1221 WOODLAWN TERU.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
COSTA HOMES, INC.
Policy Number
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No.
1221 WOODLAWN TERRACE
Company NAIC Number:
City State ZIP Code
CLEARWATER Florida 33756
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
PARCEL "C", BLOCK "C", SHADOWLAWN PID# 03-29-15-80388-003-0030
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. N 27°59'64" Long.
Accessory, etc.) RESIDENTIAL
W 82°47'21"
Horizontal Datum:
obtain flood insurance.
1.0 foot above adjacent
above adjacent grade
❑ NAD 1927
grade
x NAD 1983
2
2 photographs of the building if the
Number 8
Certificate is being used to
496 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 crawlspace
in A8.b 610 sq
or enclosure(s) within
in
sq ft
within 1.0 foot
sq in
0
X Yes ❑ No
garage:
garage 0
openings in the attached garage
in A9.b 0
X Yes X 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
12103C0106
B5. Suffix
H
B6. FIRM Index
Date
05/17/2005
B7. F RM Panel
Effective/
Revised Date
05/17/2005
B8. Flood Zone(s)
AE
B9. Base Flood Elevation(s)
(Zone AO, use Base
Flood Depth)
21'
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
N/A ❑ CBRS
data
❑ NGVD
System
or base flood depth entered in Item B9:
❑ Other/Source:
x 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
"REVISED" PLANS
RECEIVED BY !IAM
FEB 082021
PLANNING & DEVELOPMENT
CITY QFC ,-AR\AU< TFR
1221 WOODLAWN
BCP2019-090396A
ec
WOODLAWN 3
Zoning: Atlas
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.
1221 WOODLAWN TERRACE
Policy Number:
City State ZIP Code
CLEARWATER Florida 33756
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: HIGH' AND -B Vertical Datum: N.A.V.D. 1988
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) 19 30
Check the measurement used.
X feet ❑ meters
b) Top of the next higher floor 23 05
X feet ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only) NA ❑ feet ❑ meters
d) Attached garage (top of slab) NA ❑ feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 23 17
X feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 18 . 8
X feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 19 . 8
x feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including 18 . 8
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 by
1 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? X Yes ❑ No
X Check, here if attachments.
Certifier's Name License Number
SCOTT M. OSBORNE LS 6028
-
- 4
, I
1
-
LS 6028 02-01-2021
Title
PROFESSIONAL SURVEYOR & MAPPER
Company Name
ARCPOINT SURVEYING & MAPPING, LLC.
Address
2389 KNOLL DRIVE
City State ZIP Code
SPRING HILL Florida 34608
Signature Date Telephone
02-01-2021 (352) 610-2988
C all pages of thi levation 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)
A8 -A = The attached & enclosed garage is below the raised slab. The square footage of the enclosed house above the slab is 1697 sf.
C2 -E = Lowest elevation of machinery or equipment servicing the building is the raised air conditioner pad on the West side of the house.
Vents used are (2) Crawl space Door Systems Flood Vents Model CSBA-816 in the wall of the garage. They measure 16" x 8 1/4" and are rated at 305
Sq." of Hydrostatic relief per vent. Attached is the ICC -ES Evaluation Report for the Flood Flap vents.
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.
1221 WOODLAWN TERRACE
Policy Number:
City State ZIP Code
CLEARWATER Florida 33756
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,
crawlspace, or enclosure) 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 ❑ 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.
•
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
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
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.
1221 WOODLAWN TERRACE
Policy Number:
City State ZIP Code
CLEARWATER Florida 33756
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 equipment and location, per C2(e), if applicable)
1221 WOODLAWN TER
BCP2019-090396A
ec
WOODLAWN 3
Zoning: Atlas #: 251B
❑ 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.
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.
1221 WOODLAWN TERRACE
Policy Number:
City State ZIP Code
CLEARWATER Florida 33756
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.
Ver
les it:',„),,,
y
•
1
'tea tib` rgi It. " �
1 r _ y
r,.
Photo One Caption NORTH SIDE 01/23/2021
-^
mss
lam. _
'�
Photo Two Caption WEST SIDE 01/23/2021
FEMA Form 086-0-33 (12/19)
Replaces all previous editions.
Form Page 5 of 6
ELEVATION CERTIFICATE
BUILDING PHOTOGRAPHS
Continuation Page
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.
1221 WOODLAWN TERRACE
Policy Number:
City State ZIP Code
CLEARWATER Florida 33756
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.
Yi
s S
IIHII" gIIII
, , ._ .._
F rF.
C f:
A
OW/ *t kiri....
1
..... ,....., _...,
...
Photo One Caption SOUTH SIDE 01/23/2021
x
'�J. e Y f.
,'°
r.
a
Photo Two Caption EAST SIDE 01/23/2021
FEMA Form 086-0-33 (12/19)
Replaces all previous editions.
Form Page 6 of 6
ES
ICC
EVALUATION
SERVICE
Innovation
�Eic,��CN LAE.>
ETVED
FEB 05 t,6?.1'
Mast Widely Accepted and Trusted
ICC -ES Evaluation Report ESR -3851
ICC -ES 1 (800) 423-6587 1 (562) 699-0543 1 www.icc-es.org
Issued 09/2018
This report is subject to renewal 09/2019.
DIVISION: 08 00 00—OPENINGS
SECTION: 08 95 43—VENTS/FOUNDATION FLOOD VENTS
"REVISED" PLANS
RECEIVED BY J.A.VV'
FEB 08 2021
PLANNING & DEVELOPMENT
CITY OF CLEARWATER
REPORT HOLDER:
CRAWL SPACE DOOR SYSTEMS, INC.
EVALUATION SUBJECT:
CRAWL SPACE DOOR SYSTEMS FLOOD VENT
ICC ICC ICC
MG* (1466' L
"2014 Recipient of Prestigious Western States Seismic Policy Council
MEM
(WSSPC) Award in Excellence" A Subsidiary of
ICC -ES Evaluation Reports are not to be construed as representing aesthetics or any other attributes not specifically
addressed, nor are they to be construed as an endorsement of the subject of the report or a recommendation for its use.
There is no warranty by ICC Evaluation Service, LLC, express or implied, as to any finding or other matter in this
report, or as to any product covered by the report.
Copyright c 2018 ICC Evaluation Service, LLC. All rights reserved.
ANSI
ACCREDITED
fsoiteC 17065
Product Cortirdsdlon Body
61000
Most Widely Accepted and Trusted
ICC -ES Evaluation Report
ESR -3851
Issued September 2018
This report is subject to renewal September 2019.
www.icc-es.org 1 (800) 423-6587 1 (562) 699-0543
A Subsidiary of the International Code Council®
DIVISION: 08 00 00—OPENINGS
Section: 08 95 43—Vents/Foundation Flood Vents
REPORT HOLDER:
CRAWL SPACE DOOR SYSTEMS, INC.
EVALUATION SUBJECT:
CRAWL SPACE DOOR SYSTEMS FLOOD VENT
1.0 EVALUATION SCOPE
Compliance with the following codes:
• 2018 and 2015 Intemational Building Code®
• 2018 and 2015 International Residential Code®
Properties evaluated:
• Physical operation
• Water flow
• Weathering
2.0 USES
Crawl Space Door Systems flood vent is used to provide
for the equalization of hydrostatic flood forces on exterior
walls.
3.0 DESCRIPTION
3.1 General:
Crawl Space Door Systems flood vent is an engineered
mechanically operated flood vent. Upon contact with flood
water, the flood vent automatically opens and allows flood
water to enter and exit enclosed areas. The vents are
constructed of general purpose ABS SP -9010 plastic. The
vent has a faux louver with either a solid plastic plate or
wire mesh attached to the back of the louver. The louver is
dislodged from the vent upon contact with flood waters.
See Figure 1 for illustrations of the flood vent.
3.2 Engineered Opening:
The Crawl Space Door Systems static flood vent complies
with the design principle noted in Section 2.7.2.2 of
ASCE/SEI 24 for a rate of rise and fall of 5 feet per hour
(0.423 mm/s). In order to comply with the engineered
opening requirement of ASCE/SEI 24-14, the flood vent
must be installed in accordance with Section 4.0 of this
report.
4.0 DESIGN AND INSTALLATION
The Crawl Space Door Systems flood vent is designed to
be installed into walls or doors of existing or new
construction from the exterior side. Installation of the vent
must be in accordance with the manufacturer's
instructions, the applicable code and this report. In order to
comply with the engineered opening design principle noted
in Sections 2.7.2.2 and 2.7.3 of ASCE/SEI 24-14, the vent
must be installed as follows:
• With a minimum of two openings; one on different sides
of each enclosed area.
• With a minimum of one vent for the square footage of
enclosed area noted in Table 1.
• Below the base flood elevation.
• With the bottom of the vent located a maximum of
12 inches (305 mm) above grade.
5.0 CONDITIONS OF USE
The Crawl Space Door Systems flood vent described in
this report complies with, or is a suitable alternative to what
is specified in, those codes listed in Section 1.0 of this
report, subject to the following conditions:
5.1 The Crawl Space Door Systems flood vent must be
installed in accordance with this report, the applicable
code and the manufacturer's published installation
instructions. In the event of a conflict, the instructions
in this report govern.
5.2 Use of Crawl Space Door Systems flood vent as
under -floor space ventilation is outside the scope of
this report.
6.0 EVIDENCE SUBMITTED
Data in accordance with the ICC -ES Acceptance Criteria
for Mechanically Operated Flood Vents (AC364), dated
August 2015 (Editorially revised October 2017).
7.0 IDENTIFICATION
7.1 The Crawl Space Door Systems flood vent
recognized in this report must be identified by a label
bearing the manufacturer's name (Crawl Space Door
Systems), the model number, and the evaluation
report number (ESR -3851).
7.2 The report holder's contact information is the
following:
CRAWL SPACE DOOR SYSTEMS, INC.
3669 SEA GULL BLUFF DRIVE
VIRGINIA BEACH, VIRGINIA 23455
(757) 363-0005
www. c rawls pa ced oo rs. c om
ICC -ES Evaluation Reports are not to be construed as representing aesthetics or any other attributes not specifically addressed, nor are they to be construed
as an endorsement of the subject of the report or a recommendation for its use. There is no warranty by ICC Evaluation Service, LLC, express or implied, as
to any finding or other matter in this report, or as to any product covered by the report.
Copyright® 2018 ICC Evaluation Service, LLC. All rights reserved.
EBR -3851 I Most Widely Accepted and Trusted
Page 2 of 2
TABLE 1—CRAWL SPACE DOOR SYSTEMS FLOOD VENT
MODEL
OVERALL VENT SIZE
(Width x Height x Depth)
(in)
ROUGH OPENING SIZE
(Width x Height)
(in)
ENCLOSED
AREA COVERAGE
(e)
CSBA816
181/4x 101/2 x 13/4
16 x 81/4
305
FIGURE 1—CRAWL SPACE DOOR SYSTEMS FLOOD VENT
Most W delyr Accepted €id Trusted
ICC -ES Evaluation Report
ESR -3851 FBC Supplement
Issued September 2018
This report is subject to renewal September 2019.
www.icc-es.orq 1 (800) 423-6587 1 (562) 699-0543
A Subsidiary of the International Code Council®
DIVISION: 08 00 00—OPENINGS
Section: 08 95 43—Vents/Foundation Flood Vents
REPORT HOLDER:
CRAWL SPACE DOOR SYSTEMS, INC.
EVALUATION SUBJECT:
CRAWL SPACE DOOR SYSTEMS FLOOD VENT
1.0 REPORT PURPOSE AND SCOPE
Purpose:
The purpose of this evaluation report supplement is to indicate that Crawl Space Door Systems flood vent, recognized in
ICC -ES master evaluation report ESR -3851, has also been evaluated for compliance with the codes noted below.
Applicable code editions:
■ 2017 Florida Building Code—Building
• 2017 Florida Building Code—Residential
2.0 CONCLUSIONS
The Crawl Space Door Systems flood vent, described in Sections 2.0 through 7.0 of the master evaluation report ESR -3851,
complies with the Florida Building Code—Building and Florida Building Code—Residential, provided the design and
installation are in accordance with the 2015 International Building Code provisions noted in the master report.
Use of the Crawl Space Door Systems flood vent has also been found to be in compliance with the High -Velocity Hurricane
Zone provisions of the 2017 Florida Building Code—Building and Florida Building Code—Residential.
For products falling under Florida Rule 9N-3, verification that the report holder's quality assurance program is audited by a
quality assurance entity approved by the Florida Building Commission for the type of inspections being conducted is the
responsibility of an approved validation entity (or the code official when the report holder does not possess an approval by
the Commission).
This supplement expires concurrently with the master report, issued September 2018.
ICC -ES Evaluation Reports are not to be construed as representing aesthetics or any other attributes not specifically addressed, nor are they to be construed
as an endorsement of the subject of the report or a recommendation for as use. There is no warranty by ICC Evaluation Service, LLC, express or implied as
to any finding or other matter in this report, or as to any product covered by the report.
Copyright ® 2018 ICC Evaluation Service, LLC. All rights reserved. Page 3 of 3
TABLE 1 --CRAWL SPACE DOOR SYSTEMS FLOOD VENT
MODEL
OVERALL VENT SIZE
(Width x Height x Depth)
(In)
ROUGH OPENING SIZE
(Width x Height)
(In)
ENCLOSED
AREA COVERAGE
(ft )
CSBA816
181/4x 101/2 x 13/4
16 x 81/4
305
FIGURE 1 -CRAWL SPACE DOOR SYSTE
S FLOOD VENT