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1234 WOODLAWN TER - , U.S.DEPARTMEN70F HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal Emergency Management Agency Expires March 31,2012 National Flood Insuran'ce Program Important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION For h�tsuranc:e Company Use: A1. Building Owner's Name Ford Pa1�yNumber ` A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box Na Company NAiC Number 1234 Woodlawn Terrace City Clearwater State FL ZIP Code 33755 A3. Property Description(Lot and Blodc Numbers,Tax Parcel Number,Legal Description,etc.) ParceIID#03-29-15-80388-002-0200 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Garaae A5. Latitude/Longitude:Lat.27.994181 Long.82.786403 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 1A 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) N/A sq ft a) Square footage of attached garage 660 sq ft b) No.of permanent flood openings in the crawlspace or b) No.of perrnanent flood openings in the attached garage enclosure(s)within 1.0 foot above adjacent grade N/A within 1.0 foot above adjacent grade 6 c) Total net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b 768 sq in d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes ❑ No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 61.NFIP Community Name 8 Community Number B2.County Name B3.State Cleawater,Ciry of 125096 Pinellas FL B4.Map/Panel Number B5.Suffix B6.FIRM Index 67.FIRM Panel B8.Flood 69.Base Flood Elevation(s)(Zone 12103C/0106 H Date Effective/Revised Date Zone(s) AO,use base flood depth) 8-18-2009 5/17/2005 AE 21 B10. 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) B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other(Describe) 612. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes � No Designation Date N!A ❑ CBRS ❑ OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Buifding 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,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 Utilized Citv of Clearwater J-07 Vertical Datum NAVD 88 Conversion/Comments N!A Check the measurement used. a) Top of bottom floor(including basement,crawlspace,or enclosure floor)21.0 �feet ❑meters(Puerto Rico only) b) Top of the next higher floor N/A. ❑feet ❑meters(Puerto Rico only) c) Bottom of the lowest horizontal structural member(V Zones only) NlA. ❑feet ❑meters(Puerto Rico only) d) Attached garage(top of slab) 21.0 �feet ❑meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 21.0 �feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Comments) � Lowest adjacent(finished)grade next to building(LAG) 20.0 �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 20.7 �feet 0 meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs,including 20.0 �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. 1 certify that the information on this Certificate represents my best etiorts to interpiet the data available.l understand that any false statement may be punishable by fine or impnsonment under 18 U.S. Code, Section 1001.❑ � Check here if comments are provided on badc of form. Were latitude and longitude in Sedion A provided by a . licensed land surveyoft ❑ Yes � No �s��,� "�J. �, Certifier's Name Patrick J Collins License Number 5523 µ � � �/,.�; � . ±��i��-..�,'. Title PresidenUPSM Company Name Select Surveying, Inc °.`,�r �� ' ""� Address 718 W MLK BLVD SUITE 100-B City Tampa State FL ZIP Code 33603 � � `�" � �� ',.�:,_� ��;�� Signature ~ Date 6-28-12 Telephone 813.258.3210 ""�'�°� .��"j �',� ' � ,, �r�:9� ,,� K"41Y� ^ �4.b . 4 FEMA Form 81-31, Mar 09 See reverse side for continuation. Replaces alf previous�ditions , IMPORT,ANT: In these spaces,copy the corresponding information from Section A. For Insurance Company Use: Building Street AdBress(including Apt.,Unit,Suite,and/or Bidg.No.)or P.O.Route and Box No. Policy Number 1234 Woodlawr�Ter�ace City Clearwater State FL ZIP Code 33755 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 C2.e)The building being proposed to be constructed is a Garage. _ _ ,,; . .. �� f a� f' Signa�W �r, � ; �'r'' Date 6-28-12 , �`,�'� ❑ Check here if attachments , EC�10 ��UI1� G.'�LEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) . ra �a ta • <'�'; . ° ' .;, , .. � � � , .... Fur O�f,�'(vud�iou�BFE),complete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B, and �;FoY�iter,�n��:E4;�natural grade,if available. Check the measurement used. In Puerto Rico onty,enter meters. E1. Pro�udie'el,pir�titin�nf�miation for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grad��Jf`arrti tfielowest adjaoent grade(LAG). a)Top of bott�Im floor(includfng basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or Q below the HAG. b)Top of botfom floor(including basement,crawlspace,or enclosure)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 8-9 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 official must certify 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 a►e 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 documentation 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 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 Cert�cate 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 , , � � ' Building Photographs See Instructions for Item A6. For Insurance Company Use: Building Street Address(including Apt., Unit, Suite,andlor Bldg. No.)or P.O. Route and Box No. Poiicy Number 1234 Woodlawn Terrace Clty Clearwater State FL ZIP COd2 33755 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, following. View lookina from �outh of Area of Proposed Construction . � u�. '�� . , . ,� .. ,,- ,.. .. , w._ �� .. �� . ,�, �,�p �,.,. �� w � ��: . ,��'�`'� , , , � � .. . �f A!�� .. �� Sy, �C � �� - � � �� I � ;M. �� . �� -� � .��. -j �� a : .� �, ..�, ,�;;�:, �. �� w��• a.:�,,. ;_f.rai•��4'. . �� s t ��, � , r �� b _��, > ,ty. y 'f � � �'.. i/> .;. ��y~� �' '� �'f�. � � i .„� :a.. . . � . �� ' r� � .. ��. � � .r "A.i, .�� . . ' .. U, ,,.,� ..,r View looking from North of Area of Proposed Construction - -� . , ..: "'� � � �',�"� .., �:�`?!Ic }F�y„Rd �nF x'�r r�. �.3�,�e., ��,`�„ r L�4�� h {3''3�pi 1 � . . - x �. „ ~ _ . a � � 4 � F k. � i� .�'i' � „'aX-.�� . �:'�P�3t �.,. � �� ,��.. ��`" d�A�`�P..�,�� ,��— � � #�-� ' '�, '� �_� . ��; ;,�.� .� rn � .•i„ +q� " • � : . . � w � � � • � � � ,� � s, " X 1 � r .�..+,....�,.c. 1�' ' " ,� i . -�-�__. ,., . ` ` '� �.,,. �' �� ,� � �i�; , ., � �� !, � �� :�h1l�' ♦ ... • '' � �v��iv�, � T �� J N .<�� .�+ • ";��,�9�1 I � � ., . � _�:.�_ �. -+�..��''�;�.-w�' , �.' . . . � , . ,, • • '• � BUILDING DIAGRAMS The following diagrams illustrate various types of buildings. Compaze the features of the building being certified with the features shown in the diagrams and select the diagram most applicable. Enter the diagram number in Item A7, the square footage of crawlspace or enclosure(s) and the azea of flood openings in square inches in Items A8.a-c, the square footage of attached garage and the area of flood openings in square inches in Items A9.a-c, and the elevations in Items C2.a-h. In A zones, the floor elevation is taken at the top fmished surface of the floor indicated; in V zones, the floor elevation is taken at the bottom of the lowest horizontal structural member (see drawing in instructions for Section C). DIAGRAM 1A DIAGRAM 1B All slab-on�rade single-and multiple-floor buildings All raised-slab-0n�rade or slab-on-stem-wall-with-fill (other than split-level)and high-rise buildings,either single-and multiple-floor buildings(other than split- detached or row type(e.g.,townhouses);with or level),either detached or row type(e.g.,townhouses); without attached ara e. with or without attached ara e. Distinguishing Feature—The bottom floor is at or above ground level Distinguishing Feature—The bottom floor is at or above ground level (grade)on at least one side.' (grade)on at least one side." C2.b C2.b CZ.a i NEXT HIGHER � C2 a � NEXT HIGHER ' i FLOOR � FLOOR � � i GRADE BOTfOM FLOOR BOTTOM FLOOR � GRADE _ \, S�t .i�� - ., .. �i .�;�.. fdeteFl►hn�t#fiy ': :.. . .. �'.2�-t1 �tbe�tr�t?d:#�Y �cist'iit�yr�de} .. . .. . . : r' , : .. .�Shr�g 9t�s�) ; DIAGRAM 2 All single-and multiple-floor buildings with basement (other than split-level)and high-rise buildings with basement,either detached or row type(e.g., townhouses •with or without attached ara e. Distinguishing Feature—The bottom floor(basement or underground garage)is below ground level(grade)on all sides' C.2.i3 � � 1 1 C2.b NEXT HIGHER FLOOR GRADE � BOTTOM FLOOR (BASEMENT) t.. :. } r::. i . ,: . � , _�. '- �.'.��Y -� .'rr .��r.ti: .r �': C2;:f-t� �'�d;bY �zis9ntJ'gratle) _ . _ . * A floor that is below ground level(grade)on all sides is considered a basement even if the floor is used for living purposes,or as an office, garage,workshop,etc Instructions—Page 7