800 NARCISSUS AVEU.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AGENCY
National Flood Insurance Program IMPORTANT: Follow the instructions on pages 1-9.
SECTION A - PROPERTY INFORMATION
A1. Buiiding Owner's Name
AJAY AND ARCHANA MANE
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P0. Route and Box No.
OMB No. 1660-0008
Expiration Date: July 31, 2015
FOR INSURANCE COMPANY USE
Polioy Number:
Comparry NAIC Number.
City CLEARWATER State F� ZIP Code 33767-1334
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
PARCEL OS29-15-54666-029-0110, BLOCK 29, LOT 11, MANDALAY SUB, PLAT BOOK 014, PAGE 032, PINELLAS COUNTY, FLORIDA
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. 2�•9935 Long. $z•$245 Horizontal Datum: ❑ NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 5
A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawispace or enclosure(s) N�A sq ft a) Square footage of attached garage NA sq ft
b) No. of permanent flood openings in the crawlspace or b) Number of permanent flood openings in th NAttached garage
enclosure(s) within 1.0 foot above adjacent grade N�A within 1.0 foot above adjacent grade
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) Engineered flood openings? ❑ Yes � No
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number B2. County Name P�NELLAS B3. State FL
CLEARWATER CITY OF 125096
64. Map/Panel Number B5. Suffix B6. FIRM Index Date 67. FIRM Panel Effective/ 68. Flood Zone(s) 69. Base Flood Elevation(s) (Zone
Revised Date A0, use base flood depth)
12103C0102 G 08/1 B/2009 09/03/2003 X� AE 11.0 FT
610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: REV 10-6-14
❑ FIS Profile � FIRM ❑ Community Determined ❑ Other/Source: �� �
B11.Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source:
B12. Is the building located 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)
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 compiete.
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/A0. Complete Items
C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: �PS Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source:
Datum used for building elevations must be the same as that used for the BFE. h d
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 ne� to building (LAG)
g) Highest adjacent (finished) grade ne� to building (HAG)
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
structural support
Check t e measurement use .
6•77 � feet ❑ meters
N!A � feet ❑ meters
NIA � feet ❑ meters
N/A � feet ❑ meters
�•41 � feet ❑ meters
5.0 � feet ❑ meters
5.51 � feet ❑ meters
5.0 � 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 ceriify that the information on this Certificate represents my bes[ efforts to interpret the data available.
I understand that any false statement 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 tatitude and longitude in Section A provided by a
❑ Check here if attachments. licensed land surveyor? � Yes ❑ No
Certitier's Name
BILL H. HYATT, JR
Title
PRESIDENT
Address
1497 MAIN STREET #321
Signature
FEMA Form 08FrQ33 (7/12) �
License Number
#4636
Company Name
KNOW IT NOW INC
City State ZIP Code
DUNEDIN FL 34698
Date Telephone
9-25-2014 (727)415-8305
See reverse side for continuation.
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ab36 �
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LS 4636 09-25-2014
Replaces all previous editions.
ELEVATION CERTIFICATE, page 2
IMPORTANT: In these spaces, copy the corresponding iMormation from Section A. FOR INSURANCE COiNPAMY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or PO. Route and Box No. Policy Number:
800 NARCISSUS AVENUE
City State ZIP Code Company NAIC Number.
CLEARWATER FL 33767-1334
SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments EQUIPMENT LISTED ON PRIOR PAGE IS BASE OF AIR CONDITIONER UNIT
Signature
Date 09l05/2014
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, compiete 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, crawispace, 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 N� . A � 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 officiai must certify this information in Section G.
SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The properry owner or owner's authorized representative who completes Sections A, 8, and E for Zone A(without a FEMA-issued or community-issued BFE) or
Zone AO must sign here. The statements in Sections A, 6, and E are correct to the best of my knowledge.
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)
7he local official who is authorized by law or ordinance to administer the community'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 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 following information (Items G4—G9) 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 Construction ❑ Substantial Improvement
G8. Elevation of as-buiit lowest floor (inciuding basement) of the building: . ❑ feet ❑ meters Datum
G9. BFE or (in Zone AO) depth of fiooding at the building site: . ❑ feet ❑ meters Datum
G10.Community's design flood elevation:
Local Official's Name
Community Name
Signature
Comments
Title
CLEARWATER CITY OF Telephone
Date
❑ feet ❑ meters Datum
❑ Check here if attachments.
FEMA Form 086-433 (7/12) Replaces all previous editions.
0
ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS
CONTINUATION PAGE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
ADDRESS:
800 NARCISSUS AVE
CLEARWATER, FL 33767
PICS TAKEN 9/24/2014
FRONT VIEW AND CONTINUING AROUND BUILDING
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