18675 US HWY 19 N #105 a
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` U.S`DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
Federal Emergency Management Agency �/Q� Expires March 31,2012
National Flood Insurance Program Important: Read the instructions on pages 1-9.
SECTION A-PROPERTY INFORMATION ��r�""'s,i��r�ce Cg�p�ny�4lse,.
A1. Building Owner's Name Peter K.Rempel 8 Alvina G.Rempel 1�0�) ���e��r,; ��.?''
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A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.NoJ or P.O.Route and Box No. `COr�i�B��I�IAIC~+'"IV�hfI�Q"F�"
18675 US Highway 19 North#105 ke
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Ciry Clearvwater State FL ZIP Code 33764
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Parcel ID#20-29-16-03290-000-1050
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential
A5. Latitude/Longitude:Lat. 7. 71 Long.-$2.726821 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 $
A8. For a building with a crawlspace or encl$sure(s): A9. For a building with an attached garage:
a) Square footage of c�awlspace or encl8sure(s) 1434 sq R a) Square footage of attached garage N/A sq ft
b) No.of permanent flood openings in the crawlspace or b) No.of permanent flood openings in the attached garage
enclosure(s)within 1.0 foot above adjacent grade � within 1.0 foot above adjacent grade N/A
c) Total net area of flood openings in A8.b 1�10 sq in c) Total net area of flood openings in A9.b N/A 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 B2.Counry Name 63.State
City of Clearwater 125096 Pinellas FL
B4.Map/Panel Number 65.Suffix 66.FIRM Index 67.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone
12103C0128 G Date Effective/Revised Date Zone(s) AO,use base flood depth)
8-18-09 9-3-03 AE 9'
B10. 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 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other(Describe)
612. Is the building located in a Coastal Barrier Resources System(CBRS)area or Othervvise Protected Area(OPA)? ❑ Yes � No
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 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,AWAO. Complete Items C2.a-h
below according to the building diagram specified in Item A7. Use the same datum as the BFE.
Benchmark Utilized C�TIDAL FLDTVertical Datum ELEV=9.48'(N.A.V.D.I
Conversion/Comments N/A
Check the measurement used.
a) Top of bottom floor(inGuding basement,crawlspace,or enclosure floor)6.9�3 �feet ❑meters(Puerto Rico only)
b) Top of the next higher floor �.,� �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) I�.A �feet ❑meters(Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building �.42 �feet ❑meters(Puerto Rico oniy)
(Describe type of equipment and location in Comments)
� Lowest adjacent(finished)grade next to building(LAG) f.� �feet ❑meters(Puerto Rico only)
g) Highest adjacent(finished)grade next to building(HAG) F.7 �feet ❑meters(Puerto Rico only)
h) Lowest adjacent grade at lowest elevation of deck or stairs,including N.A �feet ❑meters(Puerto Rico only)
structural support
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 that the information on this Certificate represents my best efforis to interpret the data available. �,��' ✓ "" �
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I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001. .� ��-,�" -
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� Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a " � , ' �_�,:����i' i �y�
licensed land surveyor? � Yes ❑ No _ : ,
_ € ,�� • :
Certifier's Name Philip C.Stock License Number RLS#3035 f t, :.' S?;3't'c'�Er � .��`
Tttle President Company Name Target Land Surveying,Inc. ��'•�',/.�.�`�`�''�`.
Address 516 Lakeside Place City Largo State FL ZIP Code 33771 �`������{'yy~
Signature - Date 7-7-11 Telephone (727)784-0573 � � _ -
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FEMA Form 81-31, Mar 09 See reverse side for continuation. Replaces all previous editions
.
IMPORTANT: In these spaces,copy the corresponding information from Section A. �" ` °' ��`�"'
� ������:
Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. �
18675 US HighWay 79 NOrth#105 "z
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Ciry Clearvvater State FL ZIP Code 33764 ���,�
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SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community official,(2)i�surance agenUcompany,and(3)building owner.
Comments "• ��;�r' '����� `K� '��s,
Job#110706.02. ,yr� e� �I�S/� ''r :x."
C.2.e)=A/C Unit,,,� •y ...• , •/� ,,
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Signature ' ,:; � ,�, �� ' � - Date 7-7-11
: � �,, .: ._.__
❑ Check here if attachments
SECTION��'B I�,I�EIrE�4T1 ITIFORMATION(SURVEY NOT REQUIRED)FOR 20NE AO AND ZONE A(WITHOUT BFE)
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For Zones Ap and�q,�vClthe���3F�E,�,;�or�plefe�lt�ms E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B,
and C. For Items E1 4,jys �r�a�t�rdl�fide,if�vailable. Check the measurement used. In Puerto Rico only,enter meters.
E 1. 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 enGosure)is ❑feet ❑meters ❑above or�below the HAG.
b)Top of bottom floor(inGuding basement,crawlspace,or enGosure)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 ages&9 of InsVuctions),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 o�cial must certlfy 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 OwnePs Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
❑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. Chedc the measurement used in Items G8 and G9.
G1.❑ The information in Section C was taken from other documentatlon 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 o�cial 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 G4G9)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
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 all previous editions
.
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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. Po�icy►vumber
j 18675 US Highway 19 North#105
t Clrty Clearwater State FL ZIP COde 33764 Comparry NAIC N�rriber �
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fIf using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to I
i 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.
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"Front View"—Pictures Taken 7-7-11
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Forinsurance Company Use: '
Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Pollcy tvumber
I 18675 US Highway 19 North#105 �
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Clty Clearwater State FL ZIP Code 33764 ComparryNAICN�rriber i
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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." ;'
�, "Right Side View"— Pictures Taken 7-7-11
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