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U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION G�RTIFICATE
Federal Emergency Management Agency
Nationai Flood Insurance Program Important: Read the instructions on pages 1-9.
SECTION A - PROPERTY INFORMATION
A1. Buildinp Owner's Name CHRISTOPHER AND CARLINE DEAN
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
829 BRUCE AVENUE
City CLEARWATER State FL ZIP Code 337
OMB No. 1660-0008
Expires March 31, 2012
For Insurance Company Use:
Policy Number
NAIC Number
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) t1 G� (� ��•�, D� /��. I
LOTS 1 AND 2 BLOCK 22 MANDALAY `�� Q� (��
A4.
A5.
A6.
A7.
A8.
Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL
Latitude/Longitude: Lat. 27.9947° N Long. 82.8260° W Horizontal Datum: ❑ NAD 1927 � NAD 1983
Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
Building Diagram Number 6
For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enGosure(s) 1660 sq ft a) Square footage of attached garage N/A sq ft
b) No. of permanent flood openings in the crawlspace or b) No. of permanent flood openings in the attached garage
enclosure(s) within 1.0 foot above adjacent grade 10 within 1.0 foot above adjacent grade N/A
c) Total net area of flood openings in A8.b 2433 sq in c) Total net area of flood openings in A9.b N/A sq in
d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number B2. County Name 63. State
CLEARWATER - 125096 PINELLAS FLORIDA
B4. Map/Panel Number B5. Suffx B6. FIRM Index B7. FIRM Panel 68. Flood B9. Base Flood Elevation(s) (Zone
12103C0102 G Date Effective/Revised Date Zone(s) AO, use base flood depth)
5/17/05 9/3/03 AE 11'
610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9.
❑ FIS Profile ❑ FIRM ❑�Community Determined ❑ Other (Describe)
611. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other (Describe)
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: [,! Construction Drawings' ❑ Building Under Construction* � Finished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
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�i4N, AR/AO. Complete Items C2.a-h
below according to the building diagram spec�ed in Item A7. Use the same datum as the BFE. J
Benchmark Utilized #249A CITY OF CLEARWATER Vertical Datum 1988 �
�
Conversion/Comments NAVD
Check the mea ment used.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 4.16 � feet ❑ meters (Puerto Rico only)
b) Top of the next higher floor 15.63 � feet ❑ meters (Puerto Rico only)
c) Bottom of the lowest horizontal structural member (V Zones only) N.A � feet ❑ meters (Puerto Rico only)
d) Attached garage (top of slab) 3.77 � feet ❑ meters (Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building 15.25 � feet ❑ meters (Puerto Rico only)
(Describe type of equipment and location in Comments)
fl Lowest adjacent (finished) grade next to building (LAG) 2.80 � feet ❑ meters (Puerto Rico only)
g) Highest adjacent (finished) grade next to building (HAG) 3.20 � feet ❑ meters (Puerto Rico only)
h� Lowest adjacent grede at lowest elevation of deck or stairs, including N.A � feet ❑ meters (Puerto Rico onlyj
structural support
SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION �r„ ti+s,,,,� -�
This certification is to be signed and sealed by a Iand surveyor, engineer, or architect authorized by law to certify eleva�4�tr"
information. I certify that the information on this Certificate represents my best efforts to interpret the data available.x,'� a
l understand fhat any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 10Q�. ,�ti3.-� `,
� M qY
� Check here if comments are provided on back of form. Were latitude and longitude in Section A provided �i;jr� a+��'�,
licensed land surveyor? � Yes ❑ Ne �` y.; r�'
Title
C. BRENDLA
SURVEYOR Company
1-31, Mar 09
E NORTH
License Number 1269 * f
C. BRENDLA & ASSOCIATES, INC. 4„�'"j� ,y
� t �,
State FL ZIP Code �3'$78;�;�,"P,
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Telephone 727 - 576-7546 " '� �
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See reverse side for continuation.
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�I ce all previous editions
IMPORTANT: In these spaces, copy the corresponding information from Section A. For �nsurance Company Use:
Building Str�et Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box Na Policy Number
829 BRUCE AVENUE
City CLEARWATERState FL ZIP Code 33767-1308 Company NAIC Number
SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy bo��ides of this Elevation Certificate for (1) community official, �) insurance agenUcompany, and (3) building owner.
Sig
c2e:
K: M # 249A (CITY F CLEARWATER) ELEV
� � ��
NGVD ADJUSTED TO ELEV. 4.756' NAVD - M.S.L. = Q.00
Check here if attachments
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 naturai 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, crawispace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
b) Top of bottom floor (including 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 Instructions), the next 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 ❑ at�ove 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 tl�e corri�iunity'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) 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, 8, and E are correct to the best of my knowledge.
Property Owner's or Owner's Authorized Representative's Name
Address
Signature
Comments
City
Date
State ZIP Code
Telephone
❑ Check here if attachments
SECTION G - COMMUNiTY INFORMATION (OPTIONAL)
The local official 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 G8 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 official 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.
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 (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
Local O�cial's Name
Community Name
Signature
Comments
FEMA Form 81-31, Mar 09
Title
Telephone
Date
. _ � � _ .. ':
Check here if attachments
Replaces all previous editions