1530 ROSEWOOD STUS. DEPARTMENT OF HOMEWND SECURITY ELEVATiON CERTIFICATE OMB No. 5660-0008
FEDERAL EMERGENCY MANAG,EMENT AGENCY • �
x°naml Fbod � AnB� IMPORTANT: Follow the instructions on pages 1-9. fXP►ration DBte: July 31, 2015
SECTION A— PROPERTY INFORMATION k
� �
Ai. Building oamer�s Name R�rt q, and Paulette J. Keller � ,� � ��* *
-.+3'P.es.,��-� >t�'`,t�'� n�,�, z��r,� 5� { y: � .
A 2. �i ldin Street Address (includin /�t., Unit, Suite, and/a 81d�. No.) or?.0. Route and Box No. - '""
1 �30 Rosewood Str+� , ;
�m' Clearwater state �� - � , ..,.t� �� � ����rr�:
Z►P Code �3755
A3. Pro�rty Description (Lot and Block Numbers, Tax Parcei Number, Legal Descriptfon, etc.)
Lots 133 and 134 - Glenwood - Plat Bc�ok 8, .P 14
g ( ntial, Non-Residential, Addition, Accessory, et�.) B�SIdBntial
A5. Latitude/LongitudeRJ..at. ?,T B�Bg°At ._ Long. �2Ti35°IN Horiaontel Datum: ❑ WAD 1927 :� 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 1-A •
A8. For a building with a crawlspace or enclosure(s). " A9. For a buildir�g with an;attached,garage: °�
a) Sq�re �foote�ge of crawispace a� encia�ure(s) WA � • ' ,=,�
� s�l ft a) 5quare footage of attached garage 576 �q �
b) Number of pertnanent flootl openings in the crawlspace wA b) Nuinber of permaner►t flood openings in the attached gar e
or enclosure(s) within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade ���, �
c) Total net area of flood openings in A8.b �A sq in c) Total net area of flood openings in A9.b 1WA s in
tl) ErtgineeretJ flood openings? ❑ Yes � No
Q
d) Engineered flood openings? ❑ Yes � No
SECTIbN 6— FLOOD INSURANCE RATE MAP (FlRM) INFORMATION
61. NFlP Canmunity Name & Communiiy Number B2�. C� Name B3. StaYe
Clearwater -1250�J6 FMrida
84. Map/Pane! Number B5. Suifix , B6, FlRM index Date 67. F1RM Panel Effective/ B8. flood Zone(s) B9. Base Rood Elevatiorr(s) (Zone
Revised Date A0, use base flood depth)
05J17/2005 09✓03r2003 X N01JE
B10. ndira�te�the�urce of the Ba e Flood Elevation (BF� data or base flood depth entered in item B9:
�] FlS Profile � FlRM � Community Determined � Other/5ource:
B11. Indicate elevation datum used for BFE in ftem 89: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source:
Si2:is tFie bulding located in a Coast� Barrier iiesources.System (GBRS).area ,ar Othe►wise Protected Area {OP/►)? �] Yes � No ".'
l3es+gnation Dete: % J � CBf2S � OPA " . ._
_SECTION C— BlNLDING ELEVATI�1 INFQRMATiWU (SURVEY REQUIRm)
C1. Buiiding elevations are based on: Q Construction Drawings* ❑ Building Under Construction* � Finished Construction
*A new Elevafian Ce�ificate will be required when construction ofthe building is complete.
C2. Elevations — Zones A1—A30, AE, AH, A.(with 8FE). VE, V1—V30, V(with BF�, AR,-AR/A, AR/AE, AR/Ai—A30, AR/AH, AR/AO. Complete Items
C2.a—h below according to the buHding diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilizea: C� NIaD #1491 f$r+eeze ln Vertical Datum: NAW -1 �8
Indicats elevation datum used for the elsvations in items a) through h) below. �_NGVD 1929 � NAVD 1988 ❑ Other/Source:
Datum used for building efevations must be the same as that used for the BFE.
" Check the measurement used.
a) . Top of bottom.floor iincluding basement, crawl�ace, or enclosure �acarl � �._ � � feet L� mekers
b) ToP of the next higher floor . "= ; _ ' " ;,`�, g4 " � feet meters _ _ __
�... _ .�.... _ _. . . ._ _ . � ._ ..� __. _ . p._..m, ._ ._
._ _ _. . . ... __.._ . .� _
_, c) E3ottom of the lowest horizontal structliral membec (W Zones ,only) N, A�� _-- � ieet ❑,meters
°- �) Atta�hed garage (top of slab) , � . `�� ��feet �'meters
,,+e) t�we� elev�tion ofi machinery'-or EQuiprn�►#-5etvicing the building ,;,�7 . 43 � f�et ❑ meters
(L�SCiibe 1Ype �f r�uFpment and location in Commerrts)
fl Lowest �a8jacerrt (finishe� grade next to building (LAG) �. 90 .
� feet ❑ meters
� Highest adjacent (finished) grade next to tiuiiding "(HA�) _� ;$0 � f� ���
h) Lowest a�aaent grade at fowes� elevatioii ofdeck or stairs; including N_ A_ � feet ❑ meters ,_.' �
structural support -
, t`►. �:�, �� � � -�
SECT101� D— SURVEYOR, ENii1NEER, OR AR�HITECT CERTIFlCATION
This certification is to be signed and sealed by a iand surveyor, engineer, or architect authonzed by 1aw to certify el�ation
ir�fomiation: 1 certlfy that the inforination on ti�Is Certificafe represents rriy b�i efforts io fnferpret the data avatlable.
i�+'►�"� � f�e staYe�►►E'�i�may be'Punisl►able by fine or imprisonment vnder 18 U.S. Code, Sec[ion 1001. �
. _ . __ . ._
[it� Cfieck here if"commenis are provided on back ofi forrn. Were latitude a�d longitude in Section A provided by a
Q Check here if attachments. Iicensed IarM surveyor? � Yes ❑ No
Certifier's Name _ � c�e,n�se Number _
dohn a _ .. _ . _ . ..
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Brendla arrd Associates, Inc. � \
P� _ � e zIP code
_ 33781
05J27f2015 . _ _
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tMA rm ��tte�a33 (Revisgd 7/12) : �- - " �� See reverse side�torcorrtinuation. � � �� - �� �� � ep1,_ �s a11.pr�evious.ediUOns,
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ELEVATION CERTIFlCATE, page 2 ' ,
IMPORTANT: tn these spaces.topy the correspondi� information lrom Section A.
Building Street Address (ineluding Apt:; Unit, Suite, and/or 81dg. No.) or P.O. Route and Box No.
�m, State ZIP Code -'
SURVEYOR EN(i1NEER, OR ARCHITECT CERTIFlCATION CON71N � r�� �� A`, ���� � r� �� �
CleanKater r� ° . ,
SECTION D — � . � UEp) ._ � ,
�
Copy both sides of tfiis Flevation Certificate for (1) community official. (2) insurance agent/company, and (3) building owner.
Comments � e. A!C Pad il _
ouse v. -�Mi Room Elev. at 57.49'
1� E. 73.3i5' N�W adjusted to Elev. 72.55' NAVD - MSL =
�� r �ate �7/2015
�
SE 0�-— B G E ATI iNFDRMATION (SURVEY NOT-REQUIRED) FOR ZOMf AO AND ZONE A(WITHOUT BFE)
r Zone 'AO and A(wFthout BFE), compiete ftems E1-E5. tf the Certificate is intended to�upport a LOMA or LOMR-F request, complete 5ections A, B,and C.
r Items E1-E4, use natural grade, ff availabfe. Check the measurement used. In Puerto Rico only, enter meters.
E1. Provide elevaUon i�formation for the fdlowing and check the appropriate boxes to show whether the -elevation is above or below the highest adjacent
grade (H,4G) and the lowest adjacent grade (LAG).
ieet meters. ❑ above or ❑ below the HAG.
aj Top of bottom floor (including besement, crawispace, or enclosure) is --.— .., � �
b) Top of bottom floor (including basemerrt, crawlspace; or enclosure) is . ❑ feet � meters � abbve or` ❑ betow the LAG.
E2. For Building Oiagrams 6-9 with permanent flood openings provided in Section A l[ems 8 and/or 9(see pages 8-9 of InsVUCtbonsi,_
the next higfier floor (elevation C2.b in the diagrams) of the building is . ❑ feet � meters ❑ above or ❑ betow the HAG.
E3. Attached garage (top ofi siab) is . ❑ feet � meters ❑ above or ❑ below the HAG.
E4. Top of ptatfw►n �of machinery arni/or squipmerit servicing the building is . : � feet � meters ❑ abwe or ❑ below the HAG.
E5. Zone AO only: If no flood depth number is available, is the top of tMe bottom floor elevated in accordance with the community's flondplai� management
ordinance? � Yes ❑ No � Unknown. The local official must cert*fy this information in Section G.
'SEC710N F— PR�DP'ERTY OWNER {O'R OWNER'S'REPRESENTATIVE) CERTIFlCATIOPI
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 BFEj or
... _
Zone Ab=must sign here. The statements �n,.Sectiaas A, 8. and,� are cpRect.to tjae best of my knawFe�e-.
property Owner orOvmer"s Authorized Represerrtative's Name "'
Address City State ZIP Code
Signature
Date Tslephone
Comments ,
❑ Check here if attachments.
al officiai who is authwized �C�,�� ����MUNiTY INFORMATION tOPT10NAL) -
The loc by law or ar8ihance to admini�ter the community's floodpiain management ordinance can comPtete SecUons A, 8, C(or �, and
G of ttiis Elevation Certificate. Comdete the applicable item(s) 8tad sign below. Check the measurement used in ftems G8--G10.1� Puertn Rico onN e�ter meters.
G1. ❑ The information in Sec�ion G was tait�n from other docur»�tation that has been signed and seated by a li�ensed �rveyor, engine�r, w architect
who is authorized by !aw fo certify elevation infonnation. (Indicate the source and date of ihe elevation data ►n the 6omments area below.)
G2. ❑ A community officiai completed Sectic� E for a building loc'ated in Zone A(without a FEMMssued or comm�nity-issued BFE) or Zone AO.
G3. ❑ The followi�g informatian (Items G4-G10) is prwided-for community floodplain management purposes.
G4. � Pertnit Number .' G5. Date Pertnit lssued G6. Date Certificate Of Compiiance/OcCUpancy �ssued
. _ _... .. _
��. T�►is permit has been issued far: {] New Constructiori Q Substantial Improvement �
Gt3. Elevation of asbuilt iowest floor (inclutling 6asem�nt).of.the builtling: . Cl feet �❑.meters Daturx� ----�
�,9. gF� or {in �one A�}} depth o# flooding at the building 5ite: ❑ feei '❑ meters ' batum
,i6ip, Communiiy'� d8sigw ,flood elevation: � teeY �1 rr�ters Datum _
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;< OfflciaPs Name . '' � TiUe
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CommuhiLy Na1r� _ _ Telephone
Date _ .
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Gommerrts , ,, _
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_ . � Checic here 'rf attachment5�
FEMA Form 086-a33 (Revised 7/12) Replaces all previous editions.