123 MARINA DEL REY CTl
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ELEVATION CERTIFICATE �xo�allon�o��n�i08PmnPrsn_ 2��R
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANGE COMPANY USE
Building Street Address (including Apt, Unit, Suite, and/orBidg. No.) or P.O. Route and Box No: Policy Number.
123 MARINA DEL REY COURT
G�tY State ZIP Code Company NAIC Number
CLEARWATER, Florida 33767
SECTION C— BUILDING ELEVATION INFORMATION (SURYEY RECiUIRED)
C1. Building elevations are based on: ❑ Co�struction Drawings` ❑ Building Under Consiruction* [] Finished Construction
"A new Elevation Certificate will be required when construcfion of the building is complete:
C2. Etevations — Zones A1—A30, AE, AH, A(with BFE), VE, V1 V30, V(with BFE), AR, AR/A, AR/AE, ARlA1 A30, AWAH, 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: AG 0579 Vertical Datum: 5.03'
Indicate elevation datum used for the elevations in items a) through h) below.
� NGVD 1929 � NAVD 1988 � OtherlSource:
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 5 []x feet ❑ meters
' b) Top of the next higher floor � 4, Z �X feet � meters
c) Bottom of the lowest horizontal structural member (V Zones only) N�A. � feet ❑ meters
d) Attached garage (top of slab) 5. 4 � feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 5. 3 � feet [] meters
(Describe type of equipment and location in Gomments)
fl Lowest adjacent (finished) grade next to building (LAG) 5� x� feet ❑ metecs
g) Highest adjacent (finished) grade next to building (HAG) 5. � x� feet � meters
hJ Lowest adjacent grade at lowest elevation of deck or stairs, including N�A � feet � meters
structural support
SECTION D— SURVEYOR, ENGINEER, OR ARCHITECT CER'TIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, ot architect authorized by !aw to cettify elevation informa6on.
1 certify that the information on this Certificate represents my best efforts to interpret the data available. ! understand that any false
stafement mey 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? � Yes ❑ No ❑ Check here if attachments.
Certifier's Name License Number
LARRY L. EVANS FL. LS No. 2937
Title ;
LANQ SURVEYOR �; ,
Company Name Place
EVANS LAND SURVEYING, INC. ' �ea1
Address Here .' '
1460 BELTREES STREET STE. 9 �
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City State ZIP Code
DUNEDIN, Florida 34698
Signature Date Telephone
�, ,(�l,� 06/28/2016 (727) 734-382'{
Copy all pages of this evation Certificate and all attachments for (1) community o�cial, (2) insurance agenUcompany, and (3) buitding owner.
Gomments (including type of equipment and location, per C2{e), if applicable)
A8.): GROUND FLOOR IS TOTALLY ENCLOSED, AND MCLUDES PARKING, ENTRY HALLWAY, STORAGE ROOM & BATH.
C2.e): IS AN EXTERIOR A/C CQMPRESSOR ON GROUND LEVE� PAD.
FEMA Form 086-0-33 (7h 5) Replaces atl previous editieans. ' Form Page 2 of 6
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U.S. DEPARTMENT OF HOMELAND SECURITY
federat Emergency Management Agency
National flaod insurance Program
ELEVATION CERTIFICATE
Important: Foliowthe instructions on pages 1-9. %
oMS No. �ssa0008
Expiration Date: November30, 2018
Gopy a►I pages of this E►evation 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 Owners Name : Policy' Number.
DAVID COUZENS & LORI RICE
A2. Building Street Address (inGuding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and ' Company NAIC Number.
Box No.
123 MARINA DEL REY COURT
City State ZIP Code
CLEARWATER, F(orida 33767
A3. Property Description (�ot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 62, of MARINA DEL REY AT SAND KEY
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.} RESIDENTIAL
A5. LatitudelLongitude: Lat. 27deg.56'23.6" Long. 82deg.50'08.1" Horizontal 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 7
A8. For a building with a crawlspace or endosure(s): :
a) Square footage of crawlspace or enclosure(s) 442 sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b 0 sq in
d) Engineered flood openings? ❑ Yes 0 No
A9. For a building with an attached garage: ,
a) Square footage of attached garage 41 g sq ft
b) Number of permanent flood openings in the attached garage within 1.0 fooYabove adjacent grade 0
c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? � Yes x0 No
_ SECTION B— FLOOD INSURANCE RATE MAP (FIRM) INFORMATiON
- B1. N�IA Gommunity Name & Community Number B2. County Name ��; B3. State
CLEARWATER / 125096 PINELLAS ' Florida
B4. Map/Panel B9. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood Zone(s) B9. Base Flood Elevation{s)
Number . Date Effective/ �Zone AO, use Sase
Revised Date lood Depth)
12103 C 0104 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 Item B9: ❑ NGVD 1929 � NAVD 1988 � Other/Source:
812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise. Protected Area (OPA)? � Yes � No
Designation Date: � CBRS � OPA
FEMA Form 086-0-33 (7/15) Replaces all previous edi#ions. Form Page 1 of 6
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SUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CER7EFtCATE See instructions for Item A6. Expiration Date: November 30, 2018
IMPORTANT: 1n these spaces„ copy tEae cocres}�nding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address (incicrding Apt, l.ini#, Sts�te, andlor Bldg. No.) or P_O. Route and Box No. Policy Number.
123 MARINA DEL REY COUf2T
City State ZIP Code Company NAIC Number
CLEARWATER, Flonda 33767
If using the Elevation Gertificate to obtain NFiP flood insurance, affix at least 2 building photographS below according to the
instructions for Item A6. Ide�tify ali photographs wiih date taken; "Front Vew" and "Rear �ew'; and, if required, "Right Side Vew" and
"Left Side Vew." When appiicabie, photog�aphs 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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FEMA Form 086-0-33 (7/15) Replaces all previaus editions. Form Page 5 of 6