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710 ELDORADO AVEU.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, 2022 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 THE MARTHA POSEY BURKE TRUST Policy Number: A2. Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 710 ELDORADO AVENUE Company NAIC Number: City State ZIP Code CLEARWATER, Florida 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) 05-29-15-54666-002-0030 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, Accessory, etc.) Lat. 27° 59' 23.2" Long. 82° 49' 39.6" RESIDENTIAL Horizontal Datum: insurance. above ❑ NAD 1927 adjacent grade grade 0 • NAD 1983 0 2 photographs Number with 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 6 Certificate is being used to obtain flood 2090.00 sq ft or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b or enclosure(s) 0.00 sq in within 1.0 foot foot above adjacent in 0.00 sq ft ❑ Yes PAr. No garage: garage openings in the attached garage within 1.0 in A9.b 0.00 sq ❑ Yes © 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 B4. Map/Panel Number 12103 C 0102 B5. Suffix G B6. FIRM Index Date 08-18-2009 B7. FIRM Panel Effective/ Revised Date 09-03-2003 B8. Flood Zone(s) VE B9. Base Flood E evation(s) (Zone AO, use Base Flood Depth) 12.0' & 14.0' B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation Date: of the Base Flood Elevation ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ (BFE) data or base flood ❑ Other/Source: depth entered in Item B9: X FIRM datum used located in a ❑ Other/Source: Protected ■ NGVD 1929 Q NAVD 1988 System (CBRS) area or Otherwise CBRS ❑ OPA Area (OPA)? ❑ Yes • No FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2022 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. 710 ELDORADO AVENUE 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 A1—A30, AE, AH, A (with BFE), VE, V1 V30, V (with BFE), AR, AR/A, AR/AE, Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Benchmark Utilized: CITY OF CLEARWATER 1-02 Vertical Datum: 4.98' 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 X 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) Check the measurement used. 6.7 M feet ❑ meters b) Top of the next higher floor 17.7 M feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) 15.6 0 feet ❑ meters d) Attached garage (top of slab) N/A ❑ feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 28.7 (Describe type of equipment and location in Comments) KI feet meters f) Lowest adjacent (finished) grade next to building (LAG) 5.8 1 feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 6.2 M feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including feet meters structural support N/A ❑ ❑ SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by / certify that the information on this Certificate represents my best efforts to interpret the data available. statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. law to certify elevation information. / understand that any false Were latitude and longitude in Section A provided by a licensed land surveyor? 0 Yes ❑ No i Check here if attachments. Certifier's Name License Number LARRY L. EVANS FL. LS No. 2937 a\ 'J1 r 4k. `V k , i p �M� i� ffi n�s Y41.44mf l' ", r �,.. e , t �'` f; 4 4 Title LAND SURVEYOR Company Name EVANS LAND SURVEYING, INC. Address 1460 BELTREES STREET SUITE 9 City State ZIP Code��� DUNEDIN, Florida 34698,,, Signature Date Telephone Ext. 4-2.0-20 (727) 734-3821 Copy all pages of this Elevation 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) C2b.): ENTRY LEVRL FLOOR ELEVATION IS 7.7'. C2.e): IS A WATER HEATER LOCATED ON THE THIRD FLOOR. FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2022 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. 710 ELDORADO AVENUE 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 equi •ment and • «: • • lie), if applicable) Y'3 AVE Atlas #: 258A Check here if attachments. ."8`.. '^"svd • fix'. R . ' 710 ELDORADO BCP2018-04373B ELEVATION, CERT �.I BURKE, MARTHA Zoning: Low Medium Density FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 4 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2022 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. 710 ELDORADO AVENUE 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, crawispace, or endosure) 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 E 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 (12/19) Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. OMB No. 1660-0008 Expiration Date: November 30, 2022 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. 710 ELDORADO AVENUE 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 Ys s krrhY' :.F S 0 .. ✓'^ 114 ^^ t, _ K _° Photo One Photo One Caption FRONT VIEW - 04/20/2020 Clear Photo One • 1.: 7 IP 1 , t t, uI NW._ P . i yam: Photo Two Photo Two Caption REAR VIEW - 04/20/2020 Clear Photo Two FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 5 of 6 Note: The V Zone design certificate is not a substitute for the NFIP Elevation Certificate (see Fact Sheet No. 1:4, Lowest Flom Elevation), which is required to certify as -built elevatlons needed for flood insurance rating. ,y/ Posey ZONE DESIGN CERTIFICATE /i� Name A Mosey il41(kC- TN r Policy Number (Insurance Co. Use) Building Address of Other Description 7/0 F( l>i4.0 4vc- Permit No. 3cezoI$" 04373 City CJe.ilfv./ Bc4t StateFL-Zip Code 337(.1 SECTION I: Flood Insurance Rate Map (FIRM) Information Community No. / 2/ 0 3 Co Panel No. O l 0 2 Suffi4IRM Dateer p3FIRM Zone(s) \/E 13 SECTION II: Elevation Information Used for Design (NOTE: This section documents the elevations/depths used or specified In the design - it does not document surveyed elevations and is not equivalent to the as -built elevations required to be submitted during or after construction.] 1. FIRM Base Flood Elevation (BFE) I3 feet' 2. Community's Design Flood Elevation (DFE) I'f feet* 3. Elevation of the Bottom of Lowest Horizontal Structure Member I. b feet" 4. Elevation of Lowest Adjacent Grade h .( feet* 5. Depth of Anticipated Scour/Erosion used for Foundation Design 2,•Sr feet 6. Embedment Depth of Pilings of Foundation Below Lowest Adjacent Grade Z feet * Indicate elevation datum used in 1-4: 0 NGVD29 etSCNAVD88 0 Other SECTION III: V Zone Design Certification Statement I certify that: (1) I have developed or reviewed the structural design, plans, and specifications for construction of the above - referenced building and (2) that the design and methods of construction specified to be used are in accordance with accepted standards of practice** for meeting the following provisions: • The bottom of the lowest horizontal structural member of the lowest floor (excluding piles and columns) is elevated to or above the BFE. • The pile and column foundation and structure attached thereto is anchored to resist flotation, collapse, and lateral movement due to the effects of the wind and water loads acting simultaneously on all building components. Water loading values used are those associated with the base flood***. Wind loading values used are those required by the applicable State or local building code. The potential for scour and erosion at the foundation has been anticipated for conditions associated with the base flood, including wave action. • SECTION IV: Breakaway Wall Design Certification Statement (NOTE. This section must be certified by a registered engineer or architect when breakaway walls are designed to have a resistance of more than 20 psf (0.96 kN/m2) determined using allowable stress design] I certify that: (1) I have developed or reviewed the structural design, plans, and specifications for construction of breakaway walls to be constructed under the above -referenced building and (2) that the design and methods of construction specified to be used are in accordance with accepted standards of practice** for meeting the following provisions: • Breakaway wall collapse shall result from a water load less than that which would occur during the base flood***. • The elevated portion of the building and supporting foundation system shall not be subject to collapse, displacement, or other structural damage due to the effects of wind and water loads acting simultaneously on all building components (see Section III). SECTION V: Certification and Seal This certification is to be signed and sealed by a registered professional engineer or architect authorized by law to certify structural designs. I certify the V Zone Design Certification Statement (Section III) and e/ the Breakaway Wall, Design Certification Statement (Section IV, check if applicable). Certifier's Name Mit it 1144 Title ifrdei- r ,- Address 730 �• i7c City /-.' Signatu I�I�fMglt j License Number 7306 Company Name 64V41. Al giiAdW41 is�r t143 10, . i* . I01 Statere, Zip Code X3(90, 7970 Telephon0/3) CO— 0711 a Place S (l Her V;1 1.4, Lo t Floor ), why not a substitutefor th d to cert �ltt elevai NFIP Elevation Certificate (see Fact Sheet No. s needed for flood insurance rating. Name V ZONE DESIGN CERTIFICATE #100 1101 /Posey 13.vtrkc. Trust - Policy Number (Insurance Co. Use) Building Address of Other Description 1/0 1= ( 1);,(0.10 T'TVL Permit No. �CeZOi6- 04373 City Clearw%1fv' BokStateStateF -- Zip Code 3314,1 SECTION I: Flood Insurance Rate Map (FIRM) Information Panel No. O Z Suffi IRM Dated j3/O3FIRM Zone(s) V13 Community No. /2/03G SECTION II: Elevation Information Used for Design (NOTE: This section documents the elevations/depths used or specified In the design - It does not document surveyed elevations and is not equivalent to the as -built elevations required to be submitted during or atter construction.] 1. FIRM Base Flood Elevation (BFE) I3 feet* 2. Community's Design Flood Elevation (DFE) 1 'f feet' 3. Elevation of the Bottom of Lowest Horizontal Structure Member PS-. b feet* 4. Elevation of Lowest Adjacent Grade S .S feet* 5. Depth of Anticipated Scour/Erosion used for Foundation Design ____feet 6. Embedment Depth of Pilings of Foundation Below Lowest Adjacent Grade Z S feet * Indicate elevation datum used in 1-4: 0 NGVD29 ,NAVD88 0 Other SECTION III: V Zone Design Certification Statement I certify that: (1) I have developed or reviewed the structural design, plans, and specifications for construction of the above - referenced building and (2) that the design and methods of construction specified to be used are in accordance with accepted standards of practice** for meeting the following provisions: • The bottom of the lowest horizontal structural member of the lowest floor (excluding piles and columns) is elevated to or above the BFE. • The pile and column foundation and structure attached thereto is anchored to resist flotation, collapse, and lateral movement due to the effects of the wind and water loads acting simultaneously on all building components. Water loading values used are those associated with the base flood***. Wind loading values used are those required by the applicable State or local building code. The potential for scour and erosion at the foundation has been anticipated for conditions associated with the base flood, including wave action. SECTION IV: Breakaway Wall Design Certification Statement (NOTE. This section must be certified by a registered engineer or architect when breakaway walls are designed to have a resistance of more than 20 psf (0.96 kN/m2) determined using allowable stress design] I certify that: (1) I have developed or reviewed the structural design, plans, and specifications for construction of breakaway walls to be constructed under the above -referenced building and (2) that the design and methods of construction specified to be used are in accordance with accepted standards of practice** for meeting the following provisions: • Breakaway wall collapse shall result from a water load less than that which would occur during the base flood***. • The elevated portion of the building and supporting foundation system shall not be subject to collapse, displacement, or other structural damage due to the effects of wind and water loads acting simultaneously on all building components (see Section III). SECTION V: Certification and Seal This certification is to be signed and sealed by a registered professional engineer or architect authorized by law to certify structural designs. I certify the V Zone Design Certification Statement (Section III) and ✓ the Breakaway Wall Design Certification Statement (Section IV, check if applicable). Certifier's Name .L/ riiZ 1 arae 44AS License Number 73°"676 Place Seal H Title'(1rdCompany Name kl f'J(A giddv/" 1 Address1,�s) / 30 4. �7•iCr�1R p,j{. 6 M'K. tot �'j� City / r State FL Zip Code 330/ Signatu Date10/2 J?O Telephon(80) 42/'-07//