1247 HILLCREST AVE S. -z
U.8.pEl'ARTM6NT.OFHOMELANp9ECURITY ����ATION C�Ef�TIFI�A�'E �
FEDERAL EMERbENGY MANA�EMENT Aa�NCY • " OMB N0. 1660-0008 �
Nano„aca�roodr,�acn�ar�cePrograni �mpp�{ant: Read the iristrucilons on pages 1-�8. Expiration Date: July 31, 201s
CTION A � PIROPERTY INFOFiMATION
__
A1. Building Owner's Name '
-���� o iz�l,l�v/.�...r-I�/,,,) s
A2. Building 5treet A ress (Includin Apt., Unit, Suite and/or Bldg. No, or f'.O Fioute and Box Nd.
I. 24-7 �o . 4-� � tr�. �.,fz.. �. � -(� ,cl�v �= T..� c..; ��,.,:,
city C.L�,f4 P�. v*1,d,-�" ��,? , sta��:� ,� �� ZIP Cvde
1
A3. Pronertv DesGrlptlon (lot and Block Numbere, Tax °^�^- ^�..—�__ �__:., �__, .. .:
��i, ��;���T N I�.�.. ;
�N�
A�4. Bullding Uae (e.g., Residentlol, Non-�esident e� Addltlon, Aco ae�r , efo.) R� ���'�J�"i 1 (r . T
A5. Latitude/Longitude: lat. —�-� 5 ��, Long. �Z ,. ,(� Horizontal Dalum: ❑ NAD 1827 NAD 1903
A6. Attach at Isast 2 photograph�s o the buliding If Ihe CeNiflcate le beinp uF�ed to oblaln flood Ineurance:
; A7, Building Dlegrem Number �, • � •
• A8. F'or a building wlth a orawi�pace or encloaure(s)• � A9, For a GuiidlnD wllh an altaohed garage: .
' a) Square footage of crewl� ace or enciosure(s) � aq R a) Square (ootage af attaohed ga[ap�• �� � aq ft
b) Nurnber of permanant �I���I`'openinge In fhe crawlepace li) Number of permanent fiood'opeNnBs In.the attached garage
or enclosure(s) within 1����t� ebove adJacenE pFade � within 1 A foot above adJ�cent grede.
c) Totdf net area of flood o���il�lge In Ae.b �� �q In o) Tbtel net area o( Ilood openinge In A�.b: �.: aq in .
d) Engineered flood openings`� ❑ Yes ❑ No d) �ngineered,flood openinga2 ;.G] Yea .[L�I�lo
SEGTION 8-- FLOOq INSURAN�::� ftATk MAR (FIRM) INFpRMATION "
B1. NFIP Community Name & Communit Number 82. County Name B3. State � �
e��,�� w,��r-c� r�-- rZ� U � � � � N � �.�:�,, � ` ,
- D4. Map/f�anel Number 65. Suffix B8. FIRMindex Date B7. FIFtM I'anel 80. Flood 89: Base Flood Elevatlon(s) (ZonA
� �, � p �'a �„ .� � � L7� j..� � _ � � ,, p c� Eff��ctive/Revised Date Zone s) . . AO; use base flood depth). •
, �' S-►:7��� �. Z8,5 �
� 810. Indicat.e/the sbwrce of the pase Flood Elevatlon (gFE) data or ba�e floo�a depth entered In Item B9. ,
I�" rIS Proflle ❑ FIRM , ❑ Commuhlty Determined ❑_� �therlSOUrce: .. ,
611. Indlcate elevatlon datum used for BFE In Item BB: C] NQVD 1929 [v�' NAVD 1888 (� Other/Souro�: �,� '
a12. Is the building Iocated In a Coastai Barrier Resouroes 8yatem (CBRS) area or Othervviae Proteoted Area (OPA)? [� Yes �` I.�I' No
Dealgnallon Dete: d CbRB . ❑ OPA
SECTION C- BUILpINO ELEVA IQN WFORMATIQN (SURV�Y REQUIRCD) .. .� �
C1. Bulldin� elevadons are based on: (] Conatruotlon Drawinge" [� �uliding Under Canetruotion" ,[�Finlehed Constructton �
"A new Elevatloh Ce�tificate wfll be required when oonattuction of the buildin� Is aomplete.
C2. Elevativns - Zones A1-A30, AE, AH, A(with 6FE), VE, V1-V30, V(with BFH), AR, AR/A, AFt/AE, AR/At-A3n, AR/Ali, AR/A�. Complete Iteme C2.a- �
below according to the building diagrem specifled In Itern A7. In Puartb Rlcn only, anter rnetePa. ��
BenchmarkUtllized: ��T� d� G�-W2-____�"_„�"�� VeiticplDatum: Z�� � ,�.,.,�---- • (/y
Indica�e eleveHon datufn used for the �levatlone In items e) through hy belpw. ❑ NOVD�1929 N►� AVD 1998 � Qth�r/5ouroe: �
Datum used �or building eleveUqn$ must be lhe same as that ug�d fortfie BFE, . � �
Cheok the eaeurement used: U, �
a) Top of bottotn floor (Including besement, oPawlepaoe, or enclasure tloor) Z�,�., feet T O meters ,� �
b) Top of the next higher floor �__L4,_=._.�_ ❑ feet � nietere. � Q
c) Boltom of tlte loweat harizontal alructural member (V Zones only) ��A p feet. (] meters �' �
• d) Attached garage (top oLslab) ?� 9. (�5��a t Cj meters ��
e) Lowest elevaUon of inechinery or eyuipment s�rviding the building _�.� LwJ'feet CI meters i/� �
(Descrlbe type of equlpm9nt and Iocatlon In Commente) ' �y
� Lowest adJacent (flnished) grade next t6 bulidinA (LAO) �^ a�- .[�1'�eet ❑ meters �� a
g) Hlgitest adJecent (finished) grade next to bullding (HAa) �. � �'�eet [,l metera . .� V
h) Lawest adJaoent grade at Ibweat elevalion of deck or stalre, including etructurai euppori �� ❑ feet ❑ meters , r' m
� S�CTIQN D. - 8URVEYOR, ENQIN�ER, �R ARCHIT�CT C�FtTI�ICdTION ,, � . � . x. �. ',..- �,� �
This certlflca�lon is to be si ned and sealed b a land autve or en ineer, or erchit�ct authorized b law to certlf elevation �? '` ' ``''�
9 Y Y, 9 Y Y r .., �, « �
informallon. I cerflfy thaf the Informe!!on on (h!s Certlflcate rep�gsents my best effoNs fo Interpret flre dafa avallable. ,� �y,�» «���i "'�, y�'�` �; .
!�u�n�d rsfand thaf any /a/se stafement rriay Ge punlslteG/e by fiiie orlrnprlsonmenf under 18 U.S. Code; Secllon 1001. �� W�,w�� �' ��
M }' i � � * ¢ � '..: ., �'
p,�/' Check here if commenta are provlded on back of forrn. Were IaUtude and longltude in Seotlon A provided by a �x�F=« �� ���� y,Y .
L,YI Check here if eltachments. Ilcensed lend aurveyor7 ��es ❑ No �: ,�'�'�" �c ,,4v, ;. �,
Certiflar`s Naine LARRY L. EVANS License NumbeY PLS i� 2937 � „`� ,�t �j�(�j �k �� s�� �'
3 � �' �r mr,r.�ar "�!�!o"�,,. �:.
TiBe LAND SUFtVEYOR Company Name EVANS LAND 8URVEYINO, INC. �"�
AddreBS 1460 BELTRE S ST STE. 9 Clty DUNEDIN, 9tate FL ZIP Gotle 34898 _ ���` �� ������ ,�
Sfgnature_ �,� � �L.�,� � ��te Q _�` Q--� � 7elephone (727) 734-3821 v � g.�`f��"
, ,c�",
'�M.� .
w��i��l, I►R.1N. (:�k � �wl�:ti �t, page e
�MWORTANT: In tfiese spa��s, copy the corr�sponding Inforrtiatlirri�from Sectidn A.
Bulidfng Street �1d reas (Includln A t U It S it
e-' ,
8 p., �s e and/or eldg. No.) or F'.O. Rnute ahd Box No. �'�Ii�. � fi��;� ' "`°�
1 �-- �`7 � � 1; �4 � L �. c-�'�-- `t � � E,,,, v �� ,
ciry
C l,�%� 12.'�%i��r� �;..� State L� ZiP Code' . '� �
� �'� �� ' , �
3��CTION D� 8URV�YOR, �NOINE�a, OR a�REHITEGT C�RTIFICATIpN (GQNTINU�Dj
Gopy both sidea of thls �IeJatfon Certlfloats for (1) bommunity ofBclal, (2) Insucmnoe apeht/company, and (3) building owner:
Comments ' , � ; �
c�;- �;. , �"., � ; i,�,r � � 1 � = �yt; ' � r�', j �, � � :� �;�� ,0`'�:,�'a�..., G b Nt, � (� E. �� r.� (c'.,; p�.,1 �� J.� l �'.�; f� ,}� � Q �
�
Signature
a
Date �
Q�Q�' ��2,q.-:� Z;o I.
___ ----
.: . .
j 3�CTIO.N E— BU pINO ��.EVATION INFORMATION (SURV�Y,NQT REGIUIR�p) FOR Zt7N� Ap AND ZON� i4 (WI7HOU'[ �F�) .
' '�- ...
; For Zonea AQ and A(wllhout BFE); complele Itehie E1—E6. If the Certllloale la Inte(tded to euppqn � LOMA ot LOMfZ-F requeef, complete 3ecflona A, R,
and C, For. Items E1—�4, use natufaf grade, i( evailable: Check the measureme�nt us@d. In Puerto Rlco only, entar meters: ;:
'�1. Frovld� elevation InCormalion for lhe Iollowin� and cheCk fhe approprlate boxe�.lo ehow whether the elevaRlon le auaVa o�.below the hlphest adJacent
grade (HAa) and the Ioweat adJatrent grade (LA(3).
a) Top of bottam fioor Qncluding basement, orawlapace, or encloaure) Is _ ❑ feet ❑ meters [] above ur (] balow lhe HAQ.
b) Top of bottom floar (Including basement, crawlapace, or enolveure) Is „ p feet ❑ matars [1 above or Cj below the LAG.
G2. For �ullding Dlagr�me 8--9 wilii permanent flood openinga provided in Seotlon A Items 8 find/�r B(ee�e pagea 8—� of Inetructlorls), the next hfgher fiaor
(elevaUon C2.b in the diagrame) of tNe bulldin� Is j] feek ❑ metera ❑ above or fJ below the HAQ.
E3. Atlaohed garage (top of elab) Is [� feet ❑ 11�elers [� above or ❑ below lhe HAO.
E4. Top of plelform of machinery and/or equipment aervicing the building Is _� ❑ feet ❑.metere ❑ abave or � below ths NAO.
E6. �one Ap only; If no flood deplh number la avallable, is the tnp of the bott�bm flonr elevated in aocordanoe with the cammunity's tloodplaln management '�
, ordlnance? Cl Yes ❑ No ❑ Unknown. The local offlcial must certify thle informatlon In Septlan Q.
..«
3�CTIaN F- F'F�41p�RTY OWNER (OR OWN�R'8. REPRESENTA7IV�) G�RTIFICATION '-
The. property owner or owner's autltarized representaUve who obmpletes 5eotlona A, B, end E for Zone A(Witl�out.a FEMA-fseued or.commuNty-(saued BFE)
_ or Zone AO must ei�n here. The statements In Sectlona A,. B, and E are correct to tiie b�et of my knnwledge:
Property Owner's or Owner'e Authorized Repreaent�tivA's Name
Addres� Clty State zIP Code
5lgnature i bate 7elephone
�
Comments
[� ��]eG,�J�ere If attachments
w SECTION a— COMMUNI;7Y IN�ORMATIQN (DP'fiQNAL) �
1,h�.Iooai offtclat who Is authoriaed by law or ordinance ta administer tlie bommunity's fioodplaln management ordlnance cen complete Sect ons A, B;, C(or E), and O
af this Elevallon Certlllcate. Compietg ihe appllc9biaJtem(s) and sign below. Cheok lhe measur�ment used In Itema GQ-�C31d..1n Puerto Rico only, enter.metere.
C�1. ❑ 7he Informatlon In SecQon 0 was taken f�o►n other documentatlon that has heen slgned and aealed by a licensed eurveyor, engineer; or architect who
Is authorized Uy l�w fo verQfy elevation informatlon. (Inillcale the eource and date of the eleyation data in tfte Commenta area below.)
C�2. ❑ A community offlcial completed Sectlon E for a buliding Ioaated In Zone A(wlthout a FEMA-leaued or community-Isaued BFE) or �one AO.
C•i3. ❑ The following Infarmatlon (Items G4-010) la prnvlded for communlry floodplain m�na�ement purpoees:
f34. Pennit Number 05. Date Permlt Iseued 08. Date Cerlificate Of Compllance/Occupancy Issued .
C�7, Thls permlt hae been leaued for ❑ New Conetruclion [1 Substan0al Improvement `
G8. El�vation ol as-built lowest floor (Including basement) af the bulldinD: . C] feet CI meters Datum
G9. BFE ar (In Zone AO) depth of fiovding at lhe building slte: _� Q fe�t [� metera Datum
Cti10. Community's design flood elsvatltln: ❑ feet [� metere Datum �
Local Official's Name
Community Name
5lgnatura
Comments
Tltle
Telephone•
Dale �
� .__ ... . ...... . ....J
PLANNING & DEVELOPMENT DEPT
____ CI_TY OF Ci;EARWATER _
� �
`I� i' ♦
ELEVATION CERTIFICA7E, page 3 guilding Photographs
See Instructions for Item A6.
IMPORTANT: In these spaces, copy the corresponding informaltion from Section A. FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number.
. 1247 50. Hillcrest Avenue
City Statx ZIP Code Company NAIC Number.
Clearwater, Fl.
If using th .� ,' . sd insura�c af� .�e�st 2 building phot��taphs b�iow ac�orciing ta�,, .� ctions
for Item �, ith� "� �,,;, ,��`�'w' Rear Vieuv"; and� if�,requited,��-"Right Side Vaew",��' �, Side
�'` '�'" �� M'r'e resentative e�cam les of the flood � eri{r�1' � ��ts, as
View." W ,� ,t�; ' P p P �
indicated i on this page, use the Continu�tion Page.
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U.3:DEPARTMENLOEHOMELAND9ECURfTY ��,,,�vATIO� �,oEt�TIFI�A�'E . �
FEpEliAC EMER�BNGY MANAOEMENT AOENCY ' •
Nallhni�lJ%l�odlns�u•n,�cer,•og�•�„� , OMg No. 1660-0008 . �
Important: Read the iristructions on pages 1-D, Expiration Date: Jufy 31, 2015 �
' SECTION A-- F'�OPERTY INFORMATION
A1. BuilcYing Owner's Naine .i /_��� � � .. � � ', r � �F,'�{ .� ''�F;" ,
__ �� '% n1a��!/�, ��o '
_�(" 1�.1 S :
A2. Buiiding Street A dress (Includlng Apt,, Unif, Sulte�, and/or Bldg. No. or p.o. Route and Box No. , � ' ,
I 24= j � , i-{ I 1,-L- G�'� �. � -1- _ V f= ,,,,� c� c::� � � � _ � . U[ � � , �
city �� _. . �! i i � J
C-t,�/ !? ��.1,�" �. Slal�:i ZIP Code 1 � a�.
I�' c�° ��... �`ri
A3. Property Descrlptlon (Lot and Diock Numbere, Tax Parce Number, Le �iil Descrlptlon etc.)
L,aT }:/ Fo���.t>-r ��.,�.� �t,T_��_-�.�5� ���T�
A4. Buliding Use (e.g., Resldenllel, Non-�iesident a� Addltlon, Aao sso r, e�lo.) RL. a� t��.r,►-r, L,
A5. Latitude/Longitude; Lat. Z- v y— �
� Long. �, �, >,�," Horizontal Dalum: ❑ NAD 1927 NAD 1903
A6. flttach at least 2 photograp ia of the buliding If lhe Certlfioate le beln8 ueied to oblaln (Iood inauranoe:
, A7. Building Diagrem Numher �- �,
� A9. �or a building with a crawi9pace or enclosure(s): � � �
' a) ^uquare footage o( crawl� ace or encloaure(s) �� g� � A9. For A bullding wllh an attaqhed garage: . '
; b) Nurriber of permanant pl���l'openings In fhe crewiepace � � �) Square tootage ot altaohed gafege ?� � sy ft
or enclosure(s) withln 1�'t��t above ad)aceril gr'ade �) Number ot permanent ffood'openln8s In.tli �tt�ched garage
c) Totnl net area of flood oji�lilr'iga In AF3.b wlthin 1.O foot above adJ�cent grade. ���
d) Englneered flood openln9g'� ❑ Yes ���� �� .°) 7dl�f net area o( Oood openings In AJ.b � e in ,
❑ No cl) Englneered,flood openlnps2 [j Yes p
S�CTION B- F1,00D INSURAN�:E RAT� MAP (FIRM) INF'QRMATION ' 0 No
81. NFIP Community Name & Comn�uhlly�u`�mbUer .� B2. County Name � N C��
����� wf'��l"�.2 ` 1 �' � /� � B3. Stete �
- D�. MaplPanel Number B5, Suftix E18. FIRM index Date � `
87. FIFiM Panel �0.. Fiood B9: Base Flond Elevation("s) (Zone
� � 1 � � G `� � �%'� � � _ ! p EfFt�clive/Revised Date Zone s .
�'" � ��) AO; use base qood depfh)
' S-17-p�'.�- _ �,�
� 410. Indic,�a..l�e the source ot ihe Fiase Flood �levatlon (gFEj data or baee llood depth entered In Item BB.
L+i' ►-IS Proflle ' 0 FIRM ❑ Commuhlly Determined . � .
O Other%SOUrce; .. .
811. Indicate elevatlon dalum used forBFE I n i t e m B 9: [ j N o V D 1 9 2 9 � qVl7 1988
E312. is the buliding loceted In a Coestal Barrier Resources System (CBRS) area or Otl�ervvlav Proteo t� e d Arear{OPA)T.' .. 1] Yes`I' ,�..,�
Designatlon pate: C 7 CbRS . [] OPA � N0
SECTION C— BUILDIN� ELEVA ION (NFORMATIQN (SURV�Y REQUIRCD) _ .
C1. Buliding elevatlons are based on: ❑ Cvnatruotlon Drawlh98" ❑ E3uild(n� Under Conetrucfion' L Flnished Constructlon
"A new Elevatlon Certificate wlll be required when conattuction oF the �uilding is complete.
C2. Eievatlons —Zonee A1-A30, AE, AH, A(witli 8FE), VE, Vt—V3o, V(with BFE), AR, AR/A, AR/AE, AR/A1—A30, AR/AW, ARJAO. Complete Items C2.a—h
below according to the bufldlnp olagram specified In �tern A7. in Puertb Rico only, enter rnetaYs.
Benchmari< Utlilzed: ���T ��� C t—W 2� D� �°v- Verilc�l Dalum: z-'r'� �� �
Indicate elevaUon datuhi uaed (or the elevatlone in Itema a) throuph h� belaw. ❑ NOVD 1929 NAVD:1999 0 Other/Souroe;
Datum used lor bullding elevallons musl be the eame ae that ug�d for ttie BFE. . ''
Checic,t_h..,e �measurcment used:
a) Tvp o( bottom floor {I�dudiny ba3eiitent, crawispaco, or enclosure Ooor) �, � Ly'feet ❑ meters
b) Top of the next higher floor .�7 feet � tnetera �
c) B o l t o r n o f t l t e l o w e s t h o t i zo n ta l s truc ture l mein ber (V Zones only) � [j� et ❑ meters
• d) A t tac he c l garage (top of slab) 2� [� fe t � metere
e) Lowest �levatlon of inechinery or eyulpment servl�ing the building � G� ti eet [I meters
(Desctitie t y pe of e qttl pm� ht e n d I o c a l l o n I n C o m m en ta) .
� Lowest adjecent (finlshed) grade next t6 buliding (LAO) ? a� [�et ❑ meters �
g) Higitest adJacent (flnished) grade next lo bullding (HAd) �, �i Q�et. . 0 meters
h) Lowest adjacent grade at loweat elevallon of deck or stalrs, Incfuding struetural eupport ��'� ❑ feet ❑ meters
SECTION D- SURVEYOR, �NOINLER, OR ARCHfT�CT CERTIFICdTI�N � �
Tlils cerlitical(on Is to be signed and sealed by a lahd surveyor, englneer, or architecl autliorized by law to certify elevation
informatlon. I ceKlry lhat (/re lnformeflon on fhls Certlflcafe represenfs my best elfoKs fo lnteipr'ef Ure dafe avalleG/e.
I and��sfand tl�at any /alse slafament �iiay be punlshsG/e Gy flne orltnprfsonrnenf under YO U.S. Code, Sec(lon 1001.
��Check here If comments are prt�vlded on beck of forrn. Were lelltude and Iongitude fn 3ec lon A provided by a
LYCheck here if ettachrnenls. Iicensed lend surveyot7 , � es ❑ No -
Certlfler`s Naine LARRY L. EVANS Ucense �lumber PLS �F 2937
71fie LAND SURVEYOR Company Nam� EVAN9 L.AND SURVEYINO, IMC. �
Address 1460 BELTREES S� STE. 9 Clty DUNEDiN, 8tale FL ZIP Gotle 34098
�
Signature � , �� � Dale - �'
�,t�,� } �` 1 f�'l-�-� f� �'1 Z.� �'j...� t� Telephone (727) 734-3(i7_1
�� ., � ? � .•i�� ���"ti .r �. :���C � �: r"-r � � rn� � .
� ��'la�i�.x 2 } . y �?^ '�'?o� ��.ay� ���'�s"�/'�rr��� � i�3..
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