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301 WINDWARD ISLAND RDa�a. vcr�art � mtn � Vt HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AG�NCY Natronal Flood Insurance Program 1. Buiiding Owner's Name CERTIFICATE Important: Read the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION A2. Building Street Address (including Apt., Unk, Suite, and/or Bldg. No.) or P.O. Route and Box No. 301 WINDWARD ISLAND ROAD City CLEARWATER State FL ZIP Code 33767 OMB No. 1660-0008 Expiration Date: Juty 31, 2015 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 48, UNIT 4, ISLAND ESTATES OF CLEARWATER, P.B. 51, PAGES 32 & 33 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27`58'50"N Long. 82"48'38'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 1B 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 440 sq ft b) Number of permanent flood openings in the crawlspace 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 4 c) Total net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b 480 sq in d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NFIP Community Name & Community Number 62. County Name P�NELLAS 12103 PINELLAS B4. Map/Panel Number 65. Suffix 66. FIRM Index Date B7. FIRM Panel 12103C0106 H 5-17-2005 Effedive/Revised Date 5-17-2005 63. State FLA B8. Flood I B9. Base Flood Elevation(s) (Zone Zone(s) AO, use base flood depth) „AE" 11.0 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69. ❑ FIS Profile � FIRM ❑ Community Detertnined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ OthedSource: 612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Proteded Area (OPA)? Designation Date: ❑ CBRS ❑ OPA ❑ Yes � No SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construdion 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 accoMing to the building diagram specfied in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: PINELLAS Vertical Datum: NAVD 88 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ OtheNSource: Datum used for building elevations must be the same as that used for the BFE. a) Top of bottom floor (including basement, crawlspace, or enGosure 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 dedc or stairs, including structural support 11.0 N/A. N/A. 8.5 11.0 3.6 4.3 N/A. Chedc the measurement used. � feet ❑ meteis ❑ %et ❑ 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 authorized by law to certify elevation information. l certify that the infamation on fhis Certif&;ate represents my best efforts to interpret the data availab/e. I understand that any false statement may be punishable by fine or imprisonmenf under 18 U. S. Code, Section 1001. � Check here if comments are provided on badc of form. Were latitude and longitude in Section A provided by a ❑ Check here if attachments. licensed land surveyor? � Yes ❑ No Certifier's Name DONALD L Title LAND SURVEYOR Address 5020 NN F, Signature � License Number PSM #5649 Company Name WILLIAMSON & ASSOCIATES, INC. City TAMPA State FL ZIP Code 33624 Date 7-2-2015 Telephone 813-265-4795 . ,. i -�. � ,. ... f.'/'i �` �tav �-�i ����.� �'�:� <. ,' � _ �d � p�*t' � (�,y. - . .c �., � = �i�``' . !' ;,' (� c�' r? i l)�, : � : c�,``t �o i n . �} �� �1�'°las:im 31V���. ..`,r,_ /1#1tl�� FEMA Form 086-0-33 (7/12) See reverse side for continuation. Replaces all previaus 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. 301 WINDWARD ISLAND ROAD City CLEARWATER State FL ZIP Code 33767 SECTION D— SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Ce�,t+�cate for (1) community official, (2) insurance agenUcompany, and (3) building owner. Comments JO�#14-181 FNL 1 / �i IS A/C PAD Signature Date 7-2-2015 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. Chedc 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). feet ❑ meters ❑ above or � below the HAG. a) Top of bottom floor (including basement, crawlspace, or enGosure) is ❑ feet meters ❑ above or ❑ below the LAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is • ❑ ❑ 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 slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery andlor 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 ownePs 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 OwnePs 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 Certifutate. Complete the applicable item(s) and sign below. Chedc th� measurement used in Items G8—G10. In Puerto Rico only, en%r meters. G1. ❑ The information in Section C was taken from.other documentation that has been signed and sealed by a licensed surveyor, engineer, or archited who is authorized by law to certify elevation information. (�ndicate 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�10) is provided for community floodplain management purposes. G4. Pertnit 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 G9. �FE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters G10. Community's desig�n flood elevation: ❑ feet ❑ meters Local Official's Name Comm�niry Name Signature Comments Title Telephone Date Datum Datum Datum Check here if attachments. FEMA Form 086-0-33 (7/12) Replaces all previous editions.