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1025 MANDALAY AVEU.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. OMB No. 1660-0008 Expiration Date: November 30, 2018 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 Al. Building Owner's Name William and Mary Lou Vann Policy Number: A2. Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 1025 Mandalay Avenue Company NAIC Number. City State ZIP Code Clearwater Florida 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 7, Block 267, Carlouel Subdivision Pid:32-28-15-13464-267-0070 A4. Building Use (e.g., A5. Latitude/Longitude: A6. Attach at least A7. Building Diagram A8. For a building a) Square footage b) Number of c) Total net area d) Engineered A9. For a building a) Square footage b) Number of c) Total net area d) Engineered Residential, Non -Residential, Addition, Accessory, Lat. 28.0025 N Long. 82.8253 W etc.) Residential Horizontal Datum: insurance. above grade D NAD 1927 adjacent grade N/A a NAD 1983 N/A 2 photographs Number with a crawispace of crawlspace permanent flood of flood openings flood openings? with an attached of attached permanent flood of flood openings flood openings? of the building if the 1A Certificate is being used to obtain flood N/A sq ft or enclosure(s): or endosure(s) openings in the crawispace in A8.b or endosure(s) N/A sq in within 1.0 foot 1.0 foot above adjacent in No N/A sq ft ❑ Yes 1 garage: garage openings in the attached garage within in A9.b N/A sq 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 Florida B4. Map/Panel Number 12103C0064 B5. Suffix G B6. FIRM Index Date 09-03-2003 B7. FIRM Panel Effective/ Revised Date 09-03-2003 B8. Flood Zone(s) AE B9. Base Flood E evation(s) (Zone AO, use Base Flood Depth) 11.0' B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation Date: of the Base Flood Elevation Community Determined for BFE in Item B9: Coastal Barrier Resources 0 (BFE) data or base flood fl Other/Source: 1929 IE (CBRS) 0 OPA depth entered in Item B9: a FIRM datum used located in a NAVD 1988 area or Otherwise • NGVD • Other/Source. System CBRS Protected Area (OPA)? 0 Yes • No Replaces all previous editions. Form Page 1 of 6 "REVISED" PLANS RECEIVED BY: T.V. JUN 192017 PLANNING & DEVELOPMENT CITY OF CLEARWATER 1025 MANDALAY AVE BCP2017-05092 RTC VANN, WILLIAM W TRE Zoning: Low Medium Density Atlas #: 238A ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30. 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Budding Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No, 1025 Mandalay Avenue Policy Number City State ZIP Code Clearwater Florida 33767 Company MAIC Number 1 SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: 0 Construction Drawings* 0 Building Under Construction0 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: City Benchmark# J-03 Vertical Datum: Elevation 2.5951, NAVD88 Indicate elevation datum used for the elevations in items a) through h) below. 0 NGVD 1929 0 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) 6.86 0 feet 0 meters b) Top of the next higher floor N/A 0 feet 0 meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A 0 feet 0 meters d) Attached garage (top of slab) N/A 0 feet 0 meters e) Lowest elevation of machinery or servicing the building (Describe type of equipment and location in Comments) 6.28 0 feet 0 meters f) Lowest adjacent (finished) grade next to building (LAG) 6.00 0 feet 0 meters g) Highest adjacent (finished) grade next to building (HAG) 6.20 0 feet 0 meters h) Lowest ac§aoent grade at lowest elevation of deck or stairs, including structural support N/A 0 feet 0 meters SECTION 0- 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 informabon 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 A provided by a licensed land surveyor? 0 Yes 0 No 0 Check here if attachments. Certifiers Name License Number Joseph E. Williamson, PLS 6573 ott1111/ •• ''' ' 1:4744.• .. ;. .,•. ••• .•• ...., NO. 6673 % r. *. • ••• • . • .... • • ... ' STATE OF r., .. . . FLORIDA .•*. HIM Title Licensed FL Surveyor Company Name Vision Land Service Address 941 S Pennsylvania Ave City State ZIP Code Winter Park Florida 32789 _.... P 05-29-2014 (888) 399-8474 Copy all pal of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including type of equipment and location, per C2(e). if applicable) Item C2e elevation was taken on the Air Conditioner Item C2d Garage is detached, with an elevation of 6.35 This Elevation Coil was ugidated to the new form on 06-15-2017. All information shown hereon was transcribed from elevation certificate from May 29. 2014 by this firm and has not been reverified. FEMA Form 086-0-33 (7/15) Replaces all previous editio Form Page 2 of 6 ELEVATION CERTIFICATEExpiration Date: November 30,2018 OMB No1660-0008 IMPORTANT: In these spacescopy the corresponding information from Section A. FOR INSURANCE COMPANY USE BuUdiPl\Route and Box No. 1025 Mandalay Avenue Policy Number City State ZIP Code Clearwater Florida 33767 Company NAIC Number SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A , comlete IteE1—E5. If the Certificate is intended to support a complete Sections A, Band C. For Items E1—E4, use natural grade, if available. Check the measurement enter meters. El. Provide elevation information for the following and check the apropriate boxes to show whether the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawispace, or enclosure) is []feet 0metem LOMA or LOMR-F request, used. In Puerto Rico only, the elevation is above or below [J above or 11 below the HAG. D above or D below the LAG. 9 (see pages 1-2 of Instructions), U above or below the HAG. 0 above or 0 below the HAG. c: above or below the HAG. with the community's certify this information in Section G. b) Top of bottom floor (including basement, crovNspsce.orenclosure) is 0 feet [J meters E2. For BuildinDiagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or the next higher floor C2.b in the diagrams) of the building is 0 feet 0metes E3. Attached garage (top of slab) is feet 0metem E4. Top of platform of machinery and/or equipment servicing the building is feet 0metem E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance floodplain management ordinance? 0Yen Fl No 0 Unknown. The local official must SECTION F — PROPERTY OWNER (OR OWN ER's REPRESENTATIVE) CERTIFICATION Theproperty ownerproperty owner or owners authorized representative who comletes Sections AB, and E foZoneA �outeFEMA-issued nr oom��sign statements to the best of my knowledge. Property Owner or Owner's Authorized Representatives 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 OMB No. 1660-0008 Cv ..4:.... • IMPORTANT: In these spaces, copy the corresponding information from Section A. v.r••'..uv.. vc.aai. ImvVG111vC1 Jv, CU 10 FOR INSURANCE COMPANY USE Building_Street Address_(induding Apt Unit, and/or -Bldg. No.) or P.O. Route and -Box -No: Policy Number: --Suite, 1025 Mandalay Avenue City State ZIP Code Clearwater Florida 33767 • Company NAIC Number 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. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued G7. This permit has been issued for. ❑ G8. Elevation of as -built lowest floor (including of the building: G9. BFE or (in Zone AO) depth of flooding at the G10. Community's design flood elevation: New Construction ❑ Substantial Improvement basement) ❑ feet ❑ feet ❑ feet ❑ meters Datum building site: ❑ meters Datum 0 meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. Replaces all previous editions. Form Page 4 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. OMB No. 1660-0008 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. 1025 Mandalay Avenue Policy Number City State ZIP Code Clearwater Florida 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. ` -r11 3 s #w. ye. Photo One Photo One Caption Front of Building Clear Photo One I D _+ ,y s� Photo Two Photo Two Caption Rear of Building Clear Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Paae OMB No. 1660-0008 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. 1025 Mandalay Avenue Policy Number: City State ZIP Code Clearwater Florida 33767 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 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. Photo Three Photo Three Photo Three Caption Photo Four Photo Four Photo Four Caption . .. S .v. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. OMB No. 1660-0008 Expiration Date: November 30, 2018 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 Al. Building Owner's Name William and Mary Lou Vann Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 1025 Mandalay Avenue Company NAIC Number City State ZIP Code Clearwater Florida 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 7, Block 267, Carlouel Subdivision Pid:32-28-15-13464267-0070 A4. Building Use (e.g., A5. Latitude/Longitude: A6. Attach at least A7. Building Diagram A8. For a building a) Square footage b) Number of permanent c) Total net area d) Engineered A9. For a building with a) Square footage b) Number of permanent c) Total net area d) Engineered Residential, Non -Residential, Addition, Accessory, etc.) Lat. 28.0025 N Long. 82.8253 W Residential Horizontal Datum: insurance. above ❑ NAD 1927 adjacent grade grade N/A Q NAD 1983 N/A 2 photographs Number with a crawlspace of crawlspace flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? of the building if the 1A Certificate is being used to obtain flood N/A sq ft or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b or enclosure(s) N/A sq in within 1.0 foot foot above adjacent in N/A sq ft ❑ Yes a No garage: garage openings in the attached garage within 1.0 in A9.b N/A sq ❑ 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 Florida B4. Map/Panel Number 1210300064 B5. Suffix G B6. FIRM Index Date 09-03-2003 B7. FIRM Panel Effective/ Revised Date 09-03-2003 B8. Flood Zone(s) AE B9. Base Flood E evation(s) (Zone AO, use Base Flood Depth) 11.0' B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation Date: of the Base Flood Elevation ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ (BFE) data ❑ NGVD System CBRS or base flood ❑ Other/Source: depth entered in Item B9: a FIRM datum used located in a ❑ Other/Source: Protected 1929 ,/ NAVD 1988 (CBRS) area or Otherwise ❑ OPA Area (OPA)? ❑ Yes a No FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (incuxdkng Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 1025 Mandalay Avenue Policy Number: City State ZIP Code Clearwater Florida 33787 Company NAiC Number SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl . Building elevations are based on: 0 Construction Drawings* 0 Building Under Construction* El Finished Construction 'A new Elevation Certificate win 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, ARAE, AR/A1-A30, ARJAH, AR/AO. Complete Items C2.a-h below according to the budding diagram specified in item A7. In Puerto Rico only, enter meters. Benchmark Utilized: City Benchmark# J-03 Vertical Datum: Elevation 2.5951, NAVD88 indicate elevation datum used for the elevations in items a) through h) below. 0 NGVD 1929 0 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, crawispace, or enclosure floor) 6.86 Q feet ❑ meters b) Top of the next higher floor N/A 0 feet 0 meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A 0 feet 0 meters d) Attached garage (top of slab) N/A ■ feet 0 meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) 6.28 p feet 0 meters f) Lowest adjacent (finished) grade next to building (LAG) 6.00 a feet 0 meters g) Highest adjacent (finished) grade next to building (HAG) 6.20 xQ feet 0 meters h) Lowest grade at lowest elevation of deck or stairs, includingstructuupport N/A ©feet 0 meters SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by taw 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 arprisonment under 18 U.S. Code. Section 1001. Were latitude and longitude in Section A provided by a licensed land surveyor? Q Yes 0 No ❑x Check here if attachments. Certifiers Name License Number Joseph E. Williamson, PLS 6573 tooMilltioto ``f dill Aft :? 3573 • Z • : •� STATE OF 'sem :.., FLORIDA •.' www rt ttN I t t tl ,O �� Title Licensed FL Surveyor Company Name Vision Land Service _ 941 Pennsylvania Ave City State ZIP Code Winter Park Florida 32789 Signature Date Telephone Ext. 05-29-2014 (888) 399-8474 Copy all pa of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) Item C2e elevation was taken on the Air Conditioner Item C2d Garage is detached, with an elevation of 8.35 This Elevation Cert was updated to the new form on 06-15-2017. All information shown hereon was transcribed from elevation certificate from May 29. 2014 by this firm and has not been reverified. FEMA Form 086-0.33 (7/15) Replaces all s editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 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. 1025 Mandalay Avenue Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIC Number 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 complete Sections A, Band C. For Items E1—E4, use natural grade, if available. Check the measurement enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters LOMA or LOMR-F request, used. In Puerto Rico only, the elevation is above or below • above or ❑ below the HAG. ❑ above or ❑ below the LAG. 9 (see pages 1-2 of Instructions), ❑ above or ❑ below the HAG. ❑ above or ❑ below the HAG. ❑ above or ❑ below the HAG. with the community's certify this information in Section G. b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters E3. Attached garage (top of slab) is ❑ feet ❑ meters E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must SECTION F — PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owners 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 OMB No. 1660-0008 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. 1025 Mandalay Avenue Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIC Number 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. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ G8. Elevation of as -built lowest floor (including of the building: G9. BFE or (in Zone AO) depth of flooding at the G10. Community's design flood elevation: New Construction ❑ Substantial Improvement basement) ❑ feet ❑ feet ❑ feet ❑ meters Datum building site: ❑ meters Datum ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. OMB No. 1660-0008 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. nit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 1025 Mandalay Avenue Policy Number: City State ZIP Code Clearwater Florida 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. 'n .' 614 Ii ;.:4—.!",-.--,,,,,,,. .,� RIM AM& Photo One Photo One Caption Front of Building Clear Photo One 1 �,�►Mu,l ! - ---- -------- . w.. Photo Two Photo Two Caption Rear of Building Clear Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continu OMB No. 1660-0008 • -.+- •--"VII auvn vatc. I'OVCIlIUCI 3U, ZU lo 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. 1025 Mandalay Avenue Policy Number: City State ZIP Code Clearwater Florida 33767 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 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. Photo Three Photo Three Photo Three Caption Photo Four Photo Four Photo Four Caption Clear Replaces all previous editions. Form Page 6 of 6 "REVISED" PLANS �ECEIVED BY: T,V. JlJN � y 201? PLANNING & DEVELOPMENT CfTY OF CLEARWATER 1025 MANDALAY AVE BCP2017-05092 RTC VANN, WILLIAM W TRE Zoning: Low Medium Density Atlas #: 238A U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program - - - -ELEVATION CERTIFICAT� Important: Follow the instructions on pages 'I-9. OMB No. 1660-0008 Expiration Date: November 30, 2018 Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agenUcompany, and (3) building owner. SECTION A— PROPERTY INFORMATION FOR INSURANCE COMPANY USE A1. Building Owner's Name Policy Number: William and Mary Lou Vann A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number: 1025 Mandalay Avenue , City State ZIP Code Clearwater Florida 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 7, Block 267, Carlouel Subdivision Pid:32-28-15-13464-267-0070 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Residential A5. Latitude/Longitude: Lat. 28.0025 N Long. 82.8253 W Horizontal Datum: � NAD 1927 � NAD 1983 A6. Attach at least 2 photographs of the buiiding if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 1A A8. For a building with a crawispace or enclosure(s): a) Square footage of crawlspace or enclosure(s) N/A sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b N/A sq in d) Engineered flood openings? ❑ Yes � No A9. For a building with an attached garage: a) Square footage of attached garage N/A sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? � Yes � No SECTION B— FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number 62. County Name 63. State City of Clearwater, 125096 Pinellas Florida B4. Map/Panel 65. Suffix 66. FIRM Index 67. FIRM Panel B8. Flood 69. Base Flood Elevation(s) Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth) Revised Date 12103C0064 G 09-03-2003 09-03-2003 AE 11.0' 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 useo for SFE in item B9: ❑ �vvV� i�29 � NAVD 18oS � OtheriS�urce: 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 editions. Form Page 1 of 6 ELEVAT101� CERTIFlCATE OMB No. 1660-0008 Expira6on Date: November 30. 2018 IMPORTANT: tn tfiese spaofs, copy th� c�respo�din� intormation trom S�ction A. FOR INSURANCE COMPANY USE Buddmg Street Address (incfuding Apt_, U�it, Suite, andlor Bldg. Plo.) o► P.O. Route and Box No Policy Number 1025 Mandalay Avenue City Stale ZIP Code Comp�y NAIC Number C{earwater Fiorida 33767 SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Bu"r{ding elevafions are based on: ❑ Construction Drawings' � Building Under ConsVuction' �x Finished Construction 'A new Elevation Certificate wili be requ�red when oonstrudion of the build�ng is compfete. C2. Elevabons - Zones A1-A30, AE, AH, A(with BFE), VE. V1-V30, V(with BFE), AR, AR/A, ARIAE, AR/A1-A30, ARlAH, ARJAO Complete ttems CZ.a-h betaw a000rding to the building diagram specified in Item A7. In Puerto Rioo oMy, enter meters. Be�chmark Utitized: City Benchmark# J-03 VeRical Datum: Elevation 2.595t, NAVD88 Indicate elevation datum used for the eievatbns in items a) through h) bebw. � NGVO 1929 � NAVO 1988 ❑ OtheNSourcE: Oatum used tor building elevatiorts must be the same as tt�at used for the BFE. a) Top of bottom floor (including basement, crawlspace, or enclosu�e fioor) b) Top of the next higher floor c) Bottom of the lowest h�x�izortt$! structural merr�er (V Zones onlY) d) Attached garage (top af stab) e) Lo�nrest elevation of machinery or equ�merd serviang the building (Oescribe type of equipmeM and focation in Comments) fl Lowest �aoent (fmished) grade next to bu�ding (LAG) g) Highest adjaoent (finist�ed) grade next to build'mg (HAG) h) �owest adjaoeM grade at bwest eievation of deck or stairs, induding strudura! support Check the measurement used. 6�$6 []x feet ❑ meters N/A ❑ teet ❑ meters N/A � feet ❑ meters N/A ❑ feet ❑ meters 6.28 �x feet ❑ meters 6.00 �x feet ❑ meters 6.20 []x feet � meters N/A [� feet ❑ meters SECTION D- SURVEY�R, ENGINEER, OR ARCHITECT CERTIFICATiON This oerti�cation is to be signed and sealed by a land surveyor, enginee�, or arr:hited auttwrized by law lo oertify elevation iniormation_ 1 aertify tttat the infarmation an this Certilrcete repr�sents my besi el�ais b inte�ret the dsta available. I understarnd that any talse sfeteme»t mey be pun�shable by Fine or imprisonmerrf under 18 U.S. Code. Sectio» 10Q1. Were latitude and la�gitude � Section A provided by a I�censed land surveyor? � Yes ❑ No Qx Check here ii attachments. Certifiei's Name Joseph E. W�liamson. PLS Licensed FL Surveyor Company Name Vision La�d Servioe 941 S Pennsylvartia Ave City Winter Paric License Number 6573 State Florida 05-29-2014 ZIP Code 32789 (888)399-8474 `��������w ti� ���i�� ♦ jo�sE�Mi;,� '�o� �� �. ��� eF . �i : v 'p � i N0.8673 ; � � STATE OF ; � FLORIQR .�� S��';, � . ���````��• ���Jt11111��� Copy all pag�s of this Elevation Certificate and all attachments tor (1) commu�ityr off�cial, (2) insuranoe agent/compeny, and (3) building owner. -f Comments (induding type of equipment and location, per C2(e), if applicable) ttem C2e elevatiort was taken on the Air Conditioner ltem C2d Garage is detached, with an elevation oi 6.35 This ElevaGon Gert was updated to the new form on 06-15-201T. Atl infomiation shown hereon was tra�scribed from elevation certficate from May 29. 2014 by ttus firm and has nd been reverified. � FEMA Form 088-0-33 (7115) Replaoes afl previous ed�tions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building S�restAddress jincluding Apt.,- Unii, Suite, ar�d/or 81dg. No.} or P.O. Route and Box No.- Policy Number. 1025 Mandalay Avenue Clearwater State ZIP Code Company NAIC Number Florida 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 availabie. 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 enciosure) 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 Buiiding Diagrams Cr9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 1-2 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 E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO on�y: 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 � Unknown. The local officiai 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 commurnty-issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my kno�vledge. Property Owner or Owner's Authorized Representative's Name Address Signature Comments City Date State Telephone ZIP Code ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building-StreeiAddress-(in�luding Apt.-,-Uni#,-S�+te, and/or Sldg. No.) or P.O. Routeand Box No. Policy Number. 1025 Mandalay Avenue �iry State ZIP Code Company NAIC Number Clearwater � Florida 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. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued G7. This permit has been issued for: � New Construction � Substantial Improvement G8. Elevation of as-built lowest floor (including basement) of the building: ❑ feet ❑ meters Datum G9. BFE or (in Zone AO) depth of flooding at the building site: G10. Community's design flood elevation: Local Official's Name Name Title Telephone Date Comments (including type of equipment and location, per C2(e), if applicable) ❑ feet ❑ meters Datum ❑ feet ❑ meters Datum ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 BUILDING PHOTOGRAPHS OMB No. 1660-0008 ELEVATION CERTIFICATE See Instructions for Item A6. Expiration Date: November 30, 2018 IMPORTANT: tn 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: 1025 Mandalay Avenue City State ZIP Code Company NAIC Number Clearwater Florida 33767 If using the Elevation Certificate to obtain NFIP flood insurance, a�x 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. r ��', �, ' �eY, � 4''` �" qi� J % �� � '� �� � a � d � ;..,� i �t a � : � �� . ` i �4e�j� �" � ,p�'�r 'q�! 1 f f Ri ,; g Y �e .f : I P9@ �.�t:� � � S 1 �A � . � h# �I1.p s y ,.� '�� i "t - a"tr:.`_ _ iD9� � , Vf , � ..� � ��� .���� B.� .. F.., � k � '��:�� . . $� y !�' �''.i t"d "�. �: � -- a9 f` w �°"�� ,„,;.�,�,,,� - � � �f '�� � " �' '�'{�, � - y'\. ».,.«.,�:,.3.. .;;- :,� -=_ . . � ��i; � _ . ��°� � �'�.� � 4 t ��'�. a � '� sI=S,� � � � .,� � F � i„'�." ., k � .; * ` ,s -� s� ��' , y::° :'.�.�,,�+I ����"'" �i r „ '"°., � � � �� �,5�3�� � s, f. ,�� � __ � t �, `,�, i�u'rr� it�. �'^ � I , � � � m � ^ ar �u� � - � � , '%V '�''kY?�� ^�'t.� _ 4tl ��°�'.+!,F �� " �. .. 9, ' . .. ..n , � � ,._., . II t . � �r . , � ., . . ,'�A ,. 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Route and Box No. Pvlicy Number: 1025 Mandalay Avenue City State ZIP Code Company NAIC Number Clearwater Florida 33767 If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify ail 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. Photo Three Photo Three Photo Three Caption ����:�!� Photo Four Photo Four Photo Four Caption t�t���r:; FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6