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461 PALM ISLAND SE, . �, s. U.S. DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY National Flood Insurance Progrum A1. Building Owner's Name JOHN AND DIANE WELTER A2. Building Street Address (including Apt., Unit, ELEVATION CERTIFICATE IMPORTANT: Follow the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION or P0. Route and Box No. �� OMB No. 1660-0008 Expiration Date: July 31, 2015 FOR INSURANCE COMPANY USE Policy Number: City CLEARWA7ER State F� ZIP Code 33767-1939 A3. Property Description (lot and Biock Numbers, Tax Parcel Number, Legal Description, etc.} PARCEL 05-29-15-43416-OOQ-0360, lOT 36, ISLAND ESTATES OF CLEARWATER UNIT 6A, PLAT BOOK 060, PAGE d90, PINELLAS COUNTY, FLORIDA A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27-9844 �ong, 82.8138 Horizontal Datum: ❑ NAD 1927 Q 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 ONE-A A8. For a buiiding with a crawispace or enclosure(s): A9. For a building with an attached garage: a} Square footage of crawlspace or enclosure(s) N�A sq ft a) Square footage of attached garage 536 sq ft b) No. of permanent flood openings in the crawispace or b) Number of permanent flood openings in the attached garage enciosure(s) within 1.0 foot above adjacent grade N�A within 1.0 foot above adjacent grade � c) Totai net area of flood openings in A8.b N�A sq in c) Total net area of flood openings in A9.b N�p' sq in d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NFIP Communi�y Name & Community Number CLEARWATER CITY OF 125096 84. Map/Panel Number 65. Suffix 66. F 12103C0102 82. County Name P�NELLAS index Date I 67. FIRM Panel Effective/ Revised Date OS/18/2009 � 09/03f2003 � AE 610. indicate the source of the Base Flood Etevation (BFE) data or base flood depth entered in Item B9: ❑ FIS Profile � FIRM ❑ Community Determined ❑ Other/Source: 83. State F� B9. Base Flood Elevation(s) (Zone A0, use base flood depth) 11.0 FT 811. Indicate elevation datum used for BFE in item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: 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; ❑ Constnaction Drawings* ❑ Building Under Construction* � Finished Construction *A new Elevation Certificate will be required when construction of the buiiding is compiete. 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/A0. Complete items C2.a-h below according to the building diagram specifled in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: 9GPS Vertical Datum: NAVD 1988 Indicate elevation datum used for the elevations in items a} through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: Datum used for buildin� elevations must be the same as that used for the BFE. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowesi elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) � Lowest adjacent (finished) grade next to buifding {LAG) g) Highest adjacent (finished) grade next to building (HAG} h) Lowest adjacent grade at lowest elevation of deck or stairs, including structurai support Check the measurement used. 8.50 �feet ❑ meters �A � feet ❑ meters N/A � feet ❑ meters 7.60 � feet ❑ meters 7�9� � feet ❑ meters 7_5 � feet ❑ meters 7-g � feet ❑ meters 7_5 � feet ❑ meters SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveYOr, en�ineer, or architect authorized bv law to certifv elevarinn �. : � . ELEVATION CERTIFICATE, page 2 IMPORTANT: In these spaces, capy the corresponding intom�ation fiom Sectbn A. Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P0. Route and Box No. 461 PALM ISANE3 SOUTHEAST City State ZIP Code CIEARWATER FL 33767-1939 FOR INSURANCE COMPANY USE Policy Number. Comparry NAIC Number. SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFlCATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments �F EQUIPMENT iS LISTED ON PRIOR PAGE IS BASE OF AIR CONDITIONER UNIT THIS CERTIFICRTE IS NOT TO BE USED FOR CONSTRUCTION OR DESfGN, IS FOR FLOOD INSURANGE USE ONLY Signature Date d��Qa12014 SECTION E- BUIIDiNG 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, comp�ete 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, crawlspace, or enclosure) is . � feet ❑ meters � above or ❑ below the HAG. b) Top of bottom floor (inciuding 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 Instruciions), the next higher floor (e�evation C2.b in the diagrams) of the huilding is N� . A � 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) CERTIFlCATION 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 knowledge. Property Owner or Owner's Authorized Representative's Name Address City State ZIP Code Signature Comments Date Telephone ❑ Check here if attachments. SECTION G - COMMUNITY INFORMATION (OPTIONAL) The locai official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, 8, C(or E), and G of ihis Elevation Certificate. Compiete the appiicable item(s) and sign below. Check the measurement 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 communiry-issued BFE) or Zone A0. G3. ❑ The following information (Items G4-G9) is provided for community floodpiain 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-buiit lowest floor (inciuding basement) of the building: . ❑ feet ❑ meters Datum G9. BFE or (in Zone AO) depth of flooding at the building site: . ❑ feet ❑ meters Datum G10.Community's design flood elevation: Local Offlcial's Name Community Name Signature Comments Title CLEARWATER CITY OF Telephone Date ❑ feet ❑ meters Datum ❑ Check here if attachments. FEMA Form 086-433 (7/12) Replaces all previous editions.