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2676 THIRD AVE S90' U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important: Read the instructions on pages 1-9. OMB No. 1660-0008 Expires March 31, 2012 SECTION A - PROPERTY INFORMATION For Insurance Company Use: Al Building Owner's Name ROTTLUND HOMES OF FLORIDA, INC Policy Number A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 2676 THIRD AVENUE SOUTH Company NAIC Number City CLEARWATER State FL ZIP Code 33759 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 7, LAKE CHAUTAUQUA RESERVE, PLAT BOOK 133, PAGES 91-93, PINELLAS COUNTY PUBLIC RECORDS A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5, Latitude/Longitude: Lat. 28-00-10 Long. 82-43-33 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 crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) N/A sq ft b) No. of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b N/A sq in d) Engineered flood openings? ❑ Yes ® No keDcP0oo 9 - D� 10Y A9. For a building with an attached garage: a) Square footage of attached garage N/A sq ft b) No. of permanent flood openings in the attached garage within 1.0 foot above adjacent grade N/A Total net area of flood openings in A9.b N/A sq in Engineered flood openings? ❑ Yes ® No c) d) SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NFIP Community Name & Community Number B2. County Name B3. State CLEARWATER 125096 PINELLAS FL B4. Map/Panel Number B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone 12103C 0088 G Date Effective/Revised Date Zone(s) AO, use base flood depth) 5-17-2005 9-3-2003 X N/A B10. Indicate the source of he Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile ❑ FIRM ❑ Community Determined ❑ Other (Describe) N/A 611. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ❑ NAVD 1988 0 Other (Describe) N/A B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? Designation Date N/A ❑ CBRS 0 OPA ❑ Yes ® No 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, ARAE, AR/A1-A30, AR/AH, AR/A0. Complete Items C2.a-h below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized N/AVertical Datum N/A Conversion/Comments N/A Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) N/A. ❑ feet 0 meters (Puerto Rico only) b) Top of the next higher floor N/A. ❑ feet ❑ meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) N/A. ❑ feet 0 meters (Puerto Rico only) d) Attached garage (top of slab) N/A. ❑ feet 0 meters (Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building N/A. 0 feet ❑ meters (Puerto Rico only) (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) N/A. 0 feet 0 meters (Puerto Rico only) g) Highest adjacent (finished) grade next to building (HAG) N/A. 0 feet 0 meters (Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs, including N. 0 feet 0 meters (Puerto Rico only) structural support 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. / certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided bya licensed land surveyor? ® Yes ❑ No Certifier's Name Kathleen C. Lanzner, P.L.S. License Number 5120 Title Vice President Company Name Cumbey & Fair, Inc Address 2463 Enterprise Road City Clearwater Signature State FL ZIP Code 33763 Date 05/22/09 Telephone 727-797-8982 FEMA Form 81-31, Mar 09 " 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. 2676 THIRD AVENUE SOUTH Policy Number City CLEARWATERState FL ZIP Code 33759 Company NAIC Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments Signature Date ❑ 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. El. 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, crawlspace, or enclosure) is ❑ feet 0 meters 0 above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet 0 meters 0 above or ❑ below the HAG. E3. Attached garage (top of slab) is 0 feet 0 meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet 0 meters 0 above or 0 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 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, 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 Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments 0 Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) 'he local official who is authorized by taw or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), Ind G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8 and G9. 31. 0 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.) 32. 0 A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. ;3. 0 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 37. This permit has been issued for: 38. Elevation of as -built lowest floor (including 39. BFE or (in Zone AO) depth of flooding 310. Community's design flood elevation 0 New Construction 0 Substantial Improvement basement) of the building: 0 feet 0 meters (PR) Datum at the building site: 0 feet 0 meters (PR) Datum 0 feet 0 meters (PR) Datum Local Official's Name Title Community Name Telephone Signature Date Comments 0 Check here if attachments =EMA Form 81-31, Mar 09 Replaces all previous editions _ _ r _ _ _ _ U.S.DEPARTMENT OF HOMELf�ND SECJRITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal Emergency Management Agency Expires MarCh 31, 2012 Nationa►Flood Insurance Prograrn Important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION For lnsurance�ompany Use: A1. Building Owner's Name ROTTLUND HOMES OF FLORIDA,INC P���N�� AZ. Building Street Address(including Apt.,Unit,Suite,andlor Bldg.No.)or P.O.Route and Box No. Gompany NAIC i�tumber ' 2676 THIRD AVENUE SOUTH City CLEARWATER State FL ZIP Code 33759 A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) LOT 7,LAKE CHAUTAUQUA RESERVE,PLAT BOOK 133,PAGES 91-93,PINELLAS COUNTY PUBLIC RECORDS A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)RESIDENTIAL A5. Latitude/Longitude:Lat.28-00-10 Long.82-43-33 Horizontal Datum: ❑ NAD 1927 � NAD 1983 A6. Attach at least 2 photographs of the buiiding if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 1 A8. For a building with a crawispace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) N/A sq ft a) Square footage of attached garage N/A sq ft b) No.of permanent flood openings in the crawispace or b) No.of permanent flood openings in the attached garage enclosure(s)within 1.0 foot above adjacent grade N/A within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 61.NFIP Community Name&Community Number 62.County Name B3.State CLEARWATER 125096 PINELLAS FL B4.Map/Panel Number B5.Suffix 66.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone 12103C 0088 G Date Effective/Revised Date Zone(s) AO,use base flood depth) 8-18-2009 9-3-2003 X N/A B10. 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)N/A B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 ❑ NAVD 1988 ❑ Other(Describe)N/A B12. 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 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 Items C2.a-h below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized N/AVertical Datum N/A Conversion/Comments N/A Check the measurement used. a) Top of bottom floor(including basement,crawispace,or enclosure floor)N/A. ❑feet ❑meters(Puerto Rico only) b) Top of the next higher floor N/A. ❑feet ❑meters(Puerto Rico only) c) Bottom of the lowest horizontal structural member(V Zones only) N/A. ❑feet ❑meters(Puerto Rico only) d) Attached garage(top of slab) N/A. ❑feet ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building N/A. ❑feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) N/A. ❑feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) N/A. ❑feet ❑meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs,including N/A. ❑feet ❑meters(Puerto Rico only) structural support 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 on this Certificate represents my best efforts to interpret the data availab/e. ,��''''r"°e �+"t'',,r, , I understand that any false statement may be punishable by fine or impnsonment under 18 U.S. Code,Section 1001. ',°°,�M;,'� �` �;L r `� ..`�" „e r °� ` ❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a a•_�;-�• �w.�€ ; licensed land surveyor? � Yes ❑ No , , � � �^ Certifier's Name Kathleen C.Lanzner,P.L.S. License Number 5120 �� � � ,.� �., �� ,. Title Vice President Company Name Cumbey&Fair,Inc @ � � A�~�'/�� Address 463 terprise Road City Clearwater State FL ZIP Code 33763 .g" t f , K�r �:� Signat ate 09/22/09 Telephone 727-797-8982 , •`�,..,��. � ,a.'°�� FEMA Form 81-31, Ma 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 2676 THIRD AVENUE SOUTH City CLEARWATERState FL ZIP Code 33759 Company NAIC Number SECTION D-SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agenUcompany,and(3)building owner. Comments Signature Date ❑ 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 CeRificate 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 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,crawlspace,or enclosure)is ❑feet ❑meters ❑above or 0 below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions),the next higher floor (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 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,8, and E are correct 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 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 ceRify elevation information. (Indicate the source and date of the eie�•�`�^^�'�+��^+��rnmmpntS AfP.a hEIOW.� sr. G2.❑ A community official completed Section E for a building located in Zone A(without a FEMA-i � r ^ � �' G3.❑ The following information(Items G4-G9)is provided for community floodplain management F ti ` �` 1� '�_ � G4.Permit Number G5. Date Permit Issued G6. Date �l � � ��t � � _�<:�,:�(- C..�� ��'� G7. This permit has been issued for: ❑ New Construction ❑Substantial Improvement G8. Elevation of as-built lowest floor(including basement)of the building: ❑feet ❑ -r� �rv_E r„� ;,,,,� i `,� ' _ G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet [ � �" _ � � `."` � ^ _....,-.� .�..:M,M .�_._ . ;; G10.Community's design flood elevation ❑feet [ , t� Local Official's Name —J Title SEP 2 � Zu�o �; i: l� �.. !��J Communiky iJame Telephone n },�� ----- ��_i ti ,� , , . ` _ ..,. r i Signature Date ` � �'�.' . Comme^ts ❑ Check here if attachments FEMA Form 81-31, Mar 09 Replaces all previous editions