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1267 COURT STUS. DEPARTMENT OF HOME}.AND SECURITY ` FEDERAL EMERGENCY MANAGENIENT AGENCY Ncttorat Flood Luurance Progrom ELEVATION CERTIFICATE important: Read the instructions on pages 1-9. SECTION A — PROPERTY INFORMATION A1. Building Owners Name Kenny Hayslett A2. Building Street Address (inGuding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 1267 Court Street City Clearvvater State FL 7JP Code 33756 �5a� l 53���c� o� � c�� onn6 No. �ssa000s Expiration Date: July 31, 2015 " /�e . A3. Properiy Description (Lat and Blodc Numbers, Tax Parcel Number, Legal Descriptton, etc.) Paroel ID: 9 5-2&15-38574-017-0330 . ; .�� __� -- - __ A4. Bufldin9 Use {e.g., Residential. Non-ResideMial, Add'kion, Accessory, eic.} g¢sidential � -� -� A5. Latitude/Longitude: Lat. N/A Long. � Horizonta! Datum: ❑ NAD 1927 ❑ Nqp 1 gg3 A6. Attach at least 2 photographs of the build)ng if the Certificate is being used to obtain flood insurance. '��� ? f%,�� �1�. A7. Butldirig Diagram Number j,e A8. For a building with a crawlspace or enciosure(s): A9. For a building with an �� �! '{i ?� a) Square footage of cxayAspace or enctosure(s) y�! sq ft a) Square footage of �� ¢�� �'€'F; ��� �y ft b) Number of pertnanent flood openings ih the crawlspaoe b) Number of permanent flood pb ''��1 sttached garage or endosure(s) wRhln 7.0 foot above adJacerrt grade Pi/A within 1.0 foot abov�e adjaoerrt grade N/A c) Totsl net area of flood openings in AS.b �(g sq in c) 7otal net area of flood openings in A9.b [� sq 9n d) Engineered flood openMgsl ❑ Yes � No � Engineered flood openings? ❑ Yes � No SECTION B— FLOOD INSURANCE RATE MAP (FIRM) INFORMATtON B1. NFIP Community Name 8 Community Number B2_ County Name City of Clearvvater -125096 Piheflas B4. Map/Panel N�nber B5. Su}fix 66. FIRM Index Date B7. FIRM Panel 12903C010$ H 05/i7/2005 Effffet�ve/Revised pate 05/1T/2005 88. Flood Zone(s) AE B10. Indicate the source of the Base Flood Elevation (BF� data or base flood depth errtered in Item 69. ❑ FIS Profile � F1RM ❑ Community Determined ❑ OthedSouroe: 611. tndic�te e(evaUon datum used tor BFE In Item B9: ❑ NGVD 1929 � NqVp 1 ggg � pther/Souroe: B12_ ls the bu[Idtng located (n a Coastai Barrfer Resouroes Syst�m (CBRS) area or Othervvise Proteded Area (OPA)9 Designation Date: I�/A ❑ CBRS ❑ OPA 63_ State Florida B9. Base F7ood Elevation(s) (Zone AO. �e base flood dePth) 27 O Yes � No SECTION C— BiJI�DING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevationa are based on: ❑ ConstrucGon Drawings' ❑ Bui�ding Under ConsUuctipn* � Finiahed Construcdon 'A new Elevation Certific¢te wiil be required when consVuc6on of the building Is complete. C2. Eleva6ons —Zonea A7�A30. AE, AH, A(wlth BF�, VE, V1 V30, V(with BF�, AR, AR/A, AR/AE, AR/A1—A30, AR/AH, ARlAO. Complete kems C2.a—h below according to ihe building diagram spadfied In ftem A7. In Puerto Rica ony, erner meters, Benchmarlc Utilized: p�A Vart)cal Datum: 1988 Indicate elevation datum used tor the elevations in iterns a) throuflh h) befow. ❑ NGVD 1929 � NAVD 7988 � OthcdSour�x: Datum used for building elevations must be the seme as that usad for the BFE. a} Top of bottom floor pnduding basement, crawispaoe, or enGosure floor) b) Top of the next higher floor c) Bottom of the lowest horizontal structural mertiber (V Zones ony) dj Attached garage (Mp of slabl ej Lovvest elevation of machinery or aquipmeM servicing the buildfng {Describe type of equipment and bcaiion in Commentsj fj Low�est adJacant (flnished) grede next to building (LAG) g) Hlghest adjecent (finished) grade ne�ct to building (HAG) h) Lowest adja�erd grade at lowest elevation of dedc or stairo, induding atnx�tural support SECTION D — 21 •�,5 � '� N1A� L��B. �. i 2.1•Z I�(9� Check the measurement used. � �eeet ❑ meters ❑ teet ❑ meters � ieet ❑ meters p feet Q meteB ❑ fe�t ❑ mebers � feet ❑ meters � teet ❑ meters � teet ❑ meters, OR ARCHlTECT CERTIFlCATION This ceNBcatton Is to be signed end sealed by a land surveyor, enginesr, or ar�hited authorized by law to certify elevation IMormation. I certlfy �at the lr�fom�aHon on thls Certlflcate represents my best ell�rts to fnterpret the dafa evaileb/e. ! urrderstand tha� ststement may 6e punishable by fine or imprisonment under 18 U.5_ Code, Section 1001. � � Cheeli� here if comrr�ents are provided on badc of form. Were latitude and long�ude in Sedion A provided by � �,�heck here rf attaChmea�. ,�j licensed land sunreyoft ❑ Yes / / ' � � �No ;t� �ertifiers Name R ip , � Title Surveyor ' Address 37 ay�no C ur1 Signature FEMA Form � 33 {7/12) Ucense Number #3411 Campany Name Swerdlofl & Perry Surveying, inc. City Lake Mary State FI ZIP Code 32746 Date 9/30/13 Telephone (407}688-7631 See reverse side for coniinuation. '\ /�� 6/� Replaces all previous editions. ��i�4g ��v�� v��� � n ivi+� �� Maf,1Q i IMPORTANT: In these spaces, copy the corresponding tnformation from Section A. Buifding Stroet Address (�ncluding Apt., Un�, SuRe, and/or Bldg. No.) or P.O. Route and Box No. 1267 Court Sbeet City Clearvvater State FL ZIP Code 33756 - - ----.___.� m.....�.,.,,.�...,..� E TION D— SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (COfVTINUED) Copy both sides of thia Ebvatlon Certifipte for (1) community oificial, (2) inaurance agent/company, and (3) building owner. Comments SL-134688 A/C on the roaf. Signeture Dete 9/30/13 SECTION E— BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(1MTHOUT BFE) For Zones AO and A(without BF�, complete Items E1--E5. If the Certificate is Intended to suppoR a LOMA or LOMR-F request, c�mplete gac�Ons q, B, and C. For ltems Ei—E4, use natural grade, 'rf available. Chedc the measurement used. In Puerto Rico ortly, enter metera. E1. Provide elevation irrformation for the following and chedc the appropriate boxes to show whethar the elevaUon is above a beJow the highest adjaoeM grade (HAG) and the lowest adjaoent grade {LAG). a) Top of bottom floor Qncluding basemerrt, crawlspace, or endosure) is _ ❑ feeY ❑ meters ❑ above or � below the HAG. b) Top of bottom floor (tncluding basement, crewlspace, or endosure) is . ❑ feet ❑ meiers ❑ above or ❑ below the LqG, E2. For Buildin9 n�8� �� Permanent ftood openings provided in Sedion A kems 8 and/or 9(ses pages 8-9 of Instructions), the next higher floor (elevation CZ,b fn the diagrams) of the buffding is p leet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is ❑ feet ❑ meters � above or ❑ below the HAG. E4. Top of platform ot machinery and/or equipment servicing the building is � feet ❑ rneters ❑$bove or � below the HAG. E5. Zone AO only: If no flood depth number is avadabk, is the top of the bottom floor ekvated in a000rdance with the oommunitys floodplain management ordinance? ❑ Yes ❑ No ❑ Unlmown. The local otfldal muat certiy thla hrformation fn Secdon G. SECTION F— PROPERTY OWNER (OR OWNER'3 REPRE3ENTATIVE) CERTlFICATION Tha property owner or owners authorized repr�esentaWe who c�omplefes 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 Sectlons A, B, and E are correct to the best of my knowledge. Property Owners or Owners Authorasd Representative's lJame Address City State Zlp Code Signature Date Telephone Comments p Check hero if attachments SECTION G — COMMUNITY INFORMAl70N (OPTtONAL) The bcal offiaal who is autlwr¢ed by law or ordinanoe to administer the communit�s floodplain management ordinanoe can complete Sections q, g� C(or Ej, and G of tt►is Eievation Certificx6e. Compfete the appticable item(s) and sign below. Check the measuremeM used in Items G8-G'10. In Puerto Rioo only, errter meters, Gi .❑ The InformaUon in Secxion C was ffiken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architeot who is authorized by law to certify elevation infomiation. (Indicate the source and date of the elevation data in the Commecrts area below.) G2. ❑ A community officiel completed Sedion E fw a bu�7ding located in Zone A(without a FEMA-issued or oommua�y-issued BFE) or Zone AO. G3. � 7t�e following infurmation Qtems C-,4—G'10) is provided for community floodplain managemerrt purposes. G4. Permit Number G5. Date Pennft Issued G6. Date Certifi�ate OF Cortfplianoe/Ocwpancy Issued G7. This parmit has been issued for. ❑ Naw Construdlon ❑ Substarrtial lmprovement G8. Elevation of aa-buitt fowest floor fnduding basement) of the bwld'u�g: �� ���� G9. BfE or (in Zone AO) depth of flooding at the building site: ❑ feet � m�eB G10. Community's design flood elevaUon: ❑ feet ❑ meters Loca! Official's Name Community Name Signature Comments rroe Telephone Date Datum Daium Datum Chedc here if attachmeM FEMA Form 086-0-33 (7/12) Rep(aces all previous edRions.