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689 BAY ESPLANADEU.S. DEPARTMEN'T OF HOMELAND SECURITY FEDERAt EMERGENCY MANAGEMENT AGENCY National Flood Insurance Program A1. Building OwnePs Name PETER PAN ELEVATION CERTIFICATE important: Read the instructions on pages 1-9. SECTION A - PROPERTY 1NFORMATION A2. Building Street Address (including Apt., Unit, Suite, andior Bldg. No.} or P.O. Route a�d Box No. 689 BAY ESPLANADE City CLEARWATER State FL ZIP Code 33767 A3. Property Description (Lot and Blodc Numbers, Tax Parcel Number, Legal Description, etc.) PARCEL ID # 05-29-15-54756-Q77-0130 onns No. �ssa000s Expiration Date: July 31, 2015 FOR INSURANCE COMPANY USE Potic7r Number. A4. Building Use (e.g., Residential, Non-Residential, Add'Rion, Accessory, etc.) COMMERICAL (APARTMENTS) A5. LatitudetLongitude: lat. 27 59 19.7 N Long. 82 49 27.8 W Horizonta! Datum: ❑ NAD 1927 � NAD 1983 A6. Attach at least 2 photographs af the buiiding ff the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 1A A8. For a building with a crawlspace er enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclasure{s) 0 sq ft a) Square footage of attached garage g sq ft b) Number of pertnanen�flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enctosure(s) vvithin 1.0 foot above adjac�nt grade 0 within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b 0 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- F�OOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number 62. County Name B3. State CITY OF CLEARWATER 125096 0102 G 102/327 PINELLAS FL B4. Map/Panel Number B5. Suffoc 66. FIRM Index Date B7. FIRM Panel B8. Flood 69. Base Flood Elevation(s) (Zone 12103C0102 G SEPT. 3, 2003 Effective/Revised Date Zone(s) AO, use base flood depth) SEPTEMBER 3, 2003 AE 11.�0 810. fndicate the sourCe of the Base Flood Elevation (BFE) data or base flood depth entered in ttem B9. ❑ FIS Profile � FIRM ❑ Community Determined ❑ OthedSource: 891. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: B12. Is the bui{ding 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: ❑ ConsUuction Drawings' ❑ Building Under Construction` � Finished Construction ''A new Eievation Certificate will be required when construction aF the building is c�mplete. C2. Elevations -Zones At-A30, AE, AH, A(with BFE), VE, V1 V30, V(with BFE), AR, AR/A, AR/AE, AR1A1 A30, AR/AH, ARlAO. Complete Items C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: I-03 Vertical Datum: NAVD 88 Indicate elevation datum used for the 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. a) Top of bottom floor (induding basement, crawlspace, or enclosure floor) b) Top of the ne�R higher floor c) Bottom of ihe towest horizontal structuraf inember (V Zones onry) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the bui(ding (Describe type of equipment and location in Comments} f� Lowest adjacent (finished) grade next to building (LAG) gj Highest adja�nt (finished) grade next to building (HAG) h} Lowes# adjacent grade at lowest elevation of deck or stairs, inGuding structural support 6.40 15.8Q 6.40 3.20 5.80 3.90 Check the measurement used. � feet ❑ meters � feet ❑ meters ❑ feet ❑ meters p feet ❑ meters �f feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters SECTION D- SURVEYOR, ENGINEER, OR ARCMITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certity that the irrformation on this Cerfificate rep►esents my best efforts to interpret the data availabJe. I undersfand that any false statement may be pu�ishable by 5ne or imprisonment under 18 U. S. Code, Section 1001. � Check here if comments are provided on badc of #orm. Were latitude and longitude in Section A provided by a � Check here if attachments. licensed land surveyor? � Yes ❑ No Cert�ePs Name ERIC 3 SM17H Tdle OWNER License Number PSM # 6929 Company Name TLS Surveyars and Mappers, LLC Address 1460 ALADDIN RD City BRODKSVILLE State FL ZIP Code 34609 Signafure 1''�< ��� Date 02I20/2014 Telephone 352-277�550 � FEMA Form 086-0-33 (7112} See reverse side for continuation. Replaces all previous editions. ELEVATION' CERTIFICATE, IMPORTANT: In these space.s, copy the corresponding infortnation from Section A. Buiiding Street Address (+ncluding Apt., Unit, Suite, and/or Bldg. No.} or P.O. Route and Box No. 689 BAY ESPLANADE City CLEARWATER State FL ZIP Code 33767 FOR lNSURANCE COMPANY USE Policy Number: Company NAIC Number. SECTION D— SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) commun'ity official, (2) insurance agenUcompany, and (3) building owner. Comments LOWEST MACHINERY SERVICING THE BUILDING IS THE HOT WATER HEATER LOCATED ON THIS FIRST FLOOR. BENCHMARK IS FROM THE CITY OF CLEARWATER VERTICAL CONTROL NETWORK. Signature C� Date 02/20/2014 �� 7 ��""_ SECTION E- BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZC?NE 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 � E3. E4. Provide elevation infortnation for the following and check the appropriate boxes to show whether the e�evation 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 endosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. For Building Diagrams 6-9 vvith pertnanent flood openings provided in Section A Items S 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. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters ❑ 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? ❑ Yes ❑ No ❑ Unknown. The local offiaal must certify this information i� Section G. SECTION F— PROPERTY OWNER (OR OWNER'S REPRESENTATNE) CERTIFICATION The property owner or owner's authorized representative who c�mpletes 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 Signature Comments City Date State Telephone ZIP Code Chedc here ff attachments. SECTION G - COMMUNITY INFORMATION (OPTIONAL� The local official who is authorized by law or ordinance to admioister the c�mmunit�ls floodplain management orclinance can complete Sections A, B, C(or E), and G 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 infortnation. (Indicate the source and date of the elevation data in the CommeMs area below.) G2. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-iss�ed or commun"ity-issued BFE) or Zone AO. G3. ❑ The following infortnation (Rems G4—C10) 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-buik lowest fl�r {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 Official's Name Community Name Signature Comments Title Telephone Date Datum Datum Datum Check here if attachments. FEMA Form 086-0-33 (7/12) Replaces all previous editions. �LEVATION CERTIFICATE, page 3 guilding Photographs See tnstructions 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. 689 BAY ESPLANADE City CLEARWATER State FL ZIP Code 33767 FOR INSURANGE COMPANY USE Poiicy 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 phatographs with date taken; "Front Vievii' and "Rear View"; and, if required, "Right Side VievW' and "Left Side Vew." When applicable, photographs must show the foundation with representative examples of the flood openings or verrts, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. NORTH FRONT VIEW 02/20/2014 SOUTH REAR VIEW 02/20/2014 "` ���iA ��'�� �86-Q-33 �71�2) Replaces all previous editions. , • . ��.����ra�in� c��-�i�i��r�, page4 guilding Photographs Continuation Page �lViF��3RTAMT': In these spaces, copy the corresponding information from Section A. BuiOding Street Address (inciuding Apt., Unit, Suite, and/or Bfdg. No.) or P.O. Route and Box No. 689 BAY ESPLANADE City CLEARWATER State FL ZIP Code 33767 FOR INSURANCE COMPAIVY 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 Vie�' and "Rear Vew"; and, if required, "Right Side VievW' and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or verrts, as indicated in Section A8. -�TM _ - ---- ����� y w,, � ,,� - - � ��. � _ � . � .,,. 6 � 4 � . ,„. , _ . ':, : �� .*� <<� �� ���� ��� WEST SIDE VIEW 02/20/2014 ��.����� :�i�� �r'i�i(V �2/2C3f20�4 FEMA Form 086-0-33 (7/12) Replaces all previous editican�.�