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90 WINDWARD ISPage 1 of 3 not valid without all three pages U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important: Read the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION Al. Building Owner's Name ALLEN SCOTT Kt.I.RLEMAftAND STEPHANIE F _KURLEMAN A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 90 WINDWARD ISLAND City State CLEARWATER Florida A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 2, UNIT 4, ISLAND ESTATES OF CLEARWATER, according to the plat thereof, as recorded in Plat Book 51, Page 32 of the Public Records of PINELLAS County, Florida. A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential A5. Latitude/Longitude: Lat. 27 58 36.7 Long. 82 48 39.1 Horizontal Datum: 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): a) Square footage of crawlspace or enclosure(s) N/A b) No. of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b N/A d) Engineered flood openings? D Yesx❑ No OMB No. 1660-0008 Expires March 31, 2012 FL1206.1016EC 33767 sq ft sq in ❑ NAD 1927 ❑x NAD 1983 A9. For a building with an attached garage: a) Square footage of attached garage 462 sq ft b) No. of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A9.b 0 d) Engineered flood openings? ❑ Yes ® No sq in SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number CITY OF CLEARWATER 125096 B2. County Name PINELLAS B3. State B4. Map/Panel Number B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood 89. Base Flood Elevation(s) (Zone Date Effective/Revised Date Zone(s) AO, use base flood depth) 12103C - 0106 H 8/1812009 05/17/05 AE 11 . Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. 0 FIS Profile ® FIRM Community Determined ❑ Other (Describe) B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ® NAVD 1988 0 Other (Describe) 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? Designation Date Nin ❑ CBRS ❑ OPA ❑ Yes ® No SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: 0 Construction Drawings* 0 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/A0. Complete Items C2.a-h below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized L -Net Realtime Network (GPS) ; ; Vertical Datum NAVD 1988 Conversion/Comments a) b) c) d) e) f) 9) h) Top of bottom floor (including basement, crawlspace, or enclosure floor) Top of the next higher floor Bottom of the lowest horizontal structural member (V Zones only) Attached garage (top of slab) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) Lowest adjacent (finished) grade next to building (LAG) Highest adjacent (finished) grade next to building (HAG) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support Check the measurement used. 5.0. feet meters (Puerto Rico only) N/A . LXJ feet N/A. 1 feet 4.3. n feet 5.2. © feet LJ meters (Puerto Rico only) ❑ meters (Puerto Rico only) ❑ meters (Puerto Rico only) meters (Puerto Rico only) 4.3. Q feet ❑ meters (Puerto Rico only) 4.67. Q feet 0 meters (Puerto Rico only) N/A. ® feet ❑ meters (Puerto Rico only) 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 efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a licensed land surveyor? ❑Yes © No Certifier's Name License Number Wesley B. Haas 3708 Title Company Name Professional Surveyor and Mapper Exactaland Surveyors Inc Address City 12220 TOWNE LAKE DRIVE, SUITE 55 FT. MYERS Signature State ZIP Code FL 33913 Date Telephone 6/14/2012 P: (305)668-6169 FEMA Form 81-31, Mar 09 See reverse side for continuation. (rev.1 6/14/2012) Replaces all previous editions Page 2 of 3 not valid without at three pages 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. 90 WINDWARD ISLAND City State ZIP Code CLEARWATER FL 33767 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) FL1206.1016EC Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments C.2.e. equipment is A/C unit outside of building. This Elevation Certificate is only valid for the person or persons named on this certificate. Latitude and Longitude were determined by GPS using the L -Net Realtime Network. Centerline Road Elevation: 4.38 This Certificate is for flood insurance purposes only. The information on this certificate should not be used for construction or planning. Signature /' yafi�/ Date 6/14/2012 0 Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items E1 -E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For Items E1 -E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. El. 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 enclosure) is N/A _ ®feet ❑meters above or ❑below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is N/A _ ]feet ❑meters ['above or ❑below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Secti9nit Items 8 and/or 9 (see a es 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is N/A . ® feet U meters 0 above or Li below the HAG. E3. Attached garage (top of slab) is NAA ® feet ❑ meters 0 above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is N/A _ ® feet ❑ meters ❑ above or 0 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? 0 Yes ❑ No D 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, B, and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments SECTION G - COMMUNITY INFORMATION (OPTIONAL) 0 Check here if attachments 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. Check the measurement used in Items 08 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. 0 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. 0 The following information (Items G4 -G9) 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 0 Substantial Improvement 08. Elevation of as -built lowest floor (including basement) of the building ❑ feet 0 meters (PR) Datum G9. BFE or (in Zone AO) depth of flooding at the building site ❑ feet 0 meters (PR) Datum G10. Community's design flood elevation ❑ feet ❑ meters (PR) Datum Local Official's Name Title Community Name Telephone Signature Date Comments 0 Check here if attachments FEMA Form 81-31, Mar 09 Replaces all previous editions Page 3 of 3 not valid without all three pages Building Photographs See Instructions for Item A6. FL1206.1016EC Building Street Address (including Apt., 90 WINDWARD ISLAND City CLEARWATER Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. For Insurance Company Use: Policy Number State FL ZIP Code 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 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. Front Property Picture 6/13/2012 Rear Property Picture 6/13/2012 Right Property Picture Left Property Picture