Loading...
417 WASHINGTON AVE N'U.S. DEPARTMENT OF HOMELAND SECURITY f ' DERAL EMERGENCY MANAGEMENT AGENCY Nationas.Flood /nykrance Program Important: Read the instructions on pages 1-9. ELEVATION CERTIFICATE SECTION A - PROPERTY INFORMATION Al. Building Owner's Name Chris Blackerby A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 417 N Washington Avenue City Clearwater State FL ZIP Code 33755 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 16, Block 9, Country Club Addition A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc. A5. Latiti,de/Longitude: Lat. Long. Horizontal Datum: A6. Attach at least 2 photographs of the building if the Certificate Is being used A7. Building Diagram Number 1 A8. For a building with a crawlspace or enclosure(s): a) Square footage of crlspace or endpsure(s) sq ft b) Number of permanent flood openings Tri the crawlspace or enclosure(s) within 1.0 foot above adjacent grade Q c) Total net area of flood openings in A8.b Q sq in d) Engineered flood openings? 0 Yes ❑ No )Residential 0 NAD 1927 0 NAD 1983 to obtain flood insurance. Pfs OMB No. 1660-0008 Expiration Date: July 31, 2015 ;E RMOSANCE ,CO,MFANYAVSi A9. For a building with an attached garage: a) Square footage of attached garage N/A sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade Q c) Total net area of flood openings in A9.b 0 sq in d) Engineered flood openings? 0 Yes ❑ No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number City of Clearwater 125096 62. County Name Pinellas B3. State Florida 84. Map/Panel Number 1213C0106 85. Suffix H B6. FIRM Index Date 5-17-05 B7. FIRM Panel Effective/Revised Date 5-17-05 B8. Flood Zone(s) B9. Base Flood Elevation(s) (Zone AO, use base flood depth) 24' B10. Indicate the source of he Base Flood Elevation (BFE) data or base flood depth entered in Item B9. 0 FIS Profile 0 FIRM 0 Community Determined 0 Other/Source: B11. Indicate elevation datum used for BFE in Item 69: 0 NGVD 1929 0 NAVD 1988 0 Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? Designation Date: 0 CBRS 0 OPA ❑ Yes ❑ No SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: 0 Construction Drawings' ® Building Under Construction' 0 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: BREEZE W Vertical Datum: FLEV= 43.86' (N.A.V.D.) Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 0 NAVD 1988 0 Other/Source: Datum used for building 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) f) 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 N•A N.A N.A N.A �•Q 24.1 N•A Check the measurement used. ❑ feet 0 meters ❑ feet 0 meters ❑ feet 0 meters ❑ feet 0 meters ❑ feet 0 meters 0 feet 0 meters ❑ feet 0 meters ❑ feet 0 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. / 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 0 Check here if attachments. licensed land Surveyor? ® Yes 0 No Certifier's Name Philip C. Stock License Number RLS 3035 Title President Company Name Target Land Surveying, Inc. Address 516 Lakeside Place City Largo State FL ZIP Code 33771 Signature , Date .3-19-13 Telephone (727) 784-0573 FEMA Form 086-0-33 (7/12) See reverse side for continuation. Replaces all previous editions. VIVV VP'1 „V,\ V1..-1♦111 I.afl 1 V, r.ayV IMPORTANT: In these spaces, copy the corresponding information from Section A. Buildirig Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 417 N Washington Avenue FOR INSU NCE COMPANY USE Policy' Number City Clearwater State FL ZIP Code 33755 Con pany,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 job# 130315.01 Signature Date 3-19-13 SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete.tems E1 -E5. If the Certificate is Intended to support a LOMA or LOMR-F request, complete Sections A, 8, and C. For Items E1 -E4, use natural grade, If ailable. Check the measurement used. In Puerto Rico only, enter meters. El. 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 0 feet 0 meters © above or 0 below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is 0 feet 0 meters 0 above or ❑ below the LAG. 82. For Building Diagrams 6-9 with permanent flood openings provided In Section A Items 8 and/or 9 (see ages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building Is 0 feet 0 meters 0 above or 0 below the HAG. E3. Attached garage (top of slab) Is 0 feet 0 meters 0 above or 0 below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is 0 feet 0 meters 0 above or 0 below the HAG. E5. Zone AO only: If no flood depth number is available, Is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? 0 Yes 0 No 0 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 0 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, 8, C (or E), and G of this Elevation Certificate. Complete the applicable Item(s) and sign below. Check the measurement used In Items 38-G10. In Puerto Rico only, enter meters. 31, 0 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. 0 A community official completed Section E for a building located in Zone A (without a FEMA -Issued or community -Issued BFE) or Zone AO. 33. 0 The following information (Items G4 -G10) Is provided for community floodplain management purposes. 34. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: G8. Elevation of as -built lowest floor (Including 39. BFE or (in Zone AQ) depth of flooding 310. Community's design flood elevation: 0 New Construction 0 Substantial Improvement basement) of the building: 0 feet 0 feet 0 feet 0 meters 0 meters 0 meters Datum at the building site: Datum Datum Local Official's Name Title Community Name Telephone Signature Date Comments 0 Check here if attachments. FEMA Form 086-0-33 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 3 Building Photographs See Instructions for Item A6. IMPORTANT: In these spaces, copy the corresponding Information from Section A. eot Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. State ZIP Code FOR (NSURANI Polley Number,. Co early NALC Number: ,isinit the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions Iters AG, 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 lic al :d in Stiction Ab. If submitting more photographs than will fit on this page, use the Continuation Page. FE.,11,1.4 ons 0f3h-0-33 {7/12) Chep#acc>s all previous editions. E:I_L�VATION CERTIFICATE, page 4 Building Photographs Continuation Page I P(RTANT: In these spaces, copy the corresponding information from Suction A. dross (including Apt., Unit, Suite, and/or Bldg. No.) or P.U. Route and Box No. State ZIP Code FOR iNSURANCE CO Policy Number; py NAIC N tin <; more photographs than will fit on the preceding page, affix the additional photographs below, Identify all photographs -eh date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, aphs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. FEMA torn 7/12) Replaces all pre'ricau< odilic;n:-, U.S. DEPARTMENT OF HOMELAND SECURITY r(DERAL EMERGENCY MANAGEMENT AGENCY National Rood Insurance Program Important: Read the instructions on pages 1-9. ELEVATION CERTIFICATE SECTION A- PROPERTY INFORMATION OMB No. 1660-0008 Expiration Date: July 31, 2015 Al. Building Owner's Name Chris Blackerby A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 417 N Washington Avenue City Clearwater State FL ZIP Code 33755 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 16, Block 9, Country Club Addition A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) A5. Latitude/Longitude: Lat. Long. Horizontal Datum: A6. Attach at least 2 photographs of the building if the Certificate is being used A7. Building Diagram Number a A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enc sures) )y[e4 sq ft b) Number of permanent flood openings the crawlspace or enclosure(s) within 1.0 foot above adjacent grade Q c) Total net area of flood openings in A8.b Q sq In d) Engineered flood openings? 0 Yes 0 No Residential ❑ NAD 1927 0 NAD 1983 to obtain flood insurance. A9. For a building with an attached garage: a) Square footage of attached garage NLA sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade Q c) Total net area of flood openings in A9.b Q sq in d) Engineered flood openings? 0 Yes 0 No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 131. NFIP Community Name & Community Number City of Clearwater 125096 B2. County Name Pinellas 83. State Florida B4. Map/Panel Number B5. Suffix 86. FIRM Index Date " 87. FIRM Panel B8. Flood B9. Base Flood Elevations) (Zone 1213C0106 H 5-17-05 Effective/Revised Date Zone(s) AO, use base flood depth) 5-17-05 AE 24' B10. Indicate the source of he Base Flood Elevation (BFE) data or base flood depth entered in Item 89. ❑ FIS Profile 0 FIRM ❑ Community Determined 0 Other/Source: B11. Indicate elevation datum used for BFE in Item 89: 0 NGVD 1929 0 NAVD 1988 0 Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? Designation Date: 0 CBRS 0 OPA ❑ Yes ❑ No SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: 0 Construction Drawings' ® Building Under Construction* 0 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: BREEZE W Vertical Datum: gLEV= 43.86' (N.A.V.D.) Indicate elevation datum used for the elevations in items a) through h) below. 0 NGVD 1929 0 NAVD 1988 0 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) 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) f) 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 X4.9 N.9 24.1 ❑ feet ❑ feet ❑ feet ❑ feet ❑ feet ❑ feet ❑ feet ❑ feet ❑ meters ❑ meters ❑ meters ❑ meters ❑ meters ❑ meters ❑ meters ❑ 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 0 Check here if attachments. licensed land surveyor? ® Yes 0 No Certifiers Name Philip C. Stock License Number RLS 3035 Title President Company Name Target Land Surveying, Inc. Address 516 Lakeside Place City Largo State FL ZIP Code 33771 SignatureDate .3-19-13 Telephone (727) 784-0573 FEMA Form 086-0-33 (7/12) See reverse side for continuation. Replaces all previous editions. V fl I wI• #I_ S 1 11 w., , 1-, raw r IMPORTANT; In these spaces, copy the corresponding Information from Section A. Building Street Address jincluding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 417 N Washington Avenue City Clearwater State FL ZIP Code 33755 lryj� .h�',IA 44.! 't1 ppm 1, 11 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 job# 130315.01 Signature Date 3-19-13 SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete{tams 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 Araliabie. Check the measurement used. In Puerto Rico only, enter meters. E 1. 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 0 feet 0 meters 0 above or 0 below the HAG. b) Top of bottom floor (Including basement, crawlspace, or enclosure) is 0 feet 0 meters 0 above or 0 below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see ages 8-9 of Instructions), the next higher floor (elevation C2.b In the diagrams) of the building is ❑ feet 0 meters 0 above or [below the HAG. E3. Attached garage (top of slab) is 0 feet ❑ meters 0 above or 0 below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is 0 feet ❑ meters 0 above or 0 below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated In accordance with the community's floodplain management ordinance? 0 Yes 0 No 0 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 0 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. 01. ❑ 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. 0 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. 0 The following information (Items 04-G10) 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: 0 New Construction 0 Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: 0 feet 0 meters Datum G9. BFE or (In Zone AO) depth of flooding at the building site: • 0 feet 0 meters Datum G10. Community's design flood elevation: 0 feet 0 meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments 0 Check here if attachments. FEMA Form 086-0-33 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 3 Building Photographs See Instructions for Item A6. IMPORTANT: In these spaces, copy the corresponding Information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. City State ZIP Code tf 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, indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. Front Vie\ FEMA Form 086-0-33 (7/ ELEVATION CERTIFICATE, page 4 Building Photographs Continuation Page IMPORTANT: In these spaces, copy the corresponding Information from Section A Building Street Address (including Apt., Unit, Suite, and/orBldg. No.) or P.O. Route and Box No, State ZIP Code if submitting more photographs than wilt fit on the preceding page, affix the additional photographs below. Identify alt photographs I with: date taken, "Front View" and "Rear View"; and, if required, "Rift Side View" and "Left Side View." When applicable, L photographs must show the foundation with representative examples of the flood openings or vents, as indicated In Section A8. FEMA Form 086-0 33 (7/12) Replaces all previous editions. U.S.DEPAf2TMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE �, n � �����?. ��F �� E �iDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 Nation�i�.Flaod/n�}�rance Program Important: Read the instructions on pages 1-9. Expiration Date:July 31, 2015 SECTION A-PROPERTY INFORMATION ��QR INSURANCE CO,IWpAN�'�JS�� A1. Building Owner's Name Chris Blackerby --° �-°�" " + J ,� � A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O. Route and Box Na % ; . a ;,v,,;:`����, ,� �� 417 N Washington Avenue � `� �� � � ..� � � City Clearwater State FL ZIP Code 33755 �� r E A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) , �' � �, ;„Ar - Lot 16,Block 9,Country Ciub Addition y . °' � f _ �{ A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential A5. Latit�,de/Longitude:Lat. Long. Horizontaf 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 1 B A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or encl�sure(s) N/A sq ft a) Square footage of attached garage N/A sq ft b) Number of permanent flood openings'4'n the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s)within 1.0 foot above adjacent grade Q within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b Q sq in c) Total net area of flood openings in A9.b 0 sq in d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes ❑ No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 61.NFIP Community Name&Community Number 82.County Name 83.State Ciry of Cleanvater 125096 Pinellas Florida 64.Map/Panel Number B5.Su�x 66.FIRM Index Date� 67.FIRM Panel 68.Flood B9.Base Flood Elevation(s)(Zone 1213C0706 H 5-17-05 Effective/Revised Date Zone(s) AO,use base flood depth) 5-17-05 AE 24' 610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69. ❑ FIS Profile ❑ FIRM ❑ Community Determined ❑ OthedSource: B11. Indicate elevation datum used for BFE in Item 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 wili 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:BREEZE W Vertical Datum: ELEV=43.86'(N.A.V.D.I Indicate elevation datum used for the elevations in items a)through h)below. ❑NGVD 1929 O NAVD 1988 O 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(inGuding basement,crawlspace,or enciosure floor) 2�C.96 ❑feet ❑meters b)Top of the next higher floor N.A ❑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 N.A ❑feet ❑meters (Describe type of equipment and location in Comments) � Lowest adjacent(finished)grade next to building(LAG) 23.9 ❑feet ❑meters g) Highest adjacent(finished)grade next to building(HAG) 24.1 ❑feet ❑meters h) Lowest adjacent grade at lowest 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 information.I certify that the information on this Certificafe represents my best efforts fo 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 Certifier's Name Philip C.Stock License Number RLS 3035 Title President Company Name Target Land Surveying,Inc. �/��//� Address 516 Lakeside Place City Largo State FL ZIP Code 33771 ��' !>j�s� Signature , Date .3-19-13 Tele hone 727 784-0573 "� - - y-c�=l���= ,��,��.1 P � ) � �. j �� �''i /=_�.' FEMA Form 086-0-33(7/12) See reverse side for continuation. Replaces ali previous editions. �������v�� v�.���n �v���.� Nuyc a IMPORTANT: In these spaces, copy the corresponding information from Section A. ;,FOR,INSURANCE COMFANY:USE Buildir�j Street Qddress(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. Poll4y`NUmber.' 417 N Washington Avenue City Clearwater State FL ZIP Code 33755 Cortiparty,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 job#130315.01 - Signature ,-�� � � �� � Date 3-19-13 D, , �z-z_-�,�.�/l /�"i�".-�:� _ SECTION E=`BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),complete{t�ms 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 2Wailable.Check the measurement used.In Puerto Rico only,enter meters. E 1. 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 enGosure)is ❑feet ❑meters ❑above or� below the HAG. b)Top of bottom floor(including basement,crawlspace,or enGosure)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 fs ❑feet ❑meters ❑above or ❑below the HAG. E3. Attached garage(top of siab)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 compietes 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 SecGons 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(OPTIONA�) The local official who is authorized by law or ordinance to administer the communitys floodplain management ordinance can complete SecGons 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 Secfion 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 infortnation. (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�ssued 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 Telephone Signature Date Comments ❑Check here if attachments. FEMA Form 086-0-33(7/12) Replaces all previous editions. ELE`�/��flt�f� CERT'IFiCATE, page 3 guilding Photographs a � See Instructions for Item A6. �MPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE --- ---- -- _ _ . __.. Buildiny Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number: _. _ _ .___ _ Ciry State ZIP Code Company NAIC Number. - ------------ --------- � If usiny the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions 1 � for Item A6. Identify all photographs with date taken; "Front View/' and "Rear View"; and, if required, "Right Side View" and "Left Side � i View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as i ; indicated in Section Ab. If submitting more photographs than will fit on this page,use the Continuation Page. �__---- ---- --_---_-� -__---- -- - _ __ _ ; + Front View � , � i I I i � �`�R ►�-� i O�`°� ; � ��'R��.h': x_1y-;�'.N � ( + !� I a i'y:`, i � 'i �;, I �� � ra: i � ' i I � I � Rear View � I ��.;�: � ° i � � ( � � ` �,T � ri�•,"� h.�` i .�rr.,i I .x,,.L� '�`�-i.. �;} : `�T. ' i �/. }� etF`': i I I ! I � I I � "�' �w._ -y-_` ..a I � ��".f,.��h'C�� ��- -''�'� ��� � .. �tti I FEMA Form 086-0-33(7/12) Replaces all previous editions. F..LEVA��'ION CERTIFICATE, page 4 guilding Photographs , , , � Continuation Page '� IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE I ; _—_. ___,__------ ----- Buildir�g Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Pollcy Number: , ---- _.--- ---- � �%�tY State ZIP Code Company NAIC Number. , f----------- If submitting more photographs than wili fit on the preceding page, a�x the additional photographs below. Identify all photographs ' ' � with� date taken; "Front Vie�,�' and "Rear View'; and, if required, "Right Side View" and "Left Side View." When applicable, ; �� i phc�toyraphs rnust show the foundation with representative examples of the flood openings or vents,as indicated in Section A8. __ _ _------- ' Left Side View -- --------------- � ..,4i'` .. �, .:m;:. . , � . . . � . . . , 7m'+- I �� :i� � � . - �� k� I � j Y� ,��i . . � ��� .�.. � � . . ,. .. ,, ., %h . . . ,. ,. ��, .�,�t. . � ,� � �: , , . , a�� �, ..u�;:. i . �. ; _ _...... , i , .T--. � � _ ;_�__� :�'_. , w�� i - .,�:..._,,.�.. I I �,- ,��' y� y� � '� � -..��:..w�k� ...,....� ''� k . "�_:�. . I I i s: �. . I � ��;-_�d a° ��,. � �� x� I �;������� ; ' I � � i Ri ht Side View � ;�F;� ��� r t� - r i, '�t, � ,, y, � � � .y"v "4 y;i yd � + �� � k � � ,,�{ l �a �' I y.a��`3^ .kH� .{ }�9 � vit��x �! '`,� - ' d>' � "� 4"q��2R s's (t�,'�. �" .!,,ir � � ' � fi�yral �� ��L�+��ti*�5�'. � "�c y,� ? r� i � �3r„a,f;�t�a�,�a�{�� $ :',�^ 6;j►wr��,� ~ �. bI ytw,i.�ya a�.l S.t,kYw� '�v a*^�P'?'�:;"S e+ a s f � � €��,� � a, �.� ����� � ,� I p 4r4"r � i I � � � � � . � I � �,,...i�:y' .. � � ,�„�. .,��. � :`.ta' 1 � ,f+..�:,� - � � ; � �-------- FEMA Forrn 086-0-33(7/12) Replaces all previous edition5 ('� •-� r p ..^^., -'�, , ^°, ".�, U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE � �" °�w{.� � ', � ' �' � `� / ��DERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 Nationa!Flood/rrsurance Ptogram Important: Read the instructions on pages 1-9. Expiration Date:July 31,2015 SECTION A-PROPERTY tNFORMATION A1. Building Owner's Name Chris Blackerby A2. Building Street Address(inGuding Apt.,Unit,Suite,and/or Bldg.NoJ or P.O.Route and Box No. � 417 N Washington Avenue � . . �� .,.�. Ciry Clearwater State FL ZIP Code 33755 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Lot 16,Block 9,Country Club Addition A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential A5. Latitude/Longitude:Lat. Long. 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 1 B A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawispace or enGpsure(s) NL sq ft a) Square footage of attached garage � sq ft b) Number of permanen�flood openings�"n the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s)within 1.0 foot above adjacent grade Q within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in AS.b Q sq in c) Total net area of flood openings in A9.b 0 sq in d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes ❑ No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 61.NFIP Community Name&Community Number B2.County Name B3.State City of Clearwater 125096 Pinellas Florida 64. Map/Panel Number B5.Suffix B6.FIRM Index Date� 67.FIRM Panel 68.Flood 69.Base Flood Elevation(s)(Zone 1213C0106 H 5-17-05 Effective/Revised Date Zone(s) AO,use base flood depth) 5-17-05 AE 24' B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile ❑ FIRM ❑ Community Determined ❑ OthedSource: B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ❑ NAVD 1988 ❑ Other/Source: 612. Is the building located in a Coastal Barrier Resources System(CBRS)area or Othervuise 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:BREEZE W Vertical Datum: ELEV=43.86'(N.A.V.D.I indicate elevation datum used for the elevations in items a)through h)below. ❑NGVD 1929 ❑NAVD 1988 O 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(inGuding basement,crawlspace,or enGosure floor) �¢.9¢ ❑feet ❑meters b)Top of the next higher floor N,q ❑feet ❑meters c) Bottom of the lowest horizontal structural member(V Zones only) IV.A ❑feet ❑meters d)Attached garage(top of slab) IV.A ❑feet ❑meters e)Lowest elevation of machinery or equipment servicing the building IV.A (Describe type of equipment and location in Comments) ❑feet ❑meters � Lowest adjacent(finished)grade next to building(LAG) 23.� ❑feet ❑meters g)Highest adjacent(finished)grade next to building(HAG) �.1 ❑feet ❑meters h)Lowest adjacent grade at lowest elevation of deck or stairs,including structural support IV.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 certiy elevation information.I 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 `';,�~:��'li.� . . Certifier's Name Philip C.Stock License Number RLS 3035 � ��_- ' Title President Company Name Target Land Surveying,Inc. `�J���//;� � Address 516 Lakeside Place City Largo State FL ZIP Code 33771 � ;����`-.,��,��� Signature::._ ._ �, -�-�--- Date .3-19-13 Telephone (727)784-0573 .I' :';� ' ' �` �c,r'���''^ �l��rz-��} � �^ �, - ✓ .r- � FEMA Form 086-0-33(7/12) See reverse side for continuation. Replaces all previous editions. �.������v�• v����u �ve���� Nayo�. IMPORTANT: In these spaces,copy the corresponding information from Section A. �"' ��, .�:;; Building StreetAddressjincluding Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. ^ < :,: , 417 N Washington Avenue , Y�`� � ���.: ,�ri. F �w��� Ciry Clearwater State FL ZIP Code 33755 � ,�, � �% " 3 ,.., . a�.�:� 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 job#130315.01 _„ Signature ', � Date 3-19-13 �''-'�:x�-�/��.�=T�� _ ei SECTION E—BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),completeltems 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$Uailable.Check the measurement used.In Puerto Rico only,enter meters. E 1. 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 enGosure)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�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 platfoRn 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 af 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 oommunit�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 certiry elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2.❑ A communiry 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 Pertnit 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(inGuding 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 TiGe Community Name Telephone Signature Date Comments ❑Check here if attachments. FEMA Form 086-0-33(7/12) Replaces all previous editions. ELEVATION CERTIFICATE a e3 � � p 9 � � , - Building Photographs See Instructions for Item A6. I IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR WSURANCE COMPANY USE ,I Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number: City State ZIP Code Company NAIC Number. I 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 VievW' and "Rear VievW'; and, if required, "Right Side Viev�' and "Left Side i 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 � m I I i 7 I . � .. i..�... ,,.-�.: '.. .�. r� '�: ... �^:e- I I � ' Rear View i -a: r.,." � 3 i ! � I { 1 � FEMA Form 086-0-33(7/12) Replaces all previous editions. � I ELE�ATION CERTIFICATE, page 4 guilding Photographs , � � Y 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. Pollcy Number: City State ZIP Code 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 Viev�/'; and, if required, "Right Side View" and "Left Side View." When applicable, iphotographs must show the foundation with representative examples of the flood openings or vents,as indicated in Section A8. ; Left Side View ` �� i � � � � � � � , i i , � � � � f � � � � � .- I . � . I. i ����. . �� .;. , � �i' .. .,:.�!'a'. �L. ���!, `.i.: ' I I � � I � i Ri ht Side View i � � � ,. �I� r,,...�•^''` I � "` � � �-�,�� ����� a�. � �� .�' ( ,�` � ; , �~ ��. ; .�� „ ,�,. .,r , �,,�; ; � ,�; ,��`� �`' f � � i., �.� �; I . �.. ��� � ' ' iM ° 4 . �s ��#t 1�,�;r ��a. �r.-.R'�'4 � ... ` � 9 I � l�n� 1 � I � d 1 f 1 i � f FEMA Form 086-0-33(7/12) Replaces all previous editions. - d%..^.. :�' sQ?MENT OF HOMELAIr: ' �URI �;' L`�'W i FEDERAL EMERGENCY MANAGEMENT AGENCY , National Flooillnsurance Prograin �mp01�1n�, Si A1; Building Owners Name CHRIS,BLACKERBY A2. Building;Streei Address (inGuding Apt., Unit, Suite, and #417 NORTH WASHINGTOhI AVENUE Cify CIEARWATER A4. Building l A5. ` LatitudelL A6, Attach at l AT. Building, G A8. For a buik a) 5quan ' b) Numbi or enc. c) TotaF r d} EnginE �F�����J CERTIFiC�.�� --__ __ . _ C MB No. 1660-0008 Read the instructions on pages 1-9. � Ex�iration Date' July 31, 2015 „ CTION A- PROPERTY INFORMATION ��rr^�mr�*r���mn �r Bldg. No.) or P.O. Route and BoxNo. 5tate FL ZI? Code 337; --�-�---�---._. _..._...........��..y...........v�yarvn,cw.� � .:..:. . . . UNTRY CLUBADDITION , Residential, Non-Residential, Additi n, Accessory, etc.) ResidentiaF - � F e a: L�t. 28.58'15'' Long. 082.47'25" Horizontal Datum: � NAD 1927 � NAO 9983 �hotographs of fhe building if the Ced' cate is being used to obtain flood insurance. Number' 6 i a crawispace or enclosure(s): - A9. For a building wifh an athached garage: e of crawispace or enclosur�(s) N/A sq ft a) Square footage+of attached garage N/A : sq ft manenk flood openings in the craw(' ce : b) Number � permanent flood openings in the attached garage j within 1.0 foot above ad jacent grad w i t hin 1. 0 f o o t a 6ove a djacent giade of flood openings in A$.b 0_0 sq in c) Total net area of flood openings in A9.b 0_0 sq in od openings? ❑ Yes �;N d) Engineered flood openings? � Yes '� No N 61. NFIP Communitg Name & Canrrsunity Number B2. County' Name : B3. State ' CITY OF CLEARWATER - 125096 PINELLAS' F�ORIDA' B4. Map/Panei Nomber B5. Sufltx B6: FIRM Ind x Date 67. FIRNi Panei - B8. Flood B9. Base Flood Eleva6on(s} (Zone 125096:- 0106 ° H 5-17-20 Effedive/Reviseci Date Zone(s) AO, use base flood depfh) 5-17-2005. AE:: 24,0 B1 Q. lndicate the sourcz of the Base Flaod Elevation (BFE) ata or base flood depth entered.in :kem B9'. 0 FIS Profile �, FIRM ❑ Communi termined ty ❑ OtherlSource: B7 L indicate elevation datum used for BFE in Ifem B9: Q GVD 1g2g � NAVD 1988 ❑ OtherlSource: B12. 1s the building locatetl tn a Coastat BaRier Resourees tem (CBRS) area or Othennise Protected Area (OPA)? ❑ Yes � No Designation Date: ❑ CBRS ❑ OPA SEGTION C- gUILDI G ELEVATION INFORMATION (SURVEY REQUIRED) C1. Buiiding-elevations are basetl on: ❑ Gonstructio Drawings` � Building Under Construction` � Finished Construction *A new Elsvation Ce�tificate will be requited when const ctiarr of the building is complete. C2. Elevations-Zones;A1 A30, AE, AH, A(wfth BFE), VE, 1 V30, V(with BFE7, AR, ARIA, AR/AE, AWA1 A30, AWAH, AR/AO. Complete Items C2.a-h below according tothe building diagram speeified in Ite A7. IrcPuerto.Rico only, en#er meters. Benchmark Utilizedc CIIY OF CLEARWATER Vertical Datum: NAVD = 40.715 :Udicate slevation datum used for the elevaiions in items ) through h) below. ❑ NGVD 1929 � NAVD 1988 O OthedSource: Datum used for building �Ievations m�sY be 3he same as hat used for the BFE Gheck the measuremeM used a) Top of Bottom floar {in+Guding basement, crawispace, r enGosure floor) 27.01 � feet ;❑ meters bj Top ofthe ne� fi'rgher floor 0.0 � feet ❑ meters c) Bottom of the bwest horizantal st�uctural member (V ones oniy) g.0 ❑ feet -❑ meters d) Attached garage;(top of slab) 0.0 ❑ feet ❑ meters e) Lowest elevation of machinery or equipment servicing he building 27.21 � feet ❑ meters (Oescribe type of equipment and location irrGommen ) fl Lowest atljacent:(finished) grade next to butlding (LA ) 24.� � feet ❑ meters g) Highest adjacent'(finished) grade next to building (HA ) �.,� � feet ❑ meters h) Lowest adjacenkgrade at4owest eievation of dedc oP airs, including structural support �.1 � feet ❑ meters SECTION D- SURV OR, ENGINEER, OR ARCHITECT CERTIFICATlON Ttiis certification isto be sign�d and sealed by a land surve r, engineer, orarchitect authorized by law tu certify elevation information. I certify fhaf fhe information on this Certificate �esents my best efforts 10 interpret the data availab/e. ! understand that any false statement may be punishabie by �ne or impriso»ment under 18 U. S. Code, Section 100 i. � Check here 'rf comments are provided on badc ofform. Were �atitude and longitude in Section A provided by a ❑_Check here if attachments. licensed land surveyoCt � Yes ❑ No Cehifier's Name THOMAS N. GAZELL # �icense Number PSM #5387 ,����� Title PSM CompanyNarr�e BENCHMARK SURVEY,INC. ��' �L Address 2149 SUGARBU IVE City HOLIDA State FL ZIP Code 34690 �� Signature ate 06-26-2 14 Telephone 727-847-5544 �� � FEMA Fo:m 086-0-33 (7/12) 3 See reve; se side for continuation. Replace.�all previous editions. . * .• . , .-. � ��. .:- .:- d _:. _. _ _-__. . .. . � �:: - ;^ . . ... . . . . , 3. � � . J . — � . : ' '" � ;..�._,.—�. . ..,, � '��'.-. , - - � : _ r.:� M . IMPORTANT (n ti �se spaces, ;opy the corresponding information fr, m Section A. ��—"—` ' Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box N�O. FOR INSURANCE COMPAi �Y USE � 417'NORTH WASHWGTON AVENUE � Policy Number. � City CLEARWATER • State' FL ZIP C e 33755 . � , - � Company NAiC Num6er, � � :� � SECTION D �-SURV�YOR,�ENGINEER, OR ARCWITECT ��ERTIFICATION��(CONTiNUED)� GopybotM sides of this Elavation Certificate for (1) community official, (2) ins�rance agent/co any, and (3) building owner. Comments Machinery elev was the Elevated Rir Cond— itionerpad, Signature Dafe-0626- 014 SECTiON:. -- BUIl.DING ELEVAT(ON-INFORMAT(ON (SURYEY NOT REQUI ED) FOR ZON� Ad AND ZONE A(W17HOUT BFE) For Zqnes Ad 9nd A(without B�E�, comp�e}e ftems E1-ES.-lf the C$�tif�cate is intendeci to su part a LOMA or LOMR-F request, complete SecUons A, B, and C. For Items Et-E4, t�se natural grade, if available. Check the measurement used. In Pu o Rico only, eMer meters; EL Provide etevation tnfarmation for the foilowing and check the appropriate boxes to show eEher the elevation is above or below the highest adjacent grade jHAG) and the lowest ac�jaccnt grade ,(LAG). a) Top bf bottom floor (including baserrient, crauvlspace, or enclosure) fs ❑ feet ❑ meters ` b) Top of bottam floor (inctuding basernent, crawlspace, or endosur�e) is : ❑ above or Q 1�etow the HAG, E2• For Building Diagrams 8.-9 wi{h •' ❑ feet [} meters ❑ above or ❑ below the LA,G. permanent flood bpenings provided tn Secfion A Ifems 8 nd/or 8(see pages 8-8 of i�structions), the riext higher floor (elevatfon: C2.b, in the diagrarims) of the buiiding is ._ ❑ feet [] meters ❑ a ve or Q bebw the F1AG. E3• Aftached gar,�qe (top of slab} is . ❑ feet ❑ meters E4_ Top of platfortn of machine and(or Q�bove' or below t4e HAG. r�l equiPtrlentse[vi�ing the building 9s : feet ❑ meters [] above ar p belou�rthe HqG. E5. Z q n e A O p n t y: I f n o fl a o d d� p t h n u m b e r I s a v a i labie, is the top ofthe boktom flaor etevat in accordance wifh the c�ammunity's flfloodpiairi management ortlinarice7 ❑ Yss ❑ No Q Unknown.7'he tocal vffidat mus�Cetti{y this iiiformati in Section G, , SECTION F-�'PROPERIy OWNER (QR QVIiNER'S REPR SENTATI\/E) CERTIF(CATION : The property owner or ou�mers aufharized representative who c4mpletes Sectans A, B, and E cZone A(without a FEMA-issued or commani or Zo�e AO must sign hera. The statements in Sections A, B, and E are carreeb'tito the best o! knowledge, �'-�ued BFE} Praperty C�nmer's o� Ownet's Authorized Representative's Name ' Add�ess City State ` �IP Code ` Sig�ature Date Telephone Comments � _Check herw 'rf attachments SEC�lON G-COMMUNITY I�I�ORMATI (QP710NAL) : The tocal ofticial who is authorized by law or orclirtapce to administer the oommunity's ftoodpiain m agement ordinanoe pn comp�te Sectians A� g, C(a Ej, and G of this Ele'ration Certificate. Gwnplete:the appticable item(s} and sign below. Check th� measurem used in lfems G8-G10. In Puerto Rico on�yr, ent�r ��. G1, ❑ The infonnatio�, in Section C was taken from other documentatian that has been sign and sealed by a ficensed sunreyor, eng(neer, or architect who Js authorizetl by taw ta cerfify elevation infotr►tation. (Indicate the sou�ce and date of t,elevation tlata in fhe Comments a�ea below.) G2. ❑ A community offidai c�mpleted Section E for a buitding iocated in Zone A(without a� MA-issued or community-issued BFE) or Zone AO. G3. ❑ The foUovuing infoRnation (items G4-G10) is providetl for community floodpiain,manag mer�t purposes. G4. Pertnit Number G5. Date Permft issued G6. te Certificate Of CompiiancelOccupancy issued G7. This permit has been`issued for. ❑ New Gonstruction ❑ 5ubstantial Improvem nt GB. Elevation of as-buiit lowest fitoot (including basement) of the building: ❑ feet ❑ meters Datum G9. BFE or (in Zone AO) depth of flooding at fhe buiiding site: ❑ feet • ❑ meters Datum G10. Community's'design fbod elevation: ' ❑ feet • ❑ meters Datum Local Officiaf's Name 'Title 'Communjfy Name .Telephone� Signature ; Date : Commenis . � ❑' Check here if attachments FEMA Form 08G-D-33 (' 12j < � � � Repiaces ai{ previous editions. ELEVATICN CERTIFICATE, page 3 + Bu+'� IMPORTANT; In these spaces, copy tY��e corresp� Building Street Address (including Apt, Unit, Suite, and/or #417 NORTH WASH�NGTON AVENUE City CLEARWATERQ � :-.;:�;;. �ing P►�otographs . � Instructions for Item A6. g information from Section A. FOR INSURANCE COMPANY USE NoJ or P.O. Route and Box No. Policy Number. . State fL ZIP Code 33755 Company NAIG Number.. if using the Elevation Certificate to obtain NFIP flood in�urance, affix at least 2 building photographs below according to the instructions for item A6. Identify aU photographs with date taken; " ront Viewl' and "Rea� VievV'; and, if required, "Right Side Vie�nl' and "Left Side Uiew." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting m�re photographs han will fif on this page, use the Contir��Jation Page. FRONT 06-26-2014 - REAR 06-2fi-2014 �