18675 US HWY 19 #256U.S_ DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management �►9ency
National Flood Insurance Program
1.
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ELEVATION CERTIFICATE
Importarrt: Read the instructions on pages 1-9.
SECTION A - PROPERTY INFORMATION
A2. Buiiding Str�# Address (including Apt_, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
18675 U.S. 19 Lot 256
City Clearwater State FL ZIP Code 33982
A3• PropeRy Description (Lvt and Blodc Numbers, Tax Parcel Number, Legai Descri�ion, etc.)
Lot 256 8AY ARtSTOCRAT VILIAGE
OMB No. 1660-0008
Expires March 31, 2012
For insurance CampanY Use:
A4. Building Use (e.g., Residerrtiai, fdon-Residerrtial, Addttion, aa•.essory, etc.) _q i �'
A5. Latitude/Longitude: Lffi. N2745 '§�5" Long. W82Q43'3T Horizorrtal Datum: ❑ NAD 1927 � NAD 1983
A6. Attxh ffi least 2 photographs of 2he building 'rf the Certificate is being used to obtain flood insurance.
A7. Buiiding Diagram Number �
A8. For a Lwilding writh a crawispace or enclosure(s): A9. For a buifding with an attached garage:
a) Square footage of crawlspace or enclosure(s) 1602, sq ft a) Square foatage of attached garage N� sq ft
b) No. of pertnaner�t flood openings in the crawlspace or b) No_ of permanent fiood openings in the attached garage
enclosure(s) within 1.0 foot above adjacerd grade n� within 1.0 foot above adjacern grade �a/
c) Totai n� area of flood opertings in A8.b n/a sq in c) Total net ar� of flood openings in A9.b n/� sq in
� Engineered flood openings? ❑ Y�s � No
d) Engi►reered flood openl�? ❑ Yes � No
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATtON
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Gearwater, City of 125096
FM12103C0128 � G
Pineilas
Date ( Effec�ive/Revised Date � Zone(s)
��� 8/03/03 AE
FL
AO, use base flood dep#h)
9'
810. Indicate the source of the Base Flood Elevation {BFE) data or base flood depth er�tered in Item B9.
❑ FIS Profile � FIRM ❑ Canmunity Determined ❑ Other (pesc�ibe)
B11. Indicate elevation datum used for BFE in ftem B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other (pescribe)
812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Pra[eded Area (OPA)? ❑ Yes � No
Designation Date rda ❑ CBRS ❑ OPA
SECTION C- BUILDING ELEVATION INFORAAATION (SURVEY REQUIRED)
C7. Buii�ng elevations are based pn: ❑ Construc�ion Drawings' ❑ Building Under Construction' � Firrished Construdion
A new Elevation CeNificate will be required when construction of the building is canplete.
C2. Elevations—Zones A1-A30, AE, AH, A(with BFE), VE, V1-V30, V(with BFE), AR, AR/A, AR/AE, ARJA1-A30, AR/AH, ARJAO. Complete R�ns C2.a-h
below according to the building dia�qram spe 'crt'ied in Item A7. Use the same datum as the BFE.
Benchmaric Utilized 872-6689 1 Vertical Oatum NAVD,88
ConversioNComme�rts N,�
Check the measuremerrt used.
a) Top of bottom floor (induding basement, crawlspace, or endosure floor) 9.52 � feet ❑ meters (Puerto Rico only)
b) Top of the next higher floor �. ❑ feet ❑ meters (Puerto Rico oniy)
c) Bottom af the lowrest horizorrtal shuctural member (V Zones oNy) ,r /�. ❑ feet ❑ meters (Puerto Ricd only)
d) Attached 9ara9e (top of si�) N�- � feet ❑ meters (Puarto Rico oniY)
e) Lowest elevation of machinery or equipment servidng fhe building �.7 � feet ❑ meters (Puerto Rico only)
(Describe type of equi�neM and location in Comments)
f} Lowest adjacerK (finished) grade next to buiiding (lAG) �_$ � feet ❑ meters (Puerto Rico o�tyj
g) Highest adjacent (finishedj grade next to building (HAG) ¢.� � feet ❑ meters (Puerto Ric� oniy)
h� Lowest adjacerrt grade ffi lowest elevation of dedc or stairs, including �. ❑ feet ❑ meters (Puerto Rico or►ly)
StruChlfal support
SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
�� �u �tn un�esuun �s io [� s�BnBO 7�1p S@ai6p D�/ fl 18ItO SUN9�/O�, engmeer, or architect authorized by law to certity elevati�
infortnation. 1 cerlity fhat the information on this Cerdficate represents my best efforts io inferprei ihe data availab/e.
! understand that any fa/se statement may be punishab/e by Bne or imprisonment under i8 U.S. Code, Section 1001.
� Check here 'rf commerrts are provided on badc of form. Were latitude and longitude in Section A provided by a
licensed land surveyor? � Yes ❑ No
Certifler's Name Michael D. Hutchinson License Number 7654
TiUe Professionai Surveyor and Mapper Company Name HUTCHINSON SURVEYING AND MAPPING LLC
Address
Vatrico
813-817-6151
FEMA Form 81-31, Mar 09 See reverse side for continuation.
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Replaces al4;pi��rous editions
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IMPORTAPIT: In these
18675 U.S. 19 Lot 256
the
City Ciearwater State FL ZIP Code 33982
c�f�T1nN � -
inionnation from Section A.
.l or P.O. Route and Box No.
OR ARCHITECT CERTIFICATiON
For Insurance CompanY Use:
Copy both sides of this Elevation GertiBcate for (1) c�mmuniry officia�, (2) insurance agerrtR�mpanY. a�d (3) building owner.
on
here
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SECTION E- BUILDlNG ELEVATION INFORMATION (SURVEY NOT REGtUIRED) FOR ZONE AO AND ZONE A(W�THOUT B
For Zones AO and A(without BFE), comp�ete tterris E1-E5. If the Certificate is iMend� to suppo
rt a LOMA or LOMR-F request, comP�ete S�i°�s A� B°
and C. For R�ns Ei-E4, use natural grade, ii available• Check the measuremeM used. In Puerto Rico only, eMer meters.
Ei . Provide elevation ir�fom►ation for the following and ci'�edc the aPPropriate boxes to show whether the elgvation is above or belaw tfie highest adjacerd
grade (HAGj and the lowest adjacerrt grade (LAG). � f� ❑ meters ❑ above or [] be�ow U'►e HAG.
a) Top of bottom floor (nduding basement, crawispace, or endosure) is � f� � m�e� ��e or ❑ below the LAG.
b) Top of bottom floor (induding bas�nerd, crawlspace, or endosure) is
E2. For Building Diagrams 6-9 with permanerrt floal openings provided in Section A Items 8 andlor 9(see pages 8-9 of Instructions), the neut higher Noor
(elevation C2.b in the diagrams? of the bui�ding is . ❑ feet ❑ meters ❑ ab�ve or ❑ below the HAG.
E3. Attached garage (top of slab) is . ❑ fset ❑ me[ers ❑ above or ❑ be�ow the HAG.
E4. Top of platform of machinery and�or equipmeM servicing the buiiding is
❑ feet ❑ meters O�ve or C7 below the NAG.
E5. Zone AO only: If no ffood depth number is availabte, is the top of the bottom floor elevated in accordance with the community's floodP�ain manag�►erit
ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this ir�format9an in Section G.
SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
owner or owner's authorized represerdative who completes Sections A, B, and E for Zone A(wwithhout a FEMA-issued or community-issued BFE)
The property ,,,e,,,� ;,, �;� A. B. and E are coi►rect to the besi of my know+led8e.
or Zone Au musi s�y�� ��mo. .•.., ,.....-••-----
prpperty pwner's or Owner's Authorized Represerdative s Name Z'P C�e
� State
Address
Date
Signature
Commer�ts
Telephone
SECTION G- COMMUNITY INFORMATION (OPTIONw�) �e S��s A, B, C(or E),
law or ordinance to administer the community's fl�dplain management ordinanca can c�mP�
The local official who is suthorized by �e the applicable item(S) and sign below. Check the measuremeM used in ftems G8 a�d G9. `n�r, or architect who
and G of this Elevation Certifica�e• ComP�
Gi .❑ 7he irrfom►a2ion inWStection C�evation n ormationa (�d cate he souce and date of t�he elevat od a�an�theSComma�rts ara bolow.)
is authorized by la e�l �out a FEMA-issued or communiry-issued BFE) or Zone AO_
G2, (] q c�rnmunity official c�mP��� S�on E for a building located �� Zflo��ain manag�nerrt P��P°Sgs.
G3. ❑ The foilowing information (Items G4-G9) is provided for communiry G6. Date Certificate Of ComP����u�� ����
G4, permit Number G5. Date Permit Issued
SubstaMial �mproveme►n
New Construction � � feet ❑ meters (pR) Datum
G7. This Permit has bee+� issued for: ❑ of the building: '_._--
G8. Elevation of as-built lowest floor (induding basement) � f� ❑ meters (PR) Datum
G9. BFE or (in Zone AO) depth of flooding at the buiiding site: � f�t ❑ m�e� (pR) Datum
G10. Community's desi9n flood elevation
Tne
Local Offiaal's Name
Communiry Name
Signature
Comments
FEM'�81-31, Mar 09
T�
Date
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ReDlaces aii previous ediiions
Building Photographs
See Instructions for Item A6.
Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
18675 U.S. 19 Lot 256
Clty Clearwater StBte FL ZIP COde 33982
I`. ��C�3
If using the Elevation Certificate to obtain NFIR 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 Confinuation Page on the
reverse.
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