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1447 JEFFORDS ST . _ �,3 • �-`� • P �` 2�o t Co '�b C� � � i� `�' T�i - , U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Expires March 31,2012 Federal Emergency Management Agency � National Flood insurance Program lmportant: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION For Insurance Compahy Use: A1. Building Owner's Name Selim Dija 'PoNey Number A2. Building Street Address(induding Apt.,Unit,Suite,and/or Bidg.No.)or P.O.Route and Box Na Company NAIC Number 1447 jeffords Street C�tY Clearwater State FL Z�P��e 33756 1447 J E F F O RDS ST A3. Property Description(Lot and Blodc Numbers,Tau Parcei Number,Legal Description,etc.) BCP2009-05324 Lot 135,Forrest Hill Estates Und 4 A4. Building Use(e.g.,Residential,Non-Residentiai,Addition,Accessory,etc.)residential addition A5. Latitude/Longitude:Lat.27-57-11 Long.82-4 37 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 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enGosure(s) n/a sq ft a) Square faotage of attached garage 275 sq ft b) No.of permanent flood openings in the crawlspace or b) No.of permanent flood openin�s m the attached gar,age enclosure(s)within 1.0 foot above adjacent grade n/a within 1.0 foot above adjacenf grade ` Na c) Total net area of flood openings in AS.b n/a sq in c) Totaf net area of flood openings it�Ag:b Na sq m d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? -- ` ❑ Yes � No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name 8�Commu�ity Number B2.County Name B3.State City of Clearwater/125096 Pinellas FL 64.Map/Panel Number B5.Suffix 66.FIRM Index B7.FIRM Panel B8.Flood B9:�Basb�lood Elevation(s)(Zone 12103C C Date Effedive/Revised Date Zone(s) AO,u9e base flood d &18-09 5-17-05 AE 28.5� 810. 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 � NAW 1988 ❑ Other(Describe) B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Othervvise Protected Area(OPA)? ❑ Yes � o� �' 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 Elevatio�Certificate wi�l 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,ARJA,AR/AE,ARlA1-A30,AR/AH,ARlAO. Complet�,�e Items�g�'�Y below according to the building diagram specfied in Item A7. Use the same datum as the BFE. � ���;;� Benchmarlc Utilized Breeze-A Verticaf Datum NAVD 1988 � t�.�_._l•-_` Conversion/Comments r a �m � Check the measurement used. :=-#� � a) Top of bottom floor(including basement,crawlspace,or enclosure Noor)27.�, �feet ❑meters(Puerto Rico only) r r��:- �. a � � b) Top of the next higher floor n/a. ❑feet ❑meters(Puerto Rico only) �r.�3 ;�.__ � � ��-� ��- c} Bottom of the lowest horizontal structural member(V Zones only) /�a. ❑feet ❑meters(Puerto Rico only) j�;; i; ; „� � `� d) Attached garage(top of slab) 27.2 �feet ❑meters(Puerto Rico only) ;� � �y �;.., �, e) Lowest elevation of machinery o�equipment servicing the building 27.4 �feet ❑meters(Puerto Rico only) i�._; <= � � (Describe type of equipment and location in Comments) -' �� r-�t � Lowest adjacent(finished)grade next to buiWing(LAG) 26.4 �feet ❑meters(Puerto Rico only) ':.��: n ��• ��° -�-r ._. g) Highest adjacent(finished)grade next to building(HAG) 27.3 �feet ❑meters(Puerto Rico only) ° :,�y,�1T1 rt��,r h) �owest adjacent grade at lowest elevation of dedc or stairs,including n�. ❑feet ❑meters(Puerto Rico only) .��•'J`'D,�.�_`M Jn-rrq��� strudural su ort , SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION ` " �� C�`,�,, .. '> �� • .,- � - This certification is to be signed and seated by a land surveyor,engineer,or archited authorized by law to certify elevation , � : information. !certify that the information on this Certi�rcete represents my best etforfs to i�rte�pnet the data availab/e. _ ' , �, "o � := I understand that any fa/se statement may be punishabJe by fine or imprisonment under 18 U.S. Code,Section 9001. , ,. � u� � ../ ° `J s J �. � Check here if comments are provided on badc ofform. Were latitude and longitude in Section A provided by a �.�aJ�o. ,o , licensed land surveyor? � Yes ❑ No �'�'� �� �. �e` ,,,�+:�)�`j `����,� Certfiers Name Alex Thompson,Jr. License Number 5318 ��(��i9����U�� '� .�s Title Professional Surveyor Company Name Extreme Surveying of Florida,Inc. Address 29340 lace ity Wesley Chapel State FL ZIP Code 33545 Signature ' Date Telephone 813-973-2092 � 9-9-0 FEMA Form 81-31,Mar 09 See reverse side for continuation. Replaces all previous editions ... �+. Y`r .• �; y .., , y. �_` r�ti _ ._ __. .__. . _ . . - . _ _ _ . ♦ , �. + ♦ � • �'y � . � . +• `�� �.,' . 7 . r ' ♦ �. � �..! .. , � IMPORTANT: In fhese spaces,copy the corresponding information from Section A. For fnsurance Company Use: Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. Policy Number 1447 Jeffords Street City Clearvvater State FL ZIP Code 33756 Company 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 lowest machinery is a/c pad. .� Signature 1� � DateQ t ` � `�� ❑ Check here if attachments SECTION E-BUILDING ELEV FORMATIOPt(SURVEY NOT REQUIRfD)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),aomplete ftems 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 availabte. Chedc 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 enGosure)is �feet ❑meters ❑above or❑ below the LAG. E2. For Building Diagrams 6-9 with pem►aneM flood openings provided in Section A Items 8 and/or 9(see pages&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 otficial must certify this information in Sedion G. ` SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION .�hg prqpRrty owner or owners authorized representative who completes Sections A,B,and E for Zone A(without a FEMA-issued or community-issued BFE) o��one.A�must sign here. The statemenfs in Sections A,B,and E are co�ct to the best of my knowledge. Propert�C7wne�s or Owner's Authonzed Representatroe's Name EM�me Surveying of Florida,Inc. Address 29340 Rhodin Place City Wesley Chapel State FL ZIP Code 33545 Signature r, Date �4�r� Telephone 813-973-2092 Commen ❑Chedc 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 inforrnation. (Indicate the source and date of the elevation data in the Comments area betow.) 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(inGuding 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 �Check here if attachments FEMA Form 81-31,Mar 09 Replaces al!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 Number 1447 Jeffords Street Clty Clearwater State FL ZIP COd2 33756 Company NAIC Number 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 on the reverse. ,�:'"`�, � � a� L - � ���' -.-� � """ �. - .,...� 4.., �.:, . .. �- � C ' �=' r \ .__ * i e �� 3'� I F � ._��� .�. \ - i r ,.... • .: +I . ..,�. . . f. . � .... , ... -Y+¢.-.--. ; � .. �. ., .� �' ., . A �. + ._. � ...y� �� .., w::. "�' ';.: �»——. , � — � ,_ „ .:� �-�':-�. Front View . , ,� / .,'.�'"s.:'� i � _ �`�.-..�;,- !s � . ,s.. .. . �...�.. ,.,. � � ' ....... � . �. ��� � � � � i � ��-�— '' ��� :" ,���� __ � ,,,,�, y _ � _.,_ ��.��.--.�,:,��__::: -��. i ; r'.°�°� -----� -----`—`.t:.. �t _v� ,— > A �i �� '" " �i�'�,t:t��-_..�.;,;,,.�-^-----^�--,+,�,�+�-.^. . .�.q P��,.r" i'7� .__ , ;,,� - - . , �� _� ,h „ .. ...�.__=� �4 . 1 i': � `�•iL .�� — ..,- � ,,, Rear View