18675 US HWY 19 N #326 U.S.DE�ARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
Federal Emergency Management Agency Expires March 31,2012
National Flood Insurance Program Important: Read the instructions on pages 1-9.
SECTION A-PROPERTY INFORMATION ,'�br,.:Ittsurence�mpany Use:
A1. Building Owner's Name :Pd1t�gNurrit�r'
Melville A.Graham 8 Patricia A.Graham -
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P 18675 U S H I G H WAY 19 N 3
18675 US Highway 19 North,#326
City Clearwater State FL ZIP Code 33764 BCP2009-12117
A3. Property Description(Lot and Blodc Numbers,Tax Parcel Number,Legal Descriptfon,etc.)
Lot 326,Bay Aristocrat Vllage Mobile Home Park(Unrecorded),Parcel ID#20-29-16-03290-000-3260
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential
A5. Latitude/Longitude:Lat.27.942106 Long.-82.730124 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 $
A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) 246 sq ft a) Square footage of attached garage N/A sq ft
b) No.of permanent 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 Q within 1.0 foot above adjacent grade N/A
c) Total net area of flood openings in AB.b Q 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
81.NFIP Community Name&Community Number 62.County Name 63.State
Ciry of Clearvvater 125096 Pinellas FL
B4.Map/Panel Number 65.Suffix 66.FIRM Index 67.FIRM Panel 68.Flood 69.Base Flood Elevation(s)(Zone
12103C0128 G Date Effective/Revised Date Zone(s) AO,use base flood depth)
8-18-09 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 Determined ❑ Other(Describe)
B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other(Describe)
612. 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 Const •'�; �ldP"'�f ,
3 G.; . �'{ �
`A new Elevation Certificate will be required when conshuction of the building is complete. �.� ,;,r,� ;�'�` !j iP f
C2. Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1 �"IX��:�Y;omp e e .a-h
below according to the building diagram specified in Item A7. Use the same datum as the BFE. � �M
Benchmark Utilized G TIDAL FL DT Vertical Datum ELEV=9.48'(N.A.V.DJ i� ,� FEB 0 3 2010
Conversion/Comments N/A +�+
Che�lc� , ��..� � +;`;
a) Top of bottom floor(inGuding basement,crawlspace,or enclosure floor)$.�2 �feet t�er� + � t s;
b) Top of the next higher floor N.� �feet �4�� "' ' �
� toVYr r F ��.)�-' n r,.=�. .
c) Bottom of the lowest horizontal structural member(V Zones only) N.A �feet ,[�'�' o �bn�y -
d) Attached garage(top of slab) �.2� �feet �-��t � 'u ��F��co bfily)
e) Lowest etevation of machinery or equipment servicing the building $.�2 �feet ❑meters(Puerto Rico only)
(Describe rype,of equipment and location in Comments) ���./"
� Lowest adjacent(finished)grade next to building(LAG) ¢.$ �feet $]`t��_(puerto,Rico only) f Y � �
g) Highest adjacent(finished)grade next to building(HAG) 7.1 �feet ❑meters(Puerto Rico only) �
h) Lowest adjacent grade at lowest elevation of deck or stairs,inGuding N.A �feet '[�.�ters(Puerto Rico only) ���!�
structural support
. �. . _ .. _ ..., __�,..._ _
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a�and surveyor,engineer,or architect authorized by law to certify elevation
information. I certify fhat the information on thls Cert�cafe represents my best e/%rts to interpret the data available. �-„
I understand that any false statement may be punishable by frne a imprisonment under 18 U.S. Code,Section 1001. s; ; � , , ,�;-`';;';
� Check here if comments are provided on back of fortn. Were latitude and longitude in Section A provided by a;�` � '``� r. :�j'� �°r�,
, licensed land surveyor? � Yes ❑ No rµ�R °,•••""'••.,. ' f
� L',r ,,
�« ��,,��(1i-ir��,r ,� ' .� �
Certifier's Name Philip C.Stodc License Number RLS#3035 �
Title President Company Name Target Land Surveying,Inc � �Y '� '��`_ 3�."�3�
- � F� .
Address 516 Lakeside Place City Largo State FL ZIP Code 337'7t - c ' �+���;�, -'/O
. �,. � ,
': � c �C`i't`.,.•;• s.' W.::>
Signature�� ���J, � f/�}''`�- ., Date 2-3-10 Telephone (727)7840573 ��, �:;'� '�,��'��..-s�),
(.'' ""W�-^-��L...._�lAd'Z���..._.._.__....._._ t /� r.U:'�:'� 4�♦ � '•:N
FEMA Form 81-31, Mar 09 See reverse side for continuation. Replacbts`�II p�evious editions
f�iIIPORT/�NT: In these spaces,copy the corresponding information from Sectton A. ForJnsucance 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,#326
City Clearwater State FL ZIP Code 33764 Company NAIC Number
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community o�cial,(2)insurance agenUcompany,and(3)building owner.
Comments '�
Job#100126.01 . `��i t�
�� 4t��, „"
C2 e ,Wate��hJba��r ia_ � dr
C2 d �'x�Carqprt��� , •:.., ,� '�,
The adc�iti�7��,s'at�thQ sameg� �Y;pn�,s the main residence of 8.62'(N.A.V.D.)
`� ty ,,, �•, •y) �
Signature, �� .,�a� ,..• ��.��> _ Date 2-3-10
❑ Check here if attachments
SE�T�10 �-�B IL`�IN � �►TION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
r �r '.•'v •il : . ,• e"� , . . ,
For Zones�A��rit�J�,�vuilhoµt 9FE�j,,room�IPt�Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B,
and C. For�e�is��7� �'use���a�,gr�de�.,lf available. Check the measurement used. In Puerto Rico only,enter meters.
E1. Provide ef�vat��{'�i f �ri,t�y`,the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent
'I'�14�1��,1` �`
grade'�HA�)8nd e fo' ��t.adjacent grade(LAG).
a)Top of tibttom flobr:(incli�ding basement,crawlspace,or enGosure)is ❑feet ❑meters ❑above or�below the HAG.
b)Top of bottom floor(including basement,crawlspace,or enGosure)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 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 platfortn 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 representaHve who completes Sections A,B,and E for Zone A(without a FEMA-issued or communiry-issued BFE)
or Zone AO must sign here. The statements in Sections A,8,and E are correct to the best o/my knowledge.
Property OwnePs or Ovmer's Authorized Representative's Name -, s
- ' •`�+ �:a S
Address City %•• .,�?t�'t�,,,;,,.�a:.. � ;
�, � �t
Signature Date 't le '; ,� ��
� �' 010 = ,. ��
comme�ts l �yR �.
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�►�.i�NNFNG&DE'{`�.A/`�+`hT� , ''
. :�.:Chesk here if attachments
SECTION G-COMMUNITY INFORMATION ' IONAL)
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 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 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(Items G4-G9)is provided for community floodplain management purposes.
G4.Permit Number G5. Date Pertnit Issued G6. Date Certificate Of Compliance/Occupancy Issued
G7. This pertnit has been issued for: ❑New Construction ❑Substantial Improvement
G8. Elevation of as-built lowest floor(inGuding 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 elevation ❑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
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FEDERAL EMERGENCY MANAGENI�IVT NGENCY O.M.13, No. 3067-0077
��������,,{� NATIC?NAL �LOOD INSURANC� PR(�GRAM Expires December 31, 2005
eP�� L'1���►�—. �LEr.�''1�Td�JIV C�RTIF�C�ITE
, � !m or�ant: Read the instructiar�s an a es 1 -7.
SEC7101V A-pROP�RTY QWNER INFORIUTATION For I�surance Company Use:
� .vING OWNER'S NAME Palicy Numb�r
Palm H '
BUILDING STREET ADDRESS(tncluding Apt.,Unit,Suite,an or Bldg.Nn.)OR P.O.R�UTE AND BOX NO. Company NAIC Number
18675 1S 19 Nnrt$ ZtPCODE
C�-�-�, STATE
('1 c?ari�atPr, F�,Orida ��7ti4
AROPERTY DESCRIPTIO(V(Lot a�hd Block Numbers,Tax Parcel Numher,Legal Descriptlon,etc.)
BUILDtNG USE(e.g.,Resi ent�al, on-res� entia, d� ,Accessory,etc. Use a Comments area,if necessary.j
�ident i..H 1
LATITUDE/LONGlTUDE(OPTIONAL) FiORtZONTAL DATUM: SQURCE: �._)GPS(Type):
( ##°-##'-##,##" or ##.��##� �_J NAD 1927 �_�NAD 1983 �_�USGS Quad Map ���Other
SECTION B-FLOOD INSUR/�NGE RATE N1AP(FIRM) INFORMATION -
B1. NF1P COMMUNITY NAME&CQMMUNITY NUMBER B2.COUIVTY NAME B3.STATE
Citv of Clearwater 12,5�Ati Pinellas ' �
B4. MAP A1VD PANEL B5.SUFFIX Bfi. Flf:M INDEX B7.FIRM PANEL B8.FLOOD B9.BASE FLOOD ELEVATiON(S)
�iii.li�ltStR Uti i� i�.".7'I'CV i 1Vvi:��..':��3r+.�"..�+�AT�r- Z�"1�{�; ��on�an,��GP�tepth of tloodingl
f125096 0128 G � Se t. 3 2003 Se t. 3 00 9
8'!0. indicate ihe source of the Base Flaod Elevation (BI=�)data or base flood depth entered in B9.
�� F1S Profile ��� FIRM �_� Community Determined �_�Other(Describe):
811. lndieats the elevation datum used for the BFE in B9: ��) NGVD 1929 ��� NAVD 1988 �,�Other(Describe):
8'12. ls the buiiding located in a Coastal Barrier Resources Systam(CSRS)area or Otherwise Protected Area (OPA)? �T�Yes �.� No
Designation�Date:
SECTIt�N C-BUILDING ELEVATIDN IIVFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: �_�Construciion Drawings' I—IBuilding Under Gonstruction' �x�Finished Construction
new Elevation Certificate will be required when construction of the buiiding is complete.
C2. ��ilding Diagram Number 8 (Select the huilding diagram most similar to the huiiding for which this certificate is being completed-see
pages 6 and 7. Ifi 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,ARlA,AR/AE,AR/A9-R30, AR/AH, AR1A0
Complete ltems C3.a-i below according to the building diagram specified in Item C2.State the datum us�d. If the daturn is different from
the datum used far the BFE in�Ssction B,convert ttte datum to that used for the BFE.Show field measurements and datum conversion
calculation. Use the space provided o�the Comments area pf Section D or•Sectioh G,as appropriate,to document the datum conversion.
Datum NAVDRR ConversioNGamments NGVD 29 ( 1 0 90 fPPt" - nT.z�3tn s�st � foo.+- �
Elevation reference mark used cAO n�mmc �� Does the elevatian reference mark used appear on the FIRM? IT�Yes �x) No
� a) Top of bottom floor(inciuding basement or enclosurej 5 .Z.ft.(m) �
fu] b) Top of next higher fioor 9 . 2 ft.(m) � � �j
�:] c) Battom of lawest horizontal structural member(V zones oniy) tv/A _ft.(m) o Q /J � ��
❑ d)Attached gara ge (to p of slab) tv f p, _ft.(m) � � /// � f�f'G--L______.
,s� e) Lowest elevation oi mdchine�y ai�dior�quipment ;;� J����_ ,�� _ �; �
servicing the building (Describe in a Comments areaJ 9 ._..Q-ft.(m) �� �(� �-'� 1� C��
�r3 � Lowest adjacent(finished)grade (LAG) 5 .._Z_ft.(m) �in � / � l/
� g) Highest adjacent{finished) grade (HAG) ,.�i •�.tt•�n►) _ ��f f 7 I L' (
❑ h) N o.of p�rmanent o penin gs (flood vents)wfthin 1 ft.above adjacent grade n � t
� i;7qta1 area of all permanent openings(flood vents)in C3.h n sq. in. (sq. cm)
. SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATIDN
This certification is to be siyned and sealec�by a iand surveyor,engineer,or architect authorized by law to certify elevation information.
!certify that the informatier�in SE�ctia�s.A, B, an�C on this certificate represents my best efforts to interpret the data available.
I understand that anyfalss statement maybe unishable b fine or im risonment unde�98 U.S. Code, Section 1007.
CERTIFIER'S NAME � LICENSE NUMBER LS 4 0 8 6
Michael .7. �Bzker
TITLE C�MPANY NAME Michael Baker Associates
Land Surveyor
F :ESS CITY STATE . Z3 4 ODE
220 S. �afford Ave. Tar on S rin s F '
' TELEPHONE
SIGNATURE j; ; �� f , August 1 0, 2004 727-938-5026
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lmaoRTaNT: !n these spaces, copy the corr�sponding inforrriation tran��ecuon H. ru, II1SUlO��t���.v��if+u��y �+w.
6UILDING STREET A�DRESS{Including Apt.,Unit,Suite, andlar Bldg. No.)OR P.O. ROUTE AND[30X NO. Policy Number
18675 US 19 North
Cil"Y S7Al-E ZIP GODE Campany NAIC Number '
Clearwater Florida 33764
SECTIOIV D-SUf2VEYOR, ENGIIUEER, OR ARCi-UTECT CEi2TIFICATIOIV {COIVTII�fUED) _
Copy bnth sides of this Elevation Certificate for('I) community official, (2)insurance agenticompany, and (3) building owner. _
COMMENTS „ n
Elevations 7 081 feet NGVD29 �2nverted �-� Plevation- � 1 �i2 fPPt
NAVD F�F3 --
C3e Air Condition�r �_�Check here if attachments
SECTIOAt E- BUILDIN� ELEVATION 1NFORMATION (SURVEY N(]T REQUIRLD) FOR 20NE AO ANQ Z(?NE A(WtTHOUT BFE)
For Zone AO and Zone A (without BFE}, complete ftems E1.through E5. If the Elevation Gertificate is intended for use as supporting
information for a LOMA or L�NIR-F, Section C must be completed.
E1. Building Diagram Number {Selectthe building diagram most similar to the building for which this certificate is being completed–
see pages 6 and 7. If no diagram accurately represenis the building,provide a sketch or photograph.)
E2. The top of the bottom floor (including basement or enclosure)of th�building is �_�_�ft. (mj I—I—I in• (cm)�_� above or �_� below
(check one)the highest adjaceni 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
I—I—I ft• �m) �_,_.�,�in. (cm) above the highest adjacent grade. Comp►ete Items C3.h and C3.i on front of form.
�4. Tha t��of the�latform�r machir.ary?r�lor e;!�ibment servicing the buildinq is �,.�_I ft. (m) ��I_I in. (cm) �_� above or�_� below
(check one)the highest adjacent grade. (Use natural grade, if available.)
E5. For Zone AO only: It no flood depth numlaer is available,is the top of the bottom floor elevated in accordance with the community's
floodplain manaqement ordinance7 � � Yes � ► No ► � Unknown The local official must certify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATNE) CER7IFICATION
The property owner or owner's authorized repres�ntative who completes Sections A, B,C (Items C3.h and C3.i only), and E for Zone A
(4vithout a FEMA-issued or community-issued BFE)or Zone AO must sign here. The statements in Sections A, B, C, and E are correct to
the besi ofm knowled e.
PROPERTY�WNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPMONE
COMMENTS
�_� Check here if attachments
� SECTION G-COMMUNITY 1N�ORMATI�N (OPTIONAL)
The lacal o#ficiat wha 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. Camplete the applicable item(s)and sign below.
G1. �_�The information in Section C was taken from other documentation that has been signed and embassed by a licensed surveyor,
engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the
elevation data in the Comments area below.)
G2. ���A comm:.+nity o�fi�ial completed Sec�on E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or
Zone AO.
G3. �_�The foliowing iniormatio;� (Items G4-G9) is provided for community floodplain managemeni purposes.
G4.PERMIT I�:UMBER G5. DATE PERMIT ISSUED G6. DATE CERTlFICATE QF COMPLIANCEIOCCUPANCY
ISSUED
G7.This permit has been issued for: )_) New Construction �`� 5ubstantial Improvement � �m� Datum:
G8. Elevation of as-built lowest floor (including basement) of the building is: —ft, �m� Datum:
G9. BFE or{in Zone A�� depth of flooding at the building site is: —
LOCAL OfFIC1AL'S NAME TITLE
COMMUNITI'NAME TELEPMONE
SIGNATURE DATE
COMMENTS
� �Check here if attachments