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773 ISLAND WAY__ _ -��9�5 __ ___ __ U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY Nationai Floodlnsurance Program Important: Read the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION Ai. Building Owner's Name Randall 8 Laureen Moore A2. Building Street Address {including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 7'73 Island Way 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.) Island Estates Of Ctearwater Unit 8 l.ot 30 05-29-15-43458-000-0300 ___ A4. Building Use {e.g., Residential, Non-Residential, Addition, Accessory, etc.) Residential A5. LatitudelLongitude: Lat. 27°59'32.93 Long. 82°49'13.2 Horizontal Datum: ❑ NAD 1927 � NAD 1983 A6. Attach at teast 2 photographs of the building 'rf the Certificate is 6eing 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 484 sq ft b) Number of permanent flood openings in the crawlspace b) Number of peRnanent flood openings in the attached garage or enclosure(s) within 1.0 foot above adjacent grade 0 within 1.0 foot above adja�nt grade N/A c) Total net area of flood openings in A8.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 3ECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION ; _ - , B1. NFIP Community Name 8 Community Number I 62. Counry Name City of Clearwater 125096 Pinellas B4. Map/Panel Number B5. Suffix B6. FIRM Index Date B7. FIRM Panel 12103C0102 G 9/3/03 Effective/Revised Date 9/3/03 63. State FL 68. Flood B9. Base Flood Elevation(s) (Zonr Zone(s) AO, use base flood depth) AE 11.00 & 12.00 -- --_ B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile � FIRM ❑ Community Determined ❑ OthedSource: 611. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: B12. Is the building Iocated in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes � No Designation Date: N/A ❑ CBRS ❑ OPA SECTION C- BUILDING EIEVATION 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-�130, AE, AH, A(with 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, e�ter meters. \ Benchmark Utilized: PGED Avral A Vertical Datum: NAVD 1988 -_;� Iniiicate elevation datum used for the elevations in items a) through h) below. � NGVD 1929 � NAVD 1988 O OthedSource: • Datum used for building elevations must be the same as that used for the BFE. t Check the measurement used. -�, a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 7.58 � 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 4 d) Attached garage {top of slab) 6.78 � feet ❑ meters � e) Lowest elevation of machinery or equipment servicing the building 6.85 (Descrlbe rype of equlpment and Iocatlon In Comments) � Lowest adjacent (finished) grade next to building (LAG) 7.0 g) Highest adjacent (finished) grade next to building (HAG} 7,� h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 7.0 � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet � meters , � � ` SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certfication is to be signed and sealed by a land surveyor, engineer, or architeet authorized by law to certify elevation information. 1 certify that ihe information on this CeitifJcete represents my best effa►7s to interpret the date evailable. ! understand that any fa/se statement may be punishable by Bne orlmprisonment under 18 U.S. Code, Section 1001. �_ Check here if commenis are provided on back of form. Were latitude and longitude in Section A provided by a � Check here if attaChments. licensed land surveyor? � Yes ❑ No Certifier's Name Dennis J Eyre Title Land Surveyor Address 1822 Street Suite 8 Signature t FEMA Form ORFi-0-33 f7 �l License Number 2865 Company Name Geodata Services, Inc. City Clearwater State FL ZIP Code 33765 Telephone 727-447-1763 �PP fP\/PI'CA CIf�P fll� Mn�Inllafillrl �` ��a,*. ! . �t ' r� �'? � $ � �;' � , �• fn Ca V L_....:' ,;,.��.�.,,�!}:, ��: . • �� ,�. ... : � . , •' 4 r � 'i.- �,t, �;, '.�'' � ' �� p� " ,� � !� �R�,. � �, � : .. , w ,.: . �"'�' � , 4 .. ,� ,e,; , « 4 . , ,�^a ' , ' � •,��'iti CQ�F£� �� t7onl�nnn ell .,re.nnnn n.�li�in..w.. =LEVATION CERTIFICATE, paae 2 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. 773 Island Way City Clearwater State FL ZIP Code 33767 ro��cy nnmt�rt 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 c 2 e) Lowest machinery is the air condition siab Date �� .7a1 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). "" 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 infonnation 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 Ownets or Owne►'s Authorized Representative's Name Address Signature Comments City Date State Telephone ZIP Code Check here if attachments. SECTION G - COMMUNITY INFORMATION (OPTIONAL) he local official who is autltor¢ed by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C(or E), and G f this Elevation Certficate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8-G10. In Puerto Rico only, ente� meters. �1. ❑ �2• ❑ �3. ❑ The infortnation in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or archkect who is authorized by law to ce�tiTy elevation information. (Indicate the source and date of the elevation data in the Comments area below.) A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or Zone AO. The following information (Items G4--G10) is provided for cammunity floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Cert�cate Of ComplianceJOccupancy Issued �7. This permit has been issued for. ❑ New Construction ❑ Substantial Improvement �8. Elevation of as-buift lowest floor (inGuding basement) of the building: ❑ feet ❑ meters �9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters �10. Community's design flood elevation: ❑ feet ❑ meters Local OfficiaPs Name Community Name 5ignature Comrrients Title Telephone Date Datum Datum Datum Check here if attachments.: c�ee �.,..,, naa_2�� i�i�� ^--�---- -" _--- -- --�-_ �EVATION CERTIFICATE, page 3 guilding Photographs ' See Instructions for Item A6_ 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. 773 Island Way 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 photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front VievW' and "Rear vev�'; 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. If submitting more photographs than will fit on this page, use the Continuation Page. ��f ��} I�J V � U U � FE8 Z 1 201� PLANNING 8 DEVELOPMENT DEPT FRONT VIEW 02/2014 � rv� �a � _ _ e � �. - � �t .�- �� .. �.r�� ..� �� 773 ISLAND WAY BCP2014-01516 NON SUBSTANTIAL IMPROVEMENT MOORE, RANDALL Zoning: Isfand Estates Neighbor Atlas #: 249A BACK VIEW 02/2014 �� oF � � '`� ) � � 1 � v � � � v