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15 MIDWAY ISLAND� U.S.D�PARTMENTOFHOMELANDSECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 National Floodlrtsurance Program Important: Read the instructions on pages 1-9. Expiration Date: July 31, 2015 SECTION A - PROPERTY INFORMATION $� A1. Building Owner's Name TOM & GLORIA NICHOLSON ,;; �, , y� � A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 15 MIDWAY ISLAND s�� ,�_. n. � City CLEARWATER State FL ZIP Code 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 18, UNIT 3 ISLAND ESTATES OF CLEARWATER - PARCEL # 08-29-15-43344-000-0180 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27.9744°N Long. 82.8125°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 7 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) 2973 sq ft a) Square footage of attached garage N/A 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 0 within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b 0 sq in c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number 62. County Name � CITY OF CLEARWATER 125096 PINELLAS 64. Map/Panel Number 65. Suffix B6. FIRM Index Date 67. FIRM Panet B8. Flood Zone(s) Effective/Revised Date 12103C0102 G 8-18-09 9-3-03 AE 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)? Designation Date: N/A ❑ CBRS ❑ OPA B3. State FLORIDA B9. Base Flood Elevation(s) (Zone AO, use base flood depth) 11' & 12' ❑ Yes � No 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: DUNNELLON CORS ARP 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 (incfuding basement, crawlspace, or enclosure floor) 6.62 b) Top of the next higher floor N/A c) Bottom of the lowest horizontal structural member (V Zones only) N/A d) Attached garage (top of slab) N/A e) Lowest elevation of machinery or equipment servicing the building N/A (Describe type of equipment and location in Comments) � Lowest adjacent (finished) grade next to building (LAG) 5.7 g) Highest adjacent (finished) grade next to building (HAG) 6.0 h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support N/A Check the measurement 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 authorized by law to certify elevation information. I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or impnsonment under 18 U. S. Code, Section 1001. ;<+,� ��, y' �; � Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a •' �'�, A. S`'t •, � Check here if attachments. licensed land surveyor? � Yes ❑ No , ' 4�;.-•`" '�� „« � tG rtsaE t�11 `' 1p " Certifier's Name GEORGE A. SHIMP III Job Number 150197-B License Number 6137 Title VICE PRESIDENT Company Name GEORGE A. SHIMP II & ASSOCIATES, INC. Address 3301 DeSOTO BLVD., SUITE D City PALM HARBOR State FL ZIP Code 34683 FEMA Form 086-0-33 (7/12) Date 10-14-15 Telephone 727-784-5496 See reverse side for continuation. C` � �.�'� i,.�Q.. � � en �. � 'r� tu1o� 61 T. � - � a . �t _ ". �f, �'. 31Acls= f}F . '#6'�3y•�ate«�� ', ''8( • F: :;�,,... ,.a.i � t,� Replaces all previous editions. .9 � 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. 15 MIDWAY ISLAND City CLEARWATER State FL ZIP Code 33767 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 SEE PAGE 5 FOR SURVEYOR'S COMMENTS (THIS DOCUMENT IS NOT VALID WITHOUT ALL 5 PAGES) Signature Date 10-14-15 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 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 enclosure) 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 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 owners 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's 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 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 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—G10) 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 G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters G10. Community's design flood elevation: ❑ feet ❑ meters Local Official's Name Community Name Signature Comments Title Telephone Date Datum Datum Datum Check here if attachments. FEMA Form 086-0-33 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 3 guilding Photographs See Instructions for Item A6. 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. 15 MIDWAY ISLAND City CLEARWATER State FL ZIP Code 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. FEMA Form 086-0-33 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 4 guilding Photographs Continuation Page 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. 15 MIDWAY ISLAND City CLEARWATER State FL ZIP Code 33767 FOR INSURANCE COMPANY USE Policy Number: Company NAIC Number: If submitting more photographs than will fit on the preceding page, affix the additional photographs below. 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. � � �� =�:�:, � . �_ -,,. .. �� :�. � � �� z, � - � � � � `" �, q� ,: p2� � � � , `T -& , .'F 1�. �*,�� k � Z.... .;S .Y. .di► L. -.. ' �. �p �� ?� �: f ' . � Jt It �. � a . . .'� . � �: , ,. ' � �tI � :� _ ,_= ;— i . � � r� � -� x 3 ��` .R, 1 � ` �- �'"' o a� %: ✓ .� ,�� ,;� � _ '��C* �1��+� F � t ��'{m �+5: "� '� 4 �i � . ., ..�u� � . � � . � � ��..: � � � �'•' � '"°f r ., ,,. „�t +a { "� °� �.a�* j ' ,r ' �. � ', � • r � � i `y � C.:._-i..�a � . ,��' � � A � �' ' � ) } � Z � 1 � c � 3� -� � � ..�f� � r< i� � ! Yx � �� ' .i �� a �. � � - Z 1 + � ' ' - � � .. : t.. '�6 #' � � i� � . ' 8 i A' f'r � 3 � ��jF`: ��. } �� .•�t y `� t� . ti ��"' �1.� z �i� ' s . ` '�:"'. , . �� :�, �� '�� .� �, .1 ; , _.., i�� J .�t �3'3 .i - �.f �\ . �'! � . . .'l. _ �1 z . , . 1"s .. _. ` � - . � . REAR VIEW Picture taken on: 10-14-15 FEMA Form 086-0-33 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 5 IMPORTANT: in these spaces, copy the Surveyor's Notes Continuation Page ing information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 15 MIDWAY ISLAND City CLEARWATER State FL ZIP Code 33767 SECTION D— SURVEYOR'S CERTIFICATION (CONTINUED FROM PAGE 2) A1. ) THIS ELEVATION CERTIFICATE WAS PREPARED EXCLUSIVELY FOR THE USE AND BENEFIT OF THE PARTY SPECIFIED IN SECTION A, ITEM 1, FOR THE SPECIFIC PURPOSE OF OBTAINING FLOOD INSURANCE AND/OR VERIFYING FLOOD ZONE COMPLIANCE WITH THE LOCAL GOVERNING AUTHORITY. THIS DOCUMENT SHALL NOT BE VALID AND BINDING AGAINST THE SIGNING SURVEYOR WITHOUT THE ORIGINAL RAISED SEAL AND SIGNATURE OF THE FLORIDA LICENSED SURVEYOR AND MAPPER. USE OF THIS DOCUMENT BY ANY OTHER PARTY OR FOR ANY OTHER PURPOSES IS STRICTLY PROHIBITED AND SHALL RENDER THIS DOCUMENT INVALID FOR THOSE PURPOSES. UNAUTHORIZED COPIES ARE STRICTLY PROHIBITED AND SHALL NOT BE VALID. REQUESTS FOR ANY ADDITIONAL OFFICIAL SIGNED AND SEALED COPIES MUST BE DIRECTED TO GEORGE A. SHIMP II & ASSOCIATES, INC. A4.) THE BUILDING USE WAS DETERMINED BY PHYSICAL OBSERVATIONS MADE ON THE DATE OF SURVEY. A5.) THE LATITUDE AND LONGITUDE COORDINATES WERE OBTAINED USING A HAND HELD G.P.S. UNIT WHICH MEETS OR EXCEEDS FEMA'S REQUIRED ACCURACY OF 66 FEET. A7.) THE BUILDING DIAGRAM NUMBER WAS DETERMINED BY PHYSICAL OBSERVATIONS MADE ON THE DATE OF SURVEY. CERTAIN STRUCTURAL FEATURES NOT VISIBLE TO THE SURVEYOR (PILINGS, GRADE BEAMS, ETC.) OR USE OF ANY AREAS BELOW THE BASE FLOOD ELEVATION THAT DOES NOT COMPLY WITH FEMA REGULATIONS CAN AFFECT THIS DETERMINATION. A8.) FOR THE PURPOSE OF THIS DOCUMENT, A BUILDING ENCLOSURE IS DEFINED AS THAT PORTION OF AN ELEVATED BUILDING, BELOW THE LOWEST ELEVATED FLOOR, THAT IS EITHER PARTIALLY OR FULLY SHUT IN BY RIGID WALLS. A GARAGE BELOW OR ATTACHED TO AN ELEVATED BUILDING IS CONSIDERED AN ENCLOSURE. SUCH AREAS SHALL NOT CONTAIN MORE THAN 20 LINEAR FEET OF FINISHED INTERIOR WALLS (PANELING, ETC.) OR IT WILL BE CONSIDERED A FINISHED (HABITABLE) AREA. IF APPLICABLE, THE STRUCTURE CONTAINS: ❑ CRAWLSPACE � ENCLOSURE ❑ ATTACHED GARAGE ❑ N/A IF APPLICABLE, THE CRAWLSPACE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER N/A SQ. FT. PER OPENING (MANUFACTURER: N/A — MODEL: N_ /A). IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER N/A SQ. FT. PER OPENING (MANUFACTURER: N/A — MODEL: N/�. IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAINS: N/A IF APPLICABLE, DOES THE BOTTOM FLOOR ENCLOSURE APPEAR TO CONTAIN BREAK-AWAY WALLS? ❑ YES ❑ NO � N/A A9.) IF APPLICABLE, THE ATTACHED GARAGE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER N/A SQ. FT. PER OPENING (MANUFACTURER: N/A—MODEL: N/A). A8. & A9.) FOR THE PURPOSE OF THIS DOCUMENT, A FLOOD OPENING IS DEFINED AS A PERMANENT OPENING IN AN EXTERIOR WALL THAT IS NO HIGHER THAN 1.0 FOOT ABOVE THE HIGHER OF THE EXTERIOR OR INTERIOR GRADE OR FLOOR IMMEDIATELY BELOW THE OPENING. B8.) UNLESS OTHERWISE NOTED IN SECTION B, ITEM 10, THE FLOOD ZONE WAS DETERMINED BASED ON THE FLOOD INSURANCE RATE MAP. IN CERTAIN CASES WHERE AN ACCURATE DETERMINATION COULD NOT BE MADE FROM THE MAP, THE COUNTY'S G.I.S. OVERLAY MAY HAVE BEEN UTILIZED TO DETERMINE THE FLOOD ZONE. NO SEARCH OF THE PUBLIC RECORDS WAS PERFORMED FOR LOMA'S, LOMR'S, ETC. WHICH MAY AFFECT THE SITE. C2.e) NO MACHINERY AND/OR EQUIPMENT HAS BEEN INSTALLED. BOTTOM OF ELEVATOR PIT ELEVATION = 5.91' U.S. DEPARTMENT OF HOAAELAIVD SECURITY OMB No. 1660-0008 Federal Emergency Management Agency Expiration Date: November 30, 2018 � National Flood Insurance Program ELEVATION CERTIFICAiE �� -D � � ` Smq��a�dara�: Follow the instructions on pages 1-9. Copy all pages of this Eleva4ion Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. SECTIOld A— PROPE9�TV IN1E'ORAAAT90N FOR IIVSURANCE COIUIPANY USE A1. Building Owner's Name Policy Number: T011A & GLORIA IVICHOLSON A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company iVAIC IVumber: Box No. 15 IVIIDWAY ISLAfVD City State ZIP Code CLEARWATER FLORIDA 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 18, UfVIT 3 ISLAiVD ESTATES OF CLEARWATER - PARCEL # 08-29-15-43344-000-0180 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27.9744° fV. Long. 82.8125° VN. Horizontal Datum: ❑ NAD 1927 0 NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram iVumber 7 1 A8. For a building with a crawlspace or enclo�ure(s): a) Square footage of crawlspace or enclosure(s) 2973 sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade g c) Total net area of flood openings in A8.b 3226 sq in d) Engineered flood openings? ❑ Yes 0 iVo A9. For a building vvith an attached garage: a) Square footage of attached garage N/A sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade �y/,q c) Total net area of flood openings in A9.b �/,q sq in d) Engineered flcod openings? ❑ Yes � No SE��'IORI �— F�.�OD 9�4YSa912�eB49�E 9t�TE INm�P jEBBaIN) 89VF�RIYIATI�B�7 B1. NFIP Community Name & Community IVumber 62. County Name B3. State CITY OF CLEARWATER - 125096 PINELLAS COUIVTY FLORIDA 64. Nlap/Panel 65. Suffix 66. FIRM Index B7. FIRM Panel 68. Flood Zone(s) B9. Base Flood Elevation(s) Number Date Effective/ (Zone AO, use Base Revised Date Flood Depth) 12103C0102 G 8-18-09 9-3-03 AE 11' & 12' 610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: ` ❑ FIS Profile � FIRIVI ❑ Community Determined ❑ Other/Source: 611. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � IVAVD 1988 � Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? � Yes ❑x IVo Designation Date: N/A ❑ CBRS ❑ OPA FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 OMB No. 1660-0008 ELEVATIOI�I CERTIFICATE Expiration Date: November 30, 2o�s 9NNPORTs4NT: Ira tlte�� space�, copy the cou�respondang aaafo��t6��o ipo�'o S�c�OOrta A. FOR INSURANCE COMPAIVY USE Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box fVo. Policy Number: 15 AflIDWAY ISLAND City State ZIP Code Company NAIC Number CLEARVVATER FLORIDA 33767 SECI'ION � — �999LDBNi'a EL�ATB�N @9�F�RIYEATB�1� QS�IRVE� 92EGiUIRED) C1. Building elevations are based on: ❑ Cons4ruction Drawings* ❑ Building Under Construction* Q Finished Construction *A new Elevation Certificate wrill be required dvhen construcfiion of the building is complete. C2. Elevations — Zones A1—A30, AE, AH, A(with BFE), VE, V1—V30, V(with BFE), AR, AR/,4, 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: DUiVYVELLON CORS ARP Vertical Datum: YV.A.V.D. 1988 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 x❑ IVAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 6, 76 �x feet ❑ meters b) Top of the next higher floor 17 , 59 �x feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) �.� � feet ❑ meters d) Attached garage (top of slab) �. A ❑x feet ❑ meters e) Lowest elevation of machinery or equipment seroicing the building � 2. 55 �x feet ❑ meters (Describe type of equipment and location in Comments) fl Lovvest adjacent (finished) grade next to building (WG) �. 2 �x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 6, 5 � feet ❑ meters h) Lowrest adjacent grade at lowrest elevation of deck or s4airs, including �. A � feet ❑ meters structural support S��Y9�N � — Sfl�93@/��R, �B�2a9B��R, �Q� �►ffF�I�B��CF �ERT9�9��A'8'BON 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 the information on this Certificate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishable by fine or imprisonment under 98 U. S. Code, Secfion 9001. VVere latitude and longitude in Section A provided by a licensed land surveyor? ❑x Yes ❑ No 0 Check here if attachments. Certifier's Rlame License Number GEORGE A. SHIIUIP III 6137 Title Job iVumber P(ace VICE PRESIDER�T 150197-C sea� Company Name Here GEORGE A. fiHIIVIP II & ASSOCI,4TES, ING �/�`,�p' ��'�°�� „�,.-- Address 3301 DeSOTO BOULEVARD, SUITE D # 613i Date: 9-7-2016 City Sfate ZIP Code (�yot valid unless embossed uvith PALNI HARBOR FLORIDA 34683 surveyor's original raised seal) Sjgr�ature � � Date Telephone f!`' 9-7-2016 727-784-5496 Copy all pages of fhis E evation Certificate and all attachments for (1) community official, (2) insurance agenUcompany, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) SEE ATTACHMENT PAGE 7 OF 7 FOR SURVEYOR°S NOTES AND COIVIMENTS. TFiIS DOCUNIENT IS NOT VALID UNLESS SIGNED AND EIUI�OSSED VVBTH THE SUFtVEYOR°S ORIC�BR9,4L RAISED SEAL AND 11AUST GOIVTAIN ALL 7 PAC�ES. FEMA Form 086-0-33 (7/15) Replaces all previous edi4ions. rorm rage L or u ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 IIIAPORTANT: In thes� spaces, copy the corresponding inforrnation froce� Secfion A. FOR INSURANCE COMPAIdY USE Building Street Address (inciuding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number. 15 11flIDWAY ISLAIVD City State ZIP Code Company NAIC Mumber CLEARWATER FLORIDA 33767 SECTION C— BUILDiNG ELEVATIOPd BIdF012MAYlON (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construdion Drawings* ❑ Building Under Construction` ❑x Finished Constructio� `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: DUNNELLON CORS ARP Vertical Datum: N.A.V.D. 1988 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 Q NAVD 1988 � Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor (inGuding basement, crawlspace, or enGosure floor) 6. 76 �x {�eet � meters b) Top of the next higher floor 17 , 59 �x fieet � meters c) Bottan of the lowest horizontal structural member (V Zones only) �. A �x feet ❑ meters d) Attached garage (top of slab) N. A �x {�eet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 12 , S5 0{,�{ �� (Describe type of equipment a�d location in Comments) t� Lowest adjacent (finished) grade next to building (LAG) 4. 2 x0 feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 6, 5 �x feet � meters h) Lowest adjacent grade at lowrest elevation of dedc or stairs, induding N, A �x f�eet � meters structural support SECTIOPI D— SURVEY09t, ENiGBYdEE92, OR �eRCHYTECT GER'iIEICATION9 This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I ce►6fy that the information on this Ceriificate represents my besf eff� to interpret the data available. I understand that any false statemenf may be punisi►able by fiine or imprisonment under 98 U. S. Code, Sec�ion 1001. VVere labtude and longitude in Section A provided by a licensed land surveyor? ❑x Yes ❑ No Qx Chedc here if attachments. Certifier's iVame License idumber GEORGE A. SHINflP III 6137 Tdle Job Number VICE PRESIDENT P�a`� 150197-C �,� Company Name Here GEORGE A. SFiIAAP II & ASSOCIATES, IIVC. �� /l „-�' ,4ddress �� 3301 DeSOTO BOULEVARD, SUITE D # 6137 Date: 9-7-2016 ��tY State ZIP Code (Not valid uNess embossed with PALIIA HARBOR FLORIDA �83 surveyor's original raised seal) S' ature Date Telephone � � � 9-7-2016 727-784-5496 Copy all pages of this E evation Certificate and all attachments for (1) community offiaal, (2) insurance agenUcompany, and (3) building owner. Comments (inGuding type of equipment and location, per C2(e), if applicable) SEE ATTACHMENT PAGE 7 OF 7 FOR SURVEYOR'S NOTES AND COMMENTS. THIS DOCUMENT IS NOT VALID UNLESS SIGNED AIVD EAABOSSED WITH THE SURVEYOR'S ORIGINAL RAISED SEAL AND MUST CONTAIRI ALL 7 PAGES. FEAAA FoRn 086-0-33 (7/15) Replaces all previous editions. FoRn Page 2 of 6 OMB No. 1660-0008 ELEi/e4i101�1 CEI�TIFICe4TE Expiration Date: November30, 20�8 IMPORTANT: In these space�, copy the corresponding BnfomeatBoro frorea Sec�'ao�o A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. IVo.) or P.O. Route and Box No. Policy Number: 15 nflIDWAY ISLAND City State ZIP Code Company NAIC Mumber CLEARWATER FLORID�4 33767 SE�TBOf� E—�U9LD�NG EL.EVAT90BV �NFORNI�►TION (SURi�EY NOT REQUIliED) FOi2 ZOIeIE �►O A►1lYD ZOIVE e� (WBTB�B�U7' �EE) For Zones AO and A(without BFE), complete Items E1—E5. If the Certificate is intended to support a LOPAA or L011�R-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 4o show whether the elevation is above or below the highesi adjacent grade (HAG) and fhe 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 basemen4, crawrispace, or enclosure) is . ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-9 vvith permanent flood openings provided in Section A Items 8 and/or 9(see pages 1-2 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 equipmen4 senncing 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 uvith the community's floodplain management ordinance? ❑ Yes ❑ IVo ❑ Unknown. The local official must certify this information in SecYion G. S�CTlOBd F— PISOP�9�T� OWNER (09� �1R/Bd�R'S 88EPRES�9dT,��BQ/E) CEiZT9FBCAi90B� 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 statemenfs in Sections A, 6, and E are correct to the best of my knowledge. Property Owrner or Owner's Authorized Representative's Name Address City State ZIP Code Signa4ure Date Telephone Comments ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6 OMB No. 1660-0008 ELEi/�►TION CERTIFICATE Expiration Date: November 30, 2o1s IMPORTANT: Ira the�e spaces, copy the co�respond'o�og inffo�ot'�iion fPOm Section ,4. FOR INSURAiVCE COMPAIVY USE Building Street Address (including Apt., Uni4, Suite, and/or Bidg. Rlo.) or P.O. Route and Box No. Policy Idumber: 15 IVIIDWAY ISLAND City S4ate ZIP Code Company NAIC IVumber CLEARWATER FLORIDA 33767 S��°�oo� � — �o��Ne°�v s��►��o� (o�°�ao�v�►�) 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 Cerfificate. Compiete 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 faken from other documentation that has been signed and sealed by a licensed sunreyor, engineer, or architect who is au4horized by law to certify elevation information. (Indica4e the source and da4e of the elevation data in the Comments area below.) G2 ❑ A community official completed Sec4ion 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—G10) 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: ❑ iVew Construction ❑ Substantial Improvement G8. Eleva4ion of as-builfi lowest floor (including basement) of the building: ❑ feet ❑ meters Da4um G9. BFE or (in Zone ,40) depth of flooding a4 the building site: . ❑ feet ❑ meters Datum G10. Community's design flood elevation: . ❑ fee4 ❑ meters Datum Local Official's Name Title Community Name Telephone Signa4ure Date Comments (including type of equipmen4 and location, per C2(e), if applicable) ❑ Check here if attachments. FEn/IA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 OMB No. 1660-0008 ELEVATION CERTIFICATE Expiration Date: November 30, 20�8 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No. Policy Number. 15 11AIDWAY ISLAND �i{y State ZIP Code Company NAIC Number CLEAR1n/ATER FLORIDA 33767 SECTION G - COIIANIUNI'�Y INFORMATIOIV (OPTIONAL) The locai official who is authorized by law or orclinance 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 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 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-G10) 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. Eleva6on of as-built louvest floor (including basement) �t meters of the building: . ❑ ❑ 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 Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) � ❑ Chedc here if attachments. FENAA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 ��'�8�`� �� OMB IVo. 1660-0008 ��8�� FB��E See Instruc4ions for Ifem A6. Expiration Date: IVovember 30, 2018 BBl�P��eB��': 60� �@��se s�a�es, ��y� �9a� ��v��o� sa�ff�o°�o��a��o ff��vo ��uoa� A. FOR IiVSURANCE COMPAfVY USE Building Street,4ddress (including Apt., Unit, Suiie, and/or Bldg. No.) or P.O. Route and Box fVo. Policy Rlumber: 15 MIDWAY ISL,4ND City State ZIP Code Company NAIC Rlumber CLE,4RWATER FLORID,4 33767 If using the Elevation Certificate to obfiain YVFIP flood insurance, affix at IeasY 2 building pho4ographs below according to the insYructions for IYem A6. Identify all photographs wifih daie faken; "Front View" and "Rear View"; and, if required, "Right Side Vi�w" and "Left Side View." When applicable, phoiographs must show fhe foundation with representafive examples of the flood openings or venfis, as indicated in Section A8. If submit4ing more photographs than will fit on this page, use the Continuafion Page. � �� ; .;: ;��.. �� r� - _..�;>„,.., �� °�-�-� ��>.; � � -�� „�� ' � ,� , � - �= �-�.� �„ �.� � �� - j � � - � _ ,� i� � E� � � � ��„� � — � �r�_ ,�� .. =. ,.. .. ^-. , .. ... _ � � .:.+ n ` , ±-' . �`�; ` �..—,...,... �; � s ' .� � • . �, - , :_�� .F r� + �E >� � � _ � � _ = , � � � .. .. -_ � -� � �,�� j, tYti�..��'. _ __,. � t,; I _ w- . ., ._ . . - '� . - � i ,� ._ . . ._ __ . �,. _ _ _ � _ _° .,� __. w x . - •- , , . �_, ,�-- .�- _ • �.,�.. „, � � �- � �, „ � , � - �, �, - � , ` � � . �* ._ � _ � _ , *,� � � � � - � � Photo One Phofo One Caption FRONT VIEW 5-7-2016 � . � .-��,,. ry�;l _� _ ' - =�.,,. # ��' " �.-.: � .�; _ • - . �-..�,. �� ,t; , • . .� �.. �, � ,�: � �� '� �� -- V � _ � , � � �s � � � .-- . _ � � „_ •� < � �: ,, � � u.. , ^°-a; -, �,� — _ : _ � _ ..=a��€;"� �,„; �� , � = � — �� —�- „ � ° r� ` _ � �` ' ;=�° _ —_�� f � .. �� ... �,. E''"' -�, .. _ . �.z�" . . ; . ,. . ', P' ! .... µ ; .. .. w' � _ - ..� ��K � .�Y... � . . A � __�. . , - . � � . ..._.._ ..... . . . . � s� � .. .. ' �, � � � & -' • � � i ' - e.^` w!'.. . < � r, a _ c �� ; � w �t,. .:�. � � .� ' .. .. ,. ��.,.... ., � . ,.�� ,y rv . .... $ ;++��• ... . ::. i= �Mr �., 1 -fi- I;+q .� � " , ` t . ` , ..« �r � _ .. , .n- � . � ,.T',«; . . - ... ( . . . . Photo Two Photo'fwo Caption REAF2 VIEW 9-7-2016 r-�IVIW Form o�6-0-33 (7/15) Replaces all p�evious eoliTions. Form Page 5 ofi 6 BU9LDIN� PH01'��I��B� OfUIB fVo. 1660-0008 ��°I'�� 'B�Ot��,�� Continuation Page Expiration Date: Rlovember 30, 2018 9Y1�P��TAPd�: 9�0 �B��s� �g��, ��y 89�� sg��u�ao�g ou��'�a°aaoa�a�oro ffo��u S��aa�o� �, FOR I�ISURARICE CONiPAiVY USE Building Sfreet Address (including Ap#., Unif, Suite, and/or Bldg. Rlo.) or P.O. Rou4e and Box iVo. Policy Number: 15 MIDWAY ISLAiVD City State ZIP Code Company i�,41C i�umber CLEARWATER FLORIDA 33767 If submitting more photographs than will fit on the preceding page, affix the additional pho4ographs below. Identify all phofographs with: date taken; "Front View" and "Rear View'; and, if required, "Righ4 Side View" and "Left Side View." When applicable, phofiographs must show �he foundation wi4h represenfiative examples of 4he flood openings or venfs, as indica4ed in Seciion A8. '�''u �.. � �', �_; Photo One Photo One Caption �I/P, � �!' : � `' Photo Two Phofo Two Cap4ion f�/A FEi1lII-1 Form 086-0-33 (7/15) Replace� all pre»io� �s editions. Form Page 6 of 6 FLOODPROOFING CERTIFICATE FOR NON-RESIDENTIAL STRUCTURES (Continued) Instructions for Completing the Floodproofing Certiflcate for Non-Residential Structures receive credit for floodproofing, a completed Floodproofing Certificate for Non-Residential Structures is required for non-residential and �iness buildings in the Regular Program communities, located in zones A1—A30, AE, AR, AR Dual, AO, AH, and A with BFE. n order to ensure compliance and provide reasonabte assurance that due diligence had been applied in designing and constructing loodprooflng measures, the following information must be provided with the completed Floodproofing Certificate: • Photographs of shields, gates, barriers, or components designed to provide floodproofing protection to the structure • Written certification that all portions of the structure below the BFE that will render it watertight or substantially impermeable to the passage of water and must pertorm in accordance with Title 44 Code of Federal Regulations (44 CFR 60.3 (c)(3)) • A comprehensive Maintenance Plan for the entire structure to include but not limited to: o.,.,., � ,.o e _�_ . _. . BUILDING PHOTOGRAPFIS onna No. �sso-000s ELEVATION CERTIF9CATE Continuation Page Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding inforn�ation from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box IVo. Policy Number. 15 11flIDWAY ISLAND City State ZIP Code Company IdAIC Number CLEARWATER FLORIDA 33767 If submitting more photographs than avill fit on the preceding page, affix the additional photographs belanr. Identify all photographs with: date taken; "Fron4 �ew" and "Rear vew' ; and, if required, "Right Side View" and "Left Side vew." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. P��•� �i�t�e P1,oto a,e Photo One Caption N/A ��3�at� ��riJCa Photo Two Photo Two Caption RI/A FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 ELEVATION CERTIFICATE IMP092iAN7': In these spaces, copy tFo� Surveyor's Notes Attachment Page 7 onformatiora ff�o�ra S�ctu��a A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box IJo. 15 MIDWAY ISL,4ND C�y State ZIP Code CLEARWATER FLORIDA 33767 OMB No. 1660-0008 Expiration Date: November 30, 2018 FOR IPISURANCE COMPANY USE Pdicy Number: Company NAIC Number s�c�ao�a � — sa�aav�vo�a�s ��ra�acaa�s�� cora�'NU�� onn ��►�� a, A1. ) THIS ELEVATION CERTIFICATE WAS PREPARED EXCLUSIVELY FOR THE USE AIVD BENEFIT OF THE PARTY SPECIFIED IN SECTION A, ITEM 1, FOR THE SPECIFIC PURPOSE OF OBTAINIIVG FLOOD IfVSURANCE AiVD/OR VERIFYING FLOOD ZONE COf1NPLIAiVCE WITH THE LOCAL GOVERNING AUTHORITY. THIS DOCUIVIENT SHALL fVOT BE VALID AND BIfVDING AGAIIVST THE SIGIVIfVG SURVEYOR WITHOUT THE ORIGINAL RAISED SEAL AfVD SIGIVATURE OF THE FLORIDA LICENSED SURVEYOR AIVD MAPPER. USE OF THIS DOCUIIAENT BY ANY OTHER PARTY OR FOR ANY OTHER PURPOSES IS STRICTLY PROHIBITED AND SHALL REfVDER THIS DOCUMEIVT IfVVALtD FOR THOSE PURPOSES. UNAUTHORIZED COPIES ARE STRICTLY PROHIBITED AIVD SHALL MOT BE VALID. REQUESTS FOR AIVY ADDITIONAL OFFICIAL SIGNED AND SEALED COPIES iVIUST BE DIRECTED TO GEORGE A. SHIIUP II & ASSOCIATES, INC. A4.) THE BUILDING USE WAS DETERfVIINED BY PHYSICAL OBSERVATIOfVS fViADE ORI THE DATE OF SURVEY. A5.) THE LATITUDE AND LOfVGITUDE COORDIiVATES WERE OBTAINED USING A HAiVD HELD G.P.S. UNIT VVHICH nflEETS OR EXCEEDS FEIVIA'S REQUIRED ACCURACY OF 66 FEET. A7.) THE BUILDIIVG DIAGRAM NUMBER WAS DETERIVIIiVED BY PHYSICAL OBSERVATIOIVS �/IADE OfV THE DATE OF SURVEY. CERTAIfV STRUCTURAL FEATURES fVOT VISIBLE TO THE SURVEYOR (PILIMGS, GRADE BEAMS, ETC.) OR USE OF ANY AREAS BELOVN THE BASE FLOOD ELEVATIORI THAT DOES NOT CONiPLY VVITH FEMA REGULATIOIVS CARI AFFECT THIS DETERnAINATIOIV. A8.) FOR THE PURPOSE OF THIS DOCUMENT, A BUILDING EfVCLOSURE IS DEFINED AS THAT PORTION OF AN ELEVATED BUILDING, BELOW THE LOWEST ELEVATED FLOOR, THAT IS EITHER PARTIALLY OR FULLY SHUT IN BY RIGID WALLS. A GARAGE BELOW OR ATTACHED TO AN ELEVATED BUILDIfVG IS COfVSIDERED AfV EIVCLOSURE. SUCH AREAS SHALL NOT COiVTAIN 11AORE THAN 20 LIiVEAR FEET OF FIRIISHED IRITERIOR WALLS (PAMELING, ETC.) OR IT WILL BE COMSIDERED A FINISHED (HABITABLE) AREA. IF APPLICABLE, THE STRUCTURE CONTAINS: ❑ CRAWLSPACE ❑� ENCLOSURE ❑ ATTACHED GARAGE ❑ N/A IF APPLICABLE, THE CFL4VVLSPACE COIVTAIIVS N�A ENGIfVEERED FLOOD OPENI(VG(S) CERTIFIED TO COVER fV/A SQ. FT. PER OPENING (MANUFACTURER: RI/A — NiODEL: iV/A ), IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAIIVS RI/A ENGIfVEERED FLOOD OPEfVING(S) CERTIFIED TO COVER IV/A SQ. FT. PER OPENING (MANUFACTURER: N/A — MODEL: N/A ). IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAINS: GARAGE AREA, STORAGE AREA & STAIRS IF APPLICABLE, DOES THE BOTTOIVI FLOOR ENCLOSURE APPEAR TO COfVTAIfV BREAK-AWAY WALLS? ❑ YES � NO ❑ N/A A9.) IF APPLICABLE, THE ATTACHED GARAGE CORITAINS N�A ENGIRIEERED FLOOD OPENING(S) CERTIFIED TO COVER N/A SQ. FT. PER OPEiVIiVG (IVIANUFACTURER: RI/A — fV10DEL: N/A ). A8. & A9.) FOR THE PURPOSE OF THIS DOCUf1AENT, A FLOOD OPEIVING IS DEFIRIED AS A PERNIANEfVT OPENING IiV AN EXTERIOR V1/ALL THAT IS fV0 HIGHER THAN 1.0 FOOT ABOVE THE HIGHER OF THE EXTERIOR OR INTERIOR GRADE OR FLOOR IMfiIIEDIATELY BELOW THE OPENIiVG. B8.) URILESS OTHERWISE fVOTED IIV SECTIOfV B, ITEM 10, THE FLOOD ZONE WAS DETERMIIVED BASED OfV THE FLOOD IIVSURANCE RATE IVIAP. IRI CERTAIN CASES VVHERE AN ACCURATE DETERI�INATIO(V COULD NOT BE MADE FROM THE IVIAP, FEMA'S INTERACTIVE IVIAP OR THE COUNTY'S G.I.S. OVERLAY MAY HAVE BEEIV UTILIZED TO DETERMINE THE FLOOD ZONE. NO SEARCH OF THE PUBLIC RECORDS WAS PERFORfVIED FOR LOMA'S, LOMR'S, ETC. WHICH MAY AFFECT THE SITE. C2.e) AIR COIVDITIONER LOCATED ORI AIV ELEVATED WOOD DECK. Attachment Page 7 of 7