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507 ISLAND WAYU.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGEMCY MANAGEMENT AGENCY National Flood lnsurance Program Important: Read the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION A1. Buildinq Owner's Name DONALD R. A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 507 ISLAND WAY City CLEARWATER State FL ZIP Code 33767 OMB No. 1660-0008 Expiration Date: July 31, 2015 ',p A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 73, UNIT 6D, OF UNITS 6D, 7A, 7C, ISLAND ESTATES OF CLEARWATER - PARCEL # 05-29-15-43456-064-0730 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27.9853°N Long. 82.8180°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 crawispace 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 436 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 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 8� Community Number 62. County Name CITY OF CLEARWATER 125096 PINELLAS 64. Map/Panel Number 65. Suffix 66. FIRM Index Date 67. FIRM Panel Effective/Revised Date 12103C0102 G 8-18-09 9-3-03 68. Flood Zone(s) AE 63. State FLORIDA 69. Base Flood Elevation(s) (Zone AO, use base flood depth) 11' 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 B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: B12. 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 *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/AO. Complete Items C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: BROOKSVILLE CORS Vertical Datum: NAVD 1988 Indicate elevation datum used for the elevations 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. Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 8.32 � 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 d) Attached garage (top of slab) 7.67 � feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 8.07 � feet ❑ meters (Describe type of equipment and location in Comments) fl Lowest adjacent (finished) grade next to building (LAG) 6_8 � feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 7_5 � feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support N/A � 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 '"�" " .v information. I certify that the information on this Certificate represents my best efforts to interpret the data available. * Y"�"' a' +r ,,a�, I understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. :, �� G� �• Shr�� t' ° � Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ,,' a�;�,��LLj�,r `��,�`� � Check here if attachments. licensed land surveyor? � Yes ❑ No �� ��+. ��i 4�, ' � ` �.. Certifier's Name GEORGE A. SHIMP III Job Number 150076 License Number 6137 - � v ��- ���� ` �J Title VICE PRESIDENT Company Name GEORGE A. SHIMP II & ASSOCIATES, INC. ����;£�i '�� , �� ^ , #"LC � �U+r �, Address 3301 DeSOTO BLVD., SUITE D City PALM HARBOR State FL ZIP Code 34683 � �,,,, ,��,,,;•, ti?�� ` i r FEMA Form 086-0-33 (7/12) Date 3-20-2015 Telephone 727-784-5496 See reverse side for continuation. �. ELEVATION CERTIFICATE, page 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. 507 ISLAND WAY 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 SEE PAGE 5 FOR SURVEYOR'S COMMENTS (THIS DOCUMENT IS NOT VALID WITHOUT ALL 5 PAGES) Signature '" ' Date 3-20-2015 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 0 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 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 ZIP Code Telephone ❑ Check here if attachments. SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C(or E), and G of this Elevation Certificate. 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. Elevation of as-built lowest floor (including basement) of the building: ❑ feet ❑ meters G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters G10. Community's design flood elevation: Local Official's Name Community Name Signature Comments ❑ feet ❑ meters Title Telephone Date Datum Datum Datum ❑ Check here if attachments. FEMA Form 086-0-33 (7/12) Replaces all previous editions. �. ELEVATION 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. 507 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 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. If submitting more photographs than will fit on this page, use the Continuation Page. t, � �., ��: ;� , ,,,�,: � ° __ _ ,;T>F �i ; `�= r:����� � -- . � ,.` �_ .. �.��: °.�.�— i , _ -. _ _ ,� � . . �+�5.'�^s�F` .�-+�'s�-x-�' �c� . �. . . . +Stt�'Wd� '� '- � � :;t ,�auu. �� �.uYWY��� .�'"�`:�� _.-,�:�:a�,.. ..:� � � ` � :�c �, - '" i, ;��� . .. .. . . . . ` � . . �,-: , � FEMA Form 086-0-33 (7/12) . ___.. � _, , -•.�r .� .. � __ ,� . � . � - .,._ ��_ �., _ � � .,�., e ' } `, �� rii'A� y .. `' � �' r FRONT VIEW Picture taken on: 3-20-2015 Replaces all previous editions. ELEVATION CERTIFICATE, page 4 gu�lding Photographs � Continuation Page IMPORTANT: In these spaces, copy the 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 No. Policy Number: 507 ISLAND WAY City CLEARWATER State FL ZIP Code 33767 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 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. �IQ �''i "t`P� v , �e REAR VIEW Picture taken on: 3-20-2015 FEMA Form 086-0-33 (7/12) Replaces all previous editions. ELEVATION GERTIFICATE, page 5 IMPORTANT: In these spaces, copy the Surveyor's Notes Continuation Page information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 507 ISLAND WAY City CLEARWATER State FL ZIP Code 33767 SECTION D— SURVEYOR'S CERTIFICATION (CONTINUED FROM PAGE 2) A1. ) THIS ELEVATION CERTIFICATE WAS PREPARED EXCLUSIVELY FOR THE USE AND BENEFIT OF THE PARTY SPECIFIED IN SECTION A, ITEM 1, FOR THE SPECIFIC PURPOSE OF OBTAINING FLOOD INSURANCE AND/OR VERIFYING FLOOD ZONE COMPLIANCE WITH THE LOCAL GOVERNING AUTHORITY. THIS DOCUMENT SHALL NOT BE VALID AND BINDING AGAINST THE SIGNING SURVEYOR WITHOUT THE ORIGINAL RAISED SEAL AND SIGNATURE OF THE FLORIDA LICENSED SURVEYOR AND MAPPER. USE OF THIS DOCUMENT BY ANY OTHER PARTY OR FOR ANY OTHER PURPOSES IS STRICTLY PROHIBITED AND SHALL RENDER THIS DOCUMENT INVALID FOR THOSE PURPOSES. UNAUTHORIZED COPIES ARE STRICTLY PROHIBITED AND SHALL NOT BE VALID. REQUESTS FOR ANY ADDITIONAL OFFICIAL SIGNED AND SEALED COPIES MUST BE DIRECTED TO GEORGE A. SHIMP II & ASSOCIATES, INC. A4.) THE BUILDING USE WAS DETERMINED BY PHYSICAL OBSERVATIONS MADE ON THE DATE OF SURVEY. A5.) THE LATITUDE AND LONGITUDE COORDINATES WERE OBTAINED USING A HAND HELD G.P.S. UNIT WHICH MEETS OR EXCEEDS FEMA'S REQUIRED ACCURACY OF 66 FEET. A7.) THE BUILDING DIAGRAM NUMBER WAS DETERMINED BY PHYSICAL OBSERVATIONS MADE ON THE DATE OF SURVEY. CERTAIN STRUCTURAL FEATURES NOT VISIBLE TO THE SURVEYOR (PILINGS, GRADE BEAMS, ETC.) OR USE OF ANY AREAS BELOW THE BASE FLOOD ELEVATION THAT DOES NOT COMPLY WITH FEMA REGULATIONS CAN AFFECT THIS DETERMINATION. A8.) FOR THE PURPOSE OF THIS DOCUMENT, A BUILDING ENCLOSURE IS DEFINED AS THAT PORTION OF AN ELEVATED BUILDING, BELOW THE LOWEST ELEVATED FLOOR, THAT IS EITHER PARTIALLY OR FULLY SHUT IN BY RIGID WALLS. A GARAGE BELOW OR ATTACHED TO AN ELEVATED BUILDING IS CONSIDERED AN ENCLOSURE. SUCH AREAS SHALL NOT CONTAIN MORE THAN 20 LINEAR FEET OF FINISHED INTERIOR WALLS (PANELING, ETC.) OR IT WILL BE CONSIDERED A FINISHED (HABITABLE) AREA. IF APPLICABLE, THE STRUCTURE CONTAINS: ❑ CRAWLSPACE ❑ ENCLOSURE � ATTACHED GARAGE ❑ N/A IF APPLICABLE, THE CRAWLSPACE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER N/A SQ. FT. PER OPENING. IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER N/A SQ. FT. PER OPENING. IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAINS: N/A IF APPLICABLE, DOES THE BOTTOM FLOOR ENCLOSURE APPEAR TO CONTAIN BREAK-AWAY WALLS? ❑ YES ❑ NO � N/A A9.) IF APPLICABLE, THE ATTACHED GARAGE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER N/A SQ. FT. PER OPENING. A8. & A9.) FOR THE PURPOSE OF THIS DOCUMENT, A FLOOD OPENING IS DEFINED AS A PERMANENT OPENING IN AN EXTERIOR WALL THAT IS NO HIGHER THAN 1.0 FOOT ABOVE THE HIGHER OF THE EXTERIOR OR INTERIOR GRADE OR FLOOR IMMEDIATELY BELOW THE OPENING. B8.) UNLESS OTHERWISE NOTED IN SECTION B, ITEM 10, THE FLOOD ZONE WAS DETERMINED BASED ON THE FLOOD INSURANCE RATE MAP. IN CERTAIN CASES WHERE AN ACCURATE DETERMINATION COULD NOT BE MADE FROM THE MAP, THE COUNTY'S G.I.S. OVERLAY MAY HAVE BEEN UTILIZED TO DETERMINE THE FLOOD ZONE. NO SEARCH OF THE PUBLIC RECORDS WAS PERFORMED FOR LOMA'S, LOMR'S, ETC. WHICH MAY AFFECT THE SITE. C2.e) AIR CONDITIONER LOCATED ON A CONCRETE PAD.