200 PALM IS NWU.S. DEPARTMENT OF HOME�AND SECURITY OMB No. 1660-0008
Federal Emergency Management Agency Expiration Date: November 30, 2018
National Fiood Insurance Program
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for (1) community o�cial, (2) insurance agent/company, and (3) buildinq owner.
272313 SECTION A— PROPERTY INFORMATION FOR INSURANCE COMPANY USE
A1. Building Owner's Name Policy Number:
KENNETH G. HAMILTON AND LISA G. HAMILTON
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number:
Box No.
200 PALM ISLAND NORTHWEST
City State ZIP Code
CLEARWATER BEACH FL 33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. 27°59'05.55"N Long. 82°49'11.42"W 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 1 B
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enGosure(s) N/A 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 �No
A9. For a building with an attached garage:
a) Square footage of attached garage 400 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 �No
SECTION B— FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
61. NFIP Community Name & Community Number 62. County Name B3. State
125096 PINELLAS Florida
64. Map/Panel B5. Suffix B6. F1RM Index B7. FIRM Panel B8. Flood Zone(s) B9. Base Flood Elevation(s)
Number G Date Effective/ A�E (Zone AO, use Base
12103C0102 9/3/2003 Revised Date Flood Depth}
9/3/2003 12/13
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 69: ❑NGVD 1929 �NAVD 1988 ❑OtherlSource:
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Othervvise Protected Area (OPA)? ❑Yes �No
Designation Date: ❑CBRS ❑OPA
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6
onnB No. �ssa000s
ELEVATION GERTIFIGATE Expiration Date: November 30, 2018
272313 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:
200 PALM ISLAND NORTHWEST
City State ZIP Code Company NAIC Number
CLEARWATER BEACH FL 33767
SECTION C— BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑Construction Drawings� ❑Building Under Construction* �Finished Construction
�A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations — Zones A1 A30, AE, AH, A(with BFE), VE, V1 V30, V(with BFE), AR, AR/A, AWAE, AR/A1 A30, AR/AH, AR/AO.
Complete Items C2.a—h below acxording to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: G03.5 Vertical Datum: NAVD 1988
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) 7_7. �feet ❑meters
b) Top of the next higher N/A. �feet ❑meters
c) Bottom of the lowest horizontal structural member (V Zones only) 5_5. �feet ❑meters
d) Attached garage (top of slab) 6_8. �feet ❑meters
e) Lowest elevation of machinery or equipment servicing the building 7_9. �feet ❑meters
(Describe type of equipment and location in Comments)
� Lowest adjacent (finished) grade next to building (LAG) 6_0. �feet ❑meters
g) Highest adjacent (finished) grade next to building (HAG) 6_6. �feet ❑meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A �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 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, Secfion 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor'? �Yes ❑No ❑Check here if attachments.
Ce�tifier's Name License Number
Kenneth J. Osbome 6415 �� N� F�° s e
a t � o
Title ? � � i itall�!'s�r�ed
Registered Professional Surveyor �`' N`�' ��enneth F
K�enneth y
Company Name , Osborne �
TARGET SURVEYING, LLC �sborne °ate: w
2016.10.27 a
6250 N Military Trail #102 N� 12:52:08 -04�00'
, STATE OF v
City State ZIP Code ° ti`� o R, o" o P
West Palm Beach FL 33407 �` s u a � E�
Signature Date Telephone -
��� 10/24/2016 (561)640-4800
Copy all pages ofthis Elevation Certificate and all attachments for (1) community offiaal, (2) insurance agerrt/company, and (3) building owner.
Comments (including type of equipment and location, per C2(e), if applicable)
GARAGE SQUARE FOOTAGE IS ROUNDED TO THE NEAREST 100 SQUARE FEET. ACCESS
UNAVAILABLE. ELEVATIONS IN SECTION C2-E ARE ELEVATIONS OF A/C SLAB_
FEMA Form 086-0-33 (7/15) Replaces all previous editions.
Form Page 2 of 6
ELEVATION CERTIFICATE oMB No. �ssa000s
xpiration Date: November 30, 2018
272313 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:
200 PALM ISLAND NORTHWEST
City State ZIP Code Company NAIC Number
CLEARWATER BEACH FL 33767
SECTION E— BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED)
FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO and A(without BFE), complete Items E1—E5. If the Certificate is intended to support a LOMA or LOMR-F request,
complete 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 ❑feet ❑meters ❑above or ❑below the HAG
b) Top of bottom floor (including basement,
crawlspace, or enclosure) is ❑feet ❑meters ❑above or ❑below the LAG
E2. For Building Diagrams Cr9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 1-2 of Instructions),
the ne� higher floor (elevation C2.b in
the diagrams) of the building is �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 ❑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 acxordance with the community's
floodplain management ordinance? �Yes ❑No ❑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
❑Check here if attachments
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6
ELEVATION CERTIFICATE onns No. �ssa000s
Expiration Date: November 30, 2018
272313 IMPORTANT: In these spaces, copy the corresponding information from Secdon 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:
200 PALM ISLAND NORTHWEST
City State ZIP Code Company NAIC Number
CLEARWATER BEACH FL 33767
SECTION G — COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain 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 AO.
G3. ❑ The following information (Items G4—G10) is provided for community floodplain management purposes.
G4 ermit N ber G5. Date Permit Issued G6. Date Certificate of
� � O ` O �� ' Compliance/Occupancy Issued
1 � l� �
G7. This permit has been issued for. ❑New Construction ❑Substantial Improvement
G8. Elevation of as-built lowest floor (inGuding basement)
of the building: ❑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 Telephone
Signature Date
Comments (i�cluding type of equipment and location, per C2(e), if applicable)
❑Check here if attachments
FEMIA FoRn 086-a33 (7/15) Replaces all previous editions. Form Page 4 of 6
BUILDING OMB No. 1660-0008
ELEVATION CERTIFICATE See Instructions for Item A6. Expiration Date: November 30, 2018
272313 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:
200 PALM ISLAND NORTHWEST
City State ZIP Code Company NAIC Number
CLEARWATER BEACH FL 33767
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 VievJ' 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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Form Page 5 of 6
BUILDING
ELEVATION CERTIFICATE Continuation Page
272313 IMPORTANT: In these spaces, copy the corresponding information from Section A.
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
200 PALM ISLAND NORTHWEST
��tY State ZIP Code
CLEARWATER BEACH FL 33767
OMB No. 1660-0008
Expiration Date: November 30, 2018
FOR INSURANCE COMPANY USE
Policy Number:
Company NAIC Number
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs
with: date taken; "Front Vievd' and "Rear Viev�/'; and, if required, "Right Side Vie�n/' 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.
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FEMA Form 086-0-33 (7/15)
Phoio Two
Replaces all previous editions.
Form Page 6 of 6