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800 LANTANA AVEDEPARTMENT OF HOMELANE� SECURlT'r' Federal Emergency Managem�r�t l�yency ELEVATtON CERTiFiCATE IMPORTANT: FC3LLQtN THE IM1ISTRUC;71C3NS QIV F'AGES �-16 OM8 Control Number: 1660-0008 Expiratlon: 1 il30/2018 opy all pages of this Elevation Certificate and a31 attachments for (1) community official, 42j insurance agenUcompany, and (3) building owner. SEC710N A- PROPERTY INFQF2MATION FOf2M INS�}RANCE CQMPANY USE A1. Building Orrvner's Name � MANUAL LABOR INVESTMENTS LLC PoCicy Number; A2. Building Street Address (including Apt., Unit, Suite, andlor E3ldg. NQ.) or P.O. Route and Box No. CQmpa�y NAIC �tumber: 800 LANTANA AVENUE Cit CLEARWATER Sta#e FL Zip Gode 3366T A3. Property Description (Lot and Block Numbers, Tax Parcei Number, Legal Description, etc.) �` �� LOT 12, BLOCK 23, MAIVDALAY SUBDIVISION, PLAT [300K 14, PAGE 32, PI�dELLAS COi.�NiY, FLORIDA. A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) }�ESIDENI�IAL A5. Latitude/Longitude: Lat. z7°�g'36.6" Long. 82°4g'3C7.5" Horizontai i3at�m: ❑ NAD 1�27 � NAD 1983 A6. Attach at least 2 photographs of the buiiding if ihe Certificafe is being used to obtain flaad insurance. A7. Buiiding Uiagram Number 1A A8. For a building with a crawlspace ar enclosure(s): A8. For a bGiilding with an atta�hed garage: a) Square foatage of crawlspace or enelosure(s} N�� S� � a) Square foatage of attached garage ��A sq ft b) Number of permanent flood openings in the b) Number of permanent flond openings crawlspace or enclasure(s) within 1.0 foot in the attached garage within 1.0 foot above adjacent grade 0 abov� adjac�nt grade t� c) Total net area of flood openings in A8.b a Sq �� c} Tota( net area of ffaod �peninr�s in A9.b sq in d) Engineered f#ood apenin s? ���s ��� d) En ineered flood openings? ��P� �� �� SECTION B- FLOC)D i�iSURANCE RATE MAP (FiRM) tNFC3RMAT10N B1. NFIP �ommunity �lame & Community Numlaer B2. Cou�ty Name j B3. State CITY OF CLEARWATERJ125096 P�NELLAS � FL B4. Map/Panef t�tumber F35. BC. FlRM Index �ate B7. �1R�vi Panei Effective/ B8. Flood Zot�e�s) $9. ase F{aod Elsuation{s) (Zane Suffix Revise� Date AU, use base flood depth 12103C0102 G' 8/18/2009 09103/2003 AE 11 B10. Indicate the source af the Base Flood Eleuation {EiFE} data c�r base fload depth entered in Itern S9 ❑ FIS Profile [X� FiRM ❑ Community Determined ❑ atherlSource: B11. Indicate elevation datum used for BFE in Item B9: ��GVD 1929 � NAVD 1988 -�-� C}thsr/Source: B12. Is the building located in a Coastal Barrier Resources System (GBRS) area or Otherurise F'rotected Area {OPA)? Yes � No [JX Desi nation Date: N/A ❑ CBRS ❑ OPA SECTION C- BUILDING ELEVATION IN�ORMATION (SURVEY RE�UIRED� C1. Building elevations are based orr. ❑ Gonstruction C?rawings� [� Biaiiding Under Canstruction� [�Finished Cc�nstruction C2. Elevatians - 7_ones A1 - A30, AE, AH, A(with BFE}, VE, V'� - U3Q, V{with BFE}, AR, AR/A,, ARfAE, AR/A1 - A30, ARlAH, e4R/Ad. Compiete it�ms C2.a -h beiow according to the k�uiEding diags'am specified in item A7. In Puerto i�ico on€y, enter meters. A new Elevation Certificate will be required when construction of the building is compiete. Benchmark 4Jtilized: CITY OF CLEARWATER !-2, ELEV.=4.9: Verticai Daturra: NAVD 1g8� DATUM Indicate eleva#ion datum used for the elevations in items a} through ����,�p 19�� [�����1988 ❑ Other/5aurce: Datum used for building elevations must be the same as Ehat used fiar the B�=E. Check the measurement used. a) Top of bottom fioor {including basement, erawlapace, or eric�asure fir�c�r} � _ a� feet � meters ❑ b) Top of the ne�ct higher floor NiA � feef � meters � c) Bottom of the lowest horizontal structural rnerr�ber (t! Z.ones ranly) �r� _ fe�t [� meters ❑ d) Attached garage (top of slab) NiA - f�et �� meters n e) Lowest eleuation oi machinery or equipment servicing ttie building _ _ -� 5 � 29 feet � meters � (Describe type of equipment and location in Comments) f) Lowest adjacent (finished} grade next to buiiding (LAG) 4 � 3 feet �� meters �� g) Highest adjacent (finished} grade next to building (HAG} 4 � 5 feet � meters ❑ h) Lowest adjacent grade at lowest el�vation of deck ar stairs, ir�cltsc;rng N/A - feet ❑ meters ❑ structural support 800 LANTANA F�VENUE ELEVAT�ON CERTIFICATE CLEARWF�T�R Fl_ . QNE� Contro! Numbsr: 1�&0-00�l8 Expiration: t 1/30/2018 33667 � SECT(ON D- SURVEYOR, ENGiNEER, OR ARCHITECT CER71F9CAilt?N his certiflcation is to be signed and seated by a land surveyar, engineer, or archiiect authorized by law to certiiy elevation information. i certify �at the informatron on this Certificate represents mv best eftorts it� ir�isrpref the ciatc-� avai(atal�. ! uncierstanc9 that ar�y false s�`afe�ner�t rnay be unishable by �ne ar imp�isornnent ur7der 18 U.S. Code, Sectit�ra 1(?01. ❑ Check here if attachments. Certifier's Name GUY D. HALE W�re iatiiEad� a��d ic�ngit�de in Sec,ti€�ri A �arovided by a licensed iand surveyar? ❑X Yes C� No Title Company Name PROFESSIONAL LAND SURVEYOR GUY HALE, LANC� SURVEYINC� Address 111 FOREST Signature Gity . S. _ C?LDSMAR I Date � 4al2712016 Sta#e FL Telephone 727-73�k-426fi Lic�nse Number 462& �I� �Od@ 34677 •,� 3�' � ` ca�rr:���s ' '� ��i v� (�'•� k � �x �.� ,� ; � . . , r�: �� '` . `+-;yv * � ���'. +�" � y ��; ��� � ,,,�, ,�� ' ��n rr �� � Y� r" . f. . �� ��t` .:� .•�„�'� »°,e, r� j A � *�v `� <.;; '��' �opy both sides o#�idis Efevation Gertificate for (1 j commt�nity o'Cfici�i, �2) insurance agent/c�rr�pany, �nd (3} building owner. Comments (including type of equipment and locat+on , per C2(e}, if applicable)" THE LOWEST MACHINERY IS THE AIR GONDITlONER THIS FORM iS PRINTED ON B�TH SIUES ANO THE SEAL IS VfSISLE FQRM THE FRC)NT. Signature Date �4127i24i6 SECTtON E- BUILDING ELEVATlt�N lNFORMATIC)N (SllRVEY NOT REQUIRED} FOFt ZONE AO ,AN[1 ZONE A(WITHOUT BFE) =or Zones AO and A{without BFE), complete Btems E1 -E5. 8f the Certificate is intended #a s���ppart a I�OMA or LOMR-F request, comp{ete 3ections A, B,and C. For Items E1 -E4, use natura{ grade, if availabie. Check the measurement used. In Puerto Rico a�ly, enter meters. 1. Provide elevation information for the fallowing and check the appropriate boxes to show whether the efeva4ion is above or �elaw the highest �jacent grade (HAG} and the lowest adjacent grade �L.fiG}. a) Top of bottom floor (including basement, crawlspace, - C.)feet C_3meters L7above or C.�belaw the HAG. or enc{osurej is b) Top of bottom fioor {including basement, r.rawlspar,e, - C._�feet Cl_rr�eters (_._�l�t�c�ve or i_lbelow the LAG. or enclosurej is For Building Diagrams 6-9 with permanen# fload openings provicfed in Seciion A Items ��nd/or 9(see pages �-9 of Instructions), the next ier floor (elevation C2.b in the diagrams} of the buiiding is - �__1��et !.�meiers �.�above o� [,�b�{r�rrr th� NAG. Attached garage (top of slab) is - feet rneiers abave orbeiow the HAG. Top ot plafiform of machinery and /or squipment �icing the building is - feet meters above orbelo�v tha HAG. Zone AO only: !f no flood depth number is available, is the top of the bottom flonr efevated in accordance with #he community's floodplain raqement ardir�ance? Yes �fo Unknawn. The locai official rreust certify this in�orrnaticrn in Section t�. SECTION F- PRORERTY ONtNER (OR OWN�R'S REPRESENTATPVE) CERi1FiCAT[OtV i"he properky owner or awner's authorized representative who corz�pletes Sections A, B, an� E far Zorae A�without a FE[vtA-issued or �ommunity-issued BFE) or 7_one AO must sign here. The statements in Sectians A., B, and E are correci to the best of my knowiedge. Property Owner or Owner's Authorized F�epresentativ�'s Narne: Address Signature Comments City C?ate St�#e Tele�t�or�e ?_iP Cade ❑Check herP if attachments. i' , � ' w BUILDiNG PHOTOGRAPHS See �nstructions for item A6 OMB Control Number. 1660-0008 I�fPORTANT: In these s aces, co the corres ondin informafion from Sectian A. FOR iNSURANCE COMPANY USE Eiuilding Street Address (including Apt., Unit, Suite, andlor 8ldg. No.) or P.O. Route and Box No. _ Palicy Number: 800 LANTANA AVENUE Gity CLEARWATER State F� Zip Code Company NAIC 33667 Number. If using the Elevation Certificate to obtain NFIP flood insurance, affix ai Isast 2 building photographs below according to the instructions ior Item A6. Identify all photographs with date taken; "Front viev�' and Rear view"; and, rf required, "Right Side View" ancf "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Sect'ron A8. If submitting more photographs than will fit on this page, use the Continuation Page. EAST SIDE TAKEN Q4/27/2016 . - �, �UPLDtNG PHOTOGRAPHS S2e instruCtiOns for Item AS Otv4B Cantra� Num33er: 16S0-GGOc � 3MPORTANT: In these s aces, co the carres andin information from Section A. FOR INSUf2ANCE COMPANY USE suiiding Street Address (including Apt., Unit, Suite, andior Btdg. No.) or P.O. Route and Box No. 800 LANTANA AVEfVUE Policy 1Vumber d-�tY CLEARWATER State F� Z'tp 3��7 Company NA1C a�� using the Elevatian Certificate to obtain NFIP f{ood insurance, aif+x at teast 2 buiiding phatographs befow according to the instcuctions for Item ��.o. Identify all photographs with date taken; "Front viev+i" and Rear view"; anci, if tequired, "Right Side View" anci "Left Side View." When �:��plicable, photographs must show the foundatior� with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on fhis page, use the Continuation Page. REAR WEST SIDE TAKEN 04/27/2016 ---__ . ,� _- �.S �H` .... ._..._ ___." _.- ' n.. t.. - _. _ i.