1024 MARK DR ___ _
U.S.DEPARTMENT OF HOMELAND SECURITY ELEVH 1 IV���GK 1�IC��O� OMB No. 1660-0008
Federal Emergenc�Management Agency Expires March 31,2012
Nationai Flood Insurance Prc�ram Important: Read the instructions on pages 1-9.
SECTION A-PROPERTY INFORMATION � ti ;�
A1. Building Owner's Name GREGG WOLF � ^�---���
�.; � ' �,�;� �� .�
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bidg.No.)or P.O.Route and Box Na �
1024 MARK DR. - ` ' �� '�
3 x �
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City CLEARWATER State FL ZIP Code 33756
A3. Property Description(Lot and Blodc Numbers,Tax Parcel Number,Legal Description,etc.)
SIRMONS HEIGHTS 1�ADD LOT 49 15-29-15-82206-000-0490
A4. Building Use(e.g.,Residential,Non-Residentiai,Addkion,Accessory,etc.)RESIDENTIAL
A5. Latitude/Longitude:Lat.27°57'15.28 Long.82°46'5571 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 1A
A8. For a building with a crawlspace or endosure(s): A9. For a building with an attached garage:
a) Square footage of crawispace or encbsure(s) WA sq ft a) Square footage of attached garage 269 sq ft
b) No.of permanent flood openings in the crawispace or b) No.of permanent flood openings in the attached garage
enclosure(s)within 1.0 foot above adjacent grade 0 within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b 0 sq in c) Total net area of flood openings in A9.b 0 sq in
d) Engineered fl�d 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 83.State
CITY OF CLEARWATER 125096 PINELLAS F�
B4.Map/Panel Number B5.Suffuc 66.FIRM Index B7.FIRM Panel B8,Flood B9.Base Flood Elevation(s)(Zone
12103C0108 G Date Effective/Revised Date Zone(s) AO,use base flood depth)
5/17/05 5/17/05 AE 24.25
610. Indicate ihe source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
❑ FIS Profile � FIRM ❑ Community Determined ❑ Other(Describe}
811. Indicate elevation datum used for BFE in Item 69: ❑NGVD 1929 � NAVD 1988 ❑ Other(Describe)
B12. Is the building located in a Coastal Bamer Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes � No
Designation Date WA ❑ 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,ARlAE,AR/A1 A30,AR/AH,ARlAO. Complete Items C2.a-h
below according to the building diagram specified in Item A7. Use the same datum as the BFE.
Benchmark Utilized PCBM Breeze U.CiL D8Verticat Datum NAVD 1988
ConversionlComments N/A
Chedc the measurement used.
a) Top of bottom floor(inGuding basement,crawlspace,or endosure floor)25.10 �feet ❑meters(Puerto Rico only)
b) Top of the next higher floor N/A. ❑feet ❑meters(Puerto Rico only)
c) Bottom of the lowest horizontal structural member(V Zones only) WA. ❑feet ❑meters(Puerto Rico only)
d) Attached garage(top of slab) 24.27 �feet ❑meters(Puerto Rico only)
e) Lov+�st elevation of machinery or equipment servicing the building 24.37 �feet ❑meters(Puerto Rico onty)
(Describe type of equipment and location in Comments)
� Lovwest adjacent(finished)grade next to building(LAGj 23.9 �feet ❑meters(Puerto Rico only)
g) Highest adjacent(finished)grade next to building(HAG) 24.1 �feet ❑meters(Puerto Rico only)
h) Lowest adjaoent grade at lowest elevation of dedc or stairs,including 24.0 �feet ❑meters(Puerto Rico only)
structural support
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION - k p t
This certifiqtion is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation ` �"� � 'A+• ��L
inforrna6on. I certify that the infom►ation on this Certih'cate�piesents my best effats to inteipret the data availab/e. r,� ,#: ", , -�- ',�
l understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Secfion 1001. ����. . .f���.
� Chedc here if comments are provided on badc of form. Were latitude and longitude in Section A provided by a.k ; ;�` ,� ��� . �
licensed land surveyor? � Yes ❑ No � = ' � ✓�. '� �:
" � : � , � .- . _
Certifiers Name Dennis J.Eyre License Number 2865 � �,;,j,h, L�:'
� � �s9, �: .
Title Land Surveyor Company Name GeoData Services,Inc. � '
;, , �
`e W. � f ♦''. �y' .,. .,'_ � �R�'� J .� '
Address 18 Drew treet,Suite 8 Ci learwater State FL ZIP Code 33765 „�?'� �
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Signatu Date 10/8/12 Telephone 727-447-1763 : , '�� f 0�C5 t �'
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=EMA F rm 1-�1 11Aar - �-- ----- . - • '��a��t��
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IMPORTANT: In these spaces,copy e'corresponding information from Section A. �c�tns�t►����y,�se
Building Street Address(including Apt.,Unit,Suite,andlor Bldg. No.)or P.O. Route and Box No. �7[lcp,t+#�7�c�.�� �-
1024 MARK DR. ` +-
Ciry CLEATWATERState FL ZIP Code 33756 �C�ritpafii'�i�f1�C=1ti1tIt�F��3r��'�� ' "���
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Cert�cate for(1)community official,(2)insurance agent/company,and(3)building owner.
Commen 2 e) w�st machi�ery is the air condition slab
1
Sig tur Date 10/8/12
❑ Check here if attachments
SECTION E-BUILDING 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. Chedc the measurement used. In Puerto Rico onty,enter meters. �
E1. 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 fl�r(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or�below the HAG.
b)Top of bottom floor(inGuding 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
(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 platform of machinery andlor equipment servicing the building is ❑feet ❑meters ❑above or 0 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 inforrnation 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 fo�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 coirect to the best of my knowledge.
Property Owners or Owners Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
❑Chedc here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The loql officiai who is author¢ed by law or o►dinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),
and G of this Elevation Certifiqte. Complete the applicable item(s)and sign below. Check the measurement used in Items G8 and G9.
G1.❑ The informatron 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 R(without a FEMA-issued or community-issued BFE)or Zone AO.
G3. ❑ The folbwing information{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 permft has been issued for: ❑New Construction ❑Substantial Improvement
G8. Elevation of as-built lovvest 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 Title
Community Name Telephone
Signature Date
Comments
❑Chedc here if attachments
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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. Poiicy rvumber
1024 MARK DR.
Clt}/ CLEARWATER State FL ZIP Code 33756 Company NAIC Number
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 Viev�' 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.
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