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905 BETTY LN SPage 1 of 3 not valid without all three pages . U.S. DEPARTMENT OF HOMELAND SECURtTY FEDERAL EMERGENCY MANAGEMENT AGENCY National Pimd Insumnce Progmm A1. ELEVATION CERTIFICATE IMPORTANT: Follow the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION A2. ^Building Street Address (including Apt., Unit, Suite, and/or B�dg. No.) or F?0. Route and Box No. State OMB No. 1660-0008 Expiration Date: July 31, 2015 FL1408.3062EC FOR INSURANCE COMPANY USE Policy Number: Compa�y NAIC Number: ZIP Code A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) s3i5b PARCEL ID # 15-29-15-82206-000.0950 A4. Building Use (e.g., Residential, Non-Residential. Addition, Accessory, etc.) RESIDENTIAL A5. Lalitude/Longitude: Lat. 27 57 23.5 N Long.82 47 00.1 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 a A8. For a building with a crawispace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawispace or enclosure(s) �268 sq ft a) Square footage of attached garage 312 s ft b Number of Q ) 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 68 within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b 1350 sq in c) Total net area of flood openings in A9.b o s in d) Engineered flood openings? ❑ Yes � No 4 d) Engineered flood openings? ❑ Yes � No SECTION B- FLOOD INSURANCE RATE MAP (FlRM) INFORMATION B1. NFlP Community Name & Community Number B2. County Name 63. State CITY OF CKEARWATER 125096 PINELLAS FLORIDA 64. Map/Panei Number 65. Suffix 66. FlRM Index Date 67. FlRM Panel Effective/ 68. Flood Zone(s) 69. Base Flood Elevation(s) (Zone 12103C - 0108 H ���� Revised Date AO, use base flood depth) 05/17/2005 xs""°ma "E 23.5 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69: ❑ FlS Profile � FlRM ❑ Community Detertnined ❑ Other/Source• B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: 612.Is the building loceted in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes � No Designation Date: / / ❑ CBRS ❑ OPA SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C. w ing eTeva io sn are 6ased on: �onstruction Drawings* ❑ Buiiding Under Construction* ❑ Fnished Construction *A new Elevaiion Certificate wili be required when construction of the building is complete. C2. Elevations - Zones A1-A30, AE, AH, A(with BFE), VE, V1-V30, V(with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete items C2.a-h below according to the building diagram specified in item A7. in Puerto Rico only, enter meters. Benchmark Utilized: L-NET C,PS NETWORK •• Vertical Datum: �IAVD98 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: Datum used for bui�ding 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 buitding (Describe type of equipment and location in Comments) fl 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 �F .4Z__ �2L_ . ]L_ �5 42 24 _ cB.Z._- �4._ . 00 95 . `,�_. 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 CERTIFlCATION This certificatio� is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information on this Certificate represents my best efforts to inierpret the data availabie. 1 understand that any fa/se statement may be punishable by fine or imprisonment under 28 U.S. Code, Section 1001. � Check here if comments are provided on back of form. Were latitude and longitude in Section A provided hy a ❑ Check here if attachments. licensed land surveyoR ❑ Yes �] No Name Address 11940 FAIRWAY LAKES DRIVE Signature , ,� t_ ,- !;;:.-r`�; �`. FEMA Form 086-0-33 (Revised 7/12) (REV.O 8/29/2014) ITE 1 License Number Company Name EXACTA LAND SURVEYORS INC. City State ZIP Code FT.MYERS FL Date Telephone 8/29/2014 See reverse side for continuation. Replaces all previous editions. Page 2 of 3'not valid wiihout a�l three pages w ELEVATION CERTIFlCATE, page 2 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. City State ZIP Code FL1408.3062EC FOR INSURANCE COMPANY USE Policy Number: Company NAIC Number: SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFlCATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments NOTE: C2.E = AC UNIT PAD. NOTE: THIS ELEVATION CERTIFICATE IS ONLY VALID FOR THE PERSON OR PERSONS NAMED ON THIS ('FRTIFI('ATF THIS ('FRTIFI('ATF IS FnR FI nnn IN4(IRA �(`F Pl IRPn4FS (�til Y TE,F II�FnRMATIC�"� nl� ThIS (`FRTIFI('ATF c�+�� �� � unr or USED FOR CONSTRUCTION OR PLANNING. Signature ! ;' ,� , Date g�2g/2p1q �'� �,z.'� ;.�. .'j : vY jTe CENTERLINE ROAD ELEVATION: 24.87 SECTION E- BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BF�), complete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request, compiete Sections A, B,and C. For ttems 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 HAG. 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 availabie, is the top of the bottom floor elevated in accordance with the community's floodpiain management ordinance? � Yes ❑ No ❑ Unknown. The locai official must certify this information in Section 6. SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFlCATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A(without a FEMA-issued or community-issued BFE? or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowiedge. _ Property Owner or Owner's Authorized Representative's Name _ Address Signature Comments City Date State ZIP Code Telephone ❑ Check here if attachments. SECTION G - COMMUNITY INFORMATION (OPTIONAL) The locat official who is authorized by law or ordinance to administer the community's floodpiain 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 oniy, enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or Zone A0. G3. ❑ The foilowing information (Items G4-G10) is provided for community floodplain management purposes. G4. Permit Number Date Permit Issued G6. G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-built lowest floor (including basement) of the building: . ❑ feet ❑ meters Datum G9. BFE or (in Zone AO) depih of flooding at the building site: . ❑ feet ❑ meters Datum G10.Community's design flood elevation: . ❑ feet ❑ meters Datum Local Official's Name Community Name Signature Comments FEMA Form 086-033 (Revised 7/12) Title Telephone Date Issued ❑ Check here if attachments. Replaces all previous editions.