2369 PINELAND LNU.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICATE
OMB No. 1660-0008
Expiration Date: November 30, 2018
Important: Follow the instructions on pages 1-9.
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
DOROTHEA JEAN MARKS
Policy Number:
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No.
2369 PINELAND LN
Company NAIC Number:
City State ZIP Code
CLEARWATER Florida 33763
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
PARCEL 06.29.16.02844.000.0800
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,
Lat. 27.990504 Long. -82.738655
etc.) RESIDENTIAL
Horizontal
Datum:
insurance.
above
❑ NAD 1927
adjacent grade
grade N/A
x 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
448.00 sq ft
❑ Yes x No
garage:
garage
openings in the attached garage within 1.0
in A9.b N/A 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
12103C0126
B5. Suffix
G
B6. FIRM Index
Date
08-18-2009
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)
64.1 FEET
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:
x FIRM
datum used
located in a
❑ Other/Source:
Protected
1929 x NAVD 1988
(CBRS) area or Otherwise
❑ OPA
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.
2369 PINELAND LN
Policy Number:
City State ZIP Code
CLEARWATER Florida 33763
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, AR/A1—A30,
Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only,
Benchmark Utilized: CLEARWATER 1-13 Vertical Datum: NAVD 1988
x
Finished Construction
AR/AH, AR/AO.
enter meters.
Indicate elevation datum
❑ NGVD 1929
used
x
for the elevations in items a) through h) below.
NAVD 1988 ❑ Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
Check
a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 64.66
x
the measurement used.
feet ❑ meters
b) Top of the next higher floor N/A
x
feet ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only) N/A
x
feet ❑ meters
d) Attached garage (top of slab) 64.16
x
feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment and location in Comments) 65.08
p
feet meters
❑
f) Lowest adjacent (finished) grade next to building (LAG) 63.75
x
feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 64.22
x
feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
structural support 63.75
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
I certify that the information on this Certificate represents my best efforts to interpret
statement may be punishable by fine or imprisonment under 18 U.S. Code, Section
Were latitude and longitude in Section A provided by a licensed land surveyor?
x
authorized by law to certify elevation information.
the data available. I understand that any false
1001.
Yes ❑ No ❑ Check here if attachments.
Certifiers Name License Number
BILL HYATT FLORIDASURVEYOR@AOL.COM LS 4636
' A/:
Title
PRESIDENT
4636
Company Name
KNOW IT NOW INC
"VM► j
Address
1497 MAIN ST #321
City
DUNDEIN
BILL H State ZIP Code
HYATT Florida 34698
2018.04.24
,
Signature
12:39:43 Date Telephone Ext.
-04'00' 04-24-2018 (727) 415-8305
Copy all pages 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)
C2E ELEVATION IS TOP OF BASE OF AIR CONDITIONING UNIT
THIS IS NOT TO BE USED FOR CONSTRUCTION, IS FOR HOME INSURANCE USE ONLY
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.
2369 PINELAND LN
Policy Number:
City State ZIP Code
CLEARWATER Florida 33763
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.
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
■ 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
floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must
with the community's
certify this information in Section G.
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
OMB No. 1660-0008
ELEVATION CERTIFICATEExpiration Date: November 30, 2018
IMPORTANT: In these spaces, copy the corresponding information from Section A.
FOR INSURANCE COMPANY USE
Building StreeAddress (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
2369 PINELAND LN
Policy Number:
City State ZIP Code
CLEARWATER Florida 33763
Company NAIC Number
SECTION G — COMMUNITY INFORMATION (OPTIONAL)
The local official who is authrizod by law or ordinance to administer the commufloodplain 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 GB—Gb. 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. E---1 A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE)
or Zone A0.
G3. 0 The following information (Items G4—G10) is provided for community floodplain management purposes.
G4. Permit Number
G5. Date Permit Issued
G6. Date Crtifiv* of
Compliance/Occupancy Issued
G7. This permit has been issued for: []
G8. Elevation of as -built lowest floor (including
o��hebui�ing�
G9. BFE or (in Zone AO) depth of flooding at the
G10. Community's design flood elevation:
New Construction Fl Substantial Improvement
basement)
[��e�
0 feet
[] f t
0 meters Datum
oum
building site:
0m»tes 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)
0 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.
FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
2369 PINELAND LN
Policy Number:
City State ZIP Code
CLEARWATER Florida 33763
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 4-18-18
Clear Photo One
Photo Two
Photo Two Caption FRONT DOOR VIEW 4-18-18 Clear Photo Two.
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 5 of 6
ELEVATION CERTIFICATE
BUILDING PHOTOGRAPHS
OMB No. 1660-0008
Continuation Page 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.
2369 PINELAND LN
Policy Number:
City State ZIP Code
CLEARWATER Florida 33763
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 Caption 04-18-18 REAR VIEW
ar Photo hr
Photo Four
Photo Four Caption EQUIPMENT VIEW 04.18.18
Clear Photo Four
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 6 of 6