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1030 MANDALAY AVEPage 1 ot,4; not valid without all tour pages. � U.S. DEPAR7MENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT /�ENCY Naa�l Flood Insurunce Progr�t A1. A2. Building Street Address (including Apt, ELEVATION CERTIFlCATE IMPORTANT: Foilow the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION ar►d/or Bidg. No.) or P.O. Route and Box No. OMB No. 1660-0008 Expiration Date: July 31, 2015 FOR INSURANCE COMPANY USE Policy Number. %ulL ::.le CLEARWATER S�OeRIDA Z� 33767 A3. Property DescnpUon (Lot and Biock Numbers, Tax Parcei Number, Legai Descnpt�on, etc.) LOT 78 BLOCK 68_ MANDALAY. ACCORDING TO THE PLAT THERFnF aS REGORDED IN P�T BOOK 14 PA F'x� OF TH P B 1 R O� OF PIN 1 a OLIIifTY F� RIDA A4. Building Use {e.g., ResideMial, Non-ResideMial, Addition, Accessory, etc.)RESIDENTIAL A5. Latitude/Longitude: Lat.28 o010.2 N �p�,�2 49 32_1 W Horizontal Datum_ ❑ NAD 1927 � NAD 1983 A6. Attach at least 2 photographs of the buiiding if the Certificate is being used to obtain flood insurance. A7. Buiiding Diagam Number 1A A8. For a building with a crawispace or enclosure(s): A9. fvr a building with an attached garage: a) Square footage of crawlspace or enclosure(s) wA sq ft a b) Number of ) Square footage of attached garage N/A Sq ft permanent flood openings in the craurlspace b) Number of permanent flood o or enclosure(s) within 1.0 foot above adjacent grade 0 within 1.0 foot above �nings in the attached garage adjacerrt grade o c) Total net area of ftood openings in A8.b Q sq in c) Total net area of liood openings in A9.b � sq in d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No _ SECTION B- FLOOD INSURANCE RATE MAP (FlRM) INFORMATfON 64. 12103C - 0064 Name & B5. Suffix I 66. Name Date ( B7. FlRM Panel E� Revised Date �' �±��_. 68. Flood Zone(s) I B9_ Base Flood Elevation(s) AO, use base flood depl 11 & 12 B10. Indicate the source of the Base Flood Elevation (BF� data or base flood depth entered in Item 69: ❑ FIS Profile � FlRM ❑ Community Determined ❑ Other/Source: B11. Indicate el�ation datum used for BFE in item B9: ❑ NGVD 1929 �7 NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Othervvise Protected Area (OPA)? ❑ Yes � No Designation Date: / / ❑ CBRS ❑ OPA SECTION C- BUILDING� ELEVATION INFORMATION (SURVEI( REQUIRED) C1. Buiid'+ng elevations are based on: ❑ Conshuction Drawings* ❑ Building Under Construction* � Finished Construction *A new Eievation Certificate wili be required when construction of the buiiding 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 accordir� to the buiiding diagram specified in Item A7. In Puerto Rico oNy, enter meters. Benchmark Utilized: L-NET GPS NETVI�DRK :: Verticai Datum- NAVD 88 Indicate elevation datum used for the elev�ations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ OUier/Source- Datum used for buildin� elevations must be the same as that used for the BFE_ a) Top of bottom floor (inciuding baserr�nt, crawispace, or enclosure floor) b) Top of the next higher floor c) Bottom of the lowest horizor►tal sVuctural member (Y 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 Commerrts) � Lowest adjacent (finished) gade next to building (LAG) � Highest adjacent (finished) grade next to building {HAG) h} Lowest adjacent grade at lowest etevation of deck w stairs, including structural support d .�_ 5 .04 �U� . tira , -`� .� � .19 d _92 WA Check the measurement used. �] feet ❑ meters �J feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters p feet p meters SECTION D- SURVEYOR, EN6INEER, OR ARCHITECT CERTIFlCATION This certification is to be signed and sealed by a land surveyor engineer, or architec[ authorized by law to Certify elevation information. 1 certity that the information on this Certiiicate represems my Uest eflorts to interpreT ihe data avaJlable. ! understand that arry false statement may t� punishable by Sne w imprisonment untler 18 U.S. Code, Section 5001. C�RT � F�CqT� � Check here ff comments are provided on back of form. Were iatitude and longitude in Section A provided by a ❑ Check here if aCtachments. licensed land surveyor? ❑ Yes � No No. 6473 i � STATE OF ��ORI�% FEMA Form 086-0-33 (Revised 7/12) See reverse side for continuation. Replaces ail previous editions. (REV.2 1/14/2015) (REV.2 1/1d/2015) (REV.1 11111/2014) Page 2 ot„a; not valitl without all tour pages. FL1411.0528EC ELEVATION CERTIFlCATE, page 2 IMPORTANT: In these spaces, coPY the correspo�ding irtformation from Se�tioo A. Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Boz No. City State ZIP Code FOR INSURANCE COMPANY USE Policy Number: Comp�y NAIC Number. SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFlCATION (CONTINUED) Copy both sides of this Etevation Certificate for (1) community official, (2) insurance agent/comparry, and (3) building owner. Comments NOTE: C2.E = AC UNIT PAD. NOTE: THIS ELEVATION CERTIFICATE IS OWLY VALID FOR THE PERSON OR PERSONS NAMED ON THIS (:FRTIFICATF TNF INFl1RIutATIr11�i nR� Twc r��nnrnTE..GA�IBEUSEO.8YIHF (`ITY nF (`,j FdRWAjFg� RIf1A Ff1R PFRIu11TTIN1,/B,1 III niNl PURPOSES. ELEV. OF 12' X 22' SCREENED PATI0=4.98 NAVD 88. Signature Q /�� � pate ���4/20�5 ���� CENTERLINE ROAD ELEVATION� 2 99 SEC770N E- BUILDING ELEVATlON INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WtTHOUT BFE) For Zones AO and A(without BFE), complete Rems E1-E5. if the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B,and C_ For Rems E1-E4, use natural grade, if anrailabie. Check the rr�asurement used_ In Puerto Rico onry, enter meters_ E1. Provide eievation information for the following and check the apprapriate boxes to show whether Uie elevation is above or below the highest adjacent grade {HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawispace, or enclosure) is �. � feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is �ilA_ . � feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-9 with permanerrt flood openings provided in Section A ttems 8 and/or 9(see pages �9 of Instructions), the ne�ct higher floor (elevation C2.b in the diagrams) of the building is N�p � feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached g,arage (top of siab) is wA � feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of piatform of machinery and/or equipment servici�g the building is _d(6. � feet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO oniy: 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 REPRESENTATIV� CERTIFlCATION The properiy owner or owner's authorized representative who completes Sections A, B, and E for Zone A(writhout 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 Imowledge. Property Owner or Owner's Authorized Representative's Name Address Signature Commerrts City Date State ZIP Code Teiephone ❑ Check here if attachments. SECTION G - COMMUNITI( INFORMATION (OPTIONAL) The locai official who is authorized by law or ordinance to administer the community's ftoodplain managerr►errt 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 seaied by a iicensed 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 Bh� or Zone AO. G3. ❑ The foilowing information {items G4-G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit fssued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial ImprovemeM G8. Elevation of as-buift lowest floor (including basemeM) of ihe 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 Officiai's Name Community Name Signature Comments Title Telephone Date ❑ Check here ff attachments. FEMA Form 086-0-33 (Revised 7/12) Replaces alt previous editions. Page 3 ot,g; not valid without all tour pages. � ELEVATION CERTIFICATE, page 3 BUILDING PHOTOGRAPHS See Instructions for item A6. IMPORTANT: in these spaces, copy the corresponding irrtormation from Section A. Building Street Address (inciuding Apt., Unit, Suite, and/or Bidg. No.) or PO. Route and Box No. 1030 MANDALAY AVENUE City CLEARWATER State ZIP Code FL 33767 FL1411.0528EC FOR iNSURANCE COMPANY USE Policy Number: Comparry NAIC Number: If using the Elevation Certificate to obtain fVFIP 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 exampies 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. � y k ,.(�` ,��'/ri ¢�� - �;`'�`�, zv{: .4 � .� 3. � �: r� r�s.,� , 4 _ FRONT PROPERTY PICTURE 11/7J2014 "x� '� ���, 9 "�;, \�p� , ' ,; � 4' ° \ � ' .i r , ��! � r � � � � �II RIGHT PROPERTY PICTURE 11/7/2014 ` �'i�% �. - � s / ',7 r � A � � � �; �: � ,� , r u. . . �.: . _ REAR PROPERTY PICTURE 11/7/2014 �'. +r� ;� , �t .��. �� �R ` a�r.�.� � �1�' ,� ��' '� �,!" r� � �. � t °� , . ��,� ,�`. . � � �, � �. � � ;� ". � � A ���� � �� :��s.'^ �i.r . � � <�5�'��a*' �a ° � t �+� � ,.-. � . r �t",. � w• .''"° � ,y.. .. R„ � � � ,, . ,_ � . � « + �, N . q .�w. " .. ��� II I' �I'i, /'�� ��► �. �f� . � � � .� � � ) - � �� �� j [ � � .� . �,. � Y : � � +� �F!s �' �. `" , �;' - ... �'� � [ � . � :� � Y � _��� • � ���� � �- -� � ` � ,.t. �',�� � „�c��. � *� �!�►: . �, � �- _ . � . , �__. � R � s5 ' �' �„�r - _` _ �' - �i �.',�...� �, ��, ,:';"� _. . .d LEFT PROPERTY PICTURE 11/7/2014 FEMA Form 086-033 (Revised 7J12) Replaces all previous editions. Page 4 ot 4; not vaiid without all tour pages. '�ELEVATION CERTIFlCATE, page 4 BUILDING PHOTOGRAPHS Continuation Page FEMA Form 086-0-33 (Revised 7/12) Replaces all previous editions.