213 LEEWARD ISLANDU.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AGENCY
;lational Flood Insurance P�ogram Important: Read the instructions on pages 1-9.
SECTION A - PROPERTY INFORMATION
A2. Building Street Address (inGuding Apt., UnR, Suite, and/or BMg. NoJ or P.O. Route and Box No.
��31 EEWARD ISLAND
City CLEARWATER
A3. Property Description (Lot and Blodc Numbers, Ta�
LOT 29 ISLAND ESTATES OF CLEARWATER UNIT 1
State FL ZIP Code 33767
OMB No. 1660-0008
Expiration Date: July 31, 2015
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Residential
A5. Latitude/Longitude: Lat. 27.58'45" Long. 82.48' 1" 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 Diagram Number 016
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 484 sq R
b) Number of pertnanent flood openings in the crawlspace b) Number of permanent flood openings irt the attached 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 A8.b 0_0 sq in c) Total net area of flood openings in A9.b 0_Q sq in
d) Engineered flood openings? ❑ Yes ❑ No d) Er.gir�eered flood openings? ❑ Yes -❑ No
SECTION B- FLOOD INSURANCE RATE MAP (FIRAA) INFORMA'
61. NFIP Community Name & Community Number I 62. County Name 63. State I
CITY OF CLEARWATER 125096 PINELLAS FLORIDA
B4. Map/Panel Number 65. Suffix 66. FIRM Index Date B7. FIRM Panel B8. Flood B9. 8ase Flood Elevation(s) (Zone
125096-0102 G 9-03-2003 Effedive/Revised Date Zone(s) AO, use base flood depth)
09-03-2003 "AE"
610. Indicate the source of 2he Base Flood Elevation (BFE) data or base flood depth entered in Item 69.
❑ FIS Profile � FIRM ❑ Community Detertnined � Other/Source:
611. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 0 OthedSource:
612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Othervvise 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 witi 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: CLEARWATER RESET 20 Vertical Datum: NAVD 88 = 4.571
Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGW 1929 � NAVD 1988 � Other/Source:
Datum used for building elevations must be the same as that used, for the BFE.
a) Top of bottom floor (induding basement, crawlspace, or enctosure floor)
b) Top of the ne� 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 adjaceM (finished) grade next to building (LAG)
g) h�ighest adjacent (finished) grade next to building (HAG)
h) Lowest adjacent grade at lowest elevation of dedc or stairs, including structural support
5.87
0.0
0.0
5.40
6.46
5.2
5.5
5.4
Chedc the rneasurement used.
� feet ❑ meters
❑ feet ❑ meters
❑ feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet � meters
SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect author¢ed by law to ceRify elevation
information. ! certily that the information on this Certificate rep►eserrts my best efforts to interpret the data available.
I understand that any false statement may be punishab/e by fine or imprisonment under 18 U. S. Code, Section 1001.
� Check here if comments are provided on badc of form. Were latitude and longitude in Sedion A provided by a
❑ Check here if attachments. licensed land surveyor? � Yes ❑ No
Certifiers Name THOMAS N. GAZELL
Title PSM
Address 2149
Signature_�
License Number PSM *5387
Company Name BEIVCHMARK SURVEY, INC.
Cit}r HOLIDAY State FL ZiP Code 34690
Date 03-24-2014 Telephone 727-847-5544
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FEMA Form 086-0-33 (7/12) See reverse side for continuation. Replaces all previous editions.
�LEVATION CERTIFICATE, page 3 BUllding Photographs
See Instructions for Item A6.
IMPORTANT: In these spaces, copy the corresp�onding.information from Section A.
Building StreetAddress (including Apt., UnR, Suite, and/or Bldg. No.) or P.O. Route and Box No. Poltcy.NUmt�er_
#213 LEEWARD ISLAND
City CLEWATER State FL ZIP Code 33767 Company NAiG Number.
If using the Elevation Certificate to obtain NFtP flood insurance, affix at least 2 building photographs befow according to the instructions
for Item A6. Identify all photographs with date taken; "Front Viewi and "Rear Viewi'; and, if required, "Right Side VievW' 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 rrtore photographs than wil{ f►t on th'rs page, use the Continuation Page.
FRONT 03-20-2014
REAR 03-20-2014
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