534 MANDALAY AVE(� DEPPAAR MENT OF M LANDS TY
Federalmergency Management Agency
ELEVATION CERTIFICATE
IMPORTANT: FOLLOW THE INSTRUCTIONS ON PAGES 9-16
OMB Control Number: 1660-0008
Expiration: 11/30/2018
bopy 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
FORM INSURANCE COMPANY USE
Al. Building Owner's Name
CITY OF CLEARWATER
Policy Number:
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No.
534 MANDALAY AVENUE (MAINTENANCE BUILDING)
Company NAIC
Number:
City CLEARWATER
State FL
Zip Code 33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Parcel ID# 05-29-15-16362-000-0160, CLEARWATER CITY PARK, REVISED MAP OF CLEARWATER BEACH, PB 11, PG 5
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Non -Residential
A5. Latitude/Longitude: Lat. 27°59'04.3" N Long.82°49'37.7..wHorizontal Datum: rt NAD 1927 A 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 1B
A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawispace or enclosure(s) 1091 sq ft a) Square footage of attached garage 0 sq ft
b) Number of permanent flood openings in the b) Number of permanent flood openings
crawispace or enclosure(s) within 1.0 foot in the attached garage within 1.0 foot
above adjacent grade 8 above adjacent grade 0
c) Total net area of flood openings in A8.b 1099 sq in c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? 0 Yes 0, No d) Engineered flood openings? 0 Yes (A No
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number
CITY OF CLEARWATER 125096
B2. County Name
PINELLAS
B3. State
FL
B4. Map/Panel Number
12103C0102
B5. Suffix
G
B6. FIRM Index Date
08/18/2009
B7: FIRM Panel Effective/
Revised Date
09/03/2003
B8. Flood Zone(s)
AE
B9. Base Flood Elevation(s)
(Zone AO, use base flood
depth
12
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9:
( - FIS Profile ( FIRM O Community Determined 00 Other/Source:
B11. Indicate elevation datum used for BFE in Item B9: 0 NGVD 1929 (A NAVD 1988 0 Other/Source:
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? (5 Yes (A No
Designation Date: C CBRS 0 OPA
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl . Building elevations are based on: 0: Construction Drawings* (j' ; Building Under Construction* el, Finished Construction
C2. Elevations - Zones Al - A30, AE, AH, A (with BFE), VE, V1 - V30, V (with BEE), AR, AR/A, ARAE, AR/A1 - A30, AR/AH, AR/A0.
Complete Items C2.a -h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
* A new Elevation Certificate will be required when construction of the building is complete.
Benchmark Utilized: H-02 CITY OF CLEARWATER Vertical Datum: 5.21 FEET NAVD88
Indicate elevation datum used for the elevations in items a) through h) below. 0 NGVD 1929 (. NAVD 1988
0 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) 5 - 6 M feet r meters
b) Top of the next higher floor N/A - (A feet 00 meters
c) Bottom of the lowest horizontal structural member (V Zones only) N/A - (: feet 0 meters
d) Attached garage (top of slab) N/A - ('r feet 0, meters
e) Lowest elevation of machinery or equipment servicing the building 13 - 1 feet n meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 4 - 6 P feet (5 meters
g) Highest adjacent (finished) grade next to building (HAG) 5 - 4 ( feet 0 meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A -A feet ('A meters
structural support
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Page 3 of 15
ELEVATION CERTIFICATE
OMB Control Number: 1660-0008
Expiration: 11/30/2018
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 Certificate represents my best efforts to interpret the data available. I understand that any false statement may be
punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
Were latitude and longitude in Section AA'
14 Check here if attachments. provided by a licensed land surveyor?
(Z Yes ( No
c
^ �C
V l
Certifier's Name
DANA A. WYLLIE
License Number
LS 5874
` '
Title
SURVEY MANAGER
Company Name
DEUEL & ASSOCIATES
V
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pl;f :n,
f'
Address
565 S. HERCULES AVE.
City
CLEARWATER
State
FL
Zip Code
33764I/
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Date
Field: 9/07/2016
Telephone
(727) 822-4151
9
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments (including type of equipment and location , per C2(e), if applicable)"
A5: Latitude and longitude were determined using Google Earth. ABa: included exterior storage enclosed area.
A8c: Flood openings consist of 4 Smart Vents Model #1540-520 on exterior walls and 4 non -engineered openings on
exterior storage enclosed area. Smart Vents cover 200square feet of enclosure space per the attached ICC -ES
Evaluation Report. A 5th Smart Vent exists between the building wall and exterior storage enclosed area and was not
used for A8c calculations. FLOOD OPENINGS CALCULATION:
4 Smart Vents at 200 square inches each = 800 square, Inches plus
4 non -engineered openings = 299 square inches, Total Flood Openings =1099 square inches
C2e: There is no equipment servicing building. Elevation shown is bottom of electric meter. Lowest electric outlet
elevation 10.2 feet.
M
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Si nature s Date � -2O/(,
9 ,a s a W _1(Aa•
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A ( TH UT BFE)
For Zones AO and A (without BFE), complete Items El -E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete
Sections A, B,and C. For Items El -E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters.
El. 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, - (^' feet (' meters ❑ above or ❑ below the HAG.
or enclosure) is
b) Top of bottom floor (including basement, crawlspace, - ❑ above or ❑ below the LAG.
feet C. meters
or enclosure) is
E2. For Building Diagrams 6 -9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 8 -9 of Instructions),
higher floor (elevation C2.b in the diagrams) of the building is - m feet 0 meters ❑ above or
■
the next
below the HAG.
E3. Attached garage (top of slab) is - C; feet () meters ❑ above or ❑ below the HAG.
E4. Top of platform of machinery and /or equipment C (/��
- meters ❑ above or ❑ below the HAG.
the building is feet C,
servicing
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 0 No C 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 completes 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
4
Check here if attachments.
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Page 4 of 15
•
BUILDING PHOTOGRAPHS
See instructions for Item A6
OMB Control Number: 1660-0008
Expiration: 11/30/2018
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.
534 MANDALAY AVENUE (MAINTENANCE BUILDING)
Policy Number:
City CLEARWATER
StateFL zip Code 33767
Company NAIC
Number:
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.
FRONT VIEW (NW SIDE) 9/07/2016
REAR VIEW (SE SIDE) 9/07/2016
LEFT VIEW (NE SIDE) 9/07/2016
SMART VENTS ON NE & SW WALLS 9/07/2016
RIGHT VIEW (SW SIDE) 9/07/2016
NON -ENGINEERED OPENINGS ON SW SIDE 9/07/2016
(Exterior enclosed storage area)
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Page 6 of 15
ri. . .
DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
ELEVATION CERTIFICATE
IMPORTANT: FOLLOW THE INSTRUCTIONS ON PAGES 9-16
OMB Control Number: 1660-0008
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..,.....�..... . ,,.,
opy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agenUcompany, and (3) building owner.
SECTION A- PROPERTY INFORMATION FORM INSURANCE COMPANY USE "
A1. Building Owner's Name
CITY OF CLEARWATER Policy Number:
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No. Company NAIC
534 MANDALAY AVENUE (MAINTENANCE BUILDING) Number:
City CLEARWATER State FL Zip Code
33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Parcel ID# 05-29-15-16362-000-0160, CLEARWATER CITY PARK, REVISED MAP OF CLEARWATER BEACH, PB 11, PG 5
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Non-Residential
A5. Latitude/Longitude: Lat. 27°59'04.3" N Long.82°49'37.7"WHorizontal 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 1 B
A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) 1091 Sq ft a) Square footage of attached garage 0 sq ft
b) Number of permanent flood openings in the b) Number of permanent flood openings
crawlspace or enclosure(s) within 1.0 foot in the attached garage within 1.0 foot
above adjacent grade $ above adjacent grade 0
c) Total net area of flood openings in A8.b 1099 Sq in c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? t�' Yes (t" No d) Engineered flood openings? C�° Yes (•` No
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
61. NFIP Community Name & Community Number B2. County Name 63. State
CITY OF CLEARWATER 125096 PINELLAS FL
64. MaplPanel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel Effective/ 68. Flood Zone(s) B9. Base Flood Elevation(s)
Revised Date (Zone AO, use base flood
depth
12103C0102 G 08/18/2009 09/03/2003 AE 12
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69:
�(" FIS Profile (�'? FIRM � Community Determined � Other/Source:
B11. Indicate elevation datum used for BFE in item B9: (' NGVD 1929 �` NAVD 1988 �" Other/Source:
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? t�`' Yes l�' No
Designation Date: �" CBRS (", OPA
SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: �'" Construction Drawings" �" Building Under Construction* �! Finished Construction
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.
A new Elevation Certificate will be required when construction of the building is complete.
Benchmark Utilized: H-02 CITY OF CLEARWATER Vertical Datum: 5.21 FEET NAVD88
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) 5- s t:= feet (' meters
b) Top of the next higher floor N�A ' r feet ('` meters
c) Bottom of the lowest horizontal structural member (V Zones only) N�A - C�` feet ('` meters
d) Attached garage (top of slab) N�A - (: feet ('� meters
e) Lowest elevation of machinery or equipment servicing the building 13 - 1
(Describe type of equipment and location in Comments) %' feet � meters
f) Lowest adjacent (finished) grade next to building (LAG) 4- s (•' feet i' meters
g) Highest adjacent (finished) grade next to building (HAG) 5- 4 (� feet (" meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A -
structural support � feet �'` meters
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Page 3 of 15
ELEVATION CERTIFICATE
OMB Control Number: 1660-0008
Expiration: 11 /30/2018
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 Certificate represents my best efforts to interpret the data availab/e. ! 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 � t •
� Check here if attachments. provided by a licensed land surveyor? "�� ` j��Y '��,: �
(•' Yes (", No '� y 3 _
�- ,��
Certifier's Name License Number ��, °„`��� '' � °•�,
DANA A. WYLLIE LS 5874 �:' � �'�'✓- �� �` .� p`
Title
SURVEY MANAGER
Address
565 S. HERCULES AVE.
Company Name
DEUEL 8� ASSOCIATES
City State Zip Code
CLEARWATER FL 33764
Date Telephone
Field: 9/07/2016 (727) 822-4151
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Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenUcompany, and (3) building owner.
Comments (including type of equipment and location , per C2(e), if applicable)"
A5: Latitude and longitude were determined using Google Earth. A8a: included exterior storage enclosed area.
A8c: Flood openings consist of 4 Smart Vents Model #1540-520 on exterior walls and 4 non-engineered openings on
exterior storage enclosed area. Smart Vents cover 200 square feet of enclosure space per the attached ICC-ES
Evaluation Report. A 5th Smart Vent exists between the building wall and exterior storage enclosed area and was not
used for A8c calculations. FLOOD OPENINGS CALCULATION:
4 Smart Vents at 200 square inches each = 800 square inches plus
4 non-engineered openings = 299 square inches, Total Flood Openings = 1099 square inches
C2e: There is no equipment servicing building. Elevation shown is bottom of electric meter. Lowest electric outlet
elevation 14.2feet.
Signature� �(� � U��• Date S�� 3/2c
SECTION E- BUILDING EL I N INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A( ITH UT BF
For Zones AO and A(without BFE), complete items E1 -E5. If the Certificate is intended to support a LOMA or LOMR-F request, comple
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
b) Top of bottom floor (including basement, crawlspace,
or enclosure) is
- (" feet lP' meters
' (C' feet (" meters
� above or � below the HAG.
❑ 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 8-9 of Instructions), the next
higher floor (elevation C2.b in the diagrams) of the building is - (t" 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
servicing the building is ' R" 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 (t'' 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 completes Sections A, B, and E for Zone A(without a FI
community-issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of
Property Owner or Owner's Authorized Representative's Name:
Address
Signature
Comments
FEMA Form 086-0-33 (7/15)
City
Date
State
Telephone
Replaces all previous editions.
ZIP Code
or
� Check here if attachments.
Page 4 of 15
• . r •
BUILDING PHOTOGRAPHS
See instructions for Item A6 OMB Control Number: 1660-0008
Expi ration: 11 !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:
534 MANDALAY AVENUE (MAINTENANCE BUILDING)
City CLEARWATER State FL Zip Code 33767 Company NAIC
Number:
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.
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FRONT VIEW (NW SIDE} 9/07/2016
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LEFT VIEW (NE SIDE) 9/07/2016
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REAR VIEW (SE SIDE) 9/07/2016
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SMART VENTS ON NE & SW WALLS 9/07/2016
RIGHT VIEW (SW SIDE) 9/07/2016
NON-ENGINEERED OPENINGS ON SW SIDE 9/07/2016
(Exterior enclosed storage area)
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Page 6 of 15