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,13.S.DEPARTMENTOFHOIdELANDSECIIAITY EL�Y"ATtOtV CERTIFICATE
FEDERAl. FMERt3ENCY MANAGEMENTAGENCY QM8 No. 1660-0008
Na�fonaf Ffood Insunance Progmm lmportant: Read the inst�uctions ��n pages 1-9. p' ation Date: July 31 � G�� � I
Ex �r
5ECTtON A— PROPE�iTY INFORMATiON '
A1. 8t�lding Ov�s Name Ke�n PhiGp ���'�.P �SEq�rf:
� � ^s �i�.
�.
A2. Building SUeet AddreCS (indud'rxj ApG, Unit, Suita, andlor Bldg, No.) or P.O, Route ond Box Wo. --�;�.��r�c�a.�.n -.r�_,�.�,,.c��._.: W.���:
1Q00 Etdorado Avenue -
City Ctearwate�
Lot 6 8 northeriy 1!2 oIf tot 5, t8todc 69�, Mandalay Subcivlston
State FL ZIP Code 33767 ""^""+"�� •.•``'�'�''a�:�._w _,,; ;,
Legal Descr3ptian, elc.)
A4. Bui�ng Use {e,g„ Reside��a�, Non-Re�dential, Addition, Accessory, etaj Residential
A5. Latilude,fLongitude: Lat. 28.OQ18711 Long. -82.82T�sa,s
A6. Attach at least 2 photographs of the buitdtng (f the Certificate is being used to obtai� flood insuran�ZOnt� Datum: ❑ NRQ 1927 � NAD f 983
A7. Buildtng plagram Number $
AB_ For a bufiding with a crayvlspac� or endosure(s);
a) Square footage of cxawlspace or e�losur�(g� � Sq � AS. For a buitding with an attadied garage;
b) Number of Permau�el5t flood a} SWare �aiage of attaehed garege .�i7 sq �
or endo oPeni the crawlspace b) Number of petmanenl Aood
sure{s) withln �.0 toot above ad)acentgrade � openings in the atlached garage
c) Total net ar� af Rood ppen�ngs in AB.b `�� 1.0 toot above ad�acent grade 0
d) Engineered llood op�ingsq 0 Y� � Hfl ���^ c) Total net area of ftood openings In A9.b Q ��n
d) Engineered flood openings? ❑ Yes J� Na
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMAiION
B1. NFIP Comrnunity tJame & CornmuNty � B2 ��� �� -
City of Clearvvater 125096 P'inellas
g4. MapJl'ane� ►NUmber B5. Sufflx B6. FIRM Index Date` B7. FIRM Panel
12103COQ64 G �3-03 EfiectivelRevJsed Date
9-3-03
BB. Fbod
Zone{s)
610. Indicate the sourr,e ot the Base Flood Eleyation (BFH) ciat8 or base flpod �
❑ FIS Profile � FIRM �� ��� in 1Eem 68.
[� Cemmunity Determined ❑ C�eNSource:
611. Indicate elevatbn datum used for BFE In item B9: ❑ i�(�,Vp � 92g
� �w �� �] Other/Sou►ce:
612. Is the bu�cJng bcabed in a Coastal Banier Resources System (CBRS) ar p
83. 5tate
F�
B9. 8ase Flood Elevation(s) (Zone
AO. use base flood deptA)
93'
Oes�gnation Oate: ❑ CBRS� �❑�A Protected Ar� {OPA)? ❑ Yes �$ No
SECiIOPt C- BUILDING ELEVATION 1NFORMqTION (SURVEY REQUIRED}
C1. Building elevations are based on: ❑ Co�struc�(pR p�y,��s' ❑ Buil�ng lhider CpnstrucUpn'
"A new Eievatian Cer6ficate will be required when constructlan of Ihe bu(Iding is complete, � Finished ConsWction
C2. ElevaUons - Zones q�-A3p� AE, AH, A(with BFE� VE, V1-V30, V(with BFE), AR, AWA, AI7/qE, AR1A1-A30, AR/AH, ARfAO. Complete Items C2.a-h
below aocorcling to the �uilding diagram spedfied in Itern A7. In Puerpo {2ico only. enfer meters.
Benchmark Utilized: RE VerUcal Oa�m• ELEV= 5.40� 1N b v �
indicate alevaUon datum used for fhe elevations in Items a) Uuough hj bebw. ❑ IVG�/p 192g I� IVqVD 1988 ❑ OtherlSource:
Datum usad forbuild(ng $IevaOorts must be ihe same as ihat used {or the BFE.
a� Top of bottom floor (inciuding basement, craw(space, pr endosure floor) Check �e measurement used.
b) Top of ihe nexl higher floor i'� � �eet ❑ meters
c) eopom of the lowest horizonlai struc��ai rnembar (V Zones only) ��� � f�� ❑ mete�s
dj Attached garage (Eop of slab) -� I� feet ❑ meters
e) Lowest elevation of macftine or �'� � feet ❑ meters
(Describe type oF equipmenE � Ioc�a�Uon in Commeia�} 8 buikit�g �.� � feet ❑ meters
f} Lowest adjaceM (finished) grade next to building (LAG)
g) Highest adjacent (Mishecl) grdde neM to bulldi S'$ � feet ❑ meters
h) Lowest a acent n9 IHAGj ¢�
� grade at lowes� elevation of dac�C or shaks. indudng structwal s ��et Q meters
�0rt �•@ � feet ❑ rneters
SECTION D-- 5URYEYOR, ENGINEER, OR ARCHITEGT CERTIFlCATION
This certiftptio� is to be signed arW sealed by a lend sexveyor, eng(neer, or arc.hitect authorized by law Oo c�rti(y elevation
informadon. f certiiy that ti�e inh�rrnatjon on �s ���te ����s �� elforts to Mt
! understa�d fhat any false statsment may be punfshabJe by �ne orlmprisonment unde� 18�U.S rCode, Sectfon�001.
� Check here ff comments are provlded an badc o/ torm, Were ladtude and Ipngitude in 5ection A provided by a
� Check here If attachments. licensed land surve
Y� � Yes ❑ No
Certii+er's Name Philip C. Stodc
License Nurr�er RLSl13�35
_ Title President Gompany Name Target Land Surveying
Address 516 Lakeside Place C�h, ��a
State FL ZIP Code 33771
Signatune =—+""""� `'`'��Q� '
_ Qate 12-2413 Telephone (727) 784-0573 � �
F=EMA Form 086-0-33 (7l12) See raverse side !or confmuation.
Replaces all previaus editions.
G'�;,e.,6 � �� '�
Jun 2:714Qp ?�., ��na nti��� C.,.: ;. - J.Ei �:i� �'Js
- -"'_ - '-"' -� r--o� _
1MPORTANT: In these spaces, copy Yh0 corrasponding lnformation from SBGtiGn A. ``
C
Bu(Iding Street Address (tnc(udng Apt, Uni� Suite, and/or Bfdg. No.) or P.O. RauEe and Box No. �
100� Etdor Sdo Avenue
Cily Ciearwater
Sta1e FL ZlP Code 33767
_� `_...:'. �{. - . .. .
:OMPANIf �SSE!. ,
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SECTI�H D-SURVEYOR, ENt31NEER, OR ARCHITEC7 CERTIFfCATION (CONTINU�O)
CopY both-sides of Ihis Elevation Cetlificate for (1} commuNty official, (2} (nsurance agenf/oompanY, and (3) building owner.
Comments J�b# 131218.04
C2.e= AlC Unit
The stuckures crawl space is open
Signature u -�'`�"`��'`3�
Date 12-2413
SEC'fION E- BUILDING EL.EVATION INFORMATION �SURVEY NOT REpU1REDj FOR ZONE AO AND ZONE A(WITi10UT BFE)
For Z�es AO and A(witFwutBFE), complele�ns E9-E5. li the C�tlficate ts G�tended to �pport a LOMA or LOMR-F requesL oompiete 5ections A, B,
and C. For Items E1-E4, use natural grade, IFavaNable. Chedc the meas�uernenl used. �n Pue�to R(co oniy, enter meters.
E1. Provide elevatio� intamalion for the foilow�g and check the aPprppriate boxes to showwF�eth� tfle elevaUon is above or betow the highest adjacent
9rade (HAGj and the Wwest adjacent graCe (LAG).
a) Top of bottom floor (including basemeM, crawispace, or endosure} is ❑ feet ❑ meters ❑ above or � below the NAG.
b) Yap of bottam floo�r (including 6asemeM. crawlspace. or ertdosure? � ❑ teet ❑ meters ❑ above or ❑ below the LAG.
E2, For Building Diagrams 6-8 wiU� permanent Aood openings provided � Section A Items 8 andlor 9(see ages 8-9 of Instruc:tions}, the next higher floor
(e�evation C2.b in the diagrams) of Ihe txilding is . ❑ feet ❑ meiers ❑ above or [J below the HAG.
E3. Attached garage (tap of slab) Is ❑ feet ❑ meters ❑ abpve or ❑ peip�,y ihe HAG.
E4. Top af piatfartn of machin�y andlor equfpment seMcing the bqilding is ❑ feet ❑ metars ❑ above or 0 betaw the HAG.
E5. Zone AO �niy: lf no flood depih number is avallable. is the top of Ihe bottom tloor elevated h act�.ordance rrith the oommunit�PS floodplain management
ordinance? p Yes ❑ rvo ❑ Lkdcnown, The bc� ofFidal mu&t oertlfy thls infortnatlon h Section G.
SECTION F- PROPERIY OWNER (OR aVYNER'S REPRESENTATNE) CERTIFIGAliON
The properry ovmer or owner's aufhorized represeMative wYw compfetes Sectlons A, B, and E for Zone A(without a FEMA-issued or community-issued BFE}
or Zone AO must sign he�e. The statements in SecBons A, $, and E are o�ect to the best ofmy Ivwwiedge.
Propehy Owner's or Owner's Auihorized Representadve's Name
Address
Signature
Comments
City
Date
State Z�P Code
Telephone
❑ C�eck here if altac ments.
SECTION G - COMMIiNITY MFORMATION (OPTIONAL)
The b�al ofliaal wno is authorized by law or adinance to administer the oanmunitys floodplatn rttarragement ordiriance can oomp{ete Sediau A, B, C{or E), and G
of this Elevafion Certil3cate. Complete the appiicable item{s) and sign betow. Chedc ihe measixement used tn items GB-G10. In PueRo Rico pnly, enter melers.
G1. ❑ The infortnation in Section C was taken fram olher dpcumentation that has Aeen signed and sealed by a licer�sed surveyor, engineer, or arohitect who
is aufhorized by law to certify elevation intom�aUon. (Indicate the source and date of the elevatlon data in the CommeMs area 6elow.)
G2. ❑ A cammuniEy official completed Section E for a building loCated in Zone A(without a FEAAA-issued or community-issued BFE) or Z�e AO,
G3. ❑ The folbwfng informatfon (items G4-G10) is provided for communiy Qoadplain management puryoses.
G4. Permit Number
G5. Data Permit Issued
G8. Date Certlflcate Of Complfance/Occupancy issued
G7. This permit has been issued for. ❑ New Co�utrucUon ❑ Substan6a11mprovement
G8. Elevation ot as-buiit bwest floor (indudmg basement) of the building: ❑ feet ❑ meters
G9. BFE or (in 2one AO) depth of flooding at the building site: ❑ feet 0 meters
G9U_ Commun+ty's design ftood elevation: ❑ feet ❑ meters
LoCal O(fiCtal'S Name
Gommunity Name
Signature
Commenis
TIUe
Tetephone
Oate
Datum
Datum
Qatum
� Check here if attachmerltS.
FEMA Form 086-0-33 (7/12) Replaces all previous editions.
' _ � . Lana Phillips
ELEI�ATION t%ERTiFICATE 646-253-7768
' page 3 Building Phoiogra hs
�` S� ��structions for Item A 6
, �MpQRTA1+1T:1n these spaces, copy the corres p o n d � n g i n f orma f lan from
6u(�d1ng StreetAddress (�nc�udin S�Ctlop q,
' 0 0 0 E f d o r a do Ave+x,e g��.� U n i t, S u i te, and/or B
�d9. No.) or �.0. Route and Box No.
jCity Clearwafer
State F� ZIP Code 3376
p 3 ..
FOR INSURqNC� Cp�p� USE
!f e�sing the Elevation Certificate ta obtain �lFIP flood insura�ce, affa at least 7 ��rn �� N��
. • for Item A6. Identify a(t ph�togr�phs with date taken; "F
� View.' � 2 buildi�g phot���hs be�, a�wding to the instructions
Nhen aPPUcable, phot ra �t View" and "Rear Ye�;
�nd�cated in Sectian Ag, �p�bm� �S must sfiavv the foundatiori �m p and, if reqaired, °f�ght Side V'
►�g more �t�a� � re resenta6ve examples of ihe � and "LeP•, Side
09 aAhs than will fit on this pa�, use !he Ca►�nuation Page�� °penings or ven±s, as
�
�R GR.�,�l
�.
f
�EMA Form 086-0-3,3 (7/� 2}
Replaces a�� previous eciirinr�,
____ __
, � ,,u�i c, �� i-+v�i�oa Lana I'Pii�iips � � _ � b4o-�5.s-� �oti �� - p.4
,
ELEI�ATION CERTIFiCATE, page 4 Bu�iding Pho�ographs
Continuation Page
IMPQRTANT: In these spaces, copy the corresponding information from Sectian A.
Building Slreet Address {iriciuding Apt, Unit, Suite, andlor Bfdg. No.) or P.O. R�ufe and 8ox No.
1000 Etdorado Avenue
City Cleanrratec State FL ZIP Code 33767
FOR 1h15URANCE COMPAAlY USE
Pollcy t�umbet:
Company NAIC Number.
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. identify all photographs
with: date taken; "Front Vieanr" and 'Rear Vievw; and, if required, `Right Side L'ie�nl' and `left Side Vew.' When appiicable,
photographs must showthe foundation with �epresentative examples oithe flood openings or vents, as indicated in Section A8.
Left side view
� C��►gi�'�A
FEA4A Fcrm 086-0-33 {7l12} Replaces ali previaus editions.