1024 ELDORADO AVEU.S. DEPAQTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
National Flood Inrurance Program
E�_EVATION CERTIFICATE
Important: Read the instructions on pages 1-9.
SECTION A - PROPERTY INFORMATIO�I
A1. Building Owner's Name MITCHAM , JOHN J. A1:D ANN G.
A2. Building Street Address (inctuding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
1024 EL DORADO AVENUE.
City CLEARWATER BEACH
State FL ZIP Code 33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 12 & N 1/2 OF LOT 11 , BLOCK "69" , MANDALR,Y SUB..
OMB No. 1660-0008
Expiration Date: July 31, 2015
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. 28.00'09" Long. 82.49'36' Horizontal Datum: � NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of the building if the Cert�cate is being used to obtain flood insurance.
A7. Building Diagram Number 1 B
A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawtspace or enclosure(s' sq ft a) Square fcotage of attached garage sq ft
b) Number of permanent flood openings in the r.-?��vlspace b) Number �f permanent flood openings in the attached garage
or enclosure(s) within 1.0 foot above adjacer.' grade within 1.C� foot above adjacent grade
c) Total net area of flood openings in AB.b sq in c) Total net area of flood openings in A9.b sq in
d) Engineered flood openings? ❑ Yes ❑ No d) Engineered flood openings? ❑ Yes ❑ No
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Communiry Name 8 Community Number 62. County Name B3. State
CLEARWATER 125096 PINELLAS FL
611.
B12.
Indicate the source of the Base Flood Elevation (aFE) data or base flood depth entered in Item B9.
❑ FIS Profile � FIRM ❑ Community Determined ❑ OthedSource:
Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ OtheNSource:
Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected F�rea (OPA)?
Designation Date: ❑ CBRS ❑ OPA
❑ Yes � No
SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Conscruction Drawings' ❑ Building Under Conetruction* � Finished Construction
'A new Elevation Certificate will be required when'.;onstruction of the building is complete.
C2. Elevations - Zones A1-A30, AE, AH, A(with BFE.;.�`dE, V1-V30, V(with BFE), AR, AR/A, AR/AE, AR`:a1-A30, AR/AH, AR/AO. Complete Items C2.a-h
below according to the building diagram specified m Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: CLEARWATER i-2 ELEV. 4,�8 Vertical Datum: NAVD'88
Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � NA`�D 1988 ❑ OthedS�urce:
Datum used for building elevations must be the same as that used for the BFE.
a) Top of bottom floor (including basement, craws�^ace, or enclosure floor)
b) Top of 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 equipment servicing the building
(Describe type of equipment and location in Comments)
� Lowest adjacent (finished) grade next to building (LAG)
g) Highest adjacent (finished) grade next to buildir �(HAG)
h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support
6.12
N/A.
N/A._ .
3.94
6.64
3.8
5.7
N/A.
Check the measurement used.
� feet ❑ meters
❑ fa�i ❑ meters
❑ feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
❑ feet ❑ meters
SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT C�RTIFICATION ;,,� "
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law t� ,^,ertify elevation
information. I certify that the information on this Certit`�ste represents my best efforts to interpret the data availab/e. "
I understand that any false statemenf may be punishr��e by fine or imprisonment under 18 U. S. Code, SE..tion 1001.
❑ Check here if comments are provided on back �`'�.-m. Were latitude and longitude in Section P provided by a
❑ Check here if attachments. licensed land surveyor? ❑ Yes � No
Certifier's Name WILLIAM C. KEATING
License Number 1528
Title LAND SURVEYOR Company Name ALLIED SURVEYING
Address 1275 NO NLAN AV City CL�ARWATER State FL ZIP Code'?3755
Signature � Date I-08-14 TEL 7 2 7- 4 4 6-1 2 6 3
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F orm 086-0-33 /1 See reverse side for continuation. f2eplaces all previous editions. '
I�Nt30RT�NT� In th��e spaoos, copy the corr�
Building Stre1t�A24ess includpg
L O
City s�eEAR�iii�A��2
�
FLOR_TDA
ig information from Section A.
No.) or P.O. Route and Hox No.
33767
1 �: �� ..�x� � ���
SECTION D- SURVEYOR, ENGINEER, OR AHCHITECT CERTIFIC,�TION (CONTINUED)
Copy hoth sides p� this Elevation Certificate for (1) co� ��munity official, (2) insurance agent/company, and "�) building owner.
Commen�s(
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l`;.3�;,� �� � 2—e + AIR C�NDITION PAD = ELEV. f.64
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JANUARY 08 , 2014
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--- ❑ Check
INFO�iMATION (SURVEY NOT REQUIRED) FOR :'ONE AO AND ZONE A(WI
For Zon`es��PT�.y;d ��itT���F,�'E), complete Items E1-E5. If the Certificate is intended to support a LOhiA or LOMR-F request, complete Sections A, B,
and C. F,pY>I��t�s,�`1-E4, ��atural grade, if availabi:��. Check the measurement used. In Puerto Rico e+7�y, enter meters.
. � �
E1. 'Provid'��blQyp�iprtull�ormation 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 (LAt_�j.
a) Top of bottom floor (inctuding�basement, crav�'w�ace, or enclosure) is ❑ feet i � meters ❑ above or [] below the HAG.
b} Top of bottom floor (including basement, cra�.',,�ace, or enclosure) is ❑ feet f� meters ❑ above or ❑ below the LAG.
E2. For Building Diagrams 6-9 with permanent flood r�penings provided in Section A Items 8 and/or 9(s ? pages e-9 of Instructions), the ne�ct higher fioor
(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 iAG.
E4. Top of platform of machinery �nd/or aquipment .�ervicing the building is ❑ feet ❑ meters ❑ above or � below the HAG.
E5. Zone AO only: If no flood depth number is avail��hle, is the top of the bottom flaor etevated in accon:`ance with the community's floodplain management
ordinance? ❑ Yes ❑ No ❑ Unknown. The Iccal official must certify this information in Secti�� G.
SECTION.F - PRQPER"TY OWNER (OR OWNER'S REPRESENTAT!VEj CERTIFiCATION
The property owner or owner's authorizod representati�•� who complotas Soctions A, B, and E for Zone A�without a FEMA-issued or community-issued BFE)
or Zone AO must sign here. The statemQnts in Sectio �s A, 8, and E are correct to the best of my knowleo,qe.
Property Owner's or Owner's Authorized Representativa s Name
Address
Signature
Comments
City
Date
State ZIP Code
Telephone
' ❑ Check here if attachments
SECTIt'3�J G - COMMUNITY INFORMATION (OPTIONAL)
The local o�cial who is autharized by law or ordinance fc administer the community's fioodplain manageme:�;;t ordinance can complete Sections A, B, C(or Ej,
and G of this Elevation Certificate. Comptete the applicab�e ftem(s) and sign below. Check the measureme•-t used in Items GB and G9. ,
G1. ❑ The information in Section C was taken from oth9r documentation that has been signed and seale;c by a licensed surveyor, engineer, or architect who
is authorized by law to certify elevation infom�ati�n. (Indicate the source and date of the elevatior data in the Comments area below.)
G2: �� A community official completed Section E for �., building located in Zone A(without a FEMA-issued or community-issuad BFE) or Zone AO.
G3: ❑ The following information (Items G4-G9) is provided for communiry floodplain management purposes.
G4. Permit Number G5. Date Per;.�ii Issued G6. Date Certlficate Of CompllanceJOccupancy Issued
G7. This permit has been issued for: ❑ New Cons+truction ❑ Substantial Improvement
G8. Elevation of ss-built lowest floor (including basement) of the building: ❑ feet
G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet
G10. Community's design flood elevation ❑ feet
Loca� O�cial's Name Title
Community Name 7elephone
Signature
Comments
Date
`Q meters (PR) Datum
❑ meters (PR) Datum
❑ meters (PR) Datum
Check here if attachments
--- • • _- � • � � -- ^ Realaces all previous editions