Loading...
526 MISSOURI AVE SU.S. DEPARTAAENT OF HOMELANO SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY National Flood lnsurance Program Important: Read the instructions on pages 1-9. - SECTION A - PROPERTY INFORMATION A1. Building Owner's Name HW PROPERTIES, LTD 15-78002 A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 526 S MISSOURI AVE City CLEARWATER State FL ZIP Code 33756 A3. Property Description (Lot and Blodc Numbers, Tax Parcel Number, Legal Description, etc.) PARCEL ID - 15-29-15-55062-002-0040 NOT FOR CONSTRUCTION, NOT FOR DESIGN � onng rvo. �ssa000s Expiration Date: July 31, 2015 FORiNSURANCE COMPANY USE Number. any NAIG Number. A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) COMMERCIAL A5. Latitude/Longftude: Lat. 27°57'34.9" Long. -82°47'16.1" Horizontal Datum: ❑ NAD 1927 X NAD 1983 A6. Attach at least 2 photographs of the building if the CeRificate is being used to obtain flood insurance. A7. Buifding 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 pertnanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or encbsure(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 X No d) Engineered flood openings? ❑ Yes X No SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number 82. County Name 63. State CITY OF CLEARWATER- 125096 PINELIAS FLORIDA B4. Map/Panel Number B5. Suffix B6. FIRM Index Date 67. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone 12103C-0108 H 05/17/2005 Effedive/Revised Date Zone(s) AO, use base flood depth) 05117/2005 X& UNNUM A N/A-SEE SECTION E B10. Indicate the source of the Base Fbod Elevation (BFE) data or base flood depth eniered in Item B9. ❑ FIS Profile X FIRM ❑ Community Determined ❑ OtherlSource: 611. Indicate etevation datum used for BFE in ltem B9: ❑ NGVD 1929 X NAVD 1988 ❑ OtheNSource: 612. Is the building located in a Coastal Barrier Resouroes System (CBRS) area or Otherwise Protected Area {OPA)? ❑ Yes X No Designation Date: ❑ CBRS ❑ OPA SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction* X Finished Construction `A new Etevation 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: AG 0454 Vertical Datum: NAVD 1988 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 X NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) b) Top of the next higher floor c) Bottom of the lowest horizontal strudural member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipmerrt servicing the building (Describe type of equipment and location i� Comments) � 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 dedc or stairs, including structural support 25.3 26.0 N/.A N/.A N/.A 25.2 25.8 Nl.A Check the measurement used. X feet ❑ meters XD feet ❑ meters X feet ❑ meters X feet ❑ meters X feet ❑ meters X feet ❑ meters X feet ❑ meters X 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 infom►ation on this Ce�cate represents my best efforts to interpret the data available. ,�� r� i, � 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 fortn. Were latitude and longitude in Section A provided by a 3�' �"� ❑ Check here if attachments. licensed land surveyor? � Yes ❑ No � � �'� ��� � . �Y °+€ �. t � ': Certifier's Name LELAND F. OySARD License Number 3859 J� _ , �s s s': � [' .> Title P.L.S. Company Name AEC. INC. � -- d��,1�� :�, ~ , � �� Address 3884 PRf�GRESS AVE- #104 City NAPLES State FL ZIP Code 34104 �'{� P',<, .�6^°° �,'` ` �` e��C3 � � ��,�+''ti a7F/q��p�"S9�'�� Signature FEMA�Form 086-0-33 (7/12) 01/20/2015 Telephone 239-403-1600 See reverse side for continuation. Replaces all previous editions. tLtVA 1 IVIV V,CK I Iti(:A 1 t, page z IMPOR7ANT: t� these spaces, copy the corresponding information from Section A. Building Street Address (inctuding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 526 S MISSOURf AVE , , City CLEARWATER State FLORIDR ZIP Code 33756 FOR INSURANCE COMRANY USE Policy Number. Gompany 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 GPS COORDINATES WERE TAKEN FROM GOOGLE EARTH. NOT FOR CONSTRUCTION, NOT FOR DESIGN. FLOOD ZONE DETERMINATION PROVIDED BY FLOOD INSIGNTS. THIS DATA WAS PREPARED FOR FLOOD INSURANCE PURPOSES ONLY.THE EQUIPMENT PADDDA E OF FHER�'RKS�L�,�/ / THS� PLUS OR MINUS PRECISION. ITEM LISTED IN C2(e) IS THE CONCRETE AIR CONDITIONING Signature� � � � � � Date 01/20/2015 S�CTION E— BUILDING ELEVATIUN INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(VYITHOUT 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, 'rf available. Check the measurement used. In Puerto Rico only, enter meters. E1. Provide elevation infortnation 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 enGosure) is 0.5 � feet ❑ meters ❑ above or � below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is 0.1 � 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 tJ./A ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platfortn of machinery and/or equipment servicing the building is N!A ❑ feet ❑ meters ❑ above or 0 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 infortnation in Section G. SECTION F— PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The properry owner or owner's authorized representative who completes Sections A, B, and E for Zone A(without a FEMA-issued or commun'dy-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 Owners or Owner's Authorized Representative's Name Address Signature Comments City Date State Telephone ZlP Code Chedc here if attachments. SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local offiaat 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. 0 The following information (Items G4—G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Pertnit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for. ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-buift lowest floor (inGuding basement) of the building: G9. BFE or (in Zone AO} depth of flooding at the building site: G10. Community's design flood elevation: Local Official's Name Community Name Signature Comments ❑ feet ❑ meters Datum ❑ feet ❑ meters Datum ❑ feet ❑ meters Datum Tftle Telephone Date ❑ Check here 'rf attachments. FEMA Form 086-0-33 (7/12) Replaces all previous editions. Ei.EVATION CERTIFICATE, page 3 Building 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. :,26 S MISSOURI AVE City CLEARWATER State FLOr�IDA ZIP Code 33756 FOR INSURANCE COMPANY USE Policy Number: Company NAIC Number: If using the Elevation Certificate to obtain NF�P flood insurance, a�x 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 01l20/2015 s � ! -���x F; � ; � �.� �° �� ����``, --- -- ,,���'�-„ i _,�� -- - ---- -� y i j ` -�- - -- � - - -- - --- �" --�''�.i -- �r �. n. �- . ` � � IL! . v � �i,+,' �'�'Y� .�-��-. x'�t't; �� : >.; REAR VIEW _ FRONT VIEW ;�}/2012015 � � � � � � � ,�� � �`; � � AR � �� ���" . .� . RIGHT SIDE VIEW 01/20/2015 i'�'� � � � y�" �% � � � i ., � / �-.,_�4wa,.�,e�,� � , ; . _� � �_ � �, _..., — � — � . _.. .. � , _ __ , � - - �/ �� , -- � ,� -- y.� _ . . r7 1 . �_.. _ _—' - v° �i I ' ..- . "" '.---`�^-.-..... "' � ' .. ., , - ,.:;. � . - _ . �_ ... ..v.r.� t�r ,,, . ,. �'r"''.' . �..._. �_ . � _.. ,.m ., :- ^ _ ��� "�y,,��',a"�F,r- �. . � � .. . � . . . ........... � _ � ° ! :� �^ � o -3„- � .c,:: �;� � . _ �,. ' �; �., �� . °� �:_ , ,. _.._ _� . _ �_ � z.. . �� .,� - � - � ��_ - � : �.,, .:_. _. . .. � „ � �r ._ : _ � �„ e � = ������ �� � � , � � �: _ > .�. ,�, ? � =j�, ,;.. • � .;� ���� �: � �, -���� � �._� � �,_ .�.�`. , ._ _ _ _a� _ _ _ _ � _ __ a ,._ � _ __ , „ w � __.� . FEMA Form 086-0-33 (7/12) Replaces all previous editions. i Y E�EVdTION 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, andlor Bldg. No.) or P.O. Route and Box No. �26 S MISSOURI AVE City CLEARWATER State FI.ORICA ZIP Code 33756 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 SIDE VIEW �:� . � �.. . � ��" ` % �� ��' � � �� � � t� a��'. � � � �� . �x � � .��,;'- & Fsa =: ;a� � � �� � �� . � �� �� � �� �, , x Y �, ,�,�' �i '� 1���� ``� � i. �.. � � �� �. . /� � �� "'�,��:� � �'��' �• �� ,: � � ¢ 1 /: # ,�= � _. "�p�`�r;•!5 � � �;w�, : v�< ��. FEMA Form OS6-0-33 (7/12) Replaces all previous editions.