�...,9' .. �:�� . .�i
° ($1. [�� Tt�_ihfc�rrr�ation in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who
•-:� � .a is��lthorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
- ,�2. Q' A�Cqfn[iiunity o�cial completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO.
.,, � �: �_ i
?� , �3. ❑ T�A foHoyving information(Items G4.-G9.)is provided for community floodplain management purposes.
n - a ,.
°`. G4.Perinit�jjFumber 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
. .
Buiiding 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►vumber
331 PALM ISLAND SOUTHEAST
City CLEARWATER State FL ZI P COd2 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.
GARAGE VIEW FRONT VIEW
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