143 BAYSIDE DR; %:� I �, _ � l. � �% �7
I
Paqe 1 ot 3 nat valid without all three pages � � G G � �
U.S. DEPARTMENT OF HOMELANQ SECURITY ELEVATION CERTIFICATE
Federal Emergency Management Agency
National Flnod Insurance Program IR1POrt8flt: R82d th8 IC15tfUCtiOf1S Ofl R898S 1-9.
SECTION A - PROPERTY INFORMATlON
A1. Building Uwner's Name
A2. Building Sueet Address (including Apt., Unrt. Suite, andlor Bidg. No.) or P.O. Route and Box No.
OMB No. 1660-0008
Expires March 31, 2012
Far Insurance Company Use:
Company NAIC Number
City St�te
ZIP Code
CI FARWAT R FMrid, q47F7
A3 Proparty DescnpUon (Lot and 81ock Numbers, Tax Parcel Number. Legai Descnption, etc.)
Lot 11 81ock B BAYSIDE SUBDIVISION NO. 3 accordin 10 thu la1 therep/ as rocorded In PWt Book 2T Pa e 74 0l the Public Records ot PINELIAS CoUnt Fbrida.
A4. Building Use (e.g.. Residentiai, Non-Residential, Addition, Accessory, stc.) gESIDEN .
A5. Latitude/Longitude: Lat. N 27 58 12.q,_ long. a t Horizontal Datum: � NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of the buiiding i( the Certificate is being used to oblain flood insurance.
A7. 8uilding Diagram Number��
A8. For a building with a crawlspace or enGosure(s): A9. For a buiiding with an attached garage:
a) Square footage ot crawlspace or enGosure(sj �A sq ft a) Square /ootage o( attached garage 6t 8 Sq h
b) No. ot pertnanent flood openings in the crawlspace or b) No. of permanent flood openings in the attached garage
enclosure(s) within 1.0 foat above adjacent grade o within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in AB.b �__ sq in c) Total net area af flaod o enin s in A9.b
d) Engineered flood openings7 � Yes x No P 9 �._._ sq in
❑ d) Engineered flood openingsl � Yes � No
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
61. NFIP Community Name & Community Number 62. County Name p� c�,,o
SuBix
0102
Date � Effective/Revised Rale
38. Fload I 69. Base Fload Elevation(s} (2
Zone(s) AO, use base flood dep(h)
810. Indicate the source of the Base Flood Elevation {BFE� data or base flood depth entered in Item B9. ^ �� n,�v i
� FIS Profile � FIRh1 Community De2ermined � Other (Descr�be)
B11. Indicate elevation datum used tor BPE in Item 69: ❑ NGVD 1929 � IVAVD 1988 � Other (Descrlbe)
B12. Is the building located in a Coastal Barrier Resources System (CBRS} area or Othenvise Protected Area (OPA)� � Yes � No
Designntion Date � CBRS � OPA
SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. 8uilding elevatfons are based on: ❑ Construction Drawings• ❑ Building Under Constructio�'
'A new Elevation Certificate wi�l be requtred when const�uction of the building is complete. � Finished ConstrucRion
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, AR1A0. Complete Items C2.a-h
below according to the building diagram specified In Item A7, Use the same datum as the BFE.
Benchmark Utllized REAL,TIME NETWORK L-NET(CLW) • GPS • 84 69 Vertical DatumNAVD1988
GonversioNComments
Check the measurement used.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor} �p St .— �j�jfeet meters (Puerto Rico only)
b) Top of the next h+gher floor 21.5*!.. tx.1 feet 8 meters (PueRo Rico only)
c) Bottom of the lowest horizontal structural member (V Zones onlyj NA.�� feet ❑ meters (Puerto Rico only)
d) Attached garage (top o! slab) 5 61._„� feet ❑ meters (Puerto Rico anly)
e) Lowest etevation ot machinery or equtpment servicing the buf►ding 1o.a8._„� feet � meters (Puerto Rico only)
(Describe type oi equipment and location in Commentsj
f) Lowest adjacent (flnlshed! grade next to building (LAG) _ S.00,,p feet [� meters (Puerto Rico only)
g) Highest adjacen! (finished) grade ne�st to building (HAG) 6.00 . feet meters (Puerto Rico only)
h) �owest adjacent grade at lowest elevatian ot deck or stairs, including 5 8.� feet � meters (PUerto Rico only}
stnictural su rt
SECTION D- SURVEYOR, ENGINEER, OR ARCMITECT CERTIFICATION
This ceNfication is to be signad and sealed by a land surveyor, engineer, or architect authorized by lew to certiN elevatien
�„r�.,,,n��,.., �,.e..:�,.�..,..�_:-•----•'---.�, _ ..-
(rev.0 i2115/i010)
- �,�� ,�, �.,,u���tl�����. Kepiaces all previous editions
Page 2 of 3 no; valid withoul all three pages
IMPORTANT: In these spaces, copy the
Building Sueet Address (includino A❑t_ unir su�
City
andlor
information from Section A.
or P.O. Route and 6ox No.
State
FL7012,0T19EG
For Insurence Company Use:
ZIP Code Company
SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevafian Certificate for (1) �mmunity official, (2) insurance agentfcornpany, and �3) building owner.
Comments
� . �� •� r• �� . �� •�- . �.•h•� L.u_ � i i
Centerline Road Elevation: 4.59 This Certificate is for flood insurance u oses onl . The information on this certificate should not ba used for construction or lannin .
Signature
�.c,./�j(/��',� Date 12/15/2010
SECTION E- BUILpING ELEVATION INF4RMATION (SURVEY NOT REQUiREDj FOR ZONE AO AND ZONaE A(WITHOUTtBFE)Qnts
For Zones AO and A{without BFE), complete Items Ei-E5. If the CeRificate is intended to support a LOMA or �ODAR-F request, compl�te Sectfans A, B,
and C. For items E1-�4, use natural grade, ff 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 etevation is above or below !he highest adjacent
grade (HAGj and the lowest adjacent grade (LAG).
a) Top of bottom floor (inGuding basement, crawlspace, or enGosure) is N/A ._�{�et ❑meters �above or
b) Top of bottom floor (including basement, crawlspace, or enclosure is �be�o�n' the HAG,
J N!�_• _�feet []meters Qabove or ❑below tha LAG.
E2. For 8uilding Diagrams 6-9 with permanent flood openings provided in Sectl Items 8 and/or 9(see a es 8-9 oi InstrucUons), the next hlgher floor
{elevation C2.b in the diagrams) of the building is N/j� ._� feet �meters ❑ above or �below the HAG.
E3. Attached garage (top of slab) is �o . � teet a meters � above or � bebw the HAG.
E4. Top of platform of machinery andlor equipment servicing the duilding is n
E5. Zone AO only: If no 800d depth number is available, is the top of the botto�m�floor elevate�d n acco❑rd nce witnthe oommuni�s floo' dplahn ma agement
ordlnance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this informatlon in Section G.
SECTIQN F- PROPERTY OWNER {QR OWNER'S REPRESENTATNE) CERTIFICATION
The property owner or awner's authorized represantative who corr�letes Sections A, B, and E for Zone A(without a FEMA-issued or community-issued B�E)
or Zone AO must sign here. 7'he statements in Sections A, B, and E are correct to the best of my knowledg@.
Property �vmers or pwner's Authorized Representative's Name
Addres5 City S[ate
ZIP Code
Signature Date
Tefephone
Comments
SECTION G- COMMUNITY INFORMATION (OPTIONAL) � � k he e it attach ents
The Ioca1 officiat who is authorized by law or ordinance to adm(nister the community's floodplain management ordfnance can complete Sections A, 8, C(or E},
and G of this Elevatlon Certificate. Complete the applfcable item(s) and sign below, Check the measurement used in Items G8 and G9.
G1. � The lnformation in Section C was taken from other documentation that has been slgned and sealed by a licensed surveyor, engineer, or architect who
G2• ❑is authorized by law to certify elevation informadon. (Indicate the source and date of the elevation data in the Comments area below,)
G3. ❑A community official completed Section E for a building located in Zone A{without a FEMA-issued or community-issued BF£) or Zone AO.
The fallowing information (Items G4-G9) is provided for community floodplain management purposes,
G4. Permft Number
Date Permit Issued
G7. This permit has been Issued far: � New Construclion
G6. pale Certiflcate Of CompliancelOccupancy Issued
❑ Substandal Improvemenc
G8. Elevation of as-built lowest floor (including basement) of the building
G9. BFE or (in Zone AO) depth of flooding at the building site
G10. Communit�s design 800d efevation
—_�•
Lacal Official's Name
Title
Community Name Telephone
Sfgnatura
Comments
Date
❑ feet ❑ meters (PR)
❑ feet ❑ meters (PR)
Q faei ❑ meters (PR)
Datum
Qatum
Datum
� G ck he 'f a ac ments
FEMA Form �31-31, Mar 09
Replaces all previous editions
� � Orderad By:
PROPERIY ADORESS: 143 BAYSIDE DR, CIEARWATER, Florida 337b7
FIELD WORK DATE: +v�utoio REVISION DATEfS): �..�,o iyisrimq
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� fLOOp INFORMATIOM:
�Byp� r(orming a uarch at www.fema.gov. th� prpportyapp� an to 6a locatrd i� wn� AE (with a Bas� Flood Elevstion o! 11.0 NAVOt488). Thit P . .
in CLEARWATER. cnmmu rwrr�er 125096. dated 09A3A3. �op�rry was found
� CUEM NUMBEi� 10.Z03 OATE: 1Z/15/2p10
� ' ' AF�ILIAT�
� BUYER: JOHN ANO HIWIRY RINEHARDT �_ .. ,• �
oSElLERDE80R.4HgqRNHART �FLTA� i • ' MEMBERS
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� ��u �CESSORS,woroaass�exs:wsrNeu
g. !.n :v D 5 u A v E y O ,;; P: A13.549,4947
Exacta land Surveyors, Ina :LB 117337
� This is page 1 of Z and'a rac vai'�d withput aq pages, 6� � Ckwcla�d Sc-, Surt. 50� ..^.^.. ^F: 8 i 3.569.d94d
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Page 3 ot 3 not valid withoul ail Ihree pages
Building Street Address (including Apt., Unit,
City
Building Photographs
See Instructions for Item A6.
and/pr
State
No.) or P.O. Route and Box No.
Code
FLt012.0719EG
For Insurance C
Policy Number
Company rlAIC N
If using the Elevation Certii,cate to obtain NFIP flood insurance, aifix at least two building photographs below according to
the instructions for Item A6. Identify all photographs with: date #aken; "Front View" and "Rear VievW'; 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.
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Front Property Picture 12/14/2010
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