1061 SEDEEVA ST1).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
GALE POLLACK
Policy Number:
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No.
1061 SEDEEVA STREET
Company NAIC Number
City State ZIP Code
CLEARWATER, Florida 33755
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
03-29-15-28674-002-0160
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,
Lat. 27 deg. 59' 32.5" Long. 82
Accessory, etc.) RESIDENTIAL
deg. 47' 34.2"
Horizontal Datum:
obtain flood insurance.
1.0 foot above adjacent
adjacent grade
❑ NAD 1927
grade
x NAD 1983
0
2 photographs of the building if the
Number 1A
Certificate is being used to
0 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 0 sq
or enclosure(s) within
in
sq ft
within 1.0 foot'above
sq in
0
❑ Yes x No
garage:
garage 0
openings in the attached garage
in A9.b 0
❑ Yes x No
SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number
CLEARWATER / 125096
B2. County Name
PINELLAS
B3. State
Florida
84. Map/Panel
Number
12103 C 0106
B5. Suffix
H
86. FIRM Index
Date
08/18/2009
B7. FIRM Panel
Effective/
Revised Date
05/17/2005
B8. Flood Zone(s)
AE & X (shaded)
B9. Base Flood Elevation(s)
(Zone AO, use Base
Flood Depth)
11'
B10. Indicate the source
❑ FIS Profile
811. Indicate elevation
B12. Is the building
Designation Date:
of the Base
Flood Elevation (BFE)
❑ Community Determined
for BFE in Item B9:
Coastal Barrier Resources
❑ CBRS
data
❑ NGVD
System
or base flood depth entered in Item B9:
❑ Other/Source:
x FIRM
datum used
located in a
1988 ❑ Other/Source:
or Otherwise Protected
1929 x NAVD
(CBRS) area
Area (OPA)?
❑ Yes x No
• OPA
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 1 of 6
1061 SEDEEVA ST
BCP2017-12673
REMODEL
SAIL POLLACK
Zoning: Low Medium Density Atlas #: 251A
RECEIVED BY: C.A.K.
DEC 2 9 2017
PLANNING & DEVELOPMENT
CITY OF CLEARWATFR
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.
1061 SEDEEVA STREET
Policy Number:
City State ZIP Code
CLEARWATER, Florida 33755
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: AG 0046 Vertical Datum: 25.26'
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, crawispace, or enclosure floor) 12. 8
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) N/A
x
feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 12 5
x
feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 12. 0
x
feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 12. 4
x
feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including 11. 8
imi
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
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
the data available.
1001.
Yes ❑ No
to certify elevation information.
I understand that any false
x Check here if attachments.
Certifier's Name License Number
LARRY L. EVANS FL LS No. 2937
Place
Seal
Here
Title
LAND SURVEYOR
Company Name
EVANS LAND SURVEYING, INC.
Address
1460 BELTREES STREET STE. 9
City State ZIP Code
DUNEDIN, Florida 34698
Signature Date Telephone
09/19/2017 (727) 734-3821
Copy all page of t 1 Elevatio(((n Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments (include g type of equipment and location, per C2(e), if applicable)
C2.e): IS AN EXTERIOR A/C COMPRESSOR ON GROUND LEVEL PAD.
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.
1061 SEDEEVA STREET
Policy Number:
City State ZIP Code
CLEARWATER, Florida 33755
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 El -E5. If the Certificate is intended to support a
complete Sections A, Band C. For Items El -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.
with the community's
certify this information in Section G.
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: N
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.) orP.O. Route and Box No.
1061 SEDEEVA STREET
Policy Number:
City State ZIP Code
CLEARWATER, Florida 337
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
PREPARED FOR: GALE POLLACK
it%
POWER POLE
FD AXLE
0.4'
ay
NY
Q
I
F116 5/8"
I#6505
0..34'N.
4 0.4'
ADJACENT 6' WOOD FENCE
N 00° 01' 08" E (M)
195.00'(P)
fj
0.2'
r.0'
195.05' (M)
FIR 1/2"
0.13'8'.
0.10'5'.
SECTION 3, TOWNSHIP 29S., RANGE 15E.
PINELLAS COUNTY, FLORIDA
36'
I 6' WOOD FENCE
46.8'
i
FD .4XLE
ALUMINUM SHEDS
FENCE CORNER
FIR 1/2"
#3035
4 32.6'.x,.,.
C71
LOU
S 00° 01' 59" E (M)
0.2' E.
ADJACENT 6' WOOD FENCE
CONC. SLAB
FENCE CORNER 0.9' W
ADJACENT 1 STORY FRAME
GARAGE
A SURVEY OF: LOT 16, BLOCK B, FLORIDENA ON CLEARWATER BAY, AS RECORDED
IN PLAT BOOK 9, PAGE 39, OF THE PUBLIC RECORDS OF PINELLAS COUNTY,
FLORIDA.
N1Lav� Lam D N1J1YIEUOK29 "LOC.
1460 BELTREES STREET UNIT 9
DUNEDIN, FL 34698 (727)734-3821
I. DESCRIPTION AS PROVIDED BY CUNT.
2. SURVEY WAS PERFORMED WITHOUT BENEFIT OF AN ABSTRACT OF TITLE.
3. OTHER THAN SHOWN ON PLAT THIS FIRM HAS MADE NO ATTEMPT TO RESEARCH
INSTRUMENTS OF RECORD REFLECTING EASEMENTS, RIGHTS OF WAY, AND/OR
OWNERSHIP THAT MAY EAST BUT ARE NOT SHOWN ON THIS SURVEY.
4. NO UNOERCROUND IMPROVEMENTS WERE LOCATED.
5. PRINTED DIMENSIONS SHOWN ON DRAWING SUPERCEDE SCALED DIMENSIONS. ITEMS
MAY BE DRAWN OUT OF SCALE TO GRAPHICALLY SHOW ENCROACHMENTS AND/08
OVERLAPS.
6. USE CF THIS SURVEY BY ANYONE OTHER THAN THOSE CER11FIED TO WILL BE AT THE
RE -USERS SOLE RISK, MR -MUT UABIUTY TO THE SURVEYOR.
7. UNLESS OTHERWISE NOTED, ELEVATIONS ARE BASED UPON NAVO 1988 OATUM.
8. UNLESS OTHERWISE NOTED, FOUND CORNERS HAVE No IDENTIFYING CAP OR DISC.
SURVEY TYPE
DATE
INV NO
BOUNDARY SURVEY
9/18/2017-
2017=-278
FCM = FOUNO CONCRETE MONUMENT
FlP = FOUND IRON PIPE
FPP - FOUNO PINCH PIPE
FIR = FOUND IRON R00
FN/0= FOUND NAIL IN DISK
SN AD= SET NAIL IN DISK
SIR SET IRON- ROD (1 /2') 19416225
POL = POINT ON UNE
FO= FOUND
PCP = PERMANENT CONTROL POINT
PRM = PERMANENT REFERENCE MONUMENT
LB = LICENSED BUSINESS
00140 = CONCRETE
ESMT = EASEMENT
DRN A. DRAINAGE
M MEASURED
C = CALCULATED
P = PLAT
D = DEED
F = FIELD
CENTERUNE
FIRM- = FLOOD INSURANCE RATE MAP
BFE = BASE F1_000 ELEVATION
I HEREBY CERTIFY THAT THE SURVEY REPRESENTED HEREON MEETS
THE MINIMUM REQUIREMENTS OF CHAPTERS 5J-17.050 TO 54-17.052
OF THE FLORIDA ADMINISTRATIVE C00E
J-Zo—Z.so ( J
AIMS JOHN C. BINDER
N0. 2937 FL REC. N0. 4888
UCNSEO BUSINESS No. 6225
(SURVEY INVAUD WITHOUT SIGNATURE AND EMBOSSED SEAL)
1 STORY FRAME
RESIDENCE
•
.4/C UNIT
195.00 ' (P)
' WOOD FENCE
195.14 ' (M)
SCALE: 1"=20'
32.4'
-'� WILSON BLVD.
(NO NAME STREET—PLAT)
V ACATED
a< 1
FIR 5/8"FD AXLE L. 4
o�
0.21'N.
O.rJ'E. 3
36'
FIRM Zones
" AE (BFE 11) AND X (SHADED) " , Per Panel No. 12103 C 0106H (5-17-05)
DRAWN BY. JCB CAD FILE: FLORIDENA—LOT16B CRD ORA14A.c'r5
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.
1061 SEDEEVA STREET
Policy Number:
City
CLEARWATER,
State
Florida
ZIP Code
3375E
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 - 09/19/2017
Photo Two
Photo Two Caption REAR VIEW - 09/19/2017
FEMA Form 086-0-33 (7/15)
Replaces all previous editions. Form Page 5 of 6