125 LEEWARD ISU.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICATE
OMB No. 1660-0008
Expiration Date: November 30, 2022
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
Francisco Acosta and Natalia Wiecek-Acosta
Policy Number:
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No.
125 Leeward Island
Company NAIC Number:
City State ZIP Code
Clearwater FLORIDA 33767
A3. Property Description (Lot and Block numbers, Tax Parcel Number, Legal Description, etc.)
TAX PARCEL ID: 08-29-15-43308-000-0250
A4. Building Use (e.g.,
A5. Lattitude/Longitude:
A6. Attach at least 2 photographs
A7. Building Diagram number
A8. For a building with
a) Square footage
b) No. of permanent
c) Total net area of
d) Engineered flood
A9. For a building with
a) Square footage
b) No. of permanent
c) Total net area of
d) Engineered food
Residential, Non -Residential, Addition, Accessory, Etc.)
Lat. N 27°58'41.90 Long. W 82°48'50.28
Residential
Horizontal
Datum: NAD 1927
grade 0
NAD 1983
X
of the building if the Certificate is
1A
being used
Sq.
to obtain flood insurance
Ft.
1.0 foot above adjacent
above adjacent grade
a crawlspace or enclosure(s):
of crawlspace or
flood openings
flood openings in
openings? LJ
an attached garage:
of attached garage
flood openings
flood openings in
openings? ❑
enclosure(s) 0
in the crawlspace or enclosure(s)
A8.b 0
within
Sq. in.
Ft.
1.0 foot
Sq. in.
0
Yes X No
400 Sq.
in the attached garage within
A9.b 0
Yes X No
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81. NFIP Community Name & Community Number
CITY OF CLEAR WATER/ 125096
82. County Name
Pinellas County
83. State
FLORIDA
B4. Map/Panel Number
12103C0102G
B5. Suffix
G
86. FIRM Index Date
09/03/2003
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'
B10. Indicate the source of the Base Flood
Elevation (BFE) data or base
Determined
in Item 89: E1 NGVD
Resources System (CBRS)
0 CBRS
flood
Other (Describe)
depth entered in item 89:
FIS Profile
X FIRM Community
(Describe)
B11. Indicate elevation datum used for BFE
B12. Is the building locaed in a Costal Barrier
Designation Date N/A
1929 X
NAVD 1988 Other
area or Otherwise protected Area
fl OPA
(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
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.
125 Leeward Island
Policy Number:
City State ZIP Code
Clearwater FLORIDA 33767
Company NAIC Number:
1
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: Construction Drawings* 11 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,
to the building diagram specified in item A7. IN Puerto Rico only, enter meters.
Benchmark Utilized: FDOT GPS NETWORK Vertical Datum: NAVD 1988
X
Finished Construction
AR/AH, AR/AO. Complete items C2.a-h below according
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.
a) Top of bottom floor (Including basement, crawlspace, or enclosure floor) 5 . 77
Check
X
the measurement used.
feet meters
b) Top of the next highest floor N/A
.
feet meters
c) Bottom of the lowest horizontal structural member (V Zones only) N/A
feet meters
d) Attached Garage (top of slab) 5 50
X
feet meters
e) Lowest elevation of machinery or equipment servicing the building 6 07
X
feet meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 5 13
X
feet Lj meters
g) Highest adjacent (finished) grade next to building (HAG) 5 . 33
X
feet meters
h) Lowest adjacent grade at lowest elevation of deck or stairs including N/A [] feet [J 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
imprisonment under 18 U.S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? ❑ Yes
X
by law to certify elevation information.
available. I understand that any false statement
No
may
X
be punishable by fine or
Check here if attachments.
Certifier's Name License number
JOSE ROCHE 5935
n ao'n"t
d
SIM OF "1
:
Title
PROFESSIONAL SURVEYOR & MAPPER
Company Name
ME LAND SURVEYING
Address
10665 SW 190th STREET SUITE 3110
City State ZIP Code
MIAMI FL 33157
Signature Date Telephone
----- 08/07/2020 (305) 740-3319
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2)insurance agent/company, (3) building owner.
Comments (including type of equipment and location, per C2(e), if applicable)
LATITUDE LONGITUDE PER GOGGLE, ATTACHMENTS = BUILDING PICTURES
C2E= AC UNIT, LOCATED ON THE SOUTH SIDE OF THE HOUSE.
This elevation certificate is for flood insurance rating purposes only and may not be used for building permitting purposes due to measurement precision issues.
FEMA Form 086-0-33 (12/19)
Replaces all previous editions.
Form Page 2 of 6