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175 BAYSIDE DR _ _ _ _ _ _ _ U.S.DEPARTMZ�NT OF HOMELAND SECURITY ELEVATION CERTIFICATE �� 2� �2^�� FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 National Flood lnsurance Program Important� Read the instructions on pages 1-9. Expiration Date:July 31,2015 SECTION A-PROPERTY INFORMATION FOR INSURANCE COMPANY USE A1. Building Owner's Name AGOSTINO&MARIANN DIGIOVANNI Policy Number. A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number: 175 BAYSIDE DRIVE City CLEARWATER State FL ZIP Code 33767 �� ,� ""`i=""j��"2� "` : y � A3. Property Description(Lot and Blodc Numbers,Tax Parcel Number,Legal Description,etc.) _____.__`r M � A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)RESIDENTIAL FEB 0 � �Ot� , A5. Latitude/Longitude:Lat.27°58'12.5" Long.82°49'27.2"Horizontal Datum: ❑ NAD 1927 � NAD 1983 �,��..�,,�.. A6. Attach at least 2 photographs of the building ff the Certificate is being used to obtain flood insurance. PLANNING 8;DF_VELOPMEiVT DEPT � A7. Building Diagram Number 7 CIiY UF C�ER�INQTER„_R�_� 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) 3216 sq ft a) Square footage of attached garage sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s)within 1.0 foot above adjacent grade 12 within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b 3149 sq in c) Total net area of flood openings in A9.b 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 CITY OF CLEARWATER 12509 PINELLAS FLORIDA 64.Map/Panel Number 65.Suffix B6.FIRM Index Date 67.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone 12103C0102 G 8/18/2009 Effective/Revised Date Zone(s) AO,use base flood depth) 9/3/2003 AE 11' 610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile � FIRM ❑ Community Determined ❑ Other/Source: 611. 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 Otherwise Protected Area(OPA)? ❑ Yes � No Designation Date: ❑ CBRS ❑ OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construdion* � 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 Puerto Rico only,enter meters. Benchmark Utilized:USCE 1968"LP-15" Vertical Datum: NAVD 1988 Indicate elevation datum used for the elevations in items a)through h)below. ❑NGVD 1929 ❑NAVD 1988 �Other/Source: 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) 5.66 �feet ❑meters b)Top of the next higher floor 11 .34 �feet ❑meters c) Bottom of the lowest horizontal structural member(V Zones only) N/A. ❑feet ❑meters d)Attached garage(top of slab) N/A. ❑feet ❑meters e) Lowest elevation of machinery or equipment servicing the building 11 . 13 �feet ❑meters (Describe type of equipment and location in Comments) fl Lowest adjacent(finished)grade next to building(LAG) 5.4 �feet ❑meters g)Highest adjacent(finished)grade next to building(HAG) 5.8 �feet ❑meters h)Lowest adjacent grade at lowest elevation of dedc or stairs,including structural support N/A. ❑feet ❑meters SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION � o 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. ,,�' ;^":• •� � •.'�!�' ; 1 understand that any false statement may be punishable by fine or impnsonment under 18 U.S. Code,Section 1001. ��' +,''�.� �jy ' . ' '. ••� • Cy � Y • , ❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a Q,-� �p � � '. � ��, nry�. � ❑ Check here if attachments. licensed land surveyor? � Yes ❑ No �,�, ��r:�, '. � Certifier's Name EDWARD C.ELLIOTT License Number 3983 �-�y; H "� n : - Title P.S.M. Company Name EMME Land Surveying,LLC ^ � ' "�'•j'�� o� : �. �~ �r �-� ', �;. �- . Address 300A S.Belcher Road City Clearwater State FL ZIP Code 33765 - ; �` � �� \q•� ��' � ,s,•' . � Signature Date 2/7/2013 Telephone (727)474-3751 '�'•,��)�� r..C`�.�_' i� � �tl , \� FEMA Form 086-0-33(7/12) See reverse side for continuation. Replaces all previous editions, ��r��v�• v��n �v�� +ayv�. IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Builciing Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number: 175 BAYSIDE DRIVE City CLEARWATER State FL ZIP Code 33767 Company NAIC Number: 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 1.).)THE GARAGE IS NOT CONSIDERED AN ATTACHED GARAGE BECAUSE IT IS LOCATED BENETH THE ELEVATED FLOOR OF A SECOND STORY,THEREFOR IT IS CONStDERED AN ENCLOSURE 2.)THE ELEVATION SHOWN IN ITEM C2e IS THE AIR CONDITIONING EQUIPMENT ON THE W.SIDE OF THE BUILDING 3.)P.S.M.= OFESSIONAL SURVEYOR AND MAPPER Signatur Date 2/7/2013 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.Chedc 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 ❑meters ❑above or�below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or❑ below the LAG. E2. For Building Diagrams fr9 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 cert"rfy 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 ❑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 Certficate.Complete the applicable item(s)and sign below.Chedc the measurement used in Items G8-G10.In Puerto Rico only,enter meters. 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-G10)is provided for community floodplain management purposes. G4.Permit Number G5. Date Permit Issued G6. Date Certficate 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 Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters Datum G10.Community's design flood elevation: ❑feet ❑meters Datum Local Official's Name Title D Community Name Telephone Signature Date ° � ' l Comments PlANNING&JEVELOPMENT nFP7 t C1TY OF EAR�IVAT��h ' ments. FEMA Form 086-0-33(7/12) Replaces all previous editions. ELEVATI�N CERTIFICATE, page 3 guilding Photographs � See Instructions for Item A6. IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number: 175 BAYSIDE DRIVE City CLEARWATER State FL ZIP Code 33767 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 Vie�' and "Rear Viev�'; and, if required, "Right Side Vievd' 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. FRONT VIEW-PHOTO TAKEN 2/7/2013 - � '''�::�::�;=��r� -s ._ ., ,- _.;' -� . � , �� 1' �� s :'�� M t�; � � � "�, H � ��, �ye�„ -+str ti, ,# ' -__ . , ,.:5% w °"- ?,^t- " ' t !�"�;r�+�'.''. .. . � .. ., � . - � ,�•�..- . .,j, �, _. „ ,� �a►� r� -- � w . ` � __ ,._� � ,�.;,�, ' ..,.,"'�'�= . � _ . .� � � '`ru �� .�� -- �� . .:.,. � �� . ..4 �, �JR�T''� o'+a. II P ■�`�'� � �a '� .. -- . . r+�- � :r�, -- w � . , r. � � » � � , ..� ; . . ��, �*� ,;: , �� .�.,.,�. �.: . .. _ ; . . x. r,�.- . _ � ; . ,,,�,�. � . . : �� r'" :2�' '� �s ,,,,..,..,�. «r...,. e � .. , .._. . c .. o � C� � U C�I�� FEB 0 8 2013 � '� ______.,.�._..._� k PLANf:ING&DEVELOPNE�lT DFPT � FEMA Form 086-0-33(7/12) Replaces all previous editions. . ` ELEVATION CERTIFICATE, page 4 guilding Photographs Continuation Page IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. Policy Number: 175 BAYSIDE DRIVE City CLEARWATER State FL ZIP Code 33767 Company NAIC Number: If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear VievJ'; and, if required, "Right Side Vievd' 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. REAR VIEW—PHOTO TAKEN 2/7/2013 ��,�� .,, _ - � � , � � � �, , �;:,�� . �. ~ � i.uSr ' k ,. �� .. ..'� «{y�'� �� .�.. �'< ��.> � .r�f �,� , � » � ;. - , < �. , „, �, � . .rr. '.. .<,� „�i'; " �. , . .. ri�,.� �,�,_:' '.- t �� a,� . i�� . 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' ! {� ��,� � �(�; y .i \�,r �L�y1�r" � � a 'F' � �l Tt��' S , � .. ii ..�'• .1 . !-1c ��.`•,t ��i.§..ri r:-i.«.�.s� l��Tr�.�.�'Id-.'�,�'!a ��+�, ��i�•. U.S."iiEPARTd�AENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal Emergency Management Agency Expires March 31,2012 National Flood Insurance Program Important: Read the instructions on pages 1-9. . SECTION A-PROPERTY INFORMATION For Mnsuranc�Company t�se� A1. �uilding Owner's Name AGOSTINO&MARIANN DIGIOVANNI 'Po]icy Nt�mtrrer A2. Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O. Route and Box Na 'Company PL4IC Numbe�' 175 BAYSIDE DRIVE �ity CLEARWATER State FL ZIP Code 33767 A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) LOT 12,BAYSIDE SUBDIVISION NO.4(PLAT BOOK 32,PAGE 68) A4. �uilding Use(e.g.,Residential, Non-Residential,Addition,Accessory,etc.)RESIDENTIAL A5. Latitude/Longitude: Lat.27°58'12.5" Long.82°49'27.2"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 7 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) 3216 sq ft a) Square footage of attached garage sq ft b) No. of permanent flood openings in the crawlspace or b) No.of permanent flood openings in the attached garage enclosure(s)within 1.0 foot above adjacent grade 12 within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b 3149 sq in c) Total net area of flood openings in A9.b 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&Community Number 62. County Name 63.State CITY OF CLEARWATER 125096 PINELLAS FLORIDA 64. Map/Panel Number 65.Suffix 66.FIRM Index 67.FIRM Panei B8. Flood B9. Base Flood Elevation(s)(Zone �'`. 12103C0102 G Date Effective/Revised Date Zone(s) AO, use base flood depth) 8/18/2009 9/3/2003 I AE 11' 810. Ipdicate 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 ❑ CBRS ❑ OPA SECTION C -BUILDING ELEVATION INFORIVIAI"IOIV (SUI2VEY 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 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-h below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized USCE 1968"LP-15"Vertical Datum N.A.V.D. 1988 Conversion/Comments '• Check the measurement used. a)� Top of bottom floor(including basement,crawispace,or enclosure floor) 5. 79 �feet ❑meters(Puerto Rico only) b) Top of the next higher floor 11 . 14 �feet ❑ meters(Puerto Rico only) c) Bottom of the lowest horizontal structural member(V Zones only) N/A ._ ❑feet ❑meters(Puerto Rico only) d) . Attached garage(top of slab) N/A._ ❑feet ❑ meters(Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building N/A._ ❑feet ❑meters(Puerto Rico on�y) ' (Describe type of equipment and location in Comments) � Lowest adjacent(finished)grade next to building(LAG) 4. 9 ;�;eat ❑meters(Puerto Rico o,�fy) g) Highest adjacent(finished)grade next to building(HAG) 5. 1 ;��;e2t ❑meters(Puerto Rico�,�Iy} h) Lowest adjacent grade at lowest elevation of deck or stairs,including N/A._ ,=,j r2et ❑meters(Puertc Rico oNy) structural support • SECTION D-SURVEYOR, ENGINEER, (��ARCHITEC�CERTIFICATlON �,R t a��a,,�� This certification is to be signed and sealed by a land surveyor,engineer, or architect authorized by law to certify elevation r�� , i n f o r m a t i o n. 1 c e rt i f y th a t th e information on this Certificate re presents m y best efforts ro inter pret the data available.l o` '�� • . ,� understand that any false statement may be punishable by fine or imprisonment under 1 S U.S. Co�e, Sectio.n 1001.� ��v'"�' �ti �, �'.`�°�� '> SCheck here if comments are provided on back of form. Were latitude and longitude in S�ction A provided by a a f�,' �,,�'� � "n' �`•� "�, , licensed land surveyor? � Yes ❑ No � � ' ,�� • '� ' Certifier's Name EDWARD C. ELLIOTT License Vumber 3983 �� ' ' � �a+ _ � • � � , •• _.,�I' ��'a ." • ` ' Title�Professional Surveyor&Mapper Company Name EMME LAND SURVEY?�G, LLC � . j�� ,� s`�. r • �-. <.. . Address 300A SOUTH BELCHER ROAD City CLEARWATER State =L ZIP Code 33765 y�;l�i�� '•'�( � Z\� � '. ''�� ' • • • • .<<,� Signature Date 7/17/2012 Telephone (727)474-3751 � �'�,��); J,' . / ', FEM Form 81-31, Mar 09 See reverse side ror continua�ion. Replaces all previous editions IMRORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company t1se: Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O. Route and Box Na Policy Number 175 BAYSIDE DRIVE City CLEARWATER State FL ZIP Code 33767 CompanyPlAtC Numbe� ' 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 G� Signature ate ❑ 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. 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 ❑meters ❑above or�below the HAG. b)Top of bottom 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. eZone 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 fior Zone A(without a FEMA-issued or community-issued BFE) or Zone AO must sign here. The statements in Sections A, 8, and E are correct to the best of r.ny knowledge. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑Check here if attachments SECTION G -COMMUNITY INFORPJIATION (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 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(wit�ou:a F�MA-issued or community-issued BFE)or Zone AO. G3.❑ The following information(Items G4-G9)is provided for community floodp;ain manager^er;aurposes. G4.Permit Number G5. Date Permit Issued G6. Date Certificate 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: ❑�eet ❑ 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 U.S.DEPARTM�NTOF HOMELAND SECURITY ELEVATION CERTIFICATE �� ^� �� FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 \ationo!F�{ood Insu6nnce Progrmu Important: Read the instructions on pages 1-9. Expiration Date: July 31,2015 SECTION A-PROPERTY INFORMATION FOR INSURANCE COMPANY USE A1. Building Owner's Name AGOSTINO&MARIANN DIGIOVANNI Policy Number: A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Company NAIC Number: 175 BAYSIDE DRIVE City CLEARWATER State FL ZIP Code 33767 ��; � -;� ,,r j- c, :=w=�`: �_..�---..--.�� _ A3. Property Description(Lot and BIoGc Numbers,Tax Parcel Number,Legal Description,etc.) ! -a =� ' _, i.� 5 ;____. ..�._ ._._f , A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)RESIDENTIAL �� ° �� + �` f�:� � � A5. Latitude/LongRude:Lat.27°58'�2.5" Long.82°49'27.2"Horizontai Datum: ❑ NAD 1927 � NAD 1983 � _��___...,.___.__._w__j�""" E A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. PL.f�N�lI13G�.D�VE�CJPlV!�iJT�FWT i A7. Building Diagram Number 7 CIi'Y(��Gi��=f��:)��.�T[:R._�w 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) 3216 sq ft a) Square footage of attached garage sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s)within 1.0 foot above adjacent grade 12 within 1.0 foot above adjacent grade c) Total net area of flood openings in AB.b 3149 sq in c) Total net area of flood openings in A9.b sq in d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes ❑ No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name&Community Number B2.County Name B3.State CITY OF CLEARWATER 12509 PINELI.AS FLORIDA 64.Map/Panel Number 65.Suffix B6.FIRM Index Date 87.FIRM Panel 68.Flood 69.Base F�ood Elevation(s)(Zone 12103C0102 G 8/18/2009 Effective/Revised Date Zone(s) AO,use base flood depth) 9/3/2003 AE 11' 610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69. ❑ FIS Profile � FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes � No Designation Date: ❑ CBRS ❑ OPA 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 Puerto Rico only,enter meters. Benchmark Utilized:USCE 1968"LP-15" Vertical Datum: NAVD 1988 Indicate elevation datum used for the elevations in items a)through h)below. ❑NGVD 1929 �NAVD 1988 �Other/Source: Oatum 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) 5.66 �feet ❑meters b)Top of the next higher floor 11 .34 �feet ❑meters c) Bottom of the lowest horizontal structural member(V Zones only) N/A. ❑feet ❑meters d)Attached garage(top of slab) N/A. ❑feet ❑meters e) Lowest elevation of machinery or equipment servicing the building 11 . 13 �feet ❑meters (Describe type of equipment and Iocation in Comments) � Lowest adjacent(finished)grade next to building(LAG) 5.4 �feet ❑meters g) Highest adjacent(finished)grade next to building(HAG) 5.8 �feet ❑meters h) Lowest adjacent grade at Iowest elevation of deck or stairs,including structural support N/A. ❑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 elevation -~-- infortnation.I certi(y that the information on this Certificate represents my 6est efforts to interpret the data available. I understand that any false statement may be punishable 6y fine or imprisonment under 18 U.S. Code,Section 1001. ❑ Check here if comments are provided on back of forrn. Were latitude and longitude in Section A provided by a ❑ Check here if attachments. licensed land surveyor? � Yes ❑ No Certifier's Name EDWARD C.ELLIOTT License Number 3983 Title P.S.M. Company Name EMME Land Surveying, LLC Address 300A S.Belcher Road City Clearwater State FL ZIP Code 33765 Signature Date 2/7/2013 Telephone (727)474-3751 FEMA Form 086-0-33(7/12) See reverse side for continuation. Replaces all previous editions. IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Buildin�Street P.ddress(including Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Policy Number: 175 BAYSIDE DRIVE City CLEARWATER State FL ZIP Code 33767 Company NAIC Number: SECTION D—SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner. Comments 1.).)THE GARAGE IS NOT CONSIDERED AN ATTACHED GARAGE BECAUSE tT IS LOCATED BENETH THE ELEVATED FLOOR OF A SECOND STORY,THEREFOR IT IS CONSIDERED AN ENCLOSURE 2.)THE ELEVATION SHOWN IN ITEM C2e IS THE AIR CONDITIONING EQUIPMENT ON THE W.SIDE OF THE BUILDING 3.)P.S.M. = OFESSIONAL SURVEYOR AND MAPPER Signatur Date 2/7/2013 SECTION E—BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),compiete 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 availabie.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 Iowest adjacent grade(LAG). a)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or 0 below the HAG. b)Top of bottom 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,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 ❑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.Check the measurement used in Items G8—G10.In Puerto Rico only,enter meters. 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 o�cial 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—G10)is provided for communiry floodplain management purposes. i G4.Permit Number G5. Date Permit Issued G6. Date Certificate 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 Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters Datum G10.Community's design flood elevation: ❑feet ❑meters Datum ;,�--~ ' g r' Local Official's Name Title � �,, .� �� j �� Community Name Telephone � � i;..�...�..� i`t !i �..d,, ,, Signature Date � "'�� '� �'" i ,,,;,,,,1� Comments � PlAN`�ING$:[?FVE!_OrfViwr•1T r)�E��p r r!'(Y C)F °�F,n'N.�7��? , ��""�""�' ` Cti�K'ti8r�ifatta�hments. FEMA Form 086-0-33(7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 3 guilding Photographs � � See Instructions for Item A6. IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt.,Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Policy Number: 175 BAYSIDE DRIVE City CLEARWATER State FL ZIP Code 33767 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 View"; 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 photogr=aphs than will fit on this page, use the Continuation Puge. 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Route and Box No. Policy Number: 175 BAYSIDE DRIVE City CLEARWATER State FL ZIP Code 33767 Company NAIC Number: If submitting more photographs than will fit on the preceding page, a�x the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; 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. REAR VIEW—PHOTO TAKEN 2/7/2013 �� ..� � � . �K �ID y i . ' �� ,No-�r ..?^.:.r . .. .. �/� . . . . �� - ��i"X, � rN§ '4u}`• . . •,�,[� . .. �'� .. 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