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983 NARCISSUS AVES. EP MENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY National Flood Insurance Program A1. Building Owner's Name WILLIAM & ELEVATION CERTIFICATE Important: Read the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION A2. Building Street Address (inciuding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 983 NARCISSUS AVENUE City CLEARWATER State FL ZIP Code 33767 OMB No. 1660-0008 Expiration Date: July 31, 2015 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 2 AND PART OF LOT 1, BLOCK 266, CARLOUEL SUBDIVISION -(PARCEL # 32-28-15-13464-266-0020) A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 28.0015°N Long. 82.8244°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 327 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 N/A within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in AB.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 SECTtON B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name CITY OF CLEARWATER 125096 PINELLAS 64. Map/Panel Number 65. Suffix B6. FIRM Index Date 67. FIRM Panel B8. Flood Zone(s) 12103C-0064 G Effective/Revised Date 8-18-09 9-3-03 AE 610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69. ❑ FIS Profile � FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: 612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? Designation Date: N/A ❑ CBRS ❑ OPA 63. State FLORIDA B9 Base Flood Elevation(s) (Zone AO, use base flood depth) 11' ❑ Yes � No 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(wfth BFE), VE, 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 in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: CITY OF CLEARWATER "J-03" Vertical Datum: NAVD 1988 Indicate elevation datum used for the efevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ OthedSource: Datum used for building elevations must be the same as that used for the BFE. a) Top of bottom floor (including basement, crawlspace, 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 building (HAG) h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 4.74 N/A N/A 3.61 6.09 3.8 4.3 N/A Check the measurement used. � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters � 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. I certify that the information on this Certificate 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 100L €;� � �' '.�., � Check here if comments are provided on back of fortn. Were latitude and longitude in Section A provided by a °���,.• i`� ���''�r: �.'�. °! a.,;� � Check here if attachments. licensed land surveyor? � Yes ❑ No �� '`'� {%'' �'' Certifier's Name GEORGE A. SHIMP III Job Number 130093A License Number 6137 I itle VICE PRESIDENT Company Name GEORGE A. SHIMP II 8 ASSOCIATES, INC. Atltlress 3301 DeSOTO BLVD., SUITE D City PALM HARBOR State FL ZIP Code 34683 Date 1-9-2014 Telephone 727-784-5496 � "` F1a�,�-. � 7 +`,s,,� t _ ��. ' { �4_ .'�'� � y' �'` �iIAA'{♦ �+ : +� ti51f( ��,[`-atirnT'�'�� ... L1 ]� :LLf� . '�r ci:�<�a- i � `#61''37 Date: 4�� FEMA Form 086-0-33 (7/12) See reverse side for continuation. Replaces aN previous=editions� ELEVATION CERTIFICATE, qe 2 IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (inciuding Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No. 983 NARCISSUS AVENUE City CLEARWATER State FL ZIP Code 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 C2.e) AIR CONDITIONER ON ELEVATED CONCRETE PAD Signature Date 1-9-2014 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. 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). feet ❑ meters ❑ above or � below the HAG. a) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ 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) 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's or Owner's Authorized Representative's Name Address Signature Comments City Date State Telephone ZIP Code Check here 'rf attachments. SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by �aw or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C(or E), and G of this Elevation Certficate. 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. Etevation of as-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: Local Official's Name Community Name Signature Comments FEMA Form 086-0-33 (7/12) ❑ feet Title Telephone Date ❑ meters Datum ❑ meters Datum ❑ meters Datum Check here 'rf attachments. Replaces all previous editions. --��" ���rl�'�A��' �age 3 guilding Photographs See Instructions for Item A6. IMPORTANi: In these spaces, copy the corresponding inforrriation frorra Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. Ido.) or P.O. Route and Box No. 983 NARCISSUS AVENUE City CLEARWATER State Fl ZIP Code 33767 FOR INSURANCE COMPANY USE Policy Number: Company NAIC Number: If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building pho4ographs below according to the instructions for Item A6. Identifij all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs mus4 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. , ',��� � , , � ,� � �� � � � �� ,,�r �� � ,'- _ � i� ����� , i � h/ �, �ti � � ' � d � ``l ,'/ i � E y�.+�t Y � ��:'} �' �`'�. .� M+',•,t. FRONi �9EFi�' Picture taken on: 1-9-2014 � '�1 ,4;�, , ���, 1 �� }�,�'� �. - �, � _' . � _�e — F� '�FS�%° ;�. �.t. � # ., ' � ,, _ �. —� i, �' �. � . ���: � .. � �;. �. ,, ,'. �, �x � - t;�"` i �: ..,}, .. .. � � ..�. � . n=.n ,. . ,,` '�'�- � •-.,. - �� FEMA Form 086-0-33 (7/12) Replaces all previous editions. � ELEVATION CERTIFICAI'E, page 4 guilding Photographs Continuation Page IMPORTANT: In these spaces, copy tFae 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 IVo. Policy Number: 983 NARCISSUS AVENUE City CLEARWATER State FL ZIP Code 33767 Company NRIC Number. If submitting more photographs than will fit on the preceding page, affix the additional pho4ographs below. 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. ti � ' , ���� x� �� `�` n �' 't, a � � � �� "�� �-�: . � �� —,�' , � I - k�, ,. �,''���� . " �,. �� � �T„ `� 4 � ` � �� '��� � � . 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'h; �,n �. ��� � ��iy�„,. , 4��'�� ,� `¥� � "��� � ". . c� �� �,r 5,;� �t� ... ,� �,�� 4. _�� �}� ��,�> � �:�°- :��' FEMA Form 086-0-33 (7/12) Replaces all previous editions.