222 SAND KEY ESTATES DRU.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFIC/
Important: Follow the instructions on pages
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2)
404446 SECTION A — PROPERTY INFORMATION
Al. Building Owner's Name
RICKY SHIV KURETI
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route
Box No.
222 SAND KEY ESTATES DRIVE
City
CLEARWATER
State
FL
(\ L V I L— 1—
RECEIVED BY J.A.
JUL 1 l 2020
PLANNING & DEVELOP(_`..
CITY OF CLEARWAT_
222 SAND KEY EST,
BCP2020-060440
RTC
KURETI, RICKY
Zoning: High Density Residential Atlas #
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
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°56'15.45"N Long. 82°50'04.70"W
Accessory, etc.) RESIDENTIAL
Horizontal Datum:
obtain flood insurance.
II p CN 11r,
1.0 foot above adjacent
above adjacent grade
■ NAD
?" n
grade
0
1927 ►4 NAD 1983
t"► ► ,
0
2 photographs of the building if the
Number 1A
Certificate is being used to
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) N/A
openings in the crawlspace
in A8.b 0
sq
or enclosure(s) within
in
ft
within 1.0 foot
sq in
No
sq
■Yes
garage:
garage 400
openings in the attached garage
in A9.b 0
No
•Yes
SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
131. NFIP Community Name & Community Number
125096
B2. County Name
PI N ELLAS
B3. State
Florida
B4. Map/Panel
Number
12103C0112
B5. Suffix
G
B6. FIRM Index
Date
9/3/2003
B7. FIRM Panel
Effective/
Revised Date
9/3/2003
B8. Flood Zone(s)
AE
B9. Base Flood Elevation(s)
(Zone AO, use Base
Flood Depth)
11 (88)
B10. Indicate the source
OFIS Profile
B11. Indicate elevation
B12. Is the building
Designation Date:
of the Base Flood Elevation (BFE)
data
❑NGVD
System
or base flood depth
entered in Item B9:
No
FIRM ■Community Determined
■Other/Source:
datum used
located in a
for BFE in Item B9:
Coastal Barrier Resources
Area (OPA)?
1929 ►ZINAVD 1988 ■Other/Source:
(CBRS) area
or Otherwise Protected
II Yes ►I
■CBRS
•OPA
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
404446 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.
222 SAND KEY ESTATES DRIVE
Policy Number:
City State ZIP Code
CLEARWATER FL 33767
Company NAIC Number
SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Rico
Cl. Building elevations are based on: • Construction Drawings* ■ Building Under Construction*
►l� Finished 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: CITY OF CLEAREWATER Vertical Datum: NAVD 88
AR/A1—A30, AR/AH, AR/AO.
only, enter meters.
Indicate elevation datum used for the elevations in items a) through h) below.
■ NGVD 1929 ►1 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) 10.6.
Check the measurement used.
►Z4 feet • meters
b) Top of the next higher N/A.
►'i feet ■ meters
c) Bottom of the lowest horizontal structural member (V Zones only) N/A.
0 feet • meters
d) Attached garage (top of slab) 8;5.
►i feet ■ meters
e) Lowest elevation of machinery or equipment servicing the building 10.7.
►5 feet • meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 5_9.
feet ■ meters
g) Highest adjacent (finished) grade next to building (HAG) 8;3.
feet ■ meters
►ifeet ■meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A
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
I 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.
I understand that any false
Were latitude and longitude in Section A provided by a licensed land surveyor? ►S Yes MI No
II Check here if attachments.
Certifier's Name License Number
Kenneth J. Osborne 6415
r+ g r o s s
t c o
e r 9
1.4, o No. 6415 < 2
.k -
Kenneth Digitally signed by
brf�e
Date: enneth th20OsOs oore
b o r n e, 0:52:56 -05'00:
N ?
STATE OF b
°H F 4 0 R + °' o�
` $ u R y
Title
Registered Professional Surveyor
Company Name
Company
TARGET SURVEYING, LLC
Address
6250 N Military Trail #102
City State ZIP Code
West Palm Beach FL 33407
Signature Date Telephone
, e- add 2/14/2020 (561)640-4800
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)
GARAGE SQUARE FOOTAGE IS ROUNDED TO THE NEAREST 100 SQUARE FEET. ACCESS
UNAVAILABLE. ELEVATIONS IN SECTION C2 -E ARE ELEVATIONS OF A/C SLAB.
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
404446 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.
222 SAND KEY ESTATES DRIVE
Policy Number:
I
City State ZIP Code
CLEARWATER FL 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 LOMA or LOMR-F request,
complete Sections A, B,and C. For Items E1—E4, use natural grade, if available. Check the measurement used. In Puerto Rico only,
enter meters.
El. 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 ■feet ■meters ■above
or U below the HAG
b) Top of bottom floor (including basement,
crawlspace, or enclosure) is •feet ■ meters ■
above or ■ below the LAG
9 (see pages 1-2 of Instructions),
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 IN meters IN
above or ■ below the HAG
E3. Attached garage (top of slab) is ■ feet ■ meters ■
above or ■ below the HAG
E4. Top of platform of machinery and/or equipment
servicing the building is ■feet ■meters II
above or ■below the HAG
with the community's
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 certify
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:
404446 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.
222 SAND KEY ESTATES DRIVE
Policy Number:
City State ZIP Code
CLEARWATER FL 33767
Company NAIC Number
SECTION G — COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance
Sections A, B, C (or E), and G of this Elevation
used in Items G8—G10. In Puerto Rico only, enter
to administer the community's floodplain management ordinance can complete
Certificate. Complete the applicable item(s) and sign below. Check the measurement
meters.
from other documentation that has been signed and sealed by a licensed surveyor,
by law to certify elevation information. (Indicate the source and date of the elevation
E for a building located in Zone A (without a FEMA -issued or community -issued BFE)
is provided for community floodplain management purposes.
Gi. ■ The information in Section C was taken
engineer, or architect who is authorized
data in the Comments area below.)
G2 ■ A community official completed Section
or Zone AO.
G3. • The following information (Items G4—G10)
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:
Datum
■New Construction II Substantial Improvement
basement)
■ feet
■ meters
Datum
building site: ■feet
II meters
Datum
•feet
■meters
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
404446 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.
222 SAND KEY ESTATES DRIVE
Policy Number:
City State ZIP Code
CLEARWATER FL 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.
.;,.> .......,_m.0.! ,._.. ._..._ .....c
Photo One
Photo One Caption Front View
ga
,
Photo Two
3
Photo Two Caption Rear View
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 5 of 6
• BUILDING PHOTOGRAPHS
ELEVATION CERTIFICATE
Continuation Page
OMB No. 1660-0008
Expiration Date: November 30, 2018
404446 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.
222 SAND KEY ESTATES DRIVE
Policy Number:
City State ZIP Code
CLEARWATER FL 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.
a
4 _, _---
.fid.
Photo One
Photo One Caption Left Side View
Photo Two
Photo Two Caption Right Side View
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 6 of 6