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696 SNUG ISU.S. DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY Vationul Flood (nsurance Program A1. Building Owner's Name ELEVATION CERTIFICATE important: Read the instructions on pages 1-9. SECTlON A - PROPERTY INFORMATION TAIVIPA, INC. A2. Building Street Address (inciuding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 696 SNUG ISLE City CLEARWATER State FL ZIP Code 33767 A3. Property Oescription (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 57, ISLAND ESTATES OF CLEARWATER UNIT 76, PB 64 PG 70 ONiB No. 1660-0008 Expiration Date: July 31, 2015 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27°59'22"N Long. 82°49'07"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 1B 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) N/A sq ft a) Square footage of attached garage 500 sq ft b) Number of permanent flood openings in the crawispace b} Number of permanent flood openings in the attached garage or enclosure(s) within 1.0 foot above adjacent grade N/A within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NFIP Community Name & Community Number 62. County Name CITY OF CLEARWATER 125096 PINEILAS 64. Map/Panel Number B5. Su�x 66. FIRM Index Date B7. FIRM Panel 12103C0102 G 8-18-09 Effective/Revised Date 09-03-03 63. Scate FL B8. Flood 69. Base Flood Elevation(s) (Zone Zone(s) AO, use base flood depth) AE 11' 810. Indicate the source of the Base Flood Eievation (BFE} data or base flood depth entered in Item 69. ❑ FIS Profile � FIRM ❑ Community Determined ❑ Other/Source: 611. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: 612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Othervvise Protected Area (OPA)? Designation Date: N/A ❑ CBRS ❑ OPA ❑ Yes � No 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, 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: 2496 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. a) Top of bottom floor (including basement, crawispace, or enciosure floor) b) Top of the next higher floor c) Bottom of the lowest harizontal structurai member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments} f� Lowest adjacent (finished} grade ne� to building (LAG) g) Highest adjacent (finished) grade next to building (HAG) h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 8.0 N/A. N/A. 7.6 7.8 7.2 7.4 N/A. Check the measurement used. � feet ❑ meters ❑ feet ❑ meters ❑ feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters ❑ feet ❑ meters SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a tand surveyor, engineer, or architect authorized by law to certify elevation information. ! certify that the information on this Certificate represenls my best efforts to interpret the data avarlable. 4 I understand that any fatse statement may be punishable by fine or rmprisonment under 18 U. S. Code, Sectron 1001. ��� 5 v�,„' � Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a �, *¢;;,h ' " �� ' � ; � Check here if attachments. licensed land surve yor? � Y e s ❑ N o ` .,� Certifier's Name J. MiICHAEL FUQUA Title PSM Address 1406 W. LINEBAUGH AVE FEMA Form 086-0-33 (7l12) License Number 4192 Company Name DAVID L. SMITH SURVEYING & MAPPING Ciry TANIPA State FL ZIP Code 33612 Telephone 813 935-1960 See reverse side for continuation. �� ` � , ` ' � O J . � � . "(\�\ � ,� '�t t{\,�i./ X v '� i ¢� ,. � ��� .� .�..� ,r' � Jr :r -'�,-• . .. _ . � . < ,. "�g- . b Replaces all previous�^editions: r:} s ��� �� � �v�� v��� � u �vr� � �� Nuyc i IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (i�cluding Apt., Unit, Suite. and/or Bidg. No.) or P.O. Route and Box No. 696 SNUG ISLE Ciry CLEARWATER State FL ZIP Code 33767 FOR INSURANCE GOMPANY USE Policy Number: Gompany NAIC Number: SECTION D— SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) communiry o�cial, (2) insurance agent/company, and (3) building owner. Comments SECTION C2E REPRESENTS THE A/C PAD SECTI9N E— BUILDING ELEVATIVN'INFORMATION (SURVEY NOT REGtUIRED) 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 r9 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 ❑ 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 accordance with the communiry's floodpiain 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 compietes 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 coRect to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address Signature Comments City Date State Telephone ZIP Code Check here if attachments. SECTION G — COMMUNITY INFORMATION (OPTIONAL) The locai o�cial 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. Permit Number G5. Date Pertnit issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantiai Improvement G8. Elevation of as-built lowest floor (including basement) of the building: ❑ feet ❑ meters G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters G10. Community's design flood elevation: ❑ feet ❑ meters Local O�ciai's Name Community Name Signature Comments FEMA Form 086-0-33 (7/12) Title Telephone Date Datum Datum Datum Check here if attachments. Replaces ail previous editions. ELE�fATION•CERTIFICATE, page 3 guilding Photographs See Instructions for Item A6. 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. 696 SNUG iSLE City CLEARWATER State FL ZIP Code 33767 FOR �NSURANCE COMPANY USE Policy Number: 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. �c-iv-i�+ rRVIV I VICVV JOB NO 1412-038 e�_ ��° �' � � �.. , � ``�; X � � ��. �.�- � , � �,�nE � . :� � ' r_ ' • - ,y f �e .-' .._.. •• ` +.r y .:. �. �A � k _ ... wn ... �R �� � Y � �. . . ���y T°�M.."�' a �' :b '���k, t. . � '�� q' :� .. . . _ . .. . . . . ..... . � . ..., 4' iq'� �[,p ��E H �✓ �. .. .,. � � _ - a��Y�. �� � , �}..� g . .. � +!'�d � 4; ��I ��� : n � ' >+ & Bt r �.. :. . F �� ,.�. '-^ � � . .� a.�,� _ . . �t..`� � �� _ - .. :� � .,. � � d'T'� +&�i�-. �� �t���?�s "_.�i� �;; �„_� t P . 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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. 12-10-14 REAR VIEW JOB NO 1412-038 � � �� �.� � ���� w� �.� '� ��.� _ � � � ' �„ � `�„ � , � �� •�-�: , � �, �� � ra � � � 'f v�' ��� �'_ __ �j. $' �' � _ . ' �. :��. ;� a �;� '' ' _ . � � �.��s�. - _ _... � ; , - , �, , , : . . s ... : �..: � ..� :. i ,.�,. _, z, � �.... ., r �' .- : .. � _ s .., ,. .. pc ' �R�?t e'..� ' II � �� � ��:'. 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