1748 SUNSET DR . + '
U.S.DEPAf2TMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
Fec�eral Emergency Management Agency
National Fiood Insurance Program Important: Read the instructions on pages 1-8. 09-182 vnn
SECTION A-PROPERTY INFORMATION For Insurance Company Use:
A1. Building Owner's Name REBECCA LUSTGARTEN Policy Number
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number
1748 SUNSET DRIVE
City CLEARWATER State FL. ZIP Code 33755
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
LOT 5,BLOCK 11,NORTH SHORE PARK &SUBMERGED LAND NO. 17913 04/29/15/61488/011/0050 BUILDING 1,PINELLAS COUNTY
A4. Buiiding Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) RESIDENTiAL
A5. Latitude/Longitude:Lat 27° 59'6.86"N. Longi`;, 82°4T 53.93"W. Horizontal Datum: ❑ NAD 1927 X 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),provide A9. For a building with an attached garage,provide:
a) Square footage of crawl space or enclosure(s) N/A sq ft a) Square footage of attached garage 253 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 N/A walis within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b 0 sq in
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP Community Name&Community Number B2.County Name 63.State
UNINCORPORATED COUNTY FL#12103C F�ORIDA
PINELLAS
' B4. Map/Panel Number B5.Suffix 66.FIRM Index B7.FIRM Panel B8.Fiood B9.Base Flood Elevation(s)(Zone
Date Effective/Revised Date Zone(s) AO,use base flood depth)
12103C0106 G• 9-3-03 9-3-03 VE 15.0
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in item 69.
❑FIS Profile X FIRM Community Determined ❑Other(Describe)
B11. Indicate elevation datum used for BFE in Item 69: NGVD 1929 X NAVD 1988 ❑Other(Describe)
B12. Is the buiiding located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? Yes X No
Designation Date ❑CBRS ❑OPA
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. Building elevations are based on: ❑Construction Drawings' ❑ Building Under Construction' X Finished Construction
'A new Elevation Certificate will be required when construction of the building is compiete.
C2. Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,ARlA,AR/AE,AR/A1-A30,AR/AH,AR/AO. Compiete Items C2.a-g
below according to the building diagram specified in Item A7.
Benchmark Utilized ARUAL"F"
Conversion/Comments: NGVD 1929 TO NAVD 1988= -0.88 FEET
Check the measurement used.
a) Top of bottom floor(including basement,crawl space,or enclosure floor) 6.97 X feet ❑meters(Puerto Rico only)
b) Top of the next higher floor NIA feet ❑meters(Puerto Rico only)
c) Bottom of the lowest horizontal structural member(V Zones only) N/A feet ❑meters(Puerto Rico oniy)
d) Attached garage(top of slab) 6.12 X feet ❑meters(Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building NIA SEE X feet ❑meters(Puerto Rico only)
(Describe rype of equipment in Comments) BACK
� Lowest adjacent(finished)grade(LAG) 4.7 X feet ❑meters(Puerto Rico oniy)
g) Highest adjacent(finished)grade(HAG) 5.9 X feet ❑meters(Puerto Rico only)
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION e,, c �k�� M °'��F�a
This certification is to be signed and sealed by a iand surveyor,engineer,or architect authorized by law to certify elevation< : �ro° ��'�.-"�,. .�`F�%< .�`_
information. I certify that the information on this Certificate represents my best eHorts to interpret the data availab/e. � •
1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 100L �, �•�"4�`� ��,� �� , ;
;` , � »•�� �ACE ,
X Check here if comments are provided on back of form. � � � °a
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Certifier's N�me DAVID K.PREVOT License Number 4934 .,,- � :
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Title PROFESSIONAL SURVEYOR 8�MAPPER Company Name BAYLAND SURVEYING � �
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Address 6802 COMMERCE BLVD. City PORT RICHEY State FL ZIP Code 34668 ',�oA` �s��_�_�g ` =;
Signature Date 6-22-09 Telephone (727)845-1738 > ��/�l� �•'PRE�/OT
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:�
Buifding Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. Policy Number
1748 SUNSET DRIVE
City CLEARWATER State FL. ZIP Code 33755 Company NAIC Number
SECTION D-SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agenbcompany,and(3)building owner.
Comments
THE RESIDENCE HAS NO AIR-CONDITIONER UNIT AT THIS TIME TO MEASURE.
Signature Date 6-22-09
X Check here if attachments
SECTION E-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.
E 1. 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 Q 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 buiiding is ❑feet ❑meters ❑above or ❑beiow 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 buiiding 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 imaccordance with the communitys floodplain management
ordinance? ❑Yes ❑ No ❑ Unknown. The local official 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,B,and E are correct to the best of my knowledge.
Property Ovmer'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 officia�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 documentaGon 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 communiry 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: _❑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 attachment
FEMA Form 81-31, February 2006 Replaces all previous editions
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Building Photographs �
Continuation Pa e. 09-182
1748 SUNSET DRIVE For insurance company use:
Bui►din Street address includin A t. Unit Suite or PO Box Polic Number
Cit CLEARWATER STATE FLORIDA Zi 33755 Com an NAIC Number
If submitting more photographs than will fit on the procceding page,affix the additional photographs below.Identify alI photographs
with:date taken:"front view"and"rear view"and if required,"right side"and"left side view".
DATE TAKEN 6-18-09 VM
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