696 GULFVIEW BLVD SL1,S_ DEPARTMENT OF HOMELAND SECURITY
Feder,& Emergency Management Agency
National Fitio'Insurance Program
Copy all pages of th
ELEVATION CERTIFICATE
OMB No. 1660-0008
Expiration Date: November 30, 2022
Important Follow the instructions on pages 1-9.
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
Forest On The Beach
Policy Number:
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No.
696 S. Gulfview Blvd.
Company NAIC Number:
City State ZIP Code
Clearwater Beach Florida 33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number Legal Description, etc.)
Lot 14. Block B BAYSIDE SUBDIVISION NO. 5
A4. Building Use (e.g.. Residential, Non -Residential, Addition, Accessory, etc.)
A5. Latitude/Longitude: Lat, 27d 57' 59.93" N. Long.82d 49' 26.78"
Residential
W. Horizontal
Datum:
insurance.
above
❑ NAD 1927
adjacent grade
grade N/A
Ixi NAD 1983
N/A
A6. Attach at least 2 photographs
A7. Building Diagram Number
A8. For a budding with a crawlspace
a) Square footage of crawispace
b) Number of permanent flood
c) Total net area of flood openings
d) Engineered flood openings?
A9. For a building with an attached
a) Square footage of attached
b) Number of permanent flood
0) Total net area of flood openings
d) Engineered flood openings?
of the building if the
1A
Certificate is being used to obtain flood
NIA sq ft
or enclosure(s):
or enclosure(s)
openings in the crawispace
in A8.b
or enclosure(s)
N/A sq in
within 1.0 foot
foot above adjacent
in
N/A sq ft
E Yes ® No
garage:
garage
openings in the attached garage within 1.0
in A9.b N/A sq
❑ Yes C No
SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Comrnunity !dame & Community Number
Clearwater 125096
B2. County Name
Pinellas
i B3. State
Florida
B4, Map/Panel ? 55. Suffix
Number
12103C 0104 G
L
B6_ FIRM Index
Date
09-03-2003
I
B7. FIRM Panel
Effective/
Revised Date
09-03-2003
' B8. Flood
Zone(s)
AE
B9. Base Flood Elevation(s)
(Zone AO, use Base Flood Depth)
11.0'
1310, Indicate the source of the
C FIS Profile ® FIRM
B11. Indicate elevation daturn used
B12. Is the building located in a
Designation Date:
Base Flood Elevation
O Community Determined
for BFE in Item 69:
Coastal Barrier Resources
(BFE) data or base flood
❑ Other/Source:
❑ NGVD 1929
System (CBRS)
CBRS ❑ OPA
depth entered in Item B9:
❑ Other/Source:
Protected
Q NAVD 1988
area or Otherwise
Area (OPA)?
• Yes E No
$
FEMA Form 086-0-33 (12119)
Replaces all previous editions.
Form Page 1 of 6
ELEVATION CERTIFICATE
OMB No. 1660-0008
Expiration Date: November 30, 2022
1MPORPANI: 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.
696 S. Gulfview Blvd.
Policy Number:
City- State ZIP Code
Clearwater Beach Florida 33767
Company NAIC Number
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
01. Building elevations are based on: 0 Construction Drawings" 0 Building Under Construction* 0 Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
02. Elevations - Zones A1 -A30 AE, AH, A (with BFE), VE, V1 -V30. V (with BFE), AR, AR/A, AR/AE. AR/A1-A30, AR/AH, AR/AO.
Complete Items C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: F- 03.5 Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a) through h) below.
N NGVD 1929 E NAVD 1988 IN Other/Source:
Datum used for building elevations must he the same as that used for the BFE.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor)
Check the measurement used.
6.0 x feet • meters
b) Top of the next higher floor
NIA El feet 0 meters
c) Bottom of the lowest horizontal structural member (V Zones only)
N/A ri feet D meters
d) Attached garage (top of slab)
NIA 0 feet • meters
e) Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment and location in Comments)
N/A 0 feet ll meters
f) Lowest adjacent (finished) grade next to building (LAG)
5.7 0 feet • meters
g) Highest adjacent (finished) grade next to building (HAG) 6.0 0 feet 0 meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
structural support N/A Z feet El meters
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 cel' 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
0 Check here if attachments.
*ere latitude and longitude in Section A provided by a licensed land surveyor? El Yes n No
Certit'iersNarne License Number
Edward D. Murphy #5333
'WI is
,, c.,, ...•si IF fC4. •• '5' ->
.i Qsc,c, r • 1- ',-
(-. --
.. *
No. 5333 . _
_
.7— 73* CC =
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/‘(4c -*•:.-.Z.. 0 R lt)..!*•••••CZ-• \,:.,'
///7.-' /ep .. A14os \\\\N
iiiiiii"°
Title
Professional Land Surveyor-
Company Name
Murphy's Land Surveying, Inc.
Address
5760 11th Avenue N.
City State ZIP Code
St Petersburg Florida 33710
/
Signature ----, i -, I .;,, )Date Telephone Ext.
ki.'? ','' 05-06-2020 (727) 347-8740 -` '; te-nis.,
Copy all pages otthls Eievation fttfrcat-e II attachments for (1) community official, (2) insurance agent/company, and ) building owner.
Comments (including type of equipment and oc. ion. per C2(e), if applicable)
_ -
FEMA Form 086-0-33 (12/19)
Rep aces all prey ous editions.
Form Page 2 of 6
ELEVATION CERTIFICATE
1
•
OMB No, 1660-0008
Expiration Date: November 30,2022
IMPORDANT: In these spaces, copy the corresponding information from Section A.
FOR INSURANCE COMPANY USE
&hiding Street Address ncluding A,pt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No,
696 S. Gulfview Blvd.
Policy Number:
City State ZIP Code
Clearwater Beach Florida 33767
Company NAC Number
SECTION E — BUILDING ELEVATION NFORMATION (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.
E 1. 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 enclosure) is El feet E meters
LOMA or LOMR-F request,
used, In Puerto Rico only,
the elevation is above or below
0 above or n below the HAG.
above or below the LAG,
9 (see pages 1-2 of Instructions),
b) Top of bottom floor (including basement,
crawlspace, or enclosure) is 0 feet E meters
E2, For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 andlor
the next higher floor (elevation C2.b in
the diagrams) of the building is 0 feet 0 meters
• above or E below the HAG,
E3. Attached garage (top of slab) is fl feet LI meters
above or • below the HAG.
above or 0 below the HAG.
with the community's
certify this information in Section G.
E4. Top of platform of machinery and/or equipment
servicing the building is 0 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? fl Yes E No i 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. 8, 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 Ci y State ZIP Code
Signa u e Date Telephone
Comments
E Check here if attachments.
FEMA Form 086-0-33 (12/19)
Replaces all previous editions.
Form Page 3 of 6
,
ELEVATION CERTIFICATEExpiration Date: November 30, 2022
OMB No. 1660-0008
|x0PO| mT:mt»ws*spucea.oppythwco,ne pondinSinfnnnationhnmSecunnA.
FOR INSURANCE COMPANYVSE
Building Street Address (including Apt., Unit, Suite, and/or Bldg, No.) or P. . Route and Box No.
696 S. Gunview8|vd�
Policy Number:
City State ZIP Code
Clearwater Beach Fonda|33767
Company N&|CNumber
SECTION 0— COMMUNITY INFQRMATION (OPflONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
Sections A, 8. 0 (or E). and 0 of this Eevauon Cerbficate, Complete the applicable item(s) and sign below. Check the measurement
used inItems G8-010|nPuerto Rico only, enter meters.
enaednuovor,
�1,-- The information takendocumentation signed and sealed bya|ic�
engineer or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation
data in the Cornrnents area below.)
G2 E A community official completed Section E for a budding located in Zone A (without a FEMA -issued or community -issued BFE)
or Zone A0.
GI [] The following nformation (Items 04-010) is provided for community floodplain management purposes,
34. Permit Number i 05. Date Permit Issued
36, DmveCemfivat of
Comp|ionoe/]ucupanoy|uxued
feet
El meters Datum
07. Ths permit has been ssued /or al New Construction [] Substantial Improvement
GB. Elevation ofas-built lowest floor (including basement)
of the building:
Eme{*ra Datum
09. 8FE or (in Zone A0) depth of oodingthe builthng site: 0111
feet
0fe*t
010. Community's design flood elevation:
El meters Datum
Local Official's Name Title
Cmmnmunity Nam e Telephone
Signet e Dae
Comments (including type of equipmentand|oca\ion, per C2<e>.app|icab|e)
FEMA Form 086-O-33 (12119)
Replaces all previous editions.
Form Page 4 of 6
ELEVATION CERTIFICATE
BUILDING PHOTOGRAPHS
See Instructions for Rem A6.
OMB No. 1660-0008
Expiration Date: November 30, 2022
MPOWANT In these spaces, copy the corresponding information from Section A.
Build!rig Street Address (including Apt, Unit, Suite, and/or Bldg. No,) or P.O. Route and Box No,
696 S. Gulfview Btvd.
FOR INSURANCE COMPANY USE
Policy Number:
City
Clearwater Beach
State ZIP Code
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.
Ph'oOne
Photo One Caption FRONT VIEW
44,
Photo Two Caption REAR VIEW
FEMA Form 086-0-33 (12/19)
Replaces all prey us editions
Clear Photo Two
Form Page 5 of 6
ELEVATION CERTIFICATE
BUILDING PHOTOGRAPHS
OMB No, 1660-0008
Continuation Page Expiration Date. November 30 2022
MPORANT: In these spaces, copy the corresponding information from Section A.
Building Street Address (including Apt., Unit, Suite, and/or Bldg. Na) or P.O. Route and Box No,
696 S. Gulfyiew Blvd,
••••
FOR INSURANCE COMPANY USE
Policy Number:
City
Clearwater Beach
State
Florida
LIP Code
33767
Company NAC 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 Viewand "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 Three Caption SIDE VIEW
Clear Photo Three
Phc*o Fou
Photo Four Caption SIDE VIEW Clear Photo Fou
FEMA Form 086-0-33 (12/19)
Replaces all previous editions.
Form Page 6 of 6