831 BAY ESPLANADEU.S.DEPARTMENTOFMOMELANOSECURITY ELEVATION CERTIFICATE
; ED�RAI.�EMERGENCY MANAGEMENT AGENCY
tiutinnu! Flnnd lnstrrance P���;rR� Important: Read tfie instructions on pages 1-9.
SECTION A - PROPERTY INFORMATION
A1. Building Owner's Name
A2. Building SVeet ACdress (including Apt., Unit. Suite, and/or Bldg. No. ) or P.O. Route and Box No.
831 BAY ESPLANADE
Cibj CIEAR�P/ATER
State FL ZIP Code 33767
A3. Proper*j Description {Lot and Biodc Numbers. Tax Parcel Number, Legal Description, etc.)
LOT 3, BLOCK 39, MANDAIAY SUBD., PB 14 PG 32
Oti18 No. 1660-0008
Expiration Date: July 31, 2015
A4. Building Use (e.g., Residential, Non-Residentlai, Addition, Accessorf, etc.) RESIDENTIAL
A5. l.atitude/Longitude: Lat. 27°59'43"N Long. 82°49'24"V�/ Horizontal Datum: ❑ NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used co obtain Aood insurance.
A7. Buiiding Diagram Number 7
A8. For a building with a crawlspace or enGosure(s): A9. For a buiiding with an attached garage:
a) SGuare footage of crawlspace or enclosure(s) 2��Q sG ft a) Square footage of attached garage 2350 sq ft
b) Number of pertnanent flood openings in the crawispace b) Number of pertnanent flood openings in the attached gara�e
or enGasure(s) within 1.0 foot above adjacent grade ��"' within 1.0 foot above adjacent grade 14"
c) Total net area of flood openings in A3.b Z,Qj� sq in c) Total net area of flood openings in A9.b 1905 sq in
d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? � Yes ❑ No
SECTION 8- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
61. NF1P Community Name & Community Number 62. County Name 63. State
CITY OF CLEARWATER 125096 PINELtAS FL
B4. Map/Panel Number B5. Suffix B6. FIRM Index Date 67. FIRM Panel 88. Flood 89. Base Flood ElevaGon(s) (Zone
12103C0102 G 09-27-13 Effecfive(Revised Date Zone(s) AO, use base flood depth)
09-03-03 AE 11'
810. Indicate the source of the Base Flood ElevaUon (BFE) data or base flood depth entered in Item 69.
❑ FIS Profile � FIRM ❑ Community Detertnined ❑ Other/Source:
611. Indicate elevation datum used fw BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ OtheNSource:
812. !s the building bcated 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 eleva6ons are based on: ❑ ConsVuction Drawings' ❑ Building Under Consiruction` � Finished Construction
'A new Eleva6on Certificate will be required wtien construction of the building is complete.
C2. Elevations-Zones A1-A30, AE, AH, A(with BFEj, VE, Vt-V30, V(with BFE), AR, AR/A, ARlAE, AR/A1-A30, ARlAH, AR/AO. Complete Items C2.a-h
below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Udlized: ClW BM 238A J-03 Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a) through h) below. � fVGVD 1929 � NAVD 1988 ❑ OtherlSource:
Datum used for building eleva6ons must be the same as that used for the BFE.
a) Top of bottom floor (induding basement, crawlspace, or enclosure floor)
b) Top of the next higher floor
c) Bottom of the lowest horizontal structural member (V Zones only)
d} AttacheC garage (top of slab)
e) lowesi elevaHon of machinery or equipment servicing the building
{Describe type of equipment and location in CommenLS}
� 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
6.0
15.6
N/A.
6.0
13.7
5.6
5.7
N/A.
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 cer'�ficaGon is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation
infortnation. 1 certi(y that the irtformation on this Certificate represents my best etforts to interpret the data available. ,.�(• •,.,
1 understand that any fa/se staterrrent may be punishab/e by fine or imprisonment under 18 U.S. Code, Section 100i. ,•' �� �, ,1 '
� Check here if comments are provided on back of form. Were latitude and iongitude in Section A provided by a .�� �-���F • ,.
� Check here if attachments. licensed land surveyor? � Yes ❑ No � a� ;�,, :���';�' :.; ��
Certifier's Name J. ti1�CHAE� FUQUA
Title PSNI
Address 1aG6 W. LINEBAUGH AVE
Signatur2 � � ,,.. , :�
License Number 4192
Company Name DAV1D L. Sti11TH SURVEYING & MAPPING
Ciry TAI4IPA State FL ZIP Code 33612
Telephone 813 935-196a
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FEtiIA Form 086-0-33 {7i12) See reverse side for continuation. Replaces all previous editions.
��� s r� ��vn v��� ��� wr�a ��� Nuyc �
IMPORTANT: t� these spaces, copy the corresponding information from Section A.
BuilCir,g Street Address (including Apt.. Unit. Suite. andicr 31dg. No.; or °.O. Route and Box No
831 8AY ESPLANADE
Ciry CLEARWATER State FL Z1P Code 33767
FQR 1NSURANCE EOMPAN't' IfSE
Po�icy Number:
�ampany IVRIC IVumber � .
SECTiON D— SURVEYOR, ENGINEER, OR ARCHITECT CERTIFiCATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1j communiry official. (2) insurance agenUcompany, and (3) building owner.
Comments SECTION C2E REPRESEiVTS TNE A1C PAD ELEVATION. "SNIART VE�TS HAVE BEcN iNSTALLED. �ACH VE�T COVERS 200 SQUARE
FcET FOR A TOTAL OF 2800 SQUARE FE�T
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SECI`ibN E— BUILDING ELEVATION INF.ORMATION (SURYEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO and A(without 8FE), complete Items E1—E5. If ihe Certificate is intended to support a LOtitA or LOMR-F reGuest, complete SecSons A, B,
and C. For Items Et—E4, use natural grade, if availabie. Check the measurement used. In Puerto Rico only, enter meters.
Et. Provide elevaGon i�ortnation for the following and check the appropriate boxes to show whether the elevation is above or below �e highest adjacent
grade (HAG) and the lowest adjacent grade (LAG).
a) Top of bottom floor (indudir�g basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or � below the HAG.
b) Top of bottom floor (including basement, crawispace, or endosure) is ❑ feet ❑ meters Q 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 floo�
(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 platfortn of machiner� and/or equipment servicing the building is ❑ feet ❑ meters ❑ above or 0 below the HAG.
E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accardance with the communiry's floodplain management
ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this infortnadon 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 2one 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 Owners or Owners Authorized RepresentaUve's Name
Address
Signature
Comments
Cirj
Date
State
Telephone
ZIP Code
Check here if attachments.
SECTION G — COMMtlNITY INFORMATION (OPTIONAL)
The lopl official who is aufhor¢ed by law or ordinance to admi�ister the communiry's floodplain management wdinance pn complete Sections A. B, C(or E), and G
of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G&-G10. In Puerto Rico only, enter meters.
G1. ❑ The informaGon in Section C was taken from other documentatio� that has been signed arn1 sealed by a ticensed surveyor, engineer, or architect who
is authorized by faw to certify elevation infortnation. (Indicate the source and date of the elevatio� data in the Comments area below.)
G2. ❑ A community offiaal completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or Zone AO.
G3. ❑ The following infortnaGon (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 ConsWcGon ❑ Substantial Improvement
G8. Elevadon 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 Oatum
G10. Communiry's design flood elevation: ❑ feet ❑ meters Datum
Local Official's Name
Community Name
Sigratur=
Comments
Title
Telephone
Date
Check her2 if at;achments.
FENIA Form 086-0-33 (7i12) Replaces all previous editions.
.ELEVA�'lON CERTiFiCATE, page 3 guilding Photographs
See Instructians for 1#em A6.
IMPORTANT: In these spaces, copy the corresponding information from Section A.
Buiiding Street Address (inciuding Apt., Unit, Suite, and/or Bldg. No.} ar P.O. Route and Box No.
$31 BAY ESP�ANADE
City CIEARWATER State F!. ZIP Code 33767
FOR INSURANCE CON1PAiVY USE
Palicy Number:
Company NAIC Number:
If using the Elevatian Ce�tificate to abtain NFIP flood insurance, affix at least 2 buiiding photographs belaw accordi�g to the instrucGons
for Item A6. Identify all photographs wi#h date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side
View." When appiicabte, photagraphs must show the foundation with representative examples of the flood openings or vents, as
indicated in Section A$. If submitting more photographs ihan will flt on this page, use the Continuation Page.
FEMA Form 086-0-33 (7/12) Replaces all previous editions.
__� _
�i�EVAfiIt�N CERTIFICATE, page 4 guilding Photographs
Continuation Page
iMPORTANT: In these spaces, copythe corresponding information from Section A. FdR INSURANCE COMPANY USE
Building Street Address (inciuding Apt., Unit, Suite, andlor Bldg. IVo.) or P.O. Route and Bax No. Policy Number:
&31 BAY ESPLANADE
City CLEARWATER State FL ZIP Code 33767 Comp�ny NAIC Number:
If submitting more photographs than will fit on the p�eceding page, affix the additionai photographs below. Identify all photographs
with: date taken; "Front View" and "Rear View"; and, if required, "Right Side Viev�i' and "Left Side View." When appiicabie,
phatographs must show the faundatian with representative examples of the flood openings or vents, as indicated in SeGiion A8.
(4 2 15 REAR VI
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JOB NO 1503 118
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t � Replaces all previous editions.
�EMA Form Q86-Q-33 7/12
U.S.DEPART�IAENTOFHOMELANDSECURiTY ELEVATION CERT1FiCATE
; ED�RAL�MERGENCY MANAGEMENT AGENCY ONiB No. 166G-0008
v�,rtonut Ft���t rn.st�r�,n�e P=-��;r�m Important: Read the instructions on pages 1-9. Expiration Date: Jufy 31, 2015
SECTION A - PROPERTY INFORMATION ,F�?��t�tA���P���,�k�E'���
A1. Buiiding Owrer's Name GLASS �p(i� �s�"��": � �����,y s
� ��� �r � �� �� _ .. . . . � � ,.`. � ��^..,�,;��-!
A2. Building Street Address (includir.g Apt., Unit, Suite, andror Bidg. No. } or P.O. Route and Box No. �n ����kit��������
831 BAY ESPLANADE 'fr�sr�st;=,�� ,� �x�rr��. � `���%; . .;�N?�?��;
Cib,r CIEAR��JATER State FL ZIP Code 337&7
A3. Propertj Descriptian (Lot and Biock Numbers. Tax Parcel Number, Legai Description, etc.)
LOT 3, BLOC� 39, MANDALAY SUBD., PB 14 PG 32
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessor�, etc.) RESIDENTIAL
A5. LatitudelLongitude: Lat. 27°59'43"N Long. 82°49'24"V�/ 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
At3. Fcr a building �n�ith a crawlspace or enclosure(s): A9. For a buiiding with an attached garage:
a) SGuare footage of crawlspace or enclosure{s} N/A sG ft a) Square footage of attached garage 2350 sq ft
b) Number of permanent flocd openings in the crawtspace b) Number of permanent flood openings in the attached garage
or encicsure(s) within 1.0 foot above adjacent grade N/A within 1.0 foot above adjacent grade 14`*
cj Totai net area of flood openings in A3.b N/A sq in c) Total net area of 800d openings in A9.b 1905 sq fn
d) Engineered flood openings? ❑ Yes � No d) Engineered Flood openings? � Yes ❑ No
SECTION 8- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
� 61. NFIP Community Name & Community Number 62. County Name 63. State
CITY OF CLEARWATER 125096 PINELLAS FL
Ba. Map/Panel Number 65. Suffix 66. FIRM Index Date 67. FIRNt Parel B8. Fiood B9. Base Flood Elevation(s} (Zone
12103C0102 G 09-27-13 Effective/Re�iised Date Zone(s) AO, use base flood depth)
09-03-Q3 AE 11'
B1o. Indicate the source of the Base Fiood Elevation (BFE} data or base flood depth entered in Item B9.
❑ FIS Profile � FIRM ❑ Community Determined ❑ Other/Source:
611. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source:
612. is the building located in a Coastal Barrier Resources System (CBRS} area or Otherwise Protected Area (OPA)?
Designafion Date: N/A ❑ CBRS ❑ OPA
� ►3 .
SECTION C- SUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings' ❑ Buiiding Under Construction` � Finished Construction
'A new Elevation Certificate wiil be reGuired when construction of the building is compiete.
C2. Elevations - Zones A1-A30, AE, AH, A(with BFEj, VE, V1-V30, V(with BFE), AR, AR,'A, ARlAE, AR/A1-A30, ARlAH, AR/AO. Complete items C2.a-h
below according to the buifding diagram specified in Item A7. In PueRo Rico oniy, enter meters.
Benchmark Utilized: ClW BNt 238A J-03 Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a) through h) below. 0 NGVD 1929 � NAVD 1988 ❑ OtherlSource:
Datum used for building elevations must be the same as that used for the BFE.
a) Top of bottom Floor (including basement, crawispace, 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 eGuipment and location in Comments)
f) 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
6.0
15.6
N/A.
6.0
13.7
5.6
5.7
N/A.
Check the measurement used.
� feet ❑ meters
� feet ❑ meters
❑ feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
❑ feet ❑ meters
SECTION Q- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This cer'�fication is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation
information. I certrfy that the informatron on this Certifrcate represents my best efforts to inte�p�et the data available. �.�. . o„, �
1 understand that any false stafement may be punishable by frne or imprisonment under 18 U. S. Code, Section 100 t. ,m �-�p +,t '
� 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 c k o f f o r m. N 1 e r e l a t i t u d e a n d I 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 s� �� �~ a���, „,
� ChecK here if attachments. licensed land surveyor? � Yes ❑ No e��� ,�' p.�;;
Certifier's Name J. N1ICHAEL FUQUA
Title PSP�i
Address 1�G6 ��J. �fNEBAUGH AVE
Signatur2
FENIA Form 086-0-33 (7l12)
License Number 4192
Company Name DAVID L. SN11TH SURVEYiNG & NiAPPING
City TANIPA State FL ZIP Code 33612
T2lephone 813 935-1960
See reverse side for continuation.
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Replaces all previous editions.
VVLYnt�v�• v������ wra��� �.ruyc s
IMPORTANT: in these spaces, copy the corresponding information from Section A.
Buildirg Street Address (including Apt., Unit. Suite. ardicr 31cig. No.; or P.O. Rcute and Box No
831 3AY ESPLANADE
Cibj CLEARWATER State FL ZIP Code 33767
FOR INSURARIGE GOMP�4N7' USE
Po�icy Numiser.
�ampan}r NAICNumber.
SECTION D— SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for ( i j community officiaL (2) insurance agent/company, and (3) building cwner.
Comments SECTION C2E REPRESENTS TNE A,'C PAD �LEVATION. '"SMAR i VEi�TS HAVE BEcN INSTALLED. �ACH VEiVT COVERS 200 SQUARE
FEET FOR A TOTAL OF 2800 SQUARE FE�T
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SECI`ibN E— BUILDING ELEVATION INEORMATION (SURVEY NOT REQUIREDj FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO and A(without BFE), complete Items E1—c5. If the Certificate is intended to support a lON1A or LO(ViR-F reGuest, complete Sections A, B,
ar.d C. For Items E1—E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters.
E t. Provide elevation information for the Following and check the appropriate boxes to show whether the elevation is above or below !he highest adjacent
grade (HAG) and the lowest adjacent grade (LAG).
a) Top of bottom Floor (including basement, crawlspace, or enclosur2j is ❑ feet ❑ meters ❑ above or � below the HAG.
b} Top of bottom floor (including basement, crawlspace. or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2. For Bui�ding Diagrams fr9 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 eGuipment 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 accardance with the community's floodplain management
ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify :his information in Section G.
SECTION F— PROPERTY OWNER (OR OWNER'S REPRESENTATIVE} CERTIFiCAT10N
The propert� owner or owner's authorized representative who completes Sections A, B, and E for Zone A(witho�t a FEN1A-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
Cib�
Date
State
Telephone
ZIP Code
Check here if attachments.
SECTION G — COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the communiry's floodplain management ordinance can complete Sections A. B, C(or 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 Iicensed surveyor, engineer, or architect �Nho
is authorized by law to ce�tify eievation information. (Indicate the source and date of the elevation data in the Comments area below.)
G2. ❑ A cammunity official completed Section E for a buiiding located in Zone A(without a FEMA-issued or communit�-issued BFE) or Zone AO.
G3. ❑ The following information (Items G4—G10) is provided for community floodpiain management purposes.
G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compiiance/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:
G10. Communiry's design flood elevation:
Locai Officiai's Name
Commurity Name
Signature
Comments
_ ❑ feet ❑ meters
_ ❑ feet ❑ meters
Title
Telephone
Date
Datum
Datum
Datum
Check her2 if attachments.
FEMA Form 086-0-33 (7i12) Repiaces all previous editions.
ELEV/ATION 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.
831 BAY ESPLANADE
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 Vievd' 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.
4-2-15 FRONT VIEW
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FEMA Form 086-0-33 (7/12) Replaces all previous editions.
�1�E��A�ION 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.
831 BAY ESPLANADE
City CLEARWATER State FL ZIP Code 33767
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.
4-2-15 REAR VIEW
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FEMA Form 086-0-33 (7/12) Replaces all previous editions.
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BCIS Home Log In User Regis[ration Hot Topi6 Submit Surrherge Stats & Facts Publiptions FBC S[aff BCIS Site Map Links Search
Business
Professionai �}���ubiApproval
�� product Aonroval Menu > Producr or A�olication Search > Aooliration List > ApplkatiOn DataY ''-...
: FL # FL5822-R2 � �� �
Application Type Revision J /a
2010 � n /jn
Code Version �S //
Application SLatus Approved �! �, � ��
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Comnents ��,.� � !. ' �%
Archived ��n;R"'�.� _'t � <�iL //
Product Manufacturer
Address/Phone/Ertail
Authorized Signature
Technical Representative
Address/Phone/Emaii
Quality Assurance Representative
Address/Phone/Email
Caltegary
Subcategory
�� Compl'wnce Method
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info@srtertve�t. c om
Michael Cfaham
i�o�smartvent.com
Michael ]. Graham
20 Wartick Ave.
dassboro, N7, N] 08028
(888) 628-4115
mike�smartvent.com
Structural Corrponents
Pnoducts Introduced as a ResuR of New Technobgy
Evaluatan Report from a Florida Registered A2hftect or a Licensed Florida
Professional Engineer
-` Evaluatan Report - Hardcopy Received
Florida Engineer or Architect Name who developed the Alebs Spyrou
Evaluation Peport
Florida License PE-68101
Qualfty Assurance Entity Architectural Testing, Inc.
Quality Assura�ce Contract E�iration Date 12/31/2014
Validated By Locke Bowden
{ Validation Checklist - Hardcopy Received
Certificate of Independence
Referenced Standard and Year(of Standard)
Equivalence of Product Standards
Certified By
Sections from the Code
Product Approval Method
Date Subrtitted
fL58 2 R2 COI COI Smart Vent signed and cert.odf
1612.5(1)(1.2)
1714.2
Method 2 Optio� B
12/15/2011
Date Validated
Date Pending FBC Approval
Date Approved
Model, Number or Name
5822.1 ) � Modei #1540-510
12/16/2011
12/22/2011
O1/31/2012
Approved fw use io MVHZ: Yes
Approved for use outside HVHZ: Yes
Lnpatt IiesistaM: N/A
Deslgn Pressure: +100/-100
Othnr. One vent may be used for up to Z00 sq. ft. of interior
space.
5822.2 f Mode1 #1540-514
Limits of Use
Approved for use in NVH2: Yes
Approved fo� use outside HVH2: Yes
Lnpact ibssistant: N/A
Desi9n Pressure: +100/-100
Other, One vent rtay be used for up to 200 sq. R. of interior
space.
5822.3 I Model #1540-520
Umits of Use
Approved for use in HVHZ: Yes
Approred for use outside HVHZ: Yes
lmpad Resistant: N/A
Design Pressu�+e: +100/-100
Other. One vent rrey be used for up to 200 sq. ft. of interior
space.
5822.4 � Model #1540-524
Limits oi Use
Approved for use in HVHZ: Yes
Approved for use outside MVHZ: Yes
Impact 15esistaM: N/A
Design Pressure: +100/-100
Other. One vent may be used for up to 200 sq. ft. of interior
space.
5822.5 � Model #1540-570
Limits of Use
Approved for use in tivN2: Yes
Approved for use outside HVHZ: Yes
Lnpact ResistaM: N/A
Design Pressure: +100/-100
Other: One vent rrey be used for up to 200 sq. ft. of interior
space.
5822.6 I Model #1540-574
Limits of Use
Approved for use in FIVNZ: Yes
Approved for use outside HVMZ: Yes
Lnpact itesistant: N/A
Desiyn Pressure: +100/-100
Other. One vent may be used for up to 200 sq. ft. of interior
space.
Description
SmartVent
Installation Instivetions
PTID 5822 I Installation Instrvctions.odf
VeriFied By: Ale�ds Spyrou Florida PE 68101
Created by Independent Third Party: Yes
Evaluatlon Repoets
Fi 5822 � AE PER 1550 sianed and cert uodated.odf
F� 5g22 R2 AE SmartVent - Imoact Reauirements Letter 12 15 11
@jgned and cert.ndf
Created by Independent Third Party: Yes
SmartVer�t Werhead Door Model
7nstaNatlon Trtstructlons
FL5822 2� II Installation Instructions �df
Verified ey: Alexis Spyrou Fbrida PE 68101
Created by Independent Third Party: Yes
Evaluation Reports
FL5822 2� AE PER 1550 sioned and cert ��pdated.odf
FS822 R2 AE SmartVent - ImDact Reauirements Letter 12 15 11
�j,aned and cert.odf
Created by IndependeM Third Party: Yes
FloodVent
Installation Instnrctbns
Fi 5822 R2 II Instailation Instructions odf
Verifled By: Alexis Spyrou Fbrida PE 68101
Created by Independent Third Party: Yes
Evalwtlon iLaports
FL5822 R2 AE PER 1550 signed and cert u�dated odf
FL822 R2 AE SmartVent - Irrp�ct fLequirements Letter 12.15.11
sianed and cert.udf
Created by Independent Third Party: Yes
FloodVent Overhead Door Model
7nstaNation �nstrucdons
F� 5822 R? II In�tallation Instr�ctions odf
Verified ey: Ale�ds Spyrou Fbrida PE 58101
Created by Independent Third Party: Yes
Evalwtlon imports
F�822 R2 AE PER 1550 sianed and cert uodated.odf
FL5822 R2 AE SmartVent - Irroact Reauirements Letter 12.15.11
�igned and cert.ndf
Created by Independent Third Party: Yes
Wood Wall FbodVent
L�staNation Instructions
F1582 2� II Installation Instructions.odf
Verified By: Ale�ds Spyrvu Florida PE 68101
Created by Independent Third Party: Yes
Evaluation Reports
Fi 5822 R? AE PER 1550 sianed and cert uodated odf
FL5822 R2 AE SmartVent - Imoact Reauirements letter 12.15.11
�igned and cert.ndf
Created by Independent Third Party: Yes
Wood Wall FloodVent Overhead Door Model
L�stallation Instructions
Fi 5822 R? II Installation Instructions.odf
Verif'�ed By: Ale�ass Spyrou Florida PE 68101
Created by Independent Third Party: Yes
Evaluation f�ports
FL5822 � AE PER 1550 sianed and cert t{pdated.odf
Fi 5822 R2 AE SmartVent - Imoact Reauirements Letter 12.15.11
signed and cert,odf
Created by Independent Third Party: Yes
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f.ontac[ Us :: � 940 North Monroe Street. Tallahassee FL 32399 Phone: 850-487-1824
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Monday, June 02, 2003 14:34:03
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� FRAMED WALL INSTALLATION SHOWN
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� � \ STANDARD 16" O.C. STUD MUST BE
����'��. CUT AND AN 8" X 16" HOLE FRAMED
1. PREPARE HOLE I . '' \'��,,`` `� WITH AN ApJACENT DUMMY STUD.
2. INSERT FRAME � ,i! i � . . .� � ` � �
IN HOLE IN WALL I '���� �,
3. BEND STRAPS TO `�"`��\ \ , `
WALL THICKNESS ` �
4. PLACE STRAPS � ' � � ('���� L �
BEHIND WALL AND I `\ 16�� �� �- \�
PUSH TANGS INTO �' ���� ��._ \�.
SLOTS IN FRAME � '. �,, � � _ \'���, ,
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5. INSTALL DOOR ' \,, \ .� �� ' �
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VENT
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ALTERNATE STRAP
LOCATI�NS ON SIDES
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OPEN
8-1/4' ROUGH �
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Smart VENT� BLOCK OR POURED
INSTALLATION INSTRUCTIONS
16-1/4' ROUGH OPENING
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IN FRAME
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AND CAN BE BROKEN OfF
AT SL�TS TO AVOID
OBSTRUCTIUIS
FRAME �
12'
MAX
FINAL GRAD£
INTERIOR
� � UPPER STRAPS
BEHIND WALL
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� SIDE STRAPS
BEHIND WALI
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1. Prepare a CLEAN 16-1/4' wide by 8-1/4' high rough opening for each vent (1 btock wide x 1 block high)
with the bottoM of the hole no More then 12' above finished grade.
2, Measure wall thickness and bend (r�ore than 90') 4 straps at nearest slot to the rteasurer�ent fron pointed end,
3, Reroove door froM fraMe, (turn upslde down, rotate botto� of door outward and slide out of slots)
4, Insert two straps into two top sets of slots in frar�e froro rear. After pushing teeth through renr set slots,
ONLY PUSH STRAPS ONE CLICK INTD FRONT SL�TS, Straps shoutd have bent legs pointing up,
5, Cautk May be applled behind front fraroe flange� Tilt fraroe sa top goes into rall opening f(rst with strap tegs
going behind wall above opening, Push fraMe into opening so front flange Is tight to face of wall.
6. Reach thraugh frnroe opening and instalt two bent strnps through two bottoM sets of slots in fraMe, trnpping watl
between front flange and bent strap. Squeeze all straps tight, FraMe should be flush to walt face and secure,
7, Check that f rar�e Is square and slots are dear of debris, Mortnr and caulk.
8, Install door into fraroe by grasp�g bottoM of door Cwith plastic pins) and front <with s�aller squares) facing up,
Stide door Into fraMe such that �etal pins on each side slide into slots on sides of fraMe, Let the door sUde down
following the path of the slots, untit they are at the battoM of the slots in the dir�ptes.
g, Let the bottoM of the door go so that the door rotates down into the fraMe, Check that door is latched on both sldes,
a�sra.�.nve eitzro;s
BLITTOM STRAPS
BEH[ND WALL
Smart VENT�
888-628 4115
W W W.SMARTVENT.COM
ALTERNATE STRAPS
� L�ATIWS O�1 SIIES 2 PLS,
Smart VENT� BLOCK OR POURED SIDE BY
S1DE INSTALLATION INSTRUCTIONS
DRI�L AND INSTALL 2
OVERLAP �NE VENT FLANGE OVER THE OTHER, SS SHEETMETAL SCREVS
SILICONE JOINT �, fXTfR10k
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D�t SFWN �EN
IN i'RAI�
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astr
8 1/4'
DOat
IIPEPI
FRAME
I U . o o STRAPS fA BEFIIND yALL 12' �MAX
—Ft�UGH OPENING 33' pNp � � � �
EXTERIDR VIEW Ar �s T0 ��D
aesTaucrtora
i. Prepare a CLEAN 33 ' �Ide by 8-1/4' high rough ope�ing for each vent (2 block ride x 1 blak high) Fllld�
rFkh the botton of the hole ►ro riore then 12' obove fir�shed grnde,
2. Mensure rnll thkkness o.�d bmd G�or�e thnn 90•) 8 strcps at neurest slot to the neasurenent fran pdnted end.
3� Rerwve door fron frane. Cturn upside dorn, rotate bottan of door out�mrd ond slide out of slots)
4, lnsert four strups k�to t�o top sets of slots In frnne fron rean After pushFp teeth tFra�gh renr set slots,
ONLY PUSH STRAPS p� CLICK AiTO FRQ�IT SLOTS. Straps shadd hnve bent leps pohtinp �p.
5� Vlth the tw outside vent frnnes sanddcFied together cWll nnd screM the tw frnnes together dth 2 SS sh¢et netal scrers,
6� Cnulk or acMiesive rxiy be applled behind front frane flanpe. Tllt frane so top goes Into rnU apening flrst �Ith strnp leps
going beFihd rall above openk� Push frnne hto openinp so front flnnge Is tight to fnce of �aU.
7. Rench throuph frane openlnp and instoll two bent straps tFraugh tto botton sets of slots In frane, trapphp �all
betreen frant flan8e and bent strap. Squeaze nll st�^aps tigh�. Frane si�ould be flush to �nll fnce and secure.
8. Check tFat frax Is square ad slots ore denr of debris, nortar nnd caulk
9. Instntt door Into frane by prasping botton of cbor C�Ith pinstk phs dorn) nnd the �ord 'TOP' fncing up,
Slide door hto Frnne such that netal pins on ench side slide hto slots an sldes of fraux. Let the door slide do�n
follo�g the path of the slots, until they are at the botton of the slots In the dinples.
10, Let the }iotton of the door go so that the door rota4es dorn Mto the frane. Check that door Is latched on both sldes,
1L Insert twa thh blades ar cnrds hto #ie Flont slots cnd unlatch tlw door to insure free f�a�ctlonaQty, then tatch ngnin.
SIDEBYSIDEBLOCK.d &23-05
LINTEL IS REQUIRED
PER LOGAL BUILDING C�DE
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UPPER STRAPS
BEHIND VALL
r— ALTERNATE
SIDE STRAPS
BEHIND VALL
�TTQI STRAPS
BEHIND VALL
Smart VENT�
8T7-441 8368
W W W.SMARTVENT.COM
Smart VENT� BLOCK OR POURED SIDE BY
SIDE WITH INSIDE SLEEVE INSTALLATION
INSTRUCTIONS LINTEL IS REQUIRED
PER L❑CAL BUILDING
DRILL AND INSTALL 2
OVERLAP ONE VENT FLANGE OVER THE �THER, SS SHEETMETAL SCREWS crrcarna _ nf-�
DOOR
REM�VED
8 1/4•
DOOR
OPEN
fRAME
12'
EXTERI�R VIEW
1, Prepare a CLEAN 33 ' wlde by 8-1/4' high rough apening for ench vent (2 block wide x 1 block high)
wlth the bottaa of the hole no roore then l2' above flnlshed grade,
2. Reroave door fron fruroe. (turn upside down, rotate botton of door outward and sllde out of slots) FINAL G
3, Dry fit the franes In ptnce naking sure there nre no obstructions and that the front flange sits against the flnt outside rall,
Insert the inr�er sleeve froro the inslde of the building through the opening and over the vent frnne.
4, With the tNO outside vent franes sandw(ched together drlll and screN the two frones together Mith 2 SS sheet netal scrers
5, Apply construction adheslve around the front frnne flange where shown Do not npply adhesive to the Inside of venti and press in place.
6, Apply constructlon adhesive nround the inside trin flunge Mhere shown, Do not apply adhesive to the Ir�side of vent! and press In place.
7. Calk ns required
6. [nstnll daor Into frane by grasping botton of door CNith plastic pins down) and the �ard 'TOP' fncing up.
Slide door into frane such thot netnl pins on each side sUde into slots on sides of Frnne. Let the door slide dorn
fotlowfng the path of the slots, until they are nt the botton of 4he slots In the diroples.
9, Let the botton of the door go so that the door rotates down inta the fraroe. Check thnt doa^ is lotched on both sides.
10. [nsert two thin blades or cards into the float slots nnd unlatch the door to insure free functionaUty, then lntch again.
SIDEBYSIDEBLOCKwsleeve.dwg &23-05
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SIDE SECTIaN VIEW
Smart VENT�
8TT-441 8368
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SIDE SRAPS
BEHIND
R�UGH
ROUGH
CLOSED
�pEN
EXTERIOR
SMART VENT� STACKING INSTRUCTIONS
MODELS 1540-511 AN01540-521
•UPPER FRAME
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SCREWS
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SWUNG IN1dARD
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UPPER
STRAPS
BEHIND
WALL
D0� 16 3/8'
.�. ROUGH SIDE
OPEN2NG �� STRAPS
BEHIND
, WALL
T� VENT INTERIOR
DOOR SHOWN HEING
[NSERTED INTO FRAME
STRAPS GO BEHIND WALL AND
CAN BE BR�CEN Of'F AT SLOTS
TO AVOID OBSTRUCTIONS 8 PLS
� EXT ERI'
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lOM/ER FRAME
3 1�2' , � j �
MAX �
NAL GRA E + a
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STRAPS
BEHIND
WALL
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� DETAIL 'H'
,� � NYL�N SNAP-IN
SPACER 2 PLCS
SIDE SECTI�N VIEW
1, Prepare a CLEAN 16-1/4' wide by 16-3/8' high hole for each set of two stacking vents Cl block wide x 2 blocks high)
wlth the bottoM of the hole no nore then 3.5' above finished grade.
2, Mensure wall thlckness and overbend Cnore than 90') 8 strnps at nearest slot to the �easureroent froro polnted end,
3. Rer�ove doors froM fraMes. Cturn upside down, rotate bottoro of door outward and slldQ out of slots)
4, Asseroble two franes together using two nylon spacers snnpped Into holes in rear of froroes as shown In Detall 'B',
Place top frane Cone with shart bottoM flange) over and In frant of bottoro fraroe (one with short top flange) and Fasten
front of fraroes 4ogether with two self tapping screws as shown In Detalls 'A' and 'C'. Do not over tl9hten screws.
5, Insert 2 stro.ps into top slots of TOP frane, Straps should have bent tegs pointing up. After pushing teeth through rear
stots, �NLY PUSH STRAPS ONE CLICK [NTO FRONT S�OTS, they wllt be tightened tater In Installatlon,
6. Chntk nny be apptled to bnck of flanpe s for a bet4er seal to wnll fuce. Place frune nssenbly k�to rall opening by sliding
the top strnps beh�nd wall and res�ing frane botton on bottaro of wnll opvning, Press flonges tight to wall face.
7, Reach through bottoro fraroe opening and Install two bent straps into two bottoM stots with the bent legs of the straps
han�Ing down behlnd wall and trapping wall between front flange and bent strap. Squeeze tlght to wall.
8. Install a strap on each slde of both frarie openings as shown in DetnU 'D', I�stall with bent leg pointing outwnrd behind
the watl and into slots an each of up�er sldes. Squeeze tight to wall. Now, squeeze top frane straps tight to wall,
9, Make sure both fraMes are flush to wall face, secure, square, level and nll stots ar¢ clear of debris, nortar and caulk.
10, �Hold doors fron the bottoM, parnllel to graund wlth bcck facing ground and re-Install Into franes by Inserting top first nnd
letting roetal pins flnd slots. Push nit way back and ntlow door to drop and rotnte down and both sides latch dosed.
SVSTACKINSTALLRLPRT 11/03/03
Smart VENT�
888-628 4115
WYYW.SMARTVENT.COM
SCREVi
S�art VENT �VERHEAD ���R INSTALLATI�N INSTR�CTIONS
C/�ICICILJIC V1L1Y
3/8"
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1 For each Vent cut o CLEAN, S[�1ARE, LEVEL l6' wide by 7-7/8" high hole conpletely though the bottan �ver Head (�H) Ooar Ponel
with the botton of the hole level and no nore then i2" obove finished grode (drivevay), Laoks best to center Vent verticully of door pcnel,
2 For each Vent drili four (4) I/4 inch dianeter holes conpletely through door punel vhere shown. Vent frane nay be used as a tenpiote.
3, Cleon all sharp netol edges ond burrs fron opening, 8rush aNay any loose styrofoon fron the opening,
4. Renove Vent door fran Vent frone. (turn upside down, ratate batton of daor outword and slide out of frane slots)
5. Insert Vent frone into �FI �aor Ponet with SERIAL NLIMBER LABEL on the 8[]TTOM Check olignnent ot holes in Vent frnne with holes
drilled in ON doar ponel, Correct holes in �H Ooar ponel if nessesary. Make sure Frane sits LEVEL ond front flange is FLUSH with the
front of OH Door Panel. Caulk nay be applied behind Vent front frane flange to seol Vent frane to foce of [kl �oar Pa�el.
6. Place Nut Flonge on inside of Vent frane rith nuts facin9 aroy fron OH Ooor. Insert 4 screws provided through frant of Vent frane ond
through �H Door into Nut Flonge. Tiyhten screws ta secure frane to �I Ooor but do not over tighten, deforning OH [bor or Uent Frane.
7. Check thot frane is squnre ond level, Check that siots nre clear of debris, netol shovings, styrofoon and caulk.
8. Instoll Vent door buck into frane 6y grosping botton of Vent door lwith plastic pins) and sliding the netal pins on each side of the Vent
doar into slots on the insides af frane, let the Vent doar slide dawn the path of the siots until they are ot the botton in the dinples.
9, Let the botton of the Vent doar ga so that it rotates oown into the Vent frane. Cneck thot Vent doar is Intched an both sides.
10. Vent door should not open when [}i door opens, Vent doar only opens when in contact with flood vater and OH Ooor is fully closed.
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wtth the Y�m�m �i1he hNe rn mwa Ihen 3�1 /t" oY�ve AnishM Sra�e.
2 Meaa�ro iwll riickness anr �verYeM (mwe than 91')12 atra's at neare�t �N b Ihe maauroment fi�m pin6el enL
3. Ren»va �ws irn framea (tum u'a/e ��Nn� rnate Y�thm �f �wr �uMai1 an1 slile wt �f sl�ts)
�. Assemrle tw� aets �t tw� iames t�e�her usns tw� nylm e'acers ana'�ei int� hdes in rear �f twnes ae ah�wn in �efail "�'.
Nace b' fnme (w�e wilh ahrt ��tNm fan�e) wer �� in tmt �f Y�tam ir�r� (me wilh ah�rt b' Anse) m� Fasten
U�nt N fr�mea tyeTher wilh hw self faMin' acrows as ah�wn in �etrla "A �M'C'. �� n�t �ver tlshkn �crews.
5. Ineert 2 atra's inq tM sNle d eoch TK fl�na Sirq�a shMd� have Yent less MinYn� u'. Aftx ruehin� beN ttx�uush rear
aNte, N-ILY �USH 3iRN�S �NE CLICK INl'� FRN�1T SL�T3, they will Ye 5�h6enM laix in installati�n.
i. GuNc may M �pliar r Yrdi N lan'sa i�r � Ystlr eal d wall faca Macs iame oae�mYly ind waA qaNne Yy Nl�lne
he 6� etrVs YehIM waY M resinf �e btrm m YNbm d w�U qanin�. has� Aan�es Isht u w�ll face.
7. Reach f�rw�h Nenins in btbm trwnes m� Msmll hur Mnt straNa Inb rin Y�tdm �I�b wilh M�e Yent lesa �f the strMs
hansins �w� YehiM �II anI t�'in, wali Yetwwen frx�t tonae orN Ysnt atra'. 3�ueszs U�ht b radc �f vwlL
l InshN a atn► �n each dre �i fr�ns a�semYly. In�taA wl� �ent le�'Mngns �utwal Yehinl t�e a�p aM ints �INs m each
�f u�'x si�ea S�ueeu tlsht b wall. Nnv, s�ueem t� frwne aYa's tl�ht b waU.
�. Make surs frames are Aush U waA iace, seare� a�Nara level an/ �II �I�b ars dear �1 hYrla m�rt�r an� csWk
1�. H�I� N�rs G�m the Y�Ihm,'aralld M�nun� with ►adc tadns �nun� an1 rsinstall Inr� tames Yy inaxtln� 0�' Arst aM
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U.S.DEPARTNIENTOFHOMELANDSECURITY ELEVATlON CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AGENCY ON16 No. 1660-0008
vurr<<nutFroo�in.sz�,•�,,,���P,-�;ram �mportant: Read the instructions on pages 1-9. Expiration Date: July 31, 2015
SECTION A - PROPERTY INFORMATiON
A1. Building Owner's Name
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
831 BAY ESPLANADE
City CLEARV�lATER
State FL ZIP Code 33767
A3. Property Description (Lot and Block Numbers, Tax Parcei Number, Legal Description, etc.}
LOT 3, BLOCK 39, MANDALAY SUBD., PB 14 PG 32
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAI
A5. Latitude/Langitude: Lat. 27°59'43"N Long. 82°49'24"W Horizontai 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. Buiiding Diagram Number 1 B
A8. For a building with a crawispace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) N/A sG ft a) Square footage of attached garage UNKWN sq ft
b) Number of pertnarent flood openings in the crawtspace b) Number of permanent flood openings in the attached garage
or enclosure(sj within 1.0 foot above adjacent grade N/A within 1.0 foot above adjacent grade 12
c) Totai net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b 1694 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
64. 1�1ap/Panel Number I 65. Suffix 66. FIRM Index Date B7. FIRM Panel
12103C0102 G 09-27-13 Effective/Revised Date
09-03-03
B3. State
FL
68. Flood B9. Base Flood Elevation(s) {Zone
Zone(s} AO, use base flood depth)
AE 11'
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69.
❑ FIS Profile � FIRM ❑ Community Determined ❑ Other/Source:
61 i. 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)?
Designation Date: N/A ❑ CBRS ❑ OPA
❑ 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 will be required when construction of the building is complete.
C2. Elevations - Zones A1-A36, 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: CLW BM 238A J-03 Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a) through h) below. 0 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 buiiding (LAG)
g) Highest adjacent (finished) grade next to buiiding (HAG)
h) Lowest adjacent grade at fowest elevation of deck or stairs, including structural support
15.5
N/A.
N/A.
6.0
N/A.
5.2
5.2
N/A.
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
information. I ce�tifj that the informafion on this Certificate represents my best efforts to interpret the data available.
l understand that any fa/se stafement may be punishable by fine or imprisonment under 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 ❑ No
Certifier's Name J. MICHAEL FUQUA
Title PSM
Address 1406 W. �INEBAUGH AVE.
Signature , ► _ _ _ l.._ _
FEN9A Form 086-0-33 (7i12)
License Number 4192
Company Name DAVID L. SMITH SURVEYING & MAPPING
City TAMPA State FL ZIP Code 33612
Date �o �,�-�1 �� Telephone 813 935-1960
See reverse side for continuation.
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IMPORTANT: in these spaces, copy the corresponding information from Section A.
Buiiding Street Address !including Apt., Unit. Suite. and/or 81dg`;�lo.) or �`.O. Route and Box No
831 BAY ESPLANADE
City CLEARWATER State FL Z!P Code 33767
FOR INSURANC� C(7MPANYUS�
PQlicy Number:
Company NAtC Number. "
SECTiON D- SURVEYOR, ENGINEER, OR ARCHITFCT CERTIFiCATION (CONTiNUEDj
Copy both sides of ,his Elevation Certificate for (1) communib� o�cial, (2) insurance agenticompany, ard (3) building owner.
Comments
Signature
i�/yS�
SECTIO E- BUILDING ELEVATI NFORMATION (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 LON1A ar LOI�iR-F request, complete Sections A, B,
and C. For Items E1—E4, use natural grade, if availabie. Check the measurement used. In Puerto Rico only, enter meters.
E1, Provide elevation informatian for the foilowing ar,d 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 HAG.
b) Top of bottom floor (including basement, crawispace, or enciosure} is . ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2, For Building Diagrams Fr9 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 piatform of machiner� and/or equipment servicing the buiiding 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 locai 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 FENIA-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
Srate ZIP Code
Telephone
❑ Check here if attachments.
SECTION G — COMMUNITY INFORMATION (OPTIONAL)
The locai o�cial who is authorized by law or ordinance to administer the community's floodplain management ordinance can compiete Sections A, B, C(or E), and G
of this Elevation Certificate. Complete the appiicabie 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 FENIA-issued or community-issued BFE) or Zone AO.
G3. ❑ The foilowing information (Items G4—G10) is provided for community floodplain management purposes.
G4. Permit Number
G5. Date Permit issued
G6. Oate Certificate Of Compiiance/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 AOj depth of flooding at the building site: ❑ feet ❑ meters
G10. Community's design flood elevation: ❑ feet ❑ meters
Locai Official's fvame
Communib/ Name
S+grature
Comments
FEN1A Form 086-0-33 (7/12)
Title
Telephone
Date
Datum
Datum
Datum
Check here if attachmerts.
Repiaces all previous editions.
- - _ -
ELEVATION CERTIFICATE, page 3 guilding Photographs
> See Instructions for Item �6.
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.
831 BAY ESPLANADE
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 Vievd'; 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 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.
831 BAY ESPLANADE
City CLEARWATER State FL ZIP Code 33767
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 appiicable,
photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8.
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