1859 VENETIAN POINT DRJ.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICATE
OMB No. 1660-0008
Expiration Date: November 30, 2022
2492EC
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
GARCIA, CARLOS M GARCIA, KIMBERLY K GARCIA, MANUEL
Policy Number:
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No.
1859 VENETIAN POINT DRIVE
Company NAIC Number:
City State ZIP Code
CLEARWATER FLORIDA 33755
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 25, VENETIAN POINT BLK A, ACCORDING TO THE PLAT THEREOF, AS RECORDED IN PLAT BOOK 27, PAGE 26 OF THE PUBLIC RECORDS OF PINELLAS
COUNTY, FLORIDA.
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. 27° 5g 19.8" N Long. 82.
Accessory, etc.) RESIDENTIAL
47, 51.3° w
Horizontal Datum:
obtain flood insurance.
1.0 foot above adjacent
above adjacent grade
❑ NAD 1927
grade
0
In NAD 1983
0
2 photographs of the building if the
Number 1A
Certificate is being used to
N/A 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 0
sq
or enclosure(s) within
in
sq ft
within 1.0 foot
sq in
❑ Yes i7 No
garage:
garage 390
openings in the attached garage
in A9.b 0
❑ Yes I7 No
SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Bl. NFIP Community Name & Community Number
CITY OF CLEARWATER 125096
B2. County Name
PINELLAS
B3. State
FLORIDA
B4. Map/Panel
Number
12103C - 0106
B5. Suffix
H
B6. FIRM Index
Date
5/17/2005
B7. FIRM Panel
Effective/
Revised Date
05/17/2005
B8. Flood Zone(s)
AE
B9. Base Flood Elevation(s)
(Zone AO, use Base
Flood Depth)
12 AND 13
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:
ri FIRM
datum used
located in a
1988 ❑ Other/Source:
or Otherwise Protected
1929 x NAVD
(CBRS) area
❑ OPA
Area (OPA)?
❑ Yes x No
FEMA Form 086-0-33 (12/19)
Replaces all previous editions.
Form Page 1 of 6
ELEVATION CERTIFICATE
OMB No. 1660-0008
2492EC 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.
1859 VENETIAN POINT DRIVE
Policy Number:
City State ZIP Code
CLEARWATER FLORIDA 33755
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, AR/A1—A30,
Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only,
Benchmark Utilized: FLORIDA PERMANENT REFERENCE NETWORK; ; Vertical Datum: NAVD88
Li
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 58 x
the measurement used.
feet ❑ meters
b) Top of the next higher floor N/A RI
feet ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only) N/A. Li
feet ❑ meters
d) Attached garage (top of slab) 6 21 x
feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 6 15 £1
feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 5. 77 13
feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 5. 92 x
feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A. 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
I certify that the information on this Certificate represents my best efforts to interpret the data
statement maybe 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? ❑ Yes
LI
by law to certify elevation information.
available. I understand that any false
No ❑ Check here if attachments.
Certifier's Name License Number
RICHARD SHOUN 6138
S.Aro
Title
PROFESSIONAL SURVEYOR & MAPPER
.iN6 14 S i,
-v‘ '61,
6138
Company Name
RICHARD S. SHOUN, PSM
.e
�0,
STATE OF qq
E� FLORIDA 4,
1'r04, *
-
w
Address
10651 JACAMAR DRIVE
S IJRVE�o
City State ZIP Code
NEW PORT RICHEY FLORIDA 34654
Signature Date Telephone 3/11/2021
�
3/11/2021 P: (727)271-0146
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)
NOTE: C2.E =AC UNIT PAD. NOTE: THIS ELEVATION CERTIFICATE IS ONLY VALID FOR THE PERSON OR PERSONS NAMED ON THIS
CERTIFICATE. THIS CERTIFICATE IS FOR FLOOD INSURANCE PURPOSES ONLY. THE INFORMATION ON THIS CERTIFICATE SHOULD NOT BE USED FOR
CONSTRUCTION OR PLANNING.
CENTERLINE ROAD ELEVATION:
FEMA Form 086-0-33 (12/19)
Replaces all previous editions.
Form Page 2 of 6
ELEVATION CERTIFICATE
OMB No. 1660-0008
2492EC 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.
1859 VENETIAN POINT DRIVE
Policy Number:
City State ZIP Code
CLEARWATER FLORIDA 33755
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,
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.
crawlspace, or enclosure) is IFI feet ❑ meters
•
b) Top of bottom floor (including basement,
crawlspace, or enclosure) is t7 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 i7 feet ❑ meters
E3. Attached garage (top of slab) is x feet ❑ meters
E4. Top of platform of machinery and/or equipment
servicing the building is x 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 (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
OMB No. 1660-0008
2492EC 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.
1859 VENETIAN POINT DRIVE
Policy Number:
City State ZIP Code
CLEARWATER FLORIDA 33755
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 (12/19)
Replaces all previous editions.
Form Page 4 of 6
ELEVATION CERTIFICATE
BUILDING PHOTOGRAPHS
See Instructions for Item A6. 2492EC
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.
1859 VENETIAN POINT DRIVE
Policy Number:
City State ZIP Code
CLEARWATER FLORIDA 33755
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.
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Front View
" _ �.. a
Rear View
Front View Date: 3/11/2021 Rear View Date: 3/11/2021
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11•
1 -W..'.. .
Side View
rte
icy
Right
.
- _
Left
Side View
Right Side View: 3/11/2021 Left Side View: 3/11/2021
FEMA Form 086-0-33 (12/19)
Replaces all previous editions.
Form Page 5 of 6
ELEVATION CERTIFICATE
BUILDING PHOTOGRAPHS
Continuation Page 2492EC
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.
1859 VENETIAN POINT DRIVE
Policy Number:
City State ZIP Code
CLEARWATER FLORIDA 33755
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 Two
Photo Three
Photo Four
FEMA Form 086-0-33 (12/19)
Replaces all previous editions.
Form Page 6 of 6