14 WINDWARD IS U.$.DE;PARTMENT 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 '°` � `
�'�:��I�4���se�;
A1. Building Owner's Name �t � , �
w ,�.
Carol n P.Ross&Thurtnan J.Ross,Jr. ������� < ,ti
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. C�1pg ��IA1C�N�irtjtier:-:° L
14 Windward Island(Addition constructed in 2010) �
>.. ,_: ,... .
City Ciearwater State FL ZIP Code 33767 14 W I N D WA R D I S L
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Lot 15, Island Estates of Clearwater Unit 4 BC P2010-Q�F092
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential
A5. Latitude/Longitude:Lat.27.974494 Long.-82.811049 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 16
A8. For a building with a crawlspace or enciosure(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 504 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 N/A within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in AS.b N/A sq in c) Total net area of flood openings in A9.b Q 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 8 Community Number 62.County Name B3.State
City of Clearwater 125096 Pinellas FL
64.Map/Panel Number 65.Suffix 66.FIRM Index B7.FIRM Panel BS.Flood B9.Base Flood Elevation(s)(Zone
12103C0106 H Date Effective/Revised Date Zone(s) AO,use base flood depth)
&18-09 5-17-05 AE,VE 12', 13'
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(Descnbe)
611. 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 RE(�UIRED)
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 CLRW BM G-04.5 Vertical Datum ELEV=3.8527'(N.A.V.D.1 � ���6
Conversion/Comments N/A
< �- -----h ��
Check the measurement used. (7� - c-
a) Top of bottom floor(including basement,crawlspace,or enclosure floor)¢.� �feet ❑meters(Puerto Rico onl�).�� c� ��U
b) Top of the next higher floor N.A �feet ❑meters(Puerto Rico onl�� � Z �
c) Bottom of the lowest horizontal structural member(V Zones only) I�.A �feet ❑meters(Puerto Rico onlyi�y � � �
d) Attached garage(top of slab) ,�.,�,Q �feet ❑meters(Puerto Rico only.�, � 0
e) Lowest elevatiort of machinery or equipment servicing the building �.52 �feet ❑meters(Puerto Rico onl��', � N �
(Describe type of equipment and location in Comments) r�
;� �� 0 7
� Lowest adjacent(finished)grade next to building(LAG) �.2 �feet ❑meters(Puerto Rico oN � n � �
g) Highest adjacent(finished)grade next to building(HAG) �.1 �feet ❑meters(Puerto Rico onl � �� �
h) Lowest adjacent grade at lowest elevation of deck or stairs,including N.A �feet ❑meters(Puerto Rico onl ) a
structural su ort �
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. I certify that the information on this Cerfi�cate represents my best efforts to interpret the data available.
l 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 back of form. Were latitude and longitude in Section A provided by a ,• �`s� '�� V i'(';.;:';
t�
licensed land surveyor? � Yes ❑ No ` ,ti;� `;�:�E.�� .�
Certifier's Name Philip C.Stock License Number RLS#3035 .��J,� r�, �.�
"'3�:'y'M� !8(9•�w�.;�� �' � .. .
Title President Company Name Target Land Surveying,Inc. � ����� �
j^'!'� n- �
Address 516 Lakeside Place City Largo State FL ZIP Code 33771 �,�Z j`�''�'�p„jp " �'�
.� � ,� ;t,�.,� .- w. .'
Signature � Date 6-23-10 Telephone (727)7840573
...�-
FEMA Form 81-3'(, Mar 09 See reverse side for continuation. Replaces all previous editions
. t
IMPORTANT: In these spaces,copy the corresponding information from Section A. ForklnSUra�ce Company Use:
Building Street Address(including Apt., Unit,Suite,and/or Bidg.No.)or P.O.Route and Box No. PoliCy NUmben'
14 Windward Island
City Clearvvater State FL ZIP Code 33767 'Company NAIC Number
$ SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both si�s:of4thiS�Elevation Certificate for(1)community official,(2)insurance agenUcompany,and(3)building owner.
Comm9nts � � '
Job#100�1 Q3�,�� �� � ��`�';���
C2.e=A/G�Ft�"iksy;'' .... �,, •. :
Accordii�g;to��e RhSella�CQ�r�ty.����rty Appraiser,this house was built in 1960. At that time,FEMA flood maps did not exist.
The elev�tipn qtthe�add'�,tio�i�2i�Trc�i�st�uction is 6.35'(N.A.V.D.). No part of the addition falls in the VE zone.
Sign��u`e c%> ; " - . - ' i 7 ° �f;.� Date 6-23-10
�� �''�'� ❑ Check here if attachments
S�EG7�+ON •�U ` N�3;E�V�1'i"iON INFORMATION(SURVEY NOT RE(�UIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
-i�r� � � �
". '• s:�r �'^r�s s �<
For Zones A�and A(v+nt'l�ut gF��,°c�nplete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B,
and C. For ICems'�1.TE4,�u§e��atural grade,if available. Check the measurement used. In Puerto Rico only,enter meters.
E 1. Provide eleva�idr�idfdrmation,for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent
grade(HAG)and th'�B;x6west adjacent grade(LAG).
a)Top of bottom floor(including basement,crawlspace,or enGosure)is ❑feet ❑meters ❑above or 0 below the HAG.
b)Top of bottom floor(inGuding basement,crawlspace,or enGosure)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 platfoRn 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 informabon 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 SecGon 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 infortnation(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
G10.Community's design flood elevation ❑feet ❑meters(PR)Datum
Local Official's Name TiGe
Community Name Telephone
Signature Date
Comments
❑Check here if attachments
FEMA Form 81-31, Mar 09 Replaces all previous editions
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