2045 ANCHORAGE WAY U.S:•DEPARTMENT OF HOMEIAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
. , Federal Emergency Management Agency Expires Februarv 28.2009
National Flood Insurance Program Important: Read the instructions on pages 1-8.
SECTION A-PROPERTY INFORMATiON For Insurance Company Use:
A1. Building Owner's Name HARRE,JASON R.:4ND FANKUM, LAURA E. Policy Number
A2. Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number
.2045 ANCHORAGE WAY.
City CLEARWATEWR State FL ZIP Code 33755
A3. Property Description(Lot and Block Numbers,T x Parcel umber,Lega Description,etc.
LOT 8,BLOCK„A",BAY TERRACE ,43�����D.'�"ll-�)-�/�0�� �Ift��T� nnree
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) RESIDENTIAL
A5. Latitude/Lqngitude:Lat.27 59,45,,,, Long.82 47,33„ Horizontal Datum: ❑ NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of khe building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 8
A8. For a building with a crawi space or enclosure(s),provide A9. For a building with an attached garage,provide:
a) Square footage of crawl space or enclosure(s) 1306sq ft a) Square footage of attached garage 1�/A sq ft
b) No.of peRnanent 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 � walls within 1.0 foot above adja�r.ent grade
c) Total net area of flood openings in A8.b �� sq in c) Total net area of flood openings in A9.b sq in
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SECTION B•FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFiP Community Name 8�Community Number 62.County Name B3.State
CLEARWATER 125096 PINELLAS FLORIDA
B4.Map/Panel Number 65.Suffix B6.FIRM Index 67.FIRM Panel 68.Flood B9.Base Flood Elevation(s)(Zone
Date EffectivelRevised Date Zone(s) AO,use base flood depth)
12103C0106 G 3-03-03 9-03-03 AE 11.0
610. Indicate the sour�ce of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
❑FIS Profile �FIRM ❑Communiry betermined ❑Other(Describe)
611. Indicate el�vation datum used for BFE in Item B9: ❑NGVD 1929 �NAVD 1988 [�Other(Describe)
612. Is the buitding located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No
pesignatian Date ❑CBRS ❑OPA
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SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
o �m � N
C1. Building elevations are based on: ❑Gonstrudion Drawings' �Building Under Construction" ❑Finished Constr?. * �
*A new Elevation Cert�cate 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/Ap. CQmplete r- * � N(�
betow acCOrding to the building diagram specified in ftem A7. „ -
Benchmark Utilized CI,EARWATER J-6"*''** Verticat Datum NAVD'88 ELEV.7.25 � » � 0 �
Conversion/Comments * n Qp Z
Check the measurement used. � m �
� � �On
a) Top of bottom floor(including basement,crawl s��ace,or enGosure floor)_ 10.8 �feet ❑meters(Puerto Rico only) � � _
b) Top of the next higher floor 12.58 �feet ❑meters(Puerto Rico only) C� p �
c) Bottam of the lowest hor:zontal structural m<mber(�1 Zones only) �l/A. ❑�et [�d meters(PueRo Rico onfy) � � �
d) Attachtd garage(top of slab) 10..$ �feet C7 meters(Puerto Rico only) m D
e) Lowest elevation of machinery or equipme�t servicing the building N/A. �feet ❑meters(Puerto Rlco only) �
(Describe type of equipment in Comments) v rn
f} Lowest adjacent(flnisfied)grade(LAG) 10.6 �feet ❑meters(Puerto Rico onty) �
g) Highest adjacent(finished)grade(HAG) 11.2 �feet ❑meters(Puerto Rico on{y) � S
� �SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION y �
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation
information. !certify that the information on this Certificate repr�sents my best etTorts to interpret the data evailable.
I understand that any ialse statement may be punishable by fine or imprisonment under 98 U.S. Code, Section 1001. .,,�Y`'����
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❑ Check here if comments are provided on back of form. ,:',^- � 'y �
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Certifiers Name WILLIAM G.KEATING License Number LS#1528 ��-;'c�Jt +'��' �"; `'''"
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Title IAND SURVEYOR AND MAPP�R Company Name ALUED SURVEYING " • �'� '` '�� -
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Address 1275 H HIGHLA D AVENUE Cit� CLEARWATER State FL 21P Code 33755 "� ��
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Signature r Date �•04-�8 Telephone 727-446-1263 ; �
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IW.IPORTANT: In these spaces,copy the corresponding information from Section A. For Insurance Company Use:
� Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Poiicy Number
2045 ANCHDRAGE WAY
C�� CLEARWA���2 F� ZIP Code FLOR IDA 3 3 7 5 5 Company NAIC Number
SECTION D-SURVEYOR, ENGINEER,OR ARCHITEC7 CERTIFICATION(GONTINUED)
Copy both sides of this Elevation Cert�cate for(1)communiry official,(2)insurance agenUcompany,and(3)buildtng owner.
Comments
NOV 14 ��0�
N/A
Signature Date
❑ Check here if attachments
SECTION E-BUILDING ELEVATtON 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 natut�i grade,if available. Check the measur�ement used. In Puerto Rico only,enter meters.
E1. Provide elevation information f�r 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,crawi space,or enclosure)is ❑fes# 0 meters ❑above or 0 below the HAG.
b)Top of bottom floor(including basement,c�awl space,or enctosure)is ❑feei ❑mete�s ❑ebove or❑ below the LAG.
E2. For Building Diegrams 6-8 with pertnanent 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 buildi:�g is ❑feet ❑meters ❑above or ❑below the HAG.
E3. Attached garage(top of slab)is �feet �meters ❑above or ❑below the HAG.
E4. 7op 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 a�ailable,is the top of the bottom floor elevated in accordance with the community's floodplain management
oMinance? ❑Yes ❑ No ❑ Unknown. The local official must certify this information in Section G.
SEC710N F-PROPERTY OWNER(OR OWN�R'S REPRESENTATIVE)CERTIFICATION
The property owner or owners authorized representative who completes Sections A,B,and E for Zone A(withbut 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 knowledge.
Property Qwner's or Owner's Authbrized Representative's Name
JASON KUEHN
Address 1 1 08 CHARLES STREET CLEARWA�`R FLAState �#�»d�e
Signature $—0 4—0$ paie Telephone
Comments
---- - - � ❑Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL) � �
The local official who is authorized by law or ordinance to administer the communitys floodp�ain management ordinance can complete Sections A,B,C(or E),
and G of this Elevation Certificate. Complete the applicabie item(s)and sign below. Check the measurement used in Items G8.and G9.
G1.❑ The information in Seetion C was taken frorn other documentation that has been signed and sealed by a lice�sed surveyor,engineer,or architect who
is authorized by law to certify elevation infr;mation. (Indicate the source and date of the ele�r;ti�n 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 communiry-issued BFE)or Zone AO.
G3.❑ The following information(Ifems Gd.-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 ❑Substanfiat Improvement
G8.Elevation of as-buiR lowest floor(inCluding basement)of the building: _Q 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 Title
Community Name Telephone
Signature Date
Comments
2045 ANCHORAGE WAY
BCP2008-04605
(ELEVATION CERTIFICATE) f�Check here if attachments
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Zoninq: LMDR atlas# 251 A