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118 LEEWARD ISLAND. ; U.S. DEPARTMENT OF HOMELAND SECURITY ' FEDERALEMERGENCY MANAGEMENTAGENGY National Flood lnsurance Program V9�4 A� Bwld�ng Owner's Name DOUGLAS COSSABOON A2, Buiiding Street Address (inGuding Apt., 118 LEEWARD ISLAND City CLEARWATEH BEACH ELEVATION CERTIFICATE IMPORTANT: Follow the instructions on pages 1-9. A - PROPERTY INFORMATION Suite andlor Bidg. No.) or P.O. Route and Box No. State Florida OMB No. Y 660•0008 Expiration Date:July 31, 2015 FOR INSURANCE COMPANY USE Policy Number Company NAIC Numb� ZIP Code 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.j lOT 66, UNIT 1 ISLAND ESTATES OF CLEARWATER, PB 44, PG 62-63, PINELLAS COUNTY, FLORIDA. q4. Building Use (e.g., Residential, Non-Reside�tial, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude:Lat.27°58'4726" long. -82 48'S2.04' HorizontalDatum: ❑ NAD 1927 �NAD 1983 A6. Attach at least 2 photographs of the building if the Certiflcate is being used to obtain flood insurance. A7. Building Diagram Number tA A8. For a building with a crawlspace or encfosure(s): A9. For a buiiding wRh an attached garage: a) Square footage of crawlspace or enclosure(s) N/A sq ft a) Square footage of attached garage 522 sq ft b) No. of permanent flood openings in the crawispace or b) Number of permanent flood openings in the attached garage enclosure(s) within 1.0 foot above adjacerrt grade N/A within 1.0 foot above adjacerri grade N(A c) Total net area of ftood openings in AS.b N/A sq in c) Totat net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes � No d) Engineered fiood openings? 0 Yes � No SECTION 6- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION gi. NFIP Community Name & Community Number CITY GLEARWATER 125096 84. Map/Panel Number B5. Suffix B6. FIRM Indax Date 12103C 0102 � G I 8/18/09 67. FIRM Panel Effective/ Revised Date 9/3/03 88. Flood Zone(s) AE � FLORIDA 89. Base Flood ElevaGon(s) (Zone A0, use base flood depth) 11.0' B10. indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 89: ❑ FIS ProNle � FIRM ❑ Community Determined ❑ Other/Source: 811. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Bazrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes � No DesignationDate: —� � ❑ CBRS ❑ OPA SECTION C- BUILDING ELEYATION INFORMATION (SURVEY REQUIRED) Ci. Bufiding elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' � Finished Constructio� "A new Elevation Certificate will be required when construction of the building is complete. Cp, Elevations–Zones At-A30, AE, AH, A(with BFE), VE, Vt-V30, V(with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete Rems C2.a-h below according to the building diagram specified in Nem A7. Use the same datum as the BFE. Benchmark Utilized PINELLAS ENGINEERING VeRical Datum: NGVD7929 Indicate elevatio� datum used for the elevations in items a) through h) below. ❑NGVD 1929 �NAVD1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top W baRtan floa (riduding bas�neM, crawlspace or endosure fioor 6 .�_ � feet ❑ meters b) Top of the next higher floor N/A . � feet � meters c) Bottom oi the lowest horizontai structural member (V Zones only) N/A . � feet ❑ meters d) Attached garage (top of slab) �._7�_ � feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 6 .50 �teet � meters (Describe type of equipme�t and location in Comments) � Lowest adjacent (finished) grade �ext to building (LAG) �.1�_ �feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) �_.� � feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A � feet ❑ meters structural support SECTION D- SURVEYOR, ENGINEER, OR ARCHRECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engi�eer, or architect authorized by law to certify elevation information. l certify that the information on this Certificate represen(s my best elforts fo interpret the data availab/e. ^ I understand that any faJse stafement may be punishable by fine or impnsonment under i8 U.S. Code, SecBon 1001. ��j�l. A• C(�R� • �Check here ii comments are provided on back of form. Were latitude and longitude in Section A provided by a licansed �� t�'� ❑Check here if attachments. Iand surveyor? � Yes ❑No * * Certifier's Name Miguel A. Cortes License Number 5820 TiUe PSM Company Name V.I.P. SURVEYING, INC. Address 4034 Laurel Branch Lane City OHando State Florida ZIP Code 32817 �,��° � .� ��%� Date S/31/2015 Telephone (407) 810-0838 � �.icF�,rsE t.s sxla a c� `" a ��j. ��-K71TES)Fl1.ORl1)A / Q � � ����� sUV E� ��4Y FEMA Form 086-0-33 (7/12) See reverse side tor continuation. Repiaces all previous editions. , ELEVATION CERTIFICATE, page 2 IMPORTANT: In these spaces, copy fhe conesponding information from Section A. Buiiding Street Address (induding Apt., Unit, Suite, and/or Bldg. No.) or PO.Route and Box No. 118lEEWARD ISLAND ���' State ZIP Code CLEARWATER BEACH FLORIDA 33767 FOfl INSURANCE COMPANY USE Policy Number Company NAIC Number SECTION E- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATIONS (CONTINUED) Copy both sides of th�s Elevadon Certificate for (1) commurnty official, (2) insurance agenUcompang and (3) building owner. Comments BENCHMARK EIEVATION OF 5.44', CONVERTED TO NAV01988 DATUN (-0.860' VERTCON) = 4.58'. EQtqPMENT IS AfC PAD ON RISER OUTSIDE. ;s� �� � ' ''� �Y�l Date 8/31/2015 �. SECTION E- BUILDING ELEVATION 1NFORMATION (SURVEY NOT REQUIREDj FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE), compiete items E1-E5. H the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For ftems Ei-E4, use �atural grade, if available. Check the measurement used. in Puerto Rico only, enter meters. E1. Provide elevation information for the foliowing and chedc the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjace�t grade (LAG). a) Top of bottom Hoor (including basement, crawispace, or enclosure) is __ ❑ teet ❑ meters ❑ above or Q below the HAG. b) Top of bottom floor (including basement, c►awlspace, or enclosure) is __ ❑ feet ❑ meters ❑ above or � below the LAG. E2. For Building Diagrams 69 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 p meters p above or ❑ below the HAG. E3. Attached garage (top of slab) is __ p feet ❑ meters ❑ above or p below the HAG. E4. Top of piatform of machinery a�d/or equipment servicing the building is ,_ ❑ feet p meters ❑ above a 0 below the HAG. E5. Zone AO only: H rw flood depth number !s available, is the top ot the bottom Noor elevated in accordance wiih the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The iocal official must certify this information in Section G. SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENT ATIVE) CERTIFlCATION The properyowner or owner's authorized representative who completes Sections A, B, and E for Zo�e 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 of Owner's Authorized Representative's Name Address Signature Comments City Dffie State ZIP Code Telephone � Check here if attachments. SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local ofticial who is authorized by law or ordinance to administer the communiry's floodplain management ordinance can compiete 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. Gi. �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 certity elevation information. (Indicate the source and date of the eievation data in the Commerits 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 infonnation (Items G4-G9) is provided for communiry floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compiiance/Occupancy Issued G7. This permit has been issued for : ❑ New Construction ❑ SubstaMiai improvement G8. Efevation of as-built lowest fioor (including basement) of the building: . ❑ feet � meters Datum G9. BFE or (in Zone AO) depth of flooding at the building site: . ❑ feet ❑ meters Datum G10. Communiry's design flood elevation: , ❑ feet ❑ meters Datum Local OM�ciai's iVame Community Name Signature Comments TiGe Telephone Date � Check here if attachments. FEMA For m086-0-33 (7/12) Replaces ali previous ed�ions.