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173 MARINA DEL REY CTU.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY National Flood tns�mnce Program IMPORTANT: Follow the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION A1. Building Owner's Name PAUL D AND BARBARA J HAAGSMA 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 Policy Number. NAIC Number: City CLEARWATER State FL ZIP Code ��s� A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) PARCEL 19-29-15-55303-000-0370, LOT 37, MARINA DEL REY AT SAND KEY UNIT 8, PLAT BOOK 081, PAGE 054, PINELLAS COUNTY, FI.ORIDA A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27 939� Long. 92.8333 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 SEVEN 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) 85o sq ft a) Square footage of attached garage NA sq ft b) No. of permanent flood openings in the crawispace or N'A b) Number of permanent flood openings in the attached garage enclosure(s) within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade �dA c) Total net area of flood openings in A8,b N�p` 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 (FlRM) INFORMATION 61. NFIP Community Name & Communi�y Number B2. County Name 63. State CLEARWATER CITY OF 125096 PINELLAS FL B4. Map/Panel Number 65. Suffix 66. FIRM Index Date 67. FIRM Panel Effective/ 68. Flood Zone(s) B9. Base Flood Elevation(s) (Zone Revised Date A0, use base flood depth) 12103C0104 G 08/18/2009 09/03/2003 AE 11.0 FT 610. 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: B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: J�" 612. 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/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. �1 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) 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 Check the measureme�t used. 0 6.0 � feet ❑ meters 1 15.0 � feet ❑ meters ��[ N!A � feet ❑ meters ^� U N/A � feet ❑ meters \ , _ 5.6 � feet ❑ meters � 5_5 � feet ❑ meters 5-9 � feet ❑ meters BA � 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. 1 ceriify that the information on this Certificate represents my best efforts to Jnterpret the data available. 1 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 Gertifier'S Name BILL H. HYATT, JR Titie PRESIDENT Address 1497 MAIN STREET #321 Signature FEMA Form 086-033 (7/12) License Number #4636 Company Name KNOW IT NOW INC City State ZIP Code DUNEDIN FL 34698 Date Telephone 11-17-2014 (727)415-8305 See reverse side for continuation. � ' ` : � �� V � Replaces all previous editions. ELEVATION CERTIFICATE, page 2 IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P0. Route and Box No. 173 MARINA DEL REY COURT City State ZIP Code CLEAR WATER FL 33767 FOR INSURANCE COMPANY USE Poiicy 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 TYPE 7 BUILDING, GARAGE IS ENCLOSED IN BOTTOM AREA SHOWN ON A.S.A Signature Date � � �� 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, 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 N� .'4 � 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) 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 knowledge. Property Owner or Owner's Authorized Representative's Name Address Signature Comments City Date State ZIP Code Telephone ❑ Check here "rf 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 applicabie 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-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 CLEARWATER CITY OF Telephone Date ❑ Check here if attachments. Replaces all previous editions. ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS CONTINUATION PAGE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. 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