159 BAYSIDE DR15c... Z- 0/7 — 06£320
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
BILL KLEINE
Policy Number:
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
159 BAYSIDE DRIVE
Company NAIC Number:
City State ZIP Code
CLEARWATER FLORIDA 33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 14, BLOCK B, BAYSIDE SUBDIVISION NO. 3 - PARCEL # 08-29-15-04950-002-0140
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 with
a) Square footage
b) Number of permanent
c) Total net area
d) Engineered
Residential, Non -Residential, Addition, Accessory, etc.)
Lat. 27.9700° N. Long. 82.8251° W.
RESIDENTIAL
Horizontal Datum:
obtain flood insurance.
1.0 foot above adjacent
above adjacent grade
❑ NAD 1927
grade
x NAD 1983
12
2 photographs of the building if the
Number 7
Certificate is being used to
2,796 sq ft
with a crawlspace
of crawlspace
permanent 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 3,230
sq
or enclosure(s) within
in
sq ft
within 1.0 foot
sq in
N/A
❑ Yes x No
garage:
garage N/A
openings in the attached garage
in A9.b N/A
• 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
12103C0102
B5. Suffix
G
B6. FIRM Index
Date
8-18-2009
B7. FIRM Panel
Effective/
Revised Date
9-3-2003
B8. Flood Zone(s)
AE
B9. Base Flood Elevation(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 (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
N/A
1988 ❑ Other/Source:
or Otherwise Protected
1929 x NAVD
(CBRS) area
❑ OPA
Area (OPA)?
❑ Yes x No
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 1 of 8
ELEVATION CERTIFICATEExpiration Date: November 30, 2018
OMB No. 1660-0000
IMPORTANT: In these spaces, copy the correponding 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.
159 BAYSIDE DRIVE
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: LII Construction Drawings* Building Under Construction* Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations — Zones A1—A5O.AE, AH, A(with BFE).VE, V1—V30.V(with BFE).AR, AR/A.AR6uE.AR641—A3U.AR64H.ARx\O.
Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: QTYOFCLE8RVWATER''D'2" Vertical Datum: N.A.VD.1g80
Indicate elevation datum used for the elevations in items a) through h) below.
0 NGVD 1929 EJ NAVD 1988 Li 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) 6.26 0 feet 11] meters
b) Top of the next higher fl16.02 E] feet [] meters
c) Bottom of the lowest horizontal structural member (V Zones only) N/A0 feet 0motara
d) AttachedN/Ag�ro�e(�opnfo|a�) 0 feet Ej meters
125U
e) Lowest elevation of machinery or equipment servicing the building � ill] feet [1 meters
(Describe type of equipment and location in Comments)
f) Lowest adj5.0 .0 EJ feet [] meters
g) Highest adj5.7 .7 El] feet 0matore
aoengnydoat|n*mate|evadN/Aonofdeokorntairs.ino|uding ID feet 0 meters
h) Lowest adj�
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 law to certifyelevation information.
/ certify that the information on this Certificate represents my best efforts to interprethe data available. / 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'? Ell Yes []No El Check here if attaclynen'
Certifiers Name License Number
GEORGE A. GH|MPU| 6137
'.° ��«`
� � ,~ �
—
�'�a/ ��
�n�°uo mar 1 - ,
Title Job Number
VICE PRESIDENT 170181'F
Company Nam
GEORGE &GH|MPU&ASSOCIATES, INC.
/ 8. �'
Address
3301 DeGOTOBOULEVARD, SUITE D
City State �pCode
PALM HARBOR FLORIDA 84683
"�6 e�` `
(N�valid
eumeyo/ original raised oedir+
Date Telephone
7'17'2018 727-784-5496S�
°x ��—
�y_
Copy �|pages o[��E�va�nnCertificate 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)
SEE ATTACHMENT PAGES 7 AND 8 FOR SURVEYOR'S NOTES AND COMMENTS. THIS
DOCUMENT IS NOT VALID UNLESS SIGNED AND EMBOSSED WITH THE SURVEYOR'S
ORIGINAL RAISED SEAL AND MUST CONTAIN ALL 8 PAGES.
FEMA Form O86-0-337
Replaces all previous editions.
Form Page 2 of 8
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.
159 BAYSIDE DRIVE
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 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 8
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.
159 BAYSIDE DRIVE
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.
r...... 0.-- A r,f A
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
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.
159 BAYSIDE DRIVE
Policy Number:
City
CLEARWATER
State
FLORIDA
ZIP Code
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
7-17-2018
Ulf
118J18i8i11J ](8111111
Photo Two
Photo Two Caption REAR VIEW
7-17-2018
FEMA Form 086-0-33 (7/15)
Replaces all previous editions. Form Page 5 of 8
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.
159 BAYSIDE DRIVE
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 One
Photo One
Photo Three Caption N/A N/A
Photo Two
Photo Two
Photo Four Caption N/A N/A
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
orm rage c o
ELEVATION CERTIFICATE
Surveyor's Notes
Attachment Page 7
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.
159 BAYSIDE DRIVE
Policy Number:
City State ZIP Code
CLEARWATER FLORIDA 33767
Company NAIC Number
SECTION D — SURVEYOR'S CERTIFICATION (CONTINUED FROM PAGE 2)
Al.) THIS ELEVATION CERTIFICATE WAS EXCLUSIVELY PREPARED FOR AND CERTIFIED TO THE PARTY SPECIFIED IN
SECTION A, ITEM 1, FOR THE SPECIFIC PURPOSE OF OBTAINING FLOOD INSURANCE AND/OR VERIFYING FLOOD ZONE
COMPLIANCE WITH THE LOCAL GOVERNING AUTHORITY. USE OF THIS DOCUMENT BY ANY OTHER PARTY OR FOR ANY
OTHER PURPOSES IS STRICTLY PROHIBITED AND SHALL RENDER THIS DOCUMENT INVALID FOR THOSE PURPOSES. THIS
DOCUMENT SHALL NOT BE VALID OR BINDING AGAINST THE SIGNING SURVEYOR UNLESS IT IS SIGNED AND EMBOSSED
WITH THE ORIGINAL RAISED SEAL OF THE FLORIDA LICENSED SURVEYOR AND MAPPER.
UNAUTHORIZED COPIES IN ANY FORM OR BY ANY MEANS, INCLUDING PHOTOCOPYING OR OTHER ELECTRONIC OR
MECHANICAL METHODS, ARE STRICTLY PROHIBITED, SHALL NOT BE CONSIDERED AS SIGNED AND SEALED AND SHALL NOT
BE VALID. REQUESTS FOR ANY ADDITIONAL OFFICIAL SIGNED AND SEALED COPIES MUST BE DIRECTED TO GEORGE A.
SHIMP II & ASSOCIATES, INC.
A4.) THE BUILDING USE WAS DETERMINED BY PHYSICAL OBSERVATIONS MADE ON THE DATE OF SURVEY.
A5.) THE LATITUDE AND LONGITUDE COORDINATES WERE OBTAINED USING A HAND HELD G.P.S. UNIT WHICH MEETS OR
EXCEEDS FEMA'S REQUIRED ACCURACY OF 66 FEET.
A7.) THE BUILDING DIAGRAM NUMBER WAS DETERMINED BY PHYSICAL OBSERVATIONS MADE ON THE DATE OF SURVEY.
CERTAIN STRUCTURAL FEATURES NOT VISIBLE TO THE SURVEYOR (PILINGS, GRADE BEAMS, ETC.) OR USE OF ANY AREAS
BELOW THE BASE FLOOD ELEVATION THAT DOES NOT COMPLY WITH FEMA REGULATIONS CAN AFFECT THIS
DETERMINATION.
A8.) FOR THE PURPOSE OF THIS DOCUMENT, A BUILDING ENCLOSURE IS DEFINED AS THAT PORTION OF AN ELEVATED
BUILDING, BELOW THE LOWEST ELEVATED FLOOR, THAT IS EITHER PARTIALLY OR FULLY SHUT IN BY RIGID WALLS. A
GARAGE BELOW OR ATTACHED TO AN ELEVATED BUILDING IS CONSIDERED AN ENCLOSURE. SUCH AREAS SHALL NOT
CONTAIN MORE THAN 20 LINEAR FEET OF FINISHED INTERIOR WALLS (PANELING, ETC.) OR IT WILL BE CONSIDERED A
FINISHED (HABITABLE) AREA.
A8. & A9.) FOR THE PURPOSE OF THIS DOCUMENT, A FLOOD OPENING IS DEFINED AS A PERMANENT OPENING IN AN
EXTERIOR WALL THAT IS NO HIGHER THAN 1.0 FOOT ABOVE THE HIGHER OF THE EXTERIOR OR INTERIOR GRADE OR FLOOR
IMMEDIATELY BELOW THE OPENING.
IN REGARD TO ENGINEERED FLOOD OPENING(S), IF APPLICABLE, THE SURVEYOR DOES NOT KEEP COPIES OF EITHER THE
INDIVIDUAL ENGINEERED FLOOD OPENINGS CERTIFICATION OR THE EVALUATION REPORT ISSUED BY THE INTERNATIONAL
CODE COUNCIL EVALUATION SERVICE (ICC ES) ON FILE. CURRENT COPIES OF THESE DOCUMENTS SHOULD BE AVAILABLE
FROM THE MANUFACTURER OF THE ENGINEERED FLOOD OPENING(S).
B8.) UNLESS OTHERWISE NOTED IN SECTION B, ITEM 10, THE FLOOD ZONE WAS DETERMINED BASED ON THE FLOOD
INSURANCE RATE MAP. IN CERTAIN CASES WHERE AN ACCURATE DETERMINATION COULD NOT BE MADE FROM THE MAP,
FEMA'S INTERACTIVE MAP OR THE COUNTY'S G.I.S. OVERLAY MAY HAVE BEEN UTILIZED TO DETERMINE THE FLOOD ZONE.
NO SEARCH OF THE PUBLIC RECORDS WAS PERFORMED FOR LOMA'S, LOMR'S, ETC. WHICH MAY AFFECT THE SITE.
B9.) IF APPLICABLE, WHEN THE BASE FLOOD ELEVATION IS SHOWN AS A WHOLE NUMBER ON THE FIRM, IT HAS BEEN
CONVERTED TO A DECIMAL AND ENTERED TO THE NEAREST TENTH OF A FOOT AS REQUIRED BY FEMA.
IF APPLICABLE, THE STRUCTURE CONTAINS: 0 CRAWLSPACE 0 ENCLOSURE 0 ATTACHED GARAGE 0 N/A
IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAINS: GARAGE, STORAGE AREA, STAIRS & ELEVATOR
IF APPLICABLE, DOES THE BOTTOM FLOOR ENCLOSURE APPEAR TO CONTAIN BREAK -AWAY WALLS? 0 YES 0 NO 0 N/A
IF APPLICABLE, THIS ELEVATION CERTIFICATE WAS PREPARED USING THE "HISTORIC" FLOOD MAP DATA AND DATUM
(N.G.V.D. 1929) FOR POSSIBLE "GRANDFATHERING" PURPOSES: 0 YES 0 NO
Attachment Page 7 of 8
ELEVATION CERTIFICATE
Surveyor's Notes
Attachment Page 8
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.
159 BAYSIDE DRIVE
FOR INSURANCE COMPANY USE
Policy Number:
City State ZIP Code
CLEARWATER FLORIDA 33767
Company NAIC Number
SECTION D — SURVEYOR'S CERTIFICATION (CONTINUED FROM PAGE 7)
IN REGARD TO ENGINEERED FLOOD OPENINGS, AS REFERENCED IN SECTIONS A8 AND A9 IF APPLICABLE, THE STRUCTURE'S:
El CRAWLSPACE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER N/A SQ. FEET PER
OPENING (MANUFACTURER: N/A — MODEL: N/A ) FOR A TOTAL OF
N/A SQ. FEET OF COVERAGE AND N/A NON -ENGINEERED FLOOD OPENING(S) WITH A NET AREA OF N/A SQ.
INCHES, PROVIDING COVERAGE FOR A TOTAL OF N/A SQ. FEET.
ENGINEERED FLOOD OPENING(S) ARE: ❑INSTALLED ❑UNDER CONSTRUCTION 0 PER PLAN 0 N/A
NOTES: N/A
o ENCLOSURE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER N/A SQ. FEET PER OPENING
(MANUFACTURER: N/A — MODEL: N/A ) FOR A TOTAL OF N/A
SQ. FEET OF COVERAGE AND N/A NON -ENGINEERED FLOOD OPENING(S) WITH A NET AREA OF N/A SQ. INCHES,
PROVIDING COVERAGE FOR A TOTAL OF N/A SQ. FEET.
ENGINEERED FLOOD OPENING(S) ARE: 0 INSTALLED 0 UNDER CONSTRUCTION OPER PLAN 0 N/A
NOTES: N/A
El ATTACHED GARAGE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER N/A SQ. FEET PER
OPENING (MANUFACTURER: N/A — MODEL: N/A ) FOR A TOTAL OF
N/A SQ. FEET OF COVERAGE AND N/A NON -ENGINEERED FLOOD OPENING(S) WITH A NET AREA OF N/A SQ.
INCHES, PROVIDING COVERAGE FOR A TOTAL OF N/A SQ. FEET.
ENGINEERED FLOOD OPENING(S) ARE: ❑INSTALLED DUNDER CONSTRUCTION O PER PLAN 0 N/A
NOTES: N/A
C2.e) AIR CONDITIONER LOCATED ON AN ELEVATED WOOD DECK ON THE SIDE OF THE STRUCTURE.
Attachment Page 8 of 8
'/ ,7 -- 92.6
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
all. ages 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
BILL KLEINE
Policy Number:
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No.
159 BAYSIDE DRIVE
Company NAIC Number
City State ZIP Code
CLEARWATER FLORIDA 33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 14, BLOCK B, BAYSIDE SUBDIVISION NO. 3 - PARCEL # 08-29-15-04950-002-0140
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. 27.9700° N. Long.
Accessory, etc.) RESIDENTIAL
82.8251° W.
Horizontal Datum: ❑
obtain flood insurance.
1.0 foot above adjacent
above adjacent grade
NAD 1927
grade
x NAD 1983
12
2 photographs of the building if the Certificate
Number 7
is being used to
2,796 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 3,230 sq
or enclosure(s) within
in
ft
within 1.0 foot
sq in
N/A
sq
❑ Yes x No
garage:
garage N/A
openings in the attached garage
in A9.b N/A
❑ 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
12103C0102
B5. Suffix
G
B6. FIRM Index
Date
8-18-2009
B7. FIRM Panel
Effective/
Revised Date
9-3-2003
B8. Flood Zone(s)
AE
B9. Base Flood Elevation(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 (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
N/A
1988 ❑ Other/Source:
or Otherwise Protected Area (OPA)?
1929 x NAVD
(CBRS) area
❑ OPA
❑ Yes p No
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 1 of 8
ELEVATION CERTIFICATE
f
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.
159 BAYSIDE DRIVE
Policy Number:
City State ZIP Code
CLEARWATER FLORIDA 33767
Company NAIC Number
SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations
*A new Elevation
C2. Elevations —
Complete Items
Benchmark
Indicate elevation
❑ NGVD
Datum used
a) Top of bottom
b) Top of the
c) Bottom of
d) Attached
e) Lowest elevation
(Describe
f) Lowest adjacent
g) Highest adjacent
h) Lowest adjacent
structural
are based on: ❑ Construction Drawings* ❑ Building Under Construction*
Certificate will be required when construction of the building is complete.
Zones A1—A30, AE, AH, A (with BFE), VE, V1—V30, V (with BFE), AR, AR/A, AR/AE,
C2.a—h below according to the building diagram specified in Item A7. In Puerto
Utilized: CITY OF CLEARWATER "D-2" Vertical Datum: N.A.V.D.
x Finished Construction
AR/A1—A30, AR/AH, AR/AO.
Rico only, enter meters.
1988
datum used for the elevations in items a) through h) below.
1929 x NAVD 1988 ❑ Other/Source:
for building elevations must be the same as that used for the BFE.
floor (including basement, crawlspace, or enclosure floor) 6.26
Check the measurement used.
x feet ❑ meters
next higher floor 16.02
x feet ❑ meters
the lowest horizontal structural member (V Zones only) N/A
x feet ❑ meters
garage (top of slab) N/A
x feet ❑ meters
of machinery or equipment servicing the building 12.50
x feet ❑ meters
type of equipment and location in Comments)
(finished) grade next to building (LAG) 5.0
x feet ❑ meters
(finished) grade next to building (HAG) 5.7
x feet ❑ meters
grade at lowest elevation of deck or stairs, including N/A
x feet ❑ meters
support
SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification
I certify that the information
statement maybe
Were latitude and
is to be signed and sealed by a land surveyor, engineer, or architect authorized by
on this Certificate represents my best efforts to interpret the data available.
punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
law
to certify elevation information.
/ understand that any false
longitude in Section A provided by a licensed land surveyor? x Yes ❑ No
x Check here if attachments.
Certifier's Name License Number
GEORGE A. SHIMP III 6137
Place
Seal
Here
-0
Title Job Number
VICE PRESIDENT 170181-F
Company Name
GEORGE A. SHIMP II & ASSOCIATES, INC.
A /� ;,
7).
# 6137 Date: 7 17-2018
Address
3301 DeSOTO BOULEVARD, SUITE D
City State ZIP Code
PALM HARBOR FLORIDA 34683
(Not valid unless embossed with
surveyor's original raised seal)
. :ture
��� /�
Date Telephone
. . 7-17-2018 727-784-5496
Copy all pages of this Ele ation 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)
SEE ATTACHMENT PAGES 7 AND 8 FOR SURVEYOR'S NOTES AND COMMENTS. THIS
DOCUMENT IS NOT VALID UNLESS SIGNED AND EMBOSSED WITH THE SURVEYOR'S
ORIGINAL RAISED SEAL AND MUST CONTAIN ALL 8 PAGES.
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
orm Nage 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.
159 BAYSIDE DRIVE
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 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.
❑ 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 8
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.
159 BAYSIDE DRIVE
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)
159 BAYSIDE DR
BCP2017-06820A
KLEIN, WILLIAM
Zoning: Low Medium Density Atlas #: 276A
❑ Check here if attachments.
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
g
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.
159 BAYSIDE DRIVE
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.
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Photo One
Photo One Caption FRONT VIEW 7-17-2018
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Photo Two
Photo Two Caption REAR VIEW 7-17-2018
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 5 of 8
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.
159 BAYSIDE DRIVE
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 One
Photo One
Photo Three Caption N/A N/A
Photo Two
Photo Two
Photo Four Caption N/A N/A
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
ELEVATION CERTIFICATE Expiration Date: November 30, 2018
Surveyor's Notes
Attachment Page 7
OMB No. 1660-0008
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.
159 BAYSIDE DRIVE
FOR INSURANCE COMPANY USE
Policy Number:
City State ZIP Code
CLEARWATER FLORIDA 33767
Company NAIC Number
SECTION D — SURVEYOR'S CERTIFICATION (CONTINUED FROM PAGE 2)
Al.) THIS ELEVATION CERTIFICATE WAS EXCLUSIVELY PREPARED FOR AND CERTIFIED TO THE PARTY SPECIFIED IN
SECTION A, ITEM 1, FOR THE SPECIFIC PURPOSE OF OBTAINING FLOOD INSURANCE AND/OR VERIFYING FLOOD ZONE
COMPLIANCE WITH THE LOCAL GOVERNING AUTHORITY. USE OF THIS DOCUMENT BY ANY OTHER PARTY OR FOR ANY
OTHER PURPOSES IS STRICTLY PROHIBITED AND SHALL RENDER THIS DOCUMENT INVALID FOR THOSE PURPOSES. THIS
DOCUMENT SHALL NOT BE VALID OR BINDING AGAINST THE SIGNING SURVEYOR UNLESS IT IS SIGNED AND EMBOSSED
WITH THE ORIGINAL RAISED SEAL OF THE FLORIDA LICENSED SURVEYOR AND MAPPER.
UNAUTHORIZED COPIES IN ANY FORM OR BY ANY MEANS, INCLUDING PHOTOCOPYING OR OTHER ELECTRONIC OR
MECHANICAL METHODS, ARE STRICTLY PROHIBITED, SHALL NOT BE CONSIDERED AS SIGNED AND SEALED AND SHALL NOT
BE VALID. REQUESTS FOR ANY ADDITIONAL OFFICIAL SIGNED AND SEALED COPIES MUST BE DIRECTED TO GEORGE A.
SHIMP II & ASSOCIATES, INC.
A4.) THE BUILDING USE WAS DETERMINED BY PHYSICAL OBSERVATIONS MADE ON THE DATE OF SURVEY.
A5.) THE LATITUDE AND LONGITUDE COORDINATES WERE OBTAINED USING A HAND HELD G.P.S. UNIT WHICH MEETS OR
EXCEEDS FEMA'S REQUIRED ACCURACY OF 66 FEET.
A7.) THE BUILDING DIAGRAM NUMBER WAS DETERMINED BY PHYSICAL OBSERVATIONS MADE ON THE DATE OF SURVEY.
CERTAIN STRUCTURAL FEATURES NOT VISIBLE TO THE SURVEYOR (PILINGS, GRADE BEAMS, ETC.) OR USE OF ANY AREAS
BELOW THE BASE FLOOD ELEVATION THAT DOES NOT COMPLY WITH FEMA REGULATIONS CAN AFFECT THIS
DETERMINATION.
A8.) FOR THE PURPOSE OF THIS DOCUMENT, A BUILDING ENCLOSURE IS DEFINED AS THAT PORTION OF AN ELEVATED
BUILDING, BELOW THE LOWEST ELEVATED FLOOR, THAT IS EITHER PARTIALLY OR FULLY SHUT IN BY RIGID WALLS. A
GARAGE BELOW OR ATTACHED TO AN ELEVATED BUILDING IS CONSIDERED AN ENCLOSURE. SUCH AREAS SHALL NOT
CONTAIN MORE THAN 20 LINEAR FEET OF FINISHED INTERIOR WALLS (PANELING, ETC.) OR IT WILL BE CONSIDERED A
FINISHED (HABITABLE) AREA.
A8. & A9.) FOR THE PURPOSE OF THIS DOCUMENT, A FLOOD OPENING IS DEFINED AS A PERMANENT OPENING IN AN
EXTERIOR WALL THAT IS NO HIGHER THAN 1.0 FOOT ABOVE THE HIGHER OF THE EXTERIOR OR INTERIOR GRADE OR FLOOR
IMMEDIATELY BELOW THE OPENING.
IN REGARD TO ENGINEERED FLOOD OPENING(S), IF APPLICABLE, THE SURVEYOR DOES NOT KEEP COPIES OF EITHER THE
INDIVIDUAL ENGINEERED FLOOD OPENINGS CERTIFICATION OR THE EVALUATION REPORT ISSUED BY THE INTERNATIONAL
CODE COUNCIL EVALUATION SERVICE (ICC ES) ON FILE. CURRENT COPIES OF THESE DOCUMENTS SHOULD BE AVAILABLE
FROM THE MANUFACTURER OF THE ENGINEERED FLOOD OPENING(S).
88.) UNLESS OTHERWISE NOTED IN SECTION B, ITEM 10, THE FLOOD ZONE WAS DETERMINED BASED ON THE FLOOD
INSURANCE RATE MAP. IN CERTAIN CASES WHERE AN ACCURATE DETERMINATION COULD NOT BE MADE FROM THE MAP,
FEMA'S INTERACTIVE MAP OR THE COUNTY'S G.I.S. OVERLAY MAY HAVE BEEN UTILIZED TO DETERMINE THE FLOOD ZONE.
NO SEARCH OF THE PUBLIC RECORDS WAS PERFORMED FOR LOMA'S, LOMR'S, ETC. WHICH MAY AFFECT THE SITE.
B9.) IF APPLICABLE, WHEN THE BASE FLOOD ELEVATION IS SHOWN AS A WHOLE NUMBER ON THE FIRM, IT HAS BEEN
CONVERTED TO A DECIMAL AND ENTERED TO THE NEAREST TENTH OF A FOOT AS REQUIRED BY FEMA.
IF APPLICABLE, THE STRUCTURE CONTAINS: ❑ CRAWLSPACE p ENCLOSURE ❑ ATTACHED GARAGE ❑ N/A
IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAINS: GARAGE, STORAGE AREA, STAIRS & ELEVATOR
IF APPLICABLE, DOES THE BOTTOM FLOOR ENCLOSURE APPEAR TO CONTAIN BREAK -AWAY WALLS? ❑ YES 0 NO ❑ N/A
IF APPLICABLE, THIS ELEVATION CERTIFICATE WAS PREPARED USING THE "HISTORIC" FLOOD MAP DATA AND DATUM
(N.G.V.D. 1929) FOR POSSIBLE "GRANDFATHERING" PURPOSES: ❑ YES El NO
Attachment Page 7 of 8
Surveyor's Notes
Attachment Page 8
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.
159 BAYSIDE DRIVE
Policy Number:
City State ZIP Code
CLEARWATER FLORIDA 33767
Company NAIC Number
SECTION D — SURVEYOR'S CERTIFICATION (CONTINUED FROM PAGE 7)
IN REGARD TO ENGINEERED FLOOD OPENINGS, AS REFERENCED IN SECTIONS A8 AND A9 IF APPLICABLE, THE STRUCTURE'S:
0 CRAWLSPACE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER N/A SQ. FEET PER
OPENING (MANUFACTURER: N/A — MODEL: N/A ) FOR A TOTAL OF
N/A SQ. FEET OF COVERAGE AND N/A NON -ENGINEERED FLOOD OPENING(S) WITH A NET AREA OF N/A SQ.
INCHES, PROVIDING COVERAGE FOR A TOTAL OF N/A SQ. FEET.
ENGINEERED FLOOD OPENING(S) ARE: ❑INSTALLED ❑UNDER CONSTRUCTION D PER PLAN El N/A
NOTES: N/A
o ENCLOSURE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER N/A SQ. FEET PER OPENING
(MANUFACTURER: N/A — MODEL: N/A ) FOR A TOTAL OF N/A
SQ. FEET OF COVERAGE AND N/A NON -ENGINEERED FLOOD OPENING(S) WITH A NET AREA OF N/A SQ. INCHES,
PROVIDING COVERAGE FOR A TOTAL OF N/A SQ. FEET.
ENGINEERED FLOOD OPENING(S) ARE: 0 INSTALLED 0 UNDER CONSTRUCTION OPER PLAN p N/A
NOTES: N/A
o ATTACHED GARAGE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER N/A SQ. FEET PER
OPENING (MANUFACTURER: N/A — MODEL: N/A ) FOR A TOTAL OF
N/A SQ. FEET OF COVERAGE AND N/A NON -ENGINEERED FLOOD OPENING(S) WITH A NET AREA OF N/A SQ.
INCHES, PROVIDING COVERAGE FOR A TOTAL OF N/A SQ. FEET.
ENGINEERED FLOOD OPENING(S) ARE: ❑INSTALLED ❑UNDER CONSTRUCTION ❑ PER PLAN EI N/A
NOTES: N/A
C2.e) AIR CONDITIONER LOCATED ON AN ELEVATED WOOD DECK ON THE SIDE OF THE STRUCTURE.
Attachment Page 8 of 8