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62 WINDWARD ISLAND RD1 U.S. UEPARTMENT OF HOMELAND SECURfTY FEDERAL EMERGENCY MANAGEMENT AGENCY National Fiood Insumnce Progmm A1. Buildin�Owner's Name JODYMA IE SUKASH (including Apt., Unit, ELEVATION CERTIFICATE IMPORTANT: Follow the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION ) or F0. Route and Box OMB No. 1660-0008 Expiration Date: luly 31, 2015 FOR INSURANCE COMPANY USE Policy Number: Compariy ��� CLEARWATER State F� ZIP Code 337672321 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.} PARCEL 09-29-15-43362-000-0070, LOT 7, ISLAND ESTATES OF CLEARWATER UNIT 4, PLAT BOOK 051, PAGE 032, PINELLAS COUNTY, FLORIDA A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 2�-9757 Long. -82•8�09 Horizontal Datum: ❑ NAD 1927 Ox 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 ONE-A A8. For a building with a crawispace 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 462 sq ft b) No. of permanent flood openings in the crawtspace or b) Number of permanent flood openings in the attached garage enclosure(s) within 1.0 foot above adjacent grade N�A within 1.0 foot above adjacent grade NA c) Total net area of flood openings in A8.b N�A sq in c) Totai net area of flood openings in A9.b N�p` sq in d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NFIP Communi�y Name & Communi Number CLEARWATER CITY O� 125096 B4. Map/Panel Number B5. Suffix 66. FlRM Index 12103C0106 08/18/2009 62. County Name pINELLAS Revised Date OS/17/2005 83. State FL B8. Flood Zone(s) I B9. Base Flood Elevation{s) (2 AO, use base flood depth} AE 11.0 FT B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69: ❑ RS Profile � FIRM ❑ Community Determined ❑ Other/Source: 611. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: 612. is the building located in a Coastal Barrier Resour�es 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(wiih 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: �PS Verticat Datum: NavD 1sa8 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: Datum used for buiidinE elevations must be the same as that used fnr tne R� a) Top of bottom floor (including basement, crawlspace, or enctosure floor) b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only} d) Attached garage (top of siab) 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) �owest adjacent grade at lowest elevation of deck or stairs, including structurai support Check the measurement used. 12.0 �feet ❑ meters NA � feet ❑ meters N!A � feet ❑ meters 11.3 � feet ❑ meters �Z-� �feet ❑meters 11_05 � feet ❑ meters 11-2 �feet ❑meters NA � 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 informaiion on this Certificate represents my best efforts to interprei the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Coole, Section 1001. �� �" �����, ❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ,��`�,� �� ��,,�r ❑ Check here if attachments. licensed land surveyor? � Yes ❑ No �` �� /1 �� . BILL H. HYATT, JR Title PRESIDENT Address 1497 MAIN STREET #321 Signature FEMA Form 086-0-33 (7/12) � Company Name KNOW IT NOW INC CiTy DUNEDIN Date 3-11-2015 I #4636 State ZIP Code Fl. 34698 Telephone (727) 415-8305 See reverse side for continuation. �r:�u �i{ I I.i)H(I>'� 3-11-1 Replaces ail previous editions. .ELEVA'iION CERTIFlCATE, page 2 IMPORTANT: In these spac�, copy the cortesponding informat'wn trom Section A. Buiiding Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or R0. Route and Box No. 62 WINDWARD ISLAND ROAD City Siate ZIP Code CLEARWATER FL 337672321 FOR INSURANCE COMPANY USE Policy Number: Company 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 CERTtFICATE IS NOT TO BE USED FOR CONSTRUCTION OR DESIGN, IS FOR FLOOD INSURANCE USE ONLY Signature Date 03/11/2015 SECTION E- BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND 20NE 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 informatian for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the �owest adjacent grade (LAG). a} Top of bottom floor (including basement, crawlspace, or enctosure) is . � feet ❑ meters � above or ❑ below ihe HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is . � feet ❑ meters � above or ❑ below ihe 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� . A � feet ❑ meters � above or ❑ below the HAG. E3. At[ached 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? Q 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 Oate Siate ZIP Code Telephone ❑ Check here if attachments. SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local officia� who is authorized try law or ordinance to administer the communitys floodplain management ordinance can complete Sectio�s 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, eriter 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 be�ow.) 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 Compiiance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-built lowest floor (inciuding 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 Comments Title CLEARWATER CITY OF Telephone Date ❑ Check here if attachments. FEMA Form 086-0-33 (7/12) Replaces all previous editions.