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ELEVATION CERTIFICATE
O.M.I. NO. 3067-0077
Elpiras May 31. 1996
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to
provide elevation information necessary to ensure compliance with applicable community floodplain management ordinances. to
determine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR).
Instructions for completMg this form can be found on the following pages.
SECTION A PROPERTY INFORMATION
MAIMS OWNER'S NAME
..icSen_ AN iJ Eta.% 4 6u.S
STREET AOOAESS (mavens Am . Un& Sols ands mop _ Number) OR PI) RCM E 4N0 BO* NUMBER -.OMPANY NAIC NUMBER
—IP 1 p=s3„P•oft,e4 O O. AV sNU 6
OTHER OESCRIPT10N (Lot and Bloc* Numbers. ale
oT (1%4Cl< 6,431 M ANO4 AYI r &.t \4-, 161`�. 32 � S P1141 S.,(0.
CRY STATE ZIP CODE
c, ARW reit. 7-th4-10A -34.G3C%
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
FOR INSURANCE COMPANY USE
POLICY NUMBER
Provide tine following from the proper FIRM (See Instruchonsl
1 COIMJNNTY NUMBER
7.
2 PANEL NUMBER
3 SVFr t
+ 3ATE OF c,RM INOE t
, "NM /''INA
6 BASE FL000 ELEVATION
,,,, AO Zama. uta Oaps,)
125101(0
coo
F - 19 • °11
A.E.
2
12-
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE; NGVD 29 Other (describe on back)
8. For Zones A or V. where no BFE Is provided on the FIRM. and the community has established a BFE ter this building ^,Ite: indicate
the community's BFE: . : t .1 0 feet NGVD (or other FIRM datum -see Section 8. 'tem
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Certificate Instructions. indicate the diagram number from the diagrams +);:I 1 ori r' ayes 5 and 6 that best
describes the subject building's reference levet 8
2(a). FIRM Zones AI -A30. AE. AH. and A (with BFE) The top of the reference ;evei floor ,, .c rd 3 .cram ,s at an elevation
Of _ _._L`..0 feet NGVD (or other FIRM datum -see Section 8, item ';
(b). FIRM Zones V1 -V30. VE. and V (with BFE). The bottom of the lowest Horizontal struch.rai member ;;r the reference level from
theselecteddiagram. is at an elevation of . feet NGVD ,or other FIRM dat;.ir see Section B. Item 71
(c). RRM Zone A (without BFE). The floor used as the reference :ever from the selected diagram s t 8 feet ahoveX or
below -• . (check one) the highest grade adjacent to the building
(d). RAM Zone AO. The floor used as the reference level from the selected dlanram s fret above or below (check
one) the highest grade adjacent to the building It no flood depth numbers available is tt'e building's lowest floor (reference
level) elevated in accordance with the community's'loodpfain management ordinanceYet No Unknown
3. Indicate the elevation datum system used in determining the above reference !eve' elevations NGVD 29 Other (describe
under Comments On Page 2) (NOTE. It the elevation datum used in measuftng the elevations s ddrerent than that used on
the FIRM (see Section B. Item 7J. then convert the elevations to the datura- system used •_?77 rhe FIR&? and Show the ronverston
equation under Comments on Page 2.1
4. Elevation reference mark used appears on FIRM Yee. "aa See instrucuor , pr P him 4
5. The reference level elevation is based on actual construction xconstructlnr. 4rlwvg5
(NOTE: Use ofCOnstruCtsCn drawings 's only valyd_rl the building noes rot yet have, r^a •r,'rvr?;•,-r? levei floor in place. in which
Case this certificate wilt only be valid for the building durnq rhe course of : c sn ,cr cn .t : r , -nr'struct,on Elevation Certificate
will be required once construction is complete i
6 The elevation of the lowest grade immediately adjacent to tr., t: ,:'a: q s 40 1 7 ".GVD (or other FIRM datum see
Section B. Item 7)
SECTION D COMMUNITY INFORMATION
t. If the community official responsible for verifying building elevations specifies that the ret.+', ."VP? cNle6 'n Section C. Item 1
is not the 'lowest floor as defined ;n the commurjlty's tloodpi.i n management ordinarc« !I l.dhOn Jr :''e• h,:ddinq ; 'lowest
floor" as defined by the ordinance is t 6 feet NGVD C.r oche( FI M datum ;'•r `>e< t •r• i3 '!..
2 Date 01 the start of construction o• substantial improvement t 5
FEMA Form 81 31, MAY 93 REPLACES AL1 PREVIOUS EDITIONS
SEE REVERSE SIDE FOR CONTINUATION
05/26/2886 13:30
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ELEVATION CERTIFICATE
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SEC= A-PROM/11Y OWNER ilfeRMATION
PAGE 02
O.M.B. No. 3007-0077 I
Expires December 31, 2006
fortune Ceigant
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CfR1RENNW &eACHviaN Meek NUMBER 856114
MU PIIOIS OO&IANCSIitYEYORAtelimPFER OOMPANYNIME SlPVEYPRIG, INC
CORMS CRY STATE DA CCM
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IL 33734
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COMMENTS
0 M nese f ilbdiminb
=7RON E- ILAUNNOELEVATION Id:ORMATIONBIRVEV NOT RI3pl1 REO)FORMR AO AND ZONE AcATTIEMEFEj
Fa2bn•AOwarm A(a M111l.maplleIre £itaa*EA. 1M8nadonCream ItileiIndfawenaggalepbraLOMAaLCMiF.
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ieeearer NEralt %podb■a1oNraglow(*)
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ral>fdgicla.IagtllaL
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roe Co**IbesCShind (MTNdbm.
Et Ito IrpdMpltdraad=Wry a+dbrmio rclmeti*M0.011.: _1M_Inlos)❑avow D6da.(died aleph, WoeiMa lged►Ibae
apadpene.rwedeb).
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EIECIIONF- PROPERTY OWNER (ON COME S REPREEENTA111MICERTIFICATION
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PROPERTY ONRERSOtOMEREAIJTHNEZEDFEPRESefTAfiRSN
CITY STATE W
SIGNATUFE
DATE TELEPHME
Cho* lirerdram*
BQTION G . COIORMERY INFORMATION (OPTIONAL)
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03.0Tletininoteititlel(IrIeO4•011)11por Mk,com ltilwEakltrowivseponos
et M UER TE53aTiiGITEOFCdflWab00 Ei11��
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COAOAJIBTY NAME
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TELEPHONE
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JUN 0 5 2006
Fek,v25 �.6 �6:15p Lana Phillips 646-253-7768 p.1
U.S. DEPARTMENTOF HOMELAND 9ECURITY ELEVATIt�N CERT! FICATE O�B No. tsso-0006
FEDERAL EM�RGF1�tCYIMNAGEMENTAGENCY
Nationpl7Yood firsuranre Progrum �mportant: Read ths instructions on pages 1-9. Expiration Qate: July 31, 2015
SECTfON A- PROPERiY INFORMATiON
A1. Bu�dirg Owner's Name Kevin Philip
A2. Building Strest Address {including Apt.. UnR, Suite, ancilor Bldp. Na.) or P.4. Raute and Box td0.
10'SO Eldorado Avenue
City peanvater
State FL ZIP Code 33787
A3. Properly Descriptton (Lot ar�d Block Numbers, Tax Pa�cel Number, l.sgal Desc�iption, etc.j
Lot 6& norlhaly 1l`1 of LOt 5, BloCk 69, Mand818y Subdivi5ion
A4. Bullding Use (e.g., Resid�tlat, Non-Resider�at, Additbn, Acoes9ory, etc.) ' e' I
A5. LatitudelLongitude: Lat. 28.001871 t Lotg. -8'L.8270845 Horizantal �atum: ❑ NAD 1927 � NAD 1983
A6. Attach at least 2 phatographs of �he building if the Cai(flcate is being used ta obtain flood M�suranae.
A7. 8uilding Diagram Number �
,45, For a building with a cxawlspace or anclosure{s): A9. For a buiiding with an attached garage:
a) 5quare footage of cr�awlspace or en�sure(s) �¢ sq it a) square foetage ot aitad�ed garage � sq ft
b} Number of permanent flood opening tha cxawAspace b) Number of permanerat flood opentngs fn the attached garage
or endosure(Sj within 1.0 foot abave adjacent grade Q within 1.0 toal above adJacent grade �
c� Tulal net area of ilo� openings in A8.b � sq in cj Totai net area of flood open3ngs in A9.b � sq in
d) Engineered flocx! openings? ❑ Yes j8 No d) Engineered Nood openEngs? ❑ Yes � No
SECTION B- FLOOD INSURANCE RA7E MAP (FIRM)1NFORMATION
Bi. NFIP Communfty Name 8 Community Number B2. Co�xtty Name B3. State
City ot pearwater 125096 Pinellas FL
84. Map/Panel Number B5. Suff"u� 86, FIRM Index Date, B7. FIRM Panet B8. Flood B9. 8ase Flood ElevaGon(s} (Zone
12163C0084 G 9-3-03 Effedive/Revis� Oate Zone(s) AO, use bese flood depth)
9-3-03 1rE 13'
es�u. inaiq�e me source or tne t�ase r-x�o� e�evation (6FE} data or base Zlaod depth e�tered in Item S9.
❑ FtS Proflle � FIRM � Communi�+ Determined ❑ dtherJSaurce:
8'11. Indicate elevation datum used for BFE in item B9: 0 NGVD 1929 � NAVO �986 ❑ OtherlSource:
6�2. Is the bu�din8 located in a Coastal Barrier Resouroes Syslem (CBRS) area or 0lhervvise Protected Area (OPA)7 ❑ Yes � No
Designation Date: [] ��, 0 ppp,
SEGTION C- BUfLDING ELENATION INFORMA170N {SURVEY RE�UIRED)
C1. Build�g ele�rations are 3�ased an: Q Construction Drawfngs' ❑ Buildfng Under Constnictfan' � Finished Constrv#ion
`A new Elevation CerHficate will be required when Construdion af the building is cornplete.
C2. Eievatians - Zones A1-A3Q, AE, AH, A(with 8FE}, VE, V1-V30, V(with $FE), AR, AR/A, AWAE, AR1A�-A30, ARIAN, ARlAO. Comptete Items C2.a-h
belaw according to the buikiing diaqram specified in 14em A�. In Puerb Rico anly, enter meters.
BenGimartc Utilized: AURE� Vertical Datum: ELEV= 5.4fl; {N.A.V.D.1
Indicate elevaiio� datum used for Ihe elevations in items a) through h) below. O NGVp �929 � l�IA�VD 1988 ❑ Otherl5ource;
�atum used for building elevations must be the same as that used for the SFE.
Check the measurement used.
a) Top o! bottom floor (induding basement, crawispace, ar enclosure floor} A.� � feet ❑ rneters
b) Top ot the next hlgher floor �4.7 � teet ❑ meters
c) Baltom of the Iowest horizontal structural mernher (V Znnes ony) 1�.2,� � ieei ❑ meters
d) Atlached garage (iop ofslab} d•� � feel � meters
e} Lowest elevaUon of machinery or equipment seMcing the building �,�¢ � feet ❑ meters
(Desaibe type pF equipmertt and locatian in Comm�ts)
f) Lowest adjace�t (flnlshed) grade next to �fldir�g (LAG) a.a � tee� ❑ meters
g) Highest adaceM (finished} grade next to bu1ldN�g (HAG} �.� � ieet ❑ meters
h) Lowest adjacent grade at bwes! elevation of decic or stairs, indud'ing sVuctural suppor� �.� � feet ❑ meters
SEC710N b- SURYEYOR� ENGINEEtt, OR ARCHITECT CERi1FICA710N
This certification is ta be signed and sealed by a land surveyor, engineer, or ar�chitect eulhprized by iaw to certify ela�raaon
information. !�ertify that tlre inl6�m�atiorr ort thls CeRf�rcele repr+�sents my 6esteArorts to interpret the data avaNabte.
i understand fhat eny false stateme»t may ba puMshable by iaae a�r impriynnmenf urKdar 18 U.S. Code. SecNon t 0�0 i.
� Cr,edc here it commerns �e provided on badc of form. Were laptude and bngitude in Sectlon A pmvided by a
�1 Check here If attachments. licensed land surveyc►�1 � Yes ❑ Np
CerUfiers Name PMifp C. Stock Ucense Number RLS#3035
Tltie Presidanc CompOny Name Targei l.and Surveying
Address 516 Lakeside Plece
!l'�.e� � .�3�
Signature �----
City Largo
Date 12-2413
State FL ZIP Code 33771
telepFwne (727) 784-0573
{'�'. ._,.. . . .: a ;.
��� ��
FEMA Form 066-0-33 (7/12) See reverse side for conttnuatlan. Replaces all previous editions.
� �e�2� 16�6;15p Lana Phillips
.rMb�
IMPORTAN'i: !n these spaces, copythe
Ir�formation from Sectton A
646-253-7768
Building Street Add�ess {inGuding Apt, Unit, Sulte, and/or 81dg. No.) or P.U. Route and Box No.
'1010 Eldorado Avenus
City pearwater State FL ZIF Code 33767
SECTION 0— SURVEYOR, ENGlNEER, OR ARCHtTECT CERTIFICAT'ION tCON'fINUED)
Copy bottti sides oi IhIS Elevalion Certificate for (1) community official. {2) insurance agentlCOmpany, and (3) bu�ding owner.
Comments ,fob# i312�8.04
C2,e= Electric Meter
p.2
����
SignaWre � 1}ate 12-2473
SECiIONt E- BUlLDING ELEVATION INFORMATION (SURVEY NaT REQUIRED) FOR ZONE AO AND ZONE A{WITFiOUT BFE)
For Zones AO and A{without�FE), complete Rems E1-E5. ff the Certlflcale Is iMendad to support a LOMA cr LOMR-F reques� complete Sections A, B,
and C. For items E1-E4, use rratural grade, if available. Check the measurament used. In Puerto Rico only, erster meters.
E'I . Provide elevaHo� irdortnation forlhe fallowing and check the approprfate ba�s lo sha�v whether the elavatlon is abave or below the highest adjacent
grade (HAG) and the lowest adjacerrt grade (LAG►, •
a) Top of botWm floor (Induding basement, crawlspace, or endosure} is ❑ feet � meters ❑ above ar 0 bNow ihe HAG.
b} Top oi bottom floor {induding basemertt, ara+�Aspace, or enGasure} Is � feet ❑ meters ❑ abave a❑ befow the LAG.
E2. Far 8uilding Diagams 6-8 with permanent flood openings provided in Section A Iterns 8 andlor 9(see pages 8-9 of InsiNCUons}, ihe next higher flaor
�elevatlon C2.b in the diagramsj of ihe building is ❑ feet ❑ meters ❑ above or ❑ belaw the HAG,
E3. Attached garage (top of slab) is ❑ feet ❑ meters � above or ❑ below the HAG.
E4, Top of platfortn of rnachtn�y andJor equipment serviang the build'mg is ❑ f�t ❑ meters 0 above or ❑ bebw the HAG.
E5. Zane AO only: If no ilood depth number is avallable, is the bop ot the bottom floor e�evated in aocardance with the community's floodplain ma�agement
ordfnance? ❑ Yes ❑ No ❑ Unknown. The local afficial must certify this informa6on in Section G.
SECTION F- PROPERTY 01NNER (OR 01MNER'S REFRESENTATIVE) CERTtFICATi�N
The property owner a owne�'s authorized representative who campletes Sedions A. B, and E far Zone A �withoul a FENW-issued or commurwty-issued BF�}
or �onQ AO must sign here. The statemeMs In Sectlons A, B, and E are correct to the best oi my knowledge.
Properiy Owners or Owner's Autl►orized Representative's Name
Address
Signature
Comments
City
Date
State ZIP Code
Telephone
❑ Check here if atlachments.
SECT'ION G - COMMUNITY INFQRMATIOId (OPTtOi�iALj
The local of5aal who is authorized by law or ortiinance b administer fhe commir►itys Aoodplain management aNinance can carnpiete Sectians A, B, C(or E), and G
of this Elevation Certificate. Complete fhe applipble item(s) and sign bebw. Chedc the measurerrrent used tn lterns GB-G10. In Puerho Rico only, enter melers.
G� .❑ The inTorn�ation in Section C wes iaken from other docuner�tatlon Ihat has been signed and sealed by a Ac�nsed surveyor, engineer, or architect who
is author[zed by law W certiTy Hevatlan Nrformation, (lndlcate the sowae and date of the elevabon data in the Comments area below. )
G2. ❑ A vorrxnunity offidal oompleted Sectlon E for a building located in Zw�e A(without a FEMA-issued or a�mmmlty-issued BFE) or Zone AO.
G3. ❑ The foMowing inFormation {Items G4-G10) is provided for cornmiaiilyfbodpiain managemerrt p�poses.
G4. Permit Number G5. �ate Pemrt Issued GB. De�te CeAiflcate Of Cornpli�celOccupancy Issued
G7. This permii has b� issued tor. ❑ New Construction ❑ SubstanfGal Improvement
GB. Elevation of as-buik lowesi ftoor (indu�ng basernent) oFthe hdiding: [� feet ❑ meters Datum
G9. 8FE or (in Zoae AO) depth of flooding at the buAding site: ❑ feet ❑ meters Datum
G10. CommunRys design flood elevatlon: ❑ feet ❑ meters Datum
Local Ofi'iCial`s Mame Tq�g
Community Name T616phpt�e
Sigrrature Qale
Comments
❑ Check here ii attachments.
FEMA Form 086-4-33 [7/12� Replaces af1 previous editions.
� fe� 2�,16�06:15p Lana Phillips 646-253-7768 p.3
ELEVATION CERTIFICATE, page 3 guilding Photograp�s
See Instructior►s for Item A6.
IMP�R7QNT: in these spaces, copy the corresponding informatfon frorn Sec#(on A FaR INSUFZANCE COMPANY USE
Building Street Address (includhg Apt., Unit, Suile, andlor Bldg. No.} cx P.Cl. Route and Box No_ PpE�Gy (Vu�b�;
1010 Efdorado Avenue
City Clea�water State FL ZlP Code 33767 CCrnpeny NA1C Number,
If using the Ele�ation Certificate to obtain NFIP flood insurance, affix at leasl 2 building pi�otograpt�,q below according to the ins#ructians
tor Item A6. IdenEify all pholographs with date taken; "Front Uieu�' and "Rear View"; and, iF required, "Right Side Vievd' and "Left Side
View." When appYcable, photographs must show the founda#ion with representative examples of the fEood openings or vents, as
indicated in Seciion A8. lf submitting more phoEographs ti�an w�t fii on this page, use the Continuation Page.
�Frr�nF vie..fi
"Rear viev�'
FEMA Form 086-0-33 {7/12j Replaces a11 previous editions.
� Fe� 2� �6�6;16p Lana Phillips
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ELEVATIDN CERTIFICATE, page 4
Bui�ding Rhotographs
Continuafion Page
646-253-7768 p,4
IMPORTAM': In these spaces, co�►ythe corresptmding f�formation from Sectton A.
Building Street Adtlress (including Apt, Unit, Suite, andlor Btdg. No.) or P.O. ROUte 0nd BoX Np.
10'1 p Eidorado Avenue
City Gea►water State FL ZiP Code 33T67
FOR INS[1FiANCE COMPftM' USE
Pd1cy 15umber.
Cbrnpany NAIC Num6er.
If submitting more photographs than wiEl fit on the preceding page, affix the addiiiona! phobographs below. Identify all photagraphs
with: date laken; "Front View" and "Rear VieW; and, if required, "Right Side Vevi' and "Left Side View." When applicable,
phot�graphs must show the faunda6on with representaUve examples of the floai openings or vents, as iRdicated in Section A8.
Left sicie view
FEMA Form D8�-0-33 (7/12) Replaces all previous editions.