1562 BARRY RDU.S.DEPARiMENTOFHOMEIANDSECURITY ELEVATl0�1 CERTIFiCATE
FEbERAt �NSERGENCY MANAGfMENT AGENCY
Nalronal F/ood lnsurnnce Progrmri Important: Read the instructions on pages 1-9.
SECTION A - PROPERTY INFORMATION
A1. Suiiding Owner's Name JEAN E BLAKE dWYER 13-78077
A2. Bui{ding Sireet Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
1562 SARI2Y RD
City CLEARWATER State FL ZIP Code 33758
A3_ Property Qescription (Lot and Biock Numbers, Tax Parcel IVumber, Legal Qescription, etc.)
PARCEL I�- 23-29-15-303&6-000-0720 NOT FOR CONSTRUCTION, NOT FOR DESiGN
OMB No. 1660-0008
Expiration Date: July 31, 2015
FOi2 INSURANCE COMPANY USE
Policv Number: �
A4. BuiEding Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. 27°57'10.0" Long. -82°46'19.9" Horizontal Datum: ❑ NA� 1927 X NAD 1983
Ao. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 1A
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/A sq ft a) Square footage of attached garage 400 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 N/A within 1.0 foot above adjacent grade N/A
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 X No d) Engineered flood openings? ❑ Yes X No
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
61. NFIP Community Name 8 Community Number 62. County Name B3. State
CITY OF CLEARWATER- t25096 PINELLAS FLORIDA
B4. MaptPanel Number 65. Suffix 66. FIRM Index Date B7. FIRM Panel 68. Flood 69. Base Flood Etevation(s) (Zone
12103C- 0109 H 05/17/2005 Effective/Revised Date Zone{s) AO, use base flood depth)
05/17/2005 AE & X 32'
610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in item 69.
❑ FIS Profile X FIRM ❑ Community Determined ❑ OthedSource:
611. Indicate elevation datum used ior SFE in Item 69: ❑ NGVD 1929 X NAVD 1988 ❑ OthedSource:
B12. Is the building located in a Coastal 8arrier Resources System (CBRS) area or Othernrise Protected Area (OPA)? ❑ Yes X No
�esignation Date: ❑ CBRS ❑ OPA
SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C7. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction` X Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2_ Elevations - Zones A1-A30, AE, AH, A(wiih 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: AG 0355 Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a) through h) below. O NGVD 1929 X NAVD 1988 � OthedSource:
Datum used for building elevations must be the same as that used for the BFE.
a) Top of bottom floor (inGuding basement, crawlspace, or enclosure floor)
b) Top of the next higher floor
c) 8oitom of tfie lowest fiorizontal structural member (V Zones only)
d) Attached garage (top of slab)
e) Lowest elevation of machinery or equipment servicing th� building
(Describe type of equipment and location in Commenis)
� 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 suppoR
33.6
N/.A
N/.A
33.1
33.1
32.7
33.0
N/.A
Check the measurement used_
X feet ❑ meters
X❑ feet ❑ meters
X feet ❑ rrteters
X feet ❑ meters
X feet ❑ meters
X feet ❑ meters
X feet ❑ meters
X feet ❑ meters
SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFlCATION
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 Certifrcate represents my best efforts to interpret the data available. �, �
1 understand that any fa/se statement may be punishable by rne or impnsonment under 18 U.S. Code, Section 100L '� �� :; : J '
� Check here if comments are provided on back of form. Were tatitude and longitude in Section A provided by a � , F�'r�'
❑ Check here if attachments. licensed land surveyor? � Yes ❑ No ,�' ,��� l�°y, r= .��
� t.
Certifiers Name LELAND F. DySARD
Title P.L.S.
Company Name AEC, INC
Address 3884 PROGRESS AVE., /�104 City NAPLES
Signature
FEMA F�6rm 086-0-33,(7/12)
license Number 3859
State FL ZIP Code 34104
Date 10/05/2013 Telephone 239-403-1600
See reverse side for continuation.
""i{�'°5+'°�Tt: �.i.l'� -
; . 4 � � .
� L� 9�sw. - _ .
���
,4.f:i �' .-
Replaces all previous editions.
IM,PORTANT: In these spaces, copy the corresponding information from Section A.
Building Street Address (inciuding Apt., Unit, Suite, andlor Bidg. No.) or P.O. Route and Box No.
1562 BARRY t2D
City CLEAftWATER
State FLORIDA ZIP Code 33756
FOR INSURANCE COMPAtVY USE
Policy Number:
Company NAIC Number:
SECTION D— SURVEYOR, ENGINEER, OR ARCHITECT CERTIFlCATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community o�cial, (2) insurance agenUcompany, and (3) building owner.
Comments GPS COORDINATES WERE TAKEN FROM GOOGLE EARTH. NOT FOFZ CONSTRUCTION. NOT FOR DESIGN. FLOOD ZONE
DETERMINATION PROVIDED BY FLOOD INSIGFITS. THIS DATA WAS PREPARED FOR FLOOD INSURANCE PURPOSES ONLY.THE EQUIPMENT
USED IS GPS. THERE EX�T,S A 02' (TWC) TENTiiS) PLUS OR MINUS PRECISION. ITEM USTED IN C2(e) IS TIiE CONCRETE AIR CONDITIONING
?AD. OATE Of FIEI,�/W0 K)10l05/�13
Signature
Date 10/05l2013
. SECT�ON 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 boltom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or Q below the HAG.
b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the IAG.
E2. For Building Diagrams 6-9 with permanent flood openir?gs provided in Section A Items 8 and/or 9(see pages II-9 of Instructior.$), 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 onty: If no flood depth number is available, is the top of the boltom floor elevated in accordance with the community's floodplain management
ordinance? ❑ Yes ❑ No ❑ Unknown. The locat 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 correet to the best of my knowledge.
Property Owner's or Owner's Authorized Representative's Name
Address
Signature
Comments
Ciry
Date
State
Telephone
ZIP Code
Check here if attachments.
SECTION G — COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the communitys floodplain management ordinance can complete Sections A, B, C(or E), and G
of this Elevation CeRificate. Complete the applicable item(s) and sign bebw. Check the measurement used in Items G8—G10. In PueRo Rico only, enter meters.
G1. ❑
G2. ❑
G3. ❑
The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engirtee�, 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 compteted Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or Zone AO.
The following information tltems G4—G10) is provided for community floodptain management purposes.
G4. Permit Number G5. Date Permit Issued GS. 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_
G9. BFE or (in Zone AO) depth of flooding at the building site:
G10_ Community's design flood elevation:
Local Official's Name
Community Name
Signature
Comments
❑ feet ❑ meters Datum
❑ feet ❑ meters Datum
❑ feet ❑ meters Datum
Title
Telephone
Date
Check here if attachments.
FEMA Form 086-0-33 (7/12) Replaces all previous editions.
ELEVATION CERTIFICATE, page 3 guilding 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, and/or Bldg. No.) or P.O. Route and Box No. Policy Number:
1562 8ARRY RD
City CLEARWATER State FLpRIDA ZIP Code 337�� 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 submiiting more photographs than will fit on this page, use the Continuation Page.
FRONT VIEW 10/05/2013
. �`� _... , _ _ __ _~ � �{'
;
. . �.s.__.-_____ . . . � ` --.. . _.__ _ .. ` `` �'.
. � ,x �
7
... . . ' }�1 ��� .
LEFT 51U� VItW 10/05/201:�
REAR VIEW 10/05/2013
RIGHT SIDE VIEW 10/0 �/2013
�,�f�� ,�, 7� ,
„
%,;
j�;�x =' ; d i ti ;; � � ;!�
� `K rr� s � ! / 'i�: l �_;
�:� �� ,
w '<, � � �� r{�; ''1�
�� t, '� • ` ��')r�;� ;
� t `;�rt� i�� f� ��'<�!
�t�r ;�a � ��� ;l ,� - ��}.�:i
��§� � i �� ,�"'" '�t
� �. .� . x i �',�� �
j � � x� � �, !
� .. � .
Y � � � , F •
1
� �7b�2'!('��� e' ' � � i
�1, {�.4, F -.�'^c�,��a� ��'�
. . . ��y a��� � �
�'' a.
:� ' A
. t I 'e'.t"��
' �:
. r r � . � � f 11' •:.
{ —; �K�
ti.'�
•i t'd' 7 ?:._ ... .
FEMA Form 086-0-33 (7/12) Replaces all previous editions.