480 PALM ISLAND SE U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB NO. 1660-0008
� Federal Emergency Management Agency Ex�ires Februarv 28.2009
National Flood Insurance Program Important: Read the instructions on pages 1-8.
SECTION A-PROPERTY INFORMATION For insurance Company Use:
� A1. Building Owner's Name PATRICE S. MAUGHON Policy Number
A2. Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Company NAIC Number
480 PALM ISLAND SE
City CLEARWATER State FL ZIP Code 33767
A3. Property Description (Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.)
LOT 34,ISLAND ESTATES OF CLEARWATER UNIT 6-A (05-29-15-43416-000-0340)
A4. Building Use(e.g., Residential,Non-Residential,Addition,Accessory,etc.) RESIDENTIAL
A5. Latitude/Longitude:Lat.N 27.98475° Long.W 82.81364° Horizontal Datum: ❑ NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of the building if the Cert'rficate is being used to obtain flood insurance.
A7 Building Diagram Number 1
A8. For a building with a crawl space or enclosure(s),provide A9. For a building with an attached garage,provide:
a) Square tootage of crawl space or enclosure(s) NA sq ft a) Square footage of attached garage 767.2 sq ft
b) No.of permanent flood openings in the crawl space or b) No.of permanent flood openings in the attached garage
enclosure(s)walls within 1.0 foot above adjacent grade NA walls within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b NA sq in c) Total net area of flood openings in A9.b 0 sq in
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61. NFIP Community Name&Community Number B2.County Name 63.State
CITY OF CLEARWATER 125096 PINELLAS FL
64. Map/Panel Number 65.Suffix 66. FIRM Index 67. FIRM Panel B8. Flood B9.Base Flood Elevation(s)(Zone
Date Effective/Revised Date Zone(s) AO,use base flood depth)
12103C-0102 G 5-17-2005 9-3-2003 AE 11'
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)
612. 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 RE�UIRED)
C1. Building elevations are based on: ❑ Construction Drawings' � Building Under Construction' ❑ Finished Constr
'A new Elevation Certificate wili 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,AR/AH,AR/AO. Complete � N
below according to the building diagram specified in Item A7. �
Benchmark Utilized CITY OF CLEARWATER I-3.5 Vertical Datum NAVD 88 � �
Conversion/Comments N/A [] �
Check the measurement used. �
a) Top of bottom floor(including basement,crawl space,or enclosure floor)_ 8.72 ��eet ❑meters(Puerto Rico oniy) '�i
b) Top of the next higher floor N.A �teet ❑meters(Puerto Rico only) J �
c) Bottom of the lowest horizontal structural member(V Zones only) N.A �feet ❑meters(Puerto Rico only) � Q �
d) Attached garage(top of slab) 8.17 �feet ❑meters(Puerto Rico only) � � U
�
e) Lowest elevation of machinery or equipment servicing the building 9.11 �4eet ❑meters(Puerto Rico only) � � �
(Describe type of equipment in Comments) �„J pQ a
f) Lowest adjacent(finished)grade(LAG) 4.64 �feet ❑meters(Puerto Rico � 0 �
p z0
g) Highest adjacent(finished)grade(HAG) 8.07 �heet ❑met ( i � N 0 W
O p- v °'
SECTION D-SURVEYOR, ENGINEER,OR ARCHI O � U �
Q �
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized certify elevation � �• m � N
information. I certify fhat the information on this Certificate represents my best efforts to interpre ata�ablb�O ��u
1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. ,Sec rt00'�. �
� Check here if comments are provided on back of form. \+.--�����tG�y �t *���
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Certifier's Name GEORGE A.SHIMP III Job No. 080249A License Numb�6
qr�r
Title VICE PRESIDENT Company Name GEORGE A.SHIMP II&ASSOCIATES, INC.
Address 3301 DESOTO BLVD., SUITE D City PALM HARBOR State FL ZIP Code 34683 ��^'�(t � ��
� ature � Date 12-11-2008 Telephone 727-784-5496 #6137 DATE: � �1 O�l
FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions
�
IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use:
Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Policy Number ,
480 PALM ISLAND SE
City CLEARWATER State FL ZIP Code 33767 Company NAIC Number
,
SECTION D-SURVEYOR, ENG�NEER,OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for(1)community official, (2)insurance agenUcompany,and (3)building owner.
Comments C2.e)AIR CONDITIONER
/�I� 'Cf 'r �s �
Signature Date 12-11-2008
� Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT RE(�UIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO and A(without BFE),complete Items Ei-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 eievation intormation 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(inciuding basement,crawi 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 S and/or 9(see page 8 of Instructions).the next higher fioor
(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 official must certify this infortnation 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 know/edge.
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 INFORMATION(OPTIONAL)
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.
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 c.ertify elevation information. (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 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: _0 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