312 WINDWARD ISU.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFIC
Important: Follow the instructions on pageE
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2
SECTION A — PROPERTY INFORMATION
Al. Building Owner's Name
Richard Lof
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Rout
Box No.
312 Windward Island
State
312 WINDWARD ISL
BCP2016-12109C
RTC
LOF, RICHARD
Zoning: Island Estates
Atlas #: 268A
"REVISED" PLANS
RECEIVED BY: M.J.
OCT 1 1 2019
PLANNING & DEVELOPMENT
CITY sy CLEARWATER
Clearwater Florida 33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Parcel Tax ID # 09-29-15-43362-000-0570
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. N27-58-51.03 Long. W082-48-40.59
Residential
Horizontal
Datum: ❑ NAD 1927
insurance.
above adjacent grade
grade 5
x NAD 1983
9
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
8
Certificate is being used to obtain flood
2307.00 sq ft
or enclosure(s):
or enclosure(s)
openings in the crawlspace
in A8.b
or enclosure(s)
2464.00 sq in
within 1.0 foot
foot above adjacent
in
1029.00 sq ft
❑ Yes x No
garage:
garage
openings in the attached garage within 1.0
in A9.b 1280.00 sq
❑ Yes x No
SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Bl. NFIP Community Name & Community Number
City Of Clearwater 125096
B2. County Name
Pinellas County
B3. State
Florida
B4. Map/Panel
Number
12103C0106
B5. Suffix
H
B6. FIRM Index
Date
08-18-2009
B7. FIRM Panel
Effective/
Revised Date
05-17-2005
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
of the
Base Flood Elevation
❑ Community Determined
for BFE in Item B9:
Coastal Barrier Resources
❑
(BFE) data or base flood
❑ Other/Source:
❑ NGVD 1929
System (CBRS)
CBRS ❑ OPA
depth entered in Item B9:
x FIRM
datum used
located in a
Date:
❑ Other/Source:
x NAVD 1988
area or Otherwise
Protected Area (OPA)?
❑ Yes x 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 (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
312 Windward Island
Policy Number:
City State ZIP Code
Clearwater Florida 33767
Company NAIC Number
SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under 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,
Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto
Benchmark Utilized: City of Clearwater G-03.5 Vertical Datum: NAVD 1988
x Finished Construction
AR/A1—A30, AR/AH, AR/A0.
Rico only, enter meters.
Indicate elevation datum used for the elevations in items a) through h) below.
❑ NGVD 1929 x 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, crawlspace, or enclosure floor) 6.03
Check the measurement used.
x feet ❑ meters
b) Top of the next higher floor 12.07
x feet ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only) N/A ❑ feet ❑ meters
d) Attached garage (top of slab) 7.37
x feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 12.08
(Describe type of equipment and location in Comments)
x feet ❑meters
f) Lowest adjacent (finished) grade next to building (LAG) 5.50
x feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 7.30
x feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
structural support 7.30
x feet ❑ 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
I certify that the information on this Certificate represents my best efforts to interpret the data available.
statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
law to certify elevation information.
I understand that any false
❑ Check here if attachments.
Were latitude and longitude in Section A provided by a licensed land surveyor? x Yes ❑ No
Certifier's Name License Number
Mark S. Lischalk, PLS LS 5727
I t
oct ay 9
4S722
Title
President
Company Name
Zarra Boyd, Inc.
Address
1480 Beltrees Street, Suite 3
City State ZIP Code
Dunedin Florida 34698
Signatur Date Telephone
i 09-26-2019 (727) 738-9010
Ext.
Copy all pages f 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)
The elevation listed in item C2.e is the bottom of the air conditioning unit which is located on the side of the home on top of a
cantilevered platform. Flood vents were custom made.
FEMA Form 086-0-33 (7/15)
Replaces all previous 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.
312 Windward Island
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, B,and 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 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
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.
312 Windward Island
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., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
312 Windward Island
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.
Photo One
Photo One Caption Front View 09-24-2019 Clear Photo One
Photo Two
Photo Two Caption Side View 09-24-2019 Clear Photo Two
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 5 of 6
ELEVATION CERTIFICATE
BUILDING PHOTOGRAPHS
Continuation Page
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.
312 Windward Island
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.
s^.
..•,..AH° 1: �re f" pM w ... ,x3e J. �, way
Photo Three
Photo Three Caption Rear View 09-24-2019 Clear Photo Three
1
a•
it
Photo Four
Photo Four Caption Side View & Lowest Machinery 09-24-2019 Clear Photo Four
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 6 of 6
Certified To: RICHARD LOF
Scale: 1"=30' Job No. 1099JB Section 9 , Township 29 South, Range 15 East.
Use of this survey by anyone other than those certified to, will be the re—users sole risk without liability to ZBI, or the undersigned surveyor. There may be
additional restrictions affecting this property that may be found in the Public Records of this County. This survey was prepared without the benefit of a title
policy. Underground installations and improvements have not been located unless otherwise noted. Elevations are based upon NORTH AMERICAN VERTICAL
Datum, 1988 (NAVD). Unless otherwise noted, all bearings and distances were measured within an acceptable accuracy tolerance with the recorded value, (plot
or deed value). Bearings are based upon an assumed datum utilizing the recorded plat, more specifically the bearing of: THE LOT LINE BETWEEN LOTS 56 &
57 AS N80'02'34"E.
THE CONTROL BENCHMARK USED WAS CITY OF CLEARWATER BENCHMARK G-03.5 AT ELEVATION 7.42 NAVD 1988.
(N/F)
n
LOT 56
1 STORY CBS
4' VINYLROP RN
p'S 0N6' , VINYL FENCE
ON PROPER (
O BEARING BASO 5' )
N 80 02,34„ E 120.11
FCM 4")(4"
(NO ID)
FOpNi3 4"
II
• BENCHMARK
SET NAIL
EL=4.25
S.N&D
S.N&D
Z
if
C')
1"=30'
BENCHMARK
SET NAIL
EL=3.96
CLEARWATER
HARBOR
OOD PILING
((P•)
S.N&D
N 80'4320 E
VINYL FENCE N 80'40'03"
ON PROPER F NCEE
ON PROPERN LINE
(N/F)
CURVE
RADIUS
DELTA
ARC
CHORD
BEARING
C1(P)
7170.00'
00'40'45"
85.00'
85.00'
N 09'37'03" W
C2
P
150.00'
02'21'11"
6.16'
6.16'
N 11'04'35" W
C2
M
6.18'
N 13'10'43" W
C3
(P)
7050.00'
00'37'45"
77.42'
77.42'
N 09'35'33" W
C3
(M)
77.52'
N 09'12'28" W
C4
(P)
7170.00'
00'38'21"
80.00'
80.00'
N 08'37'30" W
C4
(M)
80.07'
N 09'03'07" W
C5
P)
7170.00'
0022'30"
46.93'
46.93'
N 10'08'11" W
C5
M)
46.89'
N 10'05'19" W
C6
P)
7050.00'
00'38'21"
78.66'
78.66'
N 08'37'10" W
C7
150.00'
18'28'06"
48.35'
48.14'
N 21'29'12" W
**
UE
WE
NS
(P)
M
C
R
PG. s
OR
PB
FIR
FIP
FOP
FCM
SIR
LB
LS
N+D
N/C
PT
PP
120.0 en
120.92 m
1
= 10' Utility Easement WB = Wetland Buffer
= Drainage/Access Easement (size as noted) WCA = Wetland Conservation Area
= Utility Easement
= Wall Easement
= Not Set
= Plat Data
= Measured Data (XXXX)
= Calculated Data PCP
= Radial Line C/C
= Pages (s) C/S
= Official Records Book CONC.
= Plot Book CBS
= Found Iron Rod 5/8" CLF
(LB6472 unless noted) CL
= Found Iron Rod 5/8" (LB6707) E
= Found Open Pipe 1/2"(LB148 FH
= Found Concrete Monument 4 x4"(LB148) F/S
= Set Iron Rod (5/8")&Cap(LB6472) F/C
= Corporate Certificate Number D/W
= Professional Land Surveyor/Mapper IRCV
= Nail & Disk (LB6472 unless noted) LP
= No Cap OHW
= Power Transformer 0/A
= Power Pole GV
WL = Wetland Line
WSL = Wetland Setback Line
rZ� = Direction of
Surface Drainage
= Corner Marking
= Permanent Control Point (LB6707)
= Covered Concrete
= Concrete Slab
= Concrete
= Concrete Block Structure
= Chain Link Fence
= Centerline
= Electric Control Box
= Fire Hydrant
= Fiberglass Slab
= Fence Corner
= Concrete Driveway
= Irrigation Control Valve
= Light Pole
= Overhead Wires
= Overall
= Gate Valve
N
��
SIR
FOP 3/4"
(N/C)
0.48'S
X0.07'W
LOT 58
STORY CBS
#306
FIR 1/2"
(N/C)
30HW
I
LOWEST FLOOR ELEVATIONS
CRAWL SPACE = 6.03
GARAGE = 7.37
LOWEST LIVING LEVEL = 12.07
2ND FLOOR ELEVATION = 17.42
ESMT
LE
D&L
I/E
CST
S/W
T
TV
WM
W/F
CI
WPP
WLP
SAN.
= Easement
= Landscape Easement
= Drainage & Landscape Area
= Ingress / Egress Easement
= Clear Sight Triangle
(3.5' height restriction)
= Right—of—Way
= Concrete Sidewalk
= Styrofoam Slab
= Telephone Control Box
= Cable Television Control Box
= Water Meter
= Wood Fence
= Curb Inlet
= Wood Power Pole
= Wood Light Pole
= Sanitary
Property lies within Flood Zone(s) AE
Per Flood Insurance Rate Map Number:
12103C 0106H Effective date: 5/17/05
Base Flood Elevation = 11'
A BOUNDARY SURVEY OF LOT 57 UNIT 4 ISLAND ESTATES OF CLEARWATER
AS RECORDED IN PLAT BOOK 51 , PAGE 32 OF THE PUBLIC RECORDS OF
PINELLAS COUNTY, FLORIDA
DATES OF FIELD WORK
TIE IN
11-13-17
SK
BOUNDARY
7-23-14
DRAWN
SK/ML
FINAL SURVEY
9-23-19
ML
LAYOUT
7-28-17
SK
UPDATE
LB 6472
ZARRA BOYD, INC.
Land Surveying and Mapping
1480 Beltrees, Dunedin, Florida 34698
(727)738-9010 Fax: (727)733-0083
I hereby certify that this survey meets the minimum
technical standards as set forth by the Florida Board
of Professional Land Surveyors in Chapter 5J-17.051,
Florida Administrative Code, pursuant to Section
472.027, Florida Statutes
Survey not valid without the signature and the
original raised seal of a Florida Licensed
surveyor and mapper
PROFESSIONAL LAND _SURVEYOR # 5727
STATE OF FLORIDA
U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICA
Important: Follow the instructions on pages
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2)
SECTION A — PROPERTY INFORMATION
Al. Building Owner's Name
Richard Lof
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route
Box No.
312 Windward Island
City
State
312 WINDWARD ISL
BCP2016-12109A
ELEVATION CERTIFICATE
RICHARD LOF
Zoning: Island Estates
Atlas #: 268A
RECEIVED BY: T.V.
NOV 15 2017
PLANNING & DEVELOPMENT
CITY OF CLEARVVA T ER
Clearwater rionua JJI V
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Parcel Tax ID # 09-29-15-43362-000-0570
A4. Building Use (e.g.,
A5. Latitude/Longitude:
A6. Attach at least
A7. Building Diagram
A8. For a building with
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. N27-58-51.03 Long. W082-48-40.59
Residential
Horizontal
Datum: ❑ NAD 1927
insurance.
above adjacent grade
grade 0
p NAD 1983
10
2 photographs of the building if the
Number 8
Certificate is being used to obtain flood
2307.00 sq ft
a crawlspace
of crawlspace
flood
of flood openings
flood openings?
an attached
of attached
flood
of flood openings
flood openings?
or enclosure(s):
or enclosure(s)
openings in the crawlspace
in A8.b
or enclosure(s)
2720.00 sq in
within 1.0 foot
foot above adjacent
in
1029.00 sq ft
x Yes ❑ No
garage:
garage
openings in the attached garage within 1.0
in A9.b 0.00 sq
❑ Yes x No
SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number
City Of Clearwater 125096
B2. County Name
Pinellas County
B3. State
Florida
B4. Map/Panel
Number
12103C0106
B5. Suffix
H
B6. FIRM Index
Date
08-18-2009
B7. FIRM Panel
Effective/
Revised Date
05-17-2005
B8. Flood
Zone(s)
AE
B9. Base Flood E evation(s)
(Zone AO, use Base Flood Depth)
11'
B10. Indicate the source
❑ FIS Profile
B11. Indicate elevation
B12. Is the building
Designation
of the
Base Flood Elevation
❑ Community Determined
for BFE in Item B9:
Coastal Barrier Resources
❑
(BFE) data
or base flood
❑ Other/Source:
1929
(CBRS)
❑ OPA
depth entered in Item B9:
x FIRM
datum used
located in a
Date:
❑ Other/Source:
Protected Area (OPA)?
• NGVD
System
CBRS
x NAVD 1988
area or Otherwise
❑ Yes x No
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 1 of 6
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.
312 Windward Island
Policy Number:
City State ZIP Code
Clearwater Florida 33767
Company NAIC Number
SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
❑ Finished Construction
AR/A1—A30, AR/AH, AR/A0.
Rico only, enter meters.
Cl. Building elevations are based on: ❑ Construction Drawings* x Building Under 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,
Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto
Benchmark Utilized: City of Clearwater G-03.5 Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a) through h) below.
❑ NGVD 1929 x NAVD 1988 ❑ Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
Top bottom floor (including basement, crawlspace, or enclosure floor) 6.03
Check the measurement used.
x feet ❑ meters
a) of
b) Top the higher floor 12.07
x feet ❑ meters
of next
Bottom the lowest horizontal structural member (V Zones only) N/A ❑ feet ❑ meters
c) of
d) Attached of slab) 7.37
x feet ❑ meters
garage (top
e) Lowest elevation of machinery or equipment servicing the building N/A ❑ feet ❑ meters
location in Comments)
(Describe type of equipment and
f) Lowest (finished) next to building (LAG) 5.80
x feet ❑ meters
adjacent grade
Highest adjacent (finished) grade next to building (HAG) 6.90
x feet ❑ meters
g)
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
6.90
x 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
I certify that the information on this Certificate represents my best efforts to interpret the data available.
statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
law
to certify elevation information.
I understand that any false
Were latitude and longitude in Section A provided by a licensed land surveyor? X Yes ❑ No
X Check here if attachments.
Certifier's Name License Number
Mark S. Lischalk, PLS LS 5727
/ '+ t';
r S rry 33'`�
+
z``
:Xq fl
Title
President
Company Name.
Zarra Boyd, Inc.
Address
1480 Beltrees Street, Suite 3
City State ZIP Code
Dunedin Florida 34698
x',
SignaturDate Telephone Ext.
11-14-2017 (727)738-9010
Copy all pages o 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)
Building is under construction flood vents have not been installed.
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 2 o
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.
312 Windward Island
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, B,and 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 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
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.
312 Windward Island
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:
❑ feet
❑ feet
❑ feet
❑ meters Datum
New Construction ■ Substantial Improvement
basement)
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
BUILDING PHOTOGRAPHS
ELEVATION CERTIFICATE 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.
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
312 Windward Island
FOR INSURANCE COMPANY USE
Policy Number:
City
Clearwater
State ZIP Code
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.
Photo One
Photo One Caption Side View 11-13-2017
Clear Photo One
Photo Two
Photo Two Caption Crawl Space View 11-13-2017
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Clear Photo Two
Form Page 5 of 6
ELEVATION CERTIFICATE
BUILDING PHOTOGRAPHS
Continuation Page
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.
312 Windward Island
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.
I
1 1
1
1
I I
1 , '
4 .' (
Photo Three
Photo Three Caption Rear View 11-13-2017 Clear Photo Three
Vik
gam, f
ry
4
Photo Four
`
4
-
.
Photo Four Caption Slab Construction 11-13-2017 Clear Photo Four
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 6 of 6