Loading...
2181 GULF TO BAY BLVDU.S.DEPARTMENTOFHOMELANDSECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 NatiorralFloodlnsrvanceProgram Important: Read the instructions on pages 1-9. Expiration Date: July 31, 2015 SECTION A - PROPERTY INFORMATION � �; „%� A1. Building Owner's Name PDQ CLEARWATER �.. ,$ a¢ A2. Building Street Address (inGuding Apt., Unit, SuRe, and/or Bldg. No.) or P.O. Route and Box No. � y, ��r � 2181 GULF TO BAY BOULEVARD ,��, City CLEARWATER State FL ZIP Code 33765 � A3. Property Description (Lot and Blodc Numbers, Tax Parcel Number, Legal Description, etc.) UNIT 5 CTB CONDOMINIUM O.R. 18641, PG. 1882 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) COMMERCIAL A5. Latitude/Longitude: Lat. 27°57'32.59" Long. 082°44'47.89" Horizontal Datum: ❑ NAD 1927 � NAD 7983 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 crawlspace o� 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 WA 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 7.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b N/A sq in c) Total net area of flood openings in A9.b WA sq in d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NFIP Community Name & Community Number 62. County Name 63. State CITY OF CLEARINATER 125096 PINELLAS FL B11. B72. Indicate the source of the Base Flood Elevation (BFE) data or base fload depth entered in kem 69. ❑ FIS Profile � FIRM ❑ Community Determined ❑ Other/Source: Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? Designation Date: ❑ CBRS ❑ OPA ❑ Yes � No SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings� � Building Under Construction� ❑ Finished Construction YA new Elevation Certificate will be required when construdion of the building is complete. C2. Elevatio�s - Zones A1 A30, AE, AH, A(with BFE), VE, V1-V30, V(with BFE), AR, AR/A, AR/AE, AR/A7�430, 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: 352FLHD Vertical Datum: 88 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. a) Top of bottom floor (inGuding basement, crawlspace, or enGosure floor) b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) fl Lowest adjacent (finished) grade next to building (LAG) g) Highest adjacent (finished) grade next to building (HAG) h) Lowest adjacent grade at lowest elevation of dedc or stairs, inGuding structural support Check the measurement used. 77.3 � feet WA. ❑ feet wA. � fieet WA. ❑ feet N/A. ❑ feet 77.0 � feet ?7.? � feet WA. ❑ feet 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 infortnation. l cedify that the informatron on this Certificate �epiesents my best etforts to interpret the data available. l understand that any fa/se statement may be punishable by �ne or imprisonment under 18 U. S. Code, Section 1001. � Check here if c�mments are provided on back of fortn. Were latitude and longitude in Sedion A provided by a ❑ Check here if attachments. licensed land surveyor? � Yes ❑ No Certifier's Name DAN H. RIZZUTO Title LAND Address FEMA Form 086-0-33 License Number 5227 Company Name POLARIS ASSOCIATES, INC. 5TE D City CLEARWATER State FL ZIP Code 33765 Date 11-12-15 Telephone 727-461-6113 See reverse side for continuation. ❑ meters ❑ meters ❑ meters ❑ meters ❑ meters ❑ meters ❑ meters ❑ meters. � w. Wi �� �� � r �•-�'"."�, �;;�J,,, �� ��, ���; °a :t- . 'a� „�?. ., � w �� * y ' �, ' °w � n,�« ,; ,s, ����ex- —y-- s, : � P ",f.{, ,. r �;; „�'�, �..C� �� r���' . . �..; Q� ,$ ��,'�r�,t 7 ��� f�q � � �", .! 1 i ��.�� }\ ',,'. . i � � , _ A� Replaces all previous editions. tLtVA I IUN LtK I ItII:A 1 t, page z IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt., Unit, SuRe, and/or Bldg. No.) or P.O. Route and Box No. 2181 GUIF TO BAY BOULEVARD City CLEARWATER State Fl ZIP Code 33765 Pol'�Cy Nurrrber: NumbeC SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments 1. SURVEY MAP AND REPORT OR THE COPIES THEREOF ARE NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF ORIDA LICENSED SURVEYOR AND MAPPER. ADDITIONS OR DELETIONS TO SURVEY MAPS OR REPORTS BY OTHER THAN THE SIGNIN AR OR P TIES 1�S PROHIBITED. 2. PO IS J B#43� // H. SECTION E - Date 11-12-15 _ 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 Certficate 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 � below the HAG. b) Top of bottom floor (including basement, crawlspace, or enGosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams Cr9 with permanent flood openings provided in Section A Items 8 andlor 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 andlor 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 o�cial must certrfy 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 Telephone ZIP Code 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 Sedions A, B, C(or E), and G of this Elevation Certficate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8-G10. In Puerto Rico only, enter meters. G1. ❑ The infortnation in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or archftect 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 Cert�cate 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: ❑ feet ❑ meters Local Official's Name Community Name Signature Comments FEMA Form 086-0-33 (7/12) Title Telephone Date Datum Datum Datum Check here 'rf attachments. Replaces all previous editions.