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800 DEMPSEY STU.'S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFI( Important: Follow the instructions on page Copy all pages of this Elevation Certificate and all attachments for (1) community official, SECTION A — PROPERTY INFORMATION Al. Building Owner's Name MARY A FLOAT A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Roi Box No. 800 DEMPSEY STREET City CLEARWATER State Florida "REVISED" PLANS RECEIVED BY JAW SEP 0 4 2019 PLANNING & DEVELOPMENT 800 DEMPSEY ST BCP2019-080829 ec FLOAT, MARY Zoning: Medium Density Atlas FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOTS 13 AND 14, BLOCK 5, LAKE BELLEVIEW ADDITION 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, Lat. N27.94855° Long. W82.79553° Accessory, etc.) RESIDENTIAL Horizontal Datum: obtain flood insurance. 1.0 foot above adjacent above adjacent grade ❑ NAD 1927 grade x NAD 1983 SEE NOTE 2 photographs of the building if the Number 8 Certificate is being used to 1,550 sq ft with 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 SEE NOTE sq or enclosure(s) within in sq ft within 1.0 foot sq in N/A ❑ Yes 1:1 No garage: garage N/A openings in the attached garage in A9.b N/A ❑ Yes :a No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number CITY OF CLEARWATER - 125096 B2. County Name PINELLAS B3. State Florida 84. Map/Panel Number 12103C0108 B5. Suffix H 86. FIRM Index Date 05/17/2005 87. FIRM Panel Effective/ Revised Date 05/17/2005 B8. Flood Zone(s) AE B9. Base Flood Elevation(s) (Zone AO, use Base Flood Depth) 43.0 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 N/A ❑ CBRS data ❑ NGVD System or base flood depth entered in Item B9: ❑ Other/Source: x FIRM datum used located in a 1929x❑ NAVD 1988 ❑ Other/Source: (CBRS) area or Otherwise Protected ❑ 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. 800 DEMPSEY STREET Policy Number: City State ZIP Code CLEARWATER Florida 33756 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, ARAE, Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Benchmark Utilized: FDOT PERM. REF. NETWORK Vertical Datum: NAVD 1988 x Finished Construction AR/A1—A30, AR/AH, AR/AO. Rico only, enter meters. Indicate elevation datum used for the elevations in items a) through h) below. • NGVD 1929 in NAVD 1988 ❑ 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) 42. 5 Check the measurement used. x feet ❑ meters b) Top of the next higher floor 45 3 0 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 44 2 © feet ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 42. 5 x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 45. 2 x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including 42. 5 x 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 authorized by 1 certify that the information on this Certificate represents my best efforts to interpret the data available. statement maybe punishable by fine or imprisonment under 18 U.S. Code. Section 1001. law to certify elevation information. 1 understand that any false ❑ Check here if attachments. Were latitude and longitude in Section A provided by a licensed land surveyor? X Yes ❑ No Certifier's Name License Number JONATHAN S. BRANSON FL PLS 6845 Digitally g y signed by e Jonathan 4 z=: Branson _ i ,Date: 2019.03.08 11:05:41 -05'00' Title PRESIDENT.,,,P;.;'s" Company Name ACROMIC, INC. LB 8094 Address 50 LAKEVIEW RESERVE BOULEVARD City State ZIP Code WINTER GARDEN Florida 34787 Signature i Date Telephone 03/08/2019 (321) 312-0787 ti Copy all pageW'of this Elevat.n 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) A5. COORDINATES WERE DETERMINED USING GEOREFERENCED IMAGERY. A8. CRAWLSPACE IS COVERED WITH OPEN LATTICE FOR SCREENING PURPOSES, ALLOWING AIR AND WATER MOVEMENT. C2. ELEVATIONS ARE REFERENCED TO THE FLORIDA DEPARTMENT OF TRANSPORTATION PERMANENT REFERENCE NETWORK, AS OBSERVED WITH A LEICA GS14 GPS SENSOR. C2e. IS ELEVATION OF TOP OF SLAB SUPPORTING AIR CONDITIONING UNIT LOCATED AT THE RIGHT SIDE OF THE STRUCTURE. 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. 800 DEMPSEY STREET Policy Number: City State ZIP Code CLEARWATER Florida 33756 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 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: 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. 800 DEMPSEY STREET Policy Number: City State ZIP Code CLEARWATER Florida 33756 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 ❑ meters Datum building site: ❑ meters Datum ❑ meters Datum • feet 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 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. 800 DEMPSEY STREET Policy Number: City State ZIP Code CLEARWATER Florida 33756 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. �.E /_x r. yY B _ e Yt 3j i r Photo One Photo One Caption FRONT VIEW - 03/07/2019 • k A• " 111111 ' i. ! r ' .•; 111 I 1 k 1.11 . 1•• .11• f'} may. S • •::..:•�1�' Photo Two Photo Two Caption REAR VIEW - 03/07/2019 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. 800 DEMPSEY STREET Policy Number: City CLEARWATER State Florida ZIP Code 33756 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 Caption RIGHT SIDE VIEW - 03/07/2019 Photo Two Photo Two Caption LEFT SIDE VIEW - 03/07/2019 FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6