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?aning: Tourist
U.S.DEPARTMENTOFHOMELANDSECURITY ELEVATION CERTIFICATE
r EDERAL•EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008
NationalFloodlnsuranceProgram Important: Read the instructions on pages 1-9. Expiration Date:.luly 31, 2015
SECTION A- PROPERTY INFORMATION FOR INSURANCE CqMPANY USE
A1. Building Owner's Name Michael G. Preston Policy Number;
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Gompany NAtC Number:
7 Rockaway Street
City Clearvuater State FL ZIP Code 33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Tax ParcellD # 05-29-15-57924-000-0020
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Commerciall
A5. Latitude/Longitude: Lat. N28-59-00.9 Long. W082-49-39.9 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 1A
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 N/A sq ft
b) Number of 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 N/A within 1.0 foot above 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) Engineered flood openings? ❑ Yes � No
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
61. NFIP Community Name & Community Number B2. County Name
Clearwater, City of 125096 Pinellas
64. Map/Panel Number 65. Suffix 66. FIRM Index Date B7. FIRM Panel
12103C 0102G G 08/18/09 Effective/Revised Date
9/03/03
B3. State
Florida
B8. Flood 69. Base Flood Elevation(s) (Zone
Zone(s) AO, use base flood depth)
VE 13
B10. Indicate the source of the Base Flood 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 69: ❑ 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 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: H=02 Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a) through h) below. � NGVD 1929 � NAVD 1988 O Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
Check the measurement used.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 6.8 � feet ❑ meters
b) Top of the next higher floor N/A.
❑ 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 equipment servicing the building 8.2 � feet ❑ meters
(Describe type of equipment and location in Comments)
� Lowest adjacent (finished) grade next to building (LAG) 5.5 � feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 6.9 � feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 5.5 � 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 certify that the information on this Certificate represents my best 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 latitude and longitude in Section A provided by a
� Check here if attachments. licensed land surveyor? � Yes ❑ No
Certifier's Name Mark S. Lischalk, PLS
Title President
Address 1480 Beltrees Street, Ste 3
Signature
Company Name Zarra Boyd, Inc.
City Dunedin
License Number 5727
State FL ZIP Code 34698
Date 11/20/14 Telephone 727-738-9010
FEMA Form 086-0-33 (7/12) See reverse side for continuation.
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Replaces all previous editions.
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ELEVATION CERTIFICATE, page 2
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. PolicyNumber.
7 Rockaway Street
City Clearwater State FL ZIP Code 33767 Company NAIC Number:
SECTION D— SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenUcompany, and (3) building owner.
Comments The benchmark that is listed in C2 is a City of Clearwater Benchmark. This building is being utilized as a restaurant and was built in 1950 pre-
FIRM. The elevation listed in C2.e is top of a metal stand the supports the bottom of a air handler. The air handler is located inside of the restaurant.
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Signature Date 11/20/14
SECTION E— BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT �trt�
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, 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 available, is the top of the bottom floor elevated in accordance with the community's floodplain management
ordinance? ❑ Yes ❑ No ❑ Unknown. The local 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's 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. 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 AO.
G3. ❑ The following information (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 Construction ❑ Substantial Improvement
G8. Elevation 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
FEMA Form 086-0-33 (7/12)
Title
Telephone
Date
Check here if attachments.
Replaces all previous editions.
,.ELEV.�,TION 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.
Michael G. Preston
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 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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ELEVATION 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.
Michael G. Preston
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 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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7 ROCKAWAY ST
BCP2014-11354
RTC
FRENCHY'S ROCKAWAY
Zoning: Tourist Atlas #
FEMA Form 086-0-33 (7/12) Replaces all previous editions.