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958 NARCISSUS AVEU.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY National Flood (nsurance Program IMPORTANT: follow the instructions on pages 1-9. V4955 SECTION � - PROPERTY INFORMATION A� 8uilding Owners Name KELLY LANDON A2 Building Street Address (inGuding Apt., Unit, Suite and/or Bldg. No.) or P.O. Route and Box No. 958 NARCISSUS AVENUE City CLEARWATER State Florida A3. A4. A5. A6. A7. A8. OMB No. 1660-0008 Expiration Date:July 31, 2015 FOR INSURANCE COMPANY USE Policy Number Company NAIC Number ZIP Code 33767 Property Description (Lot and Block Numbers, Tax Parcei Number, Legal Description, etc.) PID #32-28-15-13464-257-0010, PINELLAS COUNTY, FLORIDA. 8uilding Use (e.g., Residential, Non-Resident�ai, Addition, Accessory, etc.) RESIDENTiAL Latitude/Longitude:Lat.28°00'01.29' Long. 82°49'27.83' HorizontalDatum: ❑ NAD 1927 �NAD 1983 Attach at least 2 photographs of the buildi�g if the Certificate is being used to obtain flood insurance. Buiiding Diagram Number 1A For a building with a crawispace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawispace or enciosure(s) N/A sq ft a) Square footage of attached garage 308 sq ft b) No. of permanent flood openings in the crawlspace or b) Number of permanent flood openings in the attached garage enclosure(s) within 1.0 foot above adjacent grade N/A within 1.0 foot above adjacent grade N/A c) Totai net area of flood openings in AB.b N!A sq in c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes ❑ No _ SECTION B- FLOOD INSURA��CE RATE MAP (FIRM) INFORMATION g�, NFIP Community Name & Communily Number � 82.CountyName CITY OF CLEARWATER 125096 PINELLAS B4. MaplPanel Number 85. Suffix 66. FIRM Index Date 87. FIRM Panel Effective/ B8. Flood Zone(s) Revised Date 12103C 0064 G 9/3/03 9/3/03 AE � FLORIDA 89. Base Flood Elevation(s) (Zone A0, use base flood depth) 11.0' 810. indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: ❑ FIS Profile � FIRM ❑ Community Determined ❑ OtheNSource: 611. Indicate elevation datum used for BFE in Item 89: ❑ NGVD 1929 � NAVD 1988 ❑ OiheNSource: B12. Is lhe building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protecled Area (OPA)? ❑ Yes ❑ No DesignationDate: —,� � ❑ CBRS ❑ OPA SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevaUons are based on: ❑ Construction Orawings` ❑ Building Under ConstrucGon` � Finished Construction 'A ne w Elevation Certificate will be required when construction of the buiiding is complete. �2. Elevations — Zones A1-A30, AE, AH, A(with BFE), VE, V1-V30, V(with BFE), AR, ARlA, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a-h beiow according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized CLEARWATER BMK J-03 Vertical Datum: NAVD1988 Indicate elevation datum used for the elevations in items a) through h) below. Datum used for buitding eievations must be the same as that used for the BFE. a} Top of bottom floor (nduding basement, crawlspace or enclosure floor b) Top ot the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery or eouipment SeNicing the buildinQ (Describe type of equipment and location in Comments) � Lowest adjacent (finished) grade next to building (LAG) g) Highest adjacent (finished) grade next to building (HAG) h) Lowest adjacent grade at lowest e�evation of deck or stairs, including stnactural support ❑NGVD 1929 �NAVD1988 ❑ OtheNSource: 6 .O6 N/A 5 .26 5 .�R 4 .46 5 .05 N/A Check the measurement used. � feet � meters � feet ❑ meters � feet ❑ meters � feet ❑ meters F,^�eet • n me:2r� �feet ❑ meters � feet ❑ meters � 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. l certify that fhe information on this Certircate represenfs my best efforts to interpret the data available. l understand that any fa/se statement may be punishab/e by Tine or imprisonment under 18 U. S. Code, Section 1001. ��;,{., ��• C�j �Check here if comments are provided o� back of form. Were latitude and longitude in Section A provided by a licensed ��G �r�'• ❑Check here ii attachments. land surveyor7 � Yes pNo ���'�� Certifier's Name Miguel A. Cortes Title PSM Address 4034 Laurel Branch Lane CC\AA Cnrm I1RR h 74 /7/1'1\ License M�rnber 5820 Company Name V.I.P. SURVEYING, fNC. City Orlando State Florida ZIP Code 32817 Date 4/27/2013 Telephone (407) 810-0838 � 1:IC'l�.�h. ! 1 �821 � [x'`-- ;, :.. . ::% %s�: ::i _ . . . -_ �`. � ' ai.�reot rl.c�r,m:t`s C � \�I'� Ch I��/�i •I, S �,`' Fl R�, . ELEVATION CERTIRCATE, page 2 IMPORTANT: In these spaces, copy the conesponding iMormation from Section A. Buiiding Street Address (induding Apt., Unft, Suite, and/or Bldg_ No.) or F•Y�.Route and Box No. 958 NARCISSUS AVENUE City State ZIP Code CLEARWATER FLORIDA 33767 FOR INSURANCE COMPANY USE Policy Number Company NAIC Number SECTION E- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFlCATIONS (CONTiNUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenVcompar� and (3) building owner. --- - - - ---- -- — . ----- __ _-- --__ _ Comments BEN(�iAIARK � SURVEY pSK AT MfTERSECiION OF KIPL9iG PLAZA AND NARdSSUS AVE, ELEVATION OF 259'. EWIPMENf IS AIC PAD. ���`���"� �' �r-- Date A/27/2013 Signature - � I SECTION E- BUILDING ELEVATION INFORMATION (SURVEY NOT RE�UIRED) FOR ZONE AO AND 20NE A(WITHOUT BFE) For Zones AO and A(withou[ BFE), complete kems Et-E5. N the Certificate is iMended to support a LOMA a LOMR-F request, complete Sections A, B, arxi C. For ftems E1-E4, use naturat grade, 'rf available. Chadc tlie measurement used. In Puerto Rico on�y, enter meters. Et. Provide elevation information for the foltowing 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 basemeM, crawispace, or endosure) is __ ❑ feei ❑ meters ❑ above or � below the HAG. b) Top of bottom floor (including basement. crawlspace, a enclosure) is __ O teet ❑ meters ❑ above or O bebw the LAG. E2. For Building Di�rams 6-9 with pertnanerK Hood 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 0 meters ❑ above a p below the HAG. E3. Attached garage (top of slab) is __ ❑ feet � meters 0 above a � below ihe HAG. E4. Top of plattortn of machinery anci/or equipment servicing the building is _ ❑ feet O �'�eters � above a p below ihe HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the communitys floodpiain management ordinance? ❑ Yes p No 0 Unkrawn. The local offiaal must certify this information in Section G. SECr10N F- PROPERTY OWNER (OR OWNER'S REPRESENT ATIVE) CERTIFlCATION The properlyowner or owner's authorized representative who completes Sectians 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 0. B, and E are conect to the best of my knowledge, Property owner of Owner's Authorized Representative's Name Address Signature Comments � Date State ZIP Code Telephone � Check here if attachments. SECTION G - COMMUWITY 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 Elevallon Certificate. Complete the applicable item(s) and sign below. Chedc the measurement used in ftems G8-G10. In Puerto Rico only, enter meters. Gi .❑The information in Section C was taken from otl�er documentation that has been sigrred arM sealed by a licensed surveyor, engineer, or architect who is authorized by law to certily elevation informaUon. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A commu�ity oKcial completed Section E Tor a building iocated in Zone A(without a FEMA-issued or community-issued BFE) or Zone AO. G3. ❑ The following information (Items G4-G9) is provided for community floodplain management purposes. G4. Permit Number G5. bate Permit Issued G6. Date Certificate Of Comp�iance/Occupancy Issued G7. This permit has been issued fw : ❑�w Construction ❑ Substarrtial Improvement G8. Elevation of as-built lowest floor (induding basement) of the building: . ❑feet ❑ meters Datum G9. BFE or (in Zone AO) depth of flooding at the building site: —� ❑ feet ❑ meters Datum G10. Community's design flood elevation: —� ❑ feet ❑ meters Datum Local Official's Name Community Name Signature Comments Title Telephone Date ❑ Check here if attachments. FEMA For m086-0-33 (7/12) Replaces all previous editions.