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1384 HILLCREST AVEU.Jpucr Nn1Ivocuv .+.- .......• • FEDERAL EMERGENCY MANAGEMENT AGENCY National Float iasuruncc Program IUi' v{r.l• it as IMPORTANT: Follow the instructions on pages 1 -9. Expiration Date: July 31, 2015 Al. SECTION A — PROPERTY INFORMATION Building Owner's Name Sandra F. Johnson and Deanna Williams FOR INSURANCE COMPANY USE Policy Number: A2. Building treet Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 1394 S. Hillcrest Avenue Company NAIC Number: City Clearwater State FL A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 60, Block M - Brookhili Unit 6 - Plat Book 58, Page 77 ZIP Code 33756 A4. Building Use (e.g., Residential, Non - Residential, Addition, Accessory, etc) Residential A5. Latitude /Longitude: Lat. 97 4R 77 °N Long 82 7804 °W A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. AT. Building Diagram Number 1-A A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade c) Total net area of flood openings in AB.b d) Engineered flood openings? 0 Yes El No Horizontal Datum: D NAD 1927 E3 NAD 1983 N/A A9. For a building with an attached garage: sq ft a) Square footage of attached garage 480 sq ft N/A N/A sq in b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A9.b N/A d) Engineered flood openings? 0 Yes ® No sq in SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NRP Community Name & Community Number City of Clearwater- 125096 62. County Name 1 B3. State Pinellas Florida 64. Map /Panel Number 12103C0109 B5. Suffix H B6. FiRM Index Date 05/17/2005 B7. FIRM Panel Effective/ Revised Date 09/03/2003 88. Flood Zone(s) AE 89. Base Flood Elevation(s) (Zone AO, use base flood depth) 35' B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: 0 F(S Profile FIRM 0 Community Determined 0 Other /Source: 811.Indicate elevation datum used for BFE in Item B9: 0 NGVD 1929 ® NAVD 1988 0 Other/Source. 312. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 0 Yes ® No Designation Date: / / 0 CBRS 0 OPA SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: D Construction Drawings" 0 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, AR /AH, AR /AO. Complete Items C2.a -ti below according to the building diagram specified in item A7. In Puerto Rico only, enter meters. Benchmark Utilized: County Map #1226 (Breeze 1973) vertical Datum. NAVD -1988 Indicate elevation datum used for the elevations in items a) through h) below. 0 NGVD 1929 21 NAVD 1988 D Other /Source: Datum used for building elevations must be the same as that used for the BFE. Finished Construction a) Top of bottom floor (including basement, crawlspace, or enclosure floor) b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of stab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) g) Highest adjacent (finished) grade next to building (HAG) 35 68 N A N A 34 96 34 95 34 81 __ 3355 27 h) Lowest adjacent grade at lowest elevation of deck or stairs, including N A structural support Check the measurement used. el feet 0 meters ® feet 0 meters ® feet D meters ® feet ❑ meters ® feet D meters (83 feet ® feet ® feet D meters ❑ meters D 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 taw to certify elevation information. 1 certify that the Information on this Certificate represents my best efforts to interpret the data available. /understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. DQ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a licensed land surveyor? ® Yes 0 No ® Check here if attachments. Cenifier's Name John C. = endla License Number 1269 rtiEr82nd Ay SiiiM:�� /mil ny Name C. Brendle and Associates, Inc. /15/2016 MA Form 086-0-33 (Revls • 7/12) See State FL 71P Code 33781 Telephone (727)- 576 -7546 • PL./ reverse side for continuation. R p ces all previous editions. " F\,!SEO" PLAms RECEIVED BY: V.J.K SEP 2 5 2018 PLANNING & DEVELOPMENT CITY OF CLEARWATER 1394 S HILLCREST AVE BCP2018- 090314 REMODEL - RTC Zoning: Low Medium Density Atlas #: 306B tLwxr IVil 4=11 Irltai I c, page c 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. 1394 S. Iiillcrest Avenue City Clearwater - FOR INSURANCE COMPANY USE Policy Number: State ZIP Code FL 33756 Company NAIC Number: SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments 2) e. NC Pad Benchm : County Map #1226 (Breeze 1973) E1. • 1.106' NGVD adjusted to Elev. 60.49' NAVD - MSI.. = 0.00 si e !Adi Date 04/15/2016 Alir CTiO - BUILDiN w'' • T1ON INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) Zones AO and A (without BFE), complete Items E1 -E5. if the Certificate Is intended to support a LOMA or LOMR -F request, complete Sections A, B,and C. F.r Items E1-E4, use natural grade, if available. Check the measurement used. in Puerto Rico only, enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ feet ❑ meters ❑ above or ❑ below the HAG. 0 above or ❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and /or 9 (see pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building Is E3. Attached garage (top of slab) is E4. Top of platform of machinery and /or equipment servicing the building is E5. Zone AO only: If no flood depth number Is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance ?0 Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. ❑ feet ❑ meters ❑ feet ❑ meters ❑ feet ❑ meters ❑ above or ❑ below the HAG. ❑ above or ❑ below the HAG. ❑ above or ❑ below the HAG. 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. 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 08 -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 A0. 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: ❑ New Construction 0 Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: ❑ feet ❑ meters Datum G9. BFE or (in Zone A0) depth of flooding at the building site: ❑ feet ❑ meters Datum G10.Community's design flood elevation: ❑ feet ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments 0 Check here If attachments. FEMA Form 086 -033 (Revised 7/12) Replaces all previous editions.