1040 ELDORADO AVE . .. _ __ __
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U.S.DEP RTMENT OFIiOMELAND SECURITY ELEVATION CERTIFICATE OMB NO. 1660-0008
Federa�Emergency Management Agency Expires Februarv 28.2009
Nationai Fiut,Y irisurance Program Important: Read the instructions on pages 1-8.
SECTION A-PROPERTY INFORMATION For Insurance Canpany Use;; '
Building Owner's Name PHILIP SARRANTONIO&ROBIN FISHER Policy Number
A2. Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. Company NAIC Number
1040 ELDORADO AVENUE
City CLEARWATER State FL ZIP Code 33767
A3. Property Description(Lot and Block Numbers,Ta�c Parcel Number,Legal Description,etc.)
LOT 16,BLOCK 69,MANDALAY SUBDIVISION
A4. Building Use(e.g., Residential,Non-Residential,Addftion,Accessory,etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat.N 28.00334 Long.W 82.82633 Horizontal Datum: ❑NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of the building if the Certfficate is being used to obtain flood insurance.
A7. Building Diagram Number 6
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) 2730sq ft a) Square footage of attached garage N/A 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 0 walls within 1.0 foot above adjacent grade N/A
c) Total net area of flood openings in A8.b 0 sq in c) Total net area of flood openings in A9.b N/A sq in
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61.NFIP Community Name&Community Number B2.County Name B3.State
CITY OF CLEARWATER 125096 PINELLAS FL
B4. Map/Panel Number 65.Suffix B6.FIRM Index 67. FIRM Panel 68. Flood B9.Base Flood Elevation(s)(Zone
Date Effective/Revised Date Zone(s) AO,use base flood depth)
12103C 0064 G 5-17-05 9-3-03 VE 13
610. Indicate the souroe of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
❑ FIS Profile � FIRM ❑Communiry Detertnined ❑Other(Describe)
611. Indicate elevation datum used for BFE in Item B9: ❑NGVD 1929 � NAVD 1988 ❑Other(Describe)
� Is the building located in a Coastal Barrier Resources System(CBRS)area or Othervvise Protected Area(OPA)? ❑Yes �No
Designation Date NA ❑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-g
below according to the building diagram specified in Item A7.
Benchmark Utilized CLEARWATER BM J-02 Vertical Datum NAVD 88
Conversion/Comments NA
Check the measurement used.
a) Top of bottom floor(including basement,crawl space,or enclosure floor)_ 5.19 �feet ❑meters(Puerto Rico only)
b) Top of the next higher floor 17.06 �feet ❑meters(Puerto Rico only)
c) Bottom of the lowest horizontal structural member(V Zones only) 15.65 �feet ❑meters(Puerto Rico only)
d) Attached garage(top of slab) N.A �feet ❑meters(Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building N.A �feet ❑meters(Puerto Rico only)
(Describe rype of equipment in Comments)
f) Lowest adjacent(finished)grade(LAG) 4.81 �feet ❑meters(Puerto Rico only)
g) Highest adjacent(finished)grade(HAG) 6.44 �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 elevation
information. I certify thaf the information on this Certificate represenis my best efforts to interpret the data available.
�!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 form. -
Certifier's Name GEORGE A.SHIMP III License Number 6137 JOB#060599F � 4 � '
VICE PRESIDENT Company Name GEORGE A.SHIMP II&ASSOCIATES, INC.
Address 3301 DESOTO BLVD.SUITE D City PALM HARBOR State FL ZIP Code 34683 ��y^'�"7` � ��.�+-
i a re � p P � Date 11-28-07 Telephone 727-784-5496 ��'3� (�lZ�Jd /
�C /\
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. For Insurance Company Use:
Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. Policy Number ^
1040 ELDORADO AVENUE � < � �
City CLEARWATER State FL ZIP Code 33767 Company NAICNumber
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 NO COMMENTS
� �
Signatur Date 11-28-07
❑ Check here'rf attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REGIUIRED)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 foliowing and check the appropriate boxes to show whether the elevation is above or below the highest adjacent
grade(HAG)and the lowest adjacenf 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(inciuding 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 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 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 Ovmer's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
❑Check here if attachment:
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 applicab�e 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 communiry-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
Local Official's Name Title
Community Name Telephone
Signature Date
Comments •
❑Check here if attachment:
FEMA Form 81-31, February 2006 Replaces all previous edition:
, . , .
Building Photographs �
� See Instructions for Item A6. �
For Insurance Company Use:
Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Poiicy tvumber
1040 ELDORADO AVENUE
Clty CLEARWATER Stat@ FL ZIP COd@ 33767 CompanyNAlCNtmber
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 will fit on this page, use the Continuation Page,
following.
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11-27-07
, Building Photographs . � , _
Continuation Page
For Insurance Company Use:
Building Street Address(including Apt., Unit, Suite,and/or Bldg. No.)or P.O. Route and Box No. Poiicy►vumber
1040 ELDORADO AVENUE
Clty CLEARWATER State FL ZIP Code 33767 Company NAIC Ntunb�'
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all I
photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View."
___
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REAR VIEW
11-27-07
•
�.o. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE
Federal Fm@rg;�ncy f�:anagement Agency
National Fiood Insurance Program Important: Read the instructions on pages 1-8.
� �
� SECTION A - PROPERTY INFORMATION
A1. Building Owner's Name PHILIP SARRANTONIO & ROBIN FISHER
A2. Building Street Address (including Apt.. Unit. Suite. and/or Bidg. No.) or P.O. Route and Box No.
1040 ELDORADO AVENUE
City CLEARWATER State FL ZIP Code 33767
OMB No. 1660-0008
Expires Februarv 28. 2009
For Insurance Company Use:
Policy Number
Company NAIC Number
RADO AV
A3. Property Description ;Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) BCP2��6-06258
LOT 16, BLOCK 69, MANDALAY SUBDIVISION (05-29-15-54666-069-0160) ELEVATION CERT
A4. Building Use (e.g., Residential, Non-Residential. Addition. Accessory. etc.j RESIDENTIAL FISHER, ROBER/SARRANTONIO, PHI
A5. Latitude/Longitude: Lat. N 28.00334 Long. W 82.82633 Horizontal Datum: ❑ NAD 1927 � NAD 1983
A6. Attach at least 2 phot�graphs of the building if the Certificate is being used to obtain flood insurance. -
A7. Building Diagram Nurober 6.
A8. For a building with a crawl space or enclosure(s), provide A9. For a building with an attached garage, provide:
a) Square footage o� crawl space or enclosure(s) 1,877 sq ft a) Square footage of attached garage N/A 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) walis within 1.0 foot above adjacent grade 0 walis within 1.0 foot above adjacent grade N/A
c) Total net area of flood openings in AB.b 0 sq in c) Total net area of flood openings in A9.b N/A sq in
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
61. NFIP Community Narrre & Community Number B2. County Name B3. State
CITY OF CLEARWATER i25096 PINELLAS FL
B4. Map/Panel Number 65. Suffix 66. FIRM Index 67. FIRM Panel B8. Flood 69. Base Flood Elevation(s) (Zone
Date Effective/Revised Date Zone(s) AO, use base flood depth)
12103C 0064,. G 5-17-05 9-3-03 VE 13
610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 89.
❑ FIS Profile � FIRM ❑ Community Determined ❑ Other (Describe)
611. Indicate etevation da.tum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other (Describe)
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑Yes �No
Designation Date �1_A ❑ CBRS ❑ OPA
SECTION C- BUILDING ELEVATION INFORMATION (SURVEY RE�UIRED)
C1. Building eievations are based on: ❑ Construction Drawings' ❑ Building Under Construction� � Finished Construction
'A new Elevation Certificate will be required when construction of the buiiding 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.
Benchmark Utilized CLEARWATER BM J-02 Vertical Datum NAVD 88
Conversion/Comments NA '� �
a) Top of bottom floor (incfuding basement, crawl space, or enclosure floor)_
b) Top of the next higher floor
c) Bottom of the lovwest horizontal structural member (V Zones onl y)
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 ffinished) grade (LAG)
g) Highest adjacent (finished) grade (HAG)
� Check the measurement used. c�
�
5.19 � feet ❑ meters (Puerto Rico only) �``
17.19 � feet ❑ meters (Puerto Rico only) �.,�
15.65 � feet ❑ meters (Puerto Rico onl y) ��
N.A � feet ❑ meters (Puerto Rico only) ✓
17.03 � feet ❑ meters (Puerto Rico only) ��'/
4.55 � feet ❑ meters (Puerto Rico only)
6.44 � feet ❑ meters (Puerto Rico only)
SECTION D- SURVEYOR, ENGINEER, OR ARCHITE.CT CERTIFICATION
This certification is to be signed and seaied by a land surveyor. engineer, or architect authorized by law to certify elevation
information. ! certily that the information on this Certificate represents my best efforts to interpret the data available.
1 understand that any false statement may be punishable by fine or imprrsonment under 18 U.S. Code, Section 1001.
� Check here if comments are provided on back of form.
Certifier's Name GEORG�E A. SHIMP III Job No. 060599G �icense Number 6137 '
Title VICE PRESIDENT Company Name GEORGE A. SHIMP II & ASSOCIATES, INC.
Address 3301 DESOTO BLVD. SUITE D City PALM HARBOR State FL ZIP Code 34683
Uate 1-5-2009 Telephone 727-784-5496
ty �ibt1,#2j'
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��7�;�� � - �'Q� ' . .
FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions
IMPORTANT: In these spaces, copy the correspondi
Building Street Address (including Apt., Unit, Suite, and/or Bldg.
1040 ELDORADO AVENUE
City CLEARWATER State FL ZIP Code 33767
information from Section A.
1 or P.O. Route and Box No.
Forinsurance
Policy Number
Compa�y NAIC Number
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 C2.e) AIR CONDITIONER
A8) BOTTOM FLOOR IS ENCLOSED BY BREAK-AWAY WALLS
Use:
Signature" " Date 1-5-2009
� 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 0 below the HAG.
E5. Zone AO oniy: 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 siatemenis in Sections A, 8, and E are correci 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 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 bui�ding site: ❑ feet ❑ meters (PR) Datum
Local Official's Name
Community Name
Signature
Comments
Title
Telephone
Date
❑ Check here if attachments
FEMA Form 81-31, February 2006 Replaces all previous editions
�
. �' "
. Building Photographs
See Instructions for Item A6.
For Insurance Company Use:
Building Street Address (including Apt.. Unit. Suite, and/or Bldg. No.) or P.O. Route and Box No. Poiicy rvumber
�, 1040 ELDORADO AVENUE
I Clty CLEARWATER State FL ZIP Code 33767 CompanyNAlCNumber
I I
If using the Elevatior Certificate to obtain NFtP 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 "Lef? Side View.° If submitting more photographs than will fit on this page, use the Continuation Page,
, following.
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�uilding Photographs
Continuation Page
I Building Street Address (including Apt., Unit. Suite, and/or Bldg. No.) or P.O. Route and Box No.
� 1040 ELDORADO AVENUE
i
i Clty CLEARWATER State FL ZIP Code 33767
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For insurance Company Use: ��
Policy Number
NAIC Number
If submitting more photographs than will fit on the preceding page. affix the additional photographs below. Identify ali i
photographs with: date taken: "Front View" and "Rear View": and. if required. "Right Side View" and "Left Side View."
I
REAR VIEW
1-5-2009