1208 SUNSET DR /�O'�aD �d S U . ,
U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
Federal Emergency Management Agency Expires Februarv 28, 2009
National Flood Insurance Pro ram
SECTION A-PROPERTY INFORMATION For Insurance Company Use:
A1. Building Owner's Name Policy Number
HOGER PEENS
A2. Building Street Address(including Apt.,Unit,Suite,andlor Bldg.No.)or P.O.Route and Box No. Company NAIC Number
1208 SUNSET DR
City State ZIP Code
CLEARWATER FLORIDA 33755
A3. Property Description(Lot and Block Numbe�s,�Tax�Parcel Number al Description,etc.) �
LOTS 74&75 LESS N 24 FT AND N'LY 45FT OF LdT"'i GHURS 2 ADD AND SUBMERGED LAND#17617 PLAT BOOK 3 PAGE 46
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) RESIDENTIAL
A5. Latitude/Longitude:Lat.N27deg58min43sec Long.W82deg47min59sec' 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 THREE_ENTRANCE AND SOUTH SIDE IS SLAB ON GRADE,WE$T PART OF HOUSE IS ON FILLED SPACE
A8. For a building with a crawl space or enclosure(s),provide: A9. For a building with an attached garage,provide:
a) Square footage ot crawl space or enclosure(s) APPROX 1800 sq ft a) Square footage of attached garage 450+- 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 adjaceM grade none walts within 1.0 foot above adjacent grade NA
c) Total net area of flood openings in A8.b NA sq in c) Total net a�ea of flood openings in A9.b NA sq in _
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
,,.c
81.NFIP Community Name 8 Community Number B2.County Name B3.State
PINELLAS 12103G CLEARWATER 125096 PINELLAS COUNTY FLORIDA
B4.Map/Panel Number 85.Suffix B6.FIRM Index 67.FIRM Panel B8.Flood B9.Base Flood'Elevation(s)(Zone
Date EffectivelRevised Date Zone(s) AO,use base flood depth)
12103C 1� H 9-3-03 5-17-05 HOUSE AREA X=NE LOT CORNER
EAST'r4=AE AE=12.0
WEST'r4=VE VE=14.0
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 B9: ❑ 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
Designation Date �CBRS �OPA
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 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 ftems C2.a-g
below according to the building diagram specified in Item A7.
Benchmark Utilized CITY OF CLEARWATER BM G-05 Vertical Datum=NAVD 1988
Conversion/Comments (NONE)
a) Top of bottom floor(including basement,crawl space,or enclosure floor ENTRANCE AND RO � '�,
b) Top of the next higher floor MAIN LIVING AREA E
c) Bottom of the lowest horizontal structural member(V Zones only) 12.14 feet � .�-
d) Attached garage(top of slab) 12.45 feet
e) Lowest elevation of machinery or equipment servicing the building 12.60 feet SEP 0 9 2006
(Describe type of equipment in Comments)(OUTSIDE AC UNIT)
� Lowest adjacent(finished)grade(LAG) 10.1 feet
g) Highest adjacent(finished)grade(HAG) 12.5 feet DEVELOPAAENT SERVICES DEPT
C�r OF CLEARwATER
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. I certify thaf the information on this Certificate represents my besf efl`orts to interpret the data available.
I understand that any false statement may be punishable by fine or impnsonment under 18 U.S. Code, Section 1001. B I LL �3YA � �
�Check here if commerrts are provided on back of form. P�,� ���..��i��+f�, (j,r6 ;.
Certifier's Name License Number
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9�-�9 ��.p Q,�� `��` �_.
BILL HYATT FLORIDA LICENSE�4636 ; Of,�� ,--°
Title Company Name � � ; ` � D ? , ":
PRESIDENT KNOW IT NOW INC. n`� f�F'y " �' � ' #'
Address City State ZIP Code ; �� � �
MAIL=1497 MAIN STREET#321 DUNEDIN FLORIDA 34698 , ,- ir � ;�
Signature '.`!!� �, ,+ r.� '�
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DATE: 9-9-2008 TELEPHONE: 727-415-8305
FEMA Form 81-31, January 2003 See reverse side for continuation. Replaces all previous editions
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�CP Ol� f n S �
IM#�ORTANT: 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
1208 SUNSET DR
Ctty State ZIP Code Company NAIC Number
CLEARWATER FLORIDA 33755
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certifica 2 insurance agenUcompany,and(3)building owner.
Comments
SEE NOTE ON ITEM A7. C2 E IS OUT — S I N R TRUCTION
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Signature �� SEP 0 9 2008 t Date 9-9-2008 ��l���S��S�`s6/t�a/���
' ( Check here if attachments
SECTION E-BUILDING ELEV I���� REQUIRED)FOR ZONE AO AND 20NE A(WITHOUT BFE)
WATER
For Zones AO and A(without BFE},complete Items E1-E5. If the e i ded 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 adjacerrt
grade(HAG)and the lowest adjacerrt grade(LAG).
a)Top of bottom floor(including basement,crawl space,or enclosure)is ❑feet ❑ meters ❑above or ❑betow 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 Secti Items 8 and/or 9(see a e 8 of Instructions),the next higher floor
(elevation C2.b in the diagrams)of the building is _Q 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 certiTy this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or ownePs authorized representafive 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.
Prope 's ol, er' ri e Representative's Name
� �
Addr � L City S ZIP Co
Signature Date Telephone��7 ��("�'?r'1
<.� �.J�..'��../
❑Check here if attachmerrts
SECTION G-COMMUNITY INFORMATION(OPT10NAL)
The local official who is authorized by law or ordinance to administer the communit�s floodplai�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 certify 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(Rems 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 permft has been issued for: ❑ New Constructian ❑Substarrtial ImprovemeM
G8.Elevation of as-buift 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
Commerrts
❑Check here if attachments
�E��'`����70 �,
FEMA Form 81-31, February 2006 Replaces all previous editions
Building Photographs ����/s-����.5-�� aa���
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 Numner
1208 SUNSET DR
City State ZIP Code �v►�cNu�r
CLEARWATER FLORIDA 33755
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least finro building photographs below according to I,
the instructions for Item A6. Identify all photographs with: date taken; "Front Viev�' and "Rear View"; and, if required, "Right I�
Side Viev�' and "Left Side View." If submitting more photographs than will fit on this page, use the Continuation Page,
following.
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