18675 US HWY 19 N #165 � .
U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
Federal E'mergency Management Agency Exnires Februarv 28.2009
N�tional Flood Insurance Program important: Read the instructions on pages 1-8.
SECTION A-PROPERTY INFORMATION For Insurance Company Use:
A1. Building Owner's Name Policy Number
John A Care &Frances M Care
A2. Building Street A dress(in ding Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. CompanyNAIC Number`
18675 US 19 N
C�tY State ZIP Code
Clearwater FL 33756
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Lot 165 Bay Aristocrat�Ilage
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential
A5. Latitude/Longitude:Lat. N27°56.52636 long. W082°43.80744 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 crawl space or enclosure(s),provide: A9. For a building with an attached garage,provide:
a) Square footage of crawl space or enclosure(s) sq ft a) Square footage of attached garage 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 walls within 1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP Community Name&CommunityNumber 62.County Name 63.State
Ciry of Clearwater 125096 Pinellas FL
64. Map/Panel Number 65.Suffix B6.FIRM Index 67.FIRM Panel B8.Flood 69.Base Flood Elevation(s)(Zone
12103C0128 G Date Effective/Revised Date Zone(s) AO,use base flood depth)
9-3-03 9-3-03 AE 9'
810. 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) �
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) r
C1. Building elevations are based on: ❑Construction Drawings' ❑Building Under Construction` �Finished Construction Z
"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-g T
below according to the building diagram specified in Item A7.
Benchmark Utilized G Tidal FL DT Vertical Datum ELEV= 9 48(N A V D �
Conversion/Comments �-�"'� w., a
Check the measurement used. � [.� �
n ��
a) Top of bottom floor(including basement,crawl space,or enclosure floor)9.78�feet ❑meters(Puerto Rico only) =C �� �_
b To of the next hi her floor N.A feet � �� � � N
) P 9 � ❑meters(Puerto Rico only) �
c) Sottom of the lowest horizontal structural member(V Zones only) N.A�feet ❑meters(Puerto Rico only) � ` � � � �
d Attached ara e to of sl a b N.A f e e t �� "' � �` _ �
) 9 9 � P ) � ❑meters(Puerto Rico only) �� v � � O
e) Lowest elevation of machine ry or e q ui p m e n t s e rv i c i n g t h e b u i l d i n g 9.4 3�f e e t ❑m e t e r s(P u e rt o R i c o o n l y) � �� � � � �
(Describe type of equipment in Comments) ;-;� �� � S( � O
fl Lowest adjacent(finished)grade(LAG) 5.8�feet ❑meters(Puerto Rico only) t r:�; <<�:� r � � 0
Hi hest ad acent finished rade HAG 6.0�feet i.:t =➢�
9) 9 J � )9 � ) ❑meters(Puerto Rico only) �r_� n„ N
� �.. .. :=� a
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION � _'�' ` -: :.Op U
.r.� �r���� M
This certification is to be signed and sealed by a land surYeyor,engineer,or architect authorized by law to certify elevation • .,a.���� �� _:., �■•�
information. l certify that the information on this Certi�cate represents my best efforts to interpret the data available. � , ' "' �
l understand that any false statement may be punishable by�ne or impNsonment under 18 U.S. Code,Section 1001. ''��'�1 ,� • �°'`C�. '�
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�Check here if comments are provided on back of form. `
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Certifier's Name License Number .
Phillio C.Stock RLS#3035 ���, �S�:��� "�� �
. ,��. _ -;
Title Company Name ,, �_ ,�,, ,�, . � , .,
President Taraet Land Survevina Inc �', - �'��� �����V
Address City State ZIP Code ��,
1305 South Hiahland Avenue Clearwater FL 33756 � � ''
Sign . Date Telephone � " �8-8-0$
�-�-� &6-08 727 7840573
FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions
IMPORTANT: In these spaces,copythe corresponding information from Section A. �orins�t�an� 'ri�pan a"�� ^'3 , ;;_.
Building Street Address(inGuding Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. q PoU �lut'K►b„�r y,� � e� ;r
18675 US 19 N
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City State ZIP Code �Company,,NAIC Number
Clearwater FL 33756 ' '` " "
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)communiry official,(2)insurance agenUcompany,and(3)building owner.
Comments
080804.01
C2.e=A/C pad
Center line of road hi hest elevation=5.83'Center line of road lowest elevation=5.76'
Signature Date v
lo �d4p ❑ Chedc here if attachments
SECT N E-B DING 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 Rioo only,enter meters.
E1. Provide elevatlon information for the foilowing 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 enGosure)is ❑feet ❑ meters ❑above or ❑ below the HAG.
b)Top of bottom floor(including basement,crawl space,or enGosure)is _�feet ❑meters ❑above or � below the LAG.
E2. For Building Diagrams&8 with permanent flood openings provided in Secti items 8 and/or 9(see a e 8 of InsVuctions),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 _Q 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 infortnation 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 2one 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)
fhe local official who is authorized by law or orciinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),
3nd G of this Elevation Certificate. Complete the appiicable item(s)and sign below. Chedc the measurement used in Items G8.and G9.
31. � The irifortnation in Section C was haken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who
is autttiorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
32. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or communiry-issued BFE)or Zone AO.
33. ❑ The following information(Items G4:G9.)is provided for community floodplafn management purposes.
G4.Permit Number G5. Date Pertnit Issued G6. Date Certificate Of Compliance/Occupancy Issued
37.This permit has been issued for: ❑ New Construction ❑Substantial Improvement
38.Elevation of as-built lowest floor(including basement)of the building: ❑feet ❑meters(PR) Datum
39.BFE or(in�one AO)depth of flooding at the building site: ❑feet ❑meters(PR) Datum
Local Official's Nama' Title
Community Name Telephone
Signature Date
Comments
❑Check here if attachments
=EMA Form 81-31, February 2006 Replaces all previous editions
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