1390 SUNSET POINT RDU.S. pEPARTMENT OF HOMELAND SECURITY ELEVATlON CERTIFICATE
Federal Emergency Management Agency
National Flood lnsurance Program Important: Read the instructions on pages 1-9.
SECTION A - PROPERTY INFORMATION
a. Ilc.
A2. Buildin� Street Address (induding Apt., Unit, Suke, and/or &dg. No.) or F.O. Route and Box No.
1390 Suns� Poirrt Road
Clearwater State FI ZIP Code 33755
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OMB No. 1660-0008
Expires March 31, 2012
A3. Property Descriptton (Lot and Block Numbers, Tax Parcel Number, Legal Descxipqon, etc.)
Parcel # 03•29-15-65548-OOa-0090
A4. Build'mg Use (e.g., ResidenHal, Non-Residential, Additlon, Accessory, etc.� Non-Reskiential
A5. Latitude/Longitude: Lat 27d59'28.35"N Long. 82d46'48.05'W Horizontal Datum: O NAD 1927 � NAD 1983
A6. Altach at least 2 photographs of the building if the Certificate is being used to obtain flood (nsurance,
A7. Building Diqqram N�xnber �g
A8. For a bulkJing with a crawlspace w enclosure(s): A9. For a bulldfng with an ettached garage:
a) Square footage of crawlspace or encbsure{s) /�a sq ft a) Square fo�age of attached garage n�/ sq ft
b) No. of permanent flood openings in the craw�pace or b) No. oF permanent flood openings in the attached garege
enclosure(s) wdhin 1.0 foot above adjacent grade /� within 1.0 fooi above adJacent grade 1�
c} T�al net area of flood openings in AB.b Na sq in c) Total net area of flood opentngs in A9.6 � s in
q
d) EnBineered flood openings? ❑ Yes ❑ No d) Engfneered flood openfngs? ❑ Yes ❑ No
SECTION 8- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81. NFIP Community Name 8 Commun'ity Number B2. County Name B3. State
City of Ctearwater -# i25096 Pinellas p�
�umber 85. Suffix 86. FIRM index 87. FIRM Panel B8. Flood B9. Base Flood Elevafion(s) (Z
07 H Date Effective/Revised Dete Zone(s) AO, use base flaod depth)
_ OS-17-�5 05-17-OS X& AE 1 g'
B70. indicate the source of the Base Flood Elevation (BFE) d�a or base flood depth er�tered in Item 69.
❑ FIS Profile � FIRM � Comrtwnity Determined ❑ Other (Describe)
811. Ir�d7cate elevaUon datum used for BFE in kem 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other (Des�vibe)
612. Is the building located in a Coastel Barrier Resources Sjrstem (CBRS) area or Othervuise Protected Area (OPA)? ❑ Yes � No
�esfgnation Date ❑ CBRS ❑ OPA
SECTION C- BUILDINO ELEVATION INFORMATION (SURVEY REQUIRED)
C1. &rilding elevations are based on: ❑ Cor�stn�ction Drewings• . ❑ Butlding Under Constnx�lon• � F1n(shed Construction
*A new Elevation Cert�cate wili be required when cor�stnwtion of the building Es compiete.
C2. Elevations -Zones A1-A30, AE, AH, A(with BFE), VE, V1-V30, V(wtth BFE), AR, AR/A, AR/AE, AR/A1 A3D, AR/AH, AR/AO. Compiete Nems C2.a-h
below acxording to the building diagram specified in item A7. Use the same datum as the BFE.
Benchmark UtiGzed Clw/Bench I-0BVertical Datum NAVD 88
ConversioNCommer�ts
Check the measurement used.
a) Top of bottom floor (Induding basement, crawispace, or enclosure floor} �.� � feet � meters (Puerto R�o only)
b) Top of the next higher floor �. ❑ feet ❑ meters (Puerto Rico only)
c) Bottom of the lowest horizontal structural member (V Zones only) Na. ❑ feet ❑ meters (Puerto Rico only) �
d) Attached garage (top of siab) �/ ._ ❑ feet ❑ meters (Puerto Rico oniy)
e) Lawest elevaUon of machinery or equipment servk�ng the buiiding 13.4 � feet ❑ meters (Puerta Rico only)
(Describe type of equipment end locatlon in Comments) •
� Lowest adjacerrt (f�ishec� grade next to buildfng (lAa) �.� � feet ❑ meters (Puerto Rico �ly)
g) Highest adjacent (finished) grade next to bulld(ng (HAG) �3 3 � feet' � meters (Puerto Rico oniy)
h) Lowest adjacent grede at lowest elevation of deck or stairs, including l�a._ ❑ feet ❑ meters (Puerto Rko oniy)
stnu:tural supPOrt
SECTION D-SURVEYOR, ENGINEER, ORARCHRECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or arch�ect authorized by law to ceRffy elevation
information. l certr7y thaf fhe infonnadon on this Certificafe iep►esents my besf efln�is to lnterpref ihe data avallable.l
unde�stand that any fe/se sEatemenf may be punishable by fine or Jmprlsonment under 98 U. S. Code, Sec6on 1001.�
Chedc here if comments are provided on back of fam. Were latitude and longftude tn Sectioa q proyided by a
Gcensed land surveyor? � Yes ❑ No - � = . .
.,�y�t! .
Certifier's Name Paul E Hagler Ucense Number 2753 /}�
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'fitle Pres Company Name Able Land Surve}iing -•
IO�
Address 1280 Heather Ridge BNd Clty Dunedin State FI ZIP Code 34&98 I �� �!� - -
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'IMPORTANT: In these spaces, copy the eorresponding information from Section A. " �
For:i�uraqce�Company Use ,
Buikiing StreetAddress (including A�., Unft, Sufte, endlor Bidg. No.) or P.O. Route and Box No. Po� :r
1390 Sunset Polrrt Road �y Number �
k. i ,3 � ' .:� , :
City ClearwaterState Fl ZiP Code 33755 _ . _ . _ _ _ _
� SECTION D-SURVEYOR, ENGINEER, ORARCHITECT CERT�FICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) communRy otficial, (2j fnsurance agenbcompany, and (3) butiding owner. '
Commerrts Air cohd:,units on concrete slabs.
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��:..., ��n�. �- aun.u�naa tLtvs� � �vN IIVFVRMATION (SURVEY NOT REQUIREDj FOR ZONE AO AND ZONE A(WITHOUT BFEj
Por Zones RO a!id A.{�ii{tficiit BFE), complete Items E1-E5. If the CertiAcate is intended to suppat a LOMA or LOMR-F request, complete Sections A, B,
and C. For items E7-.E4; use natural grade, if available. Check the measurement used. In Puetto Rico onty, eMer meters,
E7. Provkle etevation informetton for the following and cheCk the appropriate boxes to show whether the elevation is above or below tfte highest adjeCent
grade (HAG) and the lowest adjacent grade (LAG).
a) Top of bottom floor (including basemerd, cxawlspace, or enclosure) is O feet ❑ meters ❑ above or 0 below the HAG.
b) Top of bottom floor (including basemer�t, crawlspace, or endosure) is . ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2 For Building Diagrame B� witFt permaner�t flood openinBs prov(tled In Sectlon A items 8 end/or 9(see pages &9 M instructions}, the next Mgher floor
(elevatidn C2.b in the diagramsj of the buliding is . ❑ feet ❑ meters ❑ above or ❑ befow the HAG.
E3. Attached garage (tep of slab) Is ❑ feet ❑ meters ❑ above or ❑ belaw the FiqG,
E4. Top of platform of machinery and/or equipment servicing the buildng is ❑ feet ❑ meters ❑ above or � below the HAG.
E5. Zone AO oNy: If no flood depth number � evaiiabie, is the top ot the bottom floor elevated 6� accordance wRh the commurtity's floodptafn martagemeM
adinance? ❑ Yes ❑ No ❑ Unlmown. The locai ofFicial must certify this Information in Sect(on G.
SECTION F- PROPERTY OWNER (OR OWNER'S REPRE$ENTATIVE}CERTtFiCAT10N
The property owner or ovmer's authorized represerrtative who completes 3ections A, B, and E for 2one A{wahout a FEMA-issued or communfty-Issued BFE)
or 2one AO must slgn here. The statemenFs In Secdons A, B, and E sre carect fo the best of my knowledge.
Property Ovmer's or Owner's Authorized Representative's Name
��e� ��Y State ZIP Code
Signat�e
��e Telephone
Comments
❑ Check here H attachments
SECTION Ci - COMMUNITY INFORMATION (OPTIONAL)
Tha 1oCa� ol8ciai who is authorized by iaw ar orc8nance to administer the community's floodplaln manapement ordinar�e can Complefe SeCtions A, B, C(or E),
and O ofthis Elevatiot� Certiflcate. Complete the applicable ftem(a) and sign below. Check the masurement used M Rems GB and G9.
G1. ❑ The IMamatton in Section C was taken from other dowmentation tRat has been s�ned and s�led by a Ikenaed surveyor, engineer, or architect who
is authodted bylaw to certify elevatlon informatfon. (Indlcate the souroe and date of the elevallon data In the CommeMs area betow.)
G2 C7 A commun�y officiai corrq�tetetl Section E fa� a buldir� located in Zone A(without a FEMA-fssued or commu»Ity-Issued BFE) or 2one AO.
G3. ❑ The foqoWing informaUon (Items G4G9) is provided for cammunify floodplain management purposes,
G4_ Permit Number G5. Date Permit Issued
G6. Date Certificate Of Compliance/Occupancy Issued
G7. Thts pertnit has been tssued for: ❑ New Construcdon ❑ Substantlal Improvement
G8_ Elevation of as-bu� Iowest ftoor (including basement) of the bulid(ng: ❑ feet ❑ meters (PR) Datum
G9. SFE or (in Zone AO) depth of flooding at the build�g site: ❑ feet ❑ meters (PR) Daium
G10. Communfty's desgn flood elevation ❑ feet ❑ meters (PR) �atum
Local Otttciaps Name
Commundy fVame
S�nature
Commerris
T31e
Telephone
Date
Check here tt attachments
` � Building Photographs
� Continuation Page
For Insurance Company Use:
Building Street Address (nGuding Apt., Unit, Suite, and/or B�g. No.) or P.O. Route and Box No. Poticy Number
1390 Sunsd Point Road
City Ciearvvater State Fl ZIP Code 33755 Car�panyNAlCNumber
ff submitting more photographs than will fd on the preceding page, affix the additional photographs below. Identify all
photographs with: date taken; °Fiont Viev�' and "Rear Ve�n�'; and, if required, "Righf Si�ie Vew" and "Left Side Vew."
,�i�o�UT V1C�c1 oS-o�- 13
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Building Photographs
See Instructions for ltem A6.
For insurence Company Use;
Building Streef Aid�ess (induding A�., Unit, Suite, and/or Bidg. No.) or P.��. Route and Box No. Paicy Number
1390 Sunset PoiM Raad
City Cieanroater State FI ZIP Code 337s5 . �,p�y �C �,�
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to
the instru�tions for Item A6. identify all photographs with: date taken; "Front View° and °Rear VievV'; and, if required, °Right
Side View" and "Left Side Vew." If submitting more photographs than will fd on this page, use the Continuation Page,
following.
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