920 MANDALAY AVEU.S.DEPARTMENTOFHOMELANDSECURITY ELEVATION CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AGENCY
Nac�o„a�F�ooa�,�ura„���.o�-am Important: Read the instructions on pages 1-9.
SECTION A - PROPERTY INFORMATION
A1. Bwlding Owner's Name Brian Ackerman, George Ackerman
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
920 Mandalay Avenue
OMB No. 1660-0008
Expires Auqust 31. 2015
For Insurance Company Use:
Policy Number
Company NAIC Number
1 �
City: Clearwater Beach State FL ZIP Code: 33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Mandalay Subdivision, Lot 10, Block 51, PB 14/32-35 parcel # OS-29-54666-051-0100
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Residential
A5. Latitude/Longitude: Lat. 27 59 55.20 N Long. 82 49 37.09 W Horizontal Datum: ❑ NAD 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 1A
A8. For a building with a crawl space or enclosure(s), provide A9. For a building with an attached garage, provide:
a) Square footage of crawl space or enclosure(s) 0 sq ft a) Square footage of attached garage 290 sq ft
b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage
enclosure(s) walls within 1.0 foot above adjacent grade 0 walls within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b 0 sq in c) Total net area of flood openings in A9.b 0 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 62. County Name 63. State
City of Clearwater 125096 Pinellas FL
B4. Map/Panel Number
121
B5. Suffix 66. FIRM Index Date B7. FIRM Panel Effective/Revised B8. Flood Zone(s) B9.
Date
G 9/3/2003 9/3/2003 AE
610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9.
❑ FIS Profile � FIRM ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other (Describe)
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑Yes
Designation Date / / ❑ CBRS ❑ OPA
� Flood Elevation(s) (Zone
use base flood depth)
12'
�No
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(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. Use the same datum as the BFE. In Puerto Rico only, enter meters.
Benchmark Utilized: County Datum Vertical Datum: NAVD
Indicate elevation datum used for elections in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source:
Datum used for building elevations must be the same as that used for BFE.
a) Top of bottom floor (including basement, crawl space, or enclosure floor)_
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 in Comments)
f) Lowest adjacent (finished) grade (LAG)
g) Highest adjacent (finished) grade (HAG)
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
structural support
Check the measurement used.
5.91 � feet ❑ meters
N/A ❑ feet ❑ meters
N/A ❑ feet ❑ meters
5_2 � feet ❑ meters
6_t � feet ❑ meters
5_0 � feet ❑ meters
5_1 � feet ❑ meters
N/A ❑ 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 information on this Certificate represents my best efforts to interpret the data available.
I understand that any lalse statement may be punishable by fine or imprisonment under 18 U. S. Code, Section f 001.
� Check here if comments are provided on back of form
Check here if attachments.
Certifier's Name Patrick K. Ireland
Title
Address
�;
Signature '' ` �` � '`'�`�`"�'�
& Mapper
Were latitude and longitude in Section A provided by a
licensed land surveyor? ❑Yes �No
ILicense Number 6637
r Name Ireland & Associates Survevino. Inc.
Date 4/11/16 � Telephone 407-678-3366
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FEMA Form 086-0-33 (7/12) See reverse side for continuation. Replaces all previous editions
IMPORTANT: In these spaces, copy the corresponding information from Section A.
Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No.
City: Clearwafer Beach State FL ZIP Code: 33767
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 Lowest Machinery= A/C Pad
,`j j + /, a
;`:"..1;.�,�,>. ��,, y,�r�,,_�r
Signature
Date 4/11/16
❑ Check here if attachments
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 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 information 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, crawl space, or enclosure) is ❑ feet ❑ meters ❑ above or � below the HAG.
b) Top of bottom floor (including basement, crawl space, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items S and/or 9(see page 8 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 ❑ 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? 0 Yes
❑ No ❑ Unknown. The local official 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, 8, and E are correct to the best 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. and G9.
G1. ❑
G2. ❑
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.)
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 following information (Items G4.-G9.) is provided for community floodplain management purposes.
G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued
G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement
G8. Elevation of as-built lowest floor (including basement) of the building: 0 feet ❑ meters (PR) Datum
G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters (PR) Datum
G10. Community's design flood elevation
Local Official's Name
Community Name
Signature
Comments
FEMA Form 086-0-33 (7/12)
❑ feet ❑ meters (PR) Datum
Title
Telephone
Date
Check here if attachments
Replaces all previous editions
ELEVATION CERTIFICATE, page 3
IMPORTANT: In these spa
Buiiding Street Address (
920 Mandalay Avenue
City: Clearwater Beach
Building Photographs
Continuation Pa e
the corresponding infortnation from Section A
Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
FL ZIP Code: 33767
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." W hen applicable, photographs must show the foundation with representative
examples of flood openings or vents, as indicated in Section A8.
Front View 4/11/16
FEMA Form 086-0-33 (7/12) Replaces all previous editions.
ELEVATION CERTIFICATE, page 4
Building Street Address (i
920 Mandalay Avenue
City: Clearwater Beach
Building Photographs
Continuation Page
the corresponding infortnation from Section A
Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
State FL ZIP Code: 33767
��v
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 Viev�' and "Left Side View." W hen applicable, photographs must show the foundation with representative examples
of flood openings or vents, as indicated in Section A8.
Rear View 4/11/16
FEMA Form 086-0-33 (7/12) Replaces all previous editions
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Page 1 of 2 in order 81331
File number: 7996160069
Client: SUNBELT TITLE CLEARWATER BEACH
Lender: THE MORTGAGE FIRM
Buyer: BRIAN ACKERMAN, GEORGE ACKERMAN
Seller: AMY BELANGER
Completed: 4/12/2016
Surveyed: 4/8/2016
Premises: 920 MANDALAY AVENUE , CLEARWATER BEACH, FLORIDA 33767 PINELLAS
Description of encroachments, violations or other points of interest at the time of the inspection:
NONE VISIBLE
CERTIFIED TO: SUNBELT TITLE AGENCY, THE MORTGAGE FIRM, BRIAN ACKERMAN, GEORGE ACKERMAN, TITLE RESOURCES GUARANTY
COMPANY
LEGALDESCRIPTION: LOT 'IO, BLOCK 51 MANDALAY SUBDIVISION ACCORDING TO THE PLAT THEREOF, AS
RECORDED IN PLAT BOOK 14, PAGE 32-35 OF THE PUBLIC RECORDS OF PINELLAS
COUNTY, FLORIDA.
1 4/12/2016
TRUELINE TECHNOLOGIES LLC: THE FOLLOWING PRODUCT HAS BEEN COMPLETED BY THE STATE LICENSED LAND SURVEYING FIRM AS INDICATED ON THE FOLLOWING PAGE. TRUELINE
TECHNOLOGIES LLC PROVIDES THE DIGITAL TRANSMISSION AND ARCHIVING OF THE PRODUCT, AND IS NOT INVOLVED IN ANY FACET OF THE TECHNICAL FIELD WORK PERFORMED AND MAKES
NO WARRANTIES AS TO THE ACCURACY OF SUCH WORK. ALL TRANSMISSIONS OF THE PRODUCT ARE VIA A SECURE'SHA-t' SECURE HASH MESSAGE DIGEST AUTHENTICATION CODE WITHIN ITS
SIGNATURE FILE. A MANUALLY SIGNED AND SEALED LOG OF THIS SURVEY'S SIGNATURE FILE IS KEPT ON FILE AT THE PERFORMING SURVEYORS OFFICE.
PRINTING PROCEDURES: BECAUSE THIS FILE HAS BEEN SENT ELECTRONICALLY, IT IS IMPERATIVE THAT THE PRINT SETTINGS BE CORRECT IN ORDER TO DEPICT AN ACCURATE
REPRESENTATION OF THIS DOCUMENT ON PAPER. INSTRUCTIONS: WHILE VIEWING THE PRODUCT IN ADOBE READER, SELECT PRINT UNDER THE FILE TAB. SELECT COLOR PRINTER. UNDER
PRINT R,4NGE - SELECT ALL. UNDER PAGE HANDLING, SELECT NONE FOR PAGE SCALING AND UNCHECK AUTO ROTATE AND CENTER. CHOOSE PAPER SOURCE BY PDF SIZE. CLICK PRINT.
Boundary
Survey
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J
LOT 2 z �
BLOCK 51 "
o Fnd. 4"x4" CM
_ � 0.3'E No Identification
Ireland & Associates Surveying, Inc.
1301 S. International Parkway Suite 2001
Lake Mary, Florida 32746
Office-407.678.3366 Fax-407.320.8165
LOT 9 BLOCK 51
U
��gg�� S87°14'17"E (C) 110.00' (P) � � �
IN^�
S87°14'17"E 110.05' (M) Fnd. 1°�p � N M;r
No Identification � N o
Page 2 of 2
� Block Corner
NE Corner
a Lot 6 Block 51
0
Fnd. 4"x4" CM
N No Ident'rfication
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�� N � N:::i•:: • ...... .... 30.3' in ,' N�" m° � y m
o z� o ::�::::�::�: Residence # 920 :<;::_ s o` N M W �
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.... . �.
� � i Conc �.::�::::::::::.�::.�::::::._:.� ::.........:::.�::: ::::.�:::::: :::•. Dn�eway R. o� N a a � �¢
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ai Set ��2 � a n Q I o
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" � & Cap „�B 623„ �. I
o Wood Also
Light Pole N . 8 a I
F�tl. 5/g" Rebar .
M(3.32P "�B 694�� . a .
a
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- —=- �_ _ EL_D pRq pO ,
� JESSAMIN RCLEl��� �FIELD) a `Q> . . � a �e I
R= 1002.67 (P) lso' Platied P�blic �P� �_ a
Delta= 04°34'22" (C) (AsPhalt Road)r of way� �� ' — � ; � E�
L= 80.02' (C) R= 40.00' (C) �;` a I
Chord Bearing= Delta= 46°20'44" (C) � � _ \ <S. �e ,
N81 °23'25"W (C) 80.00' (P) L = 32.36' (C) ' -� � `
Chord Bearing=
S77°43'23"W 31.48' (C)
Flood Zone: AE Community Number: 12103C Panel: 0102G Date: 09/03/2003
Graphic Scale
o� �o� 20� ao�
Scale: 1 "=20'
LEGAL DESCRIPTION: LOT 10, BLOCK 51, MANDALAY SUBDIVSION, ACCORDING TO THE MAP OR PLAT THEREOF AS Field Date:
RECORDED IN PLAT BOOK 14, PAGES 32-35 , OF THE PUBLIC RECORDS OF PINELLAS COUNTY, FLORIDA. 04/08/2016
-Legend-
C - Calculated
� - Centedine
Ce - Concrete Block
CM - Concrete Manument
Conc. - Concrete
D - Description
DE - �rainage Easement
Esmt - Easement
F.E.M.A. - Federel Emergency
Management Agency
FFE - Finished Floor Elevation
FH - Fire Hydrant
Fnd. -found
IP - Iron Pipe
L - Length (Arc)
M - Measured
N&D - Nail & Disk
N.R. - Non-Radial
ORB - Offcial Recortls Book
P - Plat
P.B. - Plat Book
- - Wood Fence -JUrv2y IVOi2S-
ac - Point of Curvamre >Survey is Based upon the Legal Description Supplied by Client.
P9 Pa9e >Abuttin Pro erties Deeds have NOT been Researched for Gaps, Ovedaps, and/or
PI - Point of Intersection Hiatus9 P
P.O.B. - Point of Beginning
P.O.L - Point on Line >Subject to any Easements and/or ResMctions of Record.
PP - Power Pole
PRM - Permanent Reference 'Bearing Basis shown hereon, is Assumed and Based upon the Line denoted with "BB".
Monument >Building Ties are NOT to be used to reconstruct Property Lines.
PT - Point of Tangency
R - Ratlius >Fence Ownership is NOT determined.
Rad. - Radial
R&C - Rebar & Cap >Roof Overhangs, Underground Utilities and/or Footers have NOT been located UNLES:
Rec. - Recovered otherwise noted.
Rftl. - Rooted >Septic Tanks and/or Drainfield locations are a roximate and MUST be verrfied b
Set - Set %" Rebar 8 PP Y
Reear Cap ^LB 76za^ appropriate Utility Location Companies.
Typ. - rypicai >Use of This Survey for Purposes other than Intended, Without Wntten Venfica[ion,
UE - Utillty Easement will be at the Users Sole Risk and Without Liability to the Surveyor. Nothing hereon
WM - Water Meter shall be Construed to Give ANY Rights or Benefits to Anyone Other than those Certified
A - Delta (Central Angle)
-X- - Cnain Link Fence >This Survey is NOT Full and Complete without the attached Survey Report- Page 1 of 2
I hereby Certify [hat this Baundary Survey of the above Descnbed Property
is True and Correct to the Best of my Knowletlge and Belief as recently
Surveyetl under my Direction on Ihe Date Shown, Basetl on IMOrmation
Furnished to Me as Noted and Conforms to the Stantlards of Prectice for
Lantl Surveying in the State of Floritla in acmrtlance with Chapter SJ-17A52
Florida Administretive Cotles, P rsuant to Section 472.027 Flonda Statutes.
QP�(�� KFiRFF .
9 6
p : NO. FOR
STAT�F. THE
� FIRM
Patrick K. I � cJ'`<oa�op 637 LB 7623
�ANO SUR��+ Date Signed: 04-12-16
This Survey is intende or the use of Said Certifed Parties.
This Survey NOT VALID UNLESS Signed antl Embossed with Surveyor's Seal.
File No. IS-27522
CA�D File: \Scott's�c\IrelantlAssaiateslMANDALAY SUBDIVISION 1547522.dwo �
��
� SUN�E�.T
� T t T L E A G E N C Y
110 Island Way, Suite B, Clearwater, FL 33767 • Phone (727) 442-2536 • Fax (303) 876-4686
Survey Disclosure Cover Letter
April 19, 2016
To: The Mortgage Firm
Amy M. Belanger
Ann Marie Krzesinski
Brian Ackerman, George Ackerman
Maryann Spearman
Property Address: 920 Mandalay Avenue Clearwater Beach, FL 33767
Seller: Amy M. Belanger
Buyer: Brian Ackerman, George Ackerman
File Number: 7996160069
Number of Pages: 1 page, including this cover page
To Whom It May Concern:
Attached for your review is the survey for above described property. Upon preliminary review the following
encroachment(s) and/or issue(s) exist:
a. If a fence is disclosed/drawn on the survey, Sunbelt Title Agency and Title Resources Guaranty Company
do not determine ownership of the fence, the fence will appear as an exception on the title policy(s) being
issued, if applicable.
b. Concrete Driveway encroaches over 20' Building Setback Line and extends beyond the boundary line
onto the 60' Platted Public Right-of-Way of Mandalay Avenue on the East side of the property.
c. Water Meter encroaches over 20' Building Setback Line on the East side of the property.
d. Concrete Driveway extends beyond the boundary line onto the 80' Platted Public Right-of-Way of El
Dorado Avenue on the South side of the property.
e. Rights of others to the land between the fence located along the West boundary and the land's boundary
line.
We will take exception to these matters on the title policy(s) being issued.
If you have any questions regarding this correspondence, please contact our office at the number listed above.
Sincerely,
Susan Pyles
SURVEY DISCLOSURE LETTER SD
REV. 10/6/15
RLM/ak
U.S.AEf�ARTMENTOFHOMELANDSECURITY ��,�,����'o� ��R 1 I�I�P'1,TE
�EAERAL EMERGENCY MANAGEMENT AGENCY
NatiorialFloodl�tsuranceProgram Important: Read the instructions on pages 1-9.
��� SECTION A - PROPERTY INFORMA710N
�A1. Builiiing Owr 's Name ��`! � � ������� �
f � ._�
A2. Building Stree Address (including Apt., nit Suite, and/or Bldg. No.) or P.O. Route and Box No.
���:� ��,�_Q,���y ��rc��,�
c�tY c. � E� rz �,.f�, �-,� �, �
Propert Description (Lot and Block Numbers, Tax Parcel
�-b � 10, __ 1'� �-� �--I�- 5 I, M�! n1 D
State � ZIP Code
L, ��,���
e«.�
OMB No. 1660-0008
Expiration Date: July 31, 2015
AG. Building Use (e,g., Resldentl�l, Non�Resident�al, Addition, Accessory, etC.) %�����' ����i��,F�, i,. �
A5. Latitude/Longitude: Lat. 2� ���'' SS. 1 Long. 8�-��-�'�7" Hori2ontal Datum: [� NAD 1927 [�NAD 1983
A6. Attach at least 2 photographs of the building If the Certfficate is being used to obtaln flood insurance.
A7. Building Dlagram Number �
A8. For a buiiding with a crawispace or enclosure(s): N/� A9. For a buiiding with an attaohed garage:
a) Square footage of crawlspaae or enclosure(s) � sq ft a) Square footage of attached garage ��'? Sq ({
b) Number of permanent flood openings In the crawispace bj Number of permanent flood openings in the tached garage
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 AB.b sq in c) Total net area of flood openings in A9.b ��" sq in
d) Engineered fiood openings7 ❑ Yes ❑ No d) Engineered flood openings7 ❑ Yes [] No
SECT(ON B- FLOOD INSURANCE RATE MAP (FIRM) INFQRMATION
B1. NFIP Community Name & Community Number B2. County Name
�?t,-� /4 �, �AJ �`r I ~� �'',�. / � 25 p � C� 1�1 r�, � �.1..../� �
84. Map/Panel Number 85. Suffix 66. FIRM index Date B7. FIRM Panei B8. Flood
�Z� p� G a I Q Z �. �_' �_ Effective/R�elvised Date Zone(s)
"% �- �-� �
910. Indioate the source of the Base Flood Elevatlon (BFE) data or bas� flood depth entered tn item 69.
❑ FIS ProFile �IRM ❑ Community Determined ❑ Other/Source: .
311. Indicate elevation datum used for BFE in Item 89: �] NOVD 1929 �AVD 1988 ❑ Other/Source:
312. Is the buiiding iocated in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)?
Designation Date:. ❑ C6RS � OPA
�'
�2.
B3. State
{ �. .
69. Base Flood Elevatfon(s) (Zone
AO, use base flood depth)
II'��2..'
❑ Yes Ly� No
SECTION G-�UILDING ELEVATIQN INFORMATION (SURVEY REQUIRED)
Buiiding elevations are based on: � Conatruction Drawings" [j Building Under Constructfon* Finished Construction
"A new Elevation Certificate will be required when construction of the building is complete.
Elevations - Zones A1-A30, AE, AH, A(with BFE), VE, V1-V30, V(with 6FE}, AR, AR!/�, AR/AE, AR/A1-A30, AR/Ahl, AR/AO. Complete Items C2.a-h
below according to tl�e buildi g diagram s�eciiled in Item A7. In Puertb Rico only, enter m te s.
Benchmaric Utilized: �'' ��� �!UI �" ��- Vertical batum: �, l N U�
Indicate elevation datum used for the elevat(ons in items a) through h); below. � NGVD 1929 � NAVD 1988 ❑ Otherl5ource:
Datum used for bullding elevations must be the same as thet used for the BFE.
Checi< the measurement used.
a) Top of bottom floor (including basement, crawispace, or enclosure iloar) �� � I�eet ❑ meters
b) Top of the next higher floor _�,� ��et � meters
a) Bottom of the lowest horizontal structural member (V Zones only) �f.� ❑' ffeet ❑ meters
d) Attached garage (top of slab) ___�, i [�reet Q meters
e) Lowest elevation of machinery or equipment servicing the building �,�_ ��et ❑ meters
(Describe type of equipment and location in Comments) ��
� Lowest adjacent (Finished) grade next to building (LAG) �� Ly'Feet ❑ meters
c�) Highest ad)acent (finished} grade next to building (HAG) _�, I (� feet ❑ meters
h) Lowest adjacent grade at lowest elevatlon of deck or stairs, including structural suppo�t ►�1.f�._ ❑ feet ❑ meters
SECTt�N D-- SURVEYOR, ENGINE�R, OR ARGHITECT CERTIFIC�ITION
This certificatlon is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation
information. / cerfi(y fhat the informafion on fl�is Certl�rcafe represenfs my besf e(torts fo fnferpret fhe dafa available.
1, �un%d rsfand that any false stafemenf ntay be punlshable by fine or impnsonment under 18 U.S. Code, Sectlon 1001.
L�y.,'/ Cliecl< here if comments are provided on back of form. Were latitude and longitude in�S�e tion A provided by a
I� Check here if attachments. Ilcensed land surveycr? I�" Yes ❑ No
Certifier's Name LARRY L. EVANS
Title IAND SURVEYOR
Address 1460 BELTREES
Sic�nature � �f
t�� � . i; �-
,
Company Name
T ;.S�TE.9 City DUNEDIN,
�.. ,.
License Number PLS # 2937
EVANS LAND SURVEYIIVG, INC.
Date j /�, - � ��
..� ..
5tate FL ZIP Code 3A�98
T-elephone {727) 7343821
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See lnstructions for Item AF3.
IMPQfiTllNi�: in fhese spaces, copy the corres�ondie�� infoi�mation from �scfiion A. FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Sulte, and/or Bldg. No.l or P.O. Route and Box No. Policy Number:
��2�-> �� � ``' �°`��t--t1 �� � �' �- y --- ---
City F ( ��� / � State ZIP Code � Com�iany NAIG Number
:
;, � ... � ��, E � �� �� �; C �. !'� ------ - � � � � � -- �._._�
If using the Eievation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions
for Item A6. Identify ali 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 fhe Continuation Page. �
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