Loading...
1425 JEFFORDS STFEDERALEMERGENCY MANAGEMENT AGENCY NATIONAL FLOQD iNSURANCE PROGRAM ELEVATION CERTIFICATE Read the instructions on pages 1- 7. SECTION A- PROPERTY OWNER INFORMATiON BUILDING OWNER'S NAME PHATON JOSEPH BUILDING STREET ADDRESS (Including Apt., Unit, Suite, andlor Bldg. No.) OR P.O. ROUTE AND BOX NO. 1425 JEFFORDS STREET O.M.B. No. 3067-0077 Expires DEC. 31, 2005 Fw Insurance Company Use: Policy Number Company NAIC Number C17Y STATE ZIP CODE CLEARWATER FL ` 33756 PROPERTY DESCRIPTION (Lot and Block Numbers, Tac Parcei Number, Legal Description, etc.) . LOT 125, FORREST HILLS ESTATES UNIT 4, PUBLIC RECORDS OF PINELLAS COUNTY. BUILDING USE (e.g., Residential, Non•residential, Addition, Accessory, etc. Use a Comments area, if necessary.) RESIDENTIAL LATITUDFJLONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (Type): ( ##° - ##' - ##.##" or ##.�) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other. SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NFIP CONIMUNITY NAME & COMMUNITY NUMBER 82. COUNTY NAME 83. STATE PINELLAS COUNN 12103C PINELLAS FLORIDA 64. MAP AND PANEL 85. SUFFIX 67. FIRM PANEL 69. BASE FLOOD ELEVATION(S) � NUMBER B6. FIRM INDEX DATE EFFECT�VEiREVISED DATE 68. FLOOD ZONE(S) (Zaie A0, use deplh of flooding) 0109 H 09-03-03 05M7105 "AE' 28.4' NAVD 1988 810. Indicaie the source of the Base Flood Elevation (BFE) data or base floai depth entered in B9. ❑ FIS Profile � FIRM ❑ Community Determined ❑ Other (Desaibe): COUNTY ENGINEER�EORGE OWENS 611. Indicate the elevation datum used for the BFE in B9: 0 NGVD 1929 � NAVD 1988 ❑ Ofher (Desaibe): _ B12 Is the building located in a Coastal Bamer Resources System (CBRS} area a Otherwise Proteded Area (OPA)? ❑ Yes � No Designation Date_ SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building eleva0ons are based on: � ConsUucUon Drawings" ❑ Bui�ing Under Construction; � Finished ConsVudion 'A new Elevation CeRificate will be required when consUuc6on of the building is canplete. C2. Building Diagram Number 1(Select the building diagram rnost similar to the buiiding fa which this certificate is being compleled - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch a photograph.) C3. Elevalions - Zones A1-A30, AE, AH, A(with BFE), VE, V1-V30, V(with BFE), AR, AWA, AWAE, AWA1-A30, AWAH, AWAO Complete Items C3.-a-i below aa;ading to the building diagram spedi'�ed in ftem C2. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion calcula6on. Use the space provided a the Comments area of Sedion D or Section G, as appropriate, to document the datum conversion. Datum NAVD ConversionlComments -a.85 Elevation reference marlc used Dces the elevation reference mark used appe� on ihe FIRM? ❑ Yes � No a) Top of bottom floor (including basement or endosure} 29.9 ft. NAVD of 1988 � � b) Top of next higher floor N/A ft. �� c) Bottom of lowest horizontal sVuctural member {V zones only) NJA fl. o� Q / d) Attached garage (top of slab) 29.2 ft. w� � Y� �Y� e) Lowest elevation of machinery andlor equipment �� a `� servicing the building (Describe in a Comments area) 29.0 ft �= D� � � �0 fl Lowest adjacent (finished) grade (LAG) 28.7 ft �, Q g) Highest adjacent (finished) grade (HAG) 29.1 ft. NAVD of 1985 � � h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 00 J i) Total area of all permanent openings (flood vents) in C3.h — sq. in. PLS&M #5545 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. l ce�7ify thaf the into�mation in Sections A, B, and C on this ce�ti�cate �ep�esents my best e(fons to inte�p�et the data available. / unde�sland that any ia/se statemenf may be punishab/e by fine o� imp�isonment unde� >8 U. S. Code, Section >00>. CERTIFIER'S NAME MOHAMMAD B. FAR LICENSE NUMBER #R5545 TITLE PROFESSIONAL LAND SURVEYOR & MAPPER COMPANY NAME MOHAMMAD B. FAR ADDRESS CITY STATE ZIP CODE 8131 MEADOWVIEW PLACE NEW PORT RICHEY FL 34655 SIGNATURE Q �� DATE TELEPHONE FAX ��Q�,p 09�p8-2005 727-375-1740 727-375-1741 FEMA Form 81-31, JUL 00 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT: In these spaces, copy the BUILDING STREETADDRESS (Induding Apt, 1425 JEF'�ORDS STREET CITY CLEARWATER information from Section A. Uni� Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX STATE FL Fa Insurance Company Use: Policy Number ZIP CODE Company NAIC Number 33756 SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevalion Certificate for (1) communiry official, (2) insurance agenUcompany, a�d (3) building owner. COMMENTS C3E — ELEVATION OF A/C PAD SERVICING STRUCTURE ❑ Check here if attachments SECTION E- BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zone AO and Zone A(without BFE), �mplete Items E1 through E4. If the Elevation Certificate is intended fa use as supporting in%rmafiai for a LOMA or LOMR-F, Section C must be completed. E1. Building Diagram Number _(Select the building diagram most similar to the building for which this certificate is being completed - see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) E2. The top of the bottom 800r (including basement or enclosure) of the building is _ ft.(m) �in.(cm) � above or ❑ befow (check one) the highest adjacent gratle. (Use natural grade, if available). E3. For Building Oiagrams 6� with openings (see page 7), the next higher floor or elevated floor (elevatior b) cf �he building is _ ft.(m) _in.(cm) above the highest adjacent grade. Complete items C3.h and C3:i on front of form. E4. For Zone AO only: If no flood depth number is available, is the top of the bottan floor elevaled in acaordance with the canrrwniry's floodplain managernent adinance? ❑ Yes ❑ No ❑ Unknown. The local official must cert'rfy this infamation in Section G. SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owners authorized representaGve who cbmpletes Sections A, B, C(Items C3.h and C3.i only), and E fa Zone A(without a FEMA-issued or community- issued BFE) or Zone AO must sign here. The statements in Sec�ons A, B, C, and E are correct to the best of my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME MOHAMMAD B. FAR ADDRESS CITY STATE ZIPC 8131 NiEADOWVIEW PLACE TRINITY FL 34655 cir.ninri iaG _ uHit TELEPHONE COMMENTS (72�� 3����40 ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the oommuniry's floodplain management adinance can complete Seciions A, B, C(a E), and G of this Eleva6on Certificate. Complete the applicable item(s) and sign below. G1. � The information in SecGon C was taken from other documentation that has been signed and embossed by a licensed sunreya, engineer, a architect who is authorized by state or local law to certify elevation informa6on. Qndicate the source and date of the elevation data in the Commenis area below.) G2. 0 A community official completed Section E for a building located in Zone A(without a FEMA-issued or oanmunity-issued BFE) a Zone A0. G3. � The following informa�on (Items G4-G9) is provided for community floodplan management purposes, PERMIT G5. DATE PERMIT G7. This permit has been issued for: ❑ New ConsUuclion ❑ Substantial Improvement G8. Elevation of as-built lowest floor (including basement) of the buiiding is: G9. BFE or (in Zone AO) depth of flooding af the building site is: LOCAL OFFICIAL'S NANiE G6. DATE CERTIFICATE OF COMMUNITY NAME TELEPHONE DA COMMENTS _. _ft.(m) Datum: — — ft•lml Datum: Check here if attachments FEMA Form 81-31, JUL 00 REPLACES ALL PREVIOUS EDITIONS � :,.FEDERAL EMERGENCY MAIVAf�EMENTAGENCY NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE on Pa9es 1- 7. A- O.M.B: No. 3067-0077 Expires DEG. 31, 2005 Use: PHATON JOSEPH Policy Number BUILDING STREET ADDRESS (Induding Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. 1425 JEFFORDS S7REET ComPany NAIC Number C�N STATE CLEARWATER F� � ZIP CODE 33756 PROPERN DESCRIPTION (Lot and Blodc Numbers, Tax Paroel Number, LegaF Description, etc.) LOT 125, FORREST HILLS ESTATES UNIT 4, PUBUC RECORDS OF PINELLAS COUNTy. � BUILDING USE (e.g., Residential, No iderrtial, Addition, Accessory, etc. Use a Comments area, if n�oessary.) RESIDENTIAL , LATITUDFJLON�ITUp�, (OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS (Cype): ( #1#° - ##' - ##.il#" or ##.#l�°) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other. SECTION B- FLOOD INSURANCE RATE MAP (FIRM)1NFORMATION B1. NFIP CO�vUv1UNIlY NAME & COAMvIUNITY NUMBER 82. COUNTY NAME B3, �q� PINELLAS COUNN 12103C PINELLAS FLORIDA _ _ --- _ ;r _ .- _,. . _ _ . �– -._ ._:_ � _ _.��. _. . - x _ ,_ , 64. MAP AND PANEL B5. SUFFIX 67. FIRM PANEL gg. gq���� - _ NUMBER 86. FIRM INDEX DATE EFFECTIVEIREVISED DATE B8. FLOODZONE(&) (ZaieAO, usedeph oflboding) 0109 H 09-03-03 05/17A5 "AE' 28.4' NAVD 1988 610. Indicate ihe sa�rce of the Base Flood FJevafion (BF� data a base flood depth entered in B9. ❑ FIS Profile � FIRM ❑ Car�nunity Determined ❑ Other(Desaibe): COUMI' ENGINEER�EORGE OWENS 611. Indicate the eleva6on datum used fa the BFE in 89: � NGVD 1929 � NAVD 1988 ❑ Olher (Desaibe); _ B12. Is the bui�ing located in a Coast� Barrier Resouroes System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes � No Des:� • Date _ � SECTION C- BUILDINGfLEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevaUons are based on: 0 Construcfion Drawings' ❑ Build'ing Under ConsUuction' � Finished Construdion i4 new Elevation Certificate will be required when oonsWctlon of tlie bui�ing is oomplete. C2. Building Diagram Number 1(Select the building diagram most similar to the bui�ing for which U�is certifiqte is beitx� oompl�ed - see pa�es 6 and 7. If no diagram accurately represents the building, provide a sketch a photograph.) C3. Elevations - Zones A1-A30, AE, AH, A(with BFE), VE, V1-V30, V(with BFE�, AR, AWA, AR/AE, ARIA1-A30, AR(AH, ARlAO Complete Items C3,-a-i below aocording to the buikling diagr�n specified in Item C2. Stafe the datum used. If the datum is diff�t irom tl�e datum used fa the BFE in Section B, c�vert the datum to that used for the BFE. Showr field measure,ments and datum conversion cak:ulati�on. Use the space provicJed a the Conur�en� area of Section D a Sec�on G, as approp�iate, to da;urn�t the datum conversion. Datum NAVD ConversiaUCanrnents -0.85 Elevation reference mark used Does the elevation reference mark used appear on the FIRM? ❑ Yes � No a) Top of bottom floor (induding baserr�ent a endosure) 29.9 ft NAVD of 1988 � � � b) Top of next higher floor IV/A ft. '� �, - . ,,�(� c) Bottom of la�est horiza�tal structural member (V za tes only) NJA ft g o (� �� d) Attached 9arage (toP of slab) 29.2 ft w W _. Sl � -� j — . � ,_ e) Lqwest elevabon of machinery andlor equipment �� � " 8. � _. _.. � serviang the build�ng (Desciibe in a Comments area) 29.6 it _,- , � - ¢_-.� Lowest ad'ac�t finish Z °' ' fl 1 I � 9� I��) 28.7 ft v y C� i� , 9) Highest adjacent (finished) 9rade (HAG) 29.1 ft NAVD of 1988 � 0 h) No. of pertnanent openings (flood va�ts) within 1 ff. above adjacent grade 00 J i) Total area of all permanent openings (flood vents) in C3.h -- sq. in. PLS&M #5545 SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT This certification is to be signed and sealed by a land suroeyor, engineer, or architect authorized tiy law to certify elevation information. l ce�tify that !he info�mation in SeGlionsA, B, and C on this cedi�cate rep�esents mybest eI/o�ts to interpret the data available. l undersfand 1ha1 any false statemenf maybe punishab/e by dne orimpnsonmenl under 18 U.S. C�'e Secfion 100>- GERTIFIERSNAME t�IO'�IAM,MADB..FAR,. LICENSENUMBER �I5545 TlTLE' RROFESSIONAL UWD �URVEI''OR & MAPPER = COMPANY NAME MOHAMNIAD;B,,�AR ; ` . , .. - ,: _ ADDRESS , � - 8131 MEAD04WIEW PLACE_ SIGNATURE i 'i� / �Qw�4l11�' � �.1 FEMA Form 81-31, JUL 00 ui r r- NEUV PORT RICHEY . DATE 09-0&2005 SEE REVERSE SIDE FOR CONTINUATION STAT�E ; , „.. �. ZIPCOQ� F� : . . � ltLtF?1UNt . ,,,tAX 72737r1?40- 727375�1741 REPLAGES ALL PREVIOUS EDITIONS