Loading...
18675 US HWY 19 N #179U.S. DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY Nadonal Flood Insurance Program A1 ELEVATION CERTIFICATE Important: Read the instructions on pages 1�. SECTION A - PROPERTY INFORMATION A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 18675 US Hwy 19 N. City Clearwater State FL ZIP Code 33764 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Unit 179, BAY ARISTOCRAT VILLAGE MOBILE HOME PARK OMB No. 1660-0008 E�cpiration Date: July 31, 2015 A4. Building Use (e.g., Residential, Non-Residential, Addi6on, Accessory, etc.) Residential A5. Latitude/Longitude: Lat. 27.9435 N Long. 82.7213 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 5 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 Na sq ft b) Number of permane�t flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enctosure(s) within 1.0 foot above adjacent grade Na within 1.0 foot above adjacent grade n/a c) Total net area of flood openings in AS.b Na sq in c) Total net area of flood openings in A9.b Na 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 Pinellas County, Florida 125139 Pinellas B4. Map/Panel Number B5. Su�x 66. FIRM Index Date 67. FIRM Panel 12103C0128 G 9/3/03 Effective/Revised Date 9/3/03 B10. Indicate the source of the Base Flood Elevation (BFE) dffia or base flood depth entered in Item 69. ❑ FIS Profile � FIRM ❑ Community Determined ❑ OtherlSource: 611. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: 612. Is the building locffied in a Coastal Barrier Resources System (CBRS) area or Othervvise Protected Area (OPA)? Designation Date: ❑ CBRS ❑ OPA 63. State Florida B9. Base Flood Elevation(s) (Zone AO, use b�e flood depth) 9' ❑ 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 wilt 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.afi below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: FIRM "RM 128-2" Vertical Datum: NAVD 1988 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. 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) � 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 sVuctural support 11.2 Na. Na. Na. 11.Q 5.7 6.4 6.0 Check 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 infwmation. l ce�tify that the information on this Certificate represents my best efforts to interpret the data available. �ndCheck he�etif commentsaar p ov�ded on back of ormy �Ae Were I toude and longit de n S ct on p ovided by a `�.`��FF NgE N�� �o���i� ❑ Check here if attachments. licensed Iand surveyor? � Yes ❑ No �� ��NQ. �� F,A`� � Certifiers Name Jeffry H. Hillig�s Title PSM Address 601 Padua Ct License Number 4488 Company Name J.H. Hilligoss, PSM City Nokomis State FL ZIP COde 34275 Signature � � 7/27/14 Telephone 941-244-8623 STATE OF FLORIDA FEMA Form 086-0-33 (7/12) See reverse side for continuation. Replaces all previous editions. ELEVATION CERTIFICATE, page 2 IMPORTANT: In these spaces, copy the corresponding information from Section A. Buiiding Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 18675 US Hwy 19 N. City Clearwater State FL ZIP Code 33764 FOR 1NSURANCE COMPANY USE Pdicy Number. Company NAIC Numbet° SECTION D— SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Cert�cate for (1) communiry o�cial, (2) insurance agenUcompany, and (3) building owner. Comments Ref: C.2(e) - A/C on rasied support platform; bottom of steel chassis elevation = 9.6' Signature / / Dffie 7/27/14 t/ 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 fw the following and check the appropriate boxes to show whether the eievation 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 encl�ure) 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 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 andlor 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 owne�'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 w Owner's Authorized Representative's Name Address Signature Comments City Date Stffie ZIP Code Telephone ❑ Check here if attachments. SECTION G — COMMUNiTY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the communit�is floodplain management ordinance can complete Sections A, B, C(or t), and V of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8�10. 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 ficensed 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 managem G4. Permit Number G5. Date Permit Issued G6. Da p��� ��.P an,� f 05rq� G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-built lowest floor (including basement) of the building: ❑ fe G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ fe G10. Community's design flood elevation: ❑ fe l.ocal Official's Name Community Name Signature Comments FEMA Form 086-0-33 (7/12) Title Telephone Date ��',�,� �,a r�` ��� � �� .�� � �� i� �J www.FloridaRefuseLakeland.com �„� Replaces all previous editions. 0 . � 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. 18675 US Hwy 19 N. - Unit 179 City Clearwater State FL ZIP Code 33764 FOR INSURANCE COMPANY USE Policy Number: Company NAIC Number. If using the Elevation Certificate to obtain NFIP flood insurance, affix at teast 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front Vie�nl' 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 submitti�g more photographs than will fit on this page, use the Continuation Page. FRONT VIEW 7/27/14 ` � �� ,� w � �� �- Y'� � y� ;� �� � � � � � � .ro `�'���r,sa�+���� y�� `_' J. ���-�. �.�.�. .., � � � REAR VIEW 7/27/14 ��, M� � � �� � y},� ,• � � � . � "�_ . � _: FEMA Form 086-0-33 (7/12) Replaces all previous editions. c � ELEVATION CERTIFICATE, page 4 guilding Photographs Continuation Page 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. 18675 US Hwy 19 N. - Unit 179 City Clearwater State FL ZIP Code 33764 FOR INSURANCE COMPANY USE Pdicy 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 Vievd' and "Rear View"; and, if required, "Right Side Vie�' 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. RIGHT SIDE VIEW 7/27/14 � .:�. ; < �,�a:. v � ��`'�` � r�� ' :., � .�; LEFT SIDE VIEW 7/27/14 ,�� a : �� ��. � -�---.�-�- � �' � <s � � - _ � � �,� �'"'�"'.' �� ���'�' �� �'�"� ' � � �k FEMA Form 086-0-33 (7/12) Replaces all previous editions.