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741 BRUCE AVEA U.S.DEPARTMENTOFHOMELANDSECURITY ELEVATION CERTIFICATE FEDEi�.4.L �wMERGENCY MANAGEMENT AGENGY OMB N0. � BBO-OOOH 9� �tua;�arFtooat,;su,•a,:reamgram �mportant: Read the instructions on pages 1-9. Expiration Date: July 31, 2Q15 SECTION A-PROPERiY INFORNAATiON -�OR 1t�S�1(�ANGE CDMPAN� USE " A1. Buiiding Owner's Name Joseph Chiilemi &Nancy Fosfer '; Rolic�r Nurr�6er x;-: �µ A2. .Buiiding Street Address (including Apt., Unit, Suiie, andlor Bfdg. No.) or P.O. Route and Box No. ���y�� ���p� �; ,� �„:. 741 Bruce Auenue =� � - t � � City ClearwaterBeach Sfate FL ZtP Code 33767 � A3. Property Qescriptian (LOt and Block Numbers, Tax Parcel Number, Legal Deseription, etc.) Lat 2, Biock 24, Mandalav Subdivision A4. Building Use (e.g., Residential, Non-ResidenUai, Addi6on, Accessory, ete.) ResidenGai A5. Latitude/LOngltude: Lat: 27d 59' 30.73" N. Long. $2d 49' 32.63" W. Horizontal Datum: ❑ NAD 1927 � NAD 1983 A6. Attach af least 2 photagraphs of the buiiding 'rf the Certificate is being used to obtain flood insurance. A7. Building Diagram Number � A8. For a buildi�g with a erawlspace or enGosure{s): A9. For a building with an attached garage: , a} Square footage of crawlspace or enciosure(s) 1�A sq ft a) Square footage of atGzched garage 304.8 sq ft b} Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s) wiYnin 1.0 foot above adjacent grade NA witttin 1.0 foot above adjacent grade N�i c) Total net area of flood openings in A8.b NA sq in c) Totai nei area of flood openings in A9.b VLq sq in : d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No ! SECTIflN 8- FLUOD tNSURANCE RATE MAP (FIRM) INFORMATION 81. NFlP Community Name & Community Number 62. County Name B3. Stata Ctearwatar 52509fi Pineilas Fiorida 64. Map/Panel Number B5. Suffix B6. F�RM tndex Date B7. FlRM Panei 68. Flood B9. Base Flood Elevation(s) (Zone '12103C 0102 G 9/3/03 Effective/Revised Date Zone{s) AO, use base flood depth) 913/03 AE 11.0' 610. indicate tha source of the Base Fbod Etevation (BFE) data or base flood depth entered in Item B8. ❑ FIS Profile � FIRM ❑ Canmunity Determined ❑ OtherlSource: B11. Indicate ei�vation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ flther(Source: 812. Is the building lorated in a Coastal8arrier Resources System (CBRS) area or Othenvise Protecied Area (OPA)? ❑ Yes � No Designation Qata: ❑ CBRS ❑ OPA SEGTkON C- BUILQING ELEVATION INFORMATfON (SURVEY REQUIREQj C1. Building eleva6o�s are based on: ❑ GonsWction �rawings' ❑ Buiiding Undar Construction' � Finished Construcfion , 'A new Eleva4on Certifiqie wi0 be required vifien construction o# the building is complete. C2. Etevations -Zones A1-A3Q, AE,AH, A(with BFE), VE, V1-V30, V{with BFE), AR, ARlA, AR/AE, AR/A1-A3�, ARlAH, AWAO. Complete Items C2.a-h below accorcfing to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: Aurai RM 3 Vertical Datum: NAVD 1988 indicate e{eva6on datum used for the elevations in items a} through h) below. ❑ NGVD 1929 1� NAVD 1988 ❑ O[hedSource: Datum used for building etevations musf be the same as that used for the BFE. a} Top of bottam flopr (inGuding basemeni, crawispace, or endosure floar) b) Top of the next higher floor cj Bottom of the bwest horizontal structural member (V Zones oniy) d) Attached garage (top of siah} e} Lowest elevation of machinery or equipment servicing the building (Desccibe type of equipment and location in Comments) fl Lowest adjacent (finished) grade next to buiidir�g (LAG) g} Highest adjacent (finishedj grade ne� to buiiding (HAG) h) Lowest adjacent grade at lowest elevadon of dedc or stairs, including structurai support 4.5 j�.A �-9 3.� 5.1 ,�.4 3.5 N.A Check the measurement used. � feei ❑ meters � faet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters SEGTION D- SURVEYOR, ENGtNEER, OR ARCHITECT CERTIFICA710N _ - Th1s cerdfiqtion is to be signed arid sealed by aJand sunreyor, engineer, ar architect authorizad by law to certify etevaGOn informaUon. t certi�`y that the information on thJs Gertiftcate represents my best efforts to interpret the data available. 1 understand thaf any fa/se stafement may be punrshabfe by frne or imprisonment unde� 18 !1. S. Code, Section 1OOi. � Check here if commentsare provided on back of farm. Were latitude and longitude in Section A provided by a ❑ Check here ff attachments. licensed land surveyor? � Yes ❑ No Certifier's Name Edward D. Murphy License N�unber 5333 Title Prof. Land Surveyar Company Name Murphy's Land Surveying, Inc. Address 576 'I1"' Aven �i. ' Gity 5t Fetersburg SYate FL ZIP Code 33710 Signature �a ate 9/16l15 Telephone 727/347-8740 FEMA Form 0$6-0.33 (7/12j See reverse side fQr continuation. Elevation certificate pg1.jpg ����� ' � � `�,' _ tf1.f Replaees af! previQUS editions. vJ � � � \. � ! Q -� ` � � ��.r..riv� .v�s a.�n �(� ea.r�� �� Nqyc i, lMPORTANT: In these spaces, eopy the corresponding information from Secticn A. "� t3r�i!"ding Street Address(including Apt., Unit, Suite, and/or Bidg. No:j or P.O. Route and Box No. 741 Bruce Avenue City Gieannrater Beach Sta#e FL ZkP Code 337fi7 SECTION D- SURVEYOR, ENGlNEER, OR ARGHITEGT CERTIFfCATtON (CONTiNUED} Gopy both sides of this Elevation Certificate for (1} community afficial, (2) insurance agent/company, and (3) building owner. Comments C2e = A(C Date 9l18l15 SECTION E- 8U1LdING ELEVAi'�N INF�iMAT10N (SURVEY PIOT REQUIRED) FOR ZONE AO AND 20NE A For Zones AO and A(without BFEj, plete Items E1 5. If the Certificate is intendeti to support a �OMA or LOMR-F request, complete Sections A, B, and C. For ltems E1-E4, use natural rade, if availabie. hedc the measurement used. in Puerto Rico oniy, enter meters. E1. Provide elevation infonnation for e foilowing an eck the appropriate baxes to show whether the elevatlon is above or below the highest adjacent grada {HAG} and the lowest adjacen a�e-( G). a) Top af bottom floor (inGuding basement, crawispace, or endosure) is ❑ feet ❑ meters ❑ above or � below the HAG. b} Top of bottom floor (inciuding basement, craw(space, or endosure} is . ❑ feet ❑ meters ❑ above or ❑ betow the LAG. E2. For 8uilding Diagrams 6-9 with permanent flood openings provided in Section A Items 8 ar�/or 9(see pages 8-9 of Instructions), the next higher floor (elevafion C2.b in the diagrams) of tMe buildiog is ❑ feet ❑ meters ❑ above or 0 below the HAG. E3. Attached garage (top of slab) is ❑ feet ❑ rneters ❑ above or ❑ betow the HAG. E4. Top of platFortn ofmachinery and/or equipment servicing the building is ❑ feet ❑ meters ❑ above or � below the HAG. E5. Zone AO oniy: If no flood dapth numGer is avallabie, is the top of the battom floor elevated in accordance vvith the community's floodplain manege.rnent ordinance? ❑ Yes � No ❑ Unknown. 7he locaf o�cial must certify this informatian in Section G. SECTION F- FROPERTY OWNER {OR f�WNER'S REPRESENTATIVE) CERTiFICATION The property ownerbr ownar's authorized representative who completes Sections A, B, and E for Zone A(without a FEMA-issued or communiry-issued BFE) or Zone AO must sign here. The statements in Sections A, B, and Eare correctto ihe best of my knowiedge. Property Owner's or Qwner's Authorized Representative's Name Address Signature Comments City Date State ZIP Code Telephone I.� �heck here if attachments SECTION G - COMMUNITY INFORMATION (OPl'IONAL) The bql official who is authortzed by law or ordinance to administer the c�mmunity's floadpfain management ordinance can complete Sedions A, B, C(or E}, and G af ihis Elevation Certificate. Compiete the applicable item(s) and sign 6elow. Checic the measurement used in items G8-G10. in Puerto Rico oniy, enter meters. Gi. ❑ The information in SecGon C was t�aken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to cerGfy elevation information. (indicate the source and date of the elevatian data in the Comments area below.) G2. ❑ A Community o�cial compieted Section E for a building located in Zone A(without a FEMA-fssued or community-issued BFE� or Zone AO. G3. ❑ The fotlowing information (It�ns G4-G10} is prpvided for community floodplain management purposes. G4. Perm�t Numbar G5. Date Permit issued G6. Date Certificate Of Compiiance/Occupancy issued G7. This perrnit has been issued for. ❑ New Construction ❑ Substantiai Improvement G8. Elevafion of as-built lowest floor (inCluding basement}of the building: ❑ feet j� meters Datum G9. 8FE or (in Zone AO) depth of flooding at the buiiding site: ❑ feet ❑ meters Datum G10: Community's dasign flaod eCevaGon: ❑ feet � meters Datum Local Offrcial's Neme Gommunity Name Signature Comments FEMA Farm 086-0-33 (7/12) Title Telephone l3ate Elevation certificate pg2.jpg Check here if attachments. Replaces al{ previous editions. � ' ... . .... . . ..... . .. . . . ... . . , . . . .,._- ---- E��V�ITIC�N GERTIFIGATE, page 3 guiiding Photographs See Instructions far Item A6. iMPORTANT: In these spaces, copy the corresponding information from Sec#ion A. FOR+NSURANCE CpMPAt�tY USE BuiEding Street Address (inCiuding Apt., Unit, SuiEe, andlor Bldg. No.) or P.O. Route and Sox No. PoNcy Number: 741 6ruce Avenue City Ciearwater Beach StaYe FL ZtP Cc�de 33757 Cqmpany NAlG Niunber. {f using the Elevation Certiftcate to o6fain NFIP flood insurance, affix at least 2 building photographs belaw according to the instructions for Item R6. lde�tify ail photographs v,rith date taken; "Front Vieut' and "Rear View"; and, if required, °Righf Side VieuJ' and "Left Side View." When applicabte, photographs must show the foundation wikti representative exampies of the flooci openings or vents, as indicated in Section A8. If suhmitting more photographs than wi{i fit on this page, use fhe Gontinuation Page. E7ATE: 9/3i'! 5 FRONT VtEW: I REAR VlEW: FEMA Form Q86-0-33 {7/12) W �� Elevation certificate pg3.jpg Repiaces ali previous edifions. 0.S. DEPARTMEN7 QF HOMELAND SECURITY FEDER.�.I �MERGENCY MANAGEMEN7 AGENCY - <�c•tiblial F'�oatl li:surmzce Program ELEVATION CERTIFICATE Important: Read the instructions on pages 1-9. SECT(ON A - PROPERTY INFORMATiON A1. 6uiiding Owner's Name Joseph Ghiilemi & Nancy Foster A2. Building Street Address (including Apt., Unit, Suite, and/or BVdg. No.} ar P.O. Route and Box No. 741 Bruce Avenue City Gteatwater Beach S#ate FL ZIP Code 33767 A3. Property Description (Lot and Biock Numbers, Tax Parcel Number, Legal Description, eYc.) Lot 2, Biock 24, Mandalay Subdivision CONiB No. 1660-0048 xpiration Date: July 31, 2015 A4. Building Use (e.g., Residentiai, Non-Residential, Addition, Accessory, etc.) Residentia( ', A5. LatitudetLOngitude: Lat. 27d 59' 30.73" N. Lang. 82d 49' 32.63" W. Horizontal Datum: ❑ NAD 1927 � NAD 1983 ', A6. Attach aFieast 2 photographs of the buiiding ff the Certifieate is being used to abtain flood insurance. ' A7. Building Diagram Number jA A8. For a buiiding with a crawispace or encipsure(s): A9. For a buiiding with an attached garage: a} Square footage of crawlspace or enclosure{s) 1�A sq ft a) Square footage of attached garage 301.8 sq ft b} Number of permanent flood openings in the crawispace b) Number of permanent flaod openings tn the attached garage or enctasute{s) within 1.0 foot above adjacent grade NA within 1.0 foot above adjacent grade NA c) Total net area of flood openings in A8.b NA sq in c} Totai net area of flood openings in A9.b NA sq in d) Engineered flood openings? ❑ Yes � No d) Engineered fiood apenings? ❑ Yes � No ' SECTlON 8- FLOOD (NSURANCE RATE MAP (FIRM) INFORMATION ' 81. NF1P Communiry Name & Cammuniry Number 62. County Name B3. State Glearwater 125096 Pineflas Fiorida B4, Map/Panel Number 85. Su�x B6. FIRM Index Date B7. �IRM Panei B8. Ftood B9. Base Fiood Elevation(s) (Zone 12103C 0102 G 9/3/03 EffectivelRevised Date Zone(s) A0, use base flood depth) 9/3/03 AE 11.0' 61Q. indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 89. ❑ FIS Profile � FiRM ❑ Community Determined ❑ OthedSaurce: B1 t. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: B12. ts the building tocated in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes � No Designation Date: ❑ CBRS ❑ OPA SECTION C- 6UILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Gonstruction �rawings' ❑ 8uilding Under Construction' � Finished Constructian 'A new Elevation Certificate wiil be required when construction of the buitding is complete. C2. Elevations - Zones A1-A30, AE, AH, A(with BFE), VE, V1-V30, V(with BFE), AR, Af2iA, AR/AE, AR/A1-A3�, ARlAH, AR/A0. Complete Items C2.a-h below according to the building diagram specified in item A7. In Puerto Rico only, enter meters. Benchmark Utilized: Aurai RM 3 Venicai Datum: NAVD 1988 Indicate eleva6on datum used for the elevations in items a} through h} below. ❑ NGVD 1925 � NAVE} 1988 ❑ OtherlSource: Datum used for building etevations musf be the same as that used for the BFE. Check the measurement used. a} Top of bottom floor (inGuding basement, crawispace, or enclosure floor) b) Top of the next higher floor c} Bottom of the lowest horizontal shuctural member (V Zones oniy) d} Attached garage {top of siab) ej Lowest elevation of machinery or equipment servicing Yhe building (Describe rype of equipment and location in Comments) f� Lowest adjacent {finished) grade ne� to buiiding (LAG) gj Highest adjacent (finished) grade next to building (HAG) h) Lowest adjacent grade at lowest elevatlon of deck or stairs, including structural support 4.5 N.A N.� 3.5 �.1 � feet ❑ meters � feet 0 meters � feet ❑ meters � feet ❑ meters � feet ❑ meters �.4 � feet ❑ meters 3.5 � feet ❑ meters N.A � feet � maters SECTION D- SURVEYOR, EtJGINEER, OR ARCHITECT CERTIFICATION This cerUfication is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation informaUon. l certify that fhe information on thts Certifrcate represents my best efforts to interpret the data availabie. I understand that any false stafement may be punrshabte by fine o� imprisonment under 18 tl. S. Code, Section i00i. t � Check here if comments are pravided on back of form. Were latitude and longitude in Section A provided by a k ❑ Check here if attachments. licensed land surveyor? � Yes ❑ No , �! Certifier's Name Edward D. Murphy Title Prof. Land Surveyor ,�-� Address 576(1.1,1`h AvenUe N. j FEMA Form 086-0-33 (7/12) License Number 5333 Company Name Murphys Land Surveying, Inc. Si Petersburg State FL ZIP Code 33710 9116/15 Telephone 727f347-874Q See reverse side for continuation. Elevation certificate pg1.jpg �� 1 G �.� J Replaces all previous editions. t�b1�VI'1F[VII��/V�l..t1l tVJ1�f�� In these spaces, copy the corresponding information from Sectian A. f3euiding Street Address (inctuding Apt., Unit, Suite, andlor Bldg. No.) or P.O. Route and Box No. 741 Bruce Avenue City Gleanwater Beach SFate FL ZIP Cade 33767 SECTlON D- SURVEYOR, ENGINEER, OR ARGHITECT CERTIFtCAT{ON (CONTINUED) Copy both sides of this Elavation Certificate for (1} community o�cial, (2) insurance agent/company, and (3) buiiding owner. Comments C2e = A/C Date 9i1&t15 SECTION E- BUILDING ELEVATJO'N'INFZ�1{tMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A For Zones AO and A(without BFE), plete Items E1-�5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For Items E1-E4, use naturai rade, if availabfe. heck the measureme�t used. !n Puerto Rico only, entar meters. E1. Arovide elevation infoanation for e foliowing an heck the appropriate boxes to show whether the elavatton is above or below the highest adjacent grade (HAG) and the lawest adjacen gra�d�`( G). a) Top of bottom floor (inGuding basement, crawlspace, or endosure) is ❑ feet ❑ meters ❑ above or � below the HAG. b} Top of bottom floor (including basement, crawlspace, or endosure} is ❑ feet ❑ meters (3 above or ❑ below the LAG. E2. For Buiiding diagrams 6-9 with permanent flood openings provided in Section A ttems 8 andlor 9(see pages 8-9 of instrucbons), the next higher floor (elevation C2.b in the diagrams} of the building is ❑ feet ❑ meters ❑ a6ove or ❑ below the HAG. E3. Attached garage (top of slabj is ❑ feet ❑ meters (� above or � below the ffAG. E4. Top of piafform of machinery andlor equipment servicing the building is j� feet ❑ meters ❑ above or � below the HAG. E5. Zone A� oniy: If no flood dapth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The locaf official must certify this information in Section G. SECTION F- PROPERTY OWNER (OR OWNER'S REPRESEN7ATlVE) CERTiFiCATION The ptoperty ownar or owner's authorized representative who completes Sactions 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 knowiedge. Property Owner's or Owner's Authorized Representative's Name Address Signature Comments City Date StaYe Telephone ZIP Code Check here if attachments. SECTION G - COMMUNITY INFORMATION (OPTfONAL) The local official who is authorized by law or ordinance ta administer the community's floodplain management ordinance can complete SecGons A, B, C(or E), and G of this Eieva6on Certificate. Complete the appiicable item(s) and sign below. Checic the measurement used in items G8-G10. In Puerto Rico only, enter meters. G1. � The information in SecGon G 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. (lndicate the source and date of the elevation data in the Comments area below.j G2. ❑ A community o�cial compieted Section E for a building located in Zone A(without a FEMA-issued or communiry-issued BFE) or Zone AO. G3. ❑ The foilowing information (Items G4-G10} is pravided for communiry floodplain management purposes. . Pe ' u r_ � j-� G5. Date Permit Issued G6. Date Certificate Of Complianee/Occupancy issued � t� G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-6uiit lawest floor (including basement) of the buiiding: 0 feet ❑ meters Datum G9. BFE or (in Zone AO) depth of flooding at the buiiding site: ❑ feet ❑ meters Datum G10. Community's design flood elevation: ❑ feet ❑ meters Datum Locai Official's Name Community Name Signature Commenis FEMA Farm Q86-0-33 (7/12) Title Telephone Date Elevation certificate pg2.jpg Check here if attachments. Repiaces alt previous editions. . ' ELEVt�,TION CERTIFICATE, page 8 gu�iding Photographs See instructions for Item A6. ' IMPQE2TANT: In these spaces, copy the corresponding information fram Section A. FOR INSURANCE COMPANY USE ' Buitding Street Address (incfuding Apt., U�it, Suite, and/or Bidg. NaJ or P.O. Route and 9ox No. Policy Number: ' 741 8ruce Avenue , City Ciearwater Beach State FL ZtP Code 33767 Company NAiG Number. ', if using #he Elavation Certificate to ok�tain NFIP flood insurance, affix at least 2 b�ilding photographs belaw according to the instructions for Item A6. {de�ttify a{I photog�aphs with date taken; "Front View" and "Rear View"; and, if required, °Right Side View° and "Left Side ' View." When applicabfe, photographs must show the foundation with representa6ve exampies of the flood apenings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. DATE: 9/3/15 ! FRONT VIEW: I REAR VIEW: _..__ f--- , � �< r ....� �� � �` �S ��� . "�, � "��, � � � `� �.� �� �" .�, � � ���� � p �. - _s ��� y.'�� � � _ FEAtIA Form 086-0-33 (7112) Repiaces a8 pre�ious editions. Elevation certificate pg3.jpg 741 BRUeE qVE BCP2016-04152 REMODEL JOSEPH P CHILLEMI Zoning: Low Medium Densi _ h' Atlas #: 249A U.S. DEPARTMENT OF HOMELAND $ECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY Natrona! F(ood lnsurance Program �5v u5 A1 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. 741 Bruce Ave. City Clearwater State FL ZIP Code 33767 onnB No. �ssa000a -� Expiration Date: July 31, 2015 � A3. Property Description (Lot and Block Numbers, Tax Parcet Number, Legal Description, etc.} Mandalay Sub Blk 24, Lot 2 PID OS-29-i 5-54666-024-0020 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Residential A5. Latitude/Longitude: Lat. 27° 59'30.76 Long. 82° 49'32.72 Horizontal Datum: ❑ NAD 1927 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. ��� 1983 A7. Building Diagram Number 1A 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 3�0 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 0 within 1.0 foot above adjacent grade 0 c) Total net area ot flood openings in A8.b 0 sq in c) Total net area of flood openings in A9.b 0 sq in ,� d) Engineered flood openings? ❑ Yes ❑ No ❑ No d) Engineered flood openings? ❑ Yes SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NFIP Community Name & Community Number 62. Counry Name City of Clearvvater 125096 Pinellas B4. Map/Panel Number B5. Suffix 66. FIRM Index Date 67. FIRM Panel 12103C 0102 G 9/3/03 Effective/Revised Date 9/3/03 B3. State FL B8. Flood I 69. Base Flood Elevation(s) (Zone Z AE�S� AO, use base flood depth) 11 00 � 610. Indicate the source of the Base Flood Etevation (BFE) data or base flood depth entered in Item 69. ❑ FIS Profile � FIRM ❑ Community Determined ❑ OthedSource: B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: 612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Othervvise Protected Area (OPA)? ❑ Yes Designation Date: N/A ❑ CBRS ❑ ppq � No SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction* '- "A new Elevation Certificate will be required when construction of the building is complete. � Finished Construction � 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 �.l� below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: PCBM Aural A Vertical Datum: NAVD 1988 ''� Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ OthedSource: ��� 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 enGosure floor) 4.5 � feet ❑ meters .� b) Top of the next higher floor N/A. ❑ feet c) Bottom of the lowest horizontal structural member (V Zones only) N�A ❑ meters � ❑ feet ❑ meters d) Attached garage (top of slab) 4.5 � feet ❑ meters � e) Lowest elevation of machinery or equipment senricing the building 5.6 � feet ❑ meters (Describe type of equipment and location in Comments) � � Lowest adjacent (finished) grade next to building (LAG) 3.8 � feet ❑ meters M g) Highest adjacent (finished) grade next to building (HAG) 3 g '�,,.> � feet ❑ meters _ �? h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 3.7 � feet ❑ meters ! V l SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION .,,,. This cert�cation is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. 1 certify that the information on this Certificate represents my best efforts to interpret the data available. ! understand that any false statement may be punishable by fine or imprisonment under 98 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 sunreyor? ❑ Yes ❑ No � Certifier's Name Dennis J Eyre Tkle Land Surveyor Address 1822 ev Signature / �EMA Form 086-0-33 License Number 2865 Company Name Geodata Services, Inc. Suite 8 City Clearvvater State FL ZIP Code 33765 e Telephone 727-447_1763 r.i See r_ Prca ciriE? fnr rnntirn �a+inn � _�` �' 1�, , � � j , �' ? : ... � � . � ��, � �� . . � s,, � 1 �' � _. .b�, 7 .�. ; � � p' _ _ ' �:= C9. %� v.j . -' • � � •� , • ,�. . � � ��\�;, `. �p G r�,,• fyri+�� oe..i�.. �n_:. .... ..a:a:.._..- # 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. 741 Bruce Ave. City Clearwater State FL ZIP Code 33767 ;y �u�rtoer: SECTION D— SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate tor (1) community official, (2) insurance agenUcompany, and (3) building owner. Comments C2 e) Lowest machinery servicing the building is the air condition • Signa � �� J� � Date - . 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). a) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or � below the HAC. 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 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 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 owners 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 ZIP Code Telephone ❑ Check here if attachmeni.:... SECTION G — COMMUNITY INFORMATION (OPTIONAL) (he local official who is authorized by law or ordinance to administer the community's flootlpiam management orainance can compie[e aec�ions r+, rs, � �or ��, ana .� �f this Elevation Certficate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8--G10. In Puerto Rico only, enter meters. 31. 0 The information in Section C was taken from other documentation that has been signed and seated 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.) 32. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or communiry-issued BFE) or Zone AO. 33. ❑ The following information (Items G4—G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Cert�cate Of Compliance/Occupancy Issued ;7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement 38. Elevation of as-built lowest floor (including basement) of the building: ❑ feet ❑ meters Datum 39. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum 310. Community's design flood elevation: ❑ feet ❑ meters Datum Local Official's Name Community Name Signat�re Comments �EMA Form 086-0-33 !7/121 Title Telephone Date _� Check here if attachments. n...�-"- -" -'-•---�-- - ._.. _ . 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 Bldg. No.) or P.O. Route and Box No. 741 Bruce Ave. 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 VievJ'; 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. �_. _:, �'� < -� .., , _ _ n._.._� .� FRONT VIEW � � {��� �� i� ; y � :, � :: ,, .�: f. ., f. '"d �` p ��" �:- y�,� _'',�. `7 *`�§ �`2 �, BACK VIEW