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470 PALM ISLAND NE. r ! . U.S. DEPARTfv1ENT OF HOMELAND SECURITY Federal Emergency Management Agency National Fiood Insurance Program ELEVATION CERTIFICATE Important: Read the instructions on pages 1-8. Name JOSEPH B. TREPANI OMB No. 1660-0008 Exoires Februarv 28. 2009 SECTION A- PROPERTY INFORMATION � 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. 470 PALM ISLAND N.E. City CLEARWATE�i State FL ZIP Code 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 89, UNIT B, ISLAND ESTATES OF CLEARWATER (05-29-15-43434-000-089) Company NAIC Number 470 PALM ISLAND NE_ BCP2007-03372 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. N 27.98600 Long. W 82.81454 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 1 A8. For a building with a crawl space or enclosure(s), provide A9. For a building with an attached garage, provide: a) Square footage of crawl space or enclosure(s) N/A sq ft a) Square footage of attached garage 554.4 sq ft b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage enclosure(s) walls within 1.0 foot above adjacent grade N/A walls within 1.0 foot above adjacent grade 2 c) Total net area of flood openings in AB.b N/A sq in c) Total net area of flood openings in A9.b 802.8 sq in SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NFIP Community Name & Community Number 62. County Name 63. State CITY OF C�EARWATER 125096 PINELLAS FL B4. Map/Panel Number 65. Suffix 66. FIRM Index 87. FIRM Panel 68. Flood B9. Base Flood Elevation(s) (Zone Date Effective/Revised Date Zone(s) AO, use base flood depth) 12103C-0102 G 5/17/05 9/3/03 AE 11' B10. B11. � 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) Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other (Describe) Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑Yes �No Designation Date NA ❑ CBRS ❑ OPA SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REGIUIRED) 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/AH, AR/AO. Complete Items C2.a-g below according to the building diagram specified in Item A7. •---a-- °°--�� Benchmark Utilized CITY OF CLWTR "1-03.5" Vertical Datum NAVD 88 � ,`:.� �.°9y�� U,..._ . Conversion/Comments N/A , ,T; ,��^_•�-��°� � a) Top of bottom floor (including basement, crawl space, or enclosure floor)_ b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment in Comments) f) Lowest adjacent (finished) grade (LAG) g) Highest adjacent (finished) grade (HAG) Check the measurement used. �' � ��"� ` 11.53 � feet ❑ meters (Puerto Rico onl�� _ z � �� ;a � 24.50 � feet ❑ meters (Puerto Rico only�_ , __,� '. N.A � feet ❑ meters (Puerto Rico only�� ' `��` �� i 9.30 � feet ❑ meters (Puerto Rico only� �� ; '' 11.02 � feet ❑ meters (Puerto Rico onl`�= � ��. ��:., � ` � 5.7 � feet ❑ meters (Puerto Rico onl � � 8.4 � feet ❑ meters (Puerto Rico onl� � ,.---_�___-� SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION ' °•-�°��W--= This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information on this Certificate represents my best elforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonmenf under 18 U.S. Code, Section 1001. � Check here if comments are provided on back of forrn. Certifier's Name GEORGE A. SHIMP I11 JOB# 050370H License Number 6137 e VICE PRESIDENT Company Name GEORGE A. SHIMP II & ASSOCIATES, INC. Address 3301 DESOTO BLVD. SUITE D City PALM HARBOR State FL ZIP Code 34683 S' t r� e��„ Date 1-05-09 Telephone 727-784-5496 I(/(1'1�j�t . ' �.1fqa��, .� i, ,+�' l�I a►.fi}dij* .�`i , �F . g i�. .�� . +; ,.;> ,,,. l,iti, r► �'� � �` �, .„ !_ ..� : ,,� �' ��A f M �3 � _' a� , �� ' " ",� `� i �d'1P�, '!f :� � r? � ��13� I /5%0� FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 470 PALM ISLAND N.E. City CLEARWATER State FL ZIP Code 33767 SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION For Insurance Company Use: Policy Number Company Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenUcompany, and (3) building owner. Comments C2.e) AIR CONDITIONER �� ,�-- Signature Date 1-05-09 � Check here if attachments SECTION E- BUILDING ELEVATION INFORMATION (SURVEY NOT RE�UIRED) 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 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, crawl space, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawl space, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9(see page 8 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 ❑ above 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 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 m ust 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 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 inforrnation (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 Local Official's Name Community Name Title Telephone Signature Date . Comments ❑ Check here if attachments FEMA Form 81-31, February 2006 Replaces all previous editions Buiiding Photographs See Instructions for Item A6. uilding Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No. 470 PALM ISLAND N.E. City CLEARWATER State FL ZIP Code 33767 For Insurance Company Use: Policy Number Company NA{C Number 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 wiil fit on this page, use the Continuation Page, following. �� : • �'� � �� ° . - -� ;�a� � ,y � � ea..., ��; ''�'' ' � r; �"'7�,:. ; __. ti '_; ' '�, �'E„'- � gF.Z,��. `�--....,�'�---__. FRONT VIEW PICTURE TAKEN: 1-05-09 __ . _ � � .�,,� � � � � _ � �p.�.�.... �.,W � �� s , 'F � � a 1 � � _ =�.i ! �, i o , �� a �,� � � ° � JAN 1 % 2009 �l , ., N � i.�, i�.��.,:� ..�_..._.��,....��....,._.._.�..� U�VE�v,:�Q,w��t.� � ��a�::��r;�.�� i�Ei'1 i �i u Y Ci� GLE��#�1�1;�-fER Building Photographs Continuation Page Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 470 PALM ISLAND N.E. Clty CLEARWATER State FL ZIP Code 33767 �� i_ ' nv Us� I Policy Number NAIC Number 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." 1k� � `� ` � .� � �i ,.�,, , _ � � � �e� ..' �� ,Y"..- �'r q .ex �". {}rs»..3 �'z y�. ��;��, �� ~p� , :- ;; '� � ��*� ��up�l o�� . d h#r� � � �i � �t , S€=. 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