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210 PALM ISLAND NW� � �- i � ��,� - a o d � �;3 � �--lav' U.S. DEPARTMENTOF HOMELAND SECURITY ELEVATION C�RTIFIC�� FEDERAL EMERGENCY MANAGEIuIENT AGENCY OMB No. 1660-0008 Nationa( Flood lnsurance Program Important• Read the instructions on pages 1-9. Expiration Date: .luly 31, 2015 A1 JAMES DAUGHTRY SECTION A - PROPERTY INFORMATION A2. Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No. 210 PA�M �SLAND NW City CLEARWATER BEACH State FL ZIP Code 33767 A3. Property Description (Lot and Blodc Numbers, Tax Parcel Number, Legal Description, etc.) LOT 63, ISLAND ESTATES OF CLEARWATER, UNIT 6C FOR INSUI2ANCE COMPANY USE Company A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27°59'06.22"N Long. 82°49'10.58'W Horizontal Datum: ❑ NAD 1927 � NAD 1983 A6. Attach at least 2 photographs of the building ff the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 1� A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawispace or enGosure(s) �/A sq ft a) Square footage of attached garage �1 sq ft b) Number of peRnanent flood ope�ings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s) within 1.0 foot above adjacent grade t�/A within 1.0 foot above adjacent grade Q c) Total net area of flood openings in A8.b N� sq in c) Total net area of flood openings in A9.b Q sq in d) Engineered flood openings? ❑ Yes � No d) Enginee�ad flood openings? ❑ Yes � No SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NFIP Community Name 8 Community Number B2. County Name 63. State CITY OF CLEARWATER 125096 PINELLAS FLORIDA B4. Map/Panel Number B5. Suffix 66. FIRM Index Date 67. FIRM Panel 68. Flood 69 Base Flood Elevation(s) (Zone 12103C0102 G 8/18/09 Effective/Revised Date Zone(s) AO, use base flood depth) 9/3/03 VE,AE 13,12 610. 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: 811. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ OthedSource: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? Designation Date: N/A ❑ CBRS ❑ OPA ❑ Yes � No SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevaGons are based on: ❑ Construction Drawings` ❑ Building Under Construction` � Finished Construction 'A new Elevation Certificate will be required when construdion of the building is complete. C2. Elevations - Zonas A1-A30, AE, AH, A(with BFE), VE, V1-V30, V(with BFE), AR, AR/A, AR/AE, AR/A1-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-03.5 Vertical Datum: NAVD 1988 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ OtherlSource: Datum used for building elevations must be the same as that used for the BFE. Chedc the measurement used. a) Top of bottom floor (inGuding 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) � 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 dedc or stairs, including structural support 7.� �• NlA. 6.�5 ¢.41 f.1 �•� N/A. � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ mete►s � 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 infortnation. I certify that the information on this Certificate represents my best efforis to interpret the data available. I understand thet any false stateme»t may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. � Check here if comments are provided on back of fortn. Were latitude and longitude in Section A provided by a ❑ Check here if attachments. licensed land surveyor? � Yes ❑ No Certifier's Name JOHN R BEACH License Number 2984 Title P.L.S. Company Name JOHN R. BEACH & ASSOCIATES, INC. Address 911 S�PETERSBURG DR W` City OLDSMAR State FL ZIP Code 34677 (7/12) ��'1 , � Date 11/19/2013 Telephone 813-854-1276 See reverse side for continuation. �� ;N � � N � �� all previous editions. t ��•.�,r.v�...��.�.� �..... IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt., Unit, Suite, andlor Bldg. No.) or P.O. Route and Box No. 210 PALM ISLAND NW City CLEARWATER State FL 21P Code 33767 FOR INSURANCE COMPANY USE Policy Number: Company NAIC Number. 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 C2(e) = A/C ELEV Q � Date 11/19/2013 SECTION E�►BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND 20NE A Fo�`r ZOTi s�0 and A(without BFE), complete Items Ei—E5. If the Certificate is intended to support a IOMA or LOMR-F request, complete Sections A, B, and C. For Items E1—E4, use natural grade, if available. Chedc the measurement used. In Puerto Rico only, enter meters. E1. Provide elevation infortnation 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 enGosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Buiiding 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 eievated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certity this information fn 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 2one 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 Check here if attachments. SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the communiry'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. Chedc the measurement used in Items G8-G10. In Puerto Rico only, enter meters. G1. ❑ The information in Section C was taken from other docume�tation 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 Comments area below.) G2. ❑ A Community offlCial CompletCd 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 Compfiance/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 Chedc here if attachments. FEMA Form 086-0-33 (7/12) Replaces all previous editions. �— 0 Building Photographs See Instructions for Item A6. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 210 PALM ISLAND NW City State Zip CLEARWATER, FL 33767 For Insurance Company Use: Policy Number If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two 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." If submitting more photographs than will fit on this page, use the Continuation Page, following. ALL PICTURES TAKEN ON 11/13/2013 LOT 63, FRONT �� .__ �_..._" LOT 63. SIDE � i� LOT 63, REAR a �� ..�. *, � .�_ m� � � � � � � � =��r�l v'''��1�.ti,,... � �- ': ��. � � ''',-x� �.., �,;_