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231 MIDWAY ISLANDU.S. bEPARTIY�NT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY National Flood /nsurance Program A1. Building Owner's Name ELEVATION CERTIFICATE Important: Read the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 231 MIDWAY ISLAND City CLEARWATER State FL ZIP Code 33767 OMB No. 1660-0008 Expiration Date: July 31, 2015 A3. Property Description (Lot and Blodc Numbers, Tax Parcel Number, Legal Description, etc.) LOT 44, UNIT 3 OF ISLAND ESTATES OF CLEARWATER - PARCEL # 08-29-15-43344-000-0440 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27.9801°N Long. 82.8125°W Horizontal Datum: ❑ NAD 1927 � NAD 1983 A6. Attach at least 2 photographs of the building if the Cert�cate is being used to obtain flood insurance. A7. Building Diagram Number 7 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) 2753 sq ft a) Square footage of attached garage N/A sq ft b) Number of permanent flood openings in the crawlspace b) Number of pertnanent flood openings in the attached garage or enclosure(s) within 1.0 foot above adjacent grade 16 within 1.0 foot above adjacent grade N!A c) Total net area of flood openings in AB.b 3186 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 62. County Name CITY OF CLEARWATER 125096 PINELLAS 64. Map/Panel Number B5. Suffix B6. FIRM Index Date 67. FIRM Panel Effective/Revised Date 12103C0102 G 8-18-09 9-3-03 63. State FLORIDA 68. Flood Zone(s) B9 Base Flood Elevation(s) (Zone AE AO, use ba 11 flood depth) B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69. ❑ FIS Profile � FiRM ❑ Community Determined ❑ OthedSource: 611. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ OthedSource: 612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes � No Designation Date: N/A ❑ CBRS ❑ OPA 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 whe� 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: MAC DILL AFB 6 CORS Vertical Datum: NAVD 1988 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. Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 5.34 � feet ❑ meters b) Top of the next higher floor 16.10 � feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A � feet ❑ meters d) Attached garage (top of slab) WA � feet ❑ meters e) Lo�nrest elevation of machinery or equipment servicing the building 17.25 � feet ❑ meters (Describe type of equipment and location in Comments) fl Lowest adjacent (finished) grade next to building (LAG) 4_7 � feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 5_1 � feet ❑ meters h) Lowest adjacent grade at lowest elevation of dedc or stairs, including structural support WA � 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 cert'rfy elevation information. I certify that the information on this Certificate represents my best efforts to interpret the data available. �'�; '`- I understand that any fa/se statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. .�„� � A, ��+�,�j, �,; � C h e c k h e r e i f c o m m e n t s a r e p r o v i d e d o n b a d c o f f o r m. W e r e l a t i t u d e a n d l o n g i t u d e i n S e c t i o n A p r o v i d e d b y a :� a,`�y g� t� t t, ��';.;�^` �" � Check here if attachments. ficensed land surveyor? � Yes ❑ No C� ;�G "�� :, =�' �� Certifier's Name GEORGE A. SHIMP III Job Number 140141-D License Number 6137 �: y t�+�. �t37 `� '� r ='� _ . � , � Title VICE PRESIDENT Company Name GEORGE A. SHIMP II & ASSOCIATES, INC. �'�'�►F�•T�ciF° r' � � J ti,'.� '., FL�RaDt: , •',r8 . Address 3301 DeSOTO BLVD., SUITE D City PALM HARBOR State FL ZIP Code 34683 �,, : �.�,� �_'�-••-�:�� FEMA Form 086-0-33 (7/12) .�. Date 3-5-2015 Telephone 727-784-5496 See reverse side for continuation. z °T,,.. Replaces all;previous editions. >� _ .� ELEVATION CERTIFICATE, page 2 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. 231 MIDWAY ISLAND City CLEARWATER State FL ZIP Code 33767 SECTION D— SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insuranc:e agenUcompany, and (3) building owner. Comments SEE PAGE 5 FOR SURVEYOR'S COMMENTS (THIS DOCUMENT IS NOT VALID WITHOUT ALL 5 PAGES) � Date 3-5-2015 Signature SECTION 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). feet meters ❑ above or ❑ below the HAG. a) Top of bottom floor (including basement, crawlspace, or enclosure) is �{�et ❑ meters ❑ above or ❑ below the LAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is . ❑ ❑ E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 andlor 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 elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local 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 correct to the best of my knowledge. Property OwnePs or Owner's Authorized Representative's Name Address Signature Comments City Date State ZIP Code Telephone ❑ Check here if attachments. SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local offiaal who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C(o� 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 official 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 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-built lowest floor (including basement) of the building: ❑ feet ❑ meters Datum G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum G10. Community's design flood elevation: ❑ feet ❑ meters Datum Local Official's Name Community Name Signature Comments Tftle Teiephone Date Check here if attachments. FEMA Form 086-0-33 (7/12) Replaces all previous editions. �� go��T�9 �a�� uilcling Photographs See Instructions for Item A6. IMPORTANT: In these spaces, copy the corresponding information frorr� Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 231 MIDWAY ISLAND City CLEARWATER State FL ZIP Code 33767 FOR INSURAPIGE COMPANY U5E Policy Number: Gompany 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. F. ..y:'�' _" . . ��_� � �, �: ��, ��,a "�.,t <fi� � .��,<� �� . x _ rt � �' k .,�, ry.. ... �� i^ -,� . _.. _., ..; ..� FRONT VIEW Picture taken on: 3-5-2015 =EMA Form 086-0-33 (7/12) Replaces all previous editions. ��EV�°�'on� ��RTS�ec�ar�, page 4 guilding Photographs ' Continuation Page IMPORTANT: In these spaces, copy the corresponding information from Section A, FOR INSURAPlGE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: 231 MIDWAY ISLAND City CLEARWATER State FL ZIP Code 33767 Gompany NAIC Number: If submitting more photographs than wili fit on the preceding page, a�x 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. ��;, ��`�„rt.°>; ` � °��'��'' ," �"�°^"'� - _ _ ��:�-, � y r, � r � n �� _ � �� `� , � � , � � �.. ,. , - ;� �� ,:�,�'�'. .: - � b � ,. w, �,K. � � a� q- � , , � ��..-. �-� s r, ,. ...,. y � ;.e REAR VIEW Picture taken on: 3-5-2015 FEMA Form 086-0-33 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 5 IMPORTANT: In these spaces, copv the Surveyor's Notes Continuation Page information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No. 231 MIDWAY ISLAND City CLEARWATER State FL ZIP Code 33767 SECTION D— SURVEYOR'S CERTIFICATION (CONTINUED FROM PAGE 2) A1. ) THIS ELEVATION CERTIFICATE WAS PREPARED EXCLUSIVELY FOR THE USE AND BENEFIT OF THE PARTY SPECIFIED IN SECTION A, ITEM 1, FOR THE SPECIFIC PURPOSE OF OBTAINING FLOOD INSURANCE AND/OR VERIFYING FLOOD ZONE COMPLIANCE WITH THE LOCAL GOVERNING AUTHORITY. THIS DOCUMENT SHALL NOT BE VALID AND BINDING AGAINST THE SIGNING SURVEYOR WITHOUT THE ORIGINAL RAISED SEAL AND SIGNATURE OF THE FLORIDA LICENSED SURVEYOR AND MAPPER. USE OF THIS DOCUMENT BY ANY OTHER PARTY OR FOR ANY OTHER PURPOSES IS STRICTLY PROHIBITED AND SHALL RENDER THIS DOCUMENT INVALID FOR THOSE PURPOSES. UNAUTHORIZED COPIES ARE STRICTLY PROHIBITED AND SHALL NOT BE VALID. REQUESTS FOR ANY ADDITIONAL OFFICIAL SIGNED AND SEALED COPIES MUST BE DIRECTED TO GEORGE A. SHIMP II & ASSOCIATES, INC. A4.) THE BUILDING USE WAS DETERMINED BY PHYSICAL OBSERVATIONS MADE ON THE DATE OF SURVEY. A5.) THE LATITUDE AND LONGITUDE COORDINATES WERE OBTAINED USING A HAND HELD G.P.S. UNIT WHICH MEETS OR EXCEEDS FEMA'S REQUIRED ACCURACY OF 66 FEET. A7.) THE BUILDING DIAGRAM NUMBER WAS DETERMINED BY PHYSICAL OBSERVATIONS MADE ON THE DATE OF SURVEY. CERTAIN STRUCTURAL FEATURES NOT VISIBLE TO THE SURVEYOR (PILINGS, GRADE BEAMS, ETC.) CAN AFFECT THIS DETERMINATION. A8.) FOR THE PURPOSE OF THIS DOCUMENT, A BUILDING ENCLOSURE IS DEFINED AS THAT PORTION OF AN ELEVATED BUILDING, BELOW THE LOWEST ELEVATED FLOOR, THAT IS EITHER PARTIALLY OR FULLY SHUT IN BY RIGID WALLS. A GARAGE BELOW OR ATTACHED TO AN ELEVATED BUILDING IS CONSIDERED AN ENCLOSURE. SUCH AREAS SHALL NOT CONTAIN MORE THAN 20 LINEAR FEET OF FINISHED INTERIOR WALLS (PANELING, ETC.) OR IT WILL BE CONSIDERED A FINISHED (HABITABLE) AREA. IF APPLICABLE, THE STRUCTURE CONTAINS: ❑ CRAWLSPACE � ENCLOSURE ❑ N/A IF APPLICABLE, THE CRAWLSPACE CONTAINS N/A SMART VENT(S) CERTIFIED TO COVER N/A SQ. FT. PER VENT. IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAINS N/A SMART VENT(S) CERTIFIED TO COVER N/A SQ. FT. PER VENT. IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAINS: GARAGE AREA AND STORAGE AREA IF APPLICABLE, DOES THE BOTTOM FLOOR ENCLOSURE APPEAR TO CONTAIN BREAK-AWAY WALLS? ❑ YES � NO ❑ N/A A9.) IF APPLICABLE, THE ATTACHED GARAGE CONTAINS N/A SMART VENT(S) CERTIFIED TO COVER N/A SQ. FT. PER VENT. A8. & A9.) FOR THE PURPOSE OF THIS DOCUMENT, A FLOOD OPENING IS DEFINED AS A PERMANENT OPENING IN AN EXTERIOR WALL THAT IS NO HIGHER THAN 1.0 FOOT ABOVE THE HIGHER OF THE EXTERIOR OR INTERIOR GRADE OR FLOOR IMMEDIATELY BELOW THE OPENING. B8.) UNLESS OTHERWISE NOTED IN SECTION B, ITEM 10, THE FLOOD ZONE WAS DETERMINED BASED ON THE FLOOD INSURANCE RATE MAP. IN CERTAIN CASES WHERE AN ACCURATE DETERMINATION COULD NOT BE MADE FROM THE MAP, THE COUNTY'S G.I.S. OVERLAY MAY HAVE BEEN UTILIZED TO DETERMINE THE FLOOD ZONE. NO SEARCH OF THE PUBLIC RECORDS WAS PERFORMED FOR LOMA'S, LOMR'S, ETC. WHICH MAY AFFECT THE SITE. C2.e) AIR CONDITIONER LOCATED ON AN ELEVATED WOOD PLATFORM. U.S. DEPARTMENT OF NOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY Nationa! Flood Insurance Program Building Owner's Name ELEVATION CERTIFICATE Important: Read the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 231 MIDWAY ISLAND City CLEARWATER State FL ZIP Code 33767 OMB No. 1660-0008 Expiration Date: July 31, 2015 FOR INSURANCE COMPANY USE A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 44, UNIT 3 ISLAND ESTATES OF CLEARWATER - PARCEL # 08-29-15-43344-000-0440 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27.9800°N Long. 82.8125°W 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 7 A8. For a building with a crawlspace or enclosure(s): A9. For a buiiding with an attached garage: a) Square footage of crawlspace or enciosure(s) 2753 sq ft a) Square footage of attached garage N/A 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 16 within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b 2145 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 61. NFIP Community Name & Community Number 62. County Name CITY OF CLEARWATER 125096 PINELLAS B4. Map/Panel Number B5. Suffix 66. FIRM Index Date 67. FIRM Panel 12103C-Q102 G Effective/Revised Date � 8-18-09 9-�-03 B3. State FLORIDA 68. Flood Zone(s) I B9 Base Flood Elevation(s) (Zone AO, use base flood depth) AE �� 610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69. ❑ FIS Profile � FIRM ❑ Community Determined ❑ OtheNSource: 611. I�dicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NA`JD 1988 ❑ Other/Source: 612. Is the building located in a�Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes � No Designation Date: N/A ❑ CBRS ❑ OPA SECTION C- BUILDING ELEVATION INFORNIATION (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: MAC DILL AFB 6 CORS Vertical Datum: NAVD 1988 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: DatLm used for b;�i!ding elevatio�s must be the same as that used for the BFE. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) b; Top of ths next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation ofi 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 deck or stairs, including structural support 5.38 15.14 N/A N/A N/A 4.4 5.3 WA Cneck the measurement used. � 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 infomzation. I certify that t,he infor,rrati�n on this Certificate represents my best efforts to interpret the data available. ! understand that any fa/se s:atement may be pvnishable by fine or imprisonmsnt untier 18 U. S. Code, Section 1001. � Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a � Check here if attachments. licensed land surveyor? � Yes ❑ PJo Certifier's Name GEORGE A. SHIMP III Job Number 140141B License Number 6137 Titfe VICE PRESIDENT Company Name GEORGE A. SHIMP II & ASSOCIATES, INC. Address 3301 DeSOTO BIVD., SUITE D City PALM HARBOR State FL ZIP Code 34683 r�row rofm UiSCi-U-33 (7/12) Date 8-4-2014 Telephone 727-784-5496 See reverse side for continuation. � `: M ` - . W`,�.�� ' • � C:i` - " �� td�;' . r� �• , � j . �4 �� ,r'��^` r' � � � :;� iJ�. t'st::7 `� • Er I - t:� � •`> �` - � d�'Y SiAic- C�E� ' .t+ .�,t�t �� r�L' ' i,4'" _ . _. -��, . #6'(3� , D�4�?'1 �� „ Replaces all previous editions. CLtVA 1 IVN l:tK 1 ItII:A I C, pa je L IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (inciuding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. �31 MIDWAY ISLAND City CLEARWATER 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 agent/company, and (3) building owner. Comments BOTTOM OF ELEVATOR PIT ELEVATION = 4.50' Signature Date 8-4-2014 SECTION E— BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR 20NE 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). feet ❑ meters ❑ above or � below the HAG. a) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ b) Top of bottom floor (including basement, crawlspace, 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 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 ❑ be�ow 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 fioor elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The Iocal official must certify this information in Section G. SECTION F— PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's auihorized represeniative 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 correci to the best of my knowl�dge. Property Owner's or Owner's Auihorized Representative's Name Address Signature Comments City Date State Telephone ZIP Code Check here if attachments. SECTION G — COMMUNITY INFORMATION (OPiIONAL) The Ical otficial wrho is author�ze� by law or ordinance to administ2r the community's floodplain maragement ordi�ance can complete Sections A, B, C(or E), and G of this Elevation CeRificate. 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 authoriz�d by law to certify elevation informati�n. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Sectior. E for a buildir.g !ocated in Zone A(without a FEMA-issued er ��mmunity-issued BFE) or Zone AO. G3. ❑ The following infortnation (Items G4—G10) 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-built lowest floor (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 Narri2 Signature _� � �r, / �� •��/ Comments � � � ��\ FEMA Form 086-0-33 (7/12) Title Telephone Date Datum Datum Datum Check here if attachments. 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 Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No. 231 MIDWAY ISLAND City CLEARWATER 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. ` � ;� � �,- � � �� ,� ; � �� .� .� � � '��'�.� �,�� . �'�• �.� ,-.-°-�--°-...._ � � _ a . w � _�_ ,, �k •_. _ I "-- '. �� ... � � � �, ". LLt � . `'�� . ,��",�'��`�- ' , "�. ' �r -,:a }; I i ` � .. _. _. _ .. 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