490 POINSETTIA AVEU.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008
Federal Emergency Management Agency Expiration Date: November 30, 2018
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
Copy ail pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agenUcompany, and (3) building owner.
SECTION A— PROPERTY INFORMATION FOR INSURANCE COMPANY USE
A1. Building Owner's Name Policy Number:
PV - PELICAN WALK, LLC
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number:
Box No.
490 POINSETTIA AVENUE
City State ZIP Code
CLEARWATER Florida 33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Lots 2 through 8, Block "A", A Re-plat of Block "A" and Lots 1 to 15 incl. Block "B" of Clearwater Beach Park First Addition
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) PARKING GARAGE
A5. Latitude/Longitude: Lat. 27°58'54.4" Long. $Z°49'34.1" Horizontal Datum: � NAD 1927 Qx 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 1A
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawispace or enclosure(s) sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b sq in
d) Engineered flood openings? ❑ Yes ❑ No
A9. For a building with an attached garage:
a) Square footage of attached garage sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade
c) Total net area of flood openings in A9.b sq in
d) Engineered flood openings? � Yes ❑ No
SECTION B— FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number B2. County Name B3. State
CITY OF CLEARWATER 125096 PINELLAS Florida
B4. Map/Panel B5. Suffix B6. 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 08/18/2009 09/03/2003 AE 11'
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9:
❑ FIS Profile �x FIR.M ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 �x NAVD 1988 ❑ Other/Source:
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? � Yes �x No
Designation Date: � CBRS ❑ OPA
FEMA Form 086-0-33 (7/15) Replaces ail previous editions. Form Page 1 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November30, 2o�s
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 P.O. Route and Box No. Policy Number:
490 POINSETTIA AVENUE
City State ZIP Code Company NAIC Number
CLEARWATER Florida 33767
SECTION C— BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction" 0 Finished Construction
'A new Elevation Certificate will be required when construction of the building is compiete.
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, ARlAO.
Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: SITE BENCHMARK 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.
Check the measurement used.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 4 � ❑x feet ❑ meters
b) Top of the next higher floor 21. 35 �x feet � meters
c) Bottom of the lowest horizontal structural member (V Zones only) N�A. �x feet ❑ meters
d) Attached garage (top of slab) N�A. � feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 5 z x� feet ❑ meters
(Describe type of equipment and location in Comments)
� Lowest adjacent (finished) grade next to building (LAG) 3 6 �X feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 4 5 ❑x feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including N�A. 0 feet � meters
structural support
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 Certificafe represents my best efforts to interpret the data available. I understand that any fa/se
statement may be punishab/e by fine or imprisonment under 18 U. S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? � Yes ❑ No ❑ Check here if attachments.
Certifier's Name License Number , a�"
. ..; ,. .
EDWARD C. ELLIOTT 3983
Title •
.��..' �,
PROFESSIONAL SURVEYOR & MAPPER : ;;�,r . _..,`' �''" �'� �'
w r.:: i
Company Name : �j ; � la _+ ; �a; �� ,
ARCTURUS GROUP, LLC ;.--i °`� S aC '�� t-- �' :
Address .�,� � �';��
� �, �'�
2328 U.S. HIGHWAY 19 � `Y� ',`� ,
; .,
, ; ,• ,
City State ZIP Code , �;;:: • •
HOLIDAY Florida 34691 'i, r� t' �.
r,�cr;�,:.
Signature ��'� Date Telephone
11/22/2016 (727) 940-8888
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agenUcompany, and (3) buiiding owner.
Comments (including type of equipment and location, per C2(e), if applicable)
THE ELEVATION SHOWN IN ITEM C2e IS THE ELEVATOR ON THE GROUND FLOOR.
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
r��
INSTRUCTIONS
490 POINSETT� AVE
Bo o?015-04334 2015 EDITION
NORTH BEACH PARKING GARAGE
Zoning: Atlas #:
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RECEivE�
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PLANNING � D�VELOPMENT DEPT
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OMB No. 1660-0008
Expiration Date: November 30, 2018
U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICATE AND INSTRUCTIONS
Paperwork Reduction Act Notice
Public reporting burden for this data collection is estimated to average 3.75 hours per response. The burden estimate includes the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
submitting this form. You are not required to respond to this collection of information unless a valid OMB control number is
displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the
burden to: Information Coilections Manageme�t, Department of Homeland Security, Federal Emergency Management Agency,
1800 South Bell Street, Arlington, VA 20598-3005, Papervvork Reduction Project (1660-0008). NOTE: Do not send your
compieted form to this address.
Privacy Act Statement
Authority: Title 44 CFR § 61.7 and 61.8.
Principal Purpose(s): This information is being collected for the primary purpose of estimating the risk premium rates necessary
to provide flood insurance for new or substantially improved structures in designated Special Flood Hazard Areas.
Routine Use(s): The information on this form may be disclosed as generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act
of 1974, as amended. This includes using this information as necessary and authorized by the routine uses published in DHS/
FEMA-003 — National Flood Insurance Program Files System or Records Notice 73 Fed. Reg. 77747 (December 19, 2008); DHS/
FEMA/NFIP/LOMA-1 — National Flood Insurance Program (NFIP) Letter of Map Amendment (LOMA) System of Records Notice 71
Fed. Reg. 7990 (February 15, 2006); and upon written request, written consent, by agreement, or as required by law.
Disclosure: The disclosure of information on this form is voluntary; however, failure to provide the information requested may
result in the inability to obtain flood insurance through the National Flood Insurance Program or the applicant may be subject to
higher premium rates for flood insurance. Information will only be released as permitted by law.
Purpose of the Elevation Certificate
The Elevation Certificate is an important administrative tool of the National Flood Insurance Program (NFIP). It is to be used to
provide elevation information necessary to ensure compliance with community floodplain management ordinances, to determine
the proper insurance premium rate, and to support a request for a Letter of Map Amendment (LOMA) or Letter of Map Revision
based on fill (LOMR-F).
The Elevation Certificate is required in order to properly rate Post-FIRM buildings, which are buildings constructed after publication
of the Flood Insurance Rate Map (FIRM), located in flood insurance Zones A1—A30, AE, AH, A(with BFE), VE, V1—V30, V(with
BFE), AR, AR/A, AR/AE, AR/A1—A30, AR/AH, and AR/AO. The Elevation Certificate is not required for Pre-FIRM buildings unless
the building is being rated under the optional Post-FIRM flood insurance rules.
As part of the agreement for making flood insurance available in a community, the NFIP requires the communiry to adopt floodplain
management regulations that specify minimum requirements for reducing flood losses. One such requirement is for the community
to obtain the elevation of the lowest floor (including basement) of all new and substantially improved buildings, and maintain a
record of such information. The Elevation Certificate provides a way for a community to document compliance with the community's
floodplain management ordinance.
Use of this certificate does not provide a waiver of the flood insurance purchase requirement. Only a LOMA or LOMR-F from the
Federal Emergency Management Agency (FEMA) can amend the FIRM and remove the Federal mandate for a lending institution
to require the purchase of flood insurance. However, the lending institution has the option of requiring flood insurance even if a
LOMA/LOMR-F has been issued by FEMA. The Elevation Certificate may be used to support a LOMA or LOMR-F request. Lowest
floor and lowest adjacent grade elevations certified by a surveyor or engineer will be required if the certificate is used to support a
LOMA or LOMR-F request. A LOMA or LOMR-F request must be submitted with either a completed FEMA MT-EZ or MT-1
package, whichever is appropriate.
This certificate is used only to certify building elevations. A separate certificate is required for floodproofing. Under the NFIP, non-
residential buildings can be floodproofed up to or above the Base Flood Elevation (BFE). A floodproofed building is a building that
has been designed and constructed to be watertight (substantially impermeable to floodwaters) below the BFE. Floodproofing of
residential buildings is not permitted under the NFIP unless FrMA has granted the community an exception for residential
floodproofed basements. The community must adopt standards for design and construction of floodproofed basements before
FEMA will grant a basement exception. For both floodproofed nori-residential buildings and residential floodproofed basements in
communities that have been granted an exception by FEMA, a floodproofing certificate is required.
Additional guidance can be found in FEMA Publication 467-1, Flo��dplain Management Bulletin: Elevation Certificate, available on
FEMA's website at https://www.fema.gov/media-library/assets/documents/3539?id=1727.
FEMA Form 086-0-33 (Revised 7/15) Replaces all previous editions. F-053
U.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008
Federal Emergency Management Agency Expiration Date: November 30, 2018
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
Copv all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agenUcompany, and (3) building owner.
SECTION A— PROPERTY INFORMATION FOR INSURANCE COMPANY USE
A1. Building Owners Name Policy Number:
PV - PELICAN WALK, LLC
A2. Building StreetAddress (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number:
Box No.
490 POINSETTIA AVENUE
City State ZIP Code
CLEARWATER Florida 33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Lots 2 through 8, Block "A", A Re-p�at of Block "A" and Lots 1 to 15 incl. Block "B" of Clearwater Beach Park First Addition
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RETAIL SPACE & PARKING GARAGE
A5. Latitude/Longitude: Lat. 27°58'54.4" Long.82°49'34.1" Horizontal Datum: � NAD 1927 ❑x 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 1A
A8. ,For a building with a crawlspace or enclosure(s):
y a) Square footage of crawispace or enclosure(s) 334.8 " sq ft
/ ,
b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 11 ,
c) Total net area of flood openings in A8.b 1,338.5 sq in
�
d) Engineered flood openings? ❑x Yes ❑ No
A9. For a building with an attached garage:
a) Square footage of attached garage sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade
c) Total net area of flood openings in A9.b sq in
d) Engineered flood openings? ❑ Yes ❑ No
SECTION B— FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number B2. County Name 63. State
CITY OF CLEARWATER 125096 PINELLAS Florida
64. Map/Panel B5. Suffix 66. FIRM Index 67. FIRM Panel 68. Flood Zone(s) B9. Base Flood Elevation(s)
Number Date Effective>/ (Zone AO, use Base
Revised Date Flood Depth)
12103C0102 G OS/18/2009 09/03/2003 AE 11'
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9:
� FIS Profile Q FIRM ❑ Community Determined ❑ Other/Source:
611. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ❑x NAVD 1988 ❑ Other/Source:
812. Is the building located in a Coastal Barrier Resources System �CBRS) area or Otherwise Protected Area (OPA)? � Yes �x No
Designation Date: � CBRS ❑ OPA
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November30, 2o�s
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.) ar P.O. Route and Box No. Policy Number:
490 POINSETTIA AVENUE
City State ZIP Code Company NAIC Number
CLEARWATER Florida 33767
SECTION C— BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Buiiding 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: SITE BENCHMARK Vertical Datum: NAVD 1988
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.
Check the measurement used.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 4 � , ❑x feet ❑ meters
b) Top of the next higher floor 21. 35 � feet � meters
c) Bottom of the lowest horizontal structural member (V Zones only) N�A. � feet ❑ meters
d) Attached garage (top of slab) N�A. � feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 5. 2 x� feet ❑ meters
(Describe type of equipment and location in Comments)
� Lowest adjacent (finished) grade next to building (LAG) 3 6 � feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 4 5 ❑x feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including N�A � feet ❑ meters
structural support
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 Certi�cate represents my best efforts to interpret the data available. 1 understand that any false
statement may be punishab/e by fine or imprisonment under 18 U. S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? ❑x Yes ❑ No ❑ Check here if attachments.
Certifier's Name License Number ,
EDWARD C. ELLIOTT 3983 „,� `�- �� 2�; ;,'�f ";
Title �'
PROFESSIONAL SURVEYOR & MAPPER ,
. � f �.
Company Name `ja `•� �
ARCTURUS GROUP, LLC n . `R5 , ' �
Address ; ° er� '
2328 U.S. HIGHWAY 19 ", �.�° %`'
City State ZIP Code
HOLIDAY Florida 34691 •�'.., ' °
, ,
Signature Date Telephone '? P= a =
12/28/2016 (727) 940-8888
Copy all pages of this Elevation Certificate and all attachments for (1) oommunity official, (2) insurance agenUcompany, and (3) building owner.
Comments (including type of equipment and location, per C2(e), if applicable)
THE ELEVATION SHOWN IN ITEM C2e IS THE ELEVATOR ON TFiE GROUND FLOOR.
FEMA Form 086-0-33 (7/15) Replaces all pre�vious editions. Form Page 2 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November30, 2o�s
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 P.O. Route and Box No. Policy Number:
490 POINSETTIA AVENUE
City State ZIP Code Company NAIC Number
CLEARWATER Florida 33767
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).
a) Top of bottom floor (including 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 1-2 of Instructions),
the ne� 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
serwcing 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 compietes 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 City State ZIP Code
Signature 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
ELEVATION CERTIFICATE Expiration Date: November30, 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 Bldg. No.) or P.O. Route and Box No. Policy Number:
490 POINSETTIA AVENUE
City State ZIP Code Company NAIC Number
CLEARWATER Florida 33767
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 communiry 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 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)
❑ Check here if attachments.
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE See Instructions for Item A6. Expiration Date: November 30, 2018
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 P.O. Route and Box No. Policy Number:
490 POINSETTIA AVENUE
City State ZIP Code Company NAIC Number
CLEARWATER Florida 33767
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.
Photo One
Photo One
Photo One Caption
Pho#o Twa
Photo Two
Photo Two Caption
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30, 2018
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:
490 POINSETT'IA AVENUE
City State ZIP Code Company NAIC Number
CLEARWATER Florida 33767
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.
Photo One
Photo One
Photo One Caption
Photo Twa
Photo Two
Photo Two Caption
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6
U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
OMB No. 1660-0008
Expiration Date: November 30, 2018
Instructions for Completing the Elevation Certificate
The Elevation Certificate is to be completed by a land surveyor, engineer, or architect who is authorized by law to certify
elevation information when elevation information is required for Zones A1 A30, AE, AH, A(with BFE), VE, V1 V30, V
(with BFE), AR, AR/A, AR/AE, AR/A1 A30, AR/AH, or AR/AO. Community officials who are authorized by law or
ordinance to provide floodplain management information may also complete this form. For Zones AO and A(without
BFE), a community official, a property owner, or an owner's representative may provide information on this certificate,
unless the elevations are intended for use in supporting a request for a LOMA or LOMR-F. Certified elevations must be
included if the purpose of completing the Elevation Certificate is to obtain a LOMA or LOMR-F.
The property owner, the owner's representative, or local o�cial who is authorized by law to administer the community
floodplain ordinance can complete Section A and Section B. The partially completed form can then be given to the land
surveyor, engineer, or architect to complete Section C. The land surveyor, engineer, or architect should verify the
information provided by the property owner or owner's representative to ensure that this certificate is complete.
In Puerto Rico only, elevations for building information and flood hazard information may be entered in meters.
SECTION A — PROPERTY INFORMATION
Items A1—A4. This section identifies the building, its location, and its owner. Enter the name(s) of the building owner(s),
the building's complete street address, and the lot and block numbers. If the building's address is different from the
owner's address, enter the address of the building being certified. If the address is a rural route or a Post Office box
number, enter the lot and block numbers, the tax parcel number, the legal description, or an abbreviated location
description based on distance and direction from a fixed point of reference. For the purposes of this certificate, "building"
means both a building and a manufactured (mobile) home.
A map may be attached to this certificate to show the location of the building on the property. A tax map, FIRM, or
detailed community map is appropriate. If no map is available, provide a sketch of the property location, and the location
of the building on the property. Include appropriate landmarks such as nearby roads, intersections, and bodies of water.
For building use, indicate whether the building is residential, non-residential, an addition to an existing residential or non-
residential building, an accessory building (e.g., garage), or other type of structure. Use the Comments area of the
appropriate section if needed, or attach additional comments.
Item A5. Provide latitude and longitude coordinates for the center of the front of the building. Use either decimal degrees
(e.g., 39.5043°, —110.7585°) or degrees, minutes, seconds (e.g., 39° 30' 15.5", —110° 45' 30.7") format. If decimal
degrees are used, provide coordinates to at least 5 decimal places or better. When using degrees, minutes, seconds,
provide seconds to at least 1 decimal place or bettec The latitude and longitude coordinates must be accurate within 66
feet. When the latitude and longitude are provided by a surveyor, check the "Yes" box in Section D and indicate the
method used to determine the latitude and longitude in the Comments area of Section D. If the Elevation Certificate is
being certified by other than a licensed surveyor, engineer, or architect, this information is not required. Provide the type
of datum used to obtain the latitude and longitude. FEMA prefers the use of NAD 1983.
Item A6. If the Elevation Certificate is being used to obtain flood insurance through the NFIP, the certifier must provide at
least 2 photographs showing the front and rear of the building taken within 90 days from the date of certification. The
photographs must be taken with views confirming the building description and diagram number provided in Section A. To
the extent possible, these photographs should show the entire building including foundation. If the building has split-level
or multi-level areas, provide at least 2 additional photographs showing side views of the building. In addition, when
applicable, provide a photograph of the foundation showing a representative example of the flood openings or vents. All
photographs must be in color and measure at least 3" X 3". Digital photographs are acceptable.
Item A7. Select the diagram on pages 7-9 that best represents the building. Then enter the diagram number and use
the diagram to identify and determine the appropriate elevations requested in Items C2.a—h. If you are unsure of the
correct diagram, select the diagram that most closely resembles the building being certified.
Item A8.a. Provide the square footage of the crawlspace or enclosure(s) below the lowest elevated floor of an elevated
building with or without permanent flood openings. Take the measurement from the outside of the crawlspace or
enclosure(s). Examples of elevated buildings constructed with crawlspace and enclosure(s) are shown in Diagrams 6-9
NFIP Elevation Certificate Instructions — Page 1 of 9
Instructions for Completing the Elevation Certificate (continued)
on pages 8-9. Diagrams 2A, 26, 4, and 9 should be used for a building constructed with a crawlspace floor that is below
the e�erior grade on all sides.
Items A8.b-d. Enter in Item A8.b the number of permanent flood openings in the crawlspace or enclosure(s) that are
no higher than 1.0 foot above the higher of the exterior or interior grade or floor immediately below the opening. (A
permanent flood opening is a flood vent or other opening that allows the free passage of water automatically in both
directions without human intervention.) If the interior grade elevation is used, note this in the Comments area of
Section D. Estimate the total net area of all such permanent flood openings in square inches, excluding any bars,
louvers, or other covers of the permanent flood openings, and enter the total in Item A8.c. If the net area cannot be
reasonably estimated, provide the size of the flood openings without consideration of any covers and indicate in the
Comments area the type of cover that exists in the flood openings. Indicate in Item A8.d whether the flood openings
are engineered. If applicable, attach a copy of the Individuaf Engineered Flood Openings Certification or an
Evaluation Report issued by the International Code Council Evaluation Service (ICC ES), if you have it. If the
crawlspace or enclosure(s) have no permanent flood openings, or if the openings are not within 1.0 foot above
adjacent grade, enter "0" (zero) in Items A8.b-c.
Item A9.a. Provide the square footage of the attached garage with or without permanent flood openings. Take the
measurement from the outside of the garage.
Items A9.b�l. Enter in Item A9.b the number of permanent flood openings in the attached garage that are no higher
than 1.0 foot above the higher of the exterior or interior grade or floor immediately below the opening. (A permanent
flood opening is a flood vent or other opening that allows the free passage of water automatically in both directions
without human intervention.) If the interior grade elevation is used, note this in the Comments area of Section D. This
includes any openings that are in the garage door that are no higher than 1.0 foot above the adjacent grade. Estimate
the total net area of all such permanent flood openings in square inches and enter the total in Item A9.c. If the net
area cannot be reasonably estimated, provide the size of the flood openings without consideration of any covers and
indicate in the Comments area the type of cover that exists in the flood openings. Indicate in Item A9.d whether the
flood openings are engineered. If applicable, attach a copy of the Individual Engineered Flood Openings Certification
or an Evaluation Report issued by the International Code Council Evaluation Service (ICC ES), if you have it. If the
garage has no permanent flood openings, or if the openings are not within 1.0 foot above adjacent grade, enter
"0" (zero) in Items A9.b�.
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Complete the Elevation Certificate on the basis of the FIRM in effect at the time of the certification.
The information for Section B is obtained by reviewing the FIRM panel that includes the building's location. Information
about the current FIRM is available from the Federal Emergency Management Agency (FEMA) by calling
1-800-358-9616. If a Letter of Map Amendment (LOMA) or Letter of Map Revision (LOMR-F) has been issued by FEMA,
please provide the letter date and case number in the Comments area of Section D or Section G, as appropriate.
For a building in an area that has been annexed by one community but is shown on another community's FIRM, enter
the community name and 6-digit number of the annexing community in Item B1, the name of the county or new county, if
necessary, in Item 62, and the FIRM index date for the annexing community in Item B6. Enter information from the
actual FIRM panel that shows the building location, even if it is the FIRM for the previous jurisdiction, in Items 64, B5,
67, B8, and 69.
If the map in effect at the time of the building's construction was other than the current FIRM, and you have the past map
information pertaining to the building, provide the information in the Comments area of Section D.
Item B1. NFIP Community Name & Community Number. Enter the complete name of the community in which the
building is located and the associated 6-digit community number. For a newly incorporated community, use the name
and 6-digit number of the new community. Under the NFIP, a"community" is any State or area or political subdivision
thereof, or any Indian tribe or authorized native organization, that has authority to adopt and enforce floodplain
management regulations for the areas within its jurisdiction. To determine the current community number, see the
NFIP Community Status Book, available on FEMA's web site at https://www.fema.gov/national-flood-insurance-
program/national-flood-insurance-program-community-status-book, or call 1-800-358-9616.
NFIP Elevation Certificate Instructions - Page 2 of 9
Instructions for Completing the Elevation Certificate (continued)
Item B2. County Name. Enter the name of the county or counties in which the community is located. For an
unincorporated area of a county, enter "unincorporated area." For an independent city, enter "independent city."
Item 63. State. Enter the 2-letter state abbreviation (for example, VA, TX, CA).
Items 64-65. Map/Panel Number and Suffix. Enter the 10-character "Map Number" or "Community Panel Number"
shown on the FIRM where the building or manufactured (mobile) home is located. For maps in a county-wide format,
the sixth character of the "Map Number" is the letter "C" followed by a 4-digit map number. For maps not in a county-
wide format, enter the "Community Panel Number" shown on the FIRM.
Item 66. FIRM Index Date. Enter the effective date or the map revised date shown on the FIRM Index.
Item B7. FIRM Panel Effective/Revised Date. Enter the map effective date or the map revised date shown on the
FIRM panel. This will be the latest of all dates shown on the map. The current FIRM panel effective date can be
determined by calling 1-800-358-9616.
Item B8. Flood Zone(s). Enter the flood zone, or flood zones, in which the building is located. All flood zones
containing the letter "A" or "V" are considered Special Flood Hazard Areas. The flood zones are A, AE, A1 A30, V,
VE, V1 V30, AH, AO, AR, AR/A, AR/AE, AR/A1—A30, AR/AH, and AR/AO. Each flood zone is defined in the legend of
the FIRM panel on which it appears.
Item 69. Base Flood Elevation(s). Using the appropriate Flood Insurance Study (FIS) Profile, Floodway Data Table, or
FIRM panel, locate the property and enter the BFE (or base flood depth) of the building site. If the building is located
in more than 1 flood zone in Item 68, list all appropriate BFEs in Item 69. BFEs are shown on a FIRM or FIS Profile
for Zones A1 A30, AE, AH, V1—V30, VE, AR, AR/A, AR/AE, AR/A1—A30, AR/AH, and AR/AO; flood depth numbers are
shown for Zone A0. Use the AR BFE if the building is located in any of Zones AR/A, AR/AE, AR/A1—A30, AR/AH, or
AR/AO. In A or V zones where BFEs are not provided on the FIRM, BFEs may be available from another source. For
example, the community may have established BFEs or obtained BFE data from other sources for the building site.
For subdivisions and other developments of more than 50 lots or 5 acres, establishment of BFEs is required by the
community's floodplain management ordinance. If a BFE is obtained from another source, enter the BFE in ltem 69.
In an A Zone where BFEs are not available, complete Section E and enter N/A for Section B, Item B9. Enter the BFE
to the nearest tenth of a foot (nearest tenth of a meter, in Puerto Rico).
Item 610. Indicate the source of the BFE that you entered in Item 69. If the BFE is from a source other than FIS
Profile, FIRM, or community, describe the source of the BFE.
Item 611. Indicate the elevation datum to which the elevations on the applicable F�RM are referenced as shown on
the map legend. The vertical datum is shown in the Map Legend and/or the Notes to Users on the FIRM.
Item B12. Indicate whether the building is located in a Coastal Barrier Resources System (CBRS) area or Otherwise
Protected Area (OPA). (OPAs are portions of coastal barriers that are owned by Federal, State, or local governments
or by certain non-profit organizations and used primarily for natural resources protection.) Federal flood insurance is
prohibited in designated CBRS areas or OPAs for buildings or manufactured (mobile) homes built or substantially
improved after the date of the CBRS or OPA designation. For the first CBRS designations, that date is October 1,
1983. Information about CBRS areas and OPAs may be obtained on the FEMA web site at https://www.fema.gov/
national-flood-insurance-prog ram/coastal-ba rrier-resou rces-system.
SECTION C— BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Complete Section C if the building is located in any of Zones A1 A30, AE, AH, A(with BFE), VE, V1—V30, V(with
BFE), AR, AR/A, AR/AE, AR/A1—A30, AR/AH, orAR/AO, or if this certificate is being used to support a request for a
LOMA or LOMR-F. If the building is located in Zone AO or Zone A(without BFE), complete Section E instead. To
ensure that all required elevations are obtained, it may be necessary to enter the building (for instance, if the building
has a basement or sunken living room, split-level construction, or machinery and equipment).
Surveyors may not be able to gain access to some crawlspaces to shoot the elevation of the crawlspace floor. If
access to the crawlspace is limited or cannot be gained, follow one of these procedures.
• Use a yardstick or tape measure to measure the height from the floor of the crawlspace to the "next higher floor,"
and then subtract the crawlspace height from the elevation of the "next higher floor." If there is no access to the
NFIP Elevation Certificate Instructions — Page 3 of 9
Instructions for Completing the Elevation Certificate (continued)
crawlspace, use the exterior grade next to the structure to measure the height of the crawlspace to the "next
higher floor."
• Contact the local floodplain administrator of the community in which the building is located. The community may have
documentation of the elevation of the crawlspace floor as part of the permit issued for the building.
• If the property owner has documentation or knows the height of the crawlspace floor to the next higher floor, try to
verify this by looking inside the crawlspace through any openings or vents.
In all 3 cases, use the Comments area of Section D to provide the elevation and a brief description of how the elevation
was obtained.
Item C1. Indicate whether the elevations to be entered in this section are based on construction drawings, a building
under construction, or finished construction. For either of the first 2 choices, a post-construction Elevation Certificate will
be required when construction is complete. If the building is under construction, include only those elevations that can be
surveyed in Items C2.a-h. Use the Comments area of Section D to provide elevations obtained from the construction
plans or drawings. Select "Finished Construction" only when all machinery and/or equipment such as furnaces, hot water
heaters, heat pumps, air conditioners, and elevators and their associated equipment have been installed and the grading
around the building is completed.
Item C2. A field survey is required for Items C2.a-h. Most control networks will assign a unique identifier for each
benchmark. For example, the National Geodetic Sunrey uses the Permanent Identifier (PID). For the benchmark utilized,
provide the PID or other unique identifier assigned by the maintainer of the benchmark. For GPS survey, indicate the
benchmark used for the base station, the Continuously Operating Reference Stations (CORS) sites used for an On-line
Positioning User Service (OPUS) solution (also attach the OPUS report), or the name of the Real Time Network used.
Also provide the vertical datum for the benchmark elevation. All elevations for the certificate, including the elevations for
Items C2.�h, must use the same datum on which the BFE is based. Show the conversion from the field survey datum
used if it differs from the datum used for the BFE entered in Item 69 and indicate the conversion software used. Show the
datum conversion, if applicable, in the Comments area of Section D.
For property experiencing ground subsidence, the most recent reference mark elevations must be used for determining
building elevations. However, when subsidence is involved, the BFE should not be adjusted. Enter elevations in Items
C2.a-h to the nearest tenth of a foot (nearest tenth of a meter, in Puerto Rico).
Items C2.a-d. Enter the building elevations (excluding the attached garage) indicated by the selected building diagram
(Item A7) in Items C2.a�. If tnere is an attached garage, enter the elevation for top of attached garage slab in Item C2.d.
(Because elevation for top of attached garage slab is self-explanatory, attached garages are not illustrated in the
diagrams.) If the building is located in a V zone on the FIRM, complete Item C2.c. If the flood zone cannot be determined,
enter elevations for all of Items C2.a-h. For buildings in A zones, elevations a, b, d, and e should be measured at the top
of the flooc For buildings in V zones, elevation c must be measured at the bottom of the lowest horizontal structural
member of the floor (see drawing below). For buildings elevated on a crawlspace, Diagrams 8 and 9, enter the elevation
BUILDING ON
SLAB
A ZONES V ZONES
C2.a
r
1 '
�
,.///'�%� �rri/� ,.
BASE fIOOD
ELEVATtON CZ.0
BUILDING WITH
BASEMENT
r��.�rij
BUILDING ON PILES,
PIERS, OR COLUMNS
(',2.a A ZONES �. V ZONES
C2.a
/ �
BASE FLO00
ADJACENT EIEYATION
GRADE
NFIP Elevation Certificate Instructions — Page 4 of 9
�
�
C2.c
Instructions for Completing the Elevation Certificate (continued)
of the top of the crawlspace floor in Item C2.a, whether or not the crawlspace has permanent flood openings (flood
vents). If any item does not apply to the building, enter "N/A"for not applicable.
Item C2.e. Enter the lowest platform elevation of at least 1 of the following machinery and equipment items: elevators
and their associated equipment, furnaces, hot water heaters, heat pumps, and air conditioners in an attached garage
or enclosure or on an open utility platform that provides utility services for the building. Note that elevations for these
specific machinery and equipment items are required in order to rate the building for flood insurance. Local floodplain
management officials are required to ensure that all machinery and equipment servicing the building are protected
from flooding. Thus, local officials may require that elevation information for all machinery and equipment, including
ductwork, be documented on the Elevation Certificate. If the machinery and/or equipment is mounted to a wall, pile,
etc., enter the platform elevation of the machinery and/or equipment. Indicate machinery/equipment type and its
general location, e.g., on floor inside garage or on platForm affixed to exterior wall, in the Comments area of Section D
or Section G, as appropriate. If this item does not apply to the building, enter'N/A"for not applicable.
Items C2.f—g. Enter the elevation of the ground, sidewalk, or patio slab immediately next to the building. For Zone
AO, use the natural grade elevation, if available. This measurement must be to the nearest tenth of a foot (nearest
tenth of a meter, in Puerto Rico) if this certificate is being used to support a request for a LOMA or LOMR-F.
Item C2.h. Enter the lowest grade elevation at the deck support or stairs. For Zone AO, use the natural grade
elevation, if available. This measurement must be to the nearest tenth of a foot (nearest tenth of a meter, in Puerto
Rico) if this certificate is being used to support a request for a LOMA or LOMR-F.
SECTION D— SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
Complete as indicated. This section of the Elevation Certificate may be signed by only a land surveyor, engineer, or
architect who is authorized by law to certify elevation information. Place your license number, your seal (as allowed by
the State licensing board), your signature, and the date in the box in Section D. You are certifying that the information on
this certificate represents your best efforts to interpret the data available and that you understand that any false
statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. Use the Comments area of
Section D to provide datum, elevation, openings, or other relevant information not specified elsewhere on the certificate.
SECTION E— BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED)
FOR ZONE AO AND ZONE A(WITHOUT BFE)
Complete Section E if the building is located in Zone AO or Zone A(without BFE). Otherwise, complete Section C instead.
Explain in the Section F Comments area if the measurement provided under Items E1—E4 is based on the "natural grade."
Items E1.a and b. Enter in Item E1.a the height to the nearest tenth of a foot (tenth of a meter in Puerto Rico) of the top
of the bottom floor (as indicated in the applicable diagram) above or below the highest adjacent grade (HAG). Enter in
Item E1.b the height to the nearest tenth of a foot (tenth of a meter in Puerto Rico) of the top of the bottom floor (as
indicated in the applicable diagram) above or below the lowest adjacent grade (LAG). For buildings in Zone AO, the
community's floodplain management ordinance requires the lowest floor of the building be elevated above the highest
adjacent grade at least as high as the depth number on the FIRM. Buildings in Zone A(without BFE) may qualify for a
lower insurance rate if an engineered BFE is developed at the site.
Item E2. For Building Diagrams 6-9 with permanent flood openings (see pages 8-9), enter the height to the nearest
tenth of a foot (tenth of a meter in Puerto Rico) of the next higher floor or elevated floor (as indicated in the applicable
diagram) above or below the highest adjacent grade (HAG).
Item E3. Enter the height to the nearest tenth of a foot (tenth of a meter in Puerto Rico), in relation to the highest
adjacent grade next to the building, for the top of attached garage slab. (Because elevation for top of attached garage
slab is self-explanatory, attached garages are not illustrated in the diagrams.) If this item does not apply to the building,
enter "IV/A"fornot applicable.
Item E4. Enter the height to the nearest tenth of a foot (tenth of a meter in Puerto Rico), in relation to the highest
adjacent grade next to the building, of the platform elevation that supports the machinery and/or equipment servicing the
building. Indicate machinery/equipment type in the Comments area of Section F. If this item does not apply to the
building, enter "N/A"fornot applicable.
NFIP Elevation Certificate Instructions — Page 5 of 9
Instructions for Completing the Elevation Certificate (continued)
Item E5. For those communities where this base flood depth is not available, the community will need to determine
whether the top of the bottom floor is elevated in accordance with the community's floodplain management ordinance.
SECTION F— PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
Complete as indicated. This section is provided for certification of ineasurements taken by a property owner or property
owner's representative when responding to Sections A, B, and E. The address entered in this section must be the actual
mailing address of the property owner or property owner's representative who provided the information on the certificate.
SECTION G — COMMUNITY INFORMATION (OPTIONAL)
Complete as indicated. The community 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. Section C
may be filled in by the local official as provided in the instructions below for Item G1. If the authorized community official
completes Sections C, E, or G, complete the appropriate item(s) and sign this section.
Check Item G1 if Section C is completed with elevation data 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 of the elevation data and the date obtained in the Comments area of Section G. If you are both a community
official and a licensed land surveyor, engineer, or architect authorized by law to certify elevation information, and you
performed the actual survey for a building in Zones A1 A30, AE, AH, A(with BFE), VE, V1 V30, V(with BFE), AR, AR/
A, AR/A1 A30, AR/AE, AR/AH, or AR/AO, you must also complete Section D.
Check Item G2 if information is entered in Section E by the community for a building in Zone A(without a FEMA-issued
or community-issued BFE) or Zone AO.
Check Item G3 if the information in Items G4—G10 has been completed for community floodplain management purposes
to document the as-built lowest floor elevation of the building. Section C of the Elevation Certificate records the elevation
of various building components but does not determine the lowest floor of the building or whether the building, as
constructed, complies with the community's floodplain management ordinance. This must be done by the community.
Items G4—G10 provide a way to document these determinations.
Item G4. Permit Number. Enter the permit number or other identifier to key the Elevation Certificate to the permit issued
for the building.
Item G5. Date Permit Issued. Enter the date the permit was issued for the building.
Item G6. Date Certificate of Compliance/Occupancy Issued. Enter the date that the Certificate of Compliance or
Occupancy or similar written official documentation of as-built lowest floor elevation was issued by the community as
evidence that all work authorized by the floodplain development permit has been completed in accordance with the
community's floodplain management laws or ordinances.
Item G7. New Construction or Substantial Improvement. Check the applicable box. "Substantial Improvement" means
any reconstruction, rehabilitation, addition, or other improvement of a building, the cost of which equals or exceeds 50
percent of the market value of the building before the start of construction of the improvement. The term includes
buildings that have incurred substantial damage, regardless of the actual repair work performed.
Item G8. As-built lowest floor elevation. Enter the elevation of the lowest floor (including basement) when the
construction of the building is completed and a final inspection has been made to confirm that the building is built in
accordance with the permit, the approved plans, and the community's floodplain management laws or ordinances.
Indicate the elevation datum used.
Item G9. BFE. Using the appropriate FIRM panel, FIS Profile, or other data source, locate the property and enter the
BFE (or base flood depth) of the building site. Indicate the elevation datum used.
Item G10. Community's design flood elevation. Enter the elevation (including freeboard above the BFE) to which the
community requires the lowest floor to be elevated. Indicate the elevation datum used.
Enter your name, title, and telephone number, and the name of the community. Sign and enter the date in the
appropriate blanks.
NFIP Elevation Certificate Instructions — Page 6 of 9
Building Diagrams
The following diagrams illustrate various types of buildings. Compare the features of the building being certified with
the features shown in the diagrams and select the diagram most applicable. Enter the diagram number in Item A7,
the square footage of crawlspace or enclosure(s) and the area of flood openings in square inches in Items A8.a-c,
the square footage of attached garage and the area of flood openings in square inches in Items A9.a-c, and the
elevations in Items C2.a-h.
In A zones, the floor elevation is taken at the top finished surface of the floor indicated; in V zones, the floor elevation
is taken at the bottom of the lowest horizontal structural member (see drawing in instructions for Section C).
DIAGRAM 1A
All slab-on-grade single- and multiple-floor buildings
(other than split-level) and high-rise buildings, either
detached or row type (e.g., townhouses); with or
without attached garage.
Distinguishing Feature - The bottom floor is at or above
ground level (grade) on at least 1 side."
CZ.B � NEXT HIGHER
i FLOOR ,
i
�� BOTTOM FLOE)R
�I '
C2.f-h .�:e� 9. �e}...:.:.,......._.,.:':
DIAGRAM 2A
[ _ � 1 l �[ � I :7�j , � � L�-_ .
All raised-slab-on-grade or slab-on-stem-wall-with-fill
single- and multiple-floor buildings (other than split-
level), either detached or row type (e.g., townhouses);
with or without attached garage.
Distinguishing Feature - The bottom floor is at or above
ground level (grade) on at least 1 side.*
C2.b C2.a C2.b
i NEXT HIGHER �
i FLOOR �
All single- and multiple-floor buildings with basement
(other than split-level) and high-rise buildings with
basement, either detached or row type
(e.g., townhouses); with or without attached garage.
Distinguishing Feature - The bottom floor (basement
or underground garage) is below ground level (grade) on
all sides.'
C2.a
C2_b
NEXT HIGHER
FLOOR
GRADE
` BOTTOM FLOOR
� BASEMENT
C2.f-h
GRADE
C2.f-h
BOTTOM FLOOR
f1LLr1`71u�
All single- and multiple-floor buildings with basement
(other than split-level) and high-rise buildings with
basement, either detached or row type
(e.g., townhouses); with or without attached garage.
Distinguishing Feature - The bottom floor (basement or
underground garage) is below ground level (grade) on all
sides; most of the height of the walls is below ground level
on all sides; and the door and area of egress are also
below ground level on all sides.*
C2.8 NDCT HIGHER C2.b
FLOOR
GRADE
-- -- - -------- °
BOTTOM FIOOR � � '
BASEMENT ��
, .. : _ , ':
r
'-- - --- �- ����k.
���
; {; i..
C2.�Ft «cemun�a air..
epsting ga�ej _ .
' A floor that is below ground level (grade) on all sides is considered a basement even if the floor is used for Iiving purposes, or as an office,
garage, workshop, etc.
NFIP Elevation Certificate Instructions - Page 7 of 9
Building Diagrams
DIAGRAM 3 DIAGRAM 4
All split-level buildings that are slab-on-grade, either All split-level buildings (other than slab-on-grade),
detached or row type (e.g., townhouses); with or without either detached or row type (e.g., townhouses); with or
attached garage. without attached garage.
Distinguishing Feature — The bottom floor (excluding Distinguishing Feature — The bottom floor (basement
garage) is at or above ground level (grade) on at least or underground garage) is below ground level (grade) on
1 side.* all sides.*
C2.a
HIGHER
FLOORS
GRADE BoTTOM
� OOR
�:.�., :
`�.C2.f—h :i`�:`"'�`see
::. �`.:
NEXT HIGFiER
FLOOR
� �
� ,
' ' � C2.b
� C2.b C2.a � �
� HIGHER �
i FLOORS
GRADE NEXT HIGHER
� BOTTOM FLOOR FLOOR
�
DIAGRAM 5
All buildings elevated on piers, posts, piles, columns,
or parallel shear walls. No obstructions below the
elevated floor.
Distinguishing Feature — For ali zones, the area below the
elevated floor is open, with no obstruction to flow of floodwaters
(open lattice work and/or insect screening is permissible).
C2.b
� NEXT HIGHER �
� FLOOR i
C2.a
ELEYATED
F�OOR
Ci2.1-11� �atuennnroa [ry
e�dstlng grade) CZ.0 (ForV za�es aiy)
;,;; `I C2.f—h
DIAGRAM 6
All buildings elevated on piers, posts, piles, columns,
or parallel shear walls with full or partial enclosure
below the elevated floor.
Distinguishing Feature — For ali zones, the area below the
elevated floor is enclosed, either partially or fully. In A Zones, the
partially or fuily enciosed area below the elevated floor is with or
without openings`* present in the walls of the enclosure. Indicate
information about enclosure size and openings in Section A—
Property Information.
� NEXT HIGHER i
� FLOOR �
C2.a C2.b
ELEVATED
FLOOR ��
size 8
f any.
CZ.NI "taetm�ansanr`:, : ;.>�:...;. . : - CZ.0 (Por V zaies a�iY1
, eash�0 9rade) .. . .
* A floor that is below ground level (grade) on all sides is considered a basement even if the floor is used for living purposes, or as an office,
garage, workshop, etc.
" An "opening" is a permanent opening that allows for the free passage of water automatically in both directions without human intervention.
Under the NFIP, a minimum of 2 openings is required for enclosures or crawlspaces. The openings shall provide a total net area of not Iess than
1 square inch for every square foot of area enciosed, excluding any bars, louvers, or other covers of the opening. Alternatively, an Individual
Engineered Fiood Openings Certification or an Evaluation Report issued by the International Code Council Evaluation Service (ICC ES) must be
submitted to document that the design of the openings will allow for the automatic equalization of hydrostatic flood forces on exterior walls. A
window, a door, or a garage door is not considered an opening; openings may be installed in doors. Openings shall be on at least 2 sides of the
enclosed area. If a building has more than 1 enclosed area, each area must have openings to allow floodwater to directly enter. The bottom of
the openings must be no higher than 1.0 foot above the higher of the exterior or interior grade or floor immediately below the opening. For more
guidance on openings, see NFIP Technical Bulletin 1.
NFIP Elevation Certificate Instructions — Page 8 of 9
Building Diagrams
DIAGRAM 7
All buildings elevated on full-story foundation walls
with a partially or fully enclosed area below the elevated
floor. This includes walkout levels, where at least 1 side
is at or above grade. The principal use of this building is
located in the elevated floors of the building.
Distinguishing Feature — For all zones, the area below the
elevated floor is enclosed, either partiaily or fuliy. In A Zones, the
partially or fully enclosed area below the elevated floor is with or
without openings" present in the walls of the enclosure. Indicate
information about encfosure size and openings in Section A—
Property Information.
C2.a C2.b
NEXT HIGHER
ROOR
�DE
C2.f waxour �v� C2.g
(ENCL0.SUR�
�t
� ,. ,..:' AS.a '� , AS.b
DIAGRAM 8
All buildings elevated on a crawlspace with the floor of
the crawlspace at or above grade on at least 1 side,
with or without an attached garage.
Distinguishing Feature — For ali zones, the area below the first
floor is enclosed by solid or partial perimeter walls. In all A zones,
the crawlspace is with or without openings*"` present in the walls
of the crawlspace. Indicate information about crawlspace size
and openings in Section A— Property Information.
DIAGRAM 9
i i
C2.a ; � C2.b
)E NEXT HIGHER
ROOR
C2.f C2.g
CRAWISPACE
.
� .., t.:
_
.., ... .... . ���....�'�..
. ..- ,: . . .. .... _ _ ... .
A8.b—c A8.a
OPENINGS"
All buildings (other than split-level) elevated on a sub-
grade crawlspace, with or without attached garage.
Distinguishing Feature — The bottom (crawlspace) floor is below
ground level (grade) on all sides.` (If the distance from the crawlspace
floor to the top of the next higher floor is more than 5 feet, or the
crawispace floor is more than 2 feet below the grade [LAG] on all
sides, use Diagram 2A or 28.)
C2.a '
6RADE NEXT HfGtiER
F�ooR
\ C2.f
r^�^n�
C2.b
C2.g
.�—� :•—
_ '';-.,;;.."
A8_a+�:';:K .-
' A floor that is below ground level (grade) on all sides is considered a basement even if the floor is used for living purposes, or as an office,
garage, workshop, etc.
*' An "opening" is a permanent opening that allows for the free passage of water automatically in both directions without human intervention.
Under the NFIP, a minimum of 2 openings is required for enclosures or crawlspaces. The openings shall provide a total net area of not less than
1 square inch for every square foot of area enc�osed, excluding any bars, louvers, or other covers of the opening. Alternatively, an Individual
Engineered Flood Openings Certification or an Evaluation Report issued by the International Code Council Evaluation Service (ICC ES) must be
submitted to document that the design of the openings will allow for the automatic equalization of hydrostatic flood forces on exterior walls. A
window, a door, or a garage door is not considered an opening; openings may be installed in doors. Openings shall be on at �east 2 sides of the
enclosed area. If a building has more than 1 enclosed area, each area must have openings to allow floodwater to directly enter. The bottom of
the openings must be no higher than 1.0 foot above the higher of the exterior or interior grade or floor immediately below the opening. For more
guidance on openings, see NFIP Technical Bulletin 1.
NFIP Elevation Certificate Instructions — Page 9 of 9
U.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008
Federal Emergency Management Agency Expiration Date: November 30, 2018
National Flood insurance Program `
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agenUcompany, and (3) building owner.
SECTION A— PROPERTY INFORMATION FOR INSURANCE COMPANY USE
A1. Building Owner's Name Policy Number:
PV - PELICAN WALK, LLC
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number:
Box No.
490 POINSETTIA AVENUE
City State ZIP Code
CLEARWATER Fiorida 33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Lots 2 through 8, Block "A", A Re-plat of Block "A" and Lots 1 to 15 incl. Block "B" of Clearwater Beach Park First Addition
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) PARKING GARAGE
A5. Latitude/Longitude: Lat. 27°58'54.4" Long.82°49'34.1" 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. Building Diagram Number 1A
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) sq ft
b) Number of permanent flood openings in the crawispace or enclosure(s) within 1.0 foot above adjacent grade
c) Totai net area of flood openings in A8.b sq in
d) Engineered flood openings? ❑ Yes ❑ No
A9. For a building with an attached garage:
a) Square footage of attached garage sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade
c) Total net area of flood openings in A9.b sq in
d) Engineered flood openings? � Yes ❑ No
SECTION B— FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number 62. County Name 63. State
CITY OF CLEARWATER 125096 PINELLAS Florida
84. Map/Panel 65. Suffix 66. FIRM Index B7. FIRM Panei B8. Flood Zone(s) 89. Base Flood Elevation(s)
Number Date Effective/ (Zone AO, use Base
Revised Date Flood Depth)
12103C0102 G 08/18/2009 09/03/2003 AE 11'
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9:
� FIS Profile �x FIRM ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 �x NAVD 1988 ❑ Other/Source:
B12. Is the building located in a Coastai Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? � Yes �x No
Designation Date: � CBRS � OPA
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6
ELEVATION CERTIFICATE
OMB No. 1660-0008
Expiration Date: November 30, 2018
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 P.O. Route and Box No. Policy Number:
490 POINSETTIA AVENUE
City State ZIP Code Company NAIC Number
CLEARWATER Florida 33767
SECTION C— BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings* 0 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: SITE BENCHMARK 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.
Check the measurement used.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 4 � � feet ❑ meters
b) Top of the next higher floor 21. 35 � feet � meters
c) Bottom of the lowest horizontal structural member (V Zones only) N�A. � feet ❑ meters
d) Attached garage (top of slab) N�A. � feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building N�A � feet ❑ meters
(Describe type of equipment and location in Comments)
� Lowest adjacent (finished) grade next to building (LAG) 3 6 x❑ feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 4 5 ❑x feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including N�A. � feet ❑ meters
structural support
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 fhe information on this Certificate represents my best efforts to interpret the data available. 1 understand that any fa/se
statement may be punishab/e by fine or imprisonment under 18 U. S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? ❑x Yes ❑ No ❑ Check here if attachments.
Certifier's Name License Number �•., _ � ., .� ��
EDWARD C. ELLIOTT 3983 -` 'G • '
Title +_- �
PROFESSIONAL SURVEYOR & MAPPER , , `�' `°,
Company Name -, , . .��: �. ���1�1
ARCTURUS GROUP, LLC � � '; �e � e �' '
.� Y
Address ` 'Y � ��
x
2328 U.S. HIGHWAY 19
City State ZIP Code � ,. �,','
HOLIDAY Florida 34691 l' � y. ;� 9,,_'
Signature Date Telephone
07/05/2016 (727) 940-8888
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agenticompany, and (3) building owner.
Comments (including type of equipment and location, per C2(e), if applicable)
THERE IS NO MECHANICAL EQUIPMENT INSTALLED AS OF THE DATE OF THIS CERTIFICATE.
FEMA Form 086-0-33 (7/15) Replaces all previous editions. rorm rage � ot b
'� - `t.
U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency ManagementAgency
Natianal Fiaod lesurance Program
ELEVAT101� CERTIFIGATE
tmportant: Fallaw the instructians on pages 1-9.
OMB No: 1660-0Q08
Expira6on Date: November 30, 2018
Capy alt pages of #his Elevation Gerfificate and all attachments fac (1) communiiy offiaat, (2} insurance agenUcompany, and (3) buikiing ovmer.
SEC'TION A— PROPERTY INFORMA7'ION FQR IMSURANCE COMPANY USE
A9. Building �wne�'� Name Policy Number.
PV - PEUCAN WALK, LLG
A2. Buitding Street Address (including Apt, Unit, Suite, and/or Bldg. hto.) or P.Q. Route and Com n NA[C Number.
Box No. � Y
490 POINSET7'IA A1lENUE
G�Y Stafe ZIP Code
CLEARINATER Fiorida 337fi7
A3. Property Descripfian (Lat and Bloek Numbers, Tax Parce) Number, Lega! Descriptian, etc.)
Lots 2 through 8, Black "A°, A Re-plat af Block "A" and �ots 1 to 15 ind. Block "8" of Ctearwater Beach Park First Addi6an
A4. Building Use (e.g;, Residen#lai, Non-Residential, Additiarr, Acsessary, etc.) PARKiNG GARAGE
A5. LatitudelLongitude: Lat 27°58'54.4" �ong, 82°49'34.4" Horizonta! Datum: ❑ NAD 1927 � NAD 1983
A6. Attach at leas# 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A�'. Building �iagram Numbef 1A
A8. For a buifding with a crawispace �r endosure{s):
a} Square {�otage of crawlspace orencfasure(s) Sq ff
b} Number af permanent flood openings in the p-awispace orenclosure{s) within 1.0 foat above adjacenf g►ade
c) %tat net area of tlood openings in A8.b sq in
d7 Engineer�d flood ape�ri�gs? ❑ Yes ❑ Na
A9. For a building with an atEached garage:
aj Square fi�otage of attach� garage sq ft
b) Number af permanent flaati apenings in the attache�i garage within 1.0 ffloi above adjacent grade
cj Total ne# area af flaod ape�irrgs in A9.b sq in
d} Engineered flood apenings7` ❑ Yes � Na
SEGTIOM e— FLOOD tNSURAN�E RATE MAP (FtRM} INF�RMATION
Bi. NFIP Community Nam� & Communiry Number 82. �aunty Name B3. State
CITY t7F CLEARWATER 125Q96' PtNELIAS Fiorida
84. MaplPanel B5'. Suffix 86. FIRM (ndex B7. FIRM Panet B8. Flood Zane(s) B9. Base fiood Elevation(s)
N�mber Date Effectivet (Zone AO, use Base
Revised Date Floocf Depthj
121Q3G0'102 G DSliB/Z009 09/03/2QQ3' AE 1'I''
B9 0. (ndicate fhe source pf the Base. Flood ElevaGon (BFE} data orbase flaod depth entered in (tem B9:
(] F!S Profile ,x(] FIRM ❑ Community Determined [( Other/�ource:
Bi 1. (ndicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 x[� NAVD 1988 � O#herlSaurce:
812. Is ihe twilding located in a Goastal Barrier Resources System (CBRS) area or Othervvise Pratected Atea (OPA}? � Yes � No
Designation Date: � CBRS ❑ OPA
rcnrrH rorm uun-u-3� ��»�� Replaces a11 previous edi#ions. Form Page 9 of 6
���
ELEVATION CERTtFICATE OMB No. 1660-0008
Expirdtion Date: November 30, 2018
IMPORTANT: tn theseapaces, copy the correaponding i�fortnatian from Section A. FOR lNSURANCE CQMPANY USE
Building Street Addcess �induding Apt, Unit, Suite, and/or Bidg. No_j or P.O. Route and Box Na. Policy Number.
49[i ROINSETI'lA.AVENUE
C�h�' St�te ZIP Code Gompany NAfC Number
GLEARWATER Florida 33767
SEGTlON C— BUI�QING ELEYATION INFORMATlON (SURVEY REQUIREDj
G1: Building elevatior�s are based on: ❑ Con$truction Drawings" � Building llnder Consfructian" ❑ Finished Construction
"A new Elevation Cerrfifificake will be required when canstrudion of the building is comptete.
C2. Elevations—Zones A1—A30, AE, AH, A(with �FEj, VE, V1 V3p, V(with BFE), AR, AR/A, RRfAE, AR/A1 A30, AWAH, AWAO.
Gamplete lfiems G2.a-h below according fo the building diagram speafied in ltem A7. In Pusrto Rico onlq, enter meters.
8enchmark Utilized: SITE BENCHMARK Verticai Datum: NAVQ 1988
Ind"r�te elevation daturn used for #�e etevations in items aj thraugh h) betow'.
❑ N�uD 1929 ❑ IVAVD 1988 ❑ E3ther/Source:
Datum used for buitding elevations must l� the same as that used for the BFE.
Check the measuremertt used.
a} Top of bottom floor (induciing basemerrt, crawlspace, or enclosure �aorj `�. 0 �x fie�t � meters
b} Tap bf the next higher ftoor 21, 35 �{��t � meters
c) Battom of the lowest Ftorizontal s#ructural member (V Zones oNy} N�A. []X feet � meters
dj Attached garage {top of slab) NlA, �{�t ❑ meters
e) Lowest elevatian af machinery or equipment serviar►g the building ��a � fegt ❑ meters
(C3escribe type �f equipment and locaban fi Comments}
f} Lowest,adjacent (flnished} grade ne�ct to building {[AG) 3. � 0 feet (] meters
gj Highest adjacent (flnished} grade ae�ct to 6uifding (HAGj 4. � �#est ❑ meters
h) Lowest adjacent grade at lowest elevatio� of dedc ar stairs, including N�A. j]x fest � meters
sWdu�al support
SECfitC?(V D— SURVEYOR, ENClNEER, OR ARGHITECT CERtIFIC�4,T10N
This certi�cation' is ta be signed and sealed by a iand sunreyo�, engineer, or architecE authorized by law to certify eteva6on inforrrtation.
l cert�fytlrat the frrfiwmaHan on this Gerti�cate represents my best eilr�rts to fnterpret the dafa ava�7able. ! understand that any false
sfatemen# may be punishabta by frrte or imprisonment under 18 U: S. Code, Sec6on fQU1.
Were la#itude anrfi lo�gitude in Sedion A provided by a licens�ed land sunreya�? 0 Yes ❑ Na ❑ Ghedc hee� if attachments.
Certifie�'s iYame License Numbe�
EDWARD C, ELUOIT 3983
T�qe
PROFESSIONAL SURUEY�ft 8� MAPPER
Gompany Name F' ce
ARC'i'URUS GROUP, �.LG e
Address � � re
2328 [1.5. H1GHINAY 19
��fY Siate ZIP Code
HG3LIDAY Florida 34691
Signatuce }'j � Oa#e Telephone
�""'�^� 07/p5t2Q16 {727j 940-8888
Gopy all pages ofthis Elevation Certificate and a0 attachmenfs far (1) commu�ity o�iaai, (2j insurance agenUr�mpany, and (3) building owner.
Comments (incfuding type afiequipment and loca�on, per C2(ej, if applicable}
TNERE IS NO MECHANICAL EQUtPMENT 1NSTAlLED AS OF THE DATE dF THIS CERTIFIGATE.
FEMA Forrn Q86-0-33 (7h 5) Replaces a}i previous edi6ons. Form Paga 2 of 6