207 WINDWARD IS.
' ige � o! � nc�t valid vathout all three pages
U.S. UEPARFMENT OF HOMELAND SECURITY
Federal Emergency h1anagement Agency
Nationai Flood insurance Program
ELEVATION CERTIFfCATE
Important: Read the instructions nn pages 1-9.
SECTION A- PROPERTY INFORMATION For
A2 Bui�ding Street Address �includrng Apt., Unit, Suite, andior Bldg No j or P O. Route and Box No.
onnB No. i sso-000s
Expires March 31. 2012
Usc:
City State ZIP Code
CLEARWATER F '1RIDA 337g7
A3 Property Description (�ot and 81ock Numbers, Tax Parcel Nurrrber. Legal Description, etc ? �`
.._.__ � a.�=C t�:+t w,lrv -�, a IS+.NU [tiTt�iCS C�F i;LEFHV'Ai�R ACi;GHUiNCi Ti7 rNE F�AT THE�2C .i 4.� i;.E )kCti'�L� iN ?�aT 6iJOk �_' PA ;E 3� nN� r r>� THC ( t.BL1C f:t��)FtLS �)F t�14 _�.a.; ,_(,t,��,T :.:il'.r�
�__-_
A4 Building Use (e g. Residential, Non-Residential, Addition, Accessory. etc i RESIDENTIAL_
- ---- . __ _— -- --------.�
A5 Latitude;longitude: Lat 27 58 44.1 N � Long E2 48 38 0 W � Honzantai Datum � NAD 1927 QX NAO 15�t3
A6. Attach at Ieast 2 photogrephs of the building if the Certificate is bemg used to obtai� flood msurance.
A7 Buildi�g Diagram Number�_
A8 For a building wittr a crawispace or enclosure(s) A9. For a buildiny 4vith an attached garage
ai Square footage oi crawispace or enciosure(s) �� sq i; a i Square footage of attached garage 426 sy h
b) No. of permanent Flood openings in the cra�.vlspace or b) No. of permanert flood openings in the attached garage
enclosure(sj within 1 A tooi above adjacent grade � with�n 1 0 foot above ad�acent grade 0
c! Totai net area of flood ope�ings in A8b q_ sq �n c) Totai net area of flood openings in A9.b 0 sq m
di Engineered food openings? � Yes XQ No d) Engineered ftood openings? � Yes � No
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
, B1 NFIP Commu�ity Name & Community Number B2 County Name 83 State �
B11
812
Indicate the saurce of the Sase Flood Elevation (BFEj data or base fiood depth entered in item 89.
� FIS Profile Q FiRM Community Determined � Other (Describe;
Indicate elevation datum used for BFE 1n Item B9: ❑ NGVD 1929 � NAVD 1988 �J Other (Describe)
Is the building located in a Coastal Barrier Resources Sysiem (CBR5j area or Other�vise Proteeted Area iOPA)�
Designation Date � CBRS � OPA
� Yes O No
SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUlRED)
C 1 Buiid�ng elevations are based on � Conslruction Dra�+vings' � Bwidmg U�der Construction' Q Finished Construction
'A ne�v Elevation Certificate wili tre required when construction of the building is complete.
C2 ElevaUOns—ZonesAl-A30, AE AH, A(with BFEj. VE V1-V30, V(wdh BFE1, AR RR/A: AR;AE, AR�A�-A30 ARlAH, ARiAO Compiete items CZa-h
Geiow according to the buiiding diagram specified in !tem A7 Jse the same datum as the SFE
Benchmark Utihzeci L-NE7 GPS NETWORK :; Vertical Datum NHVD88
Ccnvers;oNComments
Check the rneasurement used.
a; Top af bottom flaor (mc}uding basement_ crawlspace, or enciosure ffeor� 5.$' 8(eet � meters (Puerto Rico only;
b i Tap of the next higher @oor ____ 6 59 feet meters (Puerto R�co only;
c) Bottom o( (f7e lowest honzantai structural member (V Zones only� _QX teet ❑ meters (Puerto Rico only)
d) Attached garage (top of slab) 5 8i QX teet ❑ meters {Puerto Rico only)
ej Lowest elevation af machinery or equipment servicirg the buiiCing o]t Q feet � meters �Puerto Rico only)
lDescribe type of equipment and location m Comments)
fi} Lo•rovsi ad}acent (fin�shedJ grade next to building (LAG; ��_Q feet � meters (Puerto Rico only�
gj Highest ad�acent ,'f�nished) grade next to building (NAG i �.�� feet � meters 4Pue�to Rico only�
hj Lov�st adjacent grade at lowest elevation of deck or stairs. mciud+ng _o feet � meters fPuerto R�co only?
structural support
SECTION D- SURVEYOR, ENGINEER, OR ARCHlTEGT CERTIFICATION
This cert9fication is to be signed and sealed by a land sun+eyor, engineer. or architect autho�zed by Iaw to certify eleva6on
infcnnation ! ceR;ty that the information on this Cerlificate reprasents my best effoRs to interpret the data avarlabfe. � �� �> i rt�Y��
I'understand that any �afse statement may be punishabie by fine or;mpnscnrrrent under 18 U S- Gode. Sect�on 1001 f�i„'� s��� rt,,, ``�t�,� �
Q Check here ii comments are provided on back o1 form Were latitude and langitude in Section A provided by a
licensed iand surveyor� �Yes QX No
Certifier's Name L.icertse Number
KEIi H A. STEPHENSUN LS 652?
T4tle Company Name
_ PRGFkSS=C�MAt SURVF �Of3 ANU MAf'PER ACTA �1ND SI1R4��1`C�RS INC'
F+ddress Crty State ZIP Code
12220 TOtiNNE LAKE pRIVE SU�TE 55 FT MYERS FL 3391�
Signature � ✓ _ CJate Telephone
�,_.•:::-� r_�.._�_�`-� 4111/2013 P (813)549�19�:7
FEMA Form 81-31, Mar Q9 See reverse side for continuation. Replaces all previous edit�ons
�;RE'v4 a�t1l"2013} �
�,.
�.
P;3,e 2 uf 3 nol valid withoet all lhree p3ge,
IMPORTANT: In these spaces, c
Building Street Address (induding Apt.,
207 WINDWARD ISLAND
City
the corresp
Suite, andlor
intormation from Section A.
No. ) or P O.
Stat?
ZIP Code
For Irisurance Comparry Use:
Number
SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy bottr sides of this Eievation Certificate for (t ) community o�cia!, (2j insurance agenUcompany, and (3) building owner.
Uomments - --
C2.E = A/C UNIT PAD NOTE THIS ELEVATION ERTIFICATE IS ONLY VALID FOR TNE PERSON OR PERSONS NAMED ON THIS CERTIFICATE.
C�NTERL!NE ROAD ELEVATION a 55
Signature Date
�,��V yL�,�� ,y";r2i1'�
�-�tij''
❑ Chedc here rf attachments
SECTION E- BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO QND ZONE A(WITHOUT BFE)
For Zones AO and A(without BFE). comptete Items E 1-E5. If the Certificate is ntended to suppoR a IOMA or LOMR-F request; complete Sections A. 6.
and C For items E1-E4, use natural grade if available Check the measurement used. In Puerto Rico onty, enter rneters.
E i Provide elevation information for the following and check the appropriate buxes to sho�� whether the elevation is above or below ihe highest ad�acent
grede (HAC,} and the lnwest adjacent grede (LAGj
a) Top of bottom floor (inGuding basement, crawlspace, or endosurej is ____ `�feet ❑meiers ❑above or ❑below the HAG.
b) Top oi bottom floor (inGuding basement, crawispace, or endosure) is ��ieet �meters Qabove or ❑6elow the �AG.
E2 For Budding Uiagrams 6-9 with permanent flaod openings provided in Secti Items 8 and/or 9(see a es 8-9 oi instructions), the next h�gher Floor
(elevation C2.b in the d;agrams) of the building is _ X� feet �meters ❑ above or �beiow the HAG
E3 Attached garage (top of slabl is � feet Q meters � above or � below the HAG
E4 Top of Flatform of machinery and/or equipment servidng the buiiding is _� feet � meters � above or � below the HAG
Eb Lone AU only: It no fiood depth number is avadabie, is the top oi the bottom floor elevateC in accordance wRh t1�e commurnty's floodpla�n management
ordinance? ❑ Yes ❑ No ❑ Unkno,vn. The loral official must certify this mformation 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 comrnunity-�ssued E3FE)
or Zone AO must sign here The statements in Sactions A. B. and E are co%rect !o the best ot my knowledge
Property Owner's or 4wner's Authorrzed Representative s Name
Address
S�gnature
Gornments
citv
Date
State ZIP Code
Telephone
--- -- - ❑ Check here rt attachments
SECTiON G - COMMUNITY INFORMATION (OPTIONAL)
The local ofticial who is aufhonzed by law or ordinance to administer the community's floodplain management ordinance can compiete Sections A, B, C ior E),
and G of this Elevation Certificate. Complete the applicabie item{sj and sign below. Check the measurement used in items G8 and G9
G 1 � The iniormation in Section C was taken from other doc.umentation that has been signed and sealed by a licensed surveyor, engineer, a! arct;�tect whc
is authonzed by iaw to cert�fy elevation �nfprmation (Indicate the source and date ot the elevation data �n the Comments area below )
G2. ❑ A community officia! completed Sechon E for a buiiding located in Zane A(saRhout a FEMA-issued or community-issued BFE) or Zone AO.
G3 ❑ The fol;owing .nformation Utems G4-G9) is provided for community 800dplain management purposes.
' G4. Permit Number I G5. Date Permii Issued ; G6 date Certificate Of ComplianceiOccu¢ancy Issued
�
G? Thrs permit has been issued foc � Ne�v Construction � Substantial Improvement
G& Eleva6on at as-buiit loa�est floor (inGudmg basementj of the buiiding ❑ feet ❑ meters (PR) Datum
G5. BFE or (in Zone AO) depth of flaocing a2 the buildmg site ❑ feet ❑ meters (Pft) Dafum
G1� Commurnty's design flood eievation _ ❑ ieet ❑ meters �PR) Datum
�ocal Offic�al's Name
�ommunity Neme
Signature
:;anments
Tifie
Telephone
Date
�� — —__ __ ❑ Check here if attachments
FEMA Fnrm 81-31, tvlar 09 Repiaces ali previous editions
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ALVES, IRMA
Zoning: Island Estates Neighbor Atlas #: 268A