Loading...
406 LEEWARD ISLAND' ' �.a �:S. DEPARTMENT OF HOMELAND SECURITY Federai Emergency Management Agency National Flood Insurance Program - 11�I933 ELEVATION CERTIFICATE Important: Read the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION A1. Building Owner's Name Grant C. White; Suzanne A. White A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 406 Leeward Island City Clearwater State FL ZIP Code 33767 A3. Property Description (Lot and Biock Numbers, Tax Parcel Number, Legal Description, etc.) PARCEL ID: 08-29-15-43308-000-0500 OMB No. 1660-0008 Expires March 31, 2012 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Residential A5. Latitude/Longitude: Lat. N/A Long. N/A 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 1A A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawispace or enclosure(s) N/A sq ft a) Square footage of attached garage 485+- 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 N/A within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b N/A 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 83. State Clearwater- 125096 Pinellas FLORIDA 64. Map/Panel Number 65. Suffix B6. FIRM Index B7. FIRM Panel 68. Flood 89. Base Fiood Eleva6on(s) (Zone 12103C0102 G Date Effective/Revised Date Zone(s) AO, use base flood depth) 9/3/2003 9/3/2003 AE 11 B10. 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) B11. Indicate elevation datum used for BFE in Item 69: ❑ 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 N/A ❑ CBRS ❑ OPA SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Buiiding elevations are based on: ❑ Construction Drawings* ❑ Buiiding 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-h below acco�ding to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized PCBM Vertical Datum 1988 Conversion/Comments N!A a) Top of bottom floor (inciuding basement, crawispace, or enclosure floor) 7.02 b) Top of the next higher fioor N/A. c) Bottom of the lowest horizontal structural member (V Zones only) N/A. d) Attached garage (top of slab) 6.14 e) Lowest elevation of machinery or equipment servicing the building 6.24(A/C) (Describe type of equipment and location in Comments) � Lowest adjacent (finished) grade next to building (LAG) 6.0 g) Highest adjacent (finished) grade next to building (HAG) 5.9 h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A. structural support Check the measurement used. � feet ❑ meters (Puerto Rico only) ❑ feet ❑ meters (Puerto Rico only) ❑ feet ❑ meters (Puerto Rico only) � feet ❑ meters (Puerto Rico only) � feet ❑ meters (Puerto Rico only) � feet ❑ meters (Puerto Rico only) � feet ❑ meters (Puerto Rico only) ❑ feet ❑ meters (Puerto Rico only) 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 elevatior information. l certify that fhe information on this Certificate represents my best efforts to interpret the data available. I understand that any false stafement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. �Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a/ iicensed land surveyoi`? ❑ Yes � No Address Signature FEMA Form 81-31. Mar 09 License Number ame Swerdloff & Perry S ry State FL Date Telephone (407)-688-7631 I n ZA� � I I See reverse side for continuation. i � >:.;.�{� .-.- � t � ;\ �� � �\� � �� Reolaces all previous editions IBQPbRTANT: 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. 406 Leeward Island City Clearwater State FL ZIP Code 33767 � both ments SECTJQN,D; - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTI for (1) community official, (2) insurance agent/company, and (3) building owner. to the A/C Pad. '���� v ❑ 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 information for the foilowing 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 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 buiiding 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 must sign here. The stafements in Sections A, B, and E are correct fo 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 compiete 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. ❑ G2. ❑ G3. ❑ 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.) 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. 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 ❑ Substantiai Improvement G8. Elevation of as-buiit 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 Official's Name Community Name Signature Comments Title Telephone Date Check here if attachments FEMA Form 81-31, Mar 09 Replaces all previous editions