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602 POINSETTIA AVE BLDG 4 U.S.DEPARTMENT 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 FbF Irl�iiri�ttt��tiff'►p�iFY�i IJS�` A1. Building Owner's Name LIESELOTTE JILLICH P�� A2. Building Street Address(induding Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. ��yr Nq��c : , .. ., POINSETTIA AVENUE, BLDG#4 :;.,�:,<.•:,. - Ciry CLEARWATER State FL ZIP Code 33767 A3. Property Description(Lot and Block Numbers,Tax Parcei Number,Legal Description,etc.) PART OF LOT 5,BLK A,MANDALAY REPLAT UNIT 5 A4. Building Use(e.g.,Residerriial,Non-Residential,Addition,Accessory,etc.)RESIDENTIAL MOTEL A5. Latitude/LongRude:Lat.27 59 06.42N Long.82 59 33.11 W Horizontal Datum; ❑ NAD 1927 � NAD 1983 A6. Atfach 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): A9. For a building with an attached garage: a) Square footage of crawlspace or enctosure(s) N/A 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 endosure(s)within 1.0 foot abov�e adjacent grade N/A within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in AB.b N/e 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 fNSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name 8 Community Number B2.County Name B3.State CITY OF CLEARWATER / 125096 PINELLAS FLORIDA B4.Map/Panel Number B5.Suffix B6.FIRM Index 67.FIRM Panel B8.Flood B9 Base Flood Elevation(s)(Zone 12103C0102 �G Date Effective/Revised Date Zone(s) AO,use base flood depth) 8/18/2009 9/03/2003 AE 11.0 B10. Indicate the souroe ot the Base Flood Elevation(BFE)data or base flood depth ente�d in Rem B9. ❑ FIS Proflle � FIRM ❑ Community Determined ❑ Other(Describe) 811. Indicate elevation datum used for BFE in Item 89: ❑ NGVD 1929 � NAVD 1988 ❑ Other(Describe) 812. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes Designation Date N/A ❑ CBRS � No .� ❑ OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings" ❑ Building Under Construdion" 'A new Elevation Certificate will be required when construction of the building is complete. � Finished Construction C2. Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/At-A30,AR/AH,AR/AO. Complete Items C2.a-h below according to the building diagram specified in Item A'7. Use the same datum as the BFE. Benchmark Utilized CITY CLEARWATER Vertical Datum NAVD 88 Conversion/Comments N/A Check the measurement used. a) Top of bottom floor(induding basement,cxawlspace,or endosure floor 5.5 b) Top of the next hgher floor �-- ��t ❑meters(Puerto Rico only) N/A. ❑feet ❑meters(Puerto Rico only) c) Bottom of the lowest howzontal strudural member(V Zones only) N/A. ❑feet ❑meters d) ABacned garage(top of slab) (Puerto Rico only) N/A. ❑feet ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipmeM servicing the buitding 6.2 �feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Comments) � Lowest adj8cent(finished)grade next to building(LAG) 4.9 �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade neM to building(HAG) �.� �feet ❑meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs,including N/A. ❑feet structural su ort ❑meters(Puerto Rico only) ,., `��.�s.��,i��`,�9'"'.. SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION " 'r� This certification is to be signed arxl sealed b a land su ng " `�' '"'O � � ' Y rveyor,e ineer,or architect authorized by law to certify elevation • + %,��1 .r�� '�;� infortnation. 1 oefify Nrat dhe infnrm,e�or►on this Cefifi�ab�p��n��,�y�eAwts to interpret the deta avaNable.l ;y :�`' ;� �. • l� �� understand that any/alse statement rrray,ye punishabk by/'rcre or imprisonment under 18 U.S.Code,Section 1001.� ' �:�' �+ o � ' Check here if comments ane ' C�� ,�' G �� provided on badc of fortn. Were la6tude and longitude in Secfion A provided by a v' 10�° r : %�' � . licensed land surveyo�? � Yes ❑ No �, a � : `' % " Certfier's Name Eugene T.Caudell . ,� � - r f- License Number PLS 4821 ` ,^<<r'•" :: v� ' Title LandSurveyor ComparryName Self '�'1�� ,,?��.e,.•�� '_`+ Address 2321 Pin Oak Ln E. Ci Clearvvater t=�� ,1,�ZVa��,• ' � State FL ZIP Code 33759 - Signafure i� Date 10/15/2012 Telephone 727 459-9186 4 �- L� '-� � . -z--,- �, FEMA Form -31, Mar 09 See reverse side for continuation. Replaces all previous editions . . IMPORTANT: In these spaces,copy the corresponding information from Sectfon A. For Insuranoe Company Use: Building Street Address(induding Apt.,Unit,Suite,and/or Bidg.No.)or P.O.Route and Box No. PoRcy Nunber 602 POINSETTIA AVENUE City CLEARWATERState FL ZIP Code 33767 CompBny NAIC NUPilbei' 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 SITE CONTAINS 4 BUILDINGS THIS CERTIFICATE IS FOR BUIIDING#4 MECHANICAL CONSISTS OF WALL AIR CONDITIONING UNITS SEE ATTACHMENT FOR BUILDING LOCATION ON SITE. Signature � Date 10l15/2012 � Chedc here if attachments SECTION E- ILDIN 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. E 1. 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 endosune)is ❑feet ❑meters ❑above or Q 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 (elevalion C2.b in the diagrams)of the building is ❑feet ❑meiers ❑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 andlor equipment senricing 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. Th�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(TnmePs or Owner's Authorized Representative's Name �dd�PSS ary State ZIP Code —�— Signature Date Telephone y. 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. Chedc the measurement used in Items G8 and G9. G1.❑ The information in Section C was taken from other documentation that has bee�signeci 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 Commerris area below.) G2.❑ A community official completed Section E for a building located in Zone A(withoul a FEMA-issued or oommunity-issued BFE)or Zone AO. G3. ❑ The following information(Items G4-G9)is provided for community floodplain management purposes. G4.Permit Number G5. Date Permit Issued G6. �ate Certificate Of Compliance/Occupancy Issued G7. This pertnit has been issued for: ❑New Construction ❑Substantial Improvement G8. Elevation of a§-built low�est floor(induding basement)of the building: ❑feet ❑meters(PR)Datum G9. BF'E 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 Jffici�l's Name � Title Community Name Telephone Siynature i Date Comment� ❑Check here if atlachments FEMA Form 81-31, Mar 09 Replaces all previous editions . � ,�o�. ��s�rf-,� �E '_� -� �� i " �� _� � -- "l.t=, T�?!, _� � � ,+ . - JUA��NAY' W • '�. ' . r , o ',' ' ,r ` a - , � � .`� � • � ► '3 . � • � . . :,: i -rJ. : f . � _ ,� �� ! .., .r ' �!,, < < ' : • ,;; :,I ,- • ��`:. �'� � ` , i ► ,�� ,t �. � �f� ,�,'�:t 1 . '� .. 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