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763 HARBOR ISLANDr US. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY Naaanal Flood lnsurmce Progmm IMPORTANT: Follow the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION A1. Building Owner's Name WILLIAM AND PATRICIA JUCHA A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or PO. Route and Box No. OMB No. 1660-0008 Expiration Date: July 31, 2015 "� � CIEARWATER ��te FL ur �oae 33767-1805 A3. Property Description (LOt and Block Numbers, Tax Parcel Number, Legal Description, etc.) PARCEL OS-29-15-43456-073-0310, LOT 31, ISLAND EST OF CLEARWATER UNITS 6D,7A,B� 7C, PLAT BOOK 064, PAGE 001, PINELLAS COUNTY, FLORIDA A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESiDENTIAL A5. Latitude/longitude: Lat. 2�.9924 Long. a2�8»o 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. Buiiding Diagrem Number ONE-A A8. For a building with a crawlspace 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 4� sq ft b) No. of permanent flood openings in the crawispace or b) Number of permanent flood openings in the attached garage enclosure(s) within 1.0 foot above adjacent grade N�'O` within 1.0 foot above adjacent grade � c} Total net area of flood openings in A8.b N�'0` sq in c) Totai net area of flood openings in A9.b WA sq in d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No SECTION B- FLOOD INSURANCE RATE MAP (FlRM) INFORMATION 61. NFIP 64. Map/Panel Number 12103C0102 Number 125096 66. FIRM Index Date G I OS/18/2009 B2. County Name pINELLAS 67. FlRM Panel Effective/ Revised Date 09/03l2003 B3. State FL Flood Zone(s) I 69. Base Flood Elevation(s) (Zone A0, use base flood depth) AE 11.0 FT 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: 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 Resources 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(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 according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: GPS Vertical Datum: NAVD 1988 indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: Datum used for buildin� elevations must be the same as that uced fn� rnP R� a) Top of bottom floor (including basement, crawlspace, or enclosure floor) b) Top of the �ext higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garege (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 ne�ct to building (LAG) g) Highest adjacent (finished) grade ne� to building (HAG) h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support Check the measurement used. 9.35 � feet ❑ meters wA � feet ❑ meters N/A � feet ❑ meters 8�57 � feet ❑ meters 9•� � feet ❑ meters 7�6� � feet ❑ meters 8�61 � feet ❑ meters NA � feet ❑ meters SECTION D- SURVEYOR, EN(iINEER, 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 [he informatton on this Certiflcate represents my best efforts to interpret the data availabie. ! understand that any false statement may be punishable by ftne or impr7sonment under 18 U.S. Code, S6CiI0I1 IOOI. 3�`Fyq�.'{,�� R ❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a .,` "%k ❑ Check here if attachments. licensed land surveyor? � Yes ❑ No � 4636 . Certifier's Name BILL H. HYATT, JR Title PRESIDENT Address 1497 MAIN STREET #321 Signature FEMA Form 086-0-33 f7/ .� I License Number #4636 Company Name KNOW IT NOW INC City State ZIP Code DUNEDIN FL 3q6gg Date Telephone 7-17-15 (727)415-8305 See reverse side for continuation. tiTA fL ()f YLORID.\ Replaces all previous editions. � �' � J_ V l_�^ �[! � � V L - ELEVATION CERTIFICATE, page 2 IMPORTANT: In these spaces, copy the corresponding i�ormatlon from Section A. - Buitding Street Address (i�cluding Apt., Unit, Suite, and/or Bldg. No.) or F0. Route and Box No. 763 HARBOR ISLE ��tY State ZIP Code CLEARWATER FL 33767-1805 SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFlCATION (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 CERTIFICATE IS NOT TO BE USED FOR CONSTRUCTION OR DESIGN, IS FOR FLOOD INSURANCE USE ONLY Date Q�� 7fz015 5EC7i0N E- BIALDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND 20NE A(WITHOUT BFE) For Zones AO and A(without BFE), complete ttems 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, crawlspace, or enclosure) is . � feet ❑ meters � above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) 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 ne�d higher floor (elevation C2.b in the diagrams) of the building is N� . A � 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 onty: 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� 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 Date State ZIP Code Telephone ❑ Check here if attachments. SECTION (i - 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 ftems 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 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 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 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: . ❑ 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 Signature Commenis Title CLEARWATER CITY OF Telephone Date ❑ Check here if attachments. FEMA Form 086-033 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS CONTINUATION PAGE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. ADDRESS: 763 HARBOR ISLAND CLEARWATER, FL 33767 PICS TAKEN 7/15/2015 FRONT VIEW AND CONTINUING AROUND BUILDING �zY.W � �:� �u., ��:� tt� �� ✓ rr -° e �� ,avm°. :'�� , �� ,, �. ,° ��r�� ; w" s; , 3,'. .N. e` �. - , " __ ,�.- :. a �. < r � .�;t.;.^. �