1270 GULF BLVDU.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AGENCY
National Flood Insurance Progmm IMPORTANT: Follow the instructions on pages 1-9.
SECTION A - PROPERTY INFORMATION
A1. Building Owner's Name
HARBOUR LIGHT TOWERS ASSOCIATION INC
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or F0. Route and Box No.
OMB No. 1660-0008
Expiration Date: July 31, 2015
FOR INSURANCE COMPANY USE
Policy Number:
Clty CLEARWATER StBte F� ZIP COde 33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
PARCEL 20-29-15-36700-000-0000, HARBOUR LIGHT TOWERS CONDO, PLAT BOOK 018, PAGE 001, PINELLAS COUNTY, FLORIDA
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDEN7IAL
A5. Latitude/Longitude: Lat. 2�•9515 Long. 82•83�8 Horizontal Datum: ❑ NAD 1927 ❑x 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 SIX
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) 800 sq ft a) Square footage of attached garage NA 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�A 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
81. NFIP Community Name & Communitv Number
CLEARWATER CITY OF 125096
84. Map/Panel Number B5. Suffix 66. FIRM Index Date
12103C0104 I G I 08/18/2009
B2. CounTy Name P�NELLAS
87. FIRM Panel Effective/
Revised Date
09/03/2003
B3. State FL
B8. Flood Zone(s) I 89. Base Flood Elevation(s) (Zone
A0, use base flood depth)
VE&AE VE=13.0
810. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9:
❑ FlS Profile � FIRM ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item 89: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source:
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Othenvise 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/A0. Compiete Items
C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: P�AT 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 buiiding elevations must be the same as that used for the BFE. Ch k h d
a) Top of bottom fioor (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 e�evation of deck or stairs, including
structural support
ec t e measurement use .
5.5 � feet ❑ meters
15•7 � feet ❑ meters
� � •� � feet ❑ meters
N�A � feet ❑ meters
5'7 � feet ❑ !ll@t@fS
5_4 � feet ❑ meters
6•? � feet ❑ meters
5_4 � 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 thls Certlficate represents my best efforts to Interpret the data avallable.
I understand that any false statement may be punlshable by flne or imprlsonment under IS U.S. Code, Sectlon 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
BILL H. HYATT, JR
7itle
PRESIDENT
Address
14971N/\:"! STREET #321
Signature
FEMA Form 086-Q33 (7/12) I
Company Name
KNOW IT NOW INC
DUNEDIN
Date
9-18-2013
License Number
#4636
State ZIP Code
FL 34698
Telephone -
(727)415-8305
See reverse side for continuation.
��NSE N�;�\
w 4636 �
STATG OF
PLORIDA
Replaces all previous editions.
ELEVATION CERTIFICATE, page 2
IMPORTANT: In these spaces, copy the corresponding information from Section A.
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or F0. Route and Box No.
1270 GULF BOULEVARD
City State ZIP Code
CLEARWATER FL 33767
FOR INSURANCE COMPANY
Policy Number:
Comparry
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
Signature
Date 09/18/2013
SECTION E- BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO and A(without BFE), complete Items E1—E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B,and C.
For Items E1—E4, use natural grade, if available. 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 (inciuding basement, crawlspace, or enclosure) is . � feet ❑ meters � above or ❑ below the HAG.
b) 7op 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 availabie, 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 knowiedge.
Property Owner or Owner's Authorized Representative's Name
Address
Signature
Comments
City
Date
State ZIP Code
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 compiete 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 A0.
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 fioor (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:
Local Official's Name
Community Name
Signature
Comments
Title
CLEARWATER CITY OF Telephone
Date
❑ feet ❑ meters Datum
❑ Check here if attachments.
FEMA Form 086-0-33 (7/12) Replaces all previous editions.
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:
1270 GULF BLVD
CLEARWATER, FL 33767
PICS TAKEN 9/15/2013
FRONT VIEW AND CONTINUING AROUND BUILDING
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