400 PALM ISELEVATION CERTIFICATE onns No. �ssa000s
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:
400 PALM ISLAND N.E.
��tY State ZIP Code Company NAIC Number
CLEARWATER, Florida 33767
SECTION C— BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings* ❑x Building Under Construction" � Finished Construction
'A new Elevation Certificate will be required when construction of the building is comp(ete.
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: CITY OF CLWR. BM #I-03.5 Vertical Datum: 6.4912'
Indicate elevation datum used for the elevations in items a) through h) below.
❑ NGVD 1929 �x 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) 6 z � feet ❑ meters
b) Top of the next higher floor � �. 2 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) 6, 2 0 feet � meters
e) Lowest elevation of machinery or equiPment servicing the building N�A. Q feet � meters
(Describe type of equipment and location in Comments)
� Lowest adjacent (finished) grade next to building (LAG) 5� OX feet � meters
g) Highest adjacent (finished) grade next to building (HAG) S 6 0 feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including N�A �x 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 etevation information.
I certify that the information on this Certificate represents my best efforts to interpret the data available. I undersfand that any false
statement may be punishable 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
LARRY L. EVANS FL. LS No. 2937 ,i,,,: • ;�,.
Title � m �:• ; � E;�;/'�,�o
LAND SURVEYOR
� ''
Company Name .� ,�� �,�p`l�a��4P,�Er �
EVANS LAND SURVEYING, INC. � � -�a-�-6}�=�-�----�> -
.._� � �'' "�, . � , ����� ' �
Address R r .+�,�le a,,,
1460 BELTREES STREET STE. 9 � ' �'
Ci ���," �'�"��� ��l : � ..
tY State ZIP Code �- � � '
DUNEDIN, Florida 34698 ` k' • � ���� ' � ��r
M``�°, ry� • . . . . �Z .
Signature Date Telephone �
, ' OS/04/2016 (727) 7343821
Copy all pag of t Elevation Certificate and all attachments for (1) community o�cial, (2) insurance agenUcompany, and (3) building,owner.
Comments (includ type of equipment and location, per C2(e), if applicable)
C2.a-h): House is under construction.
__ _
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6
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: Foilow the instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner.
SECTION A— PROPERTY INFORMATION FOR INSURANCE COMPANY USE
A1. Building Owner's Name Policy Number:
JAMES & JODI BROWN
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number:
Box Na
400 PALM ISLAND N.E.
City State ZIP Code
CLEARWATER, Florida 33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 82, UNIT 6 B- ISLAND ESTATES of CLEARWATER
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. 27deg. 59' 08.3" Long. 82deg. 48' 57 6" Horizontal Datum: � NAD 1927 � NAD 1983
A6. Attach at leastx2 photographs of the building if the Certificate is being used to obtain flood insurance.
.
A7. Building Diagram Number 7
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) 2,�2g sq ft '
b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade �10,�
c) Total net area of flood openings in A8.b 2,560 sq in
d) Engineered flood openings? �x Yes �Q-�Vo
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 0
c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? � Yes ❑x 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 65. Su�x B6. FIRM Index B7. FIRM Panel B8. Flood Zone(s) B9. Base Flood Elevation(s)
Number Date Effective/ (Zone AO, use Base
Revised Date Flood Depth)
12103 C 0102 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 ttem B9: ❑ NGVD 1929 ❑x NAVD 1988 ❑ Other/Source:
B12. Is the building Iocated in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? � Yes Ox No
Designation Date: ❑ CBRS ❑ OPA
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6