240 PALM ISLAND SW, U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
A1. Buildinq Owner's
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1-8.
SECTION A - PROPERTY INFORMATION
Douglas E. Longenecker and Sara A. Longenecker
OMB No. 1660-0008
Expires March 31, 2012
For Insurance Company Use:
A2. Building Street Address (including Apt., Unit, Suite, andlor Bldg. No.) or P.O. Route and Box No. I Company NAIC Number I
240 Palm Island SW
City State ZIP Code
Clearwater Beach Florida 33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
ParcelID: 242915000004100100
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Residential
A5. Latitude/Longitude: Lat. 27.89325 Long. 82.27007 Horizontal Datum: NAD 1927 � NAD 1983
A6. Attach at �east 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 crawl space or enclosure(s), A9. For a building with an attached garage, provide:
a) Square footage of crawl space or enclosure(s) NA sq ft a) Square footage of attached garage NA sq ft
b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage
enclosure(s) walls within 1.0 foot above adjacent grade NA walls within 1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b NA sq in c) Total net area of flood openings in A9.b 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 & Community Number 62. County Name 63. State
Cit of Clearwater 125096 Pinellas FL
84. Map/Panel Number B5. Suffix B6. FIRM Index B7. FIRM Panel 68. Flood B9. Base Flood Elevation(s) (Zone
12103C0102 G Date Effective/Revised Date Zone(s) AO, use base flood depth)
9/3/03 9/3/03 AE 12'
810. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69.
❑ FIS Profile � FIRM ❑ Community Determined ❑ Other (Describe) _
611. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other (Describe)
612. 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 REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction` � Finished Construdion
'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 Local TBM Vertical Datum NAVD
Conversion/Comments
Check the measurement used
a) Top of bottom floor (inGuding basement, crawl space, or enGosure floor)_ 7.32 ❑ feet ❑ meters (Puerto Rico only)
b) Top of the next higher floor ❑ feet ❑ meters (Puerto Rico only)
c) Bottom of the lowest horizontal structural member (V Zones only) NA ❑ feet ❑ meters (Puerto Rico only)
d) Attached garage (top of slab) 6.77 ❑ feet ❑ meters (Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building 7.20 ❑ feet ❑ meters (Puerto Rico only)
(Describe type of equipment and location in Comments)
fl Lowest adjacent (finished) grade next to building (LAG) 6.57 ❑ feet ❑ meters (Puerto Rico only)
g) Highest adjacent (finished) grade next to building (HAG) 6.72 ❑ feet ❑ meters (Puerto Rico only)
h) Lowest adjacent grade at lowest elevation of deck or stairs, including NA ❑ feet ❑ meters (Puerto Rico only)
structural support
SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sea�ed by a land surveyor, engineer, or architect authorized by law to certity elevation
information. 1 certify that the information on this Certificate represents my best efforts to interpret the data available.
1 understand that any false statement may be punishable by fine 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
Licensed land surveyor? � Yes ❑ No
Certifier's Name Billy R. Davis, Jr. License Number 5099
Title Professional Surveyor and Mapper Company Name First American PLS
Address 1700 S. Broadway, Bldg. E City Moore State OK ZIP Code 73160
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ianature Date 8/13l10 TPlenhone 405-378-5800
FEMA Form 81-31, Mar 09 See reverse side for continuation. Replaces all previous editions
ANT: In these snaces. conv the
ng
240 Palm
City
rwater Beach
information from Section A.
and/or Bidg. No.) or P.O. Route and Box No.
State ZIP Code
Florida 33767
For Insurance Company Use:
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 Machinery is AC Pad.
Signature Date 8/13/10
❑ 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, crawl space, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
b) Top of bottom floor (including basement, crawl space, 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 Instrudions), 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 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
Signature
Comments
City
Date
State ZIP Code
Telephone
r
❑ 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 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 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 (inGuding basement) of the building: _0 feet ❑ meters (PR) Datum
G9. BFE or (in Zone AO) depth of flooding at the buitding site: ❑ feet ❑ meters (PR) Datum
G10. Community's design flood elevation: ❑ feet ❑ meters (PR) Datum
Local Official's Name
Community Name
Signature
Comments
Title
Telephone
Date
Check here if attachments
FEMA Form 81-31, Mar 09 Replaces all previous editions
0
Building Photographs
See Instructions for Item A6.
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
240 Palm Island SW
City State ZIP Code
Clearwater Beach Florida 33767
Policy Number
NAIC Number
Use:
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 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.
Front View 8/12/10
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Continuation Page
For Insurance Company Use:
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Poiicy Numeer
240 Palm Island SW
City State ZIP Code Company tvP,�C rvumber
Clearwater Beach Florida 33767
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all
photographs with: date taken; "Front View° and "Rear View"; and, if required, "Right Side View" and "Left Side View."
Rear View 8/12/10
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RLS #: 10-07-0439
CLIENT q: 1179-2387032
ADDRESS FIELD DATE: OB/12/10
�� CONCREIE 240 PALM ISLAND S.W.
DRAFTER: SDS
CLEARWATER BEACH,FLORIDA33767 APPROVED:BRD
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LEGAL DESCRIPTION: (AS FURNISHED) SCALE: 1" = 30'
� e BMCK LOT 17, UNIT 6A ISLAND ESTATES OF CLEARWATER, ACCORDING TO THE PLAT THEREOF,
AS RECOROED IN PLAT BOOK 60, PAGE(S) 90, OF THE PUBL�C RECORDS OF PINELLAS COUNTY, FLORIDA.
BASIS oF BEnRINGS: BEARINGS SHOWN HEREON ARE BASED ON THE SOUTH UNE OF LOT t7, BEING S 72°43'42" W, PER PLAT
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'URVEYOR FILE NUMBER: -07-0 u.E.: Unurv ErsEMENT �.F.(:END
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CERTIFIED TO: (AS FURNISHED) lc.): cn�cu a�TEO P.G: PoINT oF CURVnTUFE
C.6.:CHOR�6EHRIrvG P.o.6.:PO1NioFBEGINNIrvG
)OUGLAS E. LONGENECKER $ CBW: CONCRETE BLOCH WALL P.O.C.: POINTOF COMMENCEMENT
3ARA A. LONGENECKER 4'. CervTFRUNE p.p.; ppWER PoLE
'IRST AMERICAN TITLE INSURANCE COMPANV C.N.A.: CORNER NOTACCESSI9LE P.R.C.: POIM OF REVERSE
VF:VINnFENCE CURVATIIRE
IANK OF AMERICA, N.A. C�V: COVEREO P.R.M.: PERMANENT REFERENCE
ANOSAFE TITLE OF FLORIDA, INC. �.U.E.: DRAINAGE d UTILIiv EnSEMErvi MOrvuMENT
(0.): �ESCRIPTION NJ�. RIGHTOF WNY
OIW:DRIVEWAV AE.:AERIFLEASEMENT
NOTES (M.�: MEASIIRED CLF'. CHNN LINK FENCE
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ourvo (FORINFO0.MAtIONALPIIRPOSESONLV)
SUBJECT PROPERTY SHOWN MEREON APPEARS TO BE LOCATEO IN
[ FLO00 ZONE AE, n o vFNR Fl00DING, PEft F.1 ftM.
s�au�nn�*o��scoraa PqNELNUMBER125[1960102EG,LASTREVISION�ATE09N3N3
consrnucnor�vuRrosES. THIS SURVEVOR MAKES NO GUARANTEES AS TO TME FCCURACV OF
NEFR OF THE PHftT1E5 LISTEO MEREON.
NoIHBILItV TO THIRD PMTIES MAY NOT BE
TRANSFERREO OR ASSIGNED.
Reviewed 8. Accepted bY:
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SURVEYOR'S CERTIFICATE
I hereby certify that [he wrvey repesented hereon meets the minimum [echniral
stanGards fw IanO surveys In FbriGa. ns se[ iorCn in C�apter 61G 1]-6, Fbritla
adminis[rative code, Purwant to Chap[er 472.@], FlohGa SfnNteS.
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LAND SERVICES t+osis�eseoo
Date /
ELECTRONIC SIGNATURE
Date
240 PALM ISL
BCP2013-11127
BATHROOM REMODEL
DOUGLASLONGENECKER
Zoning: Island Estates Neighbor Atlas #: 258B