1887 OAK FOREST DR EU.S.OEPAR7MENTOFHOMELANDSECURITY ELEVATION CERTIFICATE
FEOERAL EMERGENCY MANAGEMENT AGENCY
Natinnut Floas Insuroncc Pmgrmn (MPORTANT: Follow the instructions on pages 1-9.
SECTION A - PROPERTY INFORMATION
A1. Building Owner's Name pavid M. & Jufiana M. Stewart
A2.
Unit, 5uite, and/or Bldg. No.) or PO, Route and Box No.
OMB No. 1660-0008
Expiration Date: July 31, 2Q15
PDR INSURANCE GQMPANY USE
Policy Number.
Number:
' _ _ _ ____. . _.—..._�.�. �-•.dv. �...�...av.�rr.ra.•��t cw.�
l.ot � Forest Wood Estates, PB 69 Page 17
A4. Bmiding Use (e.g., Residentiai, Non-Residential, Addition, Accessory, etc.) B�sident8l
A5. latitude/Longitude: Lat. N 27° 53� 23.0" �ong. W 82° 42' 37:8" Horizontai Datum: ❑ NAD 1927 0 NAD 1983
A6. Attach atieast 2 photographs of the buiiding if the Certificate is heing used to obtain flood insurance.
A7. Buildi�gbiagram Number '�A
A8. for 8 building wiih a crawispace or enclosure(s}: A9. For a building with an attached garage:
a) Square footage ofcrawispace or enciosure(s} N�A sq ft a) Square footage of attached garage 38`� Sq ft
b) No. of permanert flood' openings inthe ctawlspace or N fA b) Number of permanent flood openings in the attachetl garage
enclosure(s) within 1.0 foot above adjacent grade within 1.0 foot above a�acent grade �
c) Totai net area af (lood openings in AS.b ��A sq in cj Total net area of flood openings in A9.b �
d) Er�ineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No �'n
SECTION B- FLQOD INSURANCE RATE MAP (FlRM) INFORMATION
81, NFlP�ommunity Name & Com���r Number 82. County Name __ 63_ statP
'N � f��/•1..........4... c
_"__
. ne um er . u x . RM (ndex Date 67. FlRM Panel Effective/ B8. Flood Zone(s) 89. Base Flood Elevation(s) (Zane'
Revised Date AO, use 6ase flood depth)
12103C0127 G 08/18/2009 09/03/2003 X& A 24'
810. Indicaie the source of the BaSe Flood Elevation (BFE) data or base flood depth entered in Item 64c
❑ FlS Profile ❑ FIRM � Gommunity Determined ❑ QtherJSource'
611. indicate etevaGon datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ OtherJSource:
B1Zis the buflding located in a Coastal Barrier Resources System (GBRS) area or Otherwise FMotected Area (OPA)? ❑ Yes � No
Designation Date: ��a / j ❑ CBRS ❑ OPA
SECTION G- BUILDING EI.EVATION INFORMATION (SURVEY REQUIRED)
Ci. Building elevations are based on; ❑ Construction DrBwings* ❑ B�ilding Under Construction* � Finished ConsVUCilon
*A new Elevation CettiBcate will De required when construction af 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/Al-A30, ARJAH, AR/A0. Compiete Items
C2.a-h betow according to the building diagram specified in ftem A7. In Puerto Rico oniy, enter meters.
Benchmark Utilized: _Set TBM N Rim MH 25 +/- N Prop Elev= 24.26' Verticai Datum: NAVO 1988
indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
Check the measurement used.
a) Top of bottom floor (inGuding basement, crawispace, or enclosure floor} 24 . 9 � feet ❑ meters
b) Top of the next higher floor N!A , ❑ feet ❑ meters
c) Bottom of the lowest horizontal strucwral member (v Zones only} N�A . ❑ feet ❑ meters
d) Attached garage (top of slab} 24 , 4
� feet ❑ meters
e) Lowest eievaUon of machinery or equipment servtcing the buiiding 24 , j � feet ❑ meters
(Describe type of equipment and location in Comments)
fl Lowest adjacent (finished) grade nezt to buildi�g (LAG) �3 , 9
� feet ❑ meters
g) Highest adjacent {finished} grade next to building (HAG) 24 . 4 � feet ❑ meteB
h) Lowest adjacent grade at lowest elevation of deck or stairs, induding N/A . p feet ❑ meters
structural support
SECTtON D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFlGATION
This certification is to he signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation
information. 1 certffythat the information on this Certficate represents my trest efforts to interpret the data availabJe. ��r ��, G�
! understand that arry false statemen[ may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
0 Check here if comments are pravided on back of forrn. Were latitude and longitude in Section A provided by a
0 Check here if attachments. Iicensed land surveyor? � Yes ❑ No
Certifier's Name
Thomas Michael Rooks Jr
Title
Florida Reqistered Survev�
Licen�e Number
6347
& Su
Date Telephone
10i2812015 (813) 621-7841
ZIP Cod
33619
� LF��' E
S�r1�
E-� E r� �
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FEMA Form 086-033 (7J12) 5ee reverse side for continuation. Replaces ail previous editions.
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ELEVATION CERTIFICATE, page 2
IMPORTANT: in these spaces,
Qak Forest Dr E
ry the corresponding &�fo�mation from Section A.
Apt., Unit, Suite, andJor BI�. No:} or P.Q. Route and Box No.
ZIP Code
33759
FOR INSURANCE CQMPANY USE
Policy Numt�er:
Comparry NAIC Number:
SECTtON D- SURVEYOR, ENGINEER, OR ARCNRECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation CeRificate for (I) community official, {2) insurance agent/company, and (3► building owner.
comments Not valid without the signature and originai seal of a Florida Registered Surveyor and Mapper. Date of Field Work: 10t26l2015.
Latitu d Longitude obtained with a hand held GPS device. The equipment referenced in C2e is the air conditioner, located
ide the ructu�e.
Signature- Date
10/28/2015
SECTION E- BUILDtNG ELEYATION INFORMATION (SURVEY NOT REQUIRED) FOR 20NE AO AND ZONE A(WITHdUT BFEj
For Zaies A0 and A jwithaut 8FE), complete Items Ei-E5. if the Certificate is intended to support a tOMA or LOMR-Frequest, complete Sections A, B,and C.
For ltems E1-E4, use natural grade, if availabie. CheCk the measurement used. In Puetto Rico oniy, enter metera
E1. Provide elevation information forthe foliowing and check the appropriate boxes to show whether the elevation is above oc beiow the highest adjacent
grade (NAG) and the lowest adjacentgrade (LAG).
a) Top ofbottom floor (inCluding basement, crawispace, or enclosure) is . ❑ feet ❑ meters ❑ above or ❑ below the HAG.
bj Top of bottom floor (including basement� crawlspace, or enclosure} is . ❑ feet ❑ meters ❑ abave or ❑ below the LAG.
E2, For Building �lagrams 6-9 wiih pemianent flood openings provided in Sectioa A ttems 8 and/or 9(see page& 8-9 of Instructions),
the next higher floor (elevation G2b in the diagramsj of the buildi�g is . ❑ feet ❑ meters ❑ aboue or ❑ beiow 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 6uHding is . ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E5. Zone AO onty: If no flood depth number is available, is the top of the bottqm floor elevated in accordance with the community's floodplain management
ordinance? � Yes ❑ No ❑ Unknown, The locai official must certify this infortnation in Section G.
SEGTION fi- PROPERTY OWNER (OR OWNER'S REPRESENTA'i1VE� CERTtFlCATiON
The property qwr�er or owner's authorized representative wha campletes 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, e, and E are correck to the 6est oP my knowledge.
Property Qwnet or Owner's Authorized Representative's Name
Address City State 21P Code
Date Telephone
Comments
❑ Check here ff attachments.
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
Tfie locai offlcial who is authorized by law or ordinance to administer the community's floodplain managert�nt ordinance can complete Sections A, B, C(or E), and
G of this Elevation Certificate_ Complete [he applicable item(s) antl signbelow. Check the measurement used in Items GS-G10. In Puerta Rico only, enter meters.
G1. ❑ The information in Section G was taken #rom ather documentation that has been signed and sealed by a lice�sed surveyor, engineer, or architect
who is authorized hy law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area bebw.)
G2. ❑ R community official completed Section E for a building located in Zone A(without a FEMR-issued ar community-issued BFE) or Zone A0.
G3. ❑ The fotlowing information (Items G4-G9) is provided for community floodplain management purposes.
G4. Permit Number G5. Date Permit issued G6. Oate Certificate Of Compliance/Dccupancy Issued
G7. This permit has been issued for. ❑ New ConsVuction ❑ Substantiai Improvement
G8. Ele�ation of as-buift lowest floor (including basement) of the buiiding: . ❑ feet ❑ meters Datum
G9. BFE or (in Zone AO) depth of flooding at the building site: . ❑ feet ❑ meters Datum
G10.Gommunity's design 800d elevation: , ❑ feet ❑ meters Datum
local Officia{'s Name
Community Name
Signature
Comments
Titie
Telephone
Date
0 Check here if attachments.
FEMA Form Q86-0-33 {T/12r Replaces all previous editions.
_ _ _ _
ELEVATION CERTIFICATE, page 3 BUILDING 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 PO. Route and Box No.
1887 Oak Forest Dr E
CitY State ZIP Code
Clearwater FL 33759
=0R INSURANCE COMPANY U5E
'alicy FJumber: �
;ompany NAICNumber: �
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.
FEMA Form 086-433 (7/12) Replaces all previous editions.
ELEVATION CERTIFICATE, page 4 BUILDING PHOTOGRAPHS
Continuation Page
IMPORTANT: In these spaces, copy the corresponding information from Section A.
Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P0. Route and Box No.
1887 Oak Forest Dr E
City State ZIP Code
Clearwater FL 33759
FOR WSURANCE COMPANY USE
Policy,Numbec
Company NAIC Num6er.
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.
FEMA Form 086-0-33 (7/12) Replaces all previous editions.