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324 LEEWARD ISLAND"PAFtTMaNTOFHOMELANDSECURiTY ELEVATION CERTIFICATE FED AL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 Norro IFloodlnsuranceProgram important: Read the instructions on pages 1-9. Expiration Date: July 31, 2015 SECTION A- PROPERTY INFORMATION �� t' ���� A1. Building Owner's Name COPELAND , LUAN �� � A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. � � 324 IEEWARD ISLAND � , ,�r � >; � � , 4. ..��.'. .� v .". City CLEARWATER State FL ZIP Code 33767 � �� A3. Property Description (Lot and Biock Numbers, Tax Parcel Number, Legal Description, etc.) LOT 53 , UNIT 1, ISLAND ESTATES OF CLEARWATER A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27.58'S1" Long. 82.48'S3" Horizontal Datum: �] NAD 1927 � NAD 1983 A6. Attach at least 2 photographs of the building 'rf the Certificate is being used to obtain flood insurance:� A7. Building Diagram Number 1 A8. For a building with a crawispace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) sq ft a) Square footage of attached garage sq ft b) Number of permanent flood openings in the crawlspace b) Number of pertnanent flood openings in the attached garage or enclosure(s) within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade c) Total net area of flood openings in AB.b sq in c) Total net area of flood openings in A9.b sq in d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes ❑ No ' SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NFIP Community Name 8 Community Number B2. County Name CLEARWATER 125096 PINELLAS B4. Map/Panel Number 65. Suffix B6. FIF2M Index Date 87. FIRM Panel 12103C0102 G �-03-03 Effective/Revised Date 9-03-03 B3. State FLA B8. Flood I 69. Base Flood Elevation(s) (Zone Zone(s) AO, use base flood depth) AE 11.0 B10. Indicate the source of the Base Flood Elevation (8FE) data or base flood depth entered in Item B9. ❑ FIS Profile � FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ UtneNSource: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protecteu� �,rea (OPA)? ❑ Yes � No Designation Date: ❑ CBRS ❑ OPA SECTION C- BUILDING ELEVATION INFORMATION (SURVCY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings" ❑ Building Under Construction" � Finished Construction *A new Elevation Certificate wil� 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, AW�1-A30, AR/AH, AR/AO. Complete Items C2.a-h below according to the building diagram specified �n Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: CLEARWATER "G-04.5" Vertical Datum: NAVD'88 ELEV. 3.85 Indicate elevation datum used for the elevations in Items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) N/A. ❑ feet ❑ meters b) Top of the next higher floor 5.80 � feet ❑ meters c) Bottom of the fowest horizontal structural memL•er (V Zones only) N/A. �] feet ❑ meters d) Attached garage (top of slab) ❑ feet ❑ meters e) Lowest elevation of machinery or equipment senricing the building ❑ feet ❑ meters (Describe type of equipment and location in Cornments) � � Lowest adjacent (finished) g�ade next to building (LAG) 5.4 � feet ❑ meters g) Highest adjacent (finished) grade next to buildin3 (HAG) 5.6 ❑ feet ❑ meters h) Lowest adjacent grade at �owest elevation of de�;k or stairs, inctuding structural support N/A. _ ❑ feet ❑ meters SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CE?�TIFICATION This certification is to be signed and sealed by a land rurveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information on this Certif.;ate represents my best elforts to interpret the data available. I understand that any false sfatement may be punish�:�le by fine or imprisonment under 18 U. S. Code, Section 1001. � ❑ Check here if comments are provided on back of form. Were latitude and longitude in 5ection A orovided by a f'` • ,,, ❑ Check here if attachments. licensed land surveyor? � Yes � �� ❑ No � �� . . �v . � � `` 4 ' Certifier's Name WILLIAM C. KEATING `� "" `° .•- License Number 152E : r'_ � ;-. � -- �, rt�� .'y,', ��;i 4 �...}: r -:�. Title LAND SURVEYOR Company Name ALLIED SURVEYING .;� , _ < � �_ .� . Address 1275 . HiGHLAND AVE. City CLC:ARWATER State FL ZIP Code 33755 `�V 4�r �... ;� .- Signat Date 5-Q5-13 Telephone 727-446-12:.3 ,1 / a_ . ... �iv v v v •. Form 086-0-33 (7� See reverse side for continuation. Replaces all previous editions. ..... . _....... ._... _� r«n.. � .,..�� �i2TANT: In these spaces, copy the corresponding information from Section A. EdR INSURANCE COMPANY US� � Building Street Address (including Apt., Unit, Suite, anc'!or Bldg. No.) or P.O. Route and Box No. � PoliCy Number: 324 LEEWARd IS1.�and City CLEARWATER FLOR I D�,ate 3}I��9de Company NAIC Number. SECTION D— SURVEY.�R, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation C�rtificate for (1) corimunity officiai, (2) insurance agenUcompany, ana';:.) building owner. Comments Signature Date SECTION E- BUILDING El.EVATION INFG�2MATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE?, complete Items E'-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 availabi::. Check the measurement used. In Puerto Rico on�y, enter meters. E1. Provide elevation information for the following an�i check the appropriate boxes to show whether the �levation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAC). a) Top of bottom floor (includ:ng basement, craH lspace, or enclosure) is ❑ feet ;,_; meters ❑ above or [j below the HAG. b) Top of bottom floor (including basement, craw;space, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood'apenings 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 i:� ❑ feet ❑ meters ❑ above o�' � below the HAG. E3. Attached garage (top of slab) is .❑ feet ❑ meters ❑ above or ❑ below the NHG. E4. Top of piatform of machinery andlor equipment s::rvicing the building is ❑ feet ❑ meters ❑ above or � below the HAG. E5. Zone AO only: If no flood depth number is avail: .�le, is the top of the bottom floor elevated in accc-t+:�nce with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. Th�: local official must certify this information in Sectior. G. SECTION F- PROPER'Y OWNER (OR OWNER'S REPRESENTAT.''JE) CERTIFICATION The property owner or owner's authorized representati�e 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 Sectior.:a A, B, and E are correct to the best of my knowledgs. Property Owner's or Owner's Authorized Representati�. �:'s Name Address Signature Comments City Date State Telephone ZIP Code Check here if attachments. SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local offlcial who is authorized by law or ordinance to �dminister 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 '°.;ms G8-G10. In Puerto Rico only, enter meters. G1. ❑ The information in Section C was taken from ether documentation that has been signed and seale:f ny a licensed surveyor, engineer, or architect who is authorized by law to certify eievation inforrr�:ion. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official comFl�ted Section E for �.. building located in Zone A(without a FEMA-issu��! �r community-issued BFE) or Zone AO. G3. ❑ The foilowing information (Items G4-G10) is p;ovided for community floodplain management pu�poses. G4. Permit Number G5. Date Pe :it Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Cons!ruction ❑ Substantial Improvement G8. Elevation of as-built lowest floor (including baseme:;t) of the building: ❑ feet ❑ meters G9. BFE or (in Zone AO) depth of flooding at the buildi^.g site: G10. Community's design flood elevation: Local Official's Name Community Name Signature Comments _ ❑ feet ❑ �:�eters _ ❑ feet ❑ meters Title / Telephone Date Datum Datum Datum _. ❑ Check here if attachments. GG�AA Fnrm 11RR_!1_'2'� /7/171 Ranlaroe all nrcviniie criifinne �,�.. � • , � � ELEVATION�CERTIFI �:; �;����f"4�-�� �i�� •M.8.NO3067-0077 . ,A ��w t' ,�� '�� �� - pires May 31, 1993 , FEDERAL EMERGENCY MANAGEME 3 {���'�� �.;� � NATIONAL FLOOD INSURANCE P $ '1V� l. .���- C N710N: Use of this certlficate does not provide a waiver of the flood insurance sa�gyire�e�t.'���lform is u d only to ��je elevation information necessary to ensure complfance with applicable comm od��rrYm nagement ordi nc s, to datermine the proper insurance premfum rate,and/or to support a request for a Letter of Map Amendm��t#�qt�'ib��p or LOMR). Instructions for completing this to�m can be found o th f��p�ih�ag��'„.--:y:���-�� �9 :"'r.S i 16 Y SECTION A PROPERTY INFORMATION Ci9_,,:...:�= � FOk INSURANCE COMPANY USE BUILDING OWNER'S NAME POLICY NUMBER _ EzAirrE .vArr nYx STAEE7 ADORESS(indudinq Apt.,Unit,Suite and/or Bid9.NumCer)OR P.O.ROUTE ANO BOX NUMBER COMPANY NAIC NUMBER 324 LEEWARD ISLAND OTHER OESCRIPTION(Lot and Blodc Numbers,etc.) LOT 53, IINIT 1 , ISLAND ESTATES OF CLEARWATER CITY STATE ZIP COOE CLEARFTATBR FLORIDA SECTION 8 FLOOD INSURANCE RATE MAP(FiRM) INFORMATION Provide the following irom the proper FIRM (See Instructions): 1.COMMUNITY NUMBEA 2.PANEL NUMBER 3.SUFFIX �.DATE OF FIRM INpEX 5.FIRM ZONE 6.BASE F1.0O0 EIEVATION (in AO Zones,usa de�th) 125096 0007 "D" 08/19/95 "A—E" 11 .00 7. Indicate the elevation datum system used on the FIRM for Base Fiood Elevations (BFE): ❑NGVD'29 ❑Other(describe on back) 8. For Zones A or V,where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate �he community's BFE:l ( I I I I.L,J feet NGVO (or other FIRM datum—see Section B, Item 7), SECTION C BUILDING ELEVATION INFOAMATION � �ng the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best •�cribes the subject building's re(erence level . 2(a). FIRM Zones A1=A30,AE,AH,and A{wilh BFE). The top of the reference level ftoor from �ne seiected diagram �s ae an eievauon of L i I I �•I�151(eet NGVD (or other FIRM datum—see Section B, Item 7). (b). FIRM Zones V1.-V30, VE, and V(with BFE). The bottom of the lowest horizontal structural member of�he reference level from the selected diagram, is at an elevation of � � ,(..�feet NGVD (or other FIRM datum—sea Sectien B, Item 7). (c). FIRM Zone A(without 8FE). The floor used as the reference levet from the selected diagram is W.0 feet above❑ or below❑ (check one) the highest grade adjacent to the building. �FIRM Zone AO. The floor used as the reference level irom the selected diagram is (�.Ll feet above❑ or below Q(check one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor(reference level) elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown 3. indicace the elevatlon datum system usad in determining the above reference level elevations:� NGVD'29 ❑ Other(describe under Comments on Page 2), (NOTE: I!the elevation datum used in measunng the e/evations is difterent than that used on the FfRM (see Secllon B, Item 7J, lhen convert the e/evatlons to the datum system used on the FIRM and show the conversion equation under Comments on Page 2.) G. Elevation reference mark used appears on FIRM: (� Yes ❑No (See Instructions on Page 4) , 5. The reference level elevation is based on: � actual construction ❑ construction drawings (NOTE: Use ol construction drawrngs Is only valid il the bullding does not yet have the�eference/evel!loor in p/ace, in which case this certificate wi//on/y be va/id/or the building du�ing!he course o/construction. A post-construction Elevation Certi/icate will be�equrred once construction is complete.J o. The elevation of the lowest grade immediately adjacent to the building is:L!_�__�__6�_l: feet NGV� (or other FIRM datum•see Section B, Item 7). SECTION D COMMUNITY INFORMATION • ��e community official responsible for verifying building elevations specifies that the reference level indicated in S ti is not the "lowest floor"as defined in the community's floodplain management ordinance,the elevation of the buildin�$"lowest m 1 floor"as defined by the o�dinance is: I I I ( I �,U�feet NGVD(or other FIRM datum—see 3ection B, Item 7). � 2. Date ot the start of constructfon or substantlal fmprovement FEt�ta Fo�m 81.31�MAY 90 REPLACES ALl PREVIOUS EOITIONS SEE REVEASE SIOE FOR CONTINUATION � ' � ' � . . �SECTION.E. GERTIFICATION � �rn� certitication is to be signed by a I�nd surveyor, engineer,or architect who(s authorized by state or local law to certify elevation ation when the elevatfon information for Z�nes At—A30,AE,AH,A(with BFE),V1—V30;VE,and V(with BFE)is requi�ed. ,munity officiais who are authorized by local law or o�di�ance to provide fioodplain management intormation,may also sign the .:srtitication. In the case of Zones AO and A(without a FEMA or community(ssued BFE),a building official,a property owner,or an �wner's representative may also sign the certification. � Raierence Ievei diagrams 6,7 and 8-DisUnguishing Features—If the certitier is unable to ce�tfy to breakaway/non-breakaway wall, anciosure size, location of servicing equipment,area use,wall openings,or unfinished area Feature(s), then list the Feature(s)not �ncluded in the certification under Comments below. The diagram number,Section C, Item i, must stiil be entered. :cerrify that the inlo�mation in Sections B and C on this certificate represents my best efforts to interpret the data availab/e. . r understand that any lalse statement may be punishabla by�ne or imprisonment under i8 U.S. Code, Section 10Qi. �cFTIF1ER'S NAME LICENSE NUMBER(or AHix Seal) WILLIAM C. KEATING #1528 7iTLE COMPANY NAME REGISTERED LAND SURVEYOR ALLIED SURVEYING �ooRE» 212 4 U YDALE � ��n CLEARWATER �E 3���2 5 �;URE —" _ . �.s 05/12��T� P��`�3) 446-1263 i' :;opi�'s shou d be made of this C ifi a or: 1)community official,2j insurance agenUcompany,and 3)bulid(ng owner. COMMENTS: . . "'__ ""„',�,"'`�t.'� A Y\:�. . .�^f�''�• ?4y� • .�` ,� '� M1 ,Y��� ��;���'� �p�y R� ' . � �� n�:l --��-- ��`� ��,�•�?� �� — .._._ _.____ ._ , �. � �� ���� --- x. �: A 0._ '�?�a 3a� ����y - a�„ `x 5',"r.C'1.;v�',�' -- r'�;`��J,i^� �.,��•.,.i""�� . ,qi , � � �,.''',.r'"" ON WITH ON P4ES, SIAB BASEMENT PIERS,OR COIUMNS - A � A A V 20NES 20NES ZONES ZONES 20NES AEFEnEnCE • REfERENCE � � lEvEl �gE. IEVEL i1EFEilENCE - F100D LEVEI ELEVATIOH . � ' BASE , Tj'•,Y f�i�} . :':..:}. . iM1�%.}'it,i . �, F1000 �••i•>••`•• ,ADJACFJiT �: REfE11WC8 ' � 1000 EIEV�Tpn q�gq�,E �py�ENt ��E ��� EIEV�T1pN LEVEL GMDE , � • A .H :i.{�Ci. :.`:t.i'.i:+:!:.. • ,;.:�:!:} ' ;,�: �.:... :^n: i:r.;: ; .., ._..'.::>,::.;: �i::� ,:1�:1. 1`�'r:�OJnCENT:: � .'!�'��.�'�'� . . . .:si:;IJ/�I?•;.;: CMOE •The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones. �levations tor all A Zones should be measured at the top of the reference level floor. � Elevations tor all V Zones should be measured at ihe bottom of the lowest horizontal structural member. , . . � Page 2