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1020 CHARLES ST U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 _� Federal Emergency Management Agency Expires March 31,2012 . National Flood insurance Program Important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION A1. Building Owner's Name Jaggers Keene A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. 1020 Charles St. City Clearwater State FL ZIP Code 33755 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Peale Park Blk A,E 35 Ft of Lot 4&W 40 Ft of Lot 5 / 03-29-15-68094-001-0050 A4. Building Use(e.g.,Residential, Non-Residential,Addition,Accessory,etc.)Residential A5. Latitude/Longitude:Lat.27°59'37.89 Long.82°47'38.0 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 crawlspace or enclosure(s) N/A sq ft a) Square footage of attached garage �500 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 0 within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in AB.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 61.NFIP Community Name&Community Number 62.County Name B3.State City of Clearvvater/125096 Pinellas FL 64.Map/Panel Number 65.Suffix 66.FIRM Index 67.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone-�' 12103C 0106 H Date Effective/Revised Date Zone(s) AO,use base flood depth) 5l17/05 5/17/05 AE 12.00&13.00 B10. 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) ' B11. 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 N/A ❑ 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/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 PCBM Highland DVertical Datum NAVD 1988 Conversion/Comments N/A . Check the measurement used. a) Top of bottom floor(including basement,crawlspace,or enclosuYe floor)7.78 �feet ❑meters(Puerto Rico only) b) Top of the next higher floor � 18.85 �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 siab) 7.42 �feet ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 7.9 �feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Comments) � Lowest adjacent(finished)grade next to building(LAG) 7.0 �feet ❑meters(Puerto Rico oniy) g) Highest adjacent(finished)grade next to building(HAG) 7.8 �feet ❑meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs,including 7.2 �feet ❑meters(Puerto Rico only) structural support SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION -�. ��±����; ,, This ceRfication is to be signed and sealed by a land surveyor,engineer,or architect authorized by iaw to certify elevation � ° , � J '�� t- information. I certify that the information on this Certificate represents my best efforts to inte►pret the data available. �`� �� ,������ ~" 1 understand that any false sfatement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001. �- R 4� , ,�,. E ' -. � Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a 'd,;;.'}�� ��4`^�" i_�-; 4 licensed land surveyor? � Yes ❑ No �.'�".� :. �. . �����-:� .;.r,� � �;, �.-. • `�t�. .M�a �t��'r � �..qf'��. �r Cert�er's Name Dennis J.E yre License Number 2865 �`, � ri ��R1�� � Title Land Surveyor Company Name GeoData Services,inc. � ��,`' ��'����'� f"�' ! r�'� y ,� �r.��� �'; �� Address 822 rew Street,Suite 8 City Clearwater State FL ZIP Code 33765 'v�� `� . �-� �r, ;; �"=�, �'" ;�"t�a�z�•°", `.. Sign r Date T�,! T lephone 727-447-1763 ?�•s�i�� ,s�� fv/� FEMA 81-31, r 09 See reverse side for continuation. Replaces ali previous editions IMPORTANT: In these spaces,copy the corresponding information from Section A. y:'. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. 1020 Charles St. City ClearwaterState FL ZIP Code 33755 _ ,;.,.. SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agenUcompany,and(3)building owner. Comments e west machinery is the ir condition / � r.�� J /G Zo ! Sig atur � Date ❑ Check here if attachments SECTION E- LDING EL VATION 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,completeoSections 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,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 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 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 City State ZIP Code Signature Date Telephone Comments � ❑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�aw 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 _J 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 Official's Name Title Community Name Telephone Signature Date Comments — �,: 1. ❑Check here if attachments FEMA Form 81-31, Mar 09 Replaces all previous editions U.S.DEPARTMENTOFHOMELANDSECURITY ELEVATION CERTIFICATE FEDERA[�,S€c�ENCY MANAGEMENT AGENCY OMB No. 1660-0008 Nano„�; odlnsuranceProgram (mportant: Read the instructions on pages 1-9. Expiration Date: July 31, 2015 SECTION A- PROPERTY INFORMATION FbR INSURANC� GOMPANY USE, .: A1. Building Owner's Name JAGGERS C. KEENE PbUcy NUmber A2. Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No. Corripahy NAIG N�mb�r 1020 CHARLES STREET �'�� City CLEARWATER, State FL ZIP Code 33755 A3. Property Description (Lot and Block Numbers, Tax Parcel Nurnber, Legai Description, etc.) 03-29-15-68094001-0050 A4. Building Use (e.g., Residential, Non-Residentiai, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27deg. 59' 38.1" Long. 82deg. 4T 33.0" 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 t A � . A8. For a building with a crawlspace or enclosure(s): . A9. For a building with an attached garage: a) 5quare footage of crawispace or enclosure(s) -0- sq ft a) Square footage of attached garage 429 sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s) within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade -0- c) Total net area of flood openings in AB.b sq in c) Total net area of Flood openings in A9.b -0- sq in d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes ❑ No SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION IB1. NFIP Community Name & Community Number B2. County Name B3. State CLEARWATER / 125096 PINELLAS FLORIDA B4. Map/Panel Number B5. Suffix B6. FIRM Index Date 67. FIRM Panel B8. Flood B9. Base Flood Elevation(s)'(Zone 12103 C 0106 H 8-18-09 Effective/Revised Date Zone(s) AO, use base flood depth) 5-17-05 AE 12' & 13' 610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 89. ❑ FIS Profile � FIRM ❑ Communfty Determined ❑ Other/Source: Bf 1. indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ OthedSource: B12. 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 REGlUIRED) 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, ARlA, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a-h below according to the building diagram specified in item A7. In Puerto Rico only, enter meters. Benchmark Utilized: CITY OF CLWR. BM # I-O6 Vertical Datum: 11.578' (NAVD'88� Indicate elevation datum used for the elevations in items a) through h) below. � NGVD 1929 � NAVD 1988 � OthedSource: Datum used for building eievations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor (including basement, crawispace, or enciosure floor) b) Top of the ne� 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 and location in Comments) � Lowest adjacent (finished) grade next to building (LAG) g) Highest adjacent (finished) grade next to building (HAG) h) Lowest adjacenf grade at lowest elevation of deck or stairs, including structural support 6.6 �., 7.6 i �• 7.3 7.8 5.7 �� 7.6 N/A. � feet ❑ meters � feet ❑ meters ❑ feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters ❑ feet ❑ meters SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed 6y a land surveyor, engineer, or archftect authorized by law to certify elevation �---- information. ! certify that the information on fhis Certificate represents my best efforts fo interpref the dafa availab/e. � I understand that any false statement may be punishab/e by fine orimprisonment under 18 U.S. Code, Section 1001. � L � Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a � Check here if attachments. licensed land surveyoi'? � Yes ❑ No ! Certifier's Name LARRY L. EVANS Title LAND SURVEYOR Address 1460 BELT EES: Signature , , `, , , , , . CompanyName STE.9 �City DUNEDIN, Date 5-21-13 License Number PLS # 2937 EVANS LAND SURVEYING, INC. State FL ZIP Code 34698 Telephone (727j 7343821 �2�� �������� tLtVA I IVN (:tK I It-14A I t, page z IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Gtrget Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 1029 CIHARLES STREET Policy Number: City CLEARWATER, State FL ZIP Code 33755 Compahy NAIC Number: SECTION D- SURVEYOR, ENGINEER, OR ARCHI7ECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments C2.a): IS THE LOWEST FLOOR ELEVATION OF THE NEW ADDITION. C2.b): IS THE LOWEST FLOOR ELEVATION OF THE EXISTING HOUSE. C2.e): EXTERIOR A/C COMPRESSOR (FOR THE EXISTING HOUSE), ON GROUNO LEVEL PAD. Signature SECTION'E — Date 5-21-13 ILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT 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 apprapriate 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, crawispace, or enciosure) 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 instructians), 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 WAG. 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 floodpiain 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, B, and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code i Signature Date Telephone � Comments ❑ Check here if attachments SECTION G — COMMUNITY INFORMATION (OPTIONAL) 'T'he local officiai 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 gf this Elevation Certificate. Compiete the applicable item(s) and sign below. Check the measurement used in Items GS—G10. In Puerto Rico only, enter meters. �1. ❑ 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. U3. ❑ The following information (items G4—G10) 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 GS. Elevation of as-built lowest floor (including basement) of the building: ❑ feet G9. BFE or (in Zone AO) depth of flooding at the buiiding site: ❑ feet G10. Community's design flood elevation: Local Official's Name Community Name Signature ` Comments [a feet Title Telephone Date ❑ meters Datum ❑ meters Datum ❑ meters Datum Check here if attachments. ELEVATI��J CERTIFI(;ATE, page 3 guilding Photographs See Instructions for Item A6. 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. '020 CHARLE:� STREET City CLEARWATER, State FL ZIP Code 33755 FOR INSURANCE COMPANY USE Policy Number: Company NAIC Number. If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. dentify alt photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in �;ection A8. 11� submitting more photographs than will fit on this page, use the Continuation Page. ��S .��� r'�, � � .:*-s:� � � �: � ,� ' �; ,� � � i � � � -� �� ��� . :•�!�""'.� ��.> � a t'f"'" � �� .< � '� ' � '�, �� �'�`���; �,,�'�, I ' ' `` ': � � 1.t 4 � i �`v .� ��_� $ ` I "n- "�. e , r s � �r��^ � ; � � �. _ t � t �. i�� p,�,� a 9' � ` . ,�° � $ na � I "r. y#S�� . : i. A ��� ir � �,�` � � �`� � ` �; � � � �" � ��� � � �� �a�� s�'� z.2,��7 r.;i ��'�' � ,s: `'.�- � ' z;,,_.�-.� , � �.'. �# �' ,���'l 5� E�',: � �� � w ��s � ���� ��Yi �_.._,_ . "`k � :;r�,z',�'E� . �",w�' � . . � ��� �� � £.` � . ,. �. � i� . '��T' � � �' {� : f {", �� ��e � �a' �r � ��� EXISTING HOUSE / REAR VIEW / 5-21-13 EXISTING ADDITION / WEST VIEW EXISTING STORAGE BUILDING / SOUTH VIEW � � � f°1 Eiyrd4...., �_...� � ��: y���s , , �,„:. � r, ,�� � :� �' � "° � � � �Ii M ;� � , � ' � �' . i w� �� � ��.. �; �.e�.-� �i , -�- '� �� ' �� ELEVATION �:ERTIFICATE, page 4 guilding Photographs Continuation Page IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street L�ddress (inclwding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number. 1020 CHARLES STREET City CLEARWATER, State FL ZIP Code 33755 Company NAIC Number: If submitting rnore 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." 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NEW ADDITION /uEASTpSIDE VIEW / 5-21-13 a � 0 : -z -�"' ,� � �'. � �:� � < ��� �� J y �' r� � s'¢Ttr�& , �1 �� � , �� � �.- �`�, t¥� ��,'�` �' � :�; '� � �,,.� f *^� .t -: �ae r;>, �� � �,t ,�•: - o- k � t tiR rv �����* , - .�--�--- ,,�> � �� r i �€��` ������ �` �-. , -r = k�f �'�i ���'�7 � " �' �` k y' . , � �'b`'' ��� ": ! �F �� . . ua�' � , �J�. � ,,;.. , .,��.��� A+ s rt ` 3! p �.J _ �1 . ,, i NEW ADDITION / WEST SIDE VIEW ; 5-21-1:; U.S.DEPARTMENTOFHOMELANDSECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT A(3ENCY OMB No. 1660-0008 NationalFloodlnsuranceProgram Ii17p01't811t: Read the instructions on pages 1-9. Expiration Date: July 31, 2015 SECTION A- PROPERTY INFORMATION �C�,� IN�U��'� W� �i� i�AN�I' t��� ':_ A1. Building Owner's Name JAGGERS C. KEENE PdYii�ji NUf�i �f x�� .�3 r� 5'�} ��;, � �" � � k � Jfj2 t f �S � ' ± A2. Building 5treet Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. ��bri�pgl�jl ��(; NUI'nl��p � = f 1020 CHARLES STREET , ,;, > � ,_ � � ; ; , t. r 1 �;.�." t ,:P ,� .d, {i o:." , , L °���t City CLEARWATER, State FL ZIP Code 33755 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) 03-29-15-68094-001-0050 A4. Buiiding Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27deg. 59' 38.1" Long. 82deg. 4T 33.0" Horizontai 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 A , A8. For a building with a crawlspace or enclosure(s): . A9. For a building with an attached garage: a) 5quare footage of crawlspace or enclosure(s) � sq ft a) Square footage of attached garage g.�9 sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s) wfthin 1.0 foot above adjacent grade within 1.0 foot above edjacent grade � c) Total net area of flood openings in AB.b sq in c) Total net area of flood openings in A9.b -0- sq in d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes ❑ No , SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Communfty Name & CommunRy Number 82. County Name CLEARWATER / 125096 PINELLAS 84. Map/Panel Number B5. Suffix B6. FIRM Index Date 67. FIRM Panel 12103 C 0106 H &18-09 Effective/Revised Date 5-17-05 B3. State FLORIDA B8. Flood B9. Base Flood Elevation(s) (Zone Zone(s) AO, use base flood depth) AE 12' & 13' B10. Indicate the source of the Base Flood Elevation (BFE) data or base 800d depth entered in Item B9. ❑ FIS Proffle � FIRM ❑ Community Determined ❑ OthedSource: 611. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ OthedSource: B12. Is the buiiding located in a Coastal Barrier Resources System (CBRS) area or Othervvise Protected Area (OPA)? Designation Date: ❑ CBRS ❑ OPA �] Yes � No SECtION C- BUILDIN(3 ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings' � Building Under Construction* ❑ Finished Construotion *A new Elevation Certificate will be required when construction of the building is compiete. C2. Elevations - Zones A1-A30, AE, AH, A(wfth 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 buiiding diagram speciffed in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: CITY OF CLWR. BM # 1-OB Ve�tical Datum: 11.578' (NAVD'881 Indicate elevatlon datum used for the elevations in items a) through h) below. � NGVD 1929 � NAVD 1988 0 OthedSource: Datum used for building elevations must be the same as that used for the BFE. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) b) Top of the next higher floor c) Bottom of the lowest horizontal structurat member (V Zones onlyj d) Attached garage (top of slab) e) Lowest efevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) � Lowest adjacent (flnlshed) grade next to building (LAG) g) Highest adjacent (finished) grade next to building (HAG) h) lowest adjacent grade at Iowest elevation of deck or stairs, including structural support 6.6 7.6 �• 7.3 �•$ 5.� 7.6 �• Check the measurement used. � feet p meters � feet ❑ meters ❑ feet ❑ meters � feet ❑ meters � teet ❑ meters � feet ❑ meters � feet ❑ meters ❑ feet 0 meters 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 information. 1 ce�tify fhat the informaSon on this Ce�fincate represents my best efforfs to interpret the data available. I understand that any false statement may be punishable by �ine orimprisonment under 18 U,S. Code, Section 1001. � Check here if comments are provided on back of form. Were latitude and longftude in Section A provided by a. � � Check here if attachments. licensed land surveyor? � Yes ❑ No "`�� Certifier's Name LARRY L. EVANS Title LAND SURVEYOR Address 1460 BELTREES ; Signature � CompanyName STE. 9 j City DUNEDIN, Date 5-21-13 License Number PLS # 2937 EVANS LAND SURVEYING, INC. State FL ZIP Code 34698 Telephone (727) 7343821 ,�a �' 3,.� ,'.� y +� '�' t �� = �t :�, �. ; , Y� . � � ts .,s�' �k��o: s � � ', , �i s�.� �� ;� `�.�a3�>i°. . � r, �. ,; o-`''+ ' � ' T. "t _. _ _ tLtVA I IUN (:tK I ltl(:A 1 t, page � 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. 1020 CHARLES STREET City CLEARWATER, State FL ZIP Code 33755 SECTION D- 3URVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevetion Certlficate for (1) community official, (2) insurance agenUcompany, and (3} building owner. Comments C2.a): IS THE LOWEST FLOOR ELEVATION OF THE NEW AODITION. C2.b): IS THE LOWES7 FLOOR ELEVATION OF THE EXISTING HOUSE. C2.e): EXTERIOR A/C COMPRESSOR (FOR THE EXISTING HOUSE), ON GROUND LEVEL PAD. Signature Date 5-21-13 E-�UILDINCi ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A For Zones AO and A(without BFE), complete Items E1-E5. If the Certiflcate 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 tollowing and check the approprfate 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 ((ncluding 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 andlor 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 HAC3. 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 wfth the community's floodplain management ord(nance? ❑ Yes ❑ No ❑ Unknown. The local officfal must certify this information in Section G. _ 3ECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representatfve who completes Sections A, B, and E for Zone A(without a FEMA-issued or community-issued BFE) ar Zone AO must sign here. The statements in 5ectfons A, B, and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address Signature Comments Ctty Date SECTION O - COMMUNITY INFORMATION The local official who (s authorized by law or ordinance to administer the con of this Elevatfon Certitfcate. Complete the applicable ftem(s) and sign below. State Telephone ZIP Code Check here if attachments. 's floodplain menagemeM ordinance can complete Sections A, B, C(or E), a the measurement used in Items G8-G10. In Puerto Rico only, eMer meters. G1. ❑ The information in Section C was taken from other documentatfon that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation informatfon. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Sectlon 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-G10) is provided tor community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate Ot Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ SubstanNal Improvement G8. Elevation of as-built lowest floor (including basement) of the building: ❑ feet ❑ meters G9. BFE or (in Zone AO) depth of flooding at the building sfte: ❑ feet ❑ meters G10. Community's design flood elevation: ❑ feet ❑ meters Local Official's Name Community Name Signature Comments Title Telephone Date Datum Datum Datum ❑ Check here if attachments.