1860 STEVENSON AVEU.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFIC
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
SHERRY DAY
A2. Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.Q. Rout
Box No.
1860 STEVENSON AVE.
City
State
RECEIVED BY: J.B.S.
FEB 1 1 2019
PLANNING & DEVELOPMENT
CITY OF CLEARWATER
1860 STEVENSON AVE
BCP2018- 120559
RTC
SHERRY DAY
Zoning: Low Medium Density
Atlas #: 260A
CLEARWAT ER FLORIDA 33755
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 13 AND THE NORTH 54 FEET OF LOT 14, BLOCK 0, SECOND ADDITION TO SUNSET POINT, ACCORDING TO THE PLAT THEREOF, RECORDED IN PLAT BOOK
8, PAGE(S) 14, OF THE PUBLIC RECORDS OF PINELLAS COUNTY, FLORIDA.
A4. Building Use (e.g.,
A5, Latitude /Longitude:
A6. Attach at 'east
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.27.98924065 Long. - 82.79206085
Accessory, etc.) RESIDENTIAL
Horizontal Datum: []
obtain flood insurance.
1.0 foot above adjacent
above adjacent grade
NAD 1927
grade
o
(j NAD 1983
24
2 photographs
Number 8
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
Certificate is being used to
sq ft
or enclosure(s):
or enclosure(s) 1228
openings in the crawlspace or enclosure(s) within
in A8.b 2416 sq in
❑ Yes [1 No
garage:
garage 308 _T _ sq ft
openings in the attached garage within 1.0 foot
in A9.b 0 sq in
[] Yes jyj No
'
SECTION El — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number
CITY OF CLEARWATER 125096
62. County Name
PINELLAS
133, State
FLORIDA
[34. Map /Panel
Number
12103C- 0106
65. Suffix
H
B6. FIRM Index
Date
5/17/2005
67. FIRM Panel
Effective/
Revised Date
05/17/2005
88. Flood Zone(s)
AE, AE
89. Base Flood Elevation(s)
(Zone AO, use Base
Flood Depth)
11.0/12.0
B10. indicate the source
[ ] FIS Profile
811. Indicate elevation
B12. Is the building
Designation Date:
of the Base Flood Elevation (BFE)
[] FIRM ❑ Community Determined
datum used for E3FE in Item 39:
located in a Coastal Barrier Resources
[ _] CBRS
data
1J NGVD
System
or base flood depth entered in item 89:
❑ Other /Source:
1929 'U NAVD 1988 ❑ Other /Source:
(CBRS) area or Otherwise Protected Area (OPA)?
❑ OPA
❑ Yes (X] No
FEMA Form 080 -0 -33 (7/15)
Replaces all previous editions.
Form Page 1 of 6
ELEVATION CERTIFICATE
OMB No. 1660 -0008
•
njr,, mh=
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.
1860 STEVENSON AVE.
Policy Number:
City State ZIP Code
CLEARWATER FLORIDA 33755
Company NAIC Number
SECTION C •- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: 0 Construction Drawings" Building Under Construction* [l Finished Construction
"A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations - Zones A1-A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR /A, AR /AE, AR /A1 -A30, AR /AH, AR/A0.
Complete Items C2.a -h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: COUNTY DATUM ; Vertical Datum: NAVD88
Indicate elevation datum used for the elevations in items a) through h) below.
L] NGVD 1929 Ell NAVD 19138 ❑ 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. 1
Check the measurement used
[_O feet 0 meters
b) Top of the next higher floor 9. 7
feet
c) Bottoin of the lowest horizontal structural member (V Zones only) .
[X] feet [] meters
-__
d) Attached garage (top of slab) 7 2 [)1 feet 0 meters
e) Lowest elevation of machinery or equipment servicing the building 6, 4 0 feet 0 meters
_
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 6. 2 [X] feet [] meters
g) Highest adjacent (finished) grade next to building (HAG) 8. 9
_ [5s1 feet [] meters
x feet [] meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
structural support
SECTION 0 - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation infae mation.
I certify that the information on this Certificate represents my best efforts to interpret the data available. t 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? ❑ Yes No [] Check here if attachments.
Certifier's Name License Number
PATRICK IRELAND 6637
•¢>aC. FI /' . ,
y
tt.
o : NO. 6637 fe, a
M STATE OF' a
.., . ✓ �.:
-<4NO suR'I�._o
7/31/2017
Title
PROFESSIONAL SURVEYOR AND MAPPER
Company Name � - -- - -- Y _ _ .----- __�__- _.��__ — .-- -_ -. --
IRELAND & ASSOCIATES SURVEYING, INC.
INC.
Address
1301 S. INTERNATIONAL PARKWAY, SUITE 2001
City State ZIP Code
LAKE MARY FLORIDA 32746
__
Signature //,, Date Telephone
nUr„G� . 7131/2017 P: (407)678 -3366
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance
agent/company, and (3) building owner.
OR PERSONS NAMED ON THIS
SHOULD NOT BE USED FOR
Comments ( including type of equipment and location, per C2(e), if applicable)
NOTE: C2.E = AC UNIT PAD. NOTE: THIS ELEVATION CERTIFICATE IS ONLY VALID FOR THE PERSON
CERTIFICATE. THIS CERTIFICATE IS FOR FLOOD INSURANCE PURPOSES ONLY. THE INFORMATION ON THIS CERTIFICATE
CONSTRUCTION OR PLANNING.
FEMA Form 080 -0 -33 (7/15)
Replaces all previous editions.
Farm Page 2 of 6
ELEVATION CERTIFICATE
IS- 39700EC
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.
1860 STEVENSON AVE.
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 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,
LOMA or LOMR -F request,
used. In Puerto Rica only,
the elevation is above or below
❑ above or ❑ below the HAG.
[-I 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.
crawlspace, or enclosure) is x feet Q meters
b) Top of bottom floor (including basement,
crawlspace, or enclosure) is x 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 . �,. fl feet ❑ meters
E3. Attached garage (top of slab) is feet [] meters
�
E4. Top of platform of machinery and /or equipment
servicing the building is x feet ❑ meters
E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance
floadplain management ordinance? [0 Yes ❑ No 0 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
[1 Check here if attachments.
FEMA Form 086 -0 -33 (7/15)
Replaces all previous editions,
Form Page 3 of 6
e
ELEVATION CERTIFICATE
IS-
OMB No. 1660 -0008
Expiration Date: Nave
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.
1860 STEVENSON AVE.
Policy Number:
City State ZIP Code
CLEARWATER FLORIDA 33755
Company NAIC Number
SECTION G — COMMUNITY INFORMATION (OPTIONAL)
The local officia` 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.
01. ❑ 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.)
02 ❑ 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.
04. Permit Number
05. 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:
09. BFE or (in Zone AO) depth of flooding at the
G10. Communi -,y's design flood elevation:
❑ feet
❑ meters Datum
New Construction • Substantial improvement
basement)
❑ meters Datum
building site:
• feet
❑ feet
_�r__. _�
❑ 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 066 -0 -33 (7/15)
Replaces all previous editions.
Form Page 4 of 6
ELEVATION CERTIFICATE
BUILDING PHOTOGRAPHS
See instructions for Item A6. IS- 39700Ec
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
1860 STEVENSON AVE.
City
CLEARWATER
OMB No. 1660 -0008
Expiration Date: November 30, 2018
FOR INSURANCE COMPANY USE
Policy Number:
State
ZIP Code
FLORIDA 33755
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 Itern 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.
Rear View
Front View Date: 8/14/2017
Rear View Date: 8/14/2017
Right Side View
Right Side View: 8/14/2017
FEMA Form 086 -0 -33 (7/15)
Left Side View: 8/14/2017
Replaces all previous editions.
Left Side View
Form Page 5 of 6