637 HARBOR IS.
U.S. D�PARTMENT OF HOMELAND SECURITY
FEDEf2AL EMERGENCY MANAGEMENT AGENCY
� National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1-9
SECTION A - PROPERTY INFORMATION
A1. Building Owner's Name PIUS & CATHERINE NEWELL
A2. Building StreetAddress (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
637 HARBOR ISLE
City CLEARWATER
State FL ZIP Code 33767
OMB No. 1660-0008
Expiration Date: July 31, 2015
A3. Property Description (Lot and Block Numbers, Tax Parcei Number, Legal Description, etc.)
TAX PARCEL ID #05-29-15-43456-073-0110
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. 27 °59'17.0"N Long. -82°48'57.7"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
AS. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawispace or enclosure(s) N/A sq ft a) Square footage of attached garage 473 sq ft
b) Number of permanent flood openings in the crawispace b) Number of permanent flood openings in the attached garage
or enclosure(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 � No d) Engineered flood openings? ❑ Yes � No
SEC710N B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number B2. County Name
CITY OF CLEARWATER PINELLAS
B4. Map/Panel Number B5. Su�x B6. FIRM Index Date B7. FIRM Panel
12103C0102 ` G 8/18/2009 Effective/Revised Date
• SEPTEMBER 3, 2003
B8. Flood
B10. 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:
611. Indicate elevation datum �sed for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ OtherlSource:
612. is the building tocated in a Coastal Barrier Resources System (CBRS} area or Othenvise Protected Area (OPA)?
Designation Date: ❑ CBRS ❑ OPA
B3. State
FLOR�DA
69. Base Flood Elevation(s) (Zone
AO, use base flood depth)
11
❑ Yes � No
SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Buiiding 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. In Puerto Rico only, enter meters.
Benchmark Utilized: CITY OF CLEARWATER 1-04 Verticai Datum: NAVD88 EL 5.2452
Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ OthedSource:
Datum used for building elevations must be the same as that used for the BFE.
Check the measurement used.
a) Top of bottom floor (including basement, crawispace, 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 and location in 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 deck or stairs, including structural support
7.8
N/A.
N/A.
7.1
7.1
6.9
7.5
NlA.
� feet ❑ meters
❑ feet ❑ meters
❑ feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
❑ feet ❑ meters
SECTION D- SURVEYOR, ENGINEER, OR ARCHI7ECT CERTIFICATION
�.��, ..,. ,�,al
nformat on�. l�certify that the�information'on th s Certtlficafe represents my best effoits to in erpret thel data a a�lab eevation ,,� `� .�: :�s r` -.
! understand that any false statement may be punishable by frne or imprisonment under 18 U.S. Code, Section 1001. *�` �-'��
•� •^•� �� rt.jl� , ��.'•� .
� Check here if comments are provided on badc of form. Were latitude and longitude in Section A provided by a ,�af �a,, r �
❑ Check here if attachments. licensed land surve or? � Yes ❑ No , �,� �
Y ;* �vG��..i�`,.��t%� � .1�
Certifiers Name DANA A. WYLLIE
License Number LS 5874
Title SURVEY MANAGER Company Name DEUEL & ASSOCIATES
Address 565 SOUTH HERCULES AVE City CLEARWATER State FL ZIP Code 33764
Date 4-242015 Teiephone 727-822-4151
FEMA Form 086-0-33 (7I12) See reverse side for continuation. Replaces ali previous editions.
ELEVATION CERTIFICATE, page 2
• 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.
637 HARBOR ISLE
City CLEARWATER State FL ZIP Code 33767 Company NAI'C�N�rnber '"`""
SECTION D— SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community o�ciai, (2) insurance agent/company, and (3) building owner.
Comments A5: Latitude and longitude were determined by using Googie Earth.
C2e) Elevation is lowest air conditioner platfortn
Signature
Date 424-2015
iE: `. :
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 IOMR-F request, complete Sections A, B,
and C. For Items E1—E4, use naturai grade, if available. Check the measurement used. In Puerto Rico only, enter meters.
E1. Provide elevation information for the foliowing 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 enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
b) Top of bottom floor (including basement, crawlspace, or enGosure) is ❑ 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 siab) is ❑ feet ❑ meters ❑ above or
❑ below the HAG.
E4. Top of platfoRn 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? ❑ 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, B, 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
Telephone
ZIP Code
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. Comptete 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 infortnation. (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. ❑ The following information (Items G4—G10) 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-buift lowest floor (including basement) of the building: ❑ feet
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
❑ feet
Title
Telephone
Date
❑ meters Datum
❑ meters Datum
❑ meters Datum
Check here if attachments.
FEMA Form 086-0-33 (7/12) Replaces all previous editions.
, ELEVATION CERTIFICATE, page 3 guilding 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.
637 HARBOR ISLE
City CLEARWATER State FL ZIP Code 33767
FOR INSURANCE COMPANY USE
Policy Numtier.' -
Company NAIG Number.
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions i
for Item A6. Identify all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side Viev�l' and "Left Side j
View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as I
indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. ;
; FRONT VIEW (4-22-2015) REAR VIEW (4-22-2015}
RIGHT SIDE VIEW (4-22-2015)
FEMA Form 086-0-33 (7/12)
LEFT SIDE VIEW (4-22-2015)
Replaces aii previous editions.