176, 182, 188 BRIGHTWATER DR (158 BRIGHTWATER ON STICKER)U.S. DEPAR i`MENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICA1
Important: Follow the instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insu
SECTION A — PROPERTY INFORMATION
Al. Building Owner's Name
BRIGHTWATER BLUE RESIDENCES, LLC
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No.
176 (UNITS 1-5), 182 (UNITS 1-5) & 188 (UNITS 1-5) BRIGHTWATER DR. (EAST BLD
State
FLORIDA
City
CLEARWATER
158 BRIGHTWATER
BCP2014-09208B
elev cert
BRIGHTWATER BLUE VACATION Tc
Zoning: Tourist Atla:
/1J. ri VIJCIty ue IIpLIVII ,LUL Cil IV 17IUGR IVUIIIUCIA, 1dW rdiuCI NU!! WC!, Leyal Descnp1UII, a L...,
LOTS 16 - 30, BRIGHTWATER BLUE TOWNHOMES - PARCEL #'S 08-29-15-11491-000-0160, 0160 THRU 0300
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,
Lat. 27.9716° N. Long.
Accessory, etc.) RESIDENTIAL
82.8236° W.
Horizontal Datum:
obtain flood insurance.
1.0 foot above adjacent
above adjacent grade
❑ NAD 1927
grade
x NAD 1983
45
2 photographs of the building if the
Number 7
Certificate is being used to
8393 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 9000
sq
or enclosure(s) within
in
sq ft
within 1.0 foot
sq in
N/A
x Yes ❑ No
garage:
garage N/A
openings in the attached garage
in A9.b N/A
❑ Yes x No
SECTION B — FLO'O'D INSURANCE RATE MAP (FIRM) INFORMATION
131. NFIP Community Name & Community Number
CITY OF CLEARWATER - 125096
B2. County Name
PINELLAS COUNTY
63. State
FLORIDA
B4. Map/Panel
Number
12103C0102
B5. Suffix
G
B6. FIRM Index
Date
8-18-09
B7. FIRM Panel
Effective/
Revised Date
9-3-03
B8. Flood Zone(s)
AE
B9. Base Flood Elevation(s)
(Zone AO, use Base
Flood Depth)
11'
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 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.
176 (UNITS 1-5), 182 (UNITS 1-5) & 188 (UNITS 1-5) BRIGHTWATER DR. (EAST BLDG.)
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: ❑ Construction Drawings" ❑ Building Under Construction*
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations — Zones Al 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: LENGEMANNS GNSS NETWORK Vertical Datum: N.A.V.D. 1988
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, crawlspace, or enclosure floor) 6. 52
x
the measurement used.
feet ❑ meters
b) Top of the next higher floor 17 49
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 11 17
x
feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 5 . 3
x
feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 6 . 1
x
feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including N . A
x
feet ❑ meters
structural support
SECTION D — SURVEYO,-:, ENGINEEr,, 0." ARCHITECT CERTIFIC/ TION
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
I understand
x
certify elevation information.
that any false
Check here if attachments.
Certifier's Name License Number
GEORGE A. SHIMP III 6137
,',
Place
( Seal f I
i �_ ���"`��
.
, c
-'''
M1.;
Title Job Number
VICE PRESIDENT 140283-0
Company Name
GEORGE A. SHIMP II & ASSOCIATES, INC.
�'<�l
#-6,1`7,, bats', ` '
`
.2,•23-2017
Address
3301 DeSOTO BOULEVARD, SUITE D
City State ZIP Code•
PALM HARBOR FLORIDA 34683
(Not valid unless. embossed with
surveyor's original raised seal)
Si m ture Date Telephone
%, 2-23-2017 727-784-5496
‹...121/14/17
--7.17
Copyall pages of this Elevatio Certificate and all attachments for(1)communityofficial, (2)insurance agent/company, andowner.
P9 (3) building
Comments (including type of equipment and location, per C2(e), if applicable)
SEE ATTACHMENT PAGE 7 OF 7 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 7 PAGES.
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.
176 (UNITS 1-5), 182 (UNITS 1-5) & 188 (UNITS 1-5) BRIGHTWATER DR. (EAST BLDG.)
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, B,and C. For Items El—E4, use natural grade, if available. Check the measurement
enter meters.
E1. 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 (Ii i OWNER'S EPRESENT TIVE) 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.
176 (UNITS 1-5), 182 (UNITS 1-5) & 188 (UNITS 1-5) BRIGHTWATER DR. (EAST BLDG.)
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.
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.
176 (UNITS 1-5), 182 (UNITS 1-5) & 188 (UNITS 1-5) BRIGHTWATER DR. (EAST BLDG.)
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.
10,,_
, 1
1
Photo One
Photo One Caption FRONT VIEW 2-23-2017
I ' lal ; lira I II(
111.
i
fr
Photo Two
Photo Two Caption REAR VIEW 2-23-2017
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 5 of 6
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.
176 (UNITS 1-5), 182 (UNITS 1-5) & 188 (UNITS 1-5) BRIGHTWATER DR. (EAST BLDG.)
Policy Number:
City State ZIP Code
CLEARWATER FLORIDA 33767
Company MAIC 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 One Caption N/A
Photo Two
Photo Two
Photo Two Caption N/A
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 6 of 6
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.
176 (UNITS 1-5), 182 (UNITS 1-5) & 188 (UNITS 1-5) BRIGHTWATER DR. (EAST BLDG.)
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 PREPARED EXCLUSIVELY FOR THE USE AND BENEFIT OF 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. THIS DOCUMENT SHALL NOT BE VALID AND BINDING AGAINST THE
SIGNING SURVEYOR WITHOUT THE ORIGINAL RAISED SEAL AND SIGNATURE OF THE FLORIDA LICENSED SURVEYOR AND
MAPPER. 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. UNAUTHORIZED COPIES ARE STRICTLY PROHIBITED 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.
IF APPLICABLE, THE STRUCTURE CONTAINS: ❑ CRAWLSPACE ® ENCLOSURE ❑ ATTACHED GARAGE ❑ N/A
IF APPLICABLE, THE CRAWLSPACE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER
FT. PER OPENING (MANUFACTURER: N/A — MODEL: N/A ).
IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAINS 45 ENGINEERED FLOOD OPENING(S) CERTIFIED TO
COVER 200 SQ. FT. PER OPENING (MANUFACTURER: SMART VENT — MODEL: 1540-520 ).
IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAINS: GARAGE, STORAGE, ENTRY AND STAIRS
IF APPLICABLE, DOES THE BOTTOM FLOOR ENCLOSURE APPEAR TO CONTAIN BREAK -AWAY WALLS? ❑ YES ® NO ❑ N/A
A9.) IF APPLICABLE, THE ATTACHED GARAGE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER
N/A SQ. FT. PER OPENING (MANUFACTURER: N/A — MODEL: N/A ).
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.
N/A SQ.
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.
C2.e) BOTTOM OF ELECTRIC METER LOCATED ON WALL.
Attachment Page 7 of 7
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
BRIGHTWATER BLUE RESIDENCES, LLC
Policy Number:
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No.
BRIGHTWATER DRIVE (RESTROOMS - EAST BUILDING)
Company NAIC Number:
City State ZIP Code
CLEARWATER FLORIDA 33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
TRACT A, BRIGHTWATER BLUE TOWNHOMES - PARCEL # 08-29-15-11491-000-0001
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
c) Total net area
d) Engineered
Residential, Non -Residential, Addition,
Lat. 27.9718° N. Long.
Accessory, etc.) NON-RESIDENTIAL
82.8243° W.
Horizontal Datum:
obtain flood insurance.
1.0 foot above adjacent
above adjacent grade
❑ NAD 1927
grade
x NAD 1983
N/A
2 photographs of the building if the
Number 1A
Certificate is being used to
N/A sq ft
with a crawlspace
of crawlspace
permanent flood
of flood openings
flood openings?
an attached
of attached
permanent flood
of flood openings
flood openings?
or enclosure(s):
or enclosure(s)
openings in the crawlspace
in A8.b N/A
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 -: — FLOOD INSURANCE RATE MAP (ARM) INFORM no N
B1. NFIP Community Name & Community Number
CITY OF CLEARWATER - 125096
62. County Name
PINELLAS COUNTY
B3. State
FLORIDA
B4. Map/Panel
Number
12103C0102
B5. Suffix
G
B6. FIRM Index
Date
8-18-09
B7. FIRM Panel
Effective/
Revised Date
9-3-03
B8. Flood Zone(s)
AE
B9. Base Flood Elevation(s)
(Zone AO, use Base
Flood Depth)
11'
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 6
ELEVATION CERTIFICATE
OMB No. 1660-0008 ,
Expiration Date: November 30, 2018
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 2 of 6
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.
BRIGHTWATER DRIVE (RESTROOMS - EAST BUILDING)
Policy Number:
City State ZIP Code
CLEARWATER FLORIDA 33767
Company NAIC Number
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. 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: LENGEMANNS GNSS NETWORK Vertical Datum: N.A.V.D. 1988
x
Finished Construction
AR/AH, AR/A0.
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, crawlspace, or enclosure floor) 6. 54
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 N A x
feet ❑ 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) 6 . 4 x
feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including N . A x
feet ❑ meters
structural support
SECTI( N - SURVEY() , ENGINEER, OR ARCHITECT CERTIFICATISN
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
I understand
x
certify elevation information.
that any false
Check here if attachments.
Certifiers Name License Number
GEORGE A. SHIMP III 6137
Title Job Number
VICE PRESIDENT 140283-0
�T. ' '
`sell . • �.
C'H�@_
Company Name
GEORGE A. SHIMP 11 & ASSOCIATES, INC.
•
' tic,
3 f i
Address,
3301 DeSOTO BOULEVARD, SUITE D
•
# 613�'pfe
`":, '., t'
;+-
.- , a •°'
2-23-2611
City State ZIP Code
PALM HARBOR FLORIDA 34683
(Not vafid•uniess embossed with
surveyor's original raised seal)
igrature
k Date Telephone
2-23-2017 727-784-5496
A =--.
Copy allpages of this Elevati.0/14A
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 PAGE 7 OF 7 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 7 PAGES.
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 2 of 6
r
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.
BRIGHTWATER DRIVE (RESTROOMS - EAST BUILDING)
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, B,and 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
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 certify
SECTION F — PROPERTY • NE(R 0;';NER°S REPESENTATIVE) CERTIFICATION
The property owner or owners 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,
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.
BRIGHTWATER DRIVE (RESTROOMS - EAST BUILDING)
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.
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.
BRIGHTWATER DRIVE (RESTROOMS - EAST BUILDING)
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.
r,
.t' '_
Photo One
Photo One Caption FRONT
VIEW 2-23-2017
a
_
Photo Two
Photo Two Caption REAR VIEW 2-23-2017
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 5 of 6
ELEVATION CERTIFICATE
BUILDING PHOTOGRAPHS
Continuation Page
OMB No. 1660-0008
Expiration Date: November 30, 2018
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 6 of 6
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.
BRIGHTWATER DRIVE (RESTROOMS - EAST BUILDING)
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.
II', : i 1?i l.'
Photo One
Photo One Caption N/A
Photo Two
Photo Two
Photo Two Caption N/A
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 6 of 6
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.
BRIGHTWATER DRIVE (RESTROOMS - EAST BUILDING)
Policy Number:
City State
CLEARWATER FLORIDA
ZIP Code
33767
Company NAIC Number
SECTION D — SURVEYOR'S CERTIFICATION (CONTINUEFROM PAGE 2)
Al.) THIS ELEVATION CERTIFICATE WAS PREPARED EXCLUSIVELY FOR THE USE AND BENEFIT OF 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. THIS DOCUMENT SHALL NOT BE VALID AND BINDING AGAINST THE
SIGNING SURVEYOR WITHOUT THE ORIGINAL RAISED SEAL AND SIGNATURE OF THE FLORIDA LICENSED SURVEYOR AND
MAPPER. 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. UNAUTHORIZED COPIES ARE STRICTLY PROHIBITED 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
DETERMI NATION.
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.
IF APPLICABLE, THE STRUCTURE CONTAINS: ❑ CRAWLSPACE 0 ENCLOSURE 0 ATTACHED GARAGE ® N/A
IF APPLICABLE, THE CRAWLSPACE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER N/A SQ.
FT. PER OPENING (MANUFACTURER: N/A — MODEL: N/A ).
IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO
COVER N/A SQ. FT. PER OPENING (MANUFACTURER: N/A — MODEL: N/A
IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAINS: N/A
)•
IF APPLICABLE, DOES THE BOTTOM FLOOR ENCLOSURE APPEAR TO CONTAIN BREAK -AWAY WALLS? 0 YES 0 NO ® N/A
A9.) IF APPLICABLE, THE ATTACHED GARAGE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER
N/A SQ. FT. PER OPENING (MANUFACTURER: N/A — MODEL: N/A ).
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.
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.
C2.e) NO MACHINERY AND/OR EQUIPMENT HAS BEEN INSTALLED.
Attachment Page 7 of 7
•
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
BRIGHTWATER BLUE RESIDENCES, LLC
Policy Number:
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No.
BRIGHTWATER DRIVE (POOL EQUIPMENT HOUSE - WEST BUILDING)
Company NAIC Number:
City State ZIP Code
CLEARWATER FLORIDA 33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
TRACT A, BRIGHTWATER BLUE TOWNHOMES - PARCEL # 08-29-15-11491-000-0001
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
a) Square footage
b) Number of
c) Total net area
d) Engineered
Residential, Non -Residential, Addition, Accessory, etc.)
Lat. 27.9718° N. Long. 82.8244° W.
NON-RESIDENTIAL
Horizontal Datum:
obtain flood insurance.
1.0 foot above adjacent
above adjacent grade
❑ NAD 1927
grade
x NAD 1983
N/A
2 photographs
Number
with a crawlspace
of crawlspace
permanent flood
of flood openings
flood openings?
with an attached
of attached
permanent flood
of flood openings
flood openings?
of the building if the
1A
Certificate is being used to
N/A sq ft
or enclosure(s):
or enclosure(s)
openings in the crawlspace
in A8.b N/A
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 ;; — FLOOD INSU/' NCE RATE MAP (FIR'i) 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
8-18-09
B7. FIRM Panel
Effective/
Revised Date
9-3-03
B8. Flood Zone(s)
AE
B9. Base Flood Elevation(s)
(Zone AO, use Base
Flood Depth)
11'
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 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.
BRIGHTWATER DRIVE (POOL EQUIPMENT HOUSE - WEST BUILDING)
Policy Number:
City State ZIP Code
CLEARWATER FLORIDA 33767
Company NAIC Number
SECTION C — BUILDING ELEV TION INFORMATION (SURVEY REQUIRED)
C1. 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: LENGEMANNS GNSS NETWORK Vertical Datum: N.A.V.D, 1988
x
Finished Construction
AR/AH, AR/A0.
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, crawlspace, or enclosure floor) 6 . 35
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 N A
x
feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 6 . 1
x
feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 6 . 3
x
feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including N . A
x
feet ❑ meters
structural support
SECTION Ire — SURVEYOR, ENGINEER, O;: ,.RCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect
1 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
1 understand
x
certify elevation information.
that any false
Check here if attachments.
Certifier's Name License Number
GEORGE A. SHIMP III 6137
• •Plane ;- :,
. seal
: Were
' t•Io. t;t
r :
i+l►
'" '••�
# 6i <O to
•
s;
lR,jj�_
s`��I'i
2-23=2017
Title Job Number
VICE PRESIDENT 140283-0
Company Name
GEORGE A. SHIMP 11 & ASSOCIATES, INC.
Address:;"�?�i
3301 DeSOTO BOULEVARD, SUITE D•
City State ZIP Code,
PALM HARBOR FLORIDA 34683
(Not valid unless embossed with
surveyor's original raised seal)
S -ture Date Telephone
- 2-23-2017 727-784-5496
1r0
4 `1!
Copy all pages of this Elevation C rtificate 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 PAGE 7 •F 7 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 7 PAGES.
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.
BRIGHTWATER DRIVE (POOL EQUIPMENT HOUSE - WEST BUILDING)
Policy Number:
City State ZIP Code
CLEARWATER FLORIDA 33767
Company NAIC Number
SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED)
FOR ZONE AO AND Z • NE 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 E1—E4, use natural grade, if available. Check the measurement
enter meters.
E1. 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
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 certify
SECTION F — P*PE TY O'�,'NER (OR 0NE'S REPESENIT/ TI Eli CERTIFICATION
The property owner or owners 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.
BRIGHTWATER DRIVE (POOL EQUIPMENT HOUSE - WEST BUILDING)
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.
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.
BRIGHTWATER DRIVE (POOL EQUIPMENT HOUSE - WEST BUILDING)
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.
1 v
411
"
-
i_
_ .,.._. ...ter«.,.
y
Photo One
Photo One Caption FRONT VIEW 2-23-2017
Photo Two
Photo Two Caption REAR VIEW 2-23-2017
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 5 of 6
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.
BRIGHTWATER DRIVE (POOL EQUIPMENT HOUSE - WEST BUILDING)
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 Caption N/A
Photo Two
Photo Two
Photo Two Caption N/A
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 6 of 6
•
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.
BRIGHTWATER DRIVE (POOL EQUIPMENT HOUSE - WEST BUILDING)
Policy Number:
City State
CLEARWATER FLORIDA
ZIP Code
33767
Company NAIC Number
SECTION D — SURVEYOR'S CERTIFICATION (CONTINUE', F',"OM P
GE 2)
Al.) THIS ELEVATION CERTIFICATE WAS PREPARED EXCLUSIVELY FOR THE USE AND BENEFIT OF 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. THIS DOCUMENT SHALL NOT BE VALID AND BINDING AGAINST THE
SIGNING SURVEYOR WITHOUT THE ORIGINAL RAISED SEAL AND SIGNATURE OF THE FLORIDA LICENSED SURVEYOR AND
MAPPER. 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. UNAUTHORIZED COPIES ARE STRICTLY PROHIBITED 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.
IF APPLICABLE, THE STRUCTURE CONTAINS: ❑ CRAWLSPACE ❑ ENCLOSURE ❑ ATTACHED GARAGE E N/A
IF APPLICABLE, THE CRAWLSPACE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER N/A SQ.
FT. PER OPENING (MANUFACTURER: N/A — MODEL: N/A ).
IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO
COVER N/A SQ. FT. PER OPENING (MANUFACTURER: N/A — MODEL: N/A
IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAINS: N/A
)•
IF APPLICABLE, DOES THE BOTTOM FLOOR ENCLOSURE APPEAR TO CONTAIN BREAK -AWAY WALLS? ❑ YES ❑ NO E N/A
A9.) IF APPLICABLE, THE ATTACHED GARAGE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER
N/A SQ. FT. PER OPENING (MANUFACTURER: N/A — MODEL: N/A ).
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.
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.
C2.e) NO MACHINERY AND/OR EQUIPMENT HAS BEEN INSTALLED.
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