Loading...
64 BAY ESPLANADEU.S. DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY National Flood Insra�ance Progrmn ELEVATION CERTIFICATE Important: Read the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION A2. Buikling Street Address (induding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Rou[e and Box No. 64 BAY ESPLANADE City CLEARWATER BEACH State FL ZIP Code 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 3 AND A PORTION OF LOT 2, BLOCK 79, MANDALAY UNIT No.S REPLAT, PiNELLAS, FLORIDA. OMB No. 1660-0008 F�cpiration Date: July 31, 2015 FOR INSURANGE COMPANY USE ' A4. Buildirg Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27�-59'-06.5" Long. -82*- 49'-28.8" Horizorrtal 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 1=A A8. For a building wRh a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or endosure(s) N/A sq ft a) Square footage of attached garage N/A sq ft b) Number of permanent flood openings in the crawlspace b) N�nber of pertnanerrt flood openings in the attached garage or enclosure(s) within 1.0 foot above adjacerrt grade N/A within 1.0 foot abov�e adjacent grade N/A c) Total net area of flood openings in A8.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) Ergineered flood openings? ❑ Yes � No SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2_ Courrty Name B3. State PINELLAS COUNTY 12103C PINELLAS COUNTY FLORIDA 64. Map/Panel Number 65. Suff'a B6. FIRM Index Date 67. FIRM Panel 88. Flood 69. Base Flood Elevation(s) (Zor� 12103C/0102 G 09/03/03 Effective/Revised Date Zone(s) AO, use base flood depth) 08/18J09 " AE " 11' NAVD 88 610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth eMered in Item 69. ❑ FIS Profile ❑ FIRM � Community Determir�ed ❑ Other/Source: Countv Erwineer .e B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ OtherlSource: B12. Is the building located in a Coastal Bartier Resources System (CBRS) area or Othervvise Proteded 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 Construdion* � Finished ConstruCtion `�'�" .�- 'A new Elevation Certficate 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, errter meters. Benchmark Utilized: H-02 Clearwater Vertical Datum: NAVD 88 } 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. .-Ja�' Check the measuremerrt used. a) Top of bottom floor (including basement, crawlspace, or enGosure floor) 04.90 � feet ❑ meters b) Top of the neut higher floor 14.0 � feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A. � feet ❑ meters d) Attached garage (top of slab) N/A. � feet ❑ meters e) Lowest elevation of machinery or equipmerrt servicing the building �8.�0 � feet ❑ meters (Describe type of equipment and location in Commerrts) � Lowest adjacent (finished) grade next to building (LAG) �4.0 � feet ❑ meters g) Highest adjacent (finished) grade next to buildirg (HAG) �4.8 � feet ❑ meters h) �owest adjacent grade at bwest elevation of dedc or stairs, inGuding 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 certify elevation infortnation. I certify that the informafion on this Certificate represents my best ef/orts tu interpret the data available. I understand that any false statement may be punishab/e by fine or imprisonment under 18 U. S. Code, Section 1001. „•a,°'""' °..,.`titi „ � Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ;���PMM A o B. F'"=. ❑ Chedc here if attachments. licensed land surveyor? � Yes ❑ No ,' �`�.'�,pT � F�C�lF-99 `'. Certfiers Name MOHAMMAD B. FAR Title Prof.Larxi Sunreyor Address 813}�(Sd�p$'Q,V Signatute i�/ ." ��l1 a FEMA Form 086-�33 (7/12) License Nunber 5545 Company Name MOHAMMAD B. FAR PLACE City TRINITY Date 10/20/14 State FL ZIP Code 34655 Telephone 727-375-1740 See reverse side for corrtinuation. c - No. 5545 ��s �: STATE OF s �. ;fF,9-.'`TORIO� .•6� , �, . `'�+,� SURVEVOP�y,� Replaces all previous editions. a� ,,'� �x � '--• 'J l'� ELEVATION CERTIFICATE. paae 2 IMPORTANT: In these spaces, copy the corresponding iriformation from Section A. Building Street Address (induding Apt., Unit, Suite, arxllor Bldg. No.) or P.O. Route and Box No. 64 BAY ESPLANADE City CLEARWATER BEACH State FL ZIP Code 33767 FOR INSURANCE COMPANY USE Policy Nunber: Canpany NAIC Nixnber: SECTION D— SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) communily official, (2) insurance agenUcompany, and (3) building owner. Commerrts C2.e - A/C = AIR CONDITIONING PAD �,.,,,. .^'*My,AO B �� ��T. ���8� "f_ _. �a:`o°. . Sgnature Date 10/20/14 SECTION E- BUILDING ELEVATtON 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 irrtended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For Items E1-E4, use natural grade, if available. Chedc the measuremerrt used. In Puerto Rico only, enter meters. E1. Provide elevation infortnation for the following and chedc the appropriate boxes to show whether the elevation is above or bebw the highest adjacent grade (HAG) and the lovirest adjacent grade (LAG). a) Top of bottom floor (induding basement, cxawlspace, or enclosure) is � feet ❑ meters � above or � belovv the HAG. b) Top of bottom floor (inGuding basement, aawlspace, or enclosune) is � feet ❑ meters � above or ❑ below the LAG. E2. For Building Diagrams 6-9 with pertnanent flood openings provided in Section A Rems 8 and/or 9(see pages 8-9 of Instructions), the ne�d 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 servicirg 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 offiaal must certify this information in Sedion G. SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representati� who completes Sections A, B, arxi E for Zone A(wi[hout a FEMA-issued or community-issued BFE) or Zone AO must sign here. The statemerrts in Sections A, B, and E are cornect to the best of my knowledge. Property Owners or Owners Authorized Representative's Name Address Signature CommeMs City Date State Telephone ZIP Code Chedc here if attachments. SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local offiaal who is authorized by law or ordinance to administer the communit�s floodplain managemerrt ordinanoe can cbmplete Sedions A, B, C(or E), and G of this Elevation Certificate. Complete the applipble itean(s) and sig� bebw. Chedc the measaemerrt used in ttems 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 irrtormation. (Indicate the source and date of the elevatan data in the Commerrts area below.) G2. ❑ A community official completed Sedion E for a building located in 2one A(without a FEMA-issued or community-issued BFE) or Zone AO. G3. ❑ The following information (Items G4-G10) is provided for community floodplain managemerrt purposes. G4. Pe►mit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for. ❑ New ConstruCtion ❑ Substarrtial Improvement G8. Elevation of as-buift lov�st 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 Offiaal's Name Commtmiry Name Signature Comments Title Telephone Date Datum Datum Datum Check here ff attachmerrts. FEMA Form 086-0-33 (7/12) Replaces all previous editions.