941 BAY ESPLANADE� U.3. DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMER(3ENCY MANAGEMENT AGENCY
Natioraal Fload Insurance Program
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1-9.
SECTION A - PROPERTY INFORMATION
A2. Building Street Address (inGuding Apt., Unit, Su�e, and/or Bkig. No.) or P.O. Route and Box No.
94t BAY ESPLANADE
City ClE4RWATER
State FL ZIP Code 33767
A3. Property Description (Lot and Blodc Numbers, Tax Parcel Number, Legai Description, etc.)
LOTS 13,14 B�PART 12 & PART VACATED ROAD, BIOCK 265, CARLOUEL SUB.
OMB No. 1660-0008 �
E�iration Date: July 31, 2015
FOR lNSURANGE CC)MPANY USE
Number.
A4. Buiiding Use (e.g., Residentiai, Non-Residential, Addrtion, Aocessory, etc.) RESIDENTfAL
A5. I.atitude/Longitude: Lat. 27.9995 Long. -82.8231 Horizontal Datum: ❑ NAD 1927 � NA01983
A6. Attach at bast 2 photographs of the buitding if the Certificate is being used to obtain fl�d insuranoe.
A7. Building Diagram Number 4A
AS. For a buiiding with a crawlspace or endosuro(s): A9. For a building with an attad�ed garage:
a) Square footage of crawlspace or enGosure(s) NA sq ft a? Square footage of attached garaye 5�4 sq ft
b) Number of permaneM flood openings in the crawlspace b) Number af pertnanent tlood openinga in the attached garage
or endosure(s) writhin 1.0 foot abare adjaoent grade within 4.0 foot above adjacent grade Q
c) Totel net ares of flood openings in A8.b sq in c) Total net ares of flood openings in A9.b Q 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 62. County Name B3. State
CLEARWATER 125096 PINELLAS FLORIDA
B10. Indicate the source of tfie Base Fbod Elevation (BFE) data or base Rood depth e►rtered in Rem B9.
❑ FIS Profile � FIRM ❑ Corrxnunity Detertnined ❑ Other/Source:
611. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ OtherlSource:
B12. is the buiiding located in a Coastal Barrie� Resources System (CBRS) area or Otherwise Protected Area (OPA)T ❑ Yes � No
Designation Date: � ❑ CBRS ❑ OPA
SECTION C- BUILDING ELEVATtON INFORMATION (SURVEY REQUIREQ)
C1. Buiiding elevations are based on: ❑ Construdion Drawings' ❑ Bui�ing Under Construction' � Finiahed Construction
'A new Elevation Certificate wii! be required when consVud'wn of the buiiding is compfete.
C2. Elevatio�s - Zones A1-N30, AE, AH, A(vrith BFE), VE, W V30, V(witt► BFE), AR, AR/A, AR/AE, AR/A1-,A30, AR/AH, ARlAO. Comptete Items C2.a-h
below according to the buikting disgram specified in ttem A7. In Puerto Rico only, enter metera.
Benchmaric Utiiized: SEE COMMENTS Verticai Datum: NAVD 19$$
Indicate elevation datum used for the eievations in itema a) through h) below. ❑ NGVD 1929 � NAW 1988 0 Otherf5ouroe:
Datum used for building efevatio�s must be the same as that used for the BFE.
Chedc the measu�neM used.
a) Top of botiom floor (induding basement, cravrlspace, or enGosure floor)
b) Top of the ne� higher floor
c) Bottom of the lowest horizontal stn�ctural rr�ember (V zones onh?
d) Attached garage (top of slab)
e) Lowest eievation of machinery or equipmerit servipr►g the buiWir►g
(pegcribe type of equipment snd bCation in Comments)
� Lowest adjaoent (finisF�ed} graade next to building (LAG)
g) Nigt�est adjsoeM (finished) g�de next to buildirsg (HAG)
h) Lowest ad}'acent grade at lowest elevation of deck or stairs, including stnic:tural support
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� faet ❑ meters
� feet ❑ meters
� feet � mete►s
SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a Iand surveyor, engineer, or architect authorized by law to cert'rfy elevation
infortnation. l ce�tify that the infom►ation on this Ceitificete roPres�ents my best effats to interpret the deta available.
I understarrd that any fatse stetement may be punishabte by frne or imprisonment ur�r 18 U. S. Code, Section f 001.
� Chedc here if comments are provided on badc of fortn. Were Iatitude and Iongitude in Section A provided by a
� Check here if attachments. licensed land surveyoi? � Yes ❑ No
Certifier's Name DAVID C. HAFLNER
Title LAND SURYEYOR
Address 9925 GULF BOULEVARD
Licenso Number 2650
Company Name DAVID C. HARNER
City TREASURE ISLAND Stete FL ZIP Code 33706
Signature ��.-�"' Date 12-22-14 Telephone 727-360-0636
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ELEVATION
2
IMPORTANT: in th�e spaces, copy the corr�ponding information from Section A.
Building Street Address (induding Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No.
941 &AY ESPLANADE
City CLEARWATER State FL ZIP Code 33767
fOR IIVSURANCE COMPANY USE
Policy N�xnber.
Company NAIC Number:
SECTION D- SURVEYOR, ENGiNEfR, OR ARCNITECT CERTIFICATION (CONTINUED)
C�y both sides of this Etevation Certificate for (1) communky oificial, (2) insuranoe agenticomparty, and (3) bufidirg owner.
Comme�ts C2e.�itVATER HEATER IN FRONT OF GARAGE. 21° FLOOR ELEVATION=15.1'. BENCHMARK ELEVATION=2.5951' ON CITY OF
CLEARWATER BENCHMARK #115, "J-03".
Signature � � � Date 12-22-14
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SECTION E- BUILDtNG ELEVATtON INFORMATION (SURVEY NOT REQUIRED) FOR ZOWE AO AND 20NE A(WITHOUT BFE}
For Zones AO and A(without BFE), axr►piete Items E1-E5. if the Certificate is intanded to suppoR a IOMA or LOMR-F request, complete Sectlons A, B,
arrd C. For Items Ei-E4, use natural grade, if availabb. Check the measurement used. In Puerto Rico o�ly, enter meters.
E1. Pravide elevatron i�Nortnation for tl�e following and check the appropriate boxes to show whether the etevation is above or below the higt�est adjacent
grade (HAG) and the lowest adjacent grade (IAG}.
a) Top of bottom floor (induding basement, crawispace, or end�ure) is ❑ feet ❑ meters ❑ above or � below the tiAG.
6) Top of bottom floor (inGuding basement, crawispace, or endosure) is ❑ feet ❑ meters ❑ abave or ❑ below the LAG.
E2. Fo� Building Diagrams 6-9 with permaneM flood openings provided in Sectio� A Items 8 and/o� 9(see pages 8-9 of Instrudions), the next higher floor
(elevation C2.b in the diagrams} of the building is ❑ feet ❑ rt�eters ❑ above or ❑ befow the HAG.
E3. Attached garage (top of siab) is � feet ❑ meters ❑ above or ❑ bebw the HAG.
E4. Top of piatfortn of machinery and/or equipment servicing the building is ❑ feet ❑ meters ❑ above or � below the HAG.
E5. 2one AO only: if no flood depth number is avaitable, � the top o# the bottan Noor elevatad in accorclanoe with the c�mmunity's floodpfain management
ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must oertify this ir�fortnation in Section G.
SECTION F- PRUPERTY OWNER (OR OWNER'S REPRESENTATlVE) CERTIFICATION
The property owner or owner's authorited representative who completea Sections A, B, and E for 2one A(without a FEMA-issuad or communky-issued BFE)
or 2one AO m�t sign here. The statemerKS in Sedfons A, B, and E are correct to the best of my knowledge.
Property Ovme�'s or Owners Authorized Representative's Name
address
Signatute
Comments
City
Date
State ZtP Code
Telaphone
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SECTION G - COMMUNITY INFORMATION (OPTIONAL)
1't�e ixal offiaa� vrho is authorized by law or ordinanoe to administer tt�e oar�mu�ity's floodpla�► management ordh�ance can compiete Se�ians A, B, C(or E), and G
of th� Elsvation CeRific�te. Compbte the a�lic;able item(s) and sign below. Chedc the measuremeM used 'm Items G8-G10. In Puerto Rico only, e�sr meters.
G1. ❑ The intormation in Section C was taken from other documentation tfiat has been signad and sealed by a lioensed surveyor, engineer, or architect who
is authorized by law to oeRity elevation infortnation. (lndicate the source and date of the elevetion data in the Comments area below.j
G2. ❑ A community official comp�ted Sec�ion E for a buiiding located in Zone A{vvithout a FEMA-issued or community-issued BFE) or Zone AO.
G3. ❑ The foliowing information (tte� C'r�1-G10) is providecf for c�mmunity floodplain managemerrt purposes.
G4. Pertnit Number G5. Date Permit iasued G6. Oate Certifcate Of CompliancefOccuPancy lasued
G7. This permit has been �ssued for. ❑ New Construdion ❑ Substantial lmprovement
G8. Elevation of as-built lo�st flaor (induding basement) of the building: ❑ feet
G9. BFE or (in Zone AO) depth of floodiag at the building ske: ❑ foet
G10. Communiry's design flood elevation:
Local Official's Name
Community Nama
Signature
❑ feet
Title
Telephone
Date
❑ metetg datum
❑ meters Datum
❑ meters Datum
Gomments
❑ Check here if attschrr�eMs.
I
���v,a�-ior� c��T���c�-��, ���� � �ui�ding Photo�ra��i��
�ee instructions far Item A6.
i�V11�CiRTA1V7: in these spaces, capy the correspondirtg i�ormation from Section A. FOR INSURANCE COMPANY USE
Buiiding Str�eet,4ddress (induding Apt.. UnR. Suite. arxllor Bldg. No.) or P.O. Ra�te and Box No. Policy Number:
941 BAY ESPLANAQE
�ity CLEARWATER State FL Z1P Code 33767 C�npany NAIC Nwnber.
!f using the Elevation Certificate to obtain NFIP flood irtsurance, affuc at least 2 twiFding photogcaphs below aocording to U�e instrudions
: for Item A6. Identify all photographs with date taken; `Front Vie�' and "Rear Y�'; and, if required, °Right Side V'�i and `Left Side
View.° When applicabie, photographs must show the foundation vvith represeniative e of tt�e fiood
xamples openirgs or �rents, as
indicated in Section A8. If submitting more Phorta9rapt►s th� wit{ fit on this page, use the Corrtirx�ation Page-
12-22-i 4
REAR VIEW FRONT VIEW
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