740 ELDORADO AVEU..tae ;RTMENTOF HOMELAND SECURITY ELEVATION CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AGENCY
National Flood Insurance Program Important: Read the instructions on pages 1-9.
OMB No. 1660-0008
Expiration Date: July 31, 2015
SECTION A - PROPERTY INFORMATION
FOR INSURANCE COMPANY USE
Al . Building Owner's Name THOMAS J. WELSH, JR.
Policy Number:
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
740 ELDORADO AVENUE
Company NAIC Number.
City CLEARWATER
State FL ZIP Code 33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 3, BLOCK 3, MANDALAY SUBDIVISION - (PARCEL # 05-29-15-54666-003-0030)
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. 27.99129° Long. 82.82763° 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
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) 2393 sq ft
b) Number of permanent flood openings in the crawlspace
or enclosure(s) within 1.0 foot above adjacent grade Q
c) Total net area of flood openings in A8.b 0 sq in
d) Engineered flood openings? 0 Yes ® No
A9. For a building with an attached garage:
a) Square footage of attached garage sq ft
b) Number of permanent flood openings in the attached garage
within 1.0 foot above adjacent grade NIA
c) Total net area of flood openings in A9.b 1: sq in
d) Engineered flood openings? 0 Yes ® No
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81. NFIP Community Name & Community Number
CITY OF CLEARWATER 125096
B2. County Name
PINELLAS
B3. State
FL
B4. Map/Panel Number
12103C-0102
B5. Suffix
G
B6. FIRM Index Date
8-18-09
B7. FIRM Panel
Effective/Revised Date
9-3-03
B8. Flood Zone(s)
VE
B9 Base Flood Elevation(s) (Zone
AO, use base flood depth)
13'
B10. Indicate the source of he Base Flood Elevation (BFE) data or base flood depth entered in Item B9.
0 FIS Profile E FIRM 0 Community Determined 0 Other/Source:
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ® 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: N/A 0 CBRS ❑ 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 Al -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: JJ.G.S. "F-3" Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a) through h) below. 0 NGVD 1929 El 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) 6.71 (21 feet 0 meters
b) Top of the next higher floor 17.46 ® feet 0 meters
c) Bottom of the lowest horizontal structural member (V Zones only) 14.32 ® feet 0 meters
d) Attached garage (top of slab) N/A ® feet 0 meters
e) Lowest elevation of machinery or equipment servicing the building N/A ® feet 0 meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 5.39
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
® feet 0 meters
0 feet 0 meters
0 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
® Check here if attachments. licensed land surveyor? ® Yes 0 No
Certifier's Name GEORGE A. SHIMP III
Job Number 130068-E License Number 6137
Title VICE PRESIDENT Company Name GEORGE A. SHIMP II & ASSOCIATES, INC.
Address 3301 DeSOTO BLVD., SUITE D City PALM HARBOR State FL ZIP Code 34683
stalk 4 I Date 9-16-13 Telephone 727-784-5496
FEMA Form 086-0-33 (7/12)
See reverse side for continuation. Replaces all previous editions.
.LEVATION 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 P.O. Route and Box No.
740 ELDORADO AVENUE
FOR INSURANCE COMPANY USE
Policy Number.
City CLEARWATER
State FL ZIP Code 33767
ny 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 A8.) BOTTOM FLOOR ENCLOSURE APPEARS TO CONTAIN BREAK -AWAY WALLS
_
Signature
Date 9-16-13
SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zones AO and A (without BFE), complete 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.
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 0 above or ❑ below the HAG.
b) Top of bottom floor (including basement, crawlspace, or enclosure) is 0 feet 0 meters ❑ 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 pages 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 ❑ below the HAG.
E3. Attached garage (top of slab) is 0 feet 0 meters ❑ 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 ❑ Unknown. The local official must certify this information in Section G.
SECTION F — PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owners authorized representative who completes Sections A, B, and E for Zone A (without a FEMA -issued or community -issued BFE)
r 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
4ddress
City
State ZIP Code
Signature
Date Telephone
comments
0 Check here if attachments.
SECTION G — COMMUNITY INFORMATION (OPTIONAL)
ie 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
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.
1. ❑ 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 inforrnation. (Indicate the source and date of the elevation data in the Comments area below.)
rl a nAv ,,Ni, & rmm�lnfo,i c -,i,n F fnr v hnilrfinn inrofad in 7nno D !w'dhnuf a FFMA_icsuwrf nr rnmmunifv_igsued BFE1 nr Zone AO.
3. 0 The following information (Items G4—G10) is provided for community floodplain management purposes.
3.4. Permit Number
G5. Date Permit Issued
G6. Date Certificate Of Compliance/Occupancy Issued
7. This permit has been issued for:
8. Elevation of as -built lowest floor (including
9. BFE or (in Zone AO) depth of flooding
10. Community's design flood elevation:
0 New Construction 0 Substantial Improvement
basement) of the building:
0 feet
0 feet
0 feet
0 meters
❑ meters
Datum
at the building site:
Datum
Datum
• meters
_oval Official's Name
Title
:,ommunity Name
Telephone
Signature
Date
comments
0 Check here if attachments.
EMA 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.
FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, andlor Bldg. No.) or P.O. Route and Box No.
740 ELDORADO AVENUE
Policy Number:
City CLEARWATER
State FL ZIP Code 33767
Company NAIC Number.
If using the Elevation Certificate to obtain NF|POooU insuranmu, affix at least 2 building photographs below according to the instructions
for Item A8. Identify all photographs with date taken; "Front View" and 'Rear View": and. if required, "Right Side Wow' and "Left Side
View.^ When opp|icab|e, 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
CUM BEVillt
FRONT VIEW
Picture taken on: 9-16-13
FEMA Form 086-0-33 (7/12)
Replaces all previous editions.
ELEVATION CERTIFICATE, page 4
Building Photographs
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 wv)mpoRoute and Box No,
740 ELDORADO AVENUE
City CLEARWATER
State FL ZIP Code 33767
Policy Number:
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.
~
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REAR VIEW
Picture taken on: 9'16-13
FEMA Form 086-0-33 (7/12)
Replaces all prevous editions.
U.'�PI�,RTMENT OF HOMELAND SECURITY
FE�ERAL EM�RGENCY MANAGEMENT AGENCY
National Flood /nsurance Program
A1. Building Owner's Name THOMAS J
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1-9.
JR.
SECTION A - PROPERTY INFORMATION
A2. Building Street Address (including Apt., Unit, Suite, andlor Bldg. No.) or P.O. Route and Box No.
740 ELDORADO AVENUE
City CLEARWATER
State FL ZIP Code 33767
OMB No. 1660-0008
Expiration Date: July 31, 2015
FOR INSURANCE COMPANY USE
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 3, BLOCK 3, MANDALAY SUBDIVISION -(PARCEL # 05-29-15-54666-003-0030)
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. 27.99129° Long. 82.82763° 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 6
A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) 2393 sq ft a) Square footage of attached garage N/A sq ft
b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage
or enclosure(s) within 1.0 foot above adjacent grade 0 within 1.0 foot above adjacent grade N/A
c) Total net area of flood openings in A8.b 0 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 B2. County Name
CITY OF CLEARWATER 125096 PINELLAS
B4. Map/Panel Number B5. Suffix B6. FIRM Index Date 67. FIRM Panel 68. Flood Zone(s)
Effective/Revised Date
12103C-0102 G 8-18-09 9-3-03 VE
610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69.
❑ FIS Profile � FIRM ❑ Community Determined ❑ Other/Source:
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 Othervvise Protected Area (OPA)?
Designation Date: N/A ❑ CBRS ❑ OPA
63. State
FL
69 Base Flood Elevation(s) (Zone
AO, use base flood depth)
13'
❑ Yes � No
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: N.G.S. "F-3" 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 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)
fl Lowest adjacent (finished) grade next to building (LAG)
g) Highest adjacent (finished) grade next to buiiding (HAG)
h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support
6.71
17.46
14.32
N/A
N/A
5.39
6.52
N/A
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� 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.
1 understand that any false statement may be punishable by �ne 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 GEORGE A. SHIMP III Job Number 130068-E License Number 6137
Title VICE PRESIDENT Company Name GEORGE A. SHIMP II & ASSOCIATES, INC.
Address 3301 DeS0T0 BLVD., SUITE D City PALM HARBOR State FL ZIP Code 34683
Date 9-16-13
Telephone 727-784-5496
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FEMA Form 086-0-33 (7/12) See reverse side for continuation. Replaces all previous editions.
:LEVATION CERiIFICATE, page 2 � y
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.
740 ELDORADO AVENUE
City CLEARWATER State FL ZIP Code 33767
FOR INSURANCE GOMPANY USE
Policy Number.
Gampany NAIC Number.
SECTION D— SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides ofthis Elevation Certificate for (1) community official, (2) insurance agenUcompany, and (3) building owner.
Comments A8.) BOTTOM FLOOR ENCLOSURE APPEARS TO CONTAIN BREAK-AWAY WALLS
Signature
Date 9-16-13
SECTION E— BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND 20NE 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 ❑ 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 �ocal 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)
�r 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
4ddress
5ignature
�omments
City
Date
State
Telephone
ZIP Code
Check here if attachments.
SECTION G — COMMUNITY INFORMATION (OPTIONAL)
ie 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
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.
u
2. ❑
3.❑
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.)
A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or Zone AO.
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
7. This permit has been issued for: ❑ New Construction ❑ Substantiai Improvement
S. Elevation of as-built lowest floor (including basement) of the building: ❑ feet ❑ meters
9. BFE or (in Zone AO) depth of flooding at the building site:
10. Community's design flood elevation:
_ocal Official's Name
�ommunity Name
3ignature
�omments
_ ❑ feet ❑ meters
_ ❑ feet ❑ meters
Title
Telephone
Date
Datum
Datum
Datum
Check here if attachments.
=MA Form 086-0-33 (7/12) Replaces all previous editions.
!�LEVATION CERTIFICATE, page 3 guilding 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.
740 ELDORADO AVENUE
City CLEARWATER State FL ZIP Code 33767
FOR INSURANCE COMPANY USE
Policy Number:
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.
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FEMA Form 086-0-33 (7/12) Replaces all previous editions.
ELEVATION CERTIFICATE, page 4 guilding Photographs
Continuation Page
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.
740 ELDORADO AVENUE
City CLEARWATER
State FL ZIP Code 33767
FOR INSURANCE COMPANY USE
Policy Number:
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.
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REAR VIEW
Picture taken on: 9-16-13
FEMA Form 086-0-33 (7/12) Replaces all previous editions.
U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTI FICATE -
FEDERAL EMERGENCY MANAGEMENT AGENCY OMB NO. 1660-0008
National Flood lnsurance Program Important: Read the instructions on pages 1�. Expiration Date: July 31, 2015
SECTION A - PROPERTY INFORMATION
1. Building Owner's
A2. Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No.
740 ELDORADO AVENUE
City CLEARWATER
State FL ZIP Code 33767
A3. Property Description (Lot and Blodc Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 3, BLOCK 3, MANDALAY SUBDIVISION -(PARCEL # 05-29-15-54666-003-0030)
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. 27.9913°N Long. 82.8276°W 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 6
A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) 2393 sq ft a) Square footage of attached garage N/A sq ft
b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage
or enclosure(s) within 1.0 foot above adjacent grade 0 within 1.0 foot above adjacent grade N/A
c) Total net area of flood. openings in AB.b 0 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 62. County Name 63. State
CITY OF CLEARWATER 125096 PINELLAS FL
B4. Map/Panel Number B5. Suffix B6. FIRM Index Date 67. FIRM Panel B8. Flood Zone(s) B9 Base Flood Elevation(s) (Zone
Effective/Revised Date AO, use base flood depth)
12103C-0102 G 8-18-09 9-3-03 VE 13'
B1 O. 111dIC8te th@ SOUfCe Of the Base Flood Elevation (BFE) data or base flood dspth entered in Item B9.
❑ FIS Profile � FIRM ❑ Community Determined ❑ OtheNSource:
B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source:
612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes � No
Designation Date: N/A ❑ 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: N.G.S. "F-3" Vertical Datum: NAVD 1988
Indicate elevation datum used forthe elevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ OtheNSource:
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) 6.82 � feet ❑ meters
b) Top of the next higher floor 17.52 � feet ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only) 14.32 � feet ❑ meters
d) Attached garage (top of slab) WA � feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 17.50 � feet ❑ meters
(Describe type of equipment and location in Comments) .
fl Lowest adjacent (finished) grade next to building (LAG) 5_9 � feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 6_5 � feet ❑ meters
h) Lowest adjacent grade at lowest elevation of dedc or stairs, including structural support WA � 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 certiry elevation
information. I certify that the information on this Certificate iepresents my best efforts to interpiet 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 ff 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
CertifiePs Name GEORGE A. SHIMP III Job Number 130068-F License Number 6137
Title VICE PRESIDENT Company Name GEORGE A. SHIMP II & ASSOCIATES, INC.
Address 3301 DeSOTO BLVD., SUITE D City PALM HARBOR State FL ZIP Code 34683
Date 2-7-2014 Telephone 727-784-5496
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FEMA Form 086-0-33 (7/12) See reverse side for continuation. Replaces all previous editions.
• - _ ,. � - -
ELEVATION CERTIFICATE, page 2
IMPORTANT: In these spaces, copy the cornesponding information from Section A.
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
740 ELDORADO AVENUE
City CLEARWATER State FL ZIP Code 33767
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 A8.) BOTTOM FLOOR ENCLOSURE APPEARS TO CONTAIN BREAK-AWAY WALLS
C2.e) AIR CONDITIONER ON ELEVATED DECK
Signature � � Date 2-7-2014
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 ❑ 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 locai 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.
PropeRy Owners or Owner's Authorized Representative's Name
Address
Signature
Comments
Ciry
Date
State
Telephone
SECTION G — COMMUNITY INFORMATION (OPTIONAL)
ZIP Code
Check here if attachments.
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), ana v
of this Elevation Certificate. Complete the applicable item(s) and sign below. Chedc 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
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
G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters
G10. Community's design flood elevation: ❑ feet ❑ meters
Local Officia{'s Nama
Community Name
Signature
Comments
FE'MA Form 086-0-33 (7/12)
%
.
Title
Telephone
Date
Datum
�atum
Datum
Check here if attachments.
Replaces all previous editions.
ELEVATION CERT'IFICATE, page 3 guilding 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.
740 ELDORADO AVENUE
City CLEARWATER State FL ZIP Code 33767
FOR INSURANCE COMPANY USE
Policy Number:
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.
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FEMA Form 086-0-33 (7/12) Replaces all previous editions.
ELEVATION CERTIFICATE, page 4 guilding Photographs
Continuation Page
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.
740 ELDORADO AVENUE
City CLEARWATER
State FL ZIP Code 33767
FQR INSURANCE COMPANY USE
Policy Number:
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.
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SECTION . . .5 . . , TOWNSHIP . . 29 . . SOUTH, RANGE . . 15 . . EAST, . . . , , P�NELLAS , , , , COUNTY, FLORIDA
BOUNDARY SURVEY
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BENCH MARK
N.G.S. "F 3"
ELEV.= 2.72'
N.A.V.D. 1988
LEGEND
EB — ELECTRIC BOX
� a��0 — ELEVATION
• — POWER POLE
B — RECLAIMED WATER METER
O — SEWER CLEAN OUT
� — WATER METER
— — — — OVERHEAD WIRES
BRG. REF. UNE
(GRID BEARING)
N87'36'33°E
+�t `�.:�s �
POOL
P��
TIE 20.04'
MEASURED BEARINGS ARE IN REFERENCE TO FLORIDA
STATE PLANE COORDINATE GRID NORTH, WEST ZONE,
NORTH AMERICAN DATUM OF 1983 (1990 READJUSTMENT),
AS ESTABLISHED BY THE NATIONAL GEODETIC SURVEY.
OCOPYRIGHT 2014
ALL RIGHTS RESERVED
George A. Shimp II 8� Associates, Inc.
Anyone copying this document in any monner without the
expressed consent of GEORGE A. SHIMP ll & ASSOCIATES, INC.
shall be prosecuted to the full extent of fhe low.
DO NOT COPY OR REPRODUCE
4
FND NdcD RLS/ 3616
N.E. CORNER OF
LOT 4, BLOCK 3
FC11 4'x4' 0.�6'N., 0.18'E.
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FND NdcD
(ILLEqBLE)
FpA 4'x4' 2.4� �
109.61'M; 110'R ° o.,a's., o.,3�e
63.9i1�C TO C.C.C.L. �
� F� '
� WOOD STEPS
22s3' d t�'3� � i dc DEq(
,`- Pt�l. EfltNP. �
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1HREE Sfi�RY WOtlD i �'� �,�
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RES. � 740 � � � >
s 1T.S2 �� �
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�4, w� wa� 110.00'M; 110'R � .
1.10'S. 0.51'N.
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CERiIFlCATION: I HEREBY CERiIFY TO THE BEST OF MY KNOWLEDGE AND BELIEF
THAT THE SURVEY SHOWN HEREON SUBSTANiIALLY MEETS iHE YINIAIUAI IECHNICAL
STANDARDS fOR LAND SURVEYIN6 DESCRIBED IN iHE STATE OF FLORIDA RULE 5J-17,
F.A.C. FURTHERMORE, 1HIS CERi1FlCATION SHALL NOT EXIEND TO ANY OTHER PERSONS
OR PARTIES OiHER iHAN THOSE NAMED ON iHIS SURVEY AND SHALL NOT BE
VAUD AND BINDING AGAINST iHE UNDERSIGNED SURVEYOR WIiHWT iHE ORIGINAL
RAISED SEAL AND SIGNAIURE OF THE RORIDA LICENSED SURVEYOR AND MAPPER.
�1 ,�.. ,� �l� �
GEORGE A. SHIMP III, PROFESSIONAL SURVEYOR &�IAPPER No. 6137
1HIS SURVEY IS NOT COMPLEIE OR VAUD UNLESS ATTACHED TO SURVEYOR'S REPORT.
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ELEY.= 5.88'
� N.A.V.D.1988
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wal o.irs. o.os'E. �. � .
o.�'N. � I '� �.� SET NNL dc TIN
� I � ELEV.= 5.76'
N.A.V.D. 1988
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0
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� fND 'X' CUT
S.E. CORNER OF
LOT 2, BLOCK 3
LEGAL DESCRIPTION
LOT 3, BLOCK 3, OF MANDALAY, ACCORDING TO 1HE MAP OR PLAT THEREOF AS
RECORDED IN PLAT BOOK 14, PAGES 32 THROUGH 35, OF THE PUBUC RECORDS OF
PINELLAS COUNTY, FLORIDA.
FLOOD ZONE
THE ABOVE DESCRIBED PROPERTY APPEARS TO BE IN ZONE VE (BASE FLOOD ELEVAl10N
OF 13 FEET), IN ACCORDANCE WITFI THE FlRI� �IAP OF 1HE qTY OF CLEARWAlER,
PINEW4S COUNTY, COMMUNITY NUMBER 125096 (MAP NUMBER 12103C-0102—G), MAP
DATED SEPTEI�BER 3, 2003.
PREPARED FOR
THOMAS J. WELSH, JR.; CICCOTTI ADVENTURES
JOB NUMBER: 130068F
DRAWING FlLE: 130068F.DVYG . �
LAST REVISION: N/A . �,�
T.S.
LB 1834
- C.3
-�f�
DATE SURVEYED: 2-10-2014
• , DAfiE DRAWN: 2-10-2014
� SF.REFERENCE: 130068
II
�Yl� A�S�fATES, : ��'QRPORATED
: � _-�`�ND SU.�%,�,�Y(�RS ; � �I At0 �`PLANNERS
;�3�0> •Il��f9�9U�'!'�!/YD, SUIT�' Il
'���D.� �'l.�J?IlG! . 34683
PIIBN�''fxz�r'5�8���¢96 F�l,I' �7',�7� 7'86—>,256
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A = ARC LENGTH
A/C = AIR CONDITIOI�ft
AF = ALUNINUM FENCE
ALUAI = ALUI�IINUY
ASPH = ASPFIALT
BFE = BASE FLOOD EIEVAlION
BLDG = BUILDNG
BLK = BLOq(
BN = BENqi IIARK
BNDY = BWNDARY
BRG = BEAWNG
BWF = BARBED VMRE FENCE
C = CALCULAiED
CB = CHORD BEARING
CBS = CONCRETE BLOCK STRUCTURE
CHD = CHORD
q. = CEN1ERl.INE
q.F = CIiANJ LNdK FENCE
CLOS = CLOSURE
COL = COLUI�N
CONC = CONCRETE
CR = COUNIY ROAD
C/S = CON(�EIE SUB
COR = WRNER
COV = COVERED AREA
D = DEED
DOT = DEPARII�NT OF TRANSPORTATION
DRNG = DRAINAGE
D/W = DRIVEWAY
EL OR ELEV = ELEVATION
EaP = EDGE OF PAVEIIENT
EOW = mGE OF WATER
ESY'T = EASaIENT
FCwI = FWPD CONCREiE YONUMENT
FES = Fl.ARED END SECTION
FlP = FOUND IRON PIPE
FlR = FOUND IRON ROD
FL = FLOW L1NE
FlD = FlEI.D
fT� = FWND
FaP = FWND OPEN PPE
FPC = FLORDA POWER CORP.
FPP = FOUND PINCHm PIPE
FRII = FRAGIE
FZL = fL00D ZONE LINE
GAR = GARAGE
G/E = GLASS ENCLOSURE
HWF = HOG MARE FENCE
HWL = HGH WATER UNE
INV = INVERT
LB = U1ND SURVEI1NG BUSIPESS
LFE = LOWEST FLOOR ELEV
LHSM = LOWEST HORIZONTAL SUPPORING MEMIBER
LS = W�D SURVEYOR
1� = MEASURED
YAS = MASOI�tY
YES = �tIIERED END SECTION
I�H = MANHOLE
�IHWL = NEAN Hlqi WAIER LJPE
�ISL = I�AN SFA LEVEL
N&B = NAIL AND BO1TlF CAP
N�D = NAII AND DISK
NdcT = NAII AND TAB
NGVD = NATIQNAL GEODEIIC VERTICAL DAIU�I
NO = NUNBER
0/A = OVERALL
OHW = OVERHEAD WNtE(S)
OR = OFf1qAL RECORDS
0/S = OFFSET
P = PLAT
PB = PLAT B001(
PC = POINT OF CURVE
PCC = POINT OF COGIPWND WRVE
PCP = PERMANENT CONTROL POINT
PG = PAGE
PK = PARKFR KALON
PL = PRaPER1Y lJl�
POB = PONdT OF BEqNNNG
POC = POINT OF C061NENCEIrIENT
POL = PqNT ON L1NE
PP = POWER POLE
PRC = POINT UF REVERSE WRVAiURE
PRN = PERMMENT RffERENCE NONUNFNT
PROP = PROPERTY
PSwI = PROFESSIONAL SURVEYOR � YAPPER
PT = PqNT OF TAN(�NCY
PVN'T = PA4EAENT
RAD = RADIUS
R = RECORD
Rff = REFERQrCE
RES = RESIDENCE
RL = RAOIAL UI�E
RLS = REqS1ERED LMO SURVEYOR
RND = ROUND
RNG = RANGE
RRS = RAIL ROAD SPIKE
R/W = RIGHT—OF—WAY
SCN = SET CONCRETE IIONUNENT
S/E = Sl�tEpdED ENCLOSURE
SEC = SEC110N
SET N� = SET NAIL AND DISK RI.S j 2512
SIR = SET 1/2' IRON ROD RLS� 2512
SQ = SQUARE
SRF = SPUT RAII FENCE
SR = STAIE ROAD
SiY = STORY
SUB = SUBDMSION
S/W = SDEWALK
TB = 'T' BAR
TBY = TEMPORARY BENCH NARK
TC = TOP OF CURB
TOB = TOP OF BANK
TOS = TOE OF SLOPE
1RANS = 1RMISFORIIER
TWP = TOWNSHIP
TYP = 1YPICAL
UG = UNDERGROUNO
U11L = UiIUTY
WD = WOOD
WF = WOOD FENCE
YY� = WROUGHT IRUN FENCE
WIT = WITNESS
WRF = WRE FENCE
WV = WATER VALVE
s� ABBREVIAnONS YAY ALSO BE CONCAIENATED AS REQUIRED.
�* OTHER COMMONLY RECOGNIZED AND/OR ACCEPTED ABBRENIATIONS ARE ALSO UTIUZED BUT NOT SPEqFlED HEREON.
GENB�AL NOTES
2
3.
4.
5.
6.
8.
9.
10.
11.
12.
UNLESS OTHERWISE STAlED, PiE PROPERTY DESCRIP110N SHOWN HEREON WAS PROVIDED BY THE CLIENT, OR CUENrS
DESIGNATED AGEWT.
UNDERGROUND IYPROVEWIENTS, INCLUDING BUT NOT U�IITED TO BUILDING FOUNDAl10NS, HAVE NOT BEEN LOCATED
EXCEPT AS SHOWN HEREON.
INACCESSIBLE ABOVE GROUND IMPROVEtiIENTS (EG. BUILDING OVERHANGS, THOSE WITHIN SECURED AREAS, ETC.), HAVE
NOT BE�I LOCAlED EXCEPT AS SHOWN HEREON.
UNLESS OTHERWISE STATED, THIS SURVEY WAS PREPARED WIIHOUT 1HE BENffIT OF A 11TLE SEARCH AND �IAY BE
SUBJECT TO ADDITIONAL EASaIENTS, RIGHT-OF-WAYS, AND O1HER MATIERS OF RECORD.
T}IERE ARE NO VISIBLE ENCROACHMENTS, IXCEPT AS SHOWN HEREON.
BECAUSE OF THE POSSIBIUTY OF MOVEMENT OF 1HE MONUMENTATION FROM ITS ORIqNAL PLACEir1ENT BY PERSONS
O1HER THAN 1HE SURVEYOR� IT IS RECOMMENDED THAT PRIOR TO ANY NEW IMPROVEtiIENTS ON 1HE PROPERTY
THE POSInON OF THE MONU�IENTA�ION BE VERIFlED.
UNAUIHORIZEO COPIES AND/OR REPRODUC110NS VIA ANY MEDIUI� OF THIS DOCU�IENT OR ANY PORTIONS THEREOF
ARE D(PRESSLY PROHIBITED WITHOUT THE SIGNING SURVEYOR�S WRITTEN CONSENT.
BASIS OF BEARINGS IS PLAT, UNLESS OiHERWISE SHOWN OR STATED.
ALL BUILDING TIES, PROPERTY I�ARKER LOCAiIONS AND O1HER SITE IMPROVEbIIENT LOCAl10NS SHOWN HEREON ARE
MEASURED PERPENDICULAR TO ADJACEMT BOUNDARY UNES, UNLESS OTHERIMSE STAlED.
FLOOD ZONE DESIGNAl10N AND/OR FLOOD ZONE UNES (IF ANY) SHOWN HEREON HAVE BEEN SCALED FROM iHE
REFERENCED MAP AND ARE APPROXI�IAlE. TFIE 1RUE FLOOD ZONE UNES MUST BE DElER�IINED BY AN ENqNEER.
THIS SURVEY DOES NOT DETERMINE OR IMPLY OWNERSHIP.
1HERE NAY BE ADDITIONAL RESTRICTIONS, EASEMENTS OR O1HER NATTERS OF RECORD THAT ARE NOT SHOWN
HEREON THAT MAY BE FWND IN 1HE PUBLIC RECORDS OF 1HIS COUNTY.
NOTE: 1HIS SURVEYOR'S REPORT IS NOT COMPLETE OR VALID UNLESS ATTACHED TO 1HE SURVEY.
SURVEYOR'S REPORT
GEORGE A. SHIMP II AND
ASSOCIATES, INCORPORATED
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GEORGE A. SHIMP III, �PROFL��SIry�/�I q�R�,� .dc MIIPPER No. 6137
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