31 WINDWARD IS �� ' ��• � OMB No. 1660-0008
U.S.DEP�t;MENTOF HOMEIAND SECURITY ELEVATION CERTIFICATE ��res March 31,2012
Fede�,Emergency Managemer�t Agency
National Flood Insurance Propram Important: Read the instructions on pages 1-9.
SECTION A-PROPERTY INFORMATION Fq'�rl�t���WwAY�°��'�m� '°-�'
A1. Building Ownsr�Name Georye J.Tarsitano 8 Donna J.Tarsitano �� {� �,��<;
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A2. B,�uyild�.i.n.�g S,wtreet Address(induding Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. y }a�;�
3�W�IIVAIY'SIO� � ��-x % eG9�`� � �124f �F�v;r 1 i
Cit�r Clearwater State FL ZIP Code 33767
A3. Property Deacription(Lot and Bbdc Numbe�s,Tax Paroel Number,lspal Oescriptfon,etc.)
Lot 23 and N.40'of Lot 22,Island Estates of Cbarwater,Unit 4,Plat Book 51,Paga 32,ParGel ID a1►08-29-15-43362-000-0230
A4. Buliding Use(e.g.,RasideMial,Non-ResidenUal,AddiGon,Rooessory,atc.)$esidentia(
p5. LatltudslLpn�itude:Lat.Zj 58'28.31"N Lony.�2 48'38.31"W Horizontal Datum: ❑ NAD 1927 � NAD 1983
A8. Attach at bast 2 photopraphs of the building iF tho CeniHcate is bein�used to obtain flood insuranos.
A7. Buildinp Diagram Number $
A8. For e buiidin�with a crewlspace or encbsure(s): A9. For a building with an attached garaye:
a) Squaro footage of crawlspace or endosure(s) � ,.sq ft a) Square footape of attached garage §,�Q sq R
b) No.of pertnaner�t flood openinps in the cxawlspaoe or b) No.of permanent flood openinfls in the attsched garaye
•ndosuro(s)within 1.0 foot above adjacsnt grade ,� within 1.0 foot above adjacant grade Q
c) Total net Area of flood openings in AB.b $,� sq in c) Total net area of flood openinps in A9.b Q sq in
d) Enyineered flood openings4 ❑ Yes � No d) Enpineered flood opeaings� ❑ Yes � No
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SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORAAATION
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B1.NFIP Communfty Name 8�Community Number B2.CouMy Name 63.State
City of Clearwetar 125096 Pinellas FL
84.Map/Panel Number B5.Suifnc B6.FIRM Index B7.FIRM Panel 68.Flood B9.Base Flood Elevation(s)(Zone
12103C0106 H Date Effedive/Rsvised Date Zone(s) AO,use base flood de{rth)
8N 8/09 5/17/05 AE 11'8�12'
B10. Indicate the source of the Base Flood Ebvation(BFE)data or base flood depth eM�ered in Item B9.
❑ FIS Profile � FIRM ❑ Community Determined ❑ Other(Descxibe)�
811. Indicate ebvadon datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other(Descxibe)�
612. Is the buildinp located in a Coastal Banier ResourGes System(CBRS)area or Otherwise Proteded Area(OPA)? ❑ Yes � No
Desipnaaon Date � � CBRS ❑ OPA
8ECTION C-BUILDING ELEVATION INFORMATION(SURVEY REGUIRED)
C1. Bullding ebvationa are based on: ❑ Construdion Drawinpa• ❑ Buiidinp Unde�Construdion• � Finishsd Construdion
'A new Elevation Certif�ate will be required when oonstrucdon of ths buildinq 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. Complets Itema C2.a-h
below acxordl�p to the building dia9ram specified in Item A7. Usa the sams datum as the BFE.
Benchmark Utilized NGS$72 6724 A Vertical Datum NAVD-1988
ConversbNComments PID alkkAG7196
Chedc the measurement uaed.
a) Top of boaom floor(induding basemeM,crawlspace,or enGosure floor)g.� �feet ❑meters(Puerto Rk:o ony)
b� Top of the next hiyher floor y�. �reec p meters(Puerto Rioo ony)
c) Bottom of the lowest horizontal swctural member N Zor�ony) �. �teet ❑metera(Puerto Rioo ony)
d) Attached yarsi�e(top of slab) . �.� �feet ❑meters(PueRo Rico only)
e) Lowest elevation of machinory or equipment serviciny the buildfnq �.4 �feet ❑mebers(Puerto Rk:o ony)
(Describe type of equipment and bcation in CommeMs)
� Lowest adjaoant(flnisF�d)prade next to buildinp(LAG) 4.g �feet ❑meters(Puerto Rioo onyj
9) Hiphest adjaoe�t(fini�hed)�rade next W buildinp(HAG) 4•¢ �fast ❑metars(PusRo Rico onN)
h) Loweat adjaoent grade at lowest elevetion of dedc or atairs,Indudinp ,(�J(8. �feet ❑meters(Puerto Rk:o only)
strudural su�ort
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SECTION D-SURVEYOR�ENGINEER,OR ARCHITECT CERTIFICATION
This oertification ia to be signed and sealad by a land surveyor,englneer,or a�ChiEpct authorized by law M oertiy elevetion
information. I certi/y that the/nformetion on this CertiBcate represents m�best ef/p►ts M interpret the date ava�able.l ���yti�,` �,,�r t�*�'�';, °'�,A,
understend thet any felse statemenf may be punisheble by fine or implsonment under 18 U.S.Co�e,Section 1001.� �< .�
Check hero if oomments aro provided on badc of fortn. Were latitude and bnqitude in Sedion A provided by a ���;s�.-,�'i�T a�� `� �' j";'�
licenaed land Survsyar? � Yes ❑ No .. - :�i.AC�`-.y,: ;,,.
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Certifiers Name Donald E.Artnstrong,Jr. Licsnse Number 5083 "`� �}�;�`
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Title OMmer Company Name Don Arrnstrany Land Sunreying,LLC �" �'„� y �/ ��
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Address 2187 North Green Ridge Place Clty Palm Harbor State FL ZIP Code 34683 w`�,��.'�k
Signature Date 5/25/11 Telephone 727-772-8134
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IMPORTANT: In these spaces,copy the corresponding information from Section A. For I�urance Comppny�.' � ;;
31 iW����(induding Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. FG�c�t�pllr �;��,�� �R rh���'4 �;fi y,�'
Ciqr Clearwater State FL ZIP Code 33767 Cqry�p� �G ,� , ; E , ,
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SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) •
Copy both sides of fhis Elevation Certifcate for(1)community officlal,(2)insuranoa egaM/oompany,and(3)building owner. �
Comments Lowest Elevation of Machinery in Item 2 e)is a Water Heater on a concrete pedestal in garage.Latitude and Longkude were determined from a
Pinellas County GIS Map.
Signature Date 5/25/11
� Chedc here if altachmeriffi
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY N07 REQUIRED)FOR ZONE AO AND ZONE A(1MTHOUT BFE)
For Zones AO and A(without BFE),oanplets Items E1-E5. If the CeRificcate is intended to support a LOMA or LOMR-F request,complete Sediona A,B,
and C. For IEems E1-E4,use natural grade,if available. Chedc the measuremern used. In PueRo Rloo only,enter meters.
E1. Provide ebvation informaGon for the following and chedc the appropriate boxes to show whether the elevaUon is above or below tha highest adjaoent
grade(HAG)and the lowest adjaoent grade(LAG).
a)Top of bottom floor(indudiny basement,crawlspace,or endosure)is ❑feet ❑meters ❑above or�below the HAG.
b)Top of bottom tl�oor(Including basement,crawlapace,or enGasure)is ❑feet ❑meters ❑above or❑ below the LAG.
E2. For Building Diaprams 6-9 with pertnanent flood openings provided in Sedion A Items 8 and/or 9(see peges&9 of Instn�tions),the next hipher floor
(elevatlon C2.b i�tha dfaprams)of the building is ❑feet ❑meters ❑above or O be�ow the NAG.
E3. Attached garaye(top of slab)Ia ❑feet ❑meters ❑above or ❑below the HAG.
E4. Top of platfortn of machinery and/or equipmeM serviGng 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 ebvatad in eocordance with the community's floodplain managerr�ent
ordinanoe? ❑Yes ❑ No ❑ Unknown. Tha loc;al oificial must certify this informatlon in Sedion G.
SECTION F-PROPERTY OWNER(OR OWNER'8 REPRESENTATIVE)CERTIFICATION
The propeRy owner or owner's authorized represeMative who oompletes Sedions A,B,and E for Zona A(without a FEMA-issued or community-isaued BFE)
or Zone AO must sign here. The statements in Secfions A,8,and E ere correct to the best of my kr►owledge.
Property Owner's or Owner's Authorized Representative's Name
Address City State ZIP Code
Spnature Date Telaphone
Comments
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❑Check here if at��-�ments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The bcal o(ficiai who is authorized by law or ordinanoe to administer the cortxnunflys floodplain manayement ordinance can oomplete Sections A,B,C(or E7,
and Ci of ihis Elevation Ce�te. Complete the applicable irtem(s)and si8n below. Chedc the measurement used in Items G8 and G9. -
G1.❑ The infortnation in Sedion C was taken from othe�documentation thet has been spnad and sealed by a licensed sunreyor,engineer,or archited who
ia autho►ized by law to oertify elevptlon intormation. (Indicate the souros and date of the elevation data in the Commsr�ts aroa below.)
G2.❑ A community official completed Sedion E for a buildiny located in Zone A(without a FEMA-issued
G3.❑ The followiny infortnation ptems G4-G9)is provided for community floodpiain management purpoE
G4.Permit Number GS. Date Permit Issued G6. Date Certifi
G7. This permit has been issued for. ❑New Construdion ❑Subatantial Improvement �� C�y'�/�_/ �� Tr"'
G8. Elevetion of a�buiK lowest floor(inGuding b�meM)of the buildinp: ❑feet ❑mete �
G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑mete
G10.Community'a desipn flood elevation ❑feet �mete 1�C�a� � i -Q y��a
Local O�icia0's hl�rr�e TiUe
Community Name Telephone
Sig�ature Date
Comme�s .
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n cneac nere�r aa�m,encs
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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. Poiicy N�mber
31 Windward Island
Clty Clearwater State FL ZIP COd@ 33767 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 Viev�' and "Rear VievW'; and, if required, "Right
Side View" and "Left Side View." If submitting more photographs than will fit on this page, use the Continuation Page,
following.
Front View 5/25/11
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Rear View 5/25/11
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