The URL can be used to link to this page

844 ELDORADO AVEU.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. OMB No. 1660-0008 Expiration Date: November 30, 2018 Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Jacqueline Wojas, Carl Rose Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 8.44 Eldorado Avenue Company NAIC Number: City State ZIP Code Clearwater Florida 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 4, Block 6, Mandalay "the Isle of a Thousand Palms", Plat Book 14, Pages 32-35, Pinellas County, FL A4. Building Use (e.g., A5. Latitude/Longitude: A6. Attach at least A7. Building Diagram A8. For a building a) Square footage b) Number of permanent c) Total net area d) Engineered A9. For a building with a) Square footage b) Number of permanent c) Total net area d) Engineered Residential, Non -Residential, Addition, Accessory, etc.) Lat. 82°49'40.25"W Long. 27°59'43.59"N Residential Horizontal Datum: insurance. above ❑ NAD 1927 adjacent grade grade N/A a NAD 1983 0 2 photographs Number with a crawlspace of crawlspace flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? of the building if the 6 Certificate is being used to obtain flood 2314.00 sq ft or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b or enclosure(s) 0.00 sq in within 1.0 foot foot above adjacent in N/A sq ft ❑ Yes 0 No garage: garage openings in the attached garage within 1.0 in A9.b N/A sq ❑ Yes Q No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number City of Clearwater 125096 B2. County Name Pinellas B3. State Florida B4. Map/Panel Number 12103C 0102 B5. Suffix G B6. FIRM Index Date 08-18-2009 B7. FIRM Panel Effective/ Revised Date 09-03-2003 B8. Flood Zone(s) VE B9. Base Flood E evation(s) (Zone AO, use Base Flood Depth) 13' and 14' B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation of the Base Flood Elevation ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ (BFE) data or base flood ❑ Other/Source: ❑ NGVD 1929 System (CBRS) CBRS ❑ OPA depth entered in Item B9: a FIRM datum used located in a Date: ❑ Other/Source: Protected a NAVD 1988 area or Otherwise Area (OPA)? ❑ Yes a No FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 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. 844 Eldorado Avenue Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations — Zones Al A30, AE, AH, A (with BFE), VE, V1—V30, V (with BFE), AR, AR/A, AR/AE, AR/A1—A30, Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only, Benchmark Utilized: RTK FPRN Vertical Datum: NAVD88 a Finished Construction AR/AH, AR/AO. enter meters. Indicate elevation datum ❑ NGVD 1929 used a for the elevations in items a) through h) below. NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 7.42 F2 the measurement used. feet ❑ meters b) Top of the next higher floor 17.88 a" feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) 15.02 a feet ❑ meters d) Attached garage (top of slab) N/A ❑ feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) 16.02 feet ❑ meters f) Lowest adjacent (finished) grade next to building (LAG) 6.50 a feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 7.48 IIX feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 7.18 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 I certify that the information on this Certificate represents my best efforts to interpret statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section Were latitude and longitude in Section A provided by a licensed land surveyor? A authorized by law to certify elevation information. the data available. I understand that any false 1001. Yes ❑ No ❑ Check here if attachments. Certifier's Name License Number Lloyd J. Braden LS 6174 Place Seal Here Title Professional Surveyor and Mapper Company Name Braden Land Surveying, LLC Address 10327 Hickory Hill Drive City State ZIP Code Port Richey Florida 34668 Signature Date Telephone Ext. 02-05-2020 (727) 224-8758 Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) A8.b) There were no flood openings in the ground level enclosure however the enclosure walls appear to be breakaway wall sections between the structural support columns. C2.a) Refers to ground level storage and parking enclosure area. C2.b) Refers to the lowest living floor level. C2.e) Refers to elevated air conditioning equipment located on the North and South sides of the residence. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 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. 844 Eldorado Avenue Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIC Number 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 complete Sections A, B,and C. For Items E1—E4, use natural grade, if available. Check the measurement enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters LOMA or LOMR-F request, used. In Puerto Rico only, the elevation is above or below ❑ above or ❑ below the HAG. ❑ above or ❑ below the LAG. 9 (see pages 1-2 of Instructions), ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawls pace, or enclosure) is ■ feet ■ meters E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters 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. with the community's certify this information in Section G. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must 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 or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 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. 844 Eldorado Avenue Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIC Number 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 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 Certificate of Compliance/Occupancy Issued New Construction ❑ Substantial Improvement basement) ❑ feet ❑ feet ❑ feet ❑ meters Datum G7. This permit has been issued for: II G8. Elevation of as -built lowest floor (including of the building: G9. BFE or (in Zone AO) depth of flooding at the G10. Community's design flood elevation: building site: ❑ meters Datum ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. OMB No. 1660-0008 Expiration Date: November 30, 2018 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. 844 Eldorado Avenue Policy Number: City State ZIP Code Clearwater Florida 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 photographs than will fit on this page, use the Continuation Page. y• { •_._ � b •'• -.' +„ ._.- ,..:.-:..... _. `��' i -- •! , _; Photo One Photo One Caption Front and South side view, 1/24/2020 Clear Photo One :✓: Photo Two Photo Two Photo Two Caption Front and North side view, 1/24/2020 Clear FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page OMB No. 1660-0008 Expiration Date: November 30, 2018 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. 844 Eldorado Avenue Policy Number: City State ZIP Code Clearwater Florida 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 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. 1111100 %. �' _ !,61IMI.l jj , • as..''.;..,fir- ►.�~_-tea iII�II r 11111110111g 111111 l II num!!! !!! r ' 'fit - �'1fa+ci . _ '.. , p ., .., - ' Photo Three Photo Three Caption Rear and North side view, 1/24/2020 Clear Photo Three tnic•r III 1 . ., .tea? -_-_ ti e3 Photo Four tib i Photo Four Caption Rear and South side view, 1/24/2020 Clear Photo Four FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 ' � � , - , - FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 � ^ `nj �_�O��.� NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 200f �C� ��"" � ELEVATION CERTIFICATE I Read the instruudions on es 1-7. SECTION A-PROPERTY OWNER INFORMAl10N For�naranoe C«►pary use: BUILDING OWNER'S NAME Policy Number Timberlore Construction ESS(InGuding Apt,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number 844 Eldorado Avenue STATE ZIP CODE Clearvvater FL 34630 PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel N�nber,Legal Descri�ion,etc.) Lot 4,Bbdc 6,Mandalay,Plat Book 14,Pages 32-35 BUILDING USE(e.g.,Reside�al,NorxesideMial,Addi6on,Accessory,etc. Use a Commer�ts area,'rf necessary.) Residential LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type): ( #�-##'-##.##" or ##.�) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Olher. SECTION B•FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFW CANN�JNffY NAME 8�COMIuL1NITY NUMBER B2.COUNTY NAME B3.STATE Gty d Clearweter 126096 Pinelles R B4.MAP AND PA�L B7.FIRM PANEL �.BASE FLOOD ELEVATION(S) NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVE6tEVISED DATE B8.FLOOD ZONE(S) (ZaneAO,use depth of floodi�) 0007 D 8/18192 811991 AE 17 810.Indicafe fhe souroe of the Base Flood Elevation(BF�data or base flood depih en0et�i in B9, ❑FIS P�ofile �FIRM ❑Communi�Determineci ❑Other(De.scnbe): B11.IndicaGe the elevation datum used fur the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Other(Desai�e): B12.Is ihe buikiing bcated in a Coastal Barrier Resouroes System(CBRS)area or Otheiwise Proteded Area(OPA)? ❑Yes �No Designation Da�e SEC710N C-BUILDING ELEVATION INFORMATION SURVEY REQUIRED C1.Buiding elevations are based on:0 ConsUudion Dra�uings' Bui�ing Under Construction' ❑F'�nished Construdion *A new Elevation Certifx�te wiN be requiied when oonstnxxion of . C2.Buidag Diagram Number t(Select the buiding diagram most simiar b the buidirg forwhich this certificate is being completed-see pages 6 and 7. If no diagram acwrately�epresents the bu�ding,Piovide a sketch or P��9�Ph•) C3.�eva6ons—ZonesA1,A30,AE,AH,A(with BFE�,VE,V1-V30,V(with BFE�,AR,AWA,AWAE,AWA1-A30,ARIAH,AWAO Complete Items C3.-a-i bebw acoording b the buflding diagram specified rr�16em C2.State the datum used.If the datum is di�erent from the datum used for the BFE in Section B,oonvert the datum to that used for the BFE.Show field measurements and datum oonversbn calculation. Use the spaoe provided or ihe Comments area of Section D or Sedion G,as appropriate,b document the datum oonversion. Datum NGVD-1929 ConversaNCommenLs � Elevation referenoe mark used Does the elevation referenoe mark used appearon the FIRM? ❑Yes �No O a)Top of bo�om floor(induding basement or endosure) 8. 4 ft(m) � �r;.: � • ❑b)Top af next higherfloor 17.2 ft(m) � ;�, .. 0 c)Bo�om of b�w�.st horiaonfal strudur�member(V mnes only) 15.5 ft(m) �o .� ,'A ,�, ,��; ",, , ,' � 0 d)AQadied 9arage(�P of slab) 8. 4 ft(m) W-g :: #� : '- 0 ej Lowest elevation of mad�inery andlor equipment � .:��Jy� $ m �s�013�? servicing the buiding(Descnbe in a Comments area) 16.8 ft(m) � ; ❑fl Lawest adjaoent(finisfied)grade(lAG) 6.8 ft(m) z'� ', '��v 3,,;'• ❑g)Hghest adjaoent(fmist�ed)grade(HAG) 7. 5 ft(m) �N ' a h)No,ofi pem�anent openings(flood venfs)within 1 ft above adjacent grdde 4 � ❑ i)Total area of aq pertnanent openings(flood vents)in q.h 3072 sq.in.(sq.an) SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CER7IFlCATION This cert�cation is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certifjr elevatbn information. I cerfify that the information in Sections A,B,and C on this certificate represents my besf eBo►ts to inte►pret the deta available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001. CERTIFIER'S NAME Donald E.ARnstrag Jc UCENSE NUMBER 5083 TITLE Owner COMPANY NAME Donald E.AnnsUong Jr,P,LS. ADDRESS CITY STATE ZIP CODE 40347 U S MNy 19 N,SuiBe 125 Tarpon Springs FL 34689 SIGNATURE DATE TELEPHONE 7/7�3 (12�945-1073 IMPORTANT: In these s es, the ndin informatan from Secfion A Fa ineurance c«r�peny us�: . ' ' ' BUILDING STREET ADDRESS Qndudirg Apt,Unt,S�le,ar�dla Bklg.No.)OR P.O.ROUTE AND BOX N0. PaNcy Number. 844 Eldorado Avenue ' CfTY STATE ZIP CODE Comper�y NAIC N�xriber Cleorvaater FL 34630 SEC110N D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICA710N(CONIINUED) Copy both sides of this Elevation Certificate for(1)communiry offidal,(2)insuranoe agenVoompany,and(3)buikling owr►er. COMMENTS Elevations are based upon a City of Cleanv�er Bench Mark'15-93-DA-09',Elevati�on�.636 Feet,NGVD-1929 ❑Check here iF a�achmeMs SECTION E-BUIIDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(IMT'HOUT BFE) ForZone AO and Zone A(without BFE),complefe I�ms E1 through E4. If the Elevation Certificate is intended for use as supportirg ir�formation for a LOMA or LOMR-F, Sedion C must be oompleted. E1.Building Diagram Number_(Seled ihe buiding diagram most simiar to the bu�ding forwhich this certificate is beirg completed—see pages 6 and 7. If no diagram accurately represents the buikiing,provide a sketd�or phobograph.) E2.The Oop of tlie bottom floor Qnduding basement or endosure)of the buiding is _R(m�_in.(cm)Q above or ❑below(chedc one)the hghest adjaoent grade. (Use natural grade,if available), E3.For Buikiing Diagr�uns 6�8 with openings(see page 7),tlie next higherfloor or eleva�ed floor(elevatan b)of the buidirg is _ft.(m)_�.(cm)above the hghest adjaoent grade. Complete ifems C3.h and C3.i on front of furm. E4.The Oop of the plafform of machinery and/or equipment serviang the buikling is _ft(m)_in.(an)�abo�re or ❑bebw(chedc one)the highest adjaoent grade. (Use nabural grade,'rf avadable). E5.For Zone AO only: If no flood depth number is ava�able,is the top of ihe bot�m floorelevaQed in a000rdanoe wrth the oommuniys floodplain management ordrr�ance? ❑Yes ❑No ❑Unknown. The bcal offiaal must oertify this information in Sedion G. SEC110N F•PROPERTY OWNER(OR OWNER'S REPRESENTA7IVE)CERTIFICA?lON � The prope�ty owner or owner's authorized representative who oompletes Sedions A,B,C(Items C3.h and G3.i only),and E TorZone A(wittiout a FEMA-'ssued or oommunity- issued BFE�or Zone AO must sgn here. The stetemenls h Sections A,B,C,and E are carect to the best of my Imowledc�e. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS ❑Check her�e if attachments SECitON�•COMMUNITY INFQRMATtON(OPTIONAL) The bcal offx�al who is authoriaed by law arordinar�oe m administer the oommunih/s floodplain management ordinanoe can complete Sections A,B,C(or�,and G of this Elevation CertiFicate. Complete the appiicable item(s)and sgn bebw, G1.�The ir�amation n Section C was taken from otherdoamentatbn that has been signed and embossed by a lioensed sunreyor,engir�eer,or architect who is authoriaed by state or bcal law b certify elevati�n��rtnation. Qndicate the souroe and dafe of the elevation data in the Comm�ts area below.) G2.0 A oommunity offiaal oompleted Sedion E for a bukiirg bcated in Zone A(witliout a FEMA-issued or oommuni�-issued BFE)or Zone A0. Gi.[]ll�e fdbvu�g ir�formation(I�ms G4�)is provided f�r oommunity floodplain management purposes. G4.PERMT NUM6ER C�. DATE PERMT ISSUED G6. DATE CERTIFICATE OF CONPLIANCE/OCCUPANCY ISSUED G7.This permit has been issued for.�New ConsUuction ❑Substantial Impiovement G8.Elevation of as-buift la�,est floor(induding basement)of the buiding is: __ft(m) Oalum: G9.BFE or(in ZAne AO)depth of flooding at the buildirg site is: __ft(m) Dffium: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELFPHONE SIGNATURE pATE COMMENTS ri..�---�.�--- °°-u--'-----•- � . '—� , � FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 , �� ^ O� �� NATIONAI.FLOOD INSURANCE PROGRAM ` Expires July 31, 2002 �/ . � ELEVATIORI CERTIFICA�TE p/ �ic��D��DQ�j/�j ` Important: Read the instructions on pages 1 -7. SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Numher Timberlore Construction BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number 844 Eldorado Avenue • CITY STATE ZIP CODE Clearwater FL 34630 PROPERTY DESCRIPTION(l.ot and Block Numbers,Tax Parcel Number,Legal Descrip6on,etc.j Lot 4 Block 6 Mandalay Plat Book 14 Pages 32-35 BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use Comments section'rf necessary.) Residential LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type): ( ##°-�1#'-##.##" or ##.#�##°) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other: SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION Bt.NFIP COMMUNtTY NAME 8�COMMUNITY NUMBER 62.COUNTY NAME B3.STATE Ci�y Of Clearwater 125096 Pinellas F� 84.MAP AND PANEL B5.SUFFIX B6.FIRM INDEX B7.FIRM PANEL B8.FLOOD 69.BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use depth of flooding) 0007 0 8/18/92 8/19/91 AE 12' B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9. ❑ FIS Profile � FIRM ❑Community Determined ❑Other(Describe): 611. Indicate the elevation datum used for the BFE in 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 SECTION C-BUILDING ELEVATION IN�ORMATION(SURVEY REQUIRED) C1. Building elevations are based on:�Construction Drawings• � Building Under Construdion' ❑ Finished Construdion "A new Elevation Cert�cate will be required when construction of the building is complete. C2. Building Diagram Number 1 (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.) C3. 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 C3a-i below according to the building diagram specified in Item 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 calculation. Use the space provided or the Comments area of Section D or Section G,as appropriate,to document the datum conversion. Datum NGVD-1929 ConversioNComments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? ❑Yes � No ❑ a)Top of bottom floor(inGuding basement or enclosure) 8.4 ft.(m) m ❑ b)Top of next higher floor 17.2 ft.(m) � ❑ c)Bottorn of lowest horizontal structural membe�(V zones only) N/A._ft.(m) �o ❑ d)Attached garage(top of slab) N/A._ft.(m) �� O e) Lowest elevation of machinery and/or equipment W m � ` servicing the building N/A._ft.(m) E� 0 t�Lowest adjacent grade(LAG) 6. 8ft.(m) z'� ❑ g) Highest adjacent grade(HAG) 7. 5ft.(m) � �� .�/6 �o�' ❑ h) No.of permanent openings(flood vents)within 1 ft.above adjacent grade N/A � ❑ i)Total area of all permanent openings(flood vents)in C3h N/A sq.in. (sq.cm) �f�� SECTION D-SURVEYOR�ENGINEER,OR ARCHITECT CERTIFICATIO This cert�cation is to be signed and sealed by a land surveyor, engineer, or archited authorized by law to certify elevation information. I certify that the infoimation in Sections A, B, and C on this oerfificate represents my best effo�ts to interpret the data availab�e. !understand that any fa/se statement may be punishable by fine or imprisonment under 18 U S. Code, Sectian 1001. _ CERTIFIER'S NAME Donald E.Armstrong Jr. LICENSE NUMBER 5083 TITLE Owner COMPANY NAME Donald E.Armstrong Jr.,P.L.S. ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE rruw r_.�_ n• � •��nn ��'- r�.r�ir�r.� n��r r�n ��u��t��u �r-�� e.►r�n w� � r��n��+ r�e+�T��►�r. • 'r � , � �I► FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. NO. 3067-0077 . O� ^, / O� �� NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 , G ELEVATION CERTIFICATE �y �OD�G/¢1/�j ' Im ortant: Read the instructions on pa es 1 -7. ` SECTION A-PROPERTY OWNER INFORMATION For Insurance CompanyUse: BUILDING OWNER'S NAME Policy Number ` Timberlore Construction BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number 844 Eldorado Avenue _ C�N STATE ZIP CODE Ciearwater FL 34630 PROPERTY DESCRIPTION(Lot and Block Numbers,7ax Parcel Number,Legal Description,etc.) Lot 4,Block 6,Mandala Plat Book 14 Pa es 32-35 BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use Comments section ff necessary.) Residential LATITUDEILONGITUDE(OPTIONAL) HORIZONTAL.DATUM: SOURCE: ❑GPS(Type): ( �#°-##'-##.�I#" or ##.� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other: SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 61.NFIP COMMUNITY NAME 8�COMMUNITY NUMBER B2.COUNTY NAME 63.STATE City Of Clearwater 125096 Pinellas FL 64.MAP AND PANEL B5.SUFFIX 66.FIRM INDEX B7.FIRM PANEL B8.FLOOD 69.BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use depth of flooding) 0007 D 8/18l92 8/19/91 AE 12' 610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9. ❑ FIS Profile � FIRM ❑Community Determined ❑Other(Describe): 611. Indicate the elevation datum used for the BFE in 69:� NGVD 1929 ❑ NAVD 1988 ❑Other(Describe): 612. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Proteated Area(OPA)? ❑Yes� No Designation Date 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. Building Diagram Number 1 (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.) C3. Elevations—Zones A1-A30,AE,AH,A(with BFE), VE,V1-V30,V(with BFE),AR,AR/A,AWAE,AR/A1-A30,AR/AH,AR/AO Complete Items C3a-i below according to the buildin9 diagram specifi�sd in Item C2.State the datum used. If the datum is different from the datum used for the BFE in Section B, conveR the datum to that used for the BFE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section�,as appropriate,to document the datum conversion. Datum NGVD-1929 ConversioNComments Elevation reference mark used Does the elevation�eference mark used appear on the FIRM? ❑Yes � No ❑ a)Top of bottom floor(including basement or enGosure) 8. 4 ft.(m) � � j �] b)Top of next higher floor ��•?ft•�►n) � � ��, , � ❑ c)Bottom of lowest horizontal structural member(V zones only) N/A._ft.(m) �o �''., ❑ d)Attached garage(top of slab) N/A._ft.(m) W W ,,,.�;.Fl , � ,A , 0 e)Lowest elevation of machinery and/or equipment -m � > � � �° ,�, , ,� ` servicing the building N/A._ft.(m) �� : � ' � W �', " ❑ �Lowest adjacent grade(LAG) 6. 8ft.(m) z�'� - ��j � � � � ❑ g) Highest adjacent grade(HAG) 7. 5ft.(m) � � •�� .2�,6 �o.� � h) No.of permanent openings(flood vents)within 1 ft.above adjacent grade N/A � ��-:a,ti; . ` ❑ i)Total a�ea of al�permanent openings(flood vents)in C3h N/A sq. in. (sq.cm) #-f��'3 SECTION D-SURVEYOi2�ENGINEER,OR ARCHITECT CERTIFICATIO 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 in Sections A, B, and C on this certificate represents my best efforts to interpret the dafa availab/e. !understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME Donald E.Armstrong Jr. LICENSE NUMBER 5063 TITLE Owner Ct�MPANY NAME Donald E.ArmsVong Jr.,P.L.S. ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE �r��• �__.__ n� • •��nn n�r- r+r�ie�r�n�- r.��r ri.1r i+++u�r��n�� '+rr�i e.��n w� � ��-�ni.��.�. rev�T��►�r. IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Compar�y�.�: , � � BUILDING STREET ADDRESS(inciuding Apt.,Unit,Suite,and/or 81dg.No.)OR P.O.ROUTE A�7D 60X tJO. Policy Number - ' 844 Eldorado Ave CITY STATE Zii'CODE Company NA1C Nuinber _ Clearwater FL 34630 SECTION D-SURVEYOR, ENGINEER, OR ARCHITECT Ctft i iFiCATiON(CONTINUEDj � Copy both sides of this Elevation Certificate for(1)community official, (2)insurance agent/company, and (3)building owner. COMMENTS Elevations shown are based upon Ciry of Clearwater Bench Mark"15-93-DA-09",Elevation=5.636 Feet,NGVD-1929 ❑ Check here if attachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOF2 ZONE AO AND ZON�A(WITHOUT BFE) For Zone AO and Zone A(without BFE), complete Items E1 through E4. If the E/evation C:�rtiFcate is intended for use as su�aporting information f�ra LOMA orLOMR-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 compfeted—see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) E2. The top of the bottom floor(including basement or enclosure)of the building is _ft.(m)_in.(cm)�above or ❑ below(check one) the highest adjacent grade. � E3. For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is _ft.(m),in.(cm)above the highest adjacent grade. E4. For Zone AO only: If no flood depth number is available, is ihe 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 REPRESENTA7IVE)CERTIFICATION The property owner or owner's authorized representative who complete�s Sections A, B, and E for Zone A(without a FEMA-issued or community-issued BFE)or Zone A�must sign here. 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(OPi'IONAL) 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. G1. ❑The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in tha Comments area below.) G2. 0 A community official cemplated Sedion E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3. �The following iniormation (Items G4-G9)is provided for community floodplain management purposes. G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CFRTIFICATE 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 is: _ft.(m) Datum: G9. BFE or(in Zone AO)depth of flooding at the building site is: _ft.(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS ❑ Check here if attachments �r��• r.._.. n• ..w •��r. nn �r-r�� •.vr-rr •� � e��r.n�� rr��ri��.. • t. �, Donatd E. Armstrong Jr. Professional Land Surveyor ` 90 S. Highland Ave, #9 � Tarpan Springs, Florida 34689 " Phone (727) 945-1073 ' Fax (727) 945-8343 � �,FRTIFIED T0: TIMBERLORE CONSTRUCTION 5ec. 5, Twp. 29 S., Rng. 15 E. � Pinellas County, Florida Fieid Book 29, Page 48 I�,gqj Descri tR ion: (As Provided) Job #23020 Lot 4, Block 6, MANDALAY, as recorded in Plat Book 14, Pages 32 through 35, of the Public Records of Pinellas County, Florida. NOTE: THIS SURVEY WAS PERFORMED WITHOUT THE BENEFlT �F A COMPLETE TITLE SEARCH OR POLICY AND MAY BE SUBJECT TO ADDITIONAL EASEMENTS, RESTRICYIONS, COVENANTS AND/OR OTHER CONDI110NS OF TITTLE. SCALE : 1" = 20' G U L F 0 F M E X I � p I COASTLINE (BEACH) � OR�TUND NO3'2O'OO"E C --. — . � ) 60.00' (P&C) oa sEOUND — _,_,_ �_ _ 5' EASEMENT (P) ` — o '_'_ — 0 0 O � N FOUND X CUT � �°�h ZONE LINE AS coNC. WITNESS LINE WITNESS ORNER SCALED FROM SEAWALL ��y rM =0•7�� , , ZONE � FEMA MAP-� — 6_ N�rJ��6�09�W ` � _ _ __ _ _4 _BFE=16�— - ^ '� 0.1' . ZONE AE FOUND X-CUT � 8FE=12' ^ WITNESS CORNER � � � ... 0.7' � d •"•' � � � `:.• 5.3' a� 42.8' ,� 5.4' :': � �1S?IE� O �;�' � •s. COASTAL CON57RUCT10N CONTRO� O UNE NOT LOCATED OR SHOWN O �• � i O '— ' L 0 T 4 � c� � L 0 T 3 B L 0 C K 6 � = L 0 T 5 BLOCK 6 � � � �/844 , .:, B L 0 C K 6 � . •�, �� MASONRY POURED v `• �� FOUNDATION • iz ! " • y N � a U I'; ? � BOTTOM FLOOR ELEV.=g.4�' � I ••� � �"� % :• � BOTTOM OF BEAM ELEV.=15.65' ' �"' I N `-' FIRST FLOOR ELEV.=17.17' ^ M ' o � ' o W I � RESIDENCE � o�p o � Z �r N • � M �- W RESIDENCE ,: 5.3' 23�� 9•�' � I W �m m o 12.6' S.4' � � ��i ri c,i N N 2.0 .0' ' •� I Q � TAIRWA " . • Z �. . . � rn � • 0.3' . w . �'b.3' . ' � �° °' • � •' p FOUND; ,�M � .y�. '� ' ' C� — � _._.._ . _____ X-CUT WATER ME7ER N ^' �' a " S.I.R..,..,• FOUND � � � � X-CUT � •.�',. f,�.'S03'20'00"W M � sos�o'oo'w (M) so.00• �aa�� (, ) 60.00 (PBdN) s' coNC. wauc WOODWUIILJT��W.OVERHEAD UTILITY WIRES ` S' . •• - „�. ''d POLE . , . � : in; - v �'.'. 6. '�.. :. •CONC. (TYP)• ' � . ' � :. � . �' •, ...' •'� •.'�.' � " •0��. '.. ' NOTE: 2' CONC. CURB * • "• ��DENOTES EXISTING SPOT ELEVA�ION + � ELEVATIONS SHOWN ARE BASED UPON '—'---------- -_ 1, ELDORADO AVENUE �� CITY OF CLEARWATER BENCH MARK ` --------- _ ____________^ 0• '15-93-DA-09", ELEV.=5.636 FEET, 60' R/W (p) - zp' qSPH. PVMT. + NGVD-1929 SURVEYOR'S REPORT• 1.) Use of this Survey by any�nne other than those CertifiPd To wi!I be the re-eisers sole risk without Liabiliky to this Surveynr. 2.) No underground encroachments (if any), foundations, structures, sprinklers and/or utilities have been locoted and/or shown unless otherwise indicated hereon. 3.) No instruments of record reflecting easements, rights of wa;r, restrictions and/or ownership were provided to this surveyor unless otherwise indicated hereon. 4.) The above described property appea�s to fall in Zone AE & VE, as shown on the Federal Emergency Management Agency (F.E.M.A.), National Flood Insurance Program, Flood Insurance Rate Map (F.I.R.M.), Community #125096, Panai #0007-D, Index Date 8/18/92, Map Revised 8/19/91, Base Flood Elevation �f 12 feet (AE) & 16 feet (VE), Mean Sea Level (M.S.L.) = 00.00'. 5.) Basis of 8earings: Westerly R/W of Eldorado Ave = S 03'2G'00" W (Assumed — No Angles or Bearings shown on Recorded Plat) 6.) All Bearings and Distances shown hereon are Plat and Field Measured unless otherwise shown. ABBREVIATION LEGEND: Certified For. Boundary Survey ,�+ � F.I.R FOUND IRON ROD SIZE INDICATED SEC. SEC110N •" t � S.I.R. SET IRUN ROD, 1�2' P.LS.�5083 TWP. TOWNSHIP This certifies thot a survey of the prope'rty,s4i6W��''�reon wns made F.O.P.FOUND OPEN IRON PIPE, SIZE INDICATED RGE. RnNGE under my supervision and thot the sUrv�fr I�n�e��,�,h� '. um F.P.P.FOUND PINCHEO IRON PIPE, SIZE INDICATED (D) DEED Technical Standards set forth by t.�e Fl3rit3p°�oard � ro.fessional F.N.D. FOUND NAIL AND DISK P P�T Land Surve rs and Mo ers in Cha tffs 7 . I�do:- S.N.D. SET NAIL AND DISK, P.LS.p5083 M MEASURED Y° PP P ,� F.C.M. FOUND CONCRETE MONUMFNT �C CALCULATED Administrative Code, pursuant to Sc.�n '4t� ��nda Statues. P.R.1�. PERMANENT REFERENCE ►AONUMENT CONC. CONCRETE P.C.P. PERMANENT CONTROL POINT GOV. COVERED No e: Survey not valid without the si � ��r�'i�d�'tL.tR�e' oric�fipl P.O.C.POINT OF COMMENCE�IENT ASPH. ASPHAIT raiseU seal of a Florida Licensed yor�6nd Mopp P.O.B.POINT OF BEGINNING PVMT. PAVEMEPIT ='i�'�� ;.�,yd� R.L.S. REGISTERSED IAND SURVFYOR ELEV. ELEVATIUN 2 6 03 �� P.L.S. PROFESSIONAL LAND SURVEYOR IYP. TYPICAL � � P.S.M.PROFES510NAL SURVEYOR dc MAPPER R/W RIGHT-OF-WA" Field Survey Date onald E A StfO g Jr. L8. LANO BUSINES'; Flori a Surveyor s Registration, �5083 � ' r � . �, FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 - NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 � ELEVATION CERTIFICATE ' Im ortant: Read the instructions on a es 1 -7. SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Policy Numaer ' : Timberlore Construction BUILDING STREET ADDRESS(Induding Apt.,Unit,Suite,and/or Bldg.No J OR P.O.ROUTE AND BOX NO. Company NAIC Number 844 Eldorado Avenue CITY STATE ZIP CODE Clearvrater FL 34630 PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Loi 4 Block 6 Mandalay Plat Book 14 Pages 32-35 _ BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use Comments section if necessary.) Residential LATITUDE/LONGITUDE(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 COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME 63.STATE City Of Clearwater 125096 Pinellas FL 64.MAP AND PANEL B5.SUFFIX B6.FIRM INDEX 67.FIRM PANEL B8.FLOOD 69.BASE FLOOD ELEVATION(S) NUMBER �ATE EFFECTIVEIREVISED DATE ZONE(S) {Zone AO,use depth of flooding) 0007 D 8/18l92 8/19/91 AE 12' B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9. ❑ FIS Profile � FIRM ❑Community Determined ❑ Other(Describe): B11. Indicate the elevation datum used for the BFE in 69:� NGVD 1929 ❑ NAVD 1988 ❑Other(Describe): 812. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes� No Designation Date SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: 0 Construction Drawings" � Building Under Construction' ❑ Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number 1 (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.) C3. 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 C3a-i below according to the building diagram specified in Item 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 ca�culation. Use the space provided or the Comments area of Section D or Section G, as appropriate,to document the datum conversion. Datum NGVD-1929 ConversioNComments Elevation reference mark used Does the elevation reference mark used appear on the FIRM? ❑Yes � No ❑ a)Top of bottom floor(including basement or enclosure) 8. 4 ft.(m) m ❑ b)Top of next higher floor 17 .2 ft.(m) � � ; � ,g�,fp • ❑ c)Bottom of lowest horizontal strudural member(V zones only) N/A._ft.(m) �� r."' rA�. o %� ❑ d)Attached garage(top of slab) N/A._ft.(m) � , � A,4 ,t, s � ❑ e) Lowest elevation of machinery and/or equipment w W ' `' "' �' � ` y �°,. N/A. ft. m m m ,�, ,x, , ;�� servicing the building _ ( ) �� `:: 4;� .� - 4 f� Lowest adjacent grade(LAG) 6. 8ft.(m) z'� ' `� i, �? � < µ`I"� ❑ g) Highest adjacent grade(HAG) 7. 5fl.(m) � °''«��6 �fl j ❑ h) No.of permanent openings(flood vents)within 1 ft.above adjacent grade N/A � �z'�:�� '.:� ``' ❑ i)Total area of all permanent openings(flood vents)in C3h N!A sq. in. (sq. cm) �'�� r �-f��'s SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATIO ` This cert�cation is to be signed and sealed by a land surveyor, engineer,c�r architect authorized by law to certify elevation information. 1 certify that the information in Sections A, 8, and C on this cerfificafe�presents my best efforts to interpret the data availa6le. I understand that any false statemenf may be punishable by fine or imprisonment under f 8 U.S. Code, Section 1001. CERTIFIER'S NAME Donald E.Armstron8 Jr. LICENSE NUMBER 5083 TITLE Owner COMPANY NAME Donald E.Armstrong Jr.,P.L.S. ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE �ru• �_.'__ w• • •��nn nr-� r��i'-�i+�- n�'.r rr.e�i.�.rr�u��u r.rn� w.��n •� i ��-�n��.� r-�iT�i..�n ��..�� . IMPORTANT: In these spaces,copy the corresponding information from Section A. For Insurance Compa�y.��e: t BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,andlor Bldg.No.)OR P.O.ROUTE AND BOX N0. Policy Number. . 844 Eldorado Ave CITY STATE ZiK'CODE _ Company NAIC Number Clearwater FL 34630 SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTiFIC/eTION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official, (2)insurance agent/company, and (3)building ownar. COMMENTS Elevations shown are based upon City of Clearwater Bench Mark"15-93-DA-09",Elevation=5.636 Feet,NGVD-1929 ❑ Check here if attachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FC1F2 ZONE AO AND ZONE A(Wi7HOUT BFE) For Zone AO and Zone A(without BFE), complete Items E1 through E4. If the E/evation C� tificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be comp/eted. 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 floor(including basement or enclosure)of the building is _ft.(m)_in.(cm)0 above or ❑ below(check one) the highest adjacent grade. � E3. For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is _ft.(m)_in.(cm)above the highest adjacent grade. E4. For Zone AO only: If no flood depth number is available, is the top ofi 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. 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(OPTlONAL) The local official who is authorized by law or ordinance to administer the communitys 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. G1. �The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect Mrho is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. �A community offi�ial comFleted Sedion E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3. �The fallowing 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�Substantial Improvement G8. Elevation of as-built lowest floor(including basement)of the building is: _ft.(m) Datum: G9. BFE or(in Zone AO)depth of flooding at the building site is: _ft.(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS ❑ Check here if attachments •..-�� w.vrl+ w� � �e�r�n�� '-'+�r��u� rr��• �'._" n� n� w��'+nn