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921 ELDORADO AVE � . . _ . .,.__ . ., , • -__.__4�--__ _,.__ .__ . �____ _ . _ _ O.M.B.No3067•0077 --- -ELEVATION CERTIFiCATE -- - ----�-- -- �----- Exp«e�May��,1993 ___..___ _.______ __. __. _ . ____�EDEAAL EMEAGENCY MANAGEMENT AGENCY _ ..__ _ .' NATIONAL F�OOD INSURANCE PROGRAM y ' ATTENTION:Use of this certificate does not pravide a waiver of the flood insurance purchase requirement. This form is used aniy to � provide elevatian information necessary to ensure compfiance with applicable community floodplain management ordinances,to determine the proper insurance premium rate,and/or to support a request for a Letter of Map Amendment or Revision(IOMA or LOMR). Instructions for completing this form can be fou�d on the followi�g pages. SECTION A PRaPEATY INFORMATION FOR INSURANCE COMPANV USE BUILDING OWNEA'S NAME POLICY NUMBER �n��- C'oc�. L� STREET AODFESS(Incluamg Aot..Unrt.Surte ana�or 81dg.Numder�QA P.O.ROUTE ANO BOX NUMBEA COMPANY NAIC NUMBEA `� E o(�A OTHER DESCRIPTION(Lot anci BIocK Numoers,etc.; L�T I c�c� 5 l MA-,�La�-L�yl �u �.D r v ►s t oiv ClTY ^��W ^ � � F LATE ZIP CODE 1 � \.. �t� SECTION B FLOOD INSURANCE AATE MAP{F1RM) INFORMATION Provide the follawing from the proper FiRM (Sre Instructians): 1.COMMUNITY NUMBEA 2.PANEL�UMBEa 3.SUFFIX 4.DATE OF F1FiM INDEX 5.rIRM ZUNE 6.BASE'rLOOD ELEVATION � ��O� r Q�O � � � � ^�� (in AO Zones,use tlepth) �p 7. Indicate the slevation datum system used on the FIRM for Base Fiood E!evations(BFEj: _NGVD'29 �Other(describe on back) 8. For Zones A or V,where no BFc is provided on the FIRM, and the community has established a BFE for this building site, indicate the community's BFE: ._,feet NGVD (or other F1RM datum-see Section B. Item 7). SECTION C BUILDING Ei.EVATION INFORMATION 1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best � describes the subject building's reference level� . 2(a). FIRM Zones A1-A30,AE,AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation of ! ' � ! .!�'feet NGVD (or other F1RM datum-see Section B, Item 7). (b). FIRM Zones V1-V30, VE, and V(with BFEj. The bottom of the lowest horizontal structural member of the reference level from � the selected diagram,is at an elevation of' ' � I I !,'�feet NGVD(or other FIRM datum-see Section B, Item 7). (c). FIRM Zone A(without BFE). The floor used as the reference level from the selected diagram is ��'._,�fest above r! or below� (check one) the highest grade adjacent to the buifding. (d). F1RM Zone AO. The floor used as the reference level from the selected diagram is �'.`feet above❑ or below�(check one)the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor(re�erence level)elevated in accordance with the community's floodplain management ordinance? � Yes � No ❑ Unknown 3. Indicate the elevation datum system used in determining the above reference level elevations:.r�' NGVD'29 ❑ Other(describe t= under Comments on Page 2}. (NOTE: lf the e/evation datum used in measuring the e/evations is different than that used on fhe FIRM (see Section B, ltem 7J, then convert the e/evafions to the datum system used on fhe FlRM and show the conversion equation under Comments on Page 2.) 4. Elevation reference mark used appears on FIRM: ❑ Yes ❑No (See Instructions on Page 4) 5.The reference level elevation is based on: � actual construction ❑ construction drawings (NOTE: Use of construction drawings is on/y valid if the building does not yet have the reference level floor in place,in which case this certificate will on/y be valid for the building during the course of construction. A post-construction Elevation Certificate wi11 be required on�e construction is comp/ete.) 6.The elevation of the lowest grade immediately adjacent to the building is:' I I I .'Z'- fest NGVO (or other FIRM datum-see Section B, Item 7). ' SECTION D COMMUNITY INFORMATION -- 1. If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C,Item 1 � � is not the"lowest floor"as defined in the community's floodplain management ordinance,the elevation of the building's"lowest . floor"as defined by the ordinance is: �J.L� feet NGVD(or other FIRM datum-see Seciion 8, Item�. � 2. Date of the start of construction or substantial improvement . FfMA Form 81-31�MAY 90 - REPLACES ALL PREVIOUS EDI710NS SEE REVERSE SIDE FOR CONTINUATION . ._ . - :_--- " .. _. —�_:�. -v�.... .._.:, ..._.t . -.. -. � - '`� - �. - ." . . _ ' _e, _ � '- , -SECTION E CERTIFlCATION ,'�.- w. - � ' -,... -_ — - . .� ._ � _ .� - _ - -- _ This certification is to be signed by a land surveyor,engineer,or architect who is aUthorized by state or local law to certify elevation � information when the elevation information for Zones A1—A30,AE,AH,A(with sFE),Vi—V30,VE,and V(with BFE)is required. Community officials who are authorized by local law or ordinance to provide floodplain management information, may also sign the �. certification. In the case of Zones AO and A(without a FEMA or community issued BFE},a building official,a property owner,or an owner's representative may also sign the certification. - � '" - -- Reference level diagrams 6, 7 and 8- Distinguishing Features—If the cartifier is unable to certify to breakaway/non-breakaway wall, enclosure size, location of servicing equipment, area use,wall openings,or unfinished area Feature{s),then list the Feature(s) not included in the certification under Comments below. The diagram number, Section C, Item 1, must still be entered. l certify that the information in Secfions B and C on this certificafe represenis my best efforts to in2erpret the dafa available. l understand that any false siatement may be punishab/e by frne or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME LICENSE NUMBER(or Affix Seal) (Zon�t�p �• �u �!-� �SM 3 7�7 TITLE COMPANY NAME � �� . ��E72S-�oN� N � . u.tiv, �,�C ADDFES CITY STATE ZIP I � 3 -� c. �D C f t,,� � 3� 1 S SIGNATURE � DATE PHONE Copies should be made of this Certific e for:1)community official,2)insurance agenUcompany,and 3) building owner. COMMENTS: � ON NI(TFI ON PILES, � ti• .� SlAB . BASEMENT PIERS.OR COLUMNS A V A A V ZONES ZONES 20NES ZONES ZONES � REFERENCE PEFERENCE �E LEVEL AEFERENCE IEVEI �ppp ��L SLEVATION ♦ �_ 4.SV � BASE 1::�i:r:'CS�'�'.:.''vy�` B�SE FLO00 ..:.:``��;:::: .ADJACENT :; "" REFERENCE FLOOO EIEVATION GRAOE ' '�_K:: LE�EL ELEVA710N REFERENCE Ap,IACENT ti! ' LEVEI GRAOE ;?� � :i:n:-:-:_,, " - a.�::;.,:;`'. - ,•i;r:` �;:S:i��:`°::::�::-�'.::� , . :�;:?`i - �i:'r:;:;:::=.'i;�='<-�:=:� �.:: . . . .r::�:.:.,_,.:. .�.'�i�AQIACENT�;. - �.�7 GRME .....'.��:".`:':.::... :....''}IN 11'.��:'•: �The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones. _ �- Elevations for all A Zones should be measured at the top of the reference level floor. • - - Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member. : .=_ � _._ _. _. . _, .. -- ------ --.—._ _ ___ _ _._ _�. ._._.__.____- - -___._. . . ... . __, � _ .. . . - • ---. ___. - - -.... - - . _ �. ' __a .:t,:?`• 3��} , � Page 2 � • . f.h -£��—`,��•,:�:. _ .-r._..._ ....._._ ,_. __ ----- - ,t �.,�+_-� _ _ • - _..._ _' :._. - --------- . . . -- —'-_ __ .�: -- . � ., .. . . + as' :i � � 4 _ _ _ _ �. _ ,'E . . . . . ... . .. . , . f a . ..�!s vC / � U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERALEMERGENCY MANAGEMENT AGENCY Natio❑al Flood Insuranre Program IMPORTANT: Follow the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION A1. Building Owner's Name SYLVIA AND FINIS COULIS A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P0. Route and Box No. OMB No. 1660-0008 Expiration Date: July 31, 2015 FOR' INSURANCE COMPANY USE Policy Number. Company NAIC Number. City CLEARWATER State F� ZIP COde 33767-1121 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) PARCEL 05-29-15-54666-051-0010, BLOCK 51, LOT 1, MANDALAY SUB, PLAT BOOK 014, PAGE 032, PINELLAS COUNTY, FLORIDA A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 2�.9986 Long. 82.82�2 Horizontal Datum: ❑ NAD 1927 0 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 ONE-A A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enciosure(s) N�A sq ft a) Square footage of attached garage N'4 sq ft b) No. of permanent flood openings in the crawlspace or b) Number of permanent flood openings in the attached garage enclosure(s) within 1.0 foot above adjacent grade N�A within 1.0 foot above adjacent grade NA c) Total net area of flood openings in A8.b N�'4 sq in c) Total net area of flood openings in A9.b N�A 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 CLEARWATER CITY OF 125096 B4. Map/Panel Number B5. Suffix 66. FIRM Index Date 12103C0102 � G � 08/18/2009 B2. County Name PINELLAS 67. FIRM Panel Effective/ Revised Date 09/03/2003 B3. State FL B8. Flood Zone(s) 69. Base Flood Elevation(s) (Zone AO, use base flood depth) AE 12.0 FT B10. 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: B12. Is the building Iocated 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 Consiruction *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: �PS 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 buildin� elevations must be the same as that used for the BFE. 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) � 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 deck or stairs, including structural support Check the measurement used. 6.51 � feet ❑ meters NA � feet ❑ meters N�A � feet ❑ meters N!A � feet ❑ meters 5.�2 � feet ❑ meters 4.76 � feet ❑ meters 5.00 � feet ❑ meters 4•�s � 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 information. 1 certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ❑ Check here if attachments. licensed land surveyor? � Yes ❑ No Ceitifier'S Name License Number BILL H. HYATT, JR #4636 Title Company Name PRESIDENT KNOW IT NOW INC Address City State ZIP Code 1497 MAIN STREET #321 DUNEDIN FL 34698 Signature Date Telephone 5-1-15 (727) 415-8305 FEMA Form 086-0-33 (7/12) See reverse side for continuation. Replaces all previous editions. ti ELEVATION CERTIFICATE, page 2 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 PO. Route and Box Na Policy Number. 921 ELDORADO AVENUE City State ZIPCode CompanyNAlGNumber: CLEARWATER FL 33767-1121 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 IF EQUIPMENT IS LISTED ON PRIOR PAGE IS BASE OF AIR CONDITIONER UNIT Signature �.., / .. Date 05/01/2015 �•�_�- . -,v� 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 N� . A � 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 or Owner's Authorized Representative's Name Address City State ZIP Code Signature Comments Date Telephone ❑ 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 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—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: . ❑ 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 Community Name CLEARWATER CITY OF Telephone Signature Date Comments ❑ Check here if attachments. FEMA Form 086-0-33 (7/12) Replaces all previous editions. � �,Y ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS CONTINUATION PAGE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. ADDRESS: 921 ELDORADO AVE CLEARWATER, FL 33767 PICS TAKEN 4/28/2015 FRONT VIEW AND CONTINUING AROUND BUILDING , .�.. °.�'y�"„ .. Y��i��11� . �' '�t^?' r �„�-i""��-, y - q � r. � �: ��- ..� . . _ r �` f � �„ •Y _. .�...., _ . .,._�y —.r� . ,., ` . .....,:....:'.«:d ". ! �µ,�;, ' . .....,�...._ _ "' .�a.�-b:u:.^"'F � „ '_ � # M,,-,�x'.. , , ` .�-�.. ` . � . �� ', Y �. - � ��# t�:�'� 3 �. ; � ': f�'.� '6 zz,' ¢ ..t,�, *' � �r. ?�;> �"�'t . � � �� .�� `� ,- �. 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