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128 MARINA DEL REY CTU.S.DEPARTMENTOF�HOMELAMDSECURITY ELEVATION CERTIFICATE �DERAL EMERGENCY MANAGEMENT AGENCY OMB NO. 1660-0008 ��tiona! Flood Insuronce Program �mportant: Read the instructions on pages 1-9. Expiration Date: July 31, 2015 SECTION A- PROPERTY INFORMATION ��S�i±l��l�E£�TrA�Rt�� .,":? A1. Building Owner's Name William 8� Linda Crawford G�oiic+��it� f s;,; ��t � � .., . �-, � ., �� .. . -. r w� .�, � ��"� � ; ` A2. Building StreefAddress (including Apt., Unit, Suite, andlor Bldg. No.) or P.O. Route and Box No. °�iampa�ty'?��`w�Eait�aec 128 Marina Del Rey Court � � . ,, , _ _ City Clearwate� State FI ZIP Code 33767 A3. Property Description (lot and Blodc Numbers, Tax Parcel Number, Legal Description, etc.) Parcel # 19-29-15-55303-000-0110 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Residential A5. Latitude/Longitude: Lat. 27d56'24.23"N Long. 82d50'07.25'W Horizontal Datum: ❑ NAD 1927 � NAD 1983 A6. Attach at least 2 photographs of the building if the Cert�cate is being used to obtain flood insurance. A7. Building Diagram Number 7 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) 594 sq ft a) Square footage of attached garage sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s) within 1.0 foot above adjacent grade 0 within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b 0 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 8 Community Number B2. County Name B3. State City of Clearwater -# 125096 Pinellas FI. B4. Map/Panel Number B5. Suffix 66. FIRM Index Date 67. FIRM Panel 68. Flood B9. Base Flood Elevation(s) (Zone 12103C/0104 G 09-03-20Q3 Effective/Revised Date Zone(s) AO, use base flood depth) 09-03-2003 AE 11' B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile � FIRM ❑ Community Detennined ❑ OthedSource: B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ OthedSouroe: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Proteded Area (OPA)? ❑ Yes � No Designation Date: ❑ CBRS ❑ OPA SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construdion Drawings• ❑ Building Under Construdion* � Finished Construction 'A new Elevation Certificate witl 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. In Puerto Rico only, enter meters. , Benchmark Utilized: Citv/Clw 8-02 Vertical Datum: NAVD88 Indicate etevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ Other/5ource: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclasure floor) b) Top of the next higher floor c) Bottom of the lowest horizontal strudural member (V Zones only) d) Attached garage (top of slab) ' e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) � Lowest adjacent (finished) grade next to building (LAG) g) Highest adjacent (finished) grade next to building (HAG) h) Lowest adjacent grade at lowest etevation of dedc or stairs, including structural support 5.2 �.5 Na. n/a. 6.2 4.2 4.8 Na. � feet ❑ meters � feet ❑ meters ❑ feet ❑ meters ❑ feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters ❑ feet ❑ meters 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 inte►pret the data available. 1 understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Sec6on 1001. ❑ Check here if comments are provided on badc of form. Were latitude and longitude in Section A provided by a � Check here if attachments. licensed land surveyof? � Yes ❑ No Certfiers Name Paul E. Hagler Title Pres. Address 1280 Heather ridge Blvd License Number 2753 Company Name Able Land Surveying City Dunedin State FI ZIP Code 34698 Signature ���� Date /� - J� -- r 3 Telephone 727-210-0841 �t�,�►�►t„r��'rjt 1 ��.�?.� 'y.. t"'�r�„ �t�*� ' ':: e,j C� ' � ` `��,�i'�; � `y:�� . „���� '."! x � °3.��...:...: n . .�,. � , ..., � f'R� _ � ;\ � _ _' � lry 4°t �O'l r ''�( _ �, �•.`' _ i °,�� , � �`� ELEVATION CERTIFICA�'E, page 2 �IAPORTANT: In these spaces, copy the corresponding information from Section A. Buiiding Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 128 Marina Del Rey Court City Clearwater State FI ZIP Code 33767 SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community officia�, (2) insurance agenUcompany, and (3) buiiding owner. Commer�� �2(e)�A.C, un�t on elevated concrete stab at rear of building. ��:���i; ....; .: � � ' : � ^�'►,. �`i�`e�'.4'`, ,. � ' � ,Q + -`l� "�� � � . �� f/ �'�'���-�. %� ' '� � �� � f � Date •��, 4Co :,�—. E- BI�I�DIIl� ELEVATION INFQRMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A . , . <ry;, ,, � : ��.,; � `�� For Zones,0(fDi�p{�A� (Hi'ithout 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 ltems E1-E4, use natural grade, if available. Chedc the measurement used. In Puerto Rico only, enter meters. E1. Provide elevation informaEion for the fotlowing and chedc 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 baseme�t, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or 0 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 (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 informa6on 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(wi#hout a FEMA-issued or community-issued BFE) or Zone AO must sign here. The statements in Sectio�s A, B, 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 Cade Telephone ❑ Chedc here if attachments. SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local offiaal 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 CeRificate. Complete the applicable item(s) and sign below. Chedc the measuremeM used in Items G8-G10. In Puerto Rico only, enter meters. 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-G10) 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 G9. BFE or (in 2one AO) depth of flooding at the building site: G10. Community's design flood elevation: Local Official's Name Community Name Signature Comments ❑ feet ❑ meters ❑ feet ❑ meters Title Telephone Date Datum Datum Datum Check here if attachments. ELEVA�TION CERTIFICATE, page 3 guilding Photographs See Instructions for Item A6. IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (inciuding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 128 Marina Del Rey Court City Clearwater State FI ZIP Code 33767 FOR INSURANCE COMPANY USE Policy Number. Company NA(C Number. If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 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 Viewr' and "Left Side vew.� When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. Front View —12/17/2013 ELEVA�TION CER1"IFIC94TE, page4 guilding Photographs t Continuation Page IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: 128 Mari�a Del Rey Court City Clearwater State FI ZIP Code 33767 Compa�y NAIC Number: If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front VievW' and "Rear Viewl'; and, if required, "Right Side Viev�' and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. Rear View — 12/17/2013 ��t��, �.