1620 STEVENSON'S DR U.S.DE�ARTMENT OF HOMELAND SECUF2ITY �:LEWATION CERTIFICATE OMB NO. 1660-0008
Federal Emergency Management Agency Expires Februarv 28.2009 !
National Flood Insurance Program Imrcrtant: Read the instructions on pages 1-3.
SECTION A-PROPERTY INFORMATION For Insurance Company Use:
A1. Building Owner's Name PAYNE,JOHN � Policy Number
A2. Building Street Address(including Apt., Unit,Suite,rnd/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number
.1620 STEVENSON'S DRtVE.
City CLEARWATER State FL ZIP Code 33755 16 20 S T E V E N S O N�5 D R
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) BCP2�07-02530
LOT 13 BLOCK"A" STEVENSON'S HEIGHTS r� .-,y_/S ��yy,( - �,c'+/�� Z:J�L
A4. Building Use(e.g.,Residential, Non-Residential,Addition,Accessory,etc.) RESIDENTIAL
A5. Latitude/Longitude:Lat.27 58'S5"" Long.82 47'03'_" 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 1
A8. For a building with a crawl space or enclosure(s),pmvide A9. For a building with an attached garage,provide:
a) Square footage of crawl space or enclosure{s1 NJA sq ft a) Square footage of attached garage N/A sq ft
b) No.of permanent flood openings in the craw�space or b) No.of pem7anent flood openings in the attached garage
enclosure(s)walls within 1.0 foot above adja�:ent grade wa{Is withi�i 1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in
SECTION B-�LOOD INSURANCE RATE MAP(FIRM)INF:�RMA710P1
61.NFIP Community Name&Community Number B2.County Name . B3.State �
CLEARWATER 125096 PINELLAS FLORIDA
B4.Map/Panel Number B5.Su�x B6.FIRAq Index B7.FIRM Panel �8.Flood 69. Base Flood Elevation(s)(2one
Date Effective/Revised Date Zone(s) AO,use base flood depth)
12103C0106 G 9-03=03 9-03-03 AE 10.0
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69.
❑FIS Profile �FIRM ❑CommLnity Determined ❑Other(Describe)
611. Indicate elevation datum used for BFE in Item B9: ❑IVGVD 1929 �NAVD 1988 ❑Other(Describe)
612. Is the building located in a Coastal Barrier Re$ources System(CBRS)area or Otherwise Protacted A:ea(OPA)? ❑Yes �No
Designation Date ❑CBRS ❑OPA
SEC710N C-BtJILDING IELEVATION INFORMATION(SURVEY i2EQUIRED)
C1. Building elevations are based on: ❑Construction Drawings* ❑Building Under Construction' �Finished Construction
"A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevetions-Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AWAE,AR/A1-A30,AR/AH,AR/AO. C mplete I .�
below according to the building diagram specified in Item A7.
Benchmark Utilized CLEARWATER H-08*"* Vertical Datum NAVD'88 ""ELEV. 17.72 � /V� nZ
ConversioNComments �1/ �� �
N I � Check the measurement used. 4 n
� �
a) Top of bottom floor(inCluding basement,crawl space,or enclosure floor)_ 10.02 ` �feet ❑meters(Puerto Rico only) ;�! .,,. ��.��
b) Top of the next higher floor NlA. �feet ❑meters(Puerto Rico only) �^r• � �
��:; �
c) Bottom of the lowest horizontal structural member(V Zones only) N/A. ❑feet ❑meters(Puerto Rico only) ;.�-� g ��..- �
�� lrltached garage(top of slab) N/A.. �feet ❑meters(Puerto Rico only) `�'<1° � �
e) Lowest elevation of machinery or equipment�ervicing the building N/A. �feet ❑meters(Puerto Rico only) i•� �t":�-��
���,)...;�ti: �
(Describe type of equipment in Comments) 4 i , ,,,,__,,,____.-?._._.,:
� Lowest adjacent(finished)grade(LAG) 9.6 �feet ❑meters(Puerto Rico only) 4 �= i
: i C..":-:---�' i�
g) Highest adjacent(finished)grade(HAG) 10.3 �feet ❑meters(Pue�to Rico only) 1_�r} ___-_.,_._ _.-- ..
SECTION D-SURVEYbR, 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 efforls to interpr�t the dafa available. �•�+fr��
I understand that any false statement m�y be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. �,,,}M1 ,;:+�'„� � f;.��, ,
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Certifier's Name WILLIAM C.KEATING License Number LS#1528 � ' +, s<` f'�:r " r -
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Title LAND SURVEYOR AND MAPPER Company Name ALLIED SURVEYING .;> , w'y��`€�4 � .
Address 1275 NO HIGHLAND AVENUE City CLEARWATER State FL ZIP Code 33755 � �'�, , ��1'�'�:'�
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Signature ,,�. Date 9-30-08 Telephone 727-446-1263 � C ,/�' � � ''
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�3uild�ng Pho�agraphs
See Instructions for Item':A6. .
For Insurance�ompeny.Use:
Building Street Address,(including/1pt,Uni��uite,and/or Bldg.No.)or P.O.Route and B�t No. P.,oiicy:Numbe�' "
1620 STEVENSON' S DRIVE ••
City Sta����PATEK FLOR IDA 3 3 7 5 5 ��y�N�
� -
�If using the Elevation Certificate to obtair� NFIP flood insurance, a�x at least iwo b�Jlding photographs below according to
the instructions for It�m A6. Identify all pt��tographs with: date taken; °Front View" �znd°Rear View°; and, if required, "Rigli�t
� Side Vievw' and "Leit Side View.° If su�icx,�itting more photographs than will fct o� this page, use the Continuation Page,
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PIC'.�'URES TAlKEl�i : SEPT. 3 0 , 2 0 0 8
U.S.DE�ARTMEIVT OF HOMELAND SECUf21TY ELEVATION CERTIFICATE OMB No. 1660-0008
Exqires Februarv 28.2009
Federai Emergency Management Agency
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 PAYNE,JOHN Policy Number
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number
.1620 STEVENSON'S DRIVE.
City CLEARWATER State FL ZIP Code 33755 16 2 0 S T E V E N S O N'S D R
A3. Propetty Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) �^��O o 7_O�C�O
LOT 13 BLOCK"A" STEVENSON'S HEIGHTS ���-,j����t�c ,6 -�p/�/�(� �� ��
A4. Bui�ding Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) RESIDENTIAL
' A5. Latitude/Longitude:Lat.27 58'S5"" Long.82 47'09"" 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 1
A8. For a building with a crawl space or enclosure(s),provida A9. For a building with an attached garage,provide:
a) Square footage of crawl space or enclosure(s) NIA sq ft a) Square footage of attached garage N/A sq ft
b) No.of permanent flood openings in the crawl space or b) No.of pemianent flood openings in the attached garage
enclosure(s)wall5 within 1.0 foot above adjacent grade walls within 1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b � sq in c) Total net area of flood openings in A9.b sq in
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFi3RMATION
61.NFIP Community Name 8�Community Number B2.Counry Name . B3.State
CLEARWATER 125096 PINELLAS FLORIDA
B4.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)
12103C0106 G 9-03-03 9-03-03 AE 10.0
610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 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 ReSOUrces System(GBRS)area or Otherwise Protected 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 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,ARIAH,AR/AO. C p�e I
below according to the building diagram specified in Item A7.
Benchmark Utilized CLEARWATER H-08**"' Verticel Datum NAVD'88 *"ELEV. 17.72 n? 1SU
Conversion/Comments �
Check the measurement used. 0� � ���
�-r±rJ #.__.-t,
aj . Top of bottom floor(inCluding basement,crawl space,or enclosure floor)_ 10.02 �feet ❑meters(Puerto Rico only) �t�'. -"� �r"'
b) Top of the nexE higher floor N/A. �feet ❑meters(Puerto Rico only) ,�<« N �---'�
f he lowest horizontal structural member(V Zones only) NlA. ❑feet ❑meters(Puerto Rico only) ��;� �;;:K_.,�
c) Bottom o t .
d) Attached garage(top of slab) NlA.. �feet ❑meters(Puerto Rico only) •. ' oo ` '
' e) Lowest elevation of machinery or equipment servicing the building NlA. �feet ❑meters(Puerto Rico only) �.�-a-�s� y "`'t
(Descnbe type of equipment in Comments) ���� -""'='=�--"""C
�,�.... �_
Lowest ad acent finished rade(LAG 9.6 �feet ❑meters(Puerto Rico only) �=- r ----"`"�'-:_--- ,E
� � ( )9 , 10. feet meters Puerto Rico onl � � �` ~�~�- �
g) Highest adjacent(finished)grade(HAG) � � ❑ � y� .._ - -
SECTION D-SURVEYOR,ENGlNEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation -°:cY��s�;+rr,,
information. 1 certify that the information on this Certificate�present�y best efforts to interp►et the data available. `e n< ����`-'�c�,���:
f understand that any false statement mpy be punishable b fine or im risonment under 18 U.S. Code, Section 1001. �^'
. � +����L+ • s'.A ��.�
Check here if comments are rovided on back of form. � � `�
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Certifiers Name WILLIAM C.KEATING License Number LS#1528 ��-• �- `r -
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yz�•i�., ,�:. e� .r{r: .,.�;
Title LANQ SURVEYOR AND MAPPER Company Name ALLIED SURVEYING �w��'"�,�'�., .. . ,�,�"� ;�
Address 1275 NO HIGH(AND AVENUE City CLEARWATER State FL ZtP Code 33755 �',!�'%,j 9 '. `� �
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Signature rr f,�- Date 9-30-OS` 7elephone 727-446-1263 l
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- �u�ilding Pho�agraphs
See Instructions for Itenr:A6. .
For insursnce Gompany.Use:
. .Building StreetAddress,�includin9 Apt�Uni�,�uite,and/or Bldg.No.)or P.O.Route and Bcxc No. P.,niicy'Numher. _ `� .
1620 STEVENSON'S DRIVE ••
City Sts���.�PATEK FLORIDA 3 3 7 5 5 ��Y�N�
, -
.If using the Elevation Certificate to abtain NFIP flood insurance, affix at least iwo���ilding photographs below according ta
the instructions for It�m A6. Identify all ph2tographs with: date taken; "Front Viev�° �nd"Rear Yew"; and, if required, "Right
` Side View" and °Le�ft Side View.' If 5u,1)c7,�itting more photographs than will fit os: this page, use the Continuation Page,
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� PIC'.�URES TA�E.N: SEPT. 3 0 , 2 0 0 8