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18675 US HWY 19 N #412 � U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB NO. 1660-0008 Federal Emergency ManagementAgency Expires March 31,2012 National Flood Insurance Program Important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION •� �`• " 3 . A1. Building Owner's Name John E.Duggans 8 Eileen Campbell � jY � Mfk`�a A2. Building Street Address(inGuding Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. F r .' �' 18675 US Highway 19 North#412 ,,v,� � ,„�°�� , , Ciry Clearvvater State FL ZIP Code 33764 A3. Property Description(Lot and Blodc Numbers,Tax Parcel Number,Legal Description,etc.) Parcel ID#20-29-16-03290-000-4120 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential A5. Latitude/Longitude:Lat.27. 671 Long.-82.726821 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. Buildi�g Diagram Number $ A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of�rawispace or eri�losure(s) 1445 sq ft a) Square footage of attached garage N/A sq ft b) No.of pertnanent flood openings in the crawlspace or b) No.of permanent flood openings in the attached garage enclosure(s)within 1.0 foot above adjacent grade � within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in AB.b � sq in c) Total net area of flood openings in A9.b 0 sq in d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name&Community Number B2.County Name B3.State Pinellas Counry Unincorporated Areas 125139 Pinellas FL B4.Map/Panel Number 65.Suffix 66.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone 12103C0128 G Date Effective/Revised Date Zone(s) AO,use base flood depth) 8-1&09 9-3-03 AE 9' B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile � FIRM ❑ Community Detertnined ❑ Other(Describe) B11. Indicate elevation datum used for BFE in Item 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 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 G TIDAL FLDTVertical Datum ELEV=9.48'(N.A.V.D.I Conversion/Comments N/A Check the measurement used. a) Top of bottom floor(including basement,crawlspace,or enGosure floor)�.� �feet ❑meters(Puerto Rico only) b) Top of the nent higher floor IV.A �feet ❑meters(Puerto Rico only) c) Bottom of the lowest horizontal structural member(V Zones only) IV.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 9.0 �feet ❑meters(Puerto Rico only) (Describe type of equipment and bcation in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 6.� �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 7.,� �feet ❑meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of dedc or stairs,including N.A �feet ❑meters(Puerto Rico only) structural support , , � r�r��+� `ti;,: 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 ,' ''` � �� infortnation. 1 certify that the information on thls Certi�icate represents my best e/forts to interpret the data avallable. •':�T i F!��'�., ;,;- r .; 1 understand that any fa/se statement may be punishable by�ne or imprisonment under 18 U.S.Code,Section 1001. � � ':'�;�'� �� • � Check here if comments are provided on badc of fonn. Were latitude and longitude in Section A provided by,a;: .� �>c.,�� - licensed land surveyor? � Yes ❑ No - : �v _ - � ,. � - Certifier's Name Philip C.Stock License Number RLS#3035 a ��'�t`C'' ' � ' � ' ,� ��xi '' '� � Title President Company Name Target Land Surveying,Inc. ',��'-�� ,"`` � '�,, 1 �u�, ,;��'��`�` Address 516 Lakeside Place City Largo State FL ZIP Code 33771 '�'''�+�rQ�''�..ec��/ Signature/� Date 12-5-11 Telephone (727)784-0573 �� - ..r _ :%/c.�c''�c.''� �f�-�r�FS ` FEMA Form 81-31,Mar 09 See reverse side for conUnuation. Replaces all previous editions � IMPORTANT: In these spaces,copy the corresponding informatfon from Section A. °� ';�r� Building SVeet Address(inGuding Apt.,Unit,Sufte,and/or Bldg.No.)or P.O.Route and Box No. � � , 18675 US Highway 19 North#412 ��` � City Clearwater State FL ZIP Code 33764 ° ' . �� .r SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides�fh�s C�ivaUon Gertific�te for(1)community o�cial,(2)insurance agenUcompany,and(3)building owner. �.. °� '�—� +•, Commentt ' � ; ��,t � r)�� , Job#11-11k�.U�f�.� �" ��f C.2.e)=A/C Uqfta��h ...,��l� ', , . �'' C�:�I�•,!t� ; 4 i� ��` � ��).. • ('1 . .. /`'• Signature ,.��, ,.� • , '' • ' Date 12-5-11 � -�.."�`��_� - �"� ❑ Chedc here if attachments S�CTtQN,.�.- �DlNfia , �ION INF�RMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) ,Y.'..�:� ...C�. •�� ,`h;, �� " i .L� , �. W For Zone,s'AO^'an�!'A,(wiCttO �FE'�;cpl�nRle�@ Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B, and C. For Item°s��E'��:�►��iat�SAl`grad�,,,�available. Check the measurement used. In Puerto Rico only,enter meters. E1. Provide eleva�qn.�rh�ation fpr`tlt�'f�llowing and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG)anc�th�'lowest adjacertY grade(LAG). a)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or❑below the HAG. b)Top of bottom floor(including basement,crawlspace,or endosure)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 dfagrams)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 officlal must certify this infortnatlon 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 communfty's floodplain management ordinance can complete Sectio�s A,B,C(or E), and G of this Elevation Certificate. Complete the applicable item(s)and sign below. Chedc the measurement used in Items G8 and G9. G1.❑ The infortnation 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 informaUon. (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 communiry-issued BFE)or Zone AO. G3.❑ The following infortnadon(Items G4-G9)is provided for communiry floodplain management purposes. G4.Pertnit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑New Constructlon ❑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 G10.Community's design flood elevaGon ❑feet ❑meters(PR)Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑Check here if attachments FEMA Form 81-31, Mar 09 Replaces all previous editions Building Photographs 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. Poficy Number � 18675 US Highway 19 North#412 ' City Clearwater State FL ZIP Code 33764 C«npenyNAlCNumber y--- � If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to ' the instructions for Item A6. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right � Side View" and "Left Side View." If submitting more photographs than will fit on this page, use the Continuation Page on the ; reverse. -.. "Front View"—Pictures Taken 12-5-1� �" .5� w.�., ..'H%� � � =iY@.., / q � w. ��+` '. � �� ;�; _ � �' �� 1 ia �'� � .r111 � :;:., "Rear 0/iew"— Pictures Taken 12-5-1 1 w��w.,a�«�,;�.�- � `��-'�,,,d �,.� � ��. �w�„, � �";,;.:._� � � �' � E `' '�'' ��! �: .��'� � ,, �:�: � p � '� � � , , . Building Photographs Continuation Page For Insurance Company Use: � Building Street Address(including Apt., Unit,Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number ' 18675 US Highway 19 North#412 ! City Clearwater State FL ZIP Code 33764 CompenyNAlCNumber � If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all � photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." "Ri ht Side View"— Pictures Taken 12-5-11 . .,,�,. , � � � s � � 4�� , ' � �' �, ,� �� - ,.. � - . �� , t `� � �� v , _r+; ;, � s ` �" ` tl � �^'✓.,� �� r.. . �;•�°�;k:>.:. _ � ,� r�+ i �i, "Left Side View"— Pictures Taken 12-5-11 •~�_ � -�'_ �` -� ! ,� ---�—__ : ------______---—- � � _ _—_--- «�, _ _ -- �-- -- , _ , � , __ � — � � ___ w�.m . . . �F_. ... _ .w