947 LANTANA AVEU. �. DEPA^TMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Nationai Flood Insurance Program
A1. Building anrner's Name KEVIN L. CONOLTY
ELEVATION CERTIFICATE ' - �
Important: Read the instructions on pages 1;9.
SECTION A - PROPERTY INFORMATION
A2. Building Street Address (including Apt.: Unit, Suite, andlor Bidg. No.) or P.O. Route and Box No.
947 LANTANA AVENUE
City CLEARWATER State FL ZIP Code 33767
A3. Property Descript+on (Lot and Biock Numbers, Tax Parcel Number, Legal Description, etc.)
;
OMB No. 1660-0008
Expires March 31, 2012
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. 27°59.99'N Long. 82°49.47'W Horizontat Datum: ❑ NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of the buiiding if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 1A
A8. For a building with a crawlspace or enGosure{s): A9. For a building with an attached garage:
a) St�u�re footage of crawlspace or enclosure(s) NJA sq ft a) Square footage of attached garage 28� 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 1.6 foot above adjacent grade _ within 1.0 foot above adjacent grade 0
c} Total net area of flood openings in A8.b _ sq in c) Total net area of flood openings in A9.b Q sq in
d) Engineered flood openings7 ❑ Yes ❑ No d) Engineered flood openingsl ❑ Yes ($� No
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number B2. County Name 83. State
CLEARWATER 1250960 PINELLAS FL
B4. MaplPanel Number B5. Suffix 66. FIRM Index 67. FIRM Panel B8. Flood 69. Base Flood Elevafion(s) (Zone
12103C0102 G Date EffectiveiRevised Date Zone(s) AO, use base flood depth)
8/18/09 9/03/03 AE 11.0'
610. Indicate the source of the Base Flood ElevaGon (BFE) data or base flood depth entered in Item 69.
❑ FIS Profile � FtRM Q Community Dete►mined ❑ Other (Describe)
Bi 1. Indicate elevation datum used for BFE in Item 89: ❑ NGVD 1929 � NAVD 1988 ❑ Other (Describe)
612. Is the building located in a CoasYal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes � No
Designation Date ❑ CBRS ❑ OPA
SECTION C- BUILDING ELEVATtON INFORMATION (SURVEY REQUtREDj
C1. Building elevadons are based on: ❑ Construction Drawings* ❑ Building Under Construction' � Finished Construction
"A new Elevation Cerdficate wiU 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 CLEARWATER J-02Vertical Datum 4.4385'(NGVD 1929 DATUM)
Conversion/Comments
Check the measurement used.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 4.4 � feet ❑ meters (Puerto Rico only)
b) Top of the next higher floor N/A._ ❑ feet ❑ meters (Puerto Rico oniy}
c) Bottom of the lowest horizontal structural member (V Zones oniy) NlA._ ❑ feet ❑ meters (Puerto Rico only)
d) Attached garage (top of slab) 3. 8 � feet ❑ meters (Puerto Rico oniy�
e) Lowest elevadon of machinery or equipment servicing the buiiding 4.0 � feet ❑ meters (Puerto Rico only)
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAGj 4.1 � feet ❑ meters (Puerto Rico only)
gj Highest adjacent (finished) grade next to building (HAG) 4.4 � feet ❑ meters (Puerto Rico onty)
h) Lowest adjacent grade at lowest elevation of deck or stairs, inGuding N/A._ ❑ feet ❑ meters (Puerto Rico only)
struCturai support
SECTION D- SURVEYOR, ENGINEER, OR ARCHiTECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized bv law to certifv eievannn
� ��t+�aa.co on N�cv�VUl CWliVf15
IMPORTANT: In these
Building Street Address (in
947 LANTANA AVENUE
:s, copy the corresponding information from Section A.
Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
Ciry CLEARWATERState FL ZIP Code 33767
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 C2(.e) A/C = 4.0' & RAISED A/C=4.7'
.r
�
�ature - va�C
❑ Check here ff attachments
SECTION E- BUILDING ELEVATION INFORMATION (SURVEY NOT REQU�RED) FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO and A(without BFE), complete Items E1-E5. If Yhe 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 availabie. Check the measurement used. In Puerto Rico oniy, enter meters.
E1. Provide elevation information for the followi�g 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 (includirtg basement, crawlspace, or endosure) is ❑ feet ❑ meters ❑ above or � below the HAG.
b) Top of bottom floor (incfuding basement, crawlspace, ar 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 sfab) is . ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E4. Top of platform of machinery and/or equipment servicing the buiiding is ❑ feet � meters ❑ above or � below the HAG.
E5. Zone AO oniy: if no flood depth number is availabie, is the top of the bottom floor elevated in accordance with the community's floodplain management
ordinance? ❑ Yes ❑ No ❑ Unknown. The local officiat must certify this infortnation in Section G.
SECTION F- PROPERTY �WNER (OR OWNER'S REPRESENTATNE) CERTIFiCAiION
The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A(without a FEMA-issued or communiry-issued BFE)
or Zone AO must sign he�e. The statements in Sections A, 8, and E are correct to the best of my knowledge.
Property Owner's or Owner's Authori�ed Representative's Name
Address
Signature
Comments
City
Date
State ZIP Code
Telephone
❑ Check here'rf attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
Tfie locat officia{ who is authorized by law or ordi�ance to administer the community's floodpiain management ordinance can complete Sections A, B, C(or E},
and G of this Elevation Certificate. Compiete the applicable item{s) and sign below. Check the measurement used in Items G8 and G9.
31. ❑
32. ❑
33. ❑
The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engirteer, 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.)
A community officiai completed Section E for a building located +n Zone A{without a FEPAA-issued or community-issued BFE) or Zone AO.
The following informarion {Items G4-G9) is provided tor communiry floodplain management purposes.
G4. Permit Number
37. This permit has been issued for:
G5. Date Permit Issued
G6. Date Cert+ficate Of Compiiance/Occupancy issued
❑ New Gonstruction ❑ Substantial Improvement
38. Elevation of as-built lowest floor (including basement} of ihe building: � feet ❑ meters (PR) Datum
;9. BFE or (in Zone AO) depth of flooding at the buiiding site: ❑ feet ❑ meters (PR) Datum
310. Community's design flood elevation ❑ feet ❑ meters (PR) Oatum
Locaf Official's Name
Community Name
Signature
Comments
Title
Telephone
Date
❑ Check here if attachments
EMA Form 81-31, Mar 09 Replaces all previous editions
U.:;. DEPA^TMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Fiood Insurance Program
A1. Building Owner's Name KEVIN l.. CONO�'
ELEVATION CERTIFICATE �
Important: Read the instructions on pages 1�9.
SECTION A - PROPERTY INFORMATiON
H2. Buiiding Street Address (including Api.; Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No.
947 LANTANA AVENUE
City CLEARWfk?'ER- - St�ate FL ZIP£od� 33767------
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
M' OMB No. 1660-0008
Expires March 31, 2012
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: l�at. 27°59.99'N Long. 82°49.47'W Horizontai 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 buitding with a crawispace or enclosure{s): A9. For a building with an attached garage:
a) Square footage of crawispace or enclosure(s) N/A sq ft a) Square footage of attached garage 280 sq ft
b) No. of permanent flood openings in the crawlspace or b) No. of permanent flood openings in the attached garage
enciosure(s) within 1.0 foot above adjacent grade _ within 1.0 foot above adjacent grade 0
c) Totai net area of flood openings in AS.b _ sq in c) Totat net area of flood openings in A9.b 0 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 B3. State
CLEARWATER 1250960 PINELLAS FL _
B10. Indicate the source of the Base Flood Elevation (BFE} data or base flood depth entered in ttem 69.
❑ FIS Profile � FIRM ❑ Community Determined ❑ Other (Describe)
B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 198$ L7 Other (Describe)
612. is the buiiding focated in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)7 ❑ Yes � No
Designation Date ❑ CBRS ❑ OPA
SECTION C- BUI�DING @LEVATION 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, AR/AE, AR/A1-A30, ARiAH, 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 CLEARWATER J-02Verticai Datum 4.4385'(IVGVD 1929 DATUM)
Conversion/Comments
Check the measurement used.
a) Top of bottom floor (including basement, crawispace, or enclosure floor) 4.4 � feet ❑ meters (Puerto Rico on�y)
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) N/A._ ❑ feet ❑ meters (Puerto Rico only)
d) Attached garage (top of slab} 3. S � feet ❑ meters (Puerto Rico only)
e) Lowest efevation of machinery or equipment servicing the building 4.0 � feet ❑ meters (Puerto Rico only)
(Describe typa of eq�ipment and locatior in Cemm�nts;
f) Lowest adjacent (finished) grade next to building (LAG) 4.1 � feet ❑ meters (Puerto Rico only)
g) Highest adjacent (finished) grade next to building {HAG) 4.4 � feet ❑ meters {Puerto Rico only)
h) Lowest adjacenY grade at lowest elevation of dack or stairs, inGuding N/A._ ❑ feet ❑ meters (Puerto Rico only)
structural support
SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
T�.:_ __.a:r.,,..a:,... :., a.. L... ..�.......I .....1 ......1...1 1... ., 1.,...1 c� �n.n..nr enn�nncr n. �rnhitnM �� rthnn�crl h.. I�u. fn nnrfiA. clnv�Knn
IMPORTANT: In these spaces, copy the corresponding information from Section A.
Building Street Address (including Apt., Unit, Suite, a�d/or Bldg. No.) or P.O. Route and Box No.
947 LANTANA AVENUE
Ciry CLEARWATERState FL ZIP Code 33767
SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATtON (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2} insurance agenUcompany, and (3) building owner.
Cornments C2(.e) A/C = 4.0' & RAISED A/C=4.7'
�
L �
�ifature " Date
❑ 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, compiete Sections A, B,
and C. For Items E1-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters.
E 1. 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 Roor (including basement, crawlspace, or endosure) is ❑ feet ❑ meters ❑ above or � below the HAG.
b) Top of bottom floor (including basement, crawispace, or enciosure) 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 �nstructions), 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 sfab) 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) CEI�'�IFICAI'ION
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
Signature
Comments
City
Date
State ZIP Code
Telephone
❑ Check here if attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
rhe local o�cial who is authorized by law or ordinance to administer the community's floodplaln management ordinance can complete Sections A, B, C(or E),
�nd G of this Elevation Certificat�. Complete the app►icable item(s) and sign below. Check the measurement used in Items GS and G9.
31. ❑ 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.)
32. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or Zone A0.
33. ❑ The following information (Items G4-G9) is provided for community floodplain management purposes.
G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compiiance/Occupancy issued
37. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement
38. Elevation of as-built lowest floor (including basement) of the building: ❑ feet ❑ meters (PR) Datum
39. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters (PR) Datum
�10. Community's design flood elevation
Local O�cial's Name
Community i�lame
Signature
Comments
EMA Form 81-31, Mar 09
❑ feet ❑ meters (PR) Datum
Title
Telephone
Date
Check here if attachments
Replaces all previous editions