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1031 MANDALAY AVEU.S. DER�9R�MENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY Ncitiun�d F(ooc! Insnrunce Prugrum A1. Building Owner's Name Jeffrey L. Ford ELEVATION CERTIFICATE SECTION A - PROPERTY INFORMATION A2. Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No. 1031 Mandalay Avenue Ciry Clearwater State FL ZIP Code 33767 OMB No. 1660-0008 Expiration Date: July 31, 2015 FOR il Policy Compariy A3. Property Description (lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 8 and part of Lot 9, Block 267, Carlouel Subdivision Pid: 32-28-15-13464-267-0080 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Residential A5. LatitudelLongitude: Lat. .00 7 Long. 8.8 3 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 1b 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 568 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 0 c) Total net area of flood openings in AS.b n/a 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 Community Name & Community Number I B2. County Name City of Clearwater, 125096 Pinellas 64. Map/Panel Number B5. Suffix B6. FIRM Index Date 67. FIRM Panel 12103C0064 G 09/03/03 Effective/Revised Date 09/03/03 63. State FL B8. Flood I B9. Base Flood Elevation(s) {Zone Zone(s) AO, use base flood depth) AE 11.0 610. 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: 612. Is the building tocated in a Coastal Barrier Resources System (CBRS) area or Othervvise Protected Area (OPA)? Designation Date: ❑ CBRS ❑ OPA ❑ 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: Citv Benchmark# J-03 Vertical Datum: Elevation 2.595. NAVD88 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) f) 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 support 6.31 n/a. n/a. 5.52 5.96 5.00 5.50 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 �111�) ��►�� information. 1 cerfify that the information on this Certificate represents my best efforts to interpret the data available. ��BQr; W��;ah�s �j I understand that any fa/se statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ��0 �NSE N(jMe�O'j/�' � Check here rf comments are provided on back of form. Were latitude and longitude in Section A provided by a � vG F,Sj �. �� ❑ Check here if attachments. licensed land surveyor? � Yes ❑ No : N0. 6573 �„ _ • _ _ . � Certifier's Name Jose�h E. Wi�liamson, PLS License Number 6573 Title Licensed FLS ieyor Address 941 S P ns Signature FEMA Form 0 6-0-33 (7/12) Company Name Vision Land Service Winter Park State FL ZIP Code 32789 Date 05/21/13 Telephone (888) 399-8474 See reverse side for continuation. : � A �. STATE OF .'� � r �T�; � FLORIDA • �� ,� , /� .� •�� /'',�� 1! 1111 ��,``` Replaces all previous editions. i.a�a:rniivi� �.i.��aii�a��ia:� IMPORTANT: In these spaces, copy the corresponding information from Section A Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No. 1031 Mandalay Avenue City Clearvvater. State FL ZIP 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) buiiding owner. Comments Item C2e was located on the Air Conditioner Pad Signature SECTION Date 05/21/13 BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BF i 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, crawispace, 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 �9 of instructions), the next higher floor (eievation 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 fioodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local offlcial must certify this information in Section G. SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The properry 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'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 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 officiat 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 p�rposes. 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 G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet 0 meters G10. Community's design flood elevation: ❑ feet � meters Locai Official's Name Community Name Signature Comments Titie Telephone Date 0 meters Datum _ Datum _ Datum 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. Building Street i4ddress (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 1031 fMandalay Avenue City Clearvvater 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. • � '�» t„x � ,; ; ��,� � �I.�-. ;,�, , ;� � f{ ��- _� � , N. k.�M -, „. Front of House (from West Property Line) � FEMA Form 086-0-33 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page4 guilding 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. No.) or P.O. Route and Box No. Policy Number: 1031 Mandalay Avenue City Clearwater State FL ZIP Code 33767 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. �� ,. � �� l �- .. � �4 P �` � �� $ ��' iti� 1 � �� T.'s. � a w., .�' a + �-�.��-r � � , y � �' �,. �-,« .q .��y.., . _ . � �r *�� • �A ,.�'� • �! �, �'• . �ye , 7'-."�°,`.... � - k I � C� *d � ' 'r,� r; '� � . . .� ��.�.:_.��. y'• • � y \i �P an � !^� r . i. W �� `, , � -� ,,. . . . ,., . � ,�,., , . . . : • _.�:.. . ,, a � - � . ,,.. x f� � � :�—. — � � . , .. � � ,� ., . ,. . . � � , ��M� S'�" � R �;�- '� , a� .�a ' , '� � '" , ,, . „ ; i ' Q, � � �.+r n 3 �«� � ,"! '4s : a,� , ' M ., i . . . � � �,. A �� ., � 4'�p�',:,r �� r � . , q9 .w� ''' - �'�` p�3�,' +.y r '� _ �,.� e � �-'� 1 , s ^ �, & ��...vb s� "a dt J�. � �' -n3 # qi i ��: ��T�� U �•� x � + . b ��M�� . �� i� �� f , F.+i. W' �� R �`�� "'A�� #. '�{�.� ��. ?�.'r r �., . � .. ��,�� 3 .... .. . � . i�h�ir"3°�S ,�a4 ',.r7��4�g y$' R-�A• S�i ��Ti �: Rear of House (from East Property Line) FEMA Form 086-0-33 (7l12) Replaces all previous editions. . _ � � ' Vision Land Service, LLC P.O. Box @41186 MaiUand, FL 32794 Vaoe: (888) 399-8474 Fax: (888) 467-6482 INVOICE Invoice Number: VLSR13-3446 Invoice Date: May 15, 2013 Page: 1 Duplicate TiUe Agency of Florida, Inc Title Agency of Florida, Inc 19535 Guif Blvd # C 19535 Gulf Blvd # C Indian Shores, FL 33785 Indian Shores, FL 33785 t�+�tt�rr tD t�atam�r' M�a ��rtt� �e�r�s — TiUe Agency of FL Net 30 Days Satas i�t D ' Shi�pi�g IY�th�+d ; 8t� Dat�� te �t�e A�borne 6/14/13 I . 0 - U u�v N00'S2'13"E 96.19(F) _i NOt'36'00"E 93.00�(P) � v M � fl � � o W � n �� o A z � �' O z � , : ,. S ;m �Q .N r '� �2 ':��r,a, ;.. f' �•� ,,��,. � NO3'38'00"E I � � 10.00'(C) I ��.L, ��T j� � \� � ' -., , (BFqR�NG �/ 1 p' OF �� 4', eqs�s) C�T 9 I ��Di ��(C) � � � � ?$"E ''O` _ � � \ I � � J � ` r•�) , \ �I � � Q � J o � _...>_,,. � � a N:,::::4,�,.��:,. I ' 3� � � �,>� �Z `3o'E 25.4' � J � .i.. ` ' L07 g JNC.. r y � Sfo •r B/x '�I�.�.�} � � � '�'es,��.e ,�y' 7 \ ° �' - . . .. � .. ;� � I� � Tyq T p � � N OF C0 r 9 T I��i 2.5' SUE I ----�.� � I W � = w � N o :' o � � 0 �1� ��O �s• ) N z° �c I i .,., � l.- , , � �' � � � S�Ob? �� >>a?S, e ��T � P�q TRB UF� S 26� � ��k ?o e/'qGS/oN £ 60 EASEMENT NOTE: THERE IS A 2.5' SEWER & UTIUTY EASEMENT (SUE) ON THE REAR OF THE SUBJECT PROPERTY C�T �1 P�q T e0 � DqCq Y 4, pqGe 3S - �`"`� � Jf'r,� ` ., 1�. �. � + V ` �. �� , � �W 41.1' p O � � � �pr 2 � � z � P�q T Mi S � � N��, ��'it� v T � I L�9cZ/ �eSCr%�C`%or� �ccs P�o%ded) Lots � and 9i L.E55 the /forth �p �'eet oF sa%d L.ot q, S/oc,� aG�, Car/oue/ Su6d;u�s;on� �u'�'..ordi� 20 �/�e �c� or y/c�t thereo�' as recorded �n P/at 800.� zp, Pu,yes �p �hrou9h Ga, %nc/us%ve, of' the Pu6/�c. �ec.ords oF P�.ae//as Cour,ty, f7or%du. � tJ E 5 I" p 3Q� -- SC_�LE i"=sp' �...�_",�..._: _ �� r+��0�k1�_ � , . . �-�.�� :. ADDRESS 1031 Mandalay Avenue Clearwaler, FL 33767 LEGEND ❑ � Found Concrete Monum�nt (CM) �- Found Iron Pip� k Cap (IP) �� Famd Iron Rod R Ca0 (IR) OR Book � OHlclal Record Book ��Ntary Manhds P9 POq° 4} � Powx Pda CONG � Conarste �� head Utllttles FNp � Found ID = IAentNlcotlon � � �MOtr M�tu LB � Lldnwd Budnm C� Calwlat�d Di�tanc� LS . Llcsnssd Surwyor � �d Meaauremant PVC � PdyNnyl Chlorld� (P) � Plat Dbtancs JOB#: VLSR7J-3446 � CLIENT#: 13-3JR7 � FtEW DATE: os10-i3 �y DRAFTER: e7 o APPROVED: ]EW SCALE: 1' - 30' x x BonoweM1l�cMOVAeCgman: BortowehOCW�aWetlpmern anEl�ccep�nce eMheceptence � � a a 0 � � Z a o �� < � 3 o � o`�l> � � 3 � � F � K F• 'z � e BUU��I S ... � N00'52'13'E 98.19(F1 �/,`� � O�l � o�o � M� O z� Z u�ve� EASEMENT NOTE: TIIERE IS A 2.5' � a� unun EASEMENT (SUE) ON 7HE REAR OF TME sue,�cr aROa�Tr �0r >> p�q T 'NqN @p�K 0� pAC f 3S Lesa/ .�/ eSCr�J�%on CctS Pro✓idedi Lots 8�' 9� LE55 the � th �O �=t o!' sa�d Lof 9� 8��-�' �G3, Cru�%uel Su6d'�ns%a+� acca�d�.g Ya Yik ,+ryn a� �/at ther:o{' qs rscorded ;n P/at 800k �O� Paya3 6o throuyh 6�, ��/us%ve� of'tlx Pu6/�c_ �?.r_ords of' A'.,://ms Coun[y, �;dr.. TiflEO TO: (A9 FURNISXED) ay l. Fard �gency of Floritla. Inc mvealth LAM Title Insutance Compeny �pn Tomadc ane Mery romeck SU6JECT PROP[RTV SHOWN MEREON APPEARS i0 BE LOCATCD IN FLOOD ZONE'AE", AREAS WITH A BASE FLOOD EIEVATION OF 11.0', PER F.I.RM. PANEI NVM6ER 12103C0084 G, LAST REVISIONDAiE090.408. iFtlS SURVEYOR MAKLS NO GUARANTEES PS TO TME ACCURACY OF THE ABOVE INFORMATION. THE LOCA� F.EM.A AGENI- SHOULU Bt CONTNCIEO FOR VERIFICATION. .IST OF POSSIBLE ENCROACHMENTS: =ENCES AND BRICK WALL CROSSES PROPERTY LINES JWNERSHIP OF FENCES ANO WALLS NOT OETERMINEO 3ASI5 OF BEMING 3GWNG5 ARE BASED ON THE NORTH LINE OF THE SUBJECT PROPERTY NHICH HAS A 6EARING OF 5 70°20'25" � PER FIELD. NOTES 7. UnEBrprwnE Ntltty Inatallatbne, unEerpmurM Impro�emenls, fauMatbm anNOr aner unaerg�wna swcures wero nm ioraiee oy we nnvey. z rna p�rpoaa or �n� s�rvey is r« �,.s i� ac�i�o-�p eme M�,ra� �a n� a� a�e snw,m �m oa �aae r« oo�am,aw� p.,�. 3. AtlElllons w tlelelb�n to t�ls eurvey Cy o[hw Man Rre slpM� paM1y v paNBS h prohlbHatl wlMOUt t�a wrtttan consant of ihe ey7ning paM1ya peHba. 6. Tha properly ahown �wson In aubJact to eN eesemaMa, �esbk.lMa erM ervatlons whlch may ba nhown p note0 on iM recatl plal aiM wflhln tlre pudlc rewrtla o/ the courtty tM aubJad props�y h localetl. Thla s�swy oNy eapicts survey raa�ee iniwmeuon eucn as eaeamans ana sxeacrs mm are shawn on a rocortl plat or �eve Oaen fumleheCbttwSUrveya. 5. BuIlElnp tiee antl tllmensbne for Improvemenis eAaAE not bsuseE4'i�econsfiut bountlary Ilnes. THIS SURVEY IS PREPARED FOR iHE E%CLUSIVE USE ANO BENEFIT OF THE PARTIES t15TED HEREON. LIABILIiV TO THIRO PARilES MAY NOT BE TRANSFERRED OR A3SIGNEO. GSiCUI ,LG/1.� SPJLVl.CP� ,�,LGD 941 S. Pennsylvanla Avenue Wlnter Park, FL 32189 Phone (888) 399�8474 LB ��g SURVEYOR'S CERTIFICATE 1 HEREBY LERTIFY THAT TNIS SURVEY IS A TRUE NJD ACCURATE REPRESENTATION OF A Sl1RVEY Pj�Pp}jED UIVDFR MV DIRECf[ON. NO.85I3 STATE OF FLORIDA REGISTRATION p8673 NOT VALID WRHOUT THE ELECTRONIC SIGNATURE PND/OR ORIGINAL RAISED SEAL OF TME LISTED FLORIDA LICENSEO SURVEYOR AND MAPPER Nationwide� Policy Number:50050221232013 �� Insurance FLOOD POLICY DECLARATIONS . Nationwide Mutual Fire Insurance Company . Standard Policy Type' Revised Declaration To report a clai.m call: (800) 421-3535 POIlCy Perlod: 07/16/2013 To 07/16/2014 These Declarations are effective Form' Dwelling as of: 09/06/2013 at 12:01 AM Producer Nazne and Mailing Address: Insured Name and Mailing Address: ROBERT THOMAS NEWSOME JR FORD, JEFFREY L 325 N BELCHER RD FL 2 1031 mandalay Ave w CLEARWATER, FL 33765-2623 Clearwater Beach, FL 33767-1041 t', - � � � � ia "� � �i w � � � � s� � � 0 � a no � � � � _ _ i -� w � � � �o � bu � � 0 � AgendAgency #: 090030558 Reference #: 09677-30558-001 Phone#: (727)726-4989 Property Location: 1031 MANDALAY AVE CLEARWATER BEACH, FL 33767-1041 PrincipaUPrimary Residence: Y Premium Payor: znsurea Flood Risk/Rated Zone: AE Current Zone: Community Number: 12 5096 0007 D Community Name: CLEARWATER, CITY OF Grandfathered: No Pre-Firm Construction Program Type: Regular 't�pe Building: Contents: Contents Location: ftates � Deduct is�,ioo I .�eo / .��o � 2,0 Lowest Floor Only Above Ground Level Coverage Limitations May Apply_ See Your First Mortgage: Second Mortgage: Processed by: Flood Insurance Processing Center P.O. Box 2057 Kalispell MT 59903-2057 Building Description: Single Family One Floor Slab On Grade Elevated Building: N Replacement Cost: $187,100 Number of Units: i Sub Total Premium Calculation 1_4 � Form for Details. d� °,'; OCT 11 2��:� rAi�1[ ��' �� 0o Premium Subtotal: 0o ICC Premium: CRS Discount: Reserve Fund Assmt: Federal Policy Fee: Probation Surcharge: E�dor.semenL Amoun� Total Premium Paid: Third Mortgage: JOSEPH AND MARY TOMACIC LIVING 6929 N KENNETH Ave Lincolnwood, IL 60712-4708 Additional Loss Payee: a,169.00 �o.00 336.00 .00 .00 .00 1,943.00 This Declaration Page, in conjunction with the policy, constitutes your Flood Insurance Policy. In WITNESS WHEREOF, we have signed this policy below and hereby enter into this Insurance Agreement. -�� ., ,�G�,-- 1Tark A. Pizzi, President Robert W. Horner III, Secretary 50050221232013 09/1Of2013 Nationwide Mutual Fire Znsurance Company NWLOGO INS WE OXP_00000747448