1170 MANDALAY POINT RDu.s oeraar�eNroFHOMeuwosecuRmr ELEVATION CERTIFICATE
FE�RAL EIIQ�RGENCY MANAGEMENT AGENCY
Ncuiona! F[ood /nsumrcce Program Important Read the instructions on pages 1-9.
SECTION A - PROPERTY INFORMATION
A2. Building Street Address (inGuding Apt., Unit, Suite, and/or 81dg. No.) or P.O. Route and Box No.
1170 MANDALAY POINT ROAD (PALMER HAYWARD RESERVED)
City CLEARWATER
State FL ZfP Code 33767
�3. Property Description (Lot and Biodc Numbers, Tax Parcel Number, Legal Description, etc.)
LOTS 18, 18A, 19 8 19A, FIRSTADDiT10N TO MANDALAY POINT SUBDNISION - PARCEI # 32-28-1
OMB No. 1660-0008
Expiration Date: July 31, 2015
80
A4. Building Use (e.g., Residentiat, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL '' PIA�NING & DEVELOPMENT DEP'f
A5. Latitude/Longitude: Lat. 28.0094°N long. 2.8271'W Horimntal Datum: ❑ NAD 1927 � NAD 1983 r--�--�- C�TM �� �� �AR�NATER
A6. Attach at teast 2 photographs of the building if the Certficate is being used to obtain flood insurance.
A7. Building Diagram Number 6
A8. For a building with a crawlspace or e�dosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enGosure(s) 375� sq ft a) Square footage of attached garage N/A sq ft
b) Number of pertnanent fiood openings in the crawispace b) Number of pertnanent flood openings in the attached garage
or enclosure(s) within 1.0 foot above adjacent grade Q within 1.0 foot above adjacent grade VL/A
c) Total net area of flood openings in A8.b 0 sq in c) Total net area of flood openings in A9.b � sq in
d) Engineered fiood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B�. NFIP Community Name 8 Community Number B2. County Name
CITY OF CLEARWATER 125096 PINELLAS
B4. MaplPanei Number 65. Suffix B6. FIRM Index Date B7. FIRM Panel
Effective/Revised Date
12103C0064 G &18-09 9-3-03
68. Flood Zone(s)
G\�
83. State
FLORIOA
69 Base Fiood Elevation(s) (Zone
AO, use base flood depth)
13'
B10. Indicate the source of the Base Flood Elevation (8FE) data or base flood depth entered in Item 89.
� FIS Profile � FIRM ❑ Community Detertnined ❑ OtheNSource:
B11. Indicate elevation datum used for BFE in Item 89: ❑ NGVD 1929 � NAVD 1988 ❑ OtherlSouroe:
812. is the building located in a Coastal Barrier Resources Syst�r� (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes � No
Designation Date: WA ❑ CBRS ❑ OPA
SECTION C- BUILDING ELEVATION tNFORMATION {SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Constnu�ion Drawinga' � Building Under Construction` ❑ Finished Construction
•A ne�nr Elevatan Certificate wiU be required when construction of the building � complete.
C2. Elevations - Zones A1-A30, AE, AH, A(wdh BFE), VE, V1 V30, V(with BFE), AR, ARlA, AR/AE, AR/A1-A30, AR/AH, AR/AO. Compbte Iter»s C2.a-h
below axord'mg to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Util¢ed: MAC DILL AFB 6 COR VeRical Datum: NAVO 1988
I�dicate elevation datwn used for the elevations in items a) through h) bebw. ❑ NGVD 1929 � NAVD 1988 ❑ pther/Source:
Datun used for building elevations must be the s�ne as that used fo� tt►e BFE.
a) Top of bottom floor (including basemern, crawlspace, or endosure floor)
b) Top of the next higher floor
c) Bottom of the lowest horizontai structural member (V Zones only)
d) Attached garage (top of slab)
e) Lowest elevation of machinery or equipment serviang the building
(Describe type of equipment and bcetion in Camments)
� Lowest adjacent (finished) grade next to building (LAG)
g) Highasi adjecent (finished) grade neM to building (HAG)
h) Lowest adjacent grade at lowest elevatan of dedc or stairs, induding structural support
�
16•35
�
WA
11.35
6_4
�
WA
Chedc the measu►ement 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 oertification is to be signed and sealed by a land surveyor, engineer, or ar�chftect authorized by law to certify elevation
infonnation. I c�ertily that the infamation on this Certificate rspreserrts my bes� efforts to inteipret the data available.
1 understand that arry false statement may be punlsheble by frne or imprisa►ment urtder 18 U. S. Code, Section 1001. �"'
� Check here 'rf comments are provided on badc of form. Were latituude and longitude in Secdon A provided by a �',� f+•� ��j�, '•,
� Chedc here if attachments. licertsed land surveyor? � Yes ❑ No • ��.•'y5�; (yE� '•.`fA -
�riifie�s�iVBimaS',a�QQ�aEA�SHIAAP 01 Job Numbec i5Q0fl7 . , :._ . : Lice�NUCnbec.-6137 _ ,
Title VICE PRESiDENT Company Name GEORGE A. SHIMP II 8 ASSOCIATES, INC.
Address 3301 DeSOTO BLVD., SUlTE D Cky PALM HARBOR State FL ZIP Code 34683
FEMA Form 086-0-33 (7/12)
Date 4-15-2015 Telephone 727-784-5496
See reverse side for continuation.
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Replaces all previous editions.
ELEVATION CERTIFICATE,
IMPORTANT: in these spaces, copy the corresponding infortnation from Section A.
Building Street Address (including Apt., Unit, Suite, andlor
1170 MANDALAY POINT ROAD (PALMER HAYWARD RI
City CLEARWATER
or P.O. Route and Box No.
State FL Z1P Code 33767
SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenUcornpany, and (3) building owner.
Comments SEE PAGE 5 FOR SURVEYOR'S COMMENTS (THIS DOCUMENT IS NOT VALID WRHOUT ALL 5 PAGES)
S ignature
Date 415-2015
SECTION E- BUILDING EIEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(1MTHOUT SFE)
For Zones AO and A(wrihout 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 netural grade, if available. Chedc the measurement used. In Puerto Rico only, enter meters.
E1. Provide elevation infortnation for the following and chedc 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 (inGuding basement, crawlspace, or endosure) is ❑ feet ❑ meters ❑ above or � below the HAG.
b) Top of bottom floor (inGuding basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2. For Building Oiagrams 6-9 with pertnanent 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 buiiding is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E3. Attached garage (top of slab) is ❑ Peet ❑ meters ❑ above or ❑ below the HAG.
E4. Top of platfortn of machinery andlor equipmeM serviang 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 tha bottan floor elevated in axordance with the oommunity's floodplain management
orclinance? ❑ Yes ❑ No ❑ Unknown. The loca! official must certify this informaGon in Section G.
SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owners authorized representative who completes Sections A, B, and E for Zone A(without a FEMA-issued or oommunity-issued 8FE)
or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge.
P�operty Owners orOwner's Authorized Representative's Name
Address
Signature
Commer�ts
City
Date
State
Telephone
ZIP Code
�_ i 2�. ,,- ._ -. t � _wi.-
SECTION G - COMMUNITY INFORMATION (OP'T'IONAL)
The bcal offiaal w�w is authorized by law or orciinanoe to adminiater the corrununity's floodplain management ordinanoe can oomplete Sectlons A, B, C(or �, and G
of this Elevafan Ce�tificaEe. Complete the applicable item(s) and sign bebw. Chedc the measurement used in Items Ca8�10. In Puerto Rico only, enter me�ers.
G1. ❑ The infortnffiion in Section C was taken from other documeMation that has been signed and sealed by a lioensed surveyor, engineer, or archRect who
is authorized by law to oertify elevatan infortnatlon. (Indicate the source and date of the elevation data in the Comments area below.)
G2. ❑ A community ofFicial oompleted Sectio� E for a building bcated in Zone A(without a FEMA-issued or community-issued BFE) or Zone AO.
G3. ❑ The following infortnation ptems G4-G10) is provided for oommunity floodplain managemer�t purposes.
G4. Pertnit Number G5. Date Pertnit Issued G6. Date Certificate Of ComplianceJOccupancy Issued
G7. This permft has bse� issued for: ❑ New Construdion ❑ Substantial Improvement
G8. Elevation of as-built lowest Floor (inGuding basement) of the buiWing:
G9. BFE or (in Zone AO) depth of flooding at the building site:
G10. Community's design flood elevation:
Local Official's Name
Community Nams
_�._�,_.�a��,.._._�_�.. _�
Sgnature
Comments
FEMA Form 086-0-33 (7/12)
❑ feet
❑ feet
❑ feet
Title
Telephone
Date
❑ mete►s Datum
❑ meters Datum
❑ meters Datum
Chedc here if attachments.
Replaces all previous editions.
E�EEVATIDN CERTIFICATE, page 3 guilding Photographs
See instructions for item A6.
IMPORTANT: In these apaces, copy the conesponding informatfon from Section A.
Building Street Address (inGuding Apt., Unit, Suite, and/or Bldg. No.} or P.O. Route and Box No.
1170 MANDALAY POINT ROA� (PALMER HAYWARO RESERVED)
City CLEARWATER State FL ZIP Code 33767
FQR iNSURANGE Gt?MRANY USE
Policy Number:
Company NftiG NumG+er. '
tf using ttte Elevation Gert�cate to obtain NFIP flood insurance, affix at teast 2 building photographs below according to the instructions
for Item A6. Identify ail photographs with date taken; "Front View" and "Rear Vie�nl'; and, if required, "Right Side Vew" and "Left Side
View.° When applicable, photographs must show the foundation with representative examples of the flood ope�ings or vents, as
indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Paga.
FEMA Form 086-0-33 (7/12) Replaces alt previous editions.
ELEVATION CERTIFICATE, page 4 guilding Photographs ' `
Continuation Page
IMPORTANT: in these spaces, copy the corresponding infarma6an from 5ection A. �OR INSURANGE COMPANY USE
Building Street Address {inGuding Apt., Unit, Suite, andlor Bidg. No.j or P.O. Route and Box No. Poticy Nurriber:
1170 MANQALAY POINT ROAO {PAIMER HAYWARD RESERVED)
City CLEARWAT'ER State FL ZIP Code 33767 Campany MAiG Number
If submitting more photographs than will fit on ttre preceding page, affix the additional photographs below. identify ail 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 rep�esentative examples of the Flood openings or vents, as indicated in Section A8.
FEMA Form 086-0-33 (7/12) Replaces ali previous editions.
ELEVATION CERTIFICATE, page 5 Surveyor's Notes
Continuation Page
IMPORTANT: In these spaces, copy the comesponding informatlon from Section A.
�' .
Buiiding Street Address (including Apt., Unit, Suke, and/or Bldg. No.) or P.O. Route and Box No.
1170 MANDALAY POINT ROAD (PALMER HAYWARD RESERVED) , ...
City CLEARWATER
State FL ZIP Code 33767
SECTION D- SURVEYOR'S CERTIFICA7'fON (CONTINUED FROM PAGE 2)
A1. ) THIS ELEVATION CERTIFICATE WAS PREPAREO EXCLUSIVELY FOR THE USE AND BENEFIT OF THE PARTY SPECIFIED iN
SECTION A, ITEM 1, FOR THE SPECIFIC PURPOSE OF OBTAlNING FLOOD INSURANCE AND/OR VERIFYING FLOOD ZONE
COMPLIANCE WITH THE LOCAL GOVERNING AUTHORITY. THIS DOCUMENT SHALL NOT BE VALID AND BINOiNG AGAINST THE
SIGNING SURVEYOR WITHOUT THE ORIGINAL RAISED SEAL AND SIGNATURE OF THE FIORiDA LICENSED SURVEYOR AND
MAPPER. USE OF THIS DOCUMENT BY ANY OTHER PARTY OR FOR ANY OTHER PURPOSES IS STRICTIY PROHIBITED AND
SHALL RENOER THIS DOCUMENT INVALID FOR THOSE PURPOSES. UNAUTHORIZED COPIES ARE STRICTLY PROHIBITED AND
SHALL NOT BE VALID. REQUESTS FOR ANY ADDITIONAL OFFICIAL SIGNED AND SEALEO COPIES MUST BE DIRECTEO TO
GEORGE A. SHIMP 11 & ASSOCIATES, tNC.
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 HELO G.P.S. UNIT WHICH MEETS OR
EXCEEDS FEMA'S REQUIRED ACCURACY OF 66 FEET.
A7.) THE BUILOING DIAGRAM NUMBER WAS DETERMINED BY PHYSlCAL OBSERVATtONS 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 ELEVATEO
BUILDING, BELOW THE �OWEST ELEVATED FLOOR, THAT IS EITHER PARTIALLY OR FULLY SHUT IN BY RIGID WAILS. A
GARAGE BELOW OR ATTACHED TO AN ELEVATED BUIl01NG IS CONSIDERED AN ENCLOSURE. SUCH AREAS SHALL NOT
CONTAIN MORE THAN 20 IINEAR FEET OF FINISHED INTERIOR WALLS (PANELiNG, ETC.) OR IT WILL BE CONSiUERED A
FINISHED (HABITABL� AREA.
IF APPLiCABIE, THE STRUC7URE 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 FIOOR ENCLOSURE CONTAINS N/A ENGNVEERED FLOOD OPENING(S) CERTIFIED TO COVER N/A
SQ. FT. PER OPENING. � —
IF APPLICABIE, THE BOTTOM FLOOR ENCLOSURE CONTAINS: GARAGE & STORAGE AREA
iF APPLICABIE, DOES TME BOTTOM FIOOR ENCLOSURE APPEAR TO CONTAIN BREAK-AWAY WALLS? ❑ YES � NO ❑ N/A
A9.) IF APPLICABL.E, 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 FLOQR
IMMEDIATELY BELOW THE OPENING.
B8.) UNLESS OTHERWISE NOTED IN SECTION B, ITEM 10, THE FLO00 ZONE WAS DETERMINED BASED ON THE FLO00
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 SEEN 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 AN ELEVATE� CONCRETE PAD.