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1012 OSCEOLA AVE N�'" _ ...a. U.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 HEIDE PEENS A2. Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P0. Route and Box No. OMB No. 1660-0008 Expiration Date: July 31, 2015 FOR �NSURANCE COMPANY USE Policy Number: Number: City CLEARWATER StBte F� ZIP COde 33755-3064 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) PARCEL 09-29-15-25542-001-0010, BLOCK A, LOT 1& SUBM LAND 17576 & LOT 2, ELDRIDGE J J, PLAT BOOK OH1, PAGE 085, PINELLAS COUNTY, FLORIDA A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 2�•9�69 Long. 82•$006 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 3 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) N�'4 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�'0' within 1.0 foot above adjacent grade NA c) Total net area of flood openings in A8.b N�p` 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 B1. NFIP CommunCLEARWATER�CITY OF N25096r 62. County Name pINELLAS 64. Map/Panel Number B5. Suffix 66. FIRM Index Date 67. FIRM Panel Effective/ 68. Flood Zone(s) Revised Date 12103C0106 H 08/18/2009 05/17/2005 X I63. State FL 69. Base Flood Elevation(s) (Zone A0, use base flood depth) NA 610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: ❑ FIS Profile � FIRM ❑ Community Determined ❑ Other/Source: 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 Othervvise 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. Complete Items C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: �PS Vertical Datum: NAVD 1988 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: Datum used for 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) 15•0 � feet ❑ meters b) Top of the next higher floor 18•75 � feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N�A � feet ❑ meters d) Attached garage (top of slab) N�p` � feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 14�$ � feet ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 13•8 � feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 25.�5 � feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including 13•8 � feet ❑ meters siructural support 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 '�� f'� `' information, i certify that the information on this Certificate represents my bes[ efforts to interpret the data avallable. ''� � � �V.. HYq . "�;:_;��,y /,� . 1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Sectlon 1001. �'..>>",,�,;, .,;;�. .k t�., :- �i , � +, � ❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a �.•' '��'QR '� ❑ Check here if attachments. licensed land surveyor? � Yes ❑ No ""� ri - '��" �Y ' Certifier's Name BILL H. HYATT, JR Title PRESIDENT Address 1497 MAIN STREE 21 Signature ' FEMA Form 086-0-33 (7/12) � License Number #4636 Company Name KNOW IT NOW INC City State ZIP Code DUNEDIN FL 34698 Date Telephone 11-24-2013 (727)415-8305 See reverse side for continuation. r + � f ' . c�� ; - �init.rn: - . � t'yi.o�iz,� ; 5 ° •�.. r «' 1 t.. +.' •� x"i 'f�LN{,. ,K- VO�'� �) •:y - , o�' ��is . ��// .t ,,� � Replaces all previous editions. (� • •,� ELEVATION CERTIFICATE, page 2 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P0. Route and Box No. Policy Numberi 1012 NORTH OSCEOLA AVENUE City State ZIP Code Company NAIC Number. CLEARWATER FL 33755-3064 SECTION D— SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy botr��ip�<� cf,'thY� Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comt��Ij1�,FiF' �c�llllp�IENT'�g�.k.)Sl `� .."v' � . � � .!, •�.A � `�•+k�)�ll.�j�� .r. . � .� .�. - ON PRIOR PAGE IS BASE OF AIR CONDITIONER UNIT Date ��24/2013 ,: ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) F6�i��es AQBL?td",A ( rtla,�t,��), complete Items E1—E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B,and C. For Pt�fs E1—F�;,j��e f�r@1�grade, if available. Check the measurement used. In Puerto Rico only, enter meters. E1. Provid'e��l�✓a�i�� ihid�mation for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent gYade (HAG��nd the Iowest a�ijacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is . � feet ❑ meters � above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is . � feet ❑ meters � above or ❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is N� . A � feet ❑ meters � above or ❑ below the HAG. E3. Attached garage (top of slab) is . � feet ❑ meters � above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is . � feet ❑ meters � above or ❑ below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? � Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A(without a FEMA-issued or community-issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner or Owner's Authorized Representative's Name Address 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 complete Sections A, B, C(or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8—G10. In Puerto Rico only, enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or Zone 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 floor (including basemeni) of the building: . ❑ feet ❑ meters Datum G9. BFE or (in Zone AO) depth of fiooding 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. ,_ ...w i � �-� � � j. � � � 1''1'� !i i i �i '{ jil _ ._ ; _r�i : iM1 � , . fl J� _.. �. C F�^ �� C� �i' � r i ,-,.,,.a-..,..._:: �..>.._.�_.��.»..�.. � j � '�°� ��re!!��L � ��ilE�C7pM�hJi' DEPT (�!T?� C7� �:�.�A;�'iIATER , �- � �