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436 MIDWAY ISU.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 Important: Follow the instructions on pages 1-9. 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 TIMOTHY & LISA GAGNON Policy Number. A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 436 MIDWAY ISLAND Company NAIC Number. City State ZIP Code CLEARWATER, Florida 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) 08-29-15-43344-000-0610 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° 58'58.8" Long. Accessory, etc.) RESIDENTIAL 82° 48'49.4" Horizontal Datum: obtain flood insurance. 1.0 foot above adjacent above adjacent grade 0 NAD 1927 grade ® NAD 1983 8 2 photographs of the building if the Number 7 Certificate is being used to 1,640 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 crawispace in A8.b 2,048 sq or enclosure(s) within in sq ft within 1.0 foot sq in 0 ❑ Yes '1 No garage: garage 0 openings in the attached garage in A9.b 0 Yes © No _ SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NFIP Community Name & Community Number CITY QF-CLEARWATER / 125096 B2. County Name PINELLAS v 83. State Florida B4. Map/Panel Number 12103 C 0102 85. Suffix G Be. FIRM Index Date 08/18/2009 B7. F RM Panel Effective/ Revised Date 09/03/2003 88. Flood Zone(s) AE 89. Base Flood Elevation(s) (Zone AO, use Base Flood Depth) 11.0' B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: ■ FIS Profile B11. Indicate elevation 812. Is the building Designation Date: © FIRM • Community Determined datum used for BFE in Item B9: located in a Coastal Barrier Resources CBRS • Other/Source: ISIAI • NGVD 1929 © NAVD System (CBRS) area [] OPA 436 1988 • Other/Source: or Otherwise Protected MIDWAY Area (OPA)? • Yes a No FEMA Form 086-0-33 (7/15) Replaces all pr iv�.rcv I �- I vv ELEVATION CERT TIMOTHY S GAGNON Zoning: Island Estates Atlas #: 258B if 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, andlor Bldg. No.) or P.O. Route and Box No. 436 MIDWAY ISLAND 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 —Zones Complete items Benchmark Utilized: Indicate elevation 0 NGVD Datum used for 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: 0 Construction Drawings* 2] Building Under Construction* 0 Finished Construction Certificate will be required when construction of the building is complete. 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. C2.a—'n below according to the building diagram specified in Item A7. In PuertoRico only, enter meters. CITY OF CLEARWATER G-05 Vertical Datum: 3.86 datum used for the elevations in items a) through h) below. 1929 g NAVD 1988 0 Other/Source: building elevations must be the same as that used for the BFE. floor (including basement. crawlepace, or enclosure floor) 6 0 Check the measurement used. E feet • meters next higher floor 11 3 0 feet 0 meters the lowest horizontal structural member (V Zones only) N/A 0 feet • meters garage (top of slab) N/A C".] feet 0 meters of machinery or equipment servicing the building N/A c3 feet 0 meters type of equipment and location in Comments) (finished) grade next to building (LAG) 5. 0 Eal feet 0 meters (finished) grade next to building (HAG) 5. 2 al feet • meters grade at lowest elevation of deck or stairs, including N/A. 0 feet • meters 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 certify elevation information. I certify that the information on this Certificate represents my best efforts to interpret the data available. I 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? S Yes 1:1 No 0 Check here if attachments. Certifiers Name License Number LARRY L. EVANS FL. LS No. 2937 ...- , :: .... _...., , .. , ; Seal ...f. Title LAND SURVEYOR Company Name EVANS LAND SURVEYING, INC. Address 1460 BELTREES STREET STE. 9 City State ZIP Code DUNEDIN, Florida 34698 SignatureDate Telephone 0( 141 03/17/2020 (727) 734-3821 % • dill. '' Copy all page of - Elevation Certiff and all attachments for (1) community officiaL (2) insurance agent/company, and (3) building owner. Comments (inclu C2.a): THE ENCLOSED AT ELEVATION 'type of equipment and location, per C2(e), if applicable) STAIRWELL AREA, WITHIN THE GARAGE ENCLOSURE, 18 40 HIGHER THAN THE GARAGE, 6.4' FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2