3084 OAK CREEK DR NU.S. DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
National Flood Insurance Program
A1. Building
Y
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1-9.
SECTION A- PROPERTY INFORMATION
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
3084 OAK CREEK DR N
City CLEARWATER State FL ZIP Code 33761
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 14, OAK CREEK � COUNTRYSIDE
OMB No. 1660-0008
Expiration Date: July 31, 2015
cy Numbe�:
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. LatitudelLongitude: Lat. 28°02'49.54"N Long. 82°42'38.10"W Horizontal Datum: ❑ NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 1A
A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) N/A sq ft a) Square footage of attached garage 806.4 sq ft
b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage
or enclosure(s) within 1.0 foot above adjacent grade 0 within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in AS.b 0 sq in c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
61. NFIP Community Name & Community Number 62. County Name B3. State
CLEARWATER 125096 PINELLAS FLORIDA
64. Map/Panel Number 65. Suffix 66. FIRM Index Date 67. FIRM Panel 68. Ffood 69. Base Flood Elevation(s) (Zone
12103C0087 G 9/3/03 Effective/Revised Date Zone(s) A0, use base flood depth)
9/3/03 AE 9'
610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9.
❑ FIS Profile � FIRM ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ OthedSource:
612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes � No
Designation Date: N/A ❑ CBRS ❑ OPA
SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction' � Finished 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, ARlA1-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: HATCHERY F Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
Check the measurement used.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 12.05 � feet ❑ meters
b) Top of the next higher 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) 11.15 � feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 11.46 � feet ❑ meters
(Describe type of equipment and location in Comments)
fl Lowest adjacent (finished) grade next to building (LAG) 10.9 � feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 11.0 � feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support N/A. � feet ❑ 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 law to certify elevation
information. 1 certify that the information on this Certificate represents my best efforts to interpret the data availab/e.
1 understand that any fa/se statement may be punishab/e by �ne or imprisonment under 18 U. S. Code, Section 1001.
� Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a
❑ Check here if attachments. licensed land sunreyor? � Yes ❑ No
Certifier's Name JOHN R BEACH
Title P.L.S.
License Number 2984
Company Name JOHN R. BEACH 8 ASSOCIATES, INC.
Address 911 ST. PETERSBURG DR W City OLDSMAR State FL ZIP Code 34677
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FEMA �rm�98'60-33 (7/12)
5/3/2013 Telephone 813-854-1276
See reverse side for continuation.
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IMPORTANT: In these spaces, copy the corresponding information from Section A.
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
3084 OAK CREEK DR N
City CLEARWATER State FL ZIP Code 33761
FOR INSURANCE COMPANY USE
Policy Number;
Company NAIC Number.
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 C2(e) = A/C ELEV (lowest of three units)
Signature
SECTION E— Q�LD11�G ELEVATION INFORMA'
Date 5/3/2013
NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BF
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.
E1. 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.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions), the next higher floor
(elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters ❑ above or � below the HAG.
E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the 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) CERTIFICATtON
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's or Owner's Authorized Representative's Name
Address
Signature
Comments
City
Date
State
Telephone
ZIP Code
Check here if attachments.
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: ❑ New Construction ❑ Substantial Improvement
G8. Elevation of as-built lowest floor (including basement) of the building: ❑ feet ❑ meters
G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters
G10. Community's design flood elevation:
Local Official's Name
Community Name
Signature
Comments
❑ feet ❑ meters
Title
Telephone
Date
Datum
Datum
Datum
Check here if attachments.
FEMA Form 086-0-33 (7/12) Replaces all previous editions.
Building Photographs
See Instructions for Item A6.
For Insurance Company Use:
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Poiicy Number
3084 OAK CREEK DR N
City State Zip CompanyNAlCNumber
CLEARWATER, FL 33761
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two 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." If submitting more photographs than will fit on this page, use the Continuation Page, following.
ALL PICTURES TAKEN ON 5/3/2013
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