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3412 BRAESIDE PL U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Expires March 31, 2012 Federal Emergency Management Agency Nationai Fiood ir,s�rar,ce Pro9ram Important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION Fgr lnsurance�amp�ny Use,: : A1. Building Owner's Name SAMUEL J AND HELEN L JARCZYNSKI �'°��X��m��` x A2. Buil�ing Street Address(including Apt.,Unit,Suite, and/or Bldg. No.)or P.O.Route and Box No. �Company NAI�Nutnb�r 3412 BRAESIDE PLACE City CLEARWATER State FL ZIP Code 33756 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) PARCEL 10-29-16-10758-000-0030, LOT 3, BRAESIDE PLACE, PLAT BOOK 085, PAGE 077, PINELLAS COUNTY A4. Buiiding Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)RESIDENTIAL A5. Latitude/Longitude:Lat. 27.9782 Long. 82 6945 Horizontal Datum: ❑ NAD 1927 X NAD 1983 A6. Attach at least 2 photographs of the buiidirig ifthe CeRificate is being used to obtain flood insurance. A7. Building Diagram Number EI HT 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) 4278 sq ft a) Square footage of attached garage 860 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 2 within 1.0 foot above adjacent grade 0 c) Totai net area of flood openings in A8.b 1217 sq in c) Total net area of flood openings in A9.b 0 sq in d) Engineered flood openings? ❑Yes X No d) Engineered flood openings? ❑ Yes X No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 61.NFIP Community Name&Community Number B2.County Name 63.State CLEARWATER CITY OF 125096 PINELLAS FL B4.Map/Panel Number B5.Suffix B6.FIRM index 67.FIRM Panel 68:Flood 69.Base Flood Elevation(s)(Zone Date Effective/Revised Date Zone(s) AO,use base flood depth) 12103C0127 G 08/18/2009 09/03/2003 X&AE &VE AE&VE= 9.0 FEET 610. indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69. ❑FIS Profile x FIRM ❑Community Determined ❑Other(Describe) 611. Indicate elevation datum used for BFE in Item B9: NGVD 1929 X NAVD 1988 ❑Other(Describe) 612. Is the buiiding located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes x No Designation Date ❑CBRS ❑OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) 1. Building elevations are based on: ❑Construction Drawings` ❑Building Under Construction* x 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 Vertical Datum NAVD 1988 Conversion/Comments NONE Check the measurement used. a) Top of bottom floor(including basement,crawlspace,or enclosure floor) 6.0 X feet ❑meters(Puerto Rico only) b) Top of the next higher floor 11.1 x feet ❑meters(Puerto Rico only) c) Bottom of the lowest horizontal structural member(V Zones only) 9.2 x feet ❑meters(Puerto Rico only) d) Attached garage(top of slab) 8.8 x feet ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 8.3 X feet ❑meters(Puerto Rico oniy) (Describe type of equipment and location in Comments) � Lowest adjacent(finished)grade next to building(LAG) 4.5 X feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 6.0 X feet ❑meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs,including 4.5 X feet ❑meters(Puerto Rico only) 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 Certificate represents my best efforts to interpret the data available. �,n,�;«•i;..� 1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. .,�,�`��.H, y�;�,`J XCheck here if comments are provided on back of form. Were latitude and longitude in Section A provided by a �G�kT lf��'�� licensed land surveyor? x Yes ❑No '�� 9�"� Certifier's Name: BILL HYATT License Number: LS 4636 :.y ? Stq � g m �� Title: PRESIDENT Company Name: KNOW IT NOW INC =?��OR II�F � ;: �1 �.,, ��,,.• Address: 1497 MAIN STREET#321 City: DUNEDIN State: FL ZIP Code: 34698 '• ,U{�y E�C)� ��r . ,.��`. Signature �� Date 9/21/12 Telephone: 727-415-8305 FEMA Form 81-31, Mar 09 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces,copy the corresponding information from Section A. For Insurance Company Use: Building Street Address(inciuding Apt.,Unit,Suite, andlor Bldg.No.)or P.O.Route and Box No. Policy Nufnber 3412 BRAESIDE PLACE City CLEARWATER State Fl ZIP Code 33756 Company NAIC Number: SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agenUcompany,and(3)building owner. Comments NOT TO BE USED FOR CONSTRUCTION OR DESIGN,IS FOR FLOOD INSURANCE USE ONLY FOUNDATION APPEARS TO BE BREAK AWAY WALLS,TAX ASSESSOR SAYS SPECIAL WOOD WHICH WOULD GENERALLY INDICATE BREAK AW AY Signature �� Date 9/21/12 X Check here if attachmenis SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),compiete Items E1-E5. If the Certificate is intended to support a IOMA 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. E1. Provide elevation 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 fioor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or ❑below the HAG. b)Top of bottom floor(including basement,crawispace,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 ne�higher floor (elevation C2.b in the diagrams)of the building is ❑feet ❑meters ❑above or ❑below the HAG. E3. Attached garage(top of siab)is . ❑feet ❑meters ❑above or ❑below the HAG. E4. Top of platform 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 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 fioodplain 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 Section C was taken from other documentation lhat 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 compieted 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 Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑Substantiai 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 designflood elevation ❑ feet ❑ meters(PR)Oatum Local Officiai's Name Title Community Name Telephone Signature Date Comments ❑Check here if attachments FEMA Form 81-31, Mar 09 Replaces ali previous editions _ _ ___ 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. Poi�cy N�mber 3412 BRAESIDE PLACE Clty CLEARWATER State FL ZIP Code 33756 CompanyNAlCNumber 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 View" and "Rear Vievd; and, if required, "Right Side Viev�' 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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' � ; a�„"��' �_ , w , �'��'^��Q�� 'Y�� w� .;�� ,s- r �� .. •s ,„ .,�, ^ i�' ,>'.._ .�. ... �� _ ,a5� a -� �. �'�+� �'a�" s, �. � � �� x_ � „ �'. " . � F' o- "f �'��' ,��%� _�:e� -,'_ � ,�,^�` ..� . ��3,� �,� �,�.:`� " ;,,� �' ^,� � �; II ��. a;y�: . . ��,: �. �f., �. . - �, - _ .,. � �� ' , ' ' .� t � , � _ ��„ ' �.+m.�s' �r«�..3 _,..'.,a 3, _�`�. il !i i Instructions—Page 4 � � �`D l,�] (U i � A��~r��•:��"".r.:-d \/ C [i ��_� �� -� �� ; FEB 1 1 2013 ,� �� PIANtdING&DE�lELC�� 1T L��P`I' _: 17Y f F t;t.�A4l�JA'`�E?�,.,_.. �� I -.�,..�._.�. I _ , �:�;_ _ �, c� a�� - / o� �� C.(� , � 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 �or lnsurart�@,Cc�i�tanY Us�.''. A1. Building Owners Name SAMUEL J AND HELEN L JARCZYNSKI f'��!��`�,,\ �� ' ' �b A2. Building Street Address(including Apt.,Unit,Suite,and/or Bidg.No.)or P.O.Route and Box No. C�mparl�+P�A1C�lumbp�r 3412 BRAESIDE PLACE �� City CLEARWATER State FL ZIP Code 33756 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) PARCEL 10-29-16-10758-000-0030, LOT 3, BRAESIDE PLACE, PLAT BOOK 085, PAGE 077, PINELLAS COUNTY A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)RESIDENTIAL A5. Latitude/Longitude:Lat. 27.9782 Long. 82.6945 Horizontal Datum: ❑ NAD 1927 X 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 EIGHT AS. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawispace or enclosure(s) 4278 sq ft a) Square footage of attached garage 860 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 2 within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in AB.b 1217 sq in c) Total net area of flood openings in A9.b 0 sq in d) Engineered flood openings� ❑Yes X No d) Engineered flood openings? ❑ Yes X No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 61.NFIP Community Name&Community Number 62.County Name B3.State CLEARWATER CITY OF 125096 PINELLAS FL 64.Map/Panel Number 85.Suffix 66.FIRM Index 67.FIRM Panel 68.Flood B9.Base Flood Elevation(s)(Zone Date Effective/Revised Date Zone(s) AO,use base flood depth) 12103C0127 G 08/18/2009 09/03/2003 X&AE &VE AE &VE= 9.0 FEET 610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑FIS Profile X FIRM ❑Community Determined ❑Other(Describe) B11. Indicate elevation datum used for BFE in Item B9: _NGVD 1929 X NAVD 1988 ❑Other(Describe) 612. Is the building located in a Coastal Barcier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes x No Designation Date ❑CBRS ❑OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) 1. Building elevations are based on: ❑Construction Drawings* ❑Building Under Construction' x 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 Vertical Datum NAVD 1988 Conversion/Comments NONE Check the measurement used. a) Top of bottom floor(including basement,crawlspace,or enclosure floor) 6.0 X feet ❑meters(Puerto Rico only) b) Top of the next higher floor 11.1 X feet ❑meters(Puerto Rico only) c) Bottom of the lowest horizontal structural member(V Zones only) 9.2 x feet ❑meters(Puerto Rico only) d) Attached garage(top of slab) 8.8 x feet ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 8.3 x feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 4.5 X feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 6.0 X feet ❑meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs,including 4.5 X feet ❑meters(Puerto Rico only) structural support 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 eievation information. 1 certify that the information on this Certificate represents my best e(forts to interpret the data available. ;;,,,c;�r�r,, �., I understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001. ;�.\�� H. /-�},^vw �1��1� � �� XCheck here if comments are provided on back of form. W ere latitude and longitude in Section A provided by a :r'��G�,kT IF�C�>'��;� licensed tand surveyor? X Yes ❑No x � ,E �t? �',�"c. Certifier's Name: BILL HYATT License Number: LS 4636 =!"' ; S =c��' �^ 7�� „ ., ,�r,�r � Title: PRESIDENT Company Name: KNOW IT NOW INC ':��'•�OR�� ;` � '•. Address: 1497 MAIN STREET#321 City: DUNEDIN State: FL ZIP Code: 34698 • %�'��/1��.��,.► • � �*�T Signature �'`'°7'� Date: 9/21/12 Telephone: 727-415-8305 FEMA Form 81-31,Mar 09 See reverse side for continuation. Replaces all previous editions . , IMPORTANT: In these spaces,copy the corresponding information from Section A. �+�[r��eCc�mj��+.Use-" "'�"�; Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. �y hlUlrii��t' '�� 3412 BRAESIDE PLACE ��`� �� . �a�' z City CLEARWATER State FL ZIP Code 33756 Cci�'r4p�ny�lA1 {�furl�b�a' ,��.." � y 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 NOT TO BE USED FOR CONSTRUCTION OR DESIGN,IS FOR FLOOD INSURANCE USE ONLY FOUNDATION APPEARS TO BE BREAK AWAY WALLS,TAX ASSESSOR SAYS SPECIAL WOOD WHICH WOULD GENERALLY INDICATE BREAK AW AY Signature �'—�°T� Date 9/21/12 X 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. Check the measurement used. In Puerto Rico only,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 floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or ❑below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclasure)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 buiiding 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 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 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,B,and E are correct to the best of my know/edge. 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 compiete 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 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 compieted Section E for a buiiding 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 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 Title Community Name Telephone Signature Date Comments ❑Check here if attachments FEMA Form 81-31, Mar 09 Replaces all previous editions