761 ISLAND WAY li.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
Exoires Februarv 28.200�
Fede'Fal Emergency Management Agency }
��- National Flood Insurance Program Important: Read the instructions on pages 1-8. Q
SECTION A-PROPERTY INFORMATION For Insurance Company Use: � M
A1. Buildin�'Owner's Name Policy Number �'''�
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A2. Building Street Address(including Apt.,Unit,Suite,and/or Bidg.No.)or P.O.Route and Box No. Company NAIC Number Z O
761 ISLAND WAY.. Q �
City CLEARWATER State FL ZIP Code 33767 � �
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) � �
LOT 28 UNIT 8 ISLAND ESTATES OF CLEARWATER � �- � s��-1 � w a,
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A4. Building Use(e.g.,Residential,Non-Residentiai,Addition,Accessory,etc.) RES�DENTIAL � m
A 5. L a ti tude/Lon gitude:Lat.27 59'32"" Lon g.82 49'13"" 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
A�i. 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 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 walls within 1.0 foot above adjacent 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
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61.NFIP Community Name&Community Number B2.County Name 63.State
CLEARWATER 125096 PINELLAS FIORIDA
B4.MaplPanel Number 65.Suffix 66.FIRM Index B7.FIRM Panel 68.Flood 69.Base Flood Elevation(s)(Zone
Date Effective/Revised Date Zone(s) AO,use base flood depth)
12103C0102 G 9-03-03 9-03-03 AE 12.0/11,0
610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69.
Q FIS Profile �FIRM ❑Community Determined ❑Other(Describe)
611. Indicate elevation datum used for BFE in Item B9: ❑NGVD 1929 �NAVD 1988 ❑Other(Describe)
612. Is the building located in a Coastal Barcier Resources System(CBRS)area or Othervvise Protected Area(OPA)? ❑Yes �No
Designation Date ❑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�tems C2.a
below according to the building diagram spec�ed in Item A7. �
Benchmark Utilized CLEARWATER G-03.5""' Vertical Datum NAVD'88"`ELEV.7.42 �a W
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Conversion/Comments a�
Check the measurement used. ��.; 0 3
a) Top of bottom floor(inctuding basement,crawl space,or enclosure floor)_ 10.87 �feet ❑meters(Puerto Rico only) u �Q
b) Top of the next higher floor N/A. �feet ❑meters(Puerto Ftico only) c� ��
c) Bottom of the lowest horizontal structural member(V Zones only) N/A. ❑feet ❑meters(Puerto Rico only) �°°� �V
d) Attached garage(top of s�ab) .7.78 �feet ❑meters(Puerto Rico only) � �u-
e) Lowest elevation of machinery or equipment servicing the building �feet ❑meters(Puerto Ri ) � Z�
(Describe type of equipment in Comments) Z�
� Lowest adjacent(finished)grade(LAG) 7.4 �feet ❑meters(Puerto Rico only) ^�.-.-� �V
g) Highest adjacent(finished)grade(HAG) 8.8 �feet ❑meters(Puerto Rico only) � Ql •� a
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 certify that the information on this Certificate represents my best efforts to interp►et the data available. ,,;;:,_
I understand thet any false stetement may be punishable by fine or impnsonmerrt under 18 U.S. Code, Section 1001. ' � -; _ `'
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❑ Check here if comments are provided on back of form. '�J�'� •� �i ` ,`-
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Certifier's Name WILUAM G KEATING License Number LS#1528 �>�t� `�? ' r`-^: =
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Title LAND SURVEYOR AND MAPPER Company Name ALLIED SURVEYING ! � dc* � A�� £ :`a =
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Address�NO HIGHLAND AVENUE City CLEARWATER State FL ZIP Code 33755 ....
Signature Date 5-27-09 Telephone 727-446-1263 ���``=}
� Buiiding Phatographs �
' See Instructions for Item':A6. _ .
• For insurance�ompany.Use:
Building Street Address��inGuding Apt,Unit„�u'rt�,anci/or Bidg.No.)or P.O.Route and Boc No. Poticy;ntumbe�. .� °
761 ISLAND WAY . '
Cj{�/ gtate FL ZIP COdB Contpa�tY NAIG Number
Clearwater Florida 33767 �
If using the Elevation Certificate to obtai� NFIP flood insurance, affix at least iwo �•uilding photographs below according bo
�the instructions for It�m A6. Identify all phptographs with: date taken; °Front View" i.ynd "Rear View"; and, if required, "Right.
Side View" and "Le�ft Side Visw." If $u4miEting more photographs than will fit or, this page, use the Gontinuation Page,
following.
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PLANNING & DEVEI.OP..MENt
. CITY OF CLEARWATER
PIC'�URES TAI�N: �Y 2 7 , 2 0 0 9