859 BAY ESPLANADE U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
Exoires Februarv 28.2009
Federai Emergency Management Agency
National Flood Insurance Program important: Read the instructions on pages 1-8.
SECTION A-PROPERTY INF012MATION For Insurance Company Use: �
A1. Building Owner's Name Policy Number
Brian 8 Pamela Paris
A2. Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O.Route and Box No. Company NAIC Number
859 Bay Esplanade
City Clearvvater State FL ZIP Code 33767
_-- - - ----- -- -- - ------ ------- -----
��,i. ProNeny D���riptiun(Lot and�31ock Pvuir�uers,l ax F'arce�Nunib.,r, L�yu� U��cription,etc.)
Mandalay Sub Blk 40, lot 5&rip rts/05/29/15/54666/040/0050
A4. Building Use(e.g., Residential,Non-Residential,Addition,Accessory,etc.)Residentail
A5. Latitude/Longitude: Lat.N°59'4720"Long.W 82°49'24.63" 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 Number5
A8. For a building with a crawi space or enclosure(s),provide: A9. For a building with an attached garage,provide:
a) Square footage of crawl space or enciosure(s) yll� sq ft a) Square footage of attached garage 108.4 sq ft
b) No.of permanent flood openings in the crawl space or b) No.of permanent flood openings in the attached garage
enclosure(s)walls within 1.0 foot above adjacent grade N� walis within 1.0 foot above adjacent grade 0
c) Totai net arza of flood openings in A8.b � sq in c) Totai net area of flood openings in A9.b 0 sq in
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61. NFIP Community Name 8�Community Number B2.County Name B3.State
City of Clearwater/125096 Pinellas Fi
Bn. Map/Panel Number 65.Su�x B6.FIRM Index B7. FIRM Panel B8.Flood 69 Base Flood Elevation(s)(Zone
12103C 0102 G Date Effective/Revised Date Zone(s) AO,use base flood depth)
9/3/03 9/3/03 AE 11.00 '
B10. Indicate the source of the Base Flood Eleva:ion(BFE)data or ba5e flood depth entered in Item 69.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Describe)
B11. Indicate elevation datum used for BFE in Item 69: ❑NGVD 1929 �NAVD 1988 ❑Other(Describe)
612. is the building located in a Coastai Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No
Designation DateN/A ❑CBRS ❑OPA
SECTION C-BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑Construction Drawings` ❑Buiiding Under Construction' �Finished Construction
'A new Elevation Certificate wiil be required when construction of the buiiding 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-g
below according to the building diagram specified in Item A7.
Benchmark Utilized Citv of C BM J 03Vertical DatumNAVD 1988
Conversion/Comments N/A
Check the measurement used.
a) Top of bottom floor(including basement,crawl space,or enclosure floor)7.36 �feet ❑meters(Puerto Rico only)
b) Top of the next higher floor N/A. ❑feet ❑meters(Puerto Rico only)
c) 6ottom of the lowest horizontal structural member(V Zones only) N/A. ❑feet ❑meters(PueRo Rico only)
d) Attached garage(top of slab) 4.64 �feet ❑meters(PueRo Rico only)
e) Lowest elevation of machinery or equipment servic;ng the building 8.47 �feet ❑meters(Puerto Rico only)
(Describe type of equipment in Comments)
� Lowest adjacent(finished)grade(LAG) 4.68 �feet ❑meters(Puerto Rico only)
g) Highest adjacent(finished)grade(HAG) 4.95 �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 tc certify elevation �ti`�1 ,' ''r��
information. I certify that the information on this Certificate represents my best efforts to interpret the data available. � , ' P�: ' � ,
1 understand that any false stat�ment may be punishable by fine or imprisonment under 18 U S. Code, Section 1001. ., ,�;'r
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❑ Check here if comments are provided on back of form. :,�, -��r a�� ��..x"'
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Certifier's Name License Number ;:. ,,� �3 ` �r� „ , ' ' _ ,
DENNIS J.EYRE PLS 2865 _;�. -.: -y + " '
Title Company Name _ o ° °:
PROFESSIONAL SURVEYOR&MAPPER GEODATA SERVICES. INC. � '� � ,.� ""` A
�Il
Address City State ZIP Code � s'. .� �- .,
1822 DREW REET SUITE 8 TER FLORIDA 33765 �.'Y-.:'
Signature \ Date . Telephone - ' L �-��� °
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IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use:
Building Street Address(including Apt., Unit,Suite,and/or Bidg. No.)or P.O. Route and Box No. Policy Number
859 Bay Esplanade
City State ZIP Code Company NAIC Number
Cleanvater FL 33767
SECTION D-SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for(1)community o�cial,(2)insurance agenUcompany,and(3)building owner.
Comments
��
Signat e Date ,{�
y- �r 6 U ❑ Check here if attachments
SECTION E-B G ELEVATIOIV INFORMATION (SURVEY NOT R Q iRED) FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO a A(without BFE),complete Items E1-E5. If the Certificate is intended to support a LOMA or�OMR-F request,complete Sections A, B,
and C. For Ite s E1-E4,use natural grade, if available. Check the measurement used. In Puerto Rico only,enter meters.
E1. Provide elevation information for the following and check the appropriate Coxes to show whether the elevation is above or below the highest adjacent
g�ade(HAG)and the lowest adjacent grade(LAG).
a)Top of bottom floor(including basement, crawl space,or enclosure)is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
b)Top of bottom floor(including basement,crawl space,or enclosure)is ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items E3 and/or 9(see page 8 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.
EA. 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.
SECTfOlV F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The preperty 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 hsre. The statements in Sections A, 8, and E are correct to the best of my knowledge.
Property Qwner's or Owners Authorized Representative's Name
Address City State ZIP Code
Signature
Date Telephone
Comments
f-1Check 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. Check the measurement used in Items G8.and G9.
G1. ❑ The information in Section C was taken from ather documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who
is authorized by law to ceRify 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 BFEj or Zone AO.
G3. ❑ The following information(Items G4.-G9.)is provided for community floodplain management purposes.
i G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued
i
G7.This permit has been issued for: ❑New Construction ❑Substantial Improvement
G8. Efevation 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
Local O�cial's Nam.=_� � Title
Comm�mity Name 7elephone
Signa:ure Date
Comments �
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PARTINENT OF HOMELAND SECURITY `
��� EL�VATION CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AOENCY OMB No. 1660-0008
National Flood Insurance Program Important: Read the instructions on pages 1-9. Expiration Date: July 31, 2015
- SECTION A - PROPERTY INFORMATION
A1. Building Owner's Name Brian Darby
A� _
A2. Building Street Address (including Apt., Unit, Suite, and/or Bidg. NoJ or P.O. Route and Box No. ��y ��
859 Bay Esplanade _ -
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City Clearwater State FL ZIP Code 33767
A3. Property Description (Lot and Bbdc Numbers, Tax Parcel Number, Legai Description, etc_)
Mandalay Sub Blk 40, lot 5 8� rip rts / 05-1 �.54666-040-0050
A4. Buitding Use (e.g., Residential, Nqn-Residential, Addition, Accessory, etc.) Residential
A5. Latitude/Longftude: Lat. 27°SQ'��.22 Long. 82°49'2449Horizontal Datum: ❑ NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of the building 'rf the Certificate is being used to otitain flood insurance.
A7. Building Diagram Number 5
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 N!A sq ft
b) Number of pe►manent flood openings in the crawlspace b) Number of pertnanent flood openings in the attached garage ;;
or enclosure{s) within 7.0 foot above adjacent grade 0 within 1.0 foot above adjacent grade 0
c) Total net a2a of flood openings in AB.b 0 sq in c Total net area of flood
d) Engineered flood openings? ❑ Yes � No d, En ineered flood o �nings in A9.b Q sq in ,
) g penings? ❑ Yes � No -•,y''
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name 8 Community Number I B2. County Name
City of Clearwater/ 125096 Pinellas
B4. Map/Panel Number 65. Suffix B6. FIRM Index Date B7. FIRM Panel
12103C 0102 G 9l3/03 Effective/Revised Date
9/3/03
B3. State
FL
B8. Flood ( B9. Base Flood Elevation(s) (Zone
Zone(s) AO, use base flood depth)
AE 11.00
_- -
610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9.
� FIS Profile � fIRM ❑ Community Determined ;[] OthedSource:
B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ OthedSource:
B12. Is the building located in a Coastal Barrier Resources System (GBRS) area or Othervvise Protected Area (OPA)? ❑ Yes � No
Designation Date: N1A ❑ CBRS ❑ OPA
SECTION C- BUILDING E�EVATION INFORMATIOPI (SURVEY REQUIRED)
C1. Building elevations are based on: � ❑ Construction Drawings* ❑ Building Under Construction` � Finished Construction
'A new Elevation Certificate will be required when construdion 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/R1-A30, AR/AH, AR/AO. Complete ftems C2.a-h
below aa;ording to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: Citv of CI BM J 03 Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 � OthedSource:
Datum used for building elevations must be the same as that used for the BFE.
Chedc the measurement used.
a) Top of bottom floor (inGuding basement, crawlspace, or enclosure floor) 5.21 � feet ❑ meters
b) Top of the next higher floor 7.35 ❑ feet ❑ meters
c) Bottom of the lov�st horizontal structural member (V Zones only) N/A. ❑ feet ❑ meters
d) Attached garage (top of slab) WA. � feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building g_47
(Describe type of equipment and location in CommeMs) ��t ❑ meters
� Lowest adjacent (finished) grade next to building (LAG) 4.68 � feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 4_g5 � feet � meters :
h) Lowest adjacent grade at lowest elevation of dedc or stairs, including structural support 4.68 � feet ❑ meters
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 elevatan;� �`; 1
information. l certify that the informa6on on this CerGficate represents my best efforts to interpret dre data availa6le. �° ' �� �"
I understand that any false statement may be punishable by frne or imprisonment under 18 U. S. Code, Section 1001. +' �; ;��'
� Check here 'rf comments are provided on badc of form. Were latitude and longitude in Section A provid�d by a' y �*�� �.�'
� Chedc here if attachments. licensed land surveyor? � Yes ❑ No ' x �,�;, �
Certifier's Name Dennis J Eyre
Title Land Surveyor
Address
Signature
FEMA For
Suite 8
License Number 2865
Company Name Geodata Services, Inc.
City Clearwater . State FL ZIP Code 33765
Telephone 727-447-1763
See reverse side for �ntinuation.
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ELEVATION CERTIFICATE, page 2
IMPORTAMT: in these spaces, copy the corresponding information from Seciion A.
Building Street Address (induding Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No.
859 Bay Esplanade
City Clearwater State FL ZIP Code 33767
SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) ";,.
Copy both sides of this Elevation Certificate for (1) community offxtial, (2) insurance agent/company, and (3) building ownec '"'�
Comments C2 e) Lowest machinery servicing the building is the air condition
A9 Cla�cation of structure modification, what' was fortnaNy a garage has been Gosed oif and partitioned into two separate rooms. One part the
floor h n raised and equals the adjacent floor and is part of the living area. The second portion ha� been tumed into a utilihr room and totally
separat om th interior dwellina.�e.�le�tation os 4.64
Signature
SECTION E -
Date
:.�`� ^'� i �
TION INFORMATION (3URYEY NOT REQUIRED) FOR ZONE AO AND ZONE A(VYITHOUT 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 Sedions A, B,
and C. For Items E1-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters.
E1. Provide elevation ir�formation 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 (inGuding basement, crawispace, or endosure) is ❑ feet ❑ meters ❑ above or � below the HAG.
b) Top of bottom floor (induding basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2. For Building Diagrams 6-9 with permanent 800d openiogs provided in Section A Items 8 and/or 9(see pages &-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 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? ❑ Yes ❑ No ❑ Unknown. The tocal official must certiy this information in Section G.
SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) GERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A(without a FEMA-issued or wmmunity-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
Signature
Comments
City
Date
State
Telephone
ZIP Cade
Chedc here if attachments.
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
he local official who is authorized by law or ordinance to administer the community's floodplain managemeM ord'mance can complete Sections A, B, C(or E), and G
P this Elevation Certificate. Complete the applicable item(s) and sgn below. Chedc the measurement used in Items GS-G10. In Puerto R'�co only, eMer meters.
�1. ❑ The infortnation in Section C was taken from other documentation that has been sgned and sealed by a licensed surveyor, engineer, or architect who
is authorized by law to certify elevation infortnation. (Indicate the source and date of the elevation data in the Comments area below.)
�2. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or Zone AO. -
�3. ❑ The following information (Items G4-G10) is provided for community floodplain management purposes.
G4. Pe�rnit Number
G5. Date PeRnit Issued
G6. Date Certificate Of Complisnce/Ocxupancy Issued
�7. This permit has been issued for: ❑ New Construdion ❑ Substantial Improvement
�8. Elevation of as-built lov�st floor (inGuding basement) of the building: ❑ feet ❑ meters
�9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters
�10. Community's design flood elevation_ ❑ feet ❑ meters
Local Offlcial's Name
Community Name
Signature
Comments
Title
Telephone
Date
Datum
Datum
Datum
Check here 'rf attachment�:
EMA Fomt 086-0-33 (7N2) o....�........ ..0 ............- _.,:.:___
ELEVATION CERTIFICATE, page 3 guiiding Photographs
See Instructions for Item A6.
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.
859 Bay Esplanade
City Clearwater State FL ZIP Code 33767
FOR INSURANCE COMPANY USE
Policy Number:
Company NAIC Number:
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions
for Item A6. Identify all photographs with date taken; "Front View" and "Rear Viev�'; and, if required, "Right Side View" and "Left Side
View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as
indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page.
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FRONT VIEW AUG 2013
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REAR VIEW AUG 2013
� FLOOD INSURANCE / ELEVATION SURVEY
� PLEASE COMPLETE AND RETURN TO THE PINELLAS COUNTY PROPERTYAPPRAISER WITHIN 10 DAYS
a� 23 02-Oct-2013 1,019
Transaction Dated: 09/13/2013
05-29-15-54666-040-0050 Indicated Sale Price (from Official Records): $905,000
MANDALAY SUB
BLK 40, LOT 5& RIP RTS
ROSATI, RONALD
ROMANO, LYNN
5303 ENCLAVE DR
OLDSMAR, FL 34677
859 BAY ESPLANADE
Official Record: Book 18159 Page '! 951
Property Use: 0$20
NOTE: Receipt of this form does NOT mean that your property is in a high-risk flood zone
or that it has subsidized flood insurance premiums. It is for data collection purposes only.
We are sending this to all new property owners to determine the market impact of changes in flood
insurance premiums under the Biggert-Waters Flood Insurance Reform Act of 2012 (BW-12). Your
responses to this survey will help ensure that values for property tax purposes accurately reflect the
real estate market as of the annual January 1 assessment date.
Contact Person: �c'°-°��� 2� �'T7 Daytime Phone: � � 7' s`�a � � ��Date: /� -i � � j�
1. What is the FEMA FLOOD ZONE* for this property?
High Risk Areas High Risk Coastal Areas Moderate io Unde�rmiued
Low Risk Areas Risk A reas
❑A ❑AO ❑ V ❑ B and X ❑ D
�E ❑AR ❑ VE ❑ C and X
❑A1-30 ❑A99 ❑ V1-30 Ul'�Ki�OVY1�T '
❑AH ❑ Do not know
*Note: the flood zone is not the same as the hurricane evacuation zone. You can determine your flood zone by
contactrng your municipality or the County for unincorprated areas, or on FEMA's website, www.fema.gov, where you
can also find defrnitions of FEMA Flood Zone Designations.
2. What was the Flood Insurance Annual Premium prior to your purchase? $ <;1 Q� c
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3. What is your CURRENT Flood Insurance Annual Premium? $_ t�, v� v
4. Do you have an elevation certificate on the property? �es* ❑No *If Yes, please provide a copy.
5. Do you have a Letter of Ma Amendment LOMA for the ro ert � * *
p � ) p p y. ❑Yes �o If Yes, please provide a copy.
6. Were any considerations made in the sale contract or price to account for flood insurance costs? ❑Yes" �o
*If Yes, explain:
7. Did seller disclose any prior flood damage to the property (for a single event or repeat damage)? ❑Yes* o
*If Yes, explain: �
8. Was this a cash purchase? s'' ❑ No; *If Yes, did you opt to purchase flood insurance? ❑Yes ❑No.
9. Has this property received flood mitigation assistance ?❑Yes"�Io; *If Yes, what mitigation measures were taken?
10. Please include/attach any additional information or documents related to your property's elevation fevel, flood zone, or
flood insurance that you believe may be relevant to the property value.
Our office cannot provide guidance related to flood insurance. For additional information on flood zones or insurance, see:
www.FloodSmart.gov O www.fema.gov O www.pinellascounty.org/flooding
Please contact your insurance agent with any questions about BW-12 and how it mav impact vour orooertv_
3=:ne« �U;,; Return to: Pinellas County Property Appraiser - PO Box 1957 - Clearwater, FL 33757
Email: pam@pcpao.org Fax: 727-464-3448 Website: www.pcpao.org
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859 BAY ESPLANADE
BCP2013-12460
ADDING 120' TO SUN ROOM
ROMANO ROSATI
Zoning: Low Medium Density Re Atlas #: 249A
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�'{1��PARTMENTOFHOMELANDSECURITY ELEVATION CERTIFICATE �� OMB No. 1660-0008 I
FEDERAL EMERGENGY MANAGEMENT AGENCY �
Nationa! Flood Insztrance Program (mportant: Read the instructions on pages 1-9. Expiration Date: July 31, 2015 ,
SECTION A- PROPERTY WFORMATION �������,��,'��-��N `:�
�Po�l"�tr�ier ` �x z
A1. Building Owners Name Brian Darby ' �
Y
A2. Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No. �O�iip3�y�G�1��i1�B�'
859 Bay Esplanade ' -
City Clearwater State FL ZIP Code 33767 ��'j �`�°� l� �y b�i�
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legai Description, etc.) ���'j �%�j � ��
Mandalay Sub Blk 40, lot 5& rip rts / 05-15-54666-040-0050
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Residential �'�` � n
A5. Latitude/Longitude: Lat. 27°59'47.22 Long. 82°49'2449Horizontal Datum: ❑ NAD 1927 � NAD 1983 �� ��O�'�
A6. Attach at least 2 photographs of the buiiding if the Certificate is being used to obtain flood insurance. pqj�j pUBOV
A7. Building Diagram Number 5 RTYAPPRAISER
A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached ��
a) Square footage of crawlspace or enclosure(s) N/A sq ft a) Square footage of attached garage N/A sq ft
b) Number of permanent flood openings in the crawlspace b) Number of pertnanent flood openings in the attached garage .
or enclosure(s) within 1.0 foot above adjacent grade 0 within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b 0 sq in c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? Q Yes � No -
`�: . �
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION '
B1. NFIP Community Name 8 Community Number I B2. County Name
City of Clearwated 125096 Pinellas
B4. Map/Panel Number 65. Suffix B6. FIRM Index Date B7. FIRM Panel
12103C 0102 G 9/3/03 Effective/Revised Date
9/3/03
B3. State
FL
68. Flood 69. Base Flood Elevation(s) (Zone
Zone{s) AO, use base flood depth)
AE 11.00
610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69.
❑ FIS Profile � FIRM ❑ Community Determined ❑ OthedSource_
B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source:
612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Othervuise Protected Area (OPA)?
Designation Date: N/A ❑ CBRS ❑ OPA
❑ Yes � No
SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building 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. In PueRo Rico only, enter meters.
Benchmark Utilized: Citv of CI BM J 03 Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ OthedSource:
Datum used for building elevations must be the same as that used for the BFE.
Check the measurement used.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor)
b) Top of the next higher floor
c) Bottom of the lowest horizontal structural member (V Zones only)
d) Attached garage (top of slab)
e) Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment and location in Comments)
fl Lowest adjacent {finished) grade next to building (LAG)
g) Highest adjacent (finished) grade next to building (HAG)
h) Lowest adjacent grade at lowest elevation of dedc or stairs, including structural support
5.21
7.35
N/A.
N/A.
8.47
4.68
4.95
4.68
� feet ❑ meters
❑ feet ❑ meters
❑ feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certfication 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 Cert�cate represents my 6est efforts fo interpret the data available.
1 understand thaf any false statement may be punishab/e by fine or imprisonmenf under J8 lI.S. Code, Section 1001.
� Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a p fr,� __. /
� Check here if attachments. licensed land surveyor? � Yes ❑ No _ �
Certifier's Name Dennis J Eyre
Title Land Surveyor
Address 1822 rew treet Suite 8
Signature
FEMA Fo fi86-0-33 (7/ ) /
��C
License Number 2865
Company Name Geodata Services, Inc.
City Clearwater State FL ZIP Code 33765
Telephone 727-447-1763
See reverse side for continuation.
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ELEVaTInN CERTIFICATE, page 2
IMPORTANT: !n these spaces, copy the corresponding information from Section A.
Building Street Address (inciuding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
859 Bay Esplanade
City Clearwater State FL ZIP Code 33767
SECTION D- SURVEYOR, ENGINEER, OR ARCNITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. .,..;
Comments C2 e) Lowest machinery servicing the building is the air condition
A9 Ciarification of structure mod�cation, what' was formally a garage has been closed off and partitioned into finro separate rooms. One part the
floor ha n raised and equals the adjacent floor and is part of the living area. The second portion has been tumed into a utility room and totally
separate om th interior dwellin . lev tion os 4.64
Signature
SECTION E -
Date
TION INFORMATION {SURVEY NOT REQUI
v
FOR ZONE AO AND ZONE A(WITHOUT
For Zones AO and A(without BFE), complete Items E1-E5. if the Certificate is intended to support a LOMA or LOMR-F request, compiete Sections A, B,
and C. For Items E1-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters.
E1. 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 ❑ feet
b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ meters ❑ above or � be►ow the HAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and�/oe9t(se❑e pages �of Instructi� )ethe nextLhigherfloor
(elevation C2.b in the diagrams) of the building is . ❑ feet
E3. Attached garage (top of slab) is ❑ meters ❑ above or ❑ below the HAG.
E4. Top of platform of machine and/or � feet ❑ meters ❑ above or ❑ below the HAG.
�Y equipment servicing the building is ❑ feet ❑ meters
E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance w� the comm�unity's floodplaA management
ordinance? ❑ Yes ❑ No ❑ Unknown. The loql official must cert'rfy this information in Section G.
SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATfVE) 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
Signature
Comments
City
Date
State ZIP Code
Telephone
0 Check here if attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
he 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
F this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8-G10. In Puerto Rico only, enter meters.
1. ❑ 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 ►aw to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
2. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or Zone AO.
3. ❑ The following information (Items G4-G10) is provided for community floodplain management purposes.
G4. Permit Number G5. Date Permit fssued
G6. Date Certificate Of Compliance/Occupancy Issued
7. This permit has been issued for: ❑ New Construction
❑ Substantial Improvement
8. Elevation of as-built fowest floor (including basement) of the building:
9. BFE or (in Zone AO) depth of flooding at the building site: ❑�et ❑ meters
10. Commun O feet p meters
ity's design flood elevation: ❑ feet
❑ meters
_ocal Ofncial's Name
�ommnnity Name
iignature
;omments
:MA Form 086-0-33 (7/12)
Tiile
Telephone
Date
Datum
Datum
Datum
Check here 'rf attachments�
o...,i.,...... ..n ............... ....:.:---
ELEVATION CERTIFICATE, page 3 guilding Photographs
See Instructions for Item A6.
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.
859 Bay Esplanade
City Clearvvater State FL ZIP Code 33767
FOR INSURANCE COMPANY USE
Policy Number:
Company NAIC Number:
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions
for Item A6. Identify all photographs with date taken; �Front Viev✓' and °Rear Viev�'; and, if required, "Right Side Viev�' and "Left Side
View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as
indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page.
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