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735 ISLAND WAY� N U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program A1. Buildinq Owner's Name ELEVATION CERTIFICATE Important: Read the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION OMB No. 1660-0008 Expires March 31, 2012 For insurance Company Use: Policy Number A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number 735 ISLAND WAY C�tY State ZIP Code CLEARWATER FL 33767 A3. Property Description (Lot and Block Numbers, Tax Parcei Number, Legal Description, etc.) LOT 23, UNIT 8, ISLAND ESTATES OF CLEARWATER, PLAT BOOK 64, PAGE 73 AND 74. A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27 DEG.59'27.6'N Long. 82 DEG.49'12.5"W Horizontal Datum: ❑ NAD 1927 � 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-B A8. For a building with a crawlspace 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 650.0 sq ft b) No. of permanent flood openings in the crawlspace or b) No. of pertnanent flood openings in the attached garage enclosure(s) within 1.0 foot above adjacent grade NA within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in AS.b N/A sq in c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openinqs? ❑Yes �IVo d) Engineered flood openin s� r ❑ Yes �No SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number 62. County Name B3. State CITY OF CLEARWATER 125096 PINELLAS FL 64. Map/Panel Number 65. Suffix B6. FIRM Index 67. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone Date Effective/Revised Date Zone(s) AO, use base flood depth) 12103C0102 G $/1$/09 09/03/03 AE 11.0 � 12.0 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69. ❑FIS Profile �FIRM ❑Community Determined ❑Dther (Describe) 611. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 Q NAVD 1988 ❑Other (Describe) 612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Othenvise Protected Area (OPR)? ❑ Yes ONo Designation Date ❑CBRS ❑DPA SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑Construction Drawings* ❑Building Under Construction' OFinished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations - Zones Ai-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 below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized CITY OF CLEARWATER BENCHMARK ID: I-03.5 ELEVATION 6.4912' Vertical Datum NAVD 1988 Conversion/Comments NONE Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) � 1•93 x feet ❑ meters (Puerto Rico only) b) Top of the next higher floor 21.93 x feet ❑ meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) N/A x feet ❑ meters (Puerto Rico only) d) Attached garage (top of slab) 8.93 X feet ❑ meters (Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building %�C $•�4 x feet ❑ meters (Puerto Rico only) (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 8•61 x feet � meters (Puerto Rico only) g) Highest adjacent (finished) grade next to building (HAG) 9•81 x feet Q meters (Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs, including 8.61 X 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 architect authorized by law to certify elevation infortnation. ! certily that the information on this Certificate represents my best efforts to interpret the data available. l understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. ��- '`'' �'� i ��` , � � � �i.- �Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a `` �`` ��'`�,�, licensed land surveyor? X Yes ❑ No Certifiers Name: BILL H. HYATT, JR. License Number: 4636 Title : P.S.M. Company Name : ALLSTATE SURVEYING, LLC Address: 1844 Signature HIIL ROAD #429 Ciry: SUN Date: State: FL ZIP Code: 06/13/12 Telephone : � �,. ,,, ,� % �� yf� ,r`� � J`7� � `�--�j �v �• -�--rv .�✓ _ ! � �ii �,� - � ;i,n,�r � �� :� l ` f `, r`\ j },,`z : FEMA Form 81-31, Mar 09 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these Building Street Address (in� 735 ISLAND WAY City CLEARWATER is, copy the corresponding information from Section A. Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. State FL ZIP Code 33767 For Insurarroe Comparry Use: Pdicy Number Comparry NAIC SECTfON D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenUcompany, and (3) building ovmer. AIR CONDITIONING UNIT ON CONCRETE SLA&NOT TOBE USED FOR CONSTRUCTION OR DESIGN, FLOOD INSURANCE USE ONLY , Signature � Date O6/13/12 ❑Check here if attachments SECTION E- BUILDING 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, if available. Check the measurement used. In Puerto Rico only, enter meters. E1. Provide elevation infortnation 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 enGosure) is �feet ❑meters Dabove or �elow the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is Ofeet ❑ meters ❑above or �elow the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 andlor 9(see ages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of ttie 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 Qabove 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 ordinancel �Yes ONo �Jnknown. The local official must certiiy this information in Section G. SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION 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 know/edge. Property Owner's or Owner's Authorized Representative's Name Address Signature Comments City Date State ZIP Code Telephone ❑Check here if attach ents SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local o�cial who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C(or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items GS and G9. 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 o�cial completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or Zone AO. G3. ❑ The following information (Items G4-G9) is provided for community floodplain management purposes. I 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-built lowest floor (inGuding 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 Local Official s Name ��1e Community Name Signature Comments Telephone Date U Check here if attachments FEMA Form 81-31, Mar 09 Replaces all previous editions Building Photographs See Instructions for Item A6. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 735 ISLAND WAY Clty State FL ZIP COde CLEARWATER .,.,�� For Insurance Company Use: Policv Number NAIC � If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to � the instructions for Item A6. Identify all photographs with: date taken; "Front View" and 'Rear View"; 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 I reverse. FRONT 06/11/12 �� .�:�T'! � .�°` �=�_ . ' �� . �,..� ,_.- �. ��-�_._...�.- - ��;� ��- - � �- _ . _ , . ��. - �ts. _ Building Photographs Continuation Paqe ; For Insurance Company Use: � Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Paicy Number I 735 ISLAND WAY I City State FL ZIP Code Company ruuC tvumber ! CLEARWATER 33767 � If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all � photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View.� LEFT 06/11/12 RIGHT 06/11/12 I■I��1��