1111 CARDOVA LN�,.s. �,► � ��� ��►R� E�EY�►"�'ION CE�t'� ..
FED�EIM��G�b�CY �6EMEf�tT Ata�►cv ���� ". f,?ItAB Nti. 1�-t?008
Expit`ation �i[8te: Juty �1 � 20�.5
Na�iaaClClend Insvrm�u Progiqm IMPORTANY: Fdlow the instructions on pages 1-9. �
-.,.-
;; S►ECftON A-PRiOPEli"TY tN�T10N i�R IN�t1RANGE' , t1��.
Al. �e,i�dfi�g owners Name Clearv�rater Housing Authority �cr �u�sr: : .
. ,: . .
A2.' Build7 7�t At�dre53 (Iticlri i�pt•. Unit. Suite, ahd/or Bli�: No.) or P.O. itoute end Box No. ' m�er: ,
�FdQ1/8 L.c"�R�
e�' Ciearwater state FL zr� code 33755
A3. Prop�ty p�scrfptiq�.(l,ot and, BIoCk Mumbers, Tau Parcel NUmtreti Legsi Descriptiort, etc.)
Lat 23-�. Blce�c B SecQnci f�fdition to Sunset Point �lat Book 8 Page i4� Pineltas Gounty, FL '
A4. �w"ldin� Use (e.g.. Resictet�tial, Non-ResideMial. Addition. Accessory, etc.) E+i&�ideflti� ulti-Fsm�y) •^-^_
A5. LatitNde/longitude: Lat. N 27° 59' 21.1" �p�_ W 82° 4T 3b.�" Horilontal Detu►n: Q NAD 1927 [jx NAD 1983
A6, Attach et leest 2 photographs q�thhe building if the Certificete (s being usmd to obtain fiood i�surance.
A7. Building �iagram Number 1 B
A8. Fbr a building with a crawlsp�sce oi' �r►&ipsure�s): A9. For a buiiding with � attacNed �e�gec ,
a) S�ivare Pootage otcrawlspece or enctosure(s� N/A Sy.R a
) squane„tootage of attecttect ga�ge . ��!�:_ sq it
b)` (Yo. of p�rmanent fbod openings in th�s �r�vvls��ce ar wA b) Number of perrna►ier�i flood openir�s in the at�h6 gar�ge
e
enclosure(s) within 1.0 foot above stlj8�ei�t grade within IA fopt aGove,adjacent gr8�le _, �A _,_
c} Totat r�et area Of flood openings in 118.b �A sq in c) Total net area of 11ood openir�gs in A9.b T�,� sq in
d) Engineered flood openings?' � Yes', � IVv d) Engineered floodopenings? ❑ Yes � No
, S�KiN B-- FLOt� li�HRA1!�Cf RAT� NI/F� (�IRM) INI�I��TNlN
Bi. �p� uni f�ame &� ` Number B2. Courtt�r NamePinell B�. �taie � V
�" of�G� �ier rn r
B4. Map/Panel Number 65. Suff� �86. FlRRk�eWex pate 67. FlRM Panel �ffective/ B8. Ftood Zone(s) 69. $ese Flo�rii Etev�tfort(s) iZone
Revised Date 110. use base fload depth}
' 12103C0106 H p$/18/2009 05/17/2005 AE, X, X-Shaded 11' .
B10. tntlicate the source t�f the Base Flood Ete�ttfon (BFE) data or base flood depth enfered in (tem B9:
�j FlS Profile � FIRM 0 Community i)etermhted ., ❑ Other/Sauroe: .
811. indieate sievation daWm ys�q f4r B� in It�m 69; [,'� NGtfp°i928 ,� NAVD 1988 ❑ Other/S�wrce: ;-'
612. Is the buWdir�g located in a�oas�{ Banier`Regources Syst�m (C�RS) are� a Ot�enKise Pa�tected /kea (�A)? [� 1'es �,No-
Designation Date: �� / / � CBRS , ❑ OPA , <
SE:CTIOK`C - �LWNG Et£VATlON INFOi�M� (SURVEI( R�D)
__ ___C1. Buiidi ~ eleYatioris are'based onc _.__ _-� Consiructipn
�►6 Drawtngs* _ ❑ Bwikl Under CaNiistructbn� _ � Finis�ed �Or►struction_ , _ ,
*A rlew Elevaficx� Certificate will be required when csmstruction of the bui}ding is complete. �
C2. Elevetions - Z�nss A1 A30. Af. A#f. A(with BFE), VE� V1-V3Q V(with �, AR, AR/A. Ni1AE, AR/Ai-A30. AR{AFi. AR/A0. C�DmWete Items �
C2.a-h below e�ordit� to3he building diagram specified ln Item A7. M Puerto Rico only, er�Eer meters. �r)
Ber�chmark tttitized: Sett Box Cut on Curb Eiev 14.06 Vertica� Dawm: NAVD 1988 �,
Indicate elevation datum used for the eyevaUOns in items a) thfough h) betow+. ❑ N6VD 1929 � NAVD 1988 ❑ Other/Source: �
f�tum used for buikting elevations must be the same as that used for the BFE. Check the me�suremeAt used. (
a) Tdp of buttom floor (�ncluding basement, cra�ils�ce, or enclosure �oor) 12 1 � feet , Q meters �
b) Top of tfie next hip�ler floor 20 . 8 �{�g� [] met8rs �'
c) Bottom of the I� lmrizc�rtt�t-structt�a► merabet (V Z�nes oniy) WA . D�'. D�ertee� _ Q
d) Atta�l�ed Nr�e (toA af s(ab): W/A . �:teet ❑ meters �
e) Cbwest elcvation of machinery or eq�PmeM servicing the building �. Q � feet ❑ meters
(Qescrtt►e ty� at eQuiPmeM snd tocet+on'in Comments) �
� Lowest ae�jacent (finished) grade.�e� to buitd[ng (U�) '� 9,-0 � feet [] meters v
� Highest adjacent,(fmished) gtacAe next to buitding (TiAG� ��,: �_.. �feet ❑ meters � �
h) Lowest adjacent �rade at lowest etevstinn of deck or stsirs, ir►cluding ��. 4 ❑ feet ❑ meters
Struetural support " , :
5��10N D- S�1^QR, �IN�R, OR At�CHITECT �TfFICA1xt�N '' �
'Fhis certifiCBtForY is to:be si�ed and sealed by 8 land surv�iyo�; engineer, or atchitect authorized by 18w to certity elevation ,"'�"
�. ,:. �.
inforriAation. ! certify that tt�e &�formaUon an this Certfflcate represeMS my bcsi etforts ro lnter�et the data evattabte. ..�'`'` '
1�nderstartd that any talse statement may be punlshable" b� fln� or JmpHSOnrrnent under 18 tt.S. Code, Sectlon StJ02. � �•-- ;
���..r■�� f '�_t M• .
� Check here If �ommeMs are provided on back of form. Were lat�tutle and iongftude IrrSectian A provided by a C► .� t� ;
� Check here ff atta�►ments. lic�ens8d land sur�yor? � Yes � No �' .�i'� '�s;'������,r� � *
:�.
�f �' i � ��:�f�.� i
Certifler's f11e Lice�se Nurr�er • ♦�. i
Scott R, Fowier 5985 ;�,$�►; �' 4: .,
Title Cemparry Name . + r �.�r, * ,.' �
Fiarida R'stered Surve or t"andmark En �neerin & 5urve ,' C -
8515 Patm River Ro�d �a n FLe 3�1 g �' };!� � ;,� w�
• ,• � ,�,
signaare � p 1�,�� � r:
� . 0$/12E2014 8�t3: 621-7841
FEMA Form OSfi0-33 (7/12) See revarse side for coMir�ation. ''�p "` '
� ��8: erlitions.
ELEYATION CER'i1FlC/�T�, pa�e► 2
rMRORTANT:. in tt�ese sRaceq�, copY ths i
Building Street
1111 Car c
City
Clearwater
K., Unft, SuiCe, and/or
lon from Section A.
No.) or P.O. Route and Box No.
State ZIP Code
Paticy Number:
USE
�LCTION D-�URVEYOR, ENtiNVEER, OR ARCHITECT CER7IFlCATION (GONTtNU€D)
Copy boU�r sides of this ElevaUon CertificaYe for (1) community oiftciai, (2) insurance agent/company, end (3) building owner.
commerts Not valid without the signature and originai seal of a Florida Registered Surveyor and Mapper. Date of Field Work: 08J11/2014.
Latitude and Longitude t►btained with � hand held GPS device. The equipment referenced in C2e is the Air Conditioner, located
outside the structure.
Signature _ �-���_ _ _ Date 08/12/2014
SEC't#t�N E— BUILD�NG ELEVATION 1NfORMATiON (SURVEY NOT REQUIRED) FOR ZONE AO AND 1�ONE A(WiTNOUT BfE)
For Zones Ab and A(withaut BFE), complete ftems Ei-E5. If the Certificate is intended to support a LQMA or LOMR-F request, compiete SeCtlons A, B,and C.
For Items E1-E4, use natura� grade. if available. Check the measurement used. In Puerto Rico only, enter meters.
E1.`Provide elevation information for the fotlowing and check the appropriate boxes to show whether the eievation is above or below the highest adjacent
grade (HAG) and the bwest adjacent grade (LAG).
a) Top of bottom floor (inciuding basement, crawispace, or enclosure) is . ❑ feet ❑ meters ❑ above or ❑ below the HAG.
b) Top of bottom floar (including bas�ment,-crawlspace, or enclosure) is . ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2. For Buiiding D(�grams 6-9 with permanent flood openings provided in Section A ltems 8 and/or 9(see pages $-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 piatform of machinery and/or equipment servici�g the building is . ❑ feet ❑ meters ❑ above or ❑ beiow the HAG.
E5. Zane AO onty: If no flood depth number is available, is the top of the bottom floor elevated i� accordance with the community's floodplain management
ordinance? � Yes ❑ No ❑ Unknown. The locai official must certrty this information in Section G.
SECTUpN F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who compietes Sections A, B, and E for Zone A(without a FEMA-issued o� 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 Re�resentative's Name
� Address
City
State ZIP Code
Signature Date Telepho►ie
Comments
❑ Check here if attachments.
. SECTION G - COMMUNITY INFORNFATION (OPTI4NAL)
, The locai offlcial who is authorized by levr w ordinance to atlminister the community's floodplain managemerrt ordlnance can complete Sections A, B, C(or E), and
. G of this �levation CBrtiflcate. Cvmplete ti7e applicable item(s) and sign below. Check the measurement used in ftems G8-G10. Irt Puerto Rico only, enter metsrs.
;" G1. ❑ 7he information in Seciion C was� taken from other documentatian that has been signed and sealed by a liceosed surveyor, engineer, or architect
who is authorizeQ>dy lawto certity elevetion information. (Indicate the source anG date of the elevation data in the Comments area below.)
G2. ❑ A communtty officiai compteted Section E for a building located in Zone A(without a FEMA-issued or community�issued BFE) or Zt�ne A0.
�3. ❑ The following information (Items G4-G9) is provided for community floodplain management purposes.
�'^,. , G4. PetrrtR
Permitlssued
Compfiance/Occupancy
G7. Thts permit has been lssued tor: ❑ New Construction ❑ Substantial Improvement
G8. �levation of as-buqt lowest floor (inciuding basement) of the building: . ❑ feet ❑ meters Datum
G9. 8FE or (in Zone�AO) ciepth of flooding at the buildirtg site: . ❑ feet ❑ meters Datum
GiO�Community's design flood elevation: ❑ feet ❑ meters Datum
Locai Qf��ia1's 1V�me r Title
C uo�i�.y Name - .. _ Telephone
� �,�
S � tur� � �"' �� � � Date
�. 4�
Qomments' _
�
.
�, �
- - �`
` ❑ Check here if attachments.
FEMA Form 086-433 �7Jfi2}' Replaces all previous editions.
ELEVATION CERTIFICATE, page 3 BUILDING 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 F0. Route and Box No. Poiicy Number:
1111 Cardova Lane
Cit State ZIP Cod2 Company NAIC Number:
C�earwater FL 33755
If using the Elevation Certificate to obtain NFIP flood insurance, affix at ieast 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.
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FEMA Form 086-0-33 (7/12) Replaces all previous editions.
ELEVATION CERTIFICATE, page 4 BUILDING PHOTOGRAPHS
Continuation Page
IMPORTANT: In these spaces, copy the corresponding information from Section A.
Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or FO. Route and Box No.
1111 Cardova Lane
City
Clearwater
State ZIP Code
FL 33755
FOR INSURANCE COMPANY 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 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.
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Left Side
/11/2014
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FEMA Form 086-033 (7/12) Replaces all previous editions.