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811 LANTANA AVEU.S. DEPARTM�ENT OF HOMELAND SECURITY ELEVATION CERTI FICATE FEDERAL EMERGENCY MANAGEMENT AGENCY National Flood Insurance Program IMPORTANT: Follow the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION Al. Building Owner's Name ROGER C WARD A2. Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or PO. Route and Box No. OMB No. 1660-0008 Expiration Date: July 31, 2015 FOR INSURANCE COMPANY USE Policy Number: Comparry City CLEARWATER State F� ZIP Code 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) PARCEL OS-29-155466C>029-0030, BLOCK 29, LOT 3, MANDALAY SUB, PIAT BOOK 014, PAGE 032, PINE�LAS COUNTY, F�ORIDA A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 2�.993$ Long. 82.8249 Horizontal Datum: ❑ NAD 1927 x� 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 ONE-A 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 NA sq ft b) No. of permanent flood openings in the crawispace or b) Number of permanent fiood openings in the attached garage enciosure(s) within 1.0 foot above adjacent grade N�A within 1.0 foot above adjacent grade NA 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�'4 sq in d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NFIP Communi�y Name & Communi�y Number CLEARWATER CITY OF 125096 B4. Map/Panei Number B5. Suffix B6. FIRM Index Date 12103C0102 � G � 08/18l2009 62. County Name P�NELLAS 67. FIRM Panel Effective/ Revised Date 09/03/2003 Zone(s) AE 63. State FL B9. Base Flood Elevation(s) (Zone A0, use base flood depth) 11.0 FT 610. Indicate the source of the Base Fiood Elevation (BFE) data or base flood depth entered in Item 69: ❑ fIS Profile � FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: 612. Is the building located in a Coastai 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: GPS 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 buildin� elevations must be the same as that used for the RFF_ 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 oniy) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) fl Lowest adjacent (finished) grade next to building (LAG) Check the measurement used. 5 �� feet ❑ meters N!A � feet ❑ meters N/A � feet ❑ meters N/A � feet ❑ meters NA � feet ❑ meters 4�7 � feet ❑ meters � .� l� ^'J _� `� � �� g) Highest adjacent (finished) grade next to building (HAG) S Z � feet ❑ meters v h) Lowest adjacent grede at lowest elevation of deck or stairs, including Np` � feet ❑ meters ^ n structural support � �/ � / SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be si�ned and sealed bv a land survevor. en�ineer. or architect authnri�ed hv iaw tr, �Prr�t� Pip�ar�,,., ELEVATIOM CERTIFICATE, 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 F0. Route and Box No. 811 LANTANA AVENUE City State ZIP Code CLEARWATER FL 33767 FOR INSURANCE COMPANY USE Policy Number: Comparry NAIC Number: 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 �F EQUIPMENT IS LISTED ON PRIOR PAGE IS BASE OF AIR CONDITIONER UNIT THIS CERTIFICATE IS NOT TO BE USED FOR CONSTRUCTION OR DESIGN, IS FOR FLOOD INSURANCE USE ONLY Signature Date 08/26/2014 SECTION E- BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND 20NE 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, 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 �9 of instructions), the next higher floor (elevation C2.b in the diagrams) of the building is N� . p` � 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 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 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 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 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. Comp�ete the applicable item(s) and sign below. Check the measurement used in items G�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 AO. G3. ❑ The following information (Items G4—G9) is provided for community floodpiain 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. Eievation 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 Datum G10. Community's design flood elevation: . ❑ feet ❑ meters Datum _ Local Official's Name Community Name Signature Comments Titie CLEARWATER CITY OF Telephone Date ❑ Check here if attachments. FEMA Form 086-433 (7/12) Repiaces ail previous editions. 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: 811 LANTANA AVE CLEARWATER, FL 33767 PICS TAKEN 8/19/2014 FRONT VIEW AND CONTINUING AROUND BUILDING :{. f.; ..= y , ��; � � � _ "'.�'�`� �`��'�4f ��` `�'�,� �v�� $� E'£« �, . . � _.�� i� t �;,' . � �� '' +� � � � : �� '� � � ' s� ; :; + � � �. _..�.-...-.....-,,.. _.. _.__._.. � � 4.,i� � e } �� tk� I4... � ' . � '� � ' ' � � � � , m �,.*' � � �r� ;� �, ''�, .;� � : .� , _ �" � r �s ' ��, �`m.� ra. � � , � � �, �'�" j�� -�, ,: ' �