1217 WOODLAWN TER (2)U.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, 2018
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 (induding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No.
1217 WOODLAWN TERRACE
Company NAIC Number:
City State ZIP Code
CLEARWATER Florida
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
PARCEL "B", 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
a) Square footage
b) Number of
c) Total net area
d) Engineered
A9. For a building with
a) Square footage
b) Number of
c) Total net area
d) Engineered
Residential, Non -Residential, Addition, Accessory, etc.)
Lat. N 27-59-38.5 Long. W 82-47-13.5
RESIDENTIAL
Horizontal Datum:
obtain flood insurance.
1.0 foot above adjacent
above adjacent grade
❑ NAD 1927
grade
x NAD 1983
5
2 photographs of the building if the
Number 7
Certificate is being used to
512 sq ft
with a crawlspace
of crawlspace
permanent flood
of flood openings
flood openings?
an attached
of attached
permanent flood
of flood openings
flood openings?
or enclosure(s):
or enclosure(s)
openings in the crawlspace
in A8.b 592
sq
or enclosure(s) within
in
sq ft
within 1.0 foot
sq in
0
❑ Yes x No
garage:
garage 0
openings in the attached garage
in A9.b 0
❑ Yes x No
SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number
CITY OF CLEARWATER 125098
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 A0, 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
❑ 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 (7/15)
Replaces all previous editions.
Form Page 1 of 6
1217 WOODLAWN TER
BCP2017-09532A
RTC
GEORGE M TAPIA
Zoning: Atlas #:
"REVISED" PLANS
RECEIVED BY: M.J.
NOV 2 5 2019
PLANNING & DEVELOPMENT
CITY OF CLEARWATER
ELEVATION CERTIFICATE
OMB No. 1660-0008
Expiration Date: November 30, 2018
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.
1217 WOODLAWN TERRACE
Policy Number:
City State ZIP Code
CLEARWATER Florida
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, ARAE, AR/A1—A30,
Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only,
Benchmark Utilized: HIGHLAND -B Vertical Datum: NAVD 1988
x
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) 19. 32
x
the measurement used.
feet ❑ meters
b) Top of the next higher floor 22 10
x
feet ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only) N/A
x
feet ❑ meters
d) Attached garage (top of slab) N/A
x
feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 22 15
x
feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 18. 2
x
feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 19. 3
x
feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including 18. 2
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
I certify that the information on this Certificate represents my best efforts to interpret
statement may be punishable by fine or imprisonment under 18 U.S. Code, Section
Were latitude and longitude in Section A provided by a licensed land surveyor?
x
authorized by law to certify elevation information.
the data available. I understand that any false
1001.
Yes ❑ No ❑ Check here if attachments.
Certifier's Name License Number
SCOTT OSBORNE LS 6028
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Pia
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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
11/01/2018 (352) 683-7722
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)
A8 -A = The attached & enclosed garage is below the raised slab. The square footage of the house above the slab is 2059 sf.
C2 -E = This is the elevation of the raised air conditioner pad
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
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.
1217 WOODLAWN TERRACE
Policy Number:
City State ZIP Code
CLEARWATER Florida
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 owners 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: November 30, 2018
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.
1217 WOODLAWN TERRACE
Policy Number:
City State ZIP Code
CLEARWATER Florida
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)
❑ Check here if attachments.
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 4 of 6
BUILDING PHOTOGRAPHS
ELEVATION CERTIFICATE See Instructions for Item A6.
OMB No. 1660-0008
Expiration Date: November 30, 2018
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.
1217 WOODLAWN TERRACE
Policy Number:
City
CLEARWATER
State
Florida
ZIP Code
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.
Photo One
Photo One Caption FRONT VIEW OF BUILDING 11/01/18
Photo Two
Photo Two Caption REAR VIEW OF BUILDING 11/01/18
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 5 of 6