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1874 STEVENSON AVE FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005 ��b;l��6(�-b�7�� ELEVATION CERTIFICATE Important: Read the instructions on ages 1-7. SECTION A-PROPERTY OWNER INFORMATION forinsurance Company Use: BUILDING OWNER'S NAME Policy Number SUSAN PLAYER BUILDING STREEf ADDRESS pncluding Apt.,Unit,Suite,and/or Bldg.No J OR P.O.ROUTE AND BOX NO. Company NAIC Number 1874 STEVENSON AVENUE ��' STATE ZIP CODE CLEARWATER FL 33755 PROPERIY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) LOT 11&12,BLOCK B,SUNSET POINT ADDITION 2ND BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,if necessary.) RESIDENTIAL LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DAT'UM: SOURCE: ❑GPS(Type): ( ##°-##'-##.##" or �l#.##q##°) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other: SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME 83.STATE CLEARWATER 125096 PINELLAS FL 64.MAP AND PANEL 87.FIRM PANEL 69.BASE FLOOD ELEVATION(S) NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVEIREVISED DATE 88.FLOOD ZONE(S) (Zone A0,use depih of flooding) 12103C0106 H �3-03 �17-05 AE 11 B10.Indicate the source of the Base Flootl Elevation(BFE)data or base flood depth enteretl in 69. ❑FIS Profile �FIRM ❑Community Determined ❑Other(Describe): 611.Indicate the elevation datum used for the BFE in 69:�NGVD 1929 �NAVD 1988 ❑Other(Describe): B12.Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No Desiqnation Date SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1.Building elevations are based on:[�Construction Drawings* ❑Building Under Construction' �Finished Construction 'A new Elevation Certificate will be required when constniction of the building is complete. C2.Building Diagram Number 8(Select the buiiding diagram most similar to the building for which this certificate is being completed-see pages 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.) C3.Elevations—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,ARIAE,ARIA1-A30,ARIAH,ARIAO Complete Items C3;a-i below according to the building diagram specifietl in Item C2.State the datum used.If the datum is different from the datum used for the BFE in Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Sec6on D or Section G,as appropnate,to document the datum conversion. Datum 1988 ConversionlComments NA ElevaGon referenoe mark used LOCAL Does the elevation reference mark used appear on the FIRM? ❑Yes �No o a)Top of bottom floor(induding basement or enclasure) 7. 2 ft.(m) � P L� � `�`-4�� o b)Top of next higher floor 9.5 ft.(m) �' � o c)Bottom of lowest horizontal structural member(V zones only) N.A ft.(m) o d)Attached garage(top of slab) N. A ft.(m) �� e� o e)Lowest elevation of machinery andlor equipment �r� -,� ,' �;,s,, � serviang the building(Describe in a Comments area) 7.6 ft,(m) �� ;; ` � . �. "� ��y�,,,�, r�,,,, o fl Lowest adjacent(finished)grade(LAG) 7.2 ft.(m) z'� � � o g)Highest adjacent(finished)grade(HAG) 7, 2 ft,(m� �� o h)No.of permanent openings(flood vents)within 1 ft,above adjacent grade 0 � r� '��} (';�, o i)Total area of ail permanent openings(flood vents)in C3.h 0 sq,in.(sq,cm) 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 in Sections A,B,and C on this certificate represents my best efforfs to interpret fhe data available, I understand that any false sfatement may be punishable by�ne or imprisonment under 18 U S Code,Secfion 1001 CERTIFIER'S NAME M.G,MAYER LICENSE NUMBER 4495 • TITLECEO COMPANY NAME FLORIDA BENCHMARK ADDRESS CITY STATE ZIP CODE 1298 LAKEVIEW RD. CLEARWATER FL 33756 SIGNATURE ,�' ;° DATE TELEPHONE !� � � ., ��° �,��`�� 1-20-06 727-298-0286 �. .... , FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces all previous editions _ __ ___ _ IMPORTANT; In these spaces,copy the corresponding information from Section A. For insurance com��y use: BUILDING STREET ADDRESS(Indutling Apt,Unit,Suite,antllor Bkig.No.)OR P.O.ROUTE AND BOX N0. Policy Number 1874 STEVENSON AVENUE �� STATE ZIP CODE Company NAIC Nwmber CLEARWATER FL 33755 SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) • Copy both sides of this Elevation Cerfificate for(1)canmun'�y offiaal,(2)insurance agenticompany,and(3)builtling owner. COMMENTS AC 7.6 ❑Check here if attachments SECTION E•BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zone AO and Zone A(without BFE),complete Items E1 through E4. If the Elevation Cerfificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1.Builtling Diagram Number_(Select the building diagram most similar to the building for which this certificate is being completed–see pages 6 and 7. If no tliagram accurately represents the building,provide a sketch or photograph.) E2.The top of the bottom floor(induding basement or endosure)of the building is _ft.(m)_in.(cm)�above or ❑below(check one)the highest atljacent grade. (Use natural grade,if available). E3.For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is _ft.(m)_in.(cm)above the highest adjacent grade. Complete items C3.h and C3.i on front of form. E4.The top of the platform of machinery andlor equipment serviang the building is _ft,(m)_in.(cm)❑above or ❑below(check one)the highest adjacent grade. (Use natural grade,if available). E5.For Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's flootlplain management ordinance? ❑Yes ❑No ❑Unknown. The local official must cerfiiy 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,C(Items C3.h and C3.i only),antl E for Zone A(without a FEMA-issued or community- issued BFE)or Zone AO must sign here. The statements in Sections A,8,C,and E are coriect 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 INFORMATION(OPTIONAL) The local offidal who is authorized by law or ortlinance to administer the communit�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. G1.❑The information in Sec�on C was taken from other tlocumentation that has been signed and embossetl by a licensed suNeyor,engineer,or architect who is authonzed by state or loc�law to certify elevation information. (Indicate the source and date of the elevaGon data in the Comments area below.) G2.0 A community o�aal completed Sedion E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0. G3.�The following information(Items G4-G9)is provitled 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.Eleva6on of as-built lowest floor(incJuding basement)of the builtling is: _._ft.(m) Datum:_ G9.8FE or(in Zone AO)depth of flooding at the building site is: _._ft.(m) Datum:_ LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE a°''�"''�,�� K` �, DATE • N, , � �'• , a� `�—g–'—� COMMENTS �' . _ ` '� ;� ' "'� MEnrr svcs ��-�ts FEMA Form 81-31,January 2003 Repfaces all previous editions