120 BAYSIDE DR- dEPART�1Eh(7' pF FipMEEA�ld SECURITY
�ederal �maer9encY Mana�merrt Agen�}r
ELEVATICiN CERTIFiCATE
IMPOR�'ANT: FOLLOW THF INfiTR! IY'TI!'�IUC r'tw� �n r±cn ., .,,, v� c� a�.- ,��
- -- -- . ..., ..... � ,-,.�`� a- �v Exqraaa�,: �ir.�or�is
a+� pag� ar mts E1swNon c� sn,a ai atbd,me„fs tnr (1) co� �+, t� insura+o. a�� a.a tsj buir�g cwrr,er-
�E�TION A- PROPER7Y 1�1F+�R�1/[77C1N FbRM INSURq�{{� COMPANY 11SE
A1. Buildpng drrr►�r's IV�rtkt - ._._._._____
DAN RAILEY ��y td�mber':
A2 Buiidirtig Street RddRess (includir� Myt. Urt�t, 5��. and/or Bldg. Nv.j ar P.O. Rau�e and
E�rnc Ab. 1P0 B�Y51ElE DWVE Cort�any NAtC
IVivt�ber:
� �CLFN2WATER 5fate
FLdRIDA � C.ode
A3, Prt�peril► �'�n ELot arid gb�ck hitunbers, Tax P�t�l Wum6et; Legal �lOn. etc.)
PARG'EL 09-�9-i5�U49�U-Q�pf-0040. �OCK A, LOT�,, BAY3�E SUB MU �, PB 027. P'G 0�4. PiNELLA3 tX7HihfTY. FL4WD�A
l4�i. BuiUdkt� Usv ta-g•. Re�ent4�l. hla�r-F�idendel. A�lltion, Ir�,ory, eb�)
As. l.a6itt�d�etl.origittxle: Lat 27.9705 �- �� � D�ttwtr: C' hLA,a i9�27 {: NAD 1983
A6. Atta�ch �t lea�st ? p(�tc�graphs M Ute bui�ng if fhs C,er�a � being uged to atylaLt Nood 1�.
A7- &dldirr� Dia�ram Numl�ar 1-A
A6. Fot a t�hg Wiitr �s a�w� ar e�io�lite(a): A8. F�t a
buNdN�g M�fh a� a�aCtr�d garage;
�) S�g f�o�e oi cx�wls�du °r +�r�ur�(g) NA ��} a) Sr�uare i�a� af �ti�hed �e 384 sq it
b) t+lumbbr esF p�arrnar►errt. flood �
��` � ���� � � �� �n �a�flad�ed par`age withb� 1.if �ooi NA
� ��' � NA abonro adjao�ent 9ra�e
c' Tat�l t�et � afi tloo�i apenin�s M AB.b NA ��y c) Ta�ai net aras of ik�oci upen� in A9.b NA �,q in
c!) E►'�gin+�e�'e�r! tk�c,d o�,er�in�s? C� Yes tXNr> d) E,�u'ed fbod op�,tir�s? C' Ye� {'XFW
SE.C7ION B- ELaO� HUS�tIRANCE i�A7E NAP � 1MIFORJ�Ul71C1N
Bi _ I�tP' �ar►?rnunitp tJame 8{:anmur�ity Nurrab�er 8�2. Cauti[y Ns�me B3. 5t�
f�.EJ1RWATER CITIt OF 175i196 PIh�LLA.� FL
B4. MapJP�rtel Akunber B5. SufHrc B6. FIFiM I�Meot Gab B7. FIf7M Pane�t Effeal�w�e/ B6. Flaid Zx�ne�(s) B9. Bars� Fbo�od Elevatinrr(sj
G �� (Z�rt�r AO, use l'� fkxyd
12if18C�010c7 OB/t8120f19 0�31'2i103 AE +�'p'�
11.0 FEEf
Bf 0. Intiicat�e Nte s�ourcye at the Bese �Iood Eievafion (8FE) daxa or b��se floai depth er�er�x! in Item E'39:
(` FIS Pro�le DC �I�2M t` Community 6elernuneQ f' dtitierl5ou�e:
B� 1. Itrdia�s elenraUa�tr c�Atun txsed fior SF� in Il�n B9: (' NGVD 19�9 4''( ldR1/D 1988 C' OfhedSoiur�r:
B�2. I� ttwe buNditig Irrc�bd In a Ct�stal Bareier Re�xoes Syatr,tn (C�R�j a�`ga ar � Pro�ed Area (ClPA►j? (' Yes iK' hb
o��, o�c�: � c- c�s r oPa
sEC�+ c- sui�ar� et..EV�TUOn iM�►na+ �su�v�r ��a�
1. OYNU� OIGidR�� �� L�U �. 1 ��N�'�i �� �� l f71�9{7� � WI�SO WRAIy � F� �
G2. EIew�Eio�s - Z.or�es At -1�. 11E. ItM. A(vriltl BFE}. ilE. Y'3 - it30. V�wilh BFEj. /1R, /1Ft/�►. IRWAE. ARIM - A30, llhlAH. ARlI�U.
aomplMrs lie�nts G2aa� -h belc�er �000rding b ths buil�tg dia�ram �p�d et Ibenn A7. In Puer6n Rir�o aMy, er�t� ntetier�.
!4 tra1Y Ele�►a6� �rtHlcate wNl be requ4'+ed wtien c�at�tldlon ot Che bWidlltig ts aolrlpie%.
�le�k l�iized- GPS V�1 D�hrn: NAVD 1988
rxi�c�e �anr�lan damum u�ed tar t�e e�e�r�tkx�s �n t�arr�s a) ira�ough h) beio�w. �' Nc�"v[y �s2� � N�41►D ��
[" dtl�,r�:
b�rn used inr buiklir� elevadaans must be ttre sarne � t1�eR used %x the BFE �t�edc the me�surement usecl.
� Tqa nf b�tmm fiur�r (kncluain� hr�erneni. crawlap�at�, ar enck�ur� ilwr) 6.24 ' (:� i�,et �' rrr+ehers
b} Top uf ih9 ne�t# higher�oa� Nq ' C* fi�ei i rr�heis
)�o�om dr mo �t nor� � nyerrr�er �v �«�s or�y� NA ' (*' fiaet r►,��
) A�adted g�r�age (bp M s�) 5.64 - G feet t" rrre6ers
) Low+� el�va�ton c�C rnac�riner�r or eqp�lprrierrt gervi�ing tl�re� buYdirtigi 6.0 -
([)esixiba typ�e of �t �rd kx�ion M Gartrr�ents) � feet C' rn�f+ers
L� ac�ax7eert ((1nEs�ned) grarde neuct to bt�dltig (LA6j 5.2 - f: fi� t' r►�ters
)��t (�iet�ned) grade next to b�iltlir'►g tt;AG) s.s - C*' teet C' meters
h) L,an�rest ac�aoerit grade at #ow�eat ele+r�atiar� af dedc or stair�. i�du�nS
�� � 5.2 - (* ieet (` rr�Eets
PRdY�ECI BY B�l FiYA�'T. F"F�OFESSIONAL. SURVE'l�OR FLORIC)A,SURYEYOR�A,Ot._CO�q
FENiA Fixm �(7/75) R6�p1�c;eS all pr�vi0us ed�t. PragB $ t�F 15
ELE'VATION �ERTIFICATE
120 BAYSIDE DRIVE, CLEARWATER, FL 33767
t�s cama r�nne,- �eso-aor�s
E�iratiun:11f3q12�018
SECTiDN D- 8URVEY(i(i. EMCiiNEEFi� OR ARCKTECT CERTIFlCATIOM
Tfiis oerti�n is tQ be signed �rrxt sesied by a I�d surveyor, er�'rreer, ar at�hi�ect a�fiarized try Faw b a�dfy ele�rs�iorr krform�don. l�fy
tt�ast the �r an this CerG� r�p►�en�s my best efi�r�s to �erpret lire db�a a[�d�e, I�rsian�d tt�ai arry fai�e statemer+!' m�y be
� br ��r �r�o�r�c r,r�r �8 u_s r�de, secba►r �na�. ..._._._.�..._._,
MVers laiih�te a►yd longifude � Secti�n A qta�,
�J C9t�t..k here i� a�1S, pr�1�d b�► a� iand s�,tv��Crr? x+�� �+ N' � 7'��'� C r
C: Yss t' No ` �`���' .•••!� ��'9
C.artiter`s Narn+a Li� NurnbaT ����R� l� ���
�31LL Ft1'RTT FLt7R104A5lFRYEYO�Ft�AOi..t�OM LS �6.?6 ; /� � .•
F'RESIDENT
Addr�s&
14�7 MAIN1 ST #3,Zi
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Kr�i rr �w �n�c
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oun�a�
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10-6-16
St�e I Zip C.cx1e
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Telephcxte
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C[�py bmttt sit�s a� iitis El�evafiiat C`,ertii%ate f+�t (f ) c�m�twtri.y c�fi�ia�t, (2) ir�sui'grroc�e �rtdcyornpariy, �,e �a� �,i� a,�r.
C.�unm�enis (indi.+ditfg M�e at e�meni artid loc�liort , per C2(ej, il� appNc�ble)"
NOT TO BE USED FOR CONSTRUCTION OR DESIGN
• EQUIPMENT ON LINE C.2. (e) IS BASE OF AIR CONDITIONING UNIT
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10-6-16
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. � �.,�. � - o��a�nv r�erw r � �wrc�arn� �w ��►eT �rorr �D) FOR ZONE J�O MIQ �ONE A (1!YlTHOIJT BP
� artd A(wittrout 81�. aam�ile� Items E1-E5. U�e ''cate is a�rbended bo soupport a L or L -� request, oo�r�le
A. B,arrQ C. For tter��s Ei -E4, i.t�er � grade. ii ar+�abie. t�t�e,ck Hre rr�urernent t�sect. In pue�ta 6�ioo only, errter metars.
$.�Yrrtitle el8rrafic� irda'rti�firx� fd' ilte �ibwirlg �btl c�leLic Nte� a�xd}Xi�tie boa�es tio 511orr rri'�il�'tlt� 8letiratirxt is affove� or b�low U1�
hdg�9t Adl2ux�tlt gtaxk4r (HAG) arr[! th�9loMrdst �t gr2de (LAQ)-
a� �-o� �r eo�tia,, noor �i�,�a,da,� �amer,e. craw�. - �. r� �-. � � � �. �-, �,�► � w�c_
�e��� �
b) Top of e�oemm flonrr {'u+�d�,dir� b�+a�twrd. �pe�Pi, _ �' reec C� n,eters ��bo+re or ❑ bek�w U'ne L.AQ,
or ertc�ve) is
�or Buikiing v��ms s-9 wit� per►nau�rrt iloo�a op�nir�gs prov�de�a in S�cuon 11 �lents 8 arx�or 9(see p�es s-9 c�f �nsin,ctiorrs), tne rtiext
ner fbor° (�levatir�t C2.b irt Ute df2�ra�ms) af tMs buildirrg is NA - C' fe�t C-' meters
❑ abavre or ❑ below the HAG.
Adt�+d g�r�ge (Cop cyt sla�bj fs
- t%� feer t^ m�era p�«� [� �w �re M�.
1op of pie�kEonn � madiir�ery a�c! /ar equ�tt �f' fiaet C' rneters
�icing me brd�eing is ' ('� �+ove ar (-) beNO�w trre ff�aG.
z+�e x0 only: �f no flax! depth rn,mber is �, is n ce top c�f iYae b�udn �oar eievaded a� a�noe ,�iiF► tlie «xvmurrit�'s iloodplein
�°"�"��`� C� Ye� C" N�a C� U►�Ivrc�nm. The locsd dfkdai mi� crertlty tl�s I�fat�tloh ht Sectkm G.
SECTION F- PROPERTY OYMF�R (OR OMYNEIi"8 RE#�RE8EMTATIitE.� C�A?IIFF�ATION
prnp�eriy cywrier or owrrer's rrap�esenhaiUve Sec� , and far (' a i�
c�rrrnt�,ic�-�t B�E) tir zrn,e Ao rrnt�t s�gn nere. 7he �eme� in secdio�r�s A, a. anc► E are aorrect Uo u,e r�est af my I�c
F�r�apat'ty t5wr�er ar Cfrrr�'s Authorized R�;pr�ese�►tatiMe's Naerie:
�dd�ess i�ity S`lxbe ZIP Code
,. .; .,
�a.11111t- Ytti.
FEMii� F�o�m t1�6-0-33 (71Tb)
G_:'^?'!
Telept�orre
Replaces all prr�t+lous ec�Hcros.
nr
F■ ::� .� r.,s , ti
Page 4 ail fi5
OMB Control Number: 1660-0008
Expiration: 11 /30/2018
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodptain management ordinance can complete Sections
A, B, C(or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8 -
G10. In Puerto Rico only, enter meters.
G1. � The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer,
or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the
Comments area below.)
G2 � A�COmmunity official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or Zone
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: " C� 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
Signature
Comments
Telephone
Date
❑ Check here if attachments.
FFIIAA Gnrm 11RR_(1_ZZ /7/��l Rnnl�roc all nravini�c crli4innc PanP f'i nf 1.'"i
ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS
CONTINUATION PAGE
Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and �ox No.
ADDRESS:
120 BAYSIDE DRIVE
CLEARWATER, FL 33767
PICS TAKEN 10/05/2016
FRONT VIEW AND CONTINUING AROUND BUILDING
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ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS
CONTINUATION PAGE
Building Street Address (inciuding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Ftoute and �ox No.
ADDRESS:
120 BAYSIDE DRIVE
CLEARWATER, FL 33767
PICS TAKEN 10/05/2016
FRONT VIEW AND CONTINUING AROUND BUILDING