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860 ISLAND WAYU.S.DEPARTMENTOFHOMELANDSECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY National Flood Insurance Program �mportant: Read the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION A1. Building Owner's Name GRANT 8� KATHY TRIER A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 860 ISLAND WAY City CLEARWATER State FL ZIP Code 33767 A3. Property Description (Lot and Blodc Numbers, Tax Parcel Number, Legal Description, etc.) LOT 55 ISLAND ESTATE OF CLEARWATER UNIT 8/ P.I.# 05-29-15-43458-000-0550 __ __ �� f' --�c:�! 3 s � -x �.? ? OMB No. 1660-0008 Expiration Date: July 31, 2015 FORINSURANCE Poticy Number. carna�m USE mt�er: , A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27.995611 N Long. 82.820438 W Horizontal Datum: ❑ NAD 7927 � NAD 1983 A6. Attach at least 2 photographs of the building if the Certficate is being used to obtain flood insurance. A7. Building Diagram Number 1 A8. For a building with a crawlspace or enGosure(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 506 sq ft b) Number of permanent flood openings in the crawlspace b) Number of pertnanent flood openings in the attached garage or enclosure(s) within 1.0 foot above adjacent grade N/A within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b N/A 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 B1. NFIP Community Name & Community Number B2. County Name CLEARWATER / 125096 PINELLAS 64. Map/Panel Number 65. Suffnc 66. FIRM Index Date B7. FIRM Panel 12103C0102 G 8/18/2009 Effective/Revised Date 9l03/2003 63. State FLORIDA 68. Flood I B9. Base Flood Elevation(s) (Zone Z AE S� AO, use ba 12flood depth) B10. 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: 611. tndicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: 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 j "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, AR/AH, AR/A0. Comptete Items C2.a-h _) below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. ��� Benchmark Utilized: CLEARWATER J-03.5 Vertical Datum: NAVD 88 EL 7.53 -- - Indicate elevation datum used for the elevations in items a) through h) below. L7 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 (inGuding basement, crawlspace, or enclosure floor) 9.9 � feet ❑ meters ��; --� b) Top of the next higher floor N/A. ❑ feet ❑ meters � c) Bottom of the lowest horizontal strudurat member (V Zones only) N/A. ❑ feet ❑ meters k d) Attached garage (top of slab) 9.3 Q� feet ❑ meters ('� e) Lowest elevation of machinery or equipment servicing the building 10.0 � feet ❑ meters r� (Describe type of equipment and location in Comments) � Lowest adjacent (finished) grade next to building (LAG) 8.6 � feet ❑ meters �-� g) Highest adjacent (finished) grade next to building (HAG) 9.1 � feet ❑ meters l h) Lowest adjacent grade at lowest elevation of dedc or stairs, including strudural support N/A. ❑ feet ❑ meters �' �,J SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION , 1 This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information on this Cert�cate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. � Check here if comments are provided on badc of form. Were latitude and tongitude in Sedion A provided by a ❑ Check here 'rf attachments. licensed land surveyor? � Yes ❑ No Certifiers Name EUGENE T CAUDELL Title LAND SURVEYOR Address 2321 PIN OAK LANE EAST Signature I �Y FEMA Form 0 6-0-33 (7/12) Company Name INDIVIDUAL City CLEARWATER License Number 4821 State FL ZIP Code 33759 OZ/11/14 Telephone 727 459-9186 See reverse side for continuation. �� ,')'.�"}� yc,,t(���'� ,.;� 'a, r =�''� • � ���.'`� � �'A� � •. v', : #. � �#' r'� r ' _ ` ..'. -j '- y .fi ,,-. �� � �;, y�p .`,', :,j� sa�-.; '4'. =,<,y. � i Replaces all previous edifibns. GLGYM / IV1r �rGR 1�r1�vM � G� lJtlaC G IMPORTANT: in these spaces, copy tfie comesponding infom�ation from Section A Building Street Address (induding Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 860 ISLAND WAY City CLEARWATER State FL ZIP Code 33767 Policy Nisnber: Gornpany NAIC Number. USE SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFtCAT10N {CONTINUEDj Copy both sides of this Etevation Certificate for (1) community offiaal, (2) insuranoe agent/company, and (3) building owner. Comrr�nts THE STRUCTURE IS PRESNTLY UNDER CONSTRUCTION 1. THE MECHANICAL USED, BEINC THE A/C UNIT SET AT THE SOUTH SI� OF THE STRUCTURE. 2. THE TOP OF THE BLOCK STEM WAL! FOR THE AD�I'fION AT THE REAR OF THE STRUCTURE IS 9.9 BEING THE SAME AS THE LOWEST FlNISHED FLOOR OF THE STRtICTURE Signature p� � _-�. ��G-..- �i /!'Z SECTfON E f BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) �OR ZONE AO AMD ZONE A(WITHOUT BFE) For Zones AO and A(vrithout BFE), comple�te Items E1-E5_ If the Certificate is intended to support a LOMA or LOMR-F request, oomplete Sedions A, B, and C. For Ite�ms E1-E4, use rratural grade, if available. Chedc the measurement used. In Puerto Rico only, enter meters. E 1. Provide elevation infortnatian for tl�e folbwing and check the appropriate boxes to show whether tl�e elevation is above or below the highest adjaoent grade (HAG) and the bwest adjaoent grade (LAG). a) 7op of bottom floor (indudin9 basement, crawlspa�, or endosure) is ❑ feet ❑ meters ❑ above or Q below the tiAG. b} Top of bottom floor (induding basemerrt, crawlspace, or enc�osurey is ❑ teet ❑ me6ers [� above or ❑ below the LAG. E2. For Buikiing Diagrams 6-9 with perrnanent flood openings provided � Sec�ion A Items 8 and/or 9(see pac,�s 8-9 of Instructions), the next higher floor (elevation C2.b in tl�e diagrams) of the building is ❑ feet ❑ mete�s ❑ al�e or ❑ below the HqG. E3. Rttached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HqG. E4. Top of platUorm of machinery and/or equipmeM servicing the building is ❑ feet ❑ meters ❑ above or Q below the HAG. E5. Zone AO onty: If no flood depth number is available, is the top of the bottom floor elevated in aocordance with the community's floodplam management ordinance? ❑ Yes ❑ No ❑ Unknaim. The local official must oertify this ir�formation in Section G. SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authori2ed representative who oompletes Sections A, B, and E for Zone A(without a FEMA-issued or community-issued SFE) or Zone AO must sign here. The statements in Secc�ons A, B, and E are coRed to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address Signature Gommerrts City Date State ZIP Code Telephor� fl Chedc here if a�ments. SECTION G - COMMUNiTY INFORMATION (OPTIONAL) Ths local official who is author¢ed by iaw or ordinance io administer the c�rnmunily's floodpla�, management ordinance c�n complete Sedions A, B, C(or �, and G of this Elevation Certificate. Complete the applicable item(s} and sign bebw. Chedc the measurement used in k��s C,8-G10. In PueRo Rico only, enter meters. Gi. ❑ The iMormation in Sedion C was taken from other docwne�ation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authoraed by law to oertify elevation iMar�tion_ (Irrclir,ate the souroe and date of the elevation data in the CanmeMs 8t8a belaiv.j G2. ❑ A commuruty o�iaal corr�lebed Sec�on E for a building located � Zone A(without a FEMA-issued or community-issued BFE) or 2one AO. G3. ❑ The folbwing ir�formation (Items G4-(`10j � provided for community floodplain managemerrt purppses. G4. P�mtit Number G5. Date Permit Issued G6. Dabe Ceraficate Of Compliance/Occupancy Issued G7_ This pertnit has been issued foe ❑ New Construction ❑ Subshar�tial Unprovement G8. El�wation of a5-bui� lowest floor (int�uding basement) of the building= ❑ fcet ❑ meters G9. BFE or (n Zone AO) depth oi f�od'mg at the build'mg s�e: ❑ feet ❑ meters G10. Communit�s design flood elevation: ❑ feet ❑ meters Local Officiafs Name Community Name 5ignature Comments r� Telephone Date Datum Daitum Datum ■ - . �,:, �- . «�.u� � FEMA Form 086-0-33 (7/12) Replaces all p�+evious editions. `��°'�"����� tLEVATlON CERTIFICATE N r�o�t+` �'f"""�r�r "o�,w . tmporta�: Rexl the instructions on p�g�s 1-9. i 86717 3ECTlOt�t A- PROFERTY iNEORAAATtpN A1. et�ldh►g c)wner's t�tame GRANT V. TRtER AND KATHY P. TRIER A2 Buil�ng S6'eet Addreas {indudfn9 APt� llnit, Suite. ancYor B&ig, No.} or P.O. Ro�e and Box No. 660 tSUWQ WAY Glty CLEARWATER State FL ZIP Code 33T67 A3. Property Oe�i�O� iLot and 8{ocic Ntartbers� Tax Paroet Ntrmber, �ega� p�c�iPqon. etc.) OMB No.1660-0008 Expiratbn t7ate. July 31, 2tY15 A4. BuikHng t18e (e.g.. R�esidertfiai, ►Jon,Res�en�al� Addition, A�, e;c.) R�StnFpmnt As. LaMuden.or,�tude:��� of u,e �Of9. 82-ag��a.o7�n► Hoeizonm� Da�m: ❑ ww �s2� � nwo fsa3 As. atcacn a� �sc 2 �,�dir,g tr a,e ce►ar�� �s � u�a �o otx� ��+,�,�noe. A7. BuAdh�g Dia�ram Number � . A8. For a bt�idk�g w)ttt a txswlspace or �Sr a} SQuare footage af �av�SDece or enclosu s A8. For a htniding v� an aUact�ed garage: b) Number of pam�arier�t flood openings in the aawl � �� a? �U�ars footage of attactted garage � s4 ft � endasure{sj within t.O foot above adjacsn{ gBa�e� Q b) Ntimber of permar�rrt fiood openings in the attac:hed gara9e c) Totai ne# area of flood o wiBdn 1.01'noi above ac�oent �ade Q a �� �� Q� Y� 2 SG �� c} Totat rtet area of flood ope�ings in A9.b Q sq in } En9ineered tlood apanings? � No d) Engineered flood openings? ❑ Yss � No B- FLOOD MIStJRANCE RAiE MAR et . r�►P co�, n�,e & co�y N„m�,� �. c«mty r�,6 125096 PINELLAS COUNTY p�� �cx�►n+� sa. ste� �da 84. il�isp/Pan� Nurnber B5. S�uifix 86. FiRM lndex be�a 87. Flf2M Pane! 88. Flood B9. Base Fbod Etevation(s} (Zone 12103C0102 9I3f2003 EiferA � Date ��� s) ' A�, use � flood dapth) 810. Irtdlcate tlie source of tEte 8ase Flood �evatton (8FE) dala or base flood depftt erHet�ed in item 89. ❑ FIS Prosle � FIRM ❑ Communfty peterrt�d ❑ OlhedSotrc;e: 811. Indlcate elevatlon daarm used for BFE in Item B9: ❑ NGVD 1529 � NAVD 1988 ❑ Othsr/Sou►ce: _, B12. Is tFte building bc8ted 'm a Coesta! Bartier Ra4outces System (CBRS) area a� Ol�en�iss Proteded Area (flf'A)? ❑ Yes � No Desi9nation date: ❑ C�RS C7 OPA SECTION C- BUtLO1N(3 ELEVATION INFORMATK?A! 8URYEY REQUIRED) Ci. Buifd'ing elevatlons are based on: ❑ Constrt�dlon DtavM4gs• ❑�a� u„der co�ucuor►• ����anea cons�cxion A �ew Elevatbn Certifttate wiA 6e requi�ed wfiert oonstrudion of2he buli�flng ls c�orr�tete. c2. �tevenons - z«res At-A3o, aE, ,ari, a�wan e�J, vE, v�-vaa, v{w�n sFE}, �. awA, �rtaE, Awa�-�o, AwaM. ntz��a. com� items cz.a-►, beiow act�ing ao tne buildir�g �m �gea in nem A7. m Puerao I�co ordr. er� metera. 9end,merk ut�xed: ver�ai Dahan: NAW19� In�cate elevatlon datum uaed for tl�e elevafions in kems a) Buough h) below. O MGVD 1829 � NAVD 1988 O Oiher/Sourt�: ! Deh+n used for bu�nq elevaf(otre must be 1he seme as tl�at treed for �e BFE. Chedc tl�e me�urement used. a} Top af botMm floor (kHdudf►T9 ba�me�t. crevulspsce, or �u�e floor) 3.52� �l ieet ❑�teas b) TbA oi ttse rrent Mgher floor 1`1i8� � feet ❑ meters c) Bottam of the lovwsst horizorttal sUuchxai. member (V Zone� w�y) 19�1.• 1$) f� ❑ mefers dj Attached SsraSe (top of siab} ; �. l� feet ❑ me6e[s ej lowest elevation of mgchinery or eqUprtreM �rv{�g ��� toescMbe type of ecjui�xr�er,e and �oc;auon� � c�►nr�ent,s} �.i. � test � meeers fl L°we� adjecent (fi►►ished) grade next to bullding {IAG) $,,4 � feat [7 meters 9) Hi9hest edja�ent {6nishedi grade next to �IdinB iE'r�? �• � feei ❑ r►�e�et's �% ��t 9rade at la�t elevaHoii of deck or stahs. indudir� �ai support �V.L � teet ❑ meters SECTION D- SURVEYOR, ENGINEER, OR ARCHlTECT GERTiFiCATlUN 7his oarti� is to bs si�ed �d sealect by a land swveYor, engi�eer, or archited a��horixed by �rv �a cer6fy etevadon !��� tltat fhe !rrlarmallon on Nris fi.ert'dlca(e r�Weaente mq trest eAbrts in Interprst tl�e deta auaNa6/e. a►+Y fa/se st�ernent may be p�uri�hable 6Y firre ab�Orunent unu�er 18 U.S Code, Secbon J001. � Chedc f�e ff oarrvneMs are provided on badc af for�n. Wene latliude and lo�giti�de in Sec�lon A pravtded by s ❑ Check here if attadunen#s. 8aenssd land survsYnr? � Yes ❑ No CerUfies's Nartie C3yde O_ MdVeal Tdle Reg�ts�'ad Professional Surveyor Address 8250 N Mf@t�r Tr�i #142 FEMA Form 086-0-33 (7i12} Lksnsa Nurt�er 2883 �RY Name TARGET SURVEYING, LLC City Weat Palm Beach State FL Z!P Code 33�407 See reverse side for contfnuation. ora: cN = c b. Mdaw, �� STA7E OF _ i Repiac� aii previo�es editio�ts.