969 BRUCE AVEi"� -
U.S. DE�!ARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE oMe rvo. �ssa000a
Federal Emergency Management Agency EXpifes March 31, 2012
National Flood Insurance Program ImportBnt: Read the inStruCtiO�S on pBgeS 1-9.
_
ION A - PROPERTY INFORMATION
A1. Building Ovmer's Name GREGORY A. & SUSAN A. VELOTT
A2. Buflding Street Address (including Apt., Unit, Suite, and/or Bidg. No.} or P.O. Route and Box No.
969 BRUCE AVENUE
City CLEARWATER BEACH State FL ZIP Code 33767
A3. Property Description (Lot and Biock Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 2, BLOCK 264, CARLOUEL SUBDIVISION
A4. Bufld(ng Use (e. ., Residentfai Ian-Residential, Addition, Accessory, etc.)
A5. Latitude/Longitude: . e. 00' 0.8" Long. 82deg. 49' 30.6" Horizontal Datum: ❑ NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of the building if the Certiflcate is being used to obta(n flood insurance.
A7. Building Diagram Number �
A8. For a building with a crawlspace or enclosure(s}: � A9. For a building wfth an attached garage:
a) Square footage of crawlspace or enclosure(s) � sq ft a) Square footage of attached garage 1�0 sq ft
b) No. of permanent flood openings ln the crewlspace or b) No. of permanent flood openings in the attached garage
enclosure(s) within 1.0 foot above adjacent grade � within 1.0 foot above adJacent grade -0-
c) Total net area of flood openings In AB.b I�! sq in c) Total net area of flood openinps In A9.b -0- sq tn
d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openingsT ❑ Yes ❑ No
8ECTION B- FLOOD INSURANCE RATE M/�P (FIRM) INFORMATION
i. NFIP Community Name &
CLEARWATER / 125096
FLORIDA
B4. Map/Panel Number B5. Suffix 86. FIRM index 87. FIRM Panei B8. Flood B9. Base Flood Elevatton(s) (Z
12103C0064 G Date. Effective/Revised Date Zone(s) AO, use base flood depth)
08-1 &09 09-03-03 AE � ��
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69.
❑ FIS Profile � FIRM ❑ Community Determined ❑ Other (Describe)
B11. Indicate elevation datum used for BFE fn Item 89: ❑ NGVD 1929 � NAVD 1988 ❑ Other (Describe)
B12. Is the building located in a Coastal BaRier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes � No
Designation Date ❑ CBRS ❑ OPA
SECTION C- BUILDINO ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Constructlon Drawings• ❑ Building Under Construction• � Finished Conatruction
'A new Elevation Certificate wili be required when constructton of the building Is complete.
C2. Elevattons -2ones 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
betow according to the building diagram specified in Item A7. Use the same datum as the BFE.
Benchmark Utilized AURAL RM-3 Vertical Datum 5.40' (�,AVD'88)
Conversion/Comments NGS PUBLISHED DATUM
Check the measurement used.
a) Top of bottom fioor (including basement, crawlspace, or enclosure floor) 4.9 � feet ❑ meters (Puerto Rico only)
b) Top of the next higher floor �/ . ❑ feet ❑ meters (Puerto Rico only)
c) Bottom of the lowest horizontal structural member (V Zones only) V�/A. ❑ feet p meters (Puerto Rico only)
d) Attached garage (top of slab) g.l � feet ❑ meters (Puerto Rico only)
e) Lowest elevation of machinery or equipment serv(cing the building 5.� � feet ❑ meters (Puerto Rico oniy)
(Describe type of equipment and location In Comments)
� Lowest adjacent (finished) grade next to building (LAG) 4.� � feet ❑ meters (Puerto Rico only)
g) Highest adJacent (flnished) grade next to building (HAG) 4.� � feet ❑ meters (Pue�to Rico only)
h) Lowest adjacent grade at lowest elevation of deck or stairs, inciuding ,�/ , ❑ feet ❑ meters (Puerto Rico only)
structural support
SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or archftect authorized by law to certify elevation
information. I certily thaf the infirmatfon ort this Cenificafe represents my best efforts to interpret the data availabie.l
understand that any false sfafement may be punfshable by fine or (mprlsonment undei 18 U.S. Code, Section 1009. �
Check here if comments are provided on back of form. Were latitude and longitude In Section A provided by a
licensed land surveyorl � Yes ❑ No
Certifier's Name LARRY L. EVANS License Number PLS # 2937
Title LAND SURVEYOR Company Name EVANS LAND SURVEYING, INC.
Address 1460 BELTREES STREET STE.9 CftV DUNEDIN State FL
��R��
��.�,1.
��s�;�
�,
' J" . . _
����'��
IMPORTANT: In these
iiiding Street Address (including Apt.,
969 BRUCE AVENUE
the corresponding information from Section A.
and/or B►dg. No.) or P.O. Route and 8ox No.
City CLEARWATER BEACH, State FL ZIP Code 33767
SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community oificial, (2) Insurance agent/company, and (3} buildinp owner.
Comments
C2.e): IS AN ELEVATED HOT WATER HEATER INSIDE GARAGE.
6.62' IS ELEVATION OF EXTERIOR A/C COMPRESSOR ON ELEVATED PLATFORM
"'a"°""" �(/'(`"""`(� � Check here if attachments
SECTION E- IIDINO 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, complete Sections A, B,
and C. For Items E1-E4, use natural grade, it avallable. 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 (s 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 (including basement, crawispace, or enclosure) is . ❑ feet ❑ meters ❑ above or ❑ betow the LA�.
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 ne�ct 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 0 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 offtclal must certify this tntormation In Section G.
SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorfzed representative who completes Sections A, 8, and E for Zone A(without a FEMA-issued or community-issued BFE)
or Zone AO must sign here. The statements in SecNons A, B, and E are comect to the best of my knowledge.
Propetty Owner's or Owner's Authorfzed Representative's Name
Address
Signature
Comments
City
Date
State ZIP Code
Telephone
❑ Check j�ere if attachments
SECTION 0 - COMMUNITY INFORMATION (OPTIONAL)
The lucal official who is authorized by law or ordinance to edminister the communfty's floodplaln management ordinance can complete Sections A, B,
and G of this Elevation Certificete. Complete the appifcable Rem(s) and s(gn below. Check the measurement used in Items G8 and G9.
G1. ❑ The information in Sectlon C was taken from other documentatlon that has been signed and sealed by a licensed surveyor, eng(neer, or archftect who
is authorized by law to certify elevation fnformatton. (indicate the source and date of the elevation data in the Comments area below.)
G2. ❑ A community officlal completed Section E for a buiiding located in Zone A(without a FEMA-issued or community-tssued BFE) or Zone AO.
G3. ❑ The foltowing fnformation (Items G4G9) is provided for community floodplaln management purposes.
G4. Permit Number G5. Date Permit issued G6. Date Certificate Of Compliance/Occupancy issued
G7. This permit has been i'ssued for: D New Construction ❑ Substantial Improvement
G8. Elevation of as-built lowest floor (including basement} of the building: � feet ❑ meters (PR) Datum
G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters (PR) Datum
G10. Community's design flood elevation ❑ feet ❑ meters (PR) Datum
Locai OfBcial's Name
Community Name
Signature
Comments
Titte
Telephone
Date
Check here if altachments