222 PALM ISLAND NWFeb 18 14 06:30p Deanna Simsek
U.S. DEPARTMENT OF HOMELAN� SECURITY
FEpERAL EMERGENCY MANAGEN�NTAGENCY
.Nariona! Flood lnsurance P�ngrari�
me
A2. Bu;lding Stree1 Address {including
222 PALM ISUiND NORTHWEST
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�S-Z�J-/S-1/��',.ir�,.-(f;Jf}° .(`i�,SO 727-441-3565 p.1
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ELEVATION CERTIF�CATE oMS rvo,lsso-000a
fmportant: Read the instructions on pages 1-9. Expirallon Date: Jury 31, 2015
A - PRORERTY INFORMATION
No.} or P.O. Rouie and Box No.
State FL ZIP Code
A3. Property Descriptian (Lot and Block Numbers, Tax Parcei Number, Legal Descripiion, etc.)
LOT 65, 1SLAND ESTATES OF CLEARWA7ER UNIT 6-C
A4.
A5.
A6.
A7.
A8.
WSURANCE COMPANY USE
Building Use (e.g., Residential, Non-Residenlial,Addilion,Accessory, eta) RESIDENTIAL
LatifudelLongitude: Lat. 27.9 2 Long. -82.819i4 Horizontal Datum: C NAD 1927 � NAD 1983
Attach at leasl 2 photographs of the building if the Certificate is being used to obtain ilood insurance.
Building Dlagram Number 1A
For a building wilh a Crativlspace or enGosure(s}: A9. For a build'mg with an attached garage:
a) Square tootage of crawlspace or enclosure(s) N!A sq ft a) Square f�tage of aUached garage 704 sq ft
b� Number ot permanent flood openings in the crawlspace b) Number of permanerit 800d openings in the attached garage
or enclosure(s} within 1.0 foot above adjacent grade NFA vrithin 1.0 fooi a6ove adjaceM grade 0
c) Total net area oiflood openings in A8.b I�/A sq in c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? ❑ Yes ❑ Ho d} Engineered flood openings? ❑ Yes Q No
SECTION B- FLOOD INSURANCE RATE MAp (FIRM) INFORMATION
B1. NFIP Community Name & Community Number B2. County Name B3. State
CITY QF CLEARWATER - 125096 PINELLAS F�
! 64. PAaplPanel Number 65. Suffix 8fi. FIRM Index Dale B7. FlRM Panel 68. Flood 69. Base Flood Elevation(s) (ZOne
12103C�702 G 05/17/2005 Effective�Re�ised Date Zorie(s) AO, use base ilood depth)
0910312003 AE 12
610. Indicate the source of the Base Flood Elevafion (BFE) data or base flood depth eniered in Item 89.
❑ FIS Profile ❑x FIRM ❑ Community Detertnined ❑ O1heNSource:
B1'I. Indicate elevation datum used fnr BFE in Ilem 69: � tJGW 7929 0 NAVD 1988 �J OtherlSource:
B12. Is the building located in a Coastal Barrier Resources 5ystem CBRS) area or Otherwise Protected Area {pPA)? y ❑ Yes � No
Designation Dale: ____ � CBR5 � OPA
SECTION C- BUILDING ELEVATION 1NFORMATION (SURVEY REQUIREDj
Ci. Building elevatians are based on: ❑ Gonstruction Drawings' ❑ Building Under Construction" 0 Finished Construction
"A new Elevation Cert�ficate wil� be required when construction of the building is Complete.
C2. Elevations - Zones AS-A30, AE, AH, A(with BFE), VE, V1-V30, V(with BFE), AR, ARIA, AR/AE, AR/A7-A30, AR/AH, AR/AO. Complete Items C2.a-h
below according to the building diagram spe�ified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utili2ed: CLEARIPJATER BM RESET ii-04A Vertica! Dalum: NAVD 1988
lodicate elevation datum used for the elevations in items a) lhrough h) below. ❑ NGVD 1929 � iVqVD 1988 ❑ Ofher/Source:
Datum used tor building elevations must 6e the same as tha� used for the BFE. Check the measurement used.
a) Top of bal�om floor iincluding basemeni, crawlspaCe, orenGOSUre floor) f.7 0 feet ❑ melers
b) Top af the next higher flaor N�. ❑ feet ❑ meters
c) Bottom of the lowest horizontal strudural member (V Zones only) NJg.____ ❑ feet ❑ meters
d) Attached garage (top oFslab) 5,� � feet ❑ meters
e) Lrnvest elevation Of machinery ar equipmerr! servicing the building fi,4 0 feet CI melers
(Describe ty e af e' t d I
p quipmen an acation in Commerns}
fl lowest adjacent (finished) grede next to building (LAG) g�
g) Highesl adjaceni (finished) grade next to bu�7ding (HAG) 6_1
h) Lo�vesi adlacent grade at lowest ele�ation ofdeck or stairs, including structural support NIA.,
� feet � meters
� ieet ❑ meters
❑ ieet ❑ meters
SECTIW,I D- SURVEYOR, ENGINEER, OR ARCFIIT�CT CERTIFIGATION
This certification is to be sigr►ed and sealed by a land surveyor, engineer, or architect authorized by law ta ceriify elevaGon
information. I certify fhat the inforrnation on this Certifrcafe represents my best eflerts fo inierpret the data available.
l understand that any false sta[ement may 6e punishable 6y �ne or imprisonment under 18 U. S. Code, Section f Q09. -
� Check here if comments ar� provided on back o( fflrm. Were latilude and �ongitude in Section A provided by a _�; ,y;:. ._�_
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❑ Check here if attachments, licensed land sunreypr? 0 Yes ❑ No �„" .
c;':w _
Certifier's Name JONATHAN S. BRANS�N License Numher FL PLS 6845 �� r� _
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14
FEMA FoEph 086-0-33 (7
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FL
See reverse side for continuation.
Replaces all previous editions.