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949 BAY ESPLANADEU.S.Lt�„ TMENTOFHOMELANDSECURITY �����TtON CERTIFtCATE OMBNo.1660-0008 FEDERALEMERGENCY MANAGEMENTAGENCY Na�ional Flood Insurance Program IMPORTANT: Follow the instructions on pages 1-9. Expiration Date: July 31, 2015 SECTION A - PROPERTY INFORMRTION A1. Buildin Owner's Name GREG H�NCHEL A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. City CLEARWATER State FL A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) THE S 20 FT OF LOT 10 ALL OF LOT 11 AND THE N 20 FT OF FOR INSURANCE COMPANY USE Policy Number: NAIC Number: ZIP Code 33767 LOT 12, BLOCK 265, CARLOUEL SUBDIVISION. P.B. 20 PG. 60-62. A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27 DEG. 5s'59.55" N Long. 82 DEG. 49'23.1T' 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 1-A A8. 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 ��•� sq ft b) No. of permanent flood openings in the crawispace or 0 b) Number of permanent flood openings in the attached �arage enclosure(s) within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in AB.b � sq in c) Total net area of flood openings in A9.b o sq in d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Communitv Name & Community Number CiTY OF CLEARWATER 125096 64. Map/Panel Number 65. Suffix B6. FIRM Index Date 12103C0102 � G � OS/18/2009 62. County Name B7. FIRM Panel Effective/ Revised Date 09/03/2003 PINELLAS B8. Flood Zone(s) AE B3. State FL Base Flood Elevation(s) (Zone AO, use base flood depth) 11.0 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: ❑ FIS Profile � FlRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: B12.Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes � No Designation Date: N�A / / ❑ 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/AO. Complete Items C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: P�D AG 0504 F 3 2•�2 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 building elevations must be the same as that used for the BFE. a) Top of bottom floor (including basement, crawlspace, 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 Iowest elevation of deck or stairs, including structural support Check the measurement used. 6_00 � feet ❑ meters 16_00 � feet ❑ meters N/A � feet ❑ meters 4=92 � feet ❑ meters s'22 � feet ❑ meters 4.18 � feet ❑ meters 4.73 � 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. 1 certify that the information on this Certificate represents my best etfoits to interpret the data available. 1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. y1. H' H yATT , ❑X Check here if comments are provided on back of form. � Check here if attachments, Certifier's Name BILL H HYATT JR Title P.S.M. Address 1844 N NOB HILL ROAD Signature FEMA Form 086-033 (7/12) Were latitude and longitude in Section A provided by a licensed land surveyor? � Yes ❑ No License Number #4636 Company Name ALLSTATE SURVEYING, LLC City State ZIP Code SUNRISE FL 33322 Date Telephone 05/26/15 (888) 569-0480 See reverse side for continuation. �'lGtitySE 7y�'h Y 4636 STATE OF FLORIDA Replaces ail previous editions. ELEVH ON CERTIFICQTE, 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 P0. Route and Box No. 949 BAY ESPLANADE City State ZIP Code CLEARWATER FL 33767 FOR INSURANCE COMPANY USE Policy Number. Company NAIC Number. SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments C2e MACHINERY OR EQUIPTMENT SERVICING THE BUILDING IS AN A/C UNIT. ON CONC. SLAB LATITUDE & LONGITUDE LOCATED USING HAND HELD GPS DEVICE NOT TO BE USED FOR CONSTRUCTION OR DESIGN, FLOOD INSURANCE USE ONLY. CROWN OF ROAD ELEVATION: 3.e3 Signature Date 05/26/15 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 informaiion 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 (inciuding 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 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? ❑ 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 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 ca� 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—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 compieted 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: . ❑ 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: Local Official's Name Community Name Signature Comments Title Telephone Date ❑ feet ❑ meters Datum ❑ Check here if attachments. FEMA Form 086-033 (7/12) Replaces all previous editions. GERTfFICQTE, page 3 BUILDING l�Ff0i0GRARHS See Instructions for Item A6. IMPORTANT: fn these spaces, copy the corresponding information from Section R. Buiiding Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P0. Route and Box No. 949 BAY ESPLANADE City State ZIP Code CLEARWATER FL 33767 FOR INSURANCE COMPANY USE Policy Number: Company NAIC Number: If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all 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 the Continuation Page. 05/20/15 FRONT VIEW 05/20/15 REAR VIEW FEMA Form 086-0-33 (7/12) Replaces all previous editions. �:L�� :�"'rEi FICk , page BUILDING PHOTOCRAPHS Continuation Page IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or PO. Route and Box No. Policy Number: 949 BAY ESPLANADE City State ZIP COd2 Company NAIC Number. C L EAR WATER FL 33767 If submitting more photographs than will fit on the preceding page, affix the additional photographs below. 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. 05/20/15 LEFT VIEW ��„ t � � � , � � 1 '� 7 E ( [ � � } ( � 05/20/15 RIGHT VIEW FEMA Form 086-0-33 (7/12) Replaces all previous editions.