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819 BAY ESPLANADEU.S. DEPARTMBNT OF HOMELAND SECURITY FEDERISF'. EMERGENCY MANAGEMENT AGENCY Uv�ionaJ Flovd Insr�rnnce Program A1. Building Owner's Name JOHN & ELEVATION CERTlFICATE Important: Read the instructiu;�s on pages 1-9. SECTION A - PROPERT'd INFORMATION A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg No.j or P.O F2o�_�t� and Box No. 819 BAY ESPLANADE City CLEARWATER BEACH State FL '_fP Code 34689 A3. Property Description (Lot and Block Numbers, Tax Parcel Number. Legal Descripti m etc.) LOT 5, BLOCK 33, MANDALAY SUB, PUBLIC RECORDS OF PINELLAS COUNTY Fi._ORIDA. OMB No. 1660-0008 Expiration Date: July 31, 2015 FOR INSURANCE COMPANY USE Policy Number: ber: A4. Buiiding Use (e.g., Residentiai, Non-Residential, Addition, Accessory. etc i RESiCE�NTIAL A5. Latitude/Longitude: Lat. 27'-59'-39.6" Long. -82*- 49'-25.4 Horizontal Datum: ❑ NAD 1927 � NAD 1983 A6. Attach at least 2 photographs of the buiiding if the Certificate is being used to o,^tai � fiood insurance. A7. Building Diagram Number 1_A A8. For a buiiding with a crawispace or enGosure(s): �9 For a building with an attached garage: a} Square footage of crawispace or enclosure(s) NiA sq ft a) Square footage of attached garage 500 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 NiA within 1.0 foot above adjacent grade �/A c) Total net area of flood openings in AB.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 PINELLAS COUNTY 12103C PINELLAS COUNTY 64. Map/Panel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel 12103C/0102 G 09/03l03 Effective!Revised Date d8r 1 _R,+09 B3. State FLORI DA 68. Flood I 69 Base Flood Elevation(s) (Zone Zone(s) AO, use base flood depth) "AE " 11' NAVD 88 B10. Indicate the source of the Base Fiood Elevation (BFE) data or base flood depth ent?red in Item B9. ❑ FIS ?rofile � FIRM ❑ Community Determined ❑ Oiher/Source: Countv Enaineer 811. �ndicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ OtherlSource: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Ctherwise Protected Area (OPA)? Designation Date: N/A ❑ CBRS j] OPA ❑ Yes � No SECTION C- BUILDING ELEVATtON INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings` ❑ Buiiding Under Construction" � Finished Construction *A new Elevation Certificate will be required when construction of the building is ccamplete. C2. Elevations -Zones A1-A30, AE, AH, A(with BFE), VE, V1-V30, V(�vith 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, enier meters. Benchmark Utilized: F�3 Vertical Datum: Pd,4\�D 88 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NG'VD 1929 � NAVD 1988 ❑ OtheNSource: Datum used for buiiding elevations must be the same as that used for the BFE. a) Top of bottom floor (including basement, crawlspace, or enclosure flaor) 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 iocation in Comments) Check the measurement used. 06.35 � feet ❑ meters 15.45 � feet ❑ meters N/A. � feet ❑ meters 05.81 � feet ❑ meters 09.62 � feet ❑ meters f) Lowest adjacent (finished) grade next to building (LAG) 05.5 g) Highest adjacent (finished) grade next to building (HAG) 05.8 h) Lowest adjacent grade at lowest elevation of deck or stairs, including structurai �upport N/A. � feet ❑ meters � feet ❑ meters � feet ❑ meters SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION Tnis certification is to be signed and sealed by a land surveyor, engineer, or arohitect auchonzed by law to certify elevation information. 1 certify that the information on this Certificate represents rny best efforts *o mterpret the data available. 1 understand that any false statement may be punishabJe by fine or imprisonment unUer � 8 U. S. Code, Section 1001. � Check here if comments are provided on back of form. Were fatitude and lengrtude in Section A provided by a ❑ Check here if attachments. licensed land surveyor? � Yes ❑ No Certifier's Name MOHAMMAD B. FAR Title Prof.Land Surveyor Address 81.��'�IF�DbWVIEW PLACE Signature ,�,.«,,,/ : , ° :��.�. ;. � f. FEMA Form 086-0-33 (7112) Lc�r�s�;=. Number 5545 Company Name MOHAMMAD 6. FAR City TRINIIY State °=L ZIP Code 34655 Date 01/26/15 Telephone 727-375-1740 See reverse side for continuation. , ,... , .,...ti,� ����MMAD @. �'•�, ;'��t.�,G�P` i F t����.99 �5 /��No. 5545 ��d �: �t � � . STATE OF - Q � � F` '. '�(OAiDP .' �Pc�„ 6 • 9 ' .�`' �� SURVEV OPN,.o,?, �n�V+1u��N+N Replaces all previous editions. ELE�/ATION CERTIFICA' IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt., Unit, Suite, andlor Bldg. No.) or P O. Route a+�,a 3ox No. 819 BAY ESPLANADE _ _._. City CLEARWATER BEACH State FL �!P Code 33767 FOR INSURANCE COMPANY USE Policy Number: Company NAIC Number. SECTION D— SURVEYOR, ENGINEER, OR ARCNITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance aqe� Ucompany, and (3) buiiding owner. Comments A/C = AIR CONDITIONING �i�% 8' Date C'ii26/15 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 intende� 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',c �how 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 ages 8-9 of Instrucdons), the next higher floor (elevation C2.b in the diagrams) of the buiiding 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 andlor 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 ❑ Unkno�m. The local o�ciai 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 hest 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 foliowing information (Items G4—G10j is provided for community floodplain rnanagement purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued f G7. This permit has been issued for. ❑ New Construction ❑ Substantiai I+nprovement 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 Titie Telephone �atr .__ ❑ Check here if attachments. FEMA Form 086-0-33 (7112) � Repiaces all previous editions. ELEVATION CERTIFICATE, page 3 guilding Photographs See Instructions for ttem A6. IMPORTANT: In Lhese 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. 819 BAY ESPLANADE City CLEARWATER BEACH 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. FRONT VIEW 01 /26/15 � �. � �� � � �, � � ' ; �y� - w � � � � � � �., : , ���< ` ��; ��� _���_ REAR VIEW 01 /26/15 ��� ��.�. � � � � �' - � � ` � � f '�� -���;� '"�°� �,.. � � � � �� � � ���:;� , �' ' ��. , : � �h • .»�.�.. � : ��°. �. _ " �� ����. .,:� : *` �,� .. m � .. FEMA Form 086-0-33 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 4 guilding Photographs Continuation Page 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. 819 BAY ESPLANADE City CLEARWATER BEACH State FL ZIP Code 33767 FOR INSURANCE COMPANY USE Policy Number: Company NAIC Number: If submitting more photographs than will fit on the preceding page, affix the additional photographs below. 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. LEFT VIEW 01/26/15 � , : ���� , , � f`��� �� � �' .'� � � � � , � 3 �_�t � .�''� s . . RIGHT VIEW 01/26/15 ��� x ��: � �'.<'�"'. �`" � `� � � y��f�. � � ��� �� , �'` � � � ; ° � .�. � ��. � Y� . .��'r � � ��;�� d � , .�-. � �� ` ' ���,� �. �� ;� * ;_ _ �`� �'ar'� FEMA Form 086-0-33 (7/12) Replaces all previous editions.