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967 ELDORADO AVE !S l� ��.� � 3 4�. �� , � "...�,.�...�._.., . ' � AL EMERGENCY MANAGEMENT AGENCY ��� � � r� ��03 O.M.B. No. 3067-0077 ��a IONAL FLOOD (NSURANCE PROGRAM ! _�i, Expires July 31, 2002 �-.��-��------� � EVATION CERTIFICATE � C?lE.�ae_tc:r . �f SEi�vSCES DE ���4 ` �" EAR�ATERim o ant: Read the instructions on a es 1 -7. SECTION A-PROPERTY OWNER INFORMATION For Insurance Compa�y Use: BUILDING OWNER'S NAME Policy Number Petrit Meroli BUILDING STREET ADDRESS(Including Apl.,Unil,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number 967 Eldorado Avenu,e CITY STATE ZIP CODE Clearwater Beach FL 33767 PROPERTY DESCRIPTION Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) �t �, B�ora� 6b, r�rmrs.�Y BUILOING USE(e.g.,Residential,Non-residential,Addilion,Accessory,etc. Use Comments secGon if necessary.) Residential LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: �_�GPS(Type): ( ##°-##'-##.##" or ##.#�#1#°) ��NAD 1927 ��NAD 1983 �_�USGS Quad Map �_�Other.--- — SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP COMMUNITY NAME&COMMUNIIY NUMBER B2.COUNTY NAME 83.STATE i f arwater 125096 p; r'lorid B4.MAP AND PANEL B5.SUFFIX B6.FIRM INDEX B7.FIRM PANEL B8.FLOOO B9.BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zo�e AO,use depth of flooding) 0003 F s iB 9z s is �a A-E ll.o� B10.indicate the source of the Base Floocl Elevation(BFE)data or base flood depth entered in 69. �__�FIS Profile �x.�FIRM (_�Community Determined �_�Other(Describe):,_ _ __ B11.Indicate the elevation datum used for4he BFE in 89:�X�NGVD 1929 ���NAVD 1988 �__�Other(Describe):__�_�^�__ 612.Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? �_.�Yes �X�No Designation Date:_________ SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) �' Building elevations are based on: �__�Construction Drawings' �-_�Building Under Construction' ���Finished Construction 'A new Eievation Certificate will be required when construction of the building fs complele. 8uilding Diagram Number 1_(Select the building diagram most similar to the building for which this certificale is being compieted-see pages 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.) C3. 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 C3a-i below according to the building diagram specified in Item C2.State the datum used.If the datum is different from the datum used for ihe BFE in Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G,as appropriate,to document the datum conversion. Datum _ Conversfon/Comments_ ^____ — Elevation reference mark used SEE C�'fi�1TS Does the elevation reference mark used appear on the FIRM? �_�Yes x �No 0 a)Top of bottom floor(inciuding basement or enclosure) _ _7_. 1 ft.(m) � ❑ b)Top of next higher floor 16 . 0 h.(m) � O c)Bottom of lowest horizontal structurai member(V zones oniy) ___ N .A ft.(m) o 0 ❑ d)Attached garage(top of slab) • __`____6_. 6 ft.(m) w� �°°` ❑ e)Lowest elevation of machinery and/qr equipment - ,; servicing the buildin9 • — �-•1 ft•(m) E ; �� ❑ �Lowest adjacent grade(LAG) _�_F_. 1 ft.(m) z' a 4 � {�. , ❑ g)Highest adjacent grade(HAG) _____^_6_. 3 ft.(m) �� �c: ° r ❑ h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade_ 0 � ,;, ❑ i)Total area of all permanent openings(flood vents)in C3h__ � sq.in.(sq.cm) t � SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certi(y elevation information. I certify that the informafion in Sections A, B,and C on thls certificate represents my best efforts to interpret the data available. 1 understand that any fafse statement may be punishable by fine orlmprisonment under 18 U.S. Code, Section 1001, CERTIFIER'S NAME LICENSE NUMBER dward D MurG��]�, R L S #IS-6960 TITLE COMPANY N�ME President P�urphv s Land Survevinq. Inc. ^�DRESS CITY STATE ZIP CO 5760 llth Avenue N. St. Petersb FL 710 NATURE�� O DATE � Ol TELEPH 347-8740 FEMA Form 81-31,AUG 99 EVERSE SIDE FOR CONTINUATION REPIACES ALL PREVIOUS EDITIONS IMPORTANT: In these spaces,copy the corresponding Information from Section A. For Insurance Company Use: • BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bidg.No.)OR P.O.ROUTE AND BOX NO. Policy Number C�Ty STATE ZIP CODE Company NAIC Number . Cleazwater Beac.�i FL 33767 SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agenUcompany,and(3)building owner. COMMENTS Elevations Based on P.C.E.D BencYIInark (Aural RM-3) - Elevatian = 6.193' . . . . �_-I Check here if aitachments SECTION E-BUILDING ELEVATION INFGRMATION(SURVEY NOT REQUIRED)FOR ZUNE AO AND ZONE A(WITHOUT BFE) For Zone AO and Zone A(without BFE),comptete Items E1 through E4. 1f the Elevation Certificafe is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1.Building Diagram Number___(Select the building diagram most similar to the building for which this certificate is being completed- see pages 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.) E2.The top of the bottom floor(including basement or enclosure)of the building is �_�__�ft.(m)I—I—Iin.(cm) �__�above or �__�below (check one)the highest adjacent grade. E3. For Bufiding Diagrams 6-8 with openinys(see page 7),the next higher fioor or elavated floor(elevat�on b)of the building is �—�—�ft•(m)�—�--�in.(cm)above the highest adjacent grade. E4.For Zone AO only. If no flood depth number is availab�e,is the top of the bottom floor elevate�in accordance with ihe community's floodplain management ordinance�� �Yes � �No � �Unknown. The local official must certify this information in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owner's authorized representative who completes Sections A,B,and E fo�Zone A(without a FEMA-issued or community-issued BFE)or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE • COMMENTS �_� Check here if attachments SECTION G-COMMUNITY INFORMATION(OPTIONAL) The local o�cial 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 Ce�tificate. Complete the applicable item(s)and sign below. G1.�_�The Information in Section C was taken from other documentation that has been signed and embossed by a licensed s�rveyor, engineer,or architect who is authorized b`y state or local law to certify elevation inforrnation. (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 foilowing information(Items G4-G9�is provided for community floodplain management purposes. G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPUANCE/OCCUPANCY ISSUED G7.This permit has been issued for: �__�New Construction ���Substantial Improvement G8.Elevation of as-built lowest floor(inciuding basement)of the building is: � _ __ft.(m)Datum:______ G9.BFE or(in Zone AO)depth of flooding at the buiiding site is: _ ___ft.(m)Datum:__ ___ LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS Check here if attachments . FEMA Form 81-31,AUG 99 REPLACES ALL PREVIOUS EDITIONS � t . . . _� _. . IpAPORTANT: In tliose spaces,copy tlie corresponding Info�mation(rom Section A. For Insurance Company Use: ' BUILDING STREET ADDF2ESS(Including/1p1.,Unit,Suite,and/or Bidg.No.)OR P.O.ROUTE AND BUX NO. Pdicy Number _ _967 Eldorado Avenue STATE ZIP COUC Cornpany P�nIC Number :leazwater E'�eacli I'L 33767 SECTION D-SURVEYOR,ENGINEER,OR ARCHtTECT CERTIFICATION(CONTINUED) Copy both sides of lhis Elevation Certi(icate for(1)communily official,(2)insurance agenUcompany,and(3)buildiny owner. COMMENTS Elevations I3ased on P.C.E.D. BencYurark (Aural F�3) Elevatian = 6.193' . �. . . �__� Ctieck here i(attachmenls SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO ANO ZONE A(WITIIOUT BFE) For Zone AO and Zone A(wilhoul BFE),complete Items E1 through E4. 1/the Elevation Certrficate is intended foruse as supporiing Inlormation(or a LOMA or LOMR-F,Section C must be comple(ed. E1.Building Diagram Number___(Select the building diagram mosl similar to the building for wl�icli tliis certificate is being coiTipleted- see pages 6 and 7. If no diagram accurately represents the building,provide a skelch or photograph.) E2.The lop of lhe botlom floor(including basement or enclosure)ot the buil�ing is �—�--�fl•(m)�—�_�in.(cm) �__�above or �__)below (check one)the highest adjacent grade. E3.For Building Diagrams 6-8 with openings(see page 7),lhe next higher floor or elevated(loor(elevation b)of llie building is �_�_�ft.(m)�_�__�in.(cm)above tfie highest adjacent grade. E4.For Zone AO only. If no ilood deplh number is available,Is the top ot the bottom floor elevate�i in accordance willi llie communily's (toodplaln manac�ement ordinance?�_�Yes �_�No �__�Unknown. The local officlal must cerlify thls information in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owner's auttiorized representalive who completes Sections A,B,and E to�Zone A(wittiout a FEMA-issued or communily-issued BFE)or Zone AO must slgn here. . PROPERN OWNER'S OR OWNER'S AUTHORIZED F2EPRESENTAIIVE'S NAME • • �ESS CIN ST/1T[ ZIP COUE .:�TURE DATE TELEPHONE COMMENTS ' ' '''�^^!< here �(a(tachments SECTION G-COMMUNITY INFORMATION(OPTIONAL) �� The local official who is aulhorized by law or ordinance to administer the community's Ooodplain management ordinance can cornplele Sections A,B,C(or E),and G ot this Elevation Ce�tificate. Complete ihe applicable ltem(s)and sign below. G 1.�_�The information in Section C was taken(rom otlier documentation that has been signed and embossed by a licensed surveyor, engineer,or architec;�;;ho;s authorized kiy slate or local law to certify elevation informalion. (Indicate tlie source and date of the elevation data In the Comments area below.) G2.���A community official completed Seclion E for a building located In Zone A(wilhoul a FEMA-issued or community-issued BFE)or Zone AO. G3.�_)The following information(Items G4-G9�is provided for community floodptain management purposes. G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF CnMPLIANCE/UCCUPA�lCY ISSUED G7.This permit has been issued for. �__)New Construction (_�Substantial Imp�ovement G8.Elevation of as-built lowest iloor(including basement)o(the building is: _ __,ft.(m)Uaturn:________ G9.BFE or(in Zone AO)depth of Ilooding at the building site Is: _ ___ft.(m)Datum:________ LOCAL OFFICIAL'S NAME TITLE � � r'r► �"`� \/ r n �� � r'Ll COMMUNITY NAk4E TELEPHONE SIGNATURE DATE � COMMEN7S !'Sc T` CITY OF CLEARWATER �__� Check here if attachments FEMA Form 81-31,AUG 99 REPIACES nLL PREVIOUS EDITIONS ., �t ,�,..����. -���W� .;�_�,�. �"�:,� �„ �.'� U -� . _ . ., `�-�-i t 5 w� � - . � FEDERAL EMERG[NCY MANAGEMENT AGENCY O.�M.E3. No. 30G7-0077 ' NATIONAL FLOOD (NSURANCE PROGRAM Ex��ires July 31, 2002 ELCVATION CERTIFICATE � Irti ortant: Read the instructions on a es 1 - 7. SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use: BUILDING OWNER'S NAME Pdicy Numtrer PE'.'trlt ME'Y'011 BUILDING STREET ADDRESS(Including Apl.,Unil,Suile,and/or[31dg.No.)OR P.O.ROUTE AND E30X N0. Company N/11C Nwi�er 967 Eldora.do Avenwe CITY ST/1TE ZIP COG� Cle�wat,�x Beach FL 3376? PROPERTY DESCRIPTION Lol and E31ock Numbers,Tax Parcel Number,Legal Desaiptio�,etc.) — Iot 7, B1oGk 6b N��I�3Y BUILOING USE e.g.,Residenlial,No�-residenGal,Addition,Accessory,elc. Use Commenls secGon if necessary.) Residential LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL OATUM: SOURCE: _�GPS(Type): ( qlt°-##'-##.f/#' or ##.N#!J#11°) ��N/1D 1927 ��NAD 1983 �_�USGS Quad Map �_�Olher.------ SECTION B-FLOOD iNSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP COMMUNITY NMAE&COMMUNITY NUMF3ER B2.COUNTY NAME ^ F33.STATE 25 96 I'lorid 84.AAAP ANO PANEL B5.SUFFIX B6.FIfiM INDEX B7.FIRM PM1EL BU.FLOOU D9.8/1SE FLOOD ELEV/1TION(S) NUME3ER DATE EFFECTIVElREVISED DATE ZONE S 0003 F 8 1�3 92 8 1$ 92 �E� � Rone AO,use deplh of(Iooding) • 11.0' 810.Indicate the source of the Eiase Flood Etevalion(BFE)data or base flood depth entered 1n B9. �__�FIS Profile �g�FIRM ���Communlly Determined �_�Olher(Describe):___�____________ B11.Indicale the elevation datum used forthe F3FE in 69:�X(NGVD 1929 �_�NAVD 19E18 �__�Olher(Describe):_,____________ 812.Is the building located in a Coastal Barrier Resources System(CBRS)area or Olherwise Protected Area(OPl1)? �_)Yes �X�No Designation Date:_ _ _� • SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) ulding elevations are based on: �__�ConsUuction Drawings• (__�Building Under Conslruction' (���inished Construclion .�new Elevation Certificate will be required when conslruction of the building Is complole. C2.Building Dlagram Number�_(Select lhe building diagram mosl similar to lhe building for which lhis certificate is being completed-see pages 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.) C3.Elevalions—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A7-A30,AW�H,AFZ/�O Complete Ilems C3a-I below accordf�g lo lhe building diagram specified in Item C2.5tale the dalum useu.If tf ie datum is di((erent irom the datum used for the BFE ln Section B,convert lhe datum to lhat used for the BFE.Shaw field measurements and datum conversion calculalion. Use lhe space provided or the Comme�ts area of Section D or Section G,as appropriale,to docurnent the dalum conversion. Datum _ ConversloNComments Elevation reference mark used S'� CCY�'YNf�VTS Does the elevation reference mark used appear on the FIRM7 �_�Yes �X �No O a)Top o(botlom iloor(including basemertt or enclosure) 7 . 1_it.(m) n 0 b)Top of next higher(loor 16 . 0 (t.(rn) o O c)Bottom of Iowest horizontal slrucluraf inember{V zones only) N .A ft.(m) � � ��1 " O d)Altached garage(top of slab) • 6_. 6 tt.(m) E e ❑ e)Lowest elevalion of machi�ery andlqr equipment W e servicing the building 7 . 1 ft. m ° � � � O n Lowest adjacenl grade(L�1G) -- �_,�«,��n) Z a �l�'J� ❑ g)Highest adjacent grade(HAG) 6 . 3 (t.(m) �N � O h)No.of permanenl openings(Ilood vents)wilhin 1 ft.above adjacent grade_�0 J ❑ i)Total area of all permanent openings(flood vents)(n C3h 0 sq.ln.(sq.cm) , SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION , a � � This certi(ication is to be signed and sealed by a land surveyor,engineer,or archilect authorized by law Io certify elevation V I certifylhat fl�e,nforma(ion ln Sec(ions A,a,and C on(hls certi�cafe represen(s my besf e(forts lo inforpret(he data available. 1 understand that�ny false statemen(may be punlshable by fine orlmprisonment under 18 U.S.Code,Sectron 1001. �UL � � �QQ' CERTIFIER S NAME LICENSE NUME3ER Edward D_ 1�1 �1�� R L S #k -G9G0 PLANNIN � X� pFv�� OPMENX ITLE COMP/1NY ME President r h �s It-u�d Surve i Inc. SERVICES �ESS CITY ST fE zi�co : WATER �760 llth Avenue N. St. Petersb �'L 0 �i,ic:,NATURE • ATE TELEPHU� 4 0 ��7 3�7-II7n0 FEMA Form 81-31,AUG 99 -E EVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS 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 MICHAEL F. & KELLY M. CLARK Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 967 ELDORADO AVENUE 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 7 BLOCK 60, MANDALAY SUBD., PB 14 PG 32, 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, Accessory, Lat. 28°00'02"N Long. 82°49'36"W etc.) RESIDENTIAL Horizontal Datum: insurance. above grade ❑ NAD 1927 adjacent grade 0 x NAD 1983 0 2 photographs Number with a crawlspace of crawlspace flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? of the building if the 1B Certificate is being used to obtain flood 0.00 sq ft or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b or enclosure(s) 0.00 sq in within 1.0 foot 1.0 foot above adjacent in 540.00 sq ft ❑ Yes x No garage: garage openings in the attached garage within in A9.b 0.00 sq ❑ Yes x No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number CITY OF CLEARVVATER 125096 B2. County Name PINELLAS B3. State Florida B4. Map/Panel Number 12103C0064 B5. Suffix G B6. FIRM Index Date 08-18-2009 B7. FIRM Panel Effective/ Revised Date 09-03-2003 B8. Flood Zone(s) AE & VE B9. Base Flood Elevation(s) (Zone AO, use Base Flood Depth) 12' & 10' B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation Date: of the Base Flood Elevation ❑ FIRM ❑ Community Determined datum used for BFE in Item B9: located in a Coastal Barrier Resources ❑ (BFE) data ❑ NGVD System CBRS or base flood ❑ Other/Source: depth entered in Item B9: ❑ Other/Source: Protected 1929 x NAVD 1988 (CBRS) area or Otherwise ❑ OPA Area (OPA)? ❑ Yes x No FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 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. 967 ELDORADO AVENUE Policy Number: City State ZIP Code CLEARWATER BEACH Florida 33767 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: CLEARWATER BM 238A Vertical Datum: NAVD 1988 x Finished Construction AR/AH, AR/AO. enter meters. Indicate II 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) 5.50 x the measurement used. feet ❑ meters b) Top of the next higher floor 15.50 x feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) 14.10 x feet ❑ meters d) Attached garage (top of slab) 5.50 © feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 6.90 (Describe type of equipment and location in Comments) ©feet meters f) Lowest adjacent (finished) grade next to building (LAG) 5.40 x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 5.70 x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support N/A x feet ❑ meters 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 J. MICHAEL FUQUA 4192%, t i r f ! ,. � Title<ai4 PSM '` ,, • Company Name DAVID L. SMITH SURVEYING & MAPPING, INC. _ , 1d s . Address 1406 W. LINEBAUGH AVENUE City State ZIP Code TAMPA Florida 33612 ,„” ` : °",1 Signature i Dat Telephone Ext. %1 / /0 7 / 7 (813) 935-1960 Copyages of this Elevation Certifi ate a 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) SECTION C2A REPRESENTS THE LOWER AREA FINISHED, SECTION C2B REPRESENTS THE FINISH FLOOR ELEVATION, SECTION C2D REPRESENTS THE GARAGE & C2E REPRESENTS THE A/C PAD ON THE SOUTH, FOYER ELEVATION=6.0, UTILITY STORAGE UNFINISHED ELEVATION=5.8 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. 967 ELDORADO AVENUE Policy Number: City State ZIP Code CLEARWATER BEACH Florida 33767 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 LOMA or LOMR-F request, complete Sections A, B,and C. For Items E1—E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is • feet ❑ meters ❑ above or • below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ 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 this information in Section G. 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 certify 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 (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. 967 ELDORADO AVENUE Policy Number: City State ZIP Code CLEARWATER BEACH Florida 33767 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 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS 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. 967 ELDORADO AVENUE Policy Number: City State ZIP Code CLEARWATER BEACH 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. 1 i ti i' Ii, r III" 1 �i it I .111111. 1I1•' ,;� t fl,' i . I III'���.:, I _._�,, li 4 Photo One . Photo One Caption 10-26-17 FRONT VIEW JOB NO 1710-101 Clear Photo One -- • l'► tk,i _. — - lag I or - _ • Photo Two Photo Two Caption 10-26-17 REAR VIEW JOB NO 1710-101 Clear Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page 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. 967 ELDORADO AVENUE Policy Number: City State ZIP Code CLEARWATER BEACH Florida 33767 Company NAIC Number If submitting more photographs than will fit on the preceding with: date taken; "Front View" and "Rear View"; and, photographs must show the foundation with representative page, affix the additional photographs below. Identify all photographs if required, "Right Side View" and "Left Side View." When applicable, examples of the flood openings or vents, as indicated in Section A8. Photo Three Photo Three 967 ELDORADO AVE BCP2019-100983 ,J NEW SFR >/ I CLARK RESIDENCE Zoning: Low Medium Density Atlas # 238A RECEIVED BY: J.B.S. OCT 302019 PLANNING & DEVELOPMENT CITY OF CLEARWATER Photo Three Caption 10-26-17 NO PICTURES JOB NO 1710-101 Clear Photo Three Photo Four Photo Four Photo Four Caption Clear Photo Four FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6