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18675 US HWY 19 N #216 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 „ '' `,,, �er A1. Building Owner's Name Danny J.Williamson 8 Joyce C.Williamson �� �° ; n:9, �.e A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. F �ly^' � 'NC�11il3tlf` " 18675 US Highway 19 North#216 City Clearwater State FL ZIP Code 33764 � � A3. Property Description(Lot and Blodc Numbers,Tax Parcel Number,Legal DescripNon,etc.) Parcel�D#:20-29-16-03290-000-2160 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential A5. Latitude/Longitude:Lat.27.943642 Long.-82.728171 Horizontal Datum: ❑ NAD 1927 � NAD 1983 A6. Attach at least 2 photographs of the building if the Certiflcate is being used to obtain flood insurance. A7. Building Diagram Number $ 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) 13�2 sq ft a) Square footage of attached garage N/A sq ft b) No.of permanent flood openings in the crawlspace or b) No.of pertnanent flood openings in the attached garage enclosure(s)within 1.0 foot above adjacent grade 14 within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in AB.b �4 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 Community Name&Community Number 62.County Name B3.State City of Clearvvater 125096 Pinellas FL B4.Map/Panel Number B5.Suffix B6.FIRM Index 67.FIRM Panel 68.Flood B9.Base Flood Elevation(s)(Zone 12103C0128 G Date EffecNve/Revised Date Zone(s) AO,use base flood depth) 8-18-09 9-3-03 AE 9' 610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile � FIRM ❑ Community Determined ❑ Other(Describe) 811. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other(Describe) B12. Is the building located in a Coastal BaMer Resources System(CBRS)area or Othervvise Protected Area(OPA)? ❑ Yes � No Designation Date N/A ❑ CBRS ❑ OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY RECIUIRED) C1. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' � Finished Construction 'A new Elevation Cerdficate wfll 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 Utflized G TIDAL FL DNertical Datum ELEV=9.48'(N.A.V.D.I Conversion/Comments N/A Check the measurement used. a) Top of bottom floor(including basement,crawlspace,or enclosure floor)�.41 �feet ❑meters(Puerto Rico only) b) Top of the next higher floor IV.A �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 slab) IV.A �feet ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 9.1,� �feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Comments) � Lowest adjacent(finished)grade next to building(LAG) �.7 �feet ❑meters�Puerto Rico on�y) g) Highest adjacent(finished)grade ne�ct to building(HAG) ¢.,� �feet ❑meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs,including IV.A �feet ❑meters(Puerto Rico only) struCtural support - � SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION ,��� ' ' � 1'`� � .J . This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation ` infortnation. I certily that the informallon on thJs Ceril/kate represents my best efforts to inteipret the data available. .',`�'.••"';M ';`^/ ',� I understand that any false statement may be punlshable by�ine or impr/sonment under 18 U.S.Code,Sectlon 1001. � ':.!���;•'�.`����'�'r`�, : k,:' . ,, - � Check here if comments are provided on back of fortn. Were latitude and longitude in Sectfon A provided by a ,' � �+a,j��r, licensed land surveyor? � Yes ❑ No ~ `° � • "` i w� `;;- Certifier's Name PhiNp C.Stodc License Number RLS#3035 " '1 �'•. - �-��i��r m«js ^ . �•, �;. ."� ;� P Y r9 Yi 9 � 'c.,j�.1��,��'�,� Title President Com an Name Ta et Land Surve n ,Inc. , . ,,.. � l"�':�f���b'�Y!!i�"c,��'/ Address 516 Lakeside Place City Largo State FL ZIP Code 33771 �,j��� 1 1�' •, ..:° - Signature� • _. � � �� _..., Date 12-9-11 Telephone (727)784-0573 ' ''E'_� FEMA Form 81- 1, Mar 09 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces,copy the corresponding information from Section A. .�� Building Sheet Address(including Apt..Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. ` 18675 US Highway 19 North#216 � '�"'� n ,�"� ������ City Clearwater State FL ZIP Code 33764 ,�,�, x,�� �''. ��; �. SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner. Comments Job#111208.03 C.2.e)=A/C Unit '`��`a �'t t d'�'� 5( ��,` �, �'!!l� '�'� .. � , /,;.s . ,. �. `` _+' ti r Signature ' r •,'' � ;�;•, y:' ' �" Date 12-9-11 ' ' .' �����, ❑ Chedc here if attachments S��C"['10����L[�j1�,6�ELm Y�TlbN INFORMATION(SURVEY NOT RECIUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zone�'Af,��ad',,4 tltt��lt BFE}��omp(�lte It�s E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B, and C. For It�rri�;�i=��use natdFal��;-if BVailable. Check the measurement used. In Puerto Rico only,enter meters. E 1. Provide elefv�d�r+i�f � t�pti f ��ollowing and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HA�)�lnd�`e�;ati��ent grade(LAG). a)Top of:bot�om'�flc�or�(inclwding k5asement,crawlspace,or endosure)is ❑feet ❑meters ❑above or�below the HAG. b)Top of bottom,floor(9�'clading'�a�5ement,crawlspace,or endosure)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&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 buiiding 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 certity this infortnaHon in Sectlon 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 communiry-issued BFE) or Zone AO must sign here. The statements ln Sections A,B,and E are carect 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 INFORMA�ION(OPTIONAL) The local official who is authorized by law or ordinance to administer the oommunity'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. Chedc the measurement used in Items GS and G9. G1.❑ The infortnatlon in Section C was taken from other documentaUon that has been signed and sealed by a licensed surveyor,engineer,or architect who is authorized by law to certify elevation infortnation. (Indicate the source and date of the elevation daNa 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 Pertnit Issued G6. Date CeKificate Of Compliance/Occupancy Issued � � G7. This permit has been issued for: ❑New Construction ❑Substantfal 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.Communiry'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 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. Poucy Number , ��.. 18675 US Highway 19 North#216 ( ' I Clty Clearvvater State FL ZIP Code 33764 Canperry NAIC Number � — _ _ _ .__ _ _: jIf 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 i j reverse. "Front View"—Pictures Taken 12-9-11 ; � _ , ���., , "r�r¢� y � ',� ]' '>� f�� �� � � X +z�+�t:. _,_r_--� i ��a ��'"�� �vt` s�` �.�- -''`�� - __ _. w��� „�, _ . „ _'f� �� k w, _ ,:. . _ �� �� � � _ � ��� �� � ��� �� �-� � �,� !� � � � � � � .�` �_ _ __ _ �� __ , , _ �� I . _ �ilt��, �ill I � � . .. �, .� �I �. __aT_ _s n. �.r. - � �--� --�i.Q��r., . , . � ., n ,s �� �.� �. , ,, �-�--.-�, . . �:—�--- "RP�r�iiQw" - IPictures Taken 12-�-11 � _;� Building Photographs Continuation Page For Insurance Company Use� i Building Street Address(including Apt., Unit,Suite, and/or Bldg. No.)or P.O. Route and Box No. Po�icy tvumber � , 18675 US Highway 19 North#216 � City Clearvvater State F� ZIP Code 33�sa C«nPer�ywuCNumt� , ; ; If submitting more 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." "Right Side View"—Pictures Taken 12-9-11 I��"� , , „ �� ,_ �. �� �".� ` � ,} `. i . �' r� ; ; �� �i �; � ',I '; ���� ' '�� �»,'.• ��,. � .w,�,�. •,� i ;..; .. :.,_ .. � ...... ..,.. � .,..,,.� � � .d � •�r. � ,y, g .,.., �� ... _ .��� .. •' � .. . ` '_�'�'k.�.. "Left Side View" — Pictures Taken 12-9-11 ��,�„� � ����I � ,k��� +�:n, . �:,,, -. . �,_.` A`�'"� r "�,°'"�,�,. �_"'.;,:,-===--�_��_, �- .„,"�----�---�'�_ ...«..�, _ - i „,�, ,,. _. _:� - � : �'"",,� � �i'"� . � w> � w�,� _. x��.,s. � µr...,.e ... �,..�.�?r��� �:vM'� P Y �m:^ �Art".,w'°��. " .�r r.���.,� �.- , ,„�,�i'. «� ,. �, w� .�,r ,�,,,«.K'°'°� ,j i ��:{� yx�r�r� ��������4 ��,,��' �c��� � IT'Y OF CLEARWA. TER a�'a*.���. �,,. ;csh�-^ : �,Q� Pwv,�nvc&DEVELOry�vr DFP�RrraErrr .r"^*�o _ �� Posz�OF�cs Box 474f3,Ci:�zw;��-EU,FLOizlnn 33758-47�8 ����v ���4 MLTNI�fPe�L Sh1t�'FCES BUILT�ING, IQO SOUTH MYR'CE.E 1�VENUE,CLE4R��'A"CER,FLORIDA 3375G '�'�Tr'���r� T��rxorr�(72��62-4>67 Fa,�t(7�7)562-4.576 5ite Address: 1=86T5 llS H'IGHVIIAY 19 N 216 PERMJT#BCP2011-10306 PARCEL N�.: 20>29-16-03290-000 2160 10/31/��'61UED: • -� •- � . ..:. ., '' FLMEG IHt025291 _ ACKIE PETERSON PcMEC N�A DANNY J WILLIAMSON 0 BOX 2281 xo� Po�K coutvn 18675 l�S HiGHWAY 19 AGLE LADE, FL 33839 CLEARWATER, FL 33764 '4 32824'k 12 7275355262 Permit:, �lew Mobile Home'� Cost: $3;500.00, Proposed Use: Mabile Horne � Pf�,QJ��CT DAN�Y W.�ILLfAM,S'ON PR'Q;,���T`DES�R�IPTION:, MQkBIEE`HOM:E R�EPLAGEMENT: BLAG�MENT ONLY: ` � � � 'WILL PROViDE ELE�/ATION CE�1'IF►Ga�f�VER�I�YING:PLACEMENT., � y �,;Y. ,� ,�„� �,��: , y OF�MOBILE FtOM�E AT 36"ABOVE,ADaACEN'T GRAD.E,,: , , ��..x�� �,� ��, � � � �. ������� z � �., Fees��n�c,,lude , � _ �u,���i�'9� �5�� Plurnb'in.g- .,a Roof �I,earin,g &Grubbing: °,� �. � � �� . -� t , ,�, , � . _ � � _ D , � � � . � . �. s� : Clectric �,;3 Me.�hani;ca-I .a Ga's '... ._ ..,:._ _ ; k`, _ N'OTICE BEFOREYEXCAVATING NOTIFY THE"CALL.Sl1NSHINE"NOT4FICATION CENTER A �n°` , �.� � PLEA��N4TE � � , , �'� � • 1),fF RUTHORt��ED�W�RK IS;SUSPENDED QR ABANDONED FOR A PERIOD OF SIX M C;�x F,�' ' M�R� Wl�Fhf�N;O SUC��ESSF.UL INSFECT,IONS,THE.PERMIT SHALL BECQME INVALID.�� � W� � � � �� PERJu11T FEES-ftAxl�'S�f'r��P�I�BEFORE W,OF�K CAN��R��SUM��E. � , �� � � a,..,. � � �z ° O � 2)�N�„Q:TIEE IN ADDIThQ�N,�TO THE REQUIREMENTS OF THIS PERMIT,THERE MAY BE A �? � � \� � � -' FZ�STRICTIONS�RPPk}G�ABLE TO THIS PROPERTY THAT MAY BE FOUND�kN THE.PUB�� � � � �, p��r OF`PINELLAS COUN`TY THE�E MAY- BE ADDITIONAL PERMITS REQUIRED FROM.OT p �OV�RNME�ITAL EN'�ITI.E�S.� � � g � x O� � � 3)REUI�WER PLANS MffiY"CONTAIN ADDITCONAL,I�NFORMf�TiON PERTAINING TO`PE; � @ � � � CONDITI�NS` � � �, 4)PERMIT AND PERMPTTED:PLANS SHALL BE POSTED ON THE JOB SITE IN A LOCA � y �- AND�ACCES�SIBLE T,Q,THE�INSPECTOR. � � �� � i o � � • � �� � � 5)APPLICANT.OR�CONTRACTOR IS'REQUJRED TO REQUEST INSPECTIONS IN A TIM� g �' � � r��� � g n.�N 6)CALL IN PROPER CODE FOR(ALL)FIRE INSPECTIONS, � oo W W � o=�' 0o cn c� �" ❑3� WRRN�NhG TO OYNNER: YOUR FAILURE TO RECORD A N � °°�'� � O�oNN �O`�fl#I�IIGENCvEM��N�T MeAY RES�ULT IN''YOU`R PAYING TWI.0 - If �,��R`�;��EI�I��N���$ '�Q�-YO�F,J�R P RO P ERTY. I F YO U I N.TE`N�D TO�Q����� - �?I`N�A�N�C`I=_` G,�,C�xOa� S¢[JkL�'W I'TH YO U R L E N�D�E R O R A N ATTC�R$NcEI��x �� B€E�`��2E f�E���,�,I�E��NrG YOU�R NOTICE OF COMMEN-CEME.�1.T: 'PERMIT-TO BE POSTED Q'N JOB SITE � Prin-t�ate: 10/�1r(201�1� ' � �� 1�� � ��� � � B�ilding�PerwnhtPlacard�� � � � "EQu�L E�irtiorri��r-n�rn��ci���rn��cTTON ENtrL�YEx"