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1410 SUNSET DR U.S.DEPARTMENT OF HOMELAND SECURITY ELE!(ATION CERTIFIC/�TE OMB No 1660-0008 Expires March 31,2D12 Federai Emergency Management Agexy • ' ' National Flood Insurance Program important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION For losurance Company Use: ' pt. 8uilding Ovmers Name Scott Boses Pdicy Number _ - A2. Building SVeet Address(inciuding Apt.,Unit,Suite,andlor Bidg.NoJ or P.O.Roule and Box No. � CompBhy NAIC Number 1410 Sunset Drive ._. .____ ..._.__ - City Clearwater State FI ZIP Cafe 33755 A3. Property Descnption(Lot and Block Numbers,Tax Parcei Number,Legal Descriptfon,etc.) Tax Parcel ID if 09-29-15-80442-D00-0180 _.__.. -----� A4. $uikling Use{e.g.,ResideMia{,Noo-Residential.Addttion,Accessory,etc.)Residential A5. LatitudelLongitude:Lat.N2758-49 Long.W82-47-56 Horizontal Datum: ❑ NAQ 1927 � NAD 1983 A6. Attach et least 2 photographs of the tuilding if the Certificate is being used to obtain flood insurance. A7. BuiWing Diagram Number tA A8. Fa a twikfing with a crawkspace or enclosure(s): A9 Fa a building with an attached garage: a) Square footage of crawfspace or enclosure(s) l�q1 sq ft a) Square footage of attached garage 572 sq ft b) No.of permanent flood openings in the crawtspace or 5) No.of permanent flood openings in the attached garege endosure(s)within 1 A foot above adjaceni grade NJA within 1.O/oot above adjaceM grede t�/A c) ToteE net area of tlood openings in AS.b !!� sq in c} Total net area ot flood openings in A9.b t�1A sq in d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � Nu SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATtON -- --- ---- — 61.NFIP Community Name&Community Number 82.County Name 63.State CityofCiearvrater 725096 ____....--_- __ Pinelias . Florida --_ --- ___ _ 64.Map!?anei Number 85.Su�x 86.FIRM Index B7.FIRM Panel 88.Flood 89 Base Flood E�evation(s)(Zone 12103C 0106H H Date EttectiveiRevised Date ; Zone(s) � AO,use base flood depth} &78-2009 May 17,20D5 i X,AE 8 VE I AE t7,VE 14' --__... _.._..._ 810. Indicate the source of the Base Flood Elevation{BFE)data ar base fbod depth errtered in Item B9. ❑ FIS Profiie � FIRM ❑ Community Oetermined ❑ Other(Describe)_ B14. Indkate elevaGon datum used fw BFE in ttem 89: ❑ NGVD 7928 � NAVD 1988 O �her(Describe]_ Bf 2. �s the building located in a Coastai Barrier R�ources System(CBRS)area or Otherwise Protected Area(OPAj? ❑ Yes � No Designation Date N� O CBRS ❑ OPA SECTiON C-BUILDING ELEVATiON INFORMATION(SURVEY REQUIRED) Ct. B�aWing elevatfons are based on: Q Conshuciion Drawings' L7 BuUding Under Constroctio�' � Finiahed Constnictiori , 'A new Elevatian Certificate witi be required when consbuction of the buiiding is complete. C2. Elevatioru-Zopes At-A30,AE,AH,A(with BFE),VE,W-�/30,V(wiUi BFE),AR,AR/A,AR/AE,ARlAt-A30,ARJAH,AR/AO. Compiete items C2.a-h below accading to the buliding diagram specified in ttem A7. Use the same datum as the BFE. Be�chmarit Utilized �-06_Vertical Datum NAVD 7966 ConversioNCommeMS None Chedcthe measurementusetl. a} Top of botfom floor(�dWing basemeM,crawispace.or encloswe floor)],g.4 �teet ❑meters(PUerto Rico onty) b) Top of the next higher floor �._ ❑�� ❑��(Puerto Rico oniy) c) Bottom of the lowest hor¢artai sinxhaal member(V Zorces ontY) t�/ .__ T�teet ❑meiers(Pue�to Rico onlY) d) Attached garage(top of s�ab) 13.� �teet O��(�erto Rico onty) e) Low�t elevation oi machinery a aqulpmeM servici�g the buiMing t�.$ �teet ❑meters(Puerto Rico aNy) (Describe type of e4uipmen!and location in Comments) fj Loweat adjacent(finished)grade rreM to buitdi�(LAGj 12.8 �feet �meters(?uerto Rico only) g) Highesi adjacent(finMhed)grade ne�R to buik3ing(HAG) 14.0 �feet �meters(Puerto Rico oniy) h) Lowest adjacent grade at lowest elevation of deck or stairs,incW�i� 13.4 �feet ❑meters(Puerto Rico only) stnicturel support SECTION D-SURVEYOR ENCi1NEER,OR ARCHRECT CERTlFICATION This certification is to be signed and sealed by a land surveyor,engirteer,a archAect author¢ed by law to certify elevation information, f ce�tify that the information on this CerUficate reprasents my best ellorfs to interpret the data evadahle. 1 understand that any fafse statement may be punishable by fine or imprisonment undei 18 U.S.Code,SecYion 1001. f:' {��_,, � Check here if comments are provided on back of form. Were iatitude and lorgitude in Sedion A provided by a ��'� ? ..--�-�, �icensed Wnd surveyon � Yes ❑ No �� 1�� --- _...__ _.._ Cert�er's Name Mark S.lischalk,PLS Licertse Number 5727 �? r. - -7:�-? __ _ __- __ - -_ C. , ;�/f._i TMe President Company Name Zarra Boyd,inc. � ---- __._._ -- Address 148�BeiVees Street,Sude 3 Cdy Ounedin State FL Z+P Code 34698 ..., . -- -- - t ' _ �� _1�:�. Signature �r � Date 10-09-12 Telephone 727-738-9010 (-: r; ,�._...---`... ,. ,�;.-� t ...'" `s . __. .- � �...�_ __. ...._._ ".., . . . .. ��-'� � � ��" 1410 SUNSET DR BCP2012-11145 E/C BOSES, SCOTT R TRE Zoning: Low Medium Density Re Atlas#:268B IMPORTANT: in these spaces,copy the co�responding information ftom Section A. �or Insurance Company Use: Buiking Street Address(including Apt.,Unit,Sufte,and/or Bfdg.No.)or P.O.Route and Box No. Pdicy Number � • • ' 1410 Sunset Dnve ____ _. ______------ ---- City Clearv✓ater State FL ZIP Code 33755 Company NAIC Number SECTION D-SURVEYOR,ENGINEER OR ARCHITECT CERTIFICATION(CONTINUED) ; Copy both sides of ihis Eievation Certificate fa(7)community official,(2)insure�ce agenUcompany,end(3j buildi�7 owner. � ComrtreMs The sUUCture is located In Flood Zone X and Fiood Zone AE.The elevaGon listed i�item C2.e is the top of the air conddioner slab.The benchmarlc"G-06"Is a City of Clearwater benchma��.--'``� �� , /..� / �� y�� .�f _ --.__----- _.. -._-- Sgnafure Mark S.L�scha�k LS --- �''y Date 10.09-12 �� Check here tf attachmeMs SECTION E-BUILpING E�EVATIaN INFORMATION(SURVEY NOT REQUIRED)FOR 20NE AO AND ZONE A(WITNOUT BFE) For Zones AO and A(without BFE),camplete ttems E1-E5. If the Certifkate is IMended to support a LOMA w LOMR-F request,comp�Me Sections A,B, and C. For ltems Ef-E4,use naWral grade,if available. Check the measurement used. in Puerto Rico only,enter meters. Et. Provlde elevation information tor the fdlowing end check the appropriate boxes to show whether the etevation is above or below tltie highest adjaceM grade(HAG)and the lowest adjacerk grede(LAG). e)Top of bottom fiow(nciuding basement,crawlspace,or enGOSUre)is_� ❑teet ❑meters []above or 0 belaw the FtAG. b)Top oi bottom ftoor(inGtxling basement,crawlspace,or enGOSUre)fs_ �feet ❑meters �above or❑ below the IAG. E2. Fw Buildi�g Dlagrams fi-9 ww�h permanaM ilood openings provided in Section A Items 8 and/or 9(see�_p�ges&9 of Instructions),the next higher ftoor (elevation CZ.b in the diagrams)of the building Is _ ❑feet ❑meters ❑above or ❑below the HAG. E3. Attached garage(top of sFab}is ❑feet ❑meters �aDove w ❑below Uie FiAG. E4. Top of plaifam of machi�ery and/w equipmeM servicing the 6uilding is�` CI feet ❑meters ❑above or j]below the HAG. ES. Zo�e AO only: if no fiood depth number is availaWe,is the top ot the bottom Aoor elevated fn accardance with the community's floodplain management ordinance? ❑Yes O No ❑ Un�mown. The local officiai must certi(y this infortnation in Section G. � . SECT(ON F-PROPERTY OWNER(OR OWNER'S REPRESENTATNE)CERTiFiCATION The property owner or owners authorized representative who completes Sections A,B,and E for Zone A(without a FEMA-is,wed or community-issued BFE) or Zone AO m�t sign hera. The statemerrts!n Secfions A,8,end E are correct ro Me best ot my knowtedpe. ; Property Owners or Owners Author¢ed Representative's Name ; Address City State 21P Code � -- ---------- i Signature Date Telephone CommeMs � ` ----- i ❑Check here'rf attachments SECTION G-COMMUNITY INFORMATION(OPTIONAL)• t The local officiai who is aulhorized by law or o�dinance to administer the communiry's floodplain management ordina�e can compiete Sedions A,8,C(or E), and G of this Elevation Certihcate. Complete the applicable dem(s)a nd sign below. Check the measurement used in ttems G8 and G9. G7.❑ The infortnation irt Section C rvas taken from other documentatioti that has been signed and sealed by a�icensed surveyor,engineer,a architect who � is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the CommeMS area below.) � G2.Cj A community officiai compieted Sedion E for a buflding located in Zone A(without a FEMA-issued w community-issued 6FE)or Zone AO. G3.❑ The following information(ftems G4-G9)is provided fa community floodplain management purposes. IG4.P`-- ermR Number G5. Oate Permd Issued � G6. Date Certificate Of CompliancelOccupancy Issued � i � � i IG7. This permit has been issued far: ❑New Construction ❑Subsiantial Improvement I i G8. Elevation of asbuitl lowest Aoor(including basement)of the buiiding:__ ❑feet ❑meters(PR)Datum_ G9. BFE or(n Zone AO)depth of flooding at the buikling site: ^_ ❑feet �met�s(PR)Datum _ j G10.Community's desgn flood elevatfon __ ❑feet ❑meters(PR)Oatum _ � --------------- Local Official's Name Trtle � ------ ; Community Name Telephone Signature Date : Comments --- ❑Check here H attachments