18675 US HWY 19 N #104U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
Nationai Fiood Insurance Program
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
OMB No. 1660-0008
Expiration Date: November 30, 2018
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agenUcompany, and (3) building owner.
SECTION A— PROPERTY INFORMATION FOR INSURANCE COMPANY USE
A1. Building Owner's Name Policy Number:
DENNIS W. & BEVERLY L. WEIHE REVOCABLE LIVING TRUST
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No. Company NAIC Number:
18675 US HIGHWAY 19 N#339
City State ZIP Code
CLEARWATER Florida 33764
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 339, BAY ARISTOCRAT VILLAGE MOBILE HOME PARK (UNRECORDED)
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. �atitude/Longitude: Lat. 27.94237 Long. -82.72481 Horizontal Datum: � NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of the building 'rf the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 8
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) 1,519 sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 9
c) Total net area of flood openings in A8.b 2,304 sq in
d) Engineered flood openings? ❑ Yes � No
A9. For a building with an attached garage:
a) Square footage of attached garage N/A sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade N/A
c) Total net area of flood openings in A9.b N/A sq in
d) Engineered flood openings? � Yes X� No
SECTION B— FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFiR Community Narx�e & Community Number B2. County Name B3. State
CITY OF CLEARWATER - 125096 PINELLAS Florida
64. MaplPanel B5. Suffix 66. FIRM Index B7. FIRM Panel B8. Flood Zone(s) 69. Base Flood Elevation(s)
Number Date Effective/ (Zone AO, use Base
Revised Date Flood Depth)
12103C0128 G 05/17/2005 09/03/2003 AE g
B10. 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 � OthedSource:
612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? � Yes � No
Designation Date: � CBRS � OPA
rtmH rorm utsti-u-33 �ii�5�
Replaces all previous editions.
Form Page 1 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30, 20�8
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:
18675 US HIGHWAY 19 N#339
City
State ZIP Code Company NAIC Number
CLEARWATER Florida 33764
SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings" ❑ Building Under Construction' Ox 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: FDOT PERM. REF. NETWORK Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a) through h) below.
� NGVD 1929 �x 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 (including basement, crawlspace, or enctosure floor) 5 8 � feet ❑ meters
b) Top of the next higher floor � �. 6 �x feet ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only) N�A. � feet � meters
d) Attached garage (top of slab) N�A. � feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building >>.� x❑ feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) S 3 �x feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 5 8 x� feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including 5 6 0 feet ❑ meters
structural support
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 information.
I certify that the informafion on this Certi�cate represents my best efforts to interpret the data available. I understand that any false
statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? 0 Yes ❑ No ❑ Check here if attachments.
Certifier's Name License Number
JONATHAN S. BRANSON FL PLS 6845
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PRESIDENT �� � .• '� ••., �� :
.
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Company Name _ a ��. �' -
ACROMIC, INC. LB 8094 : � '
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�ere �� � �`
Address ; � 1, „
1116 NEEDLEWOOD LOOP =� �''�� ,�•'�t`�'`
City State ZIP Code �, (�, t��;�g.`�
OVIEDO Florida 32765 � �` i ��� �� `�
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Signatur Date Telephone
11/02/2016 (321)312-0787 �
Copy all p s of this Elevati ertificate and all attachments for (1) community official, (2) insurance agenUcompany, and (3) building owner.
Comments (including type of equipment and location, per C2(e), if applicable)
C2. ELEVATIONS ARE REFERENCED TO THE FLORIDA DEPARTMENT OF TRANSPORTATION PERMANENT REFERENCE
NETWORK USING A LEICA GS14 GPS SENSOR.
C2e. IS ELEVATION OF TOP OF PLATFORM SUPPORTING AIR CONDITIONING UNIT.
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6
ELEVATION CERTIFICATE OMB No. 1660-0008
�,cN�rauon uaie: rvovemDer 30, 2018
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:
18675 US HIGHWAY 19 N#339
City State ZIP Code Company NAIC Number
CLEARWATER Florida 33764
SECTION E— BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED)
FOR ZONE AO AND 20NE A(WITHOUT BFE)
For Zones AO and A(without BFE), complete Items E1—E5. If the Certi�cate 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 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 1-2 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 or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
18675 US HIGHWAY 19, UN
BCP2016-06278
E/C
DENNIS WEIHE
Zoning: Atlas #: 318A
_
❑ Check here if ariachments.
FEMA Form 086-0-33 (7h 5) Replaces all previous edftions. Form Page 3 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30, 2o1s
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:
18675 US HIGHWAY 19 N#339
City State ZIP Code Company NAIC Number
CLEARWATER Florida 33764
SECTION G — COMMUNITY INFORMATION (OPTIONAL)
The local oificial 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) � feet ❑ meters Datum
of the building: •
G9. BFE or (in Zone AO) depth of flooding at the buitding site: . ❑ feet ❑ meters Datum
G10. Community's design flood elevation: . ❑ feet � meters Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments (including type of equipment and location, per C2(e), if applicable)
� Check here if attachments.
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30, 2018
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:
18675 US HIGHWAY 19 N#339
City State ZIP Code Company NAIC Number
CLEARWATER Florida 33764
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.
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FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE See Instructions for Item A6. Expiration Date: November 30, 2018
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, andlor Bldg. No.) or P.O. Route and Box No. Policy Number:
18675 US HIGHWAY 19 N#339
City State ZIP Code Company NAIC Number
CLEARWATER Florida 33764
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs be�ow 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.
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Photo Two Caption REAR VIEW - 11/02/2016
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6
U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
OMB No. 1660-0008
Expiration Date: November 30, 2018
Copy all pages of this Elevation Certificate and all attachments for (1) community officiai, (2) insurance agent/company, and (3) building owner.
SECTION A— PROPERTY INFORMATION FOR INSURANCE COMPANY USE
A1. Building Owner's Name Policy Number:
JOHN & MARY BRYSON
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box Na Company NAIC Number.
18675 US HWY 19 N#104
City State ZIP Code
CLEARWATER Florida 33764
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 104, BAY ARISTOCRAT VILLAGE MOBILE HOME PARK (UNRECORDED)
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. 27.94348 Long. -82.72699 Horizontal Datum: � NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of the building 'rf the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 8
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) 1,108 sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 10
c) Total net area of flood openings in A8.b 2,560 sq in
d) Engineered flood openings? ❑ Yes � No
A9. For a building with an attached garage:
a) Square footage of attached garage N�A sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade N/A
c) Total net area of flood openings in A9.b N�A sq in
d) Engineered flood openings? � Yes � No
SECTION B— FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81. NFIP Community Name & Community Number 62. County Name B3. State
CITY OF CLEARWATER - 125096 PINELLAS Florida
64. Map/Panel B5. Suffix B6. FIRM Index B7. FIRM Panel 68. Flood Zone(s) B9. Base Flood Elevation(s)
Number Date Effective/ (Zone AO, use Base
Revised Date Flood Depth)
12103C0128 G 05/17/2005 09/03/2003 AE 9
610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9:
❑ FIS Profile � FIRM � Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 � Other/Source:
612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? � Yes � No
Designation Date: � CBRS � OPA
rcmH rorm uuo-u-ss (in5)
hzeplaces all previous editions.
Form Page 1 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30, 2018
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:
18675 US HWY 19 N#104
City
State ZIP Code Company NAIC Number
CLEARWATER Florida 33764
SECTION C— BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: 0 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: FDOT PERM. REF. NETWORK Vertical Datum: NAVD 1988
Indicate elevation datum used for the elevations in items a) through h) below.
� NGVD 1929 �x 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 (including basement, crawlspace, or enclosure floor) 6 5 � feet ❑ meters
b) Top of the next higher floor � 0. � �X feet � meters
c) Bottom of the lowest horizontal structural member (V Zones only) N�A. 0 feet � meters
d) Attached garage (top of slab) N�A. Q feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 9. 6 � feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 6 5 �x feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) �� x❑ feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including 6 5 x❑ feet ❑ meters
structural support
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 information.
I certify that the information on this Certi�cate represents my best efforts to interpret the data available. I understand fhat any false
statement may be punishable by �ne or imprisonment under 18 U.S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? � Yes ❑ No ❑ Check here if attachments.
Certifier's Name License Number
JONATHAN S. BRANSON FL PLS 6845
Title
VICE PRESIDENT
Company Name
HENDRA & ASSOCIATES, INC. LB 7648
Address
5028 W LONGFELIOW AVE
City State ZIP Code
TAMPA Florida 33629
Signatu Date Telephone
10/28l2016 (727) 403-4973
Copy all p g s of this EI vatio Certificate and all attachments for (1) community o�cial, (2) insurance agenUcompany, and (3) building owner.
Comments (including type of equipment and location, per C2(e), if applicable)
A5. COORDINATES ARE DETERMINED BY GEOREFERENCED IMAGERY.
C2. ELEVATIONS ARE REFERENCED TO THE FLORIDA DEPARTMENT OF TRANSPORTATION PERMANENT REFERENCE
NETWORK USING A LEICA GS14 GPS SENSOR.
C2e. IS ELEVATION OF BOTTOM OF DECK SUPPORTING AIR CONDITIONING UNIT.
HIGHEST GROWN OF ROAD ELEVATION AT THE LOT IS 6.1 (NAVD 1988)
FEMA Form 086-0-33 (7/15) Replaces all previous editions. r�"" �°yG �"' "
ELEVATION CERTIFICATE OMB No. 1660-0008
Expiration Date: November 30, 2018
IMPORTANT: In these spaces, copy the corresponding information from Sectio� A. FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No. Policy Number:
18675 US HWY 19 N#104
City State ZIP Code Company NAIC Number
CLEARWATER Florida 33764
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 ❑ 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 1-2 of Instructions),
the next higher floor (elevation C2.b in
the diagrams) of the building is . ❑ feet ❑ meters ❑ above or ❑ betow 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 or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
��� ��
_-
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18575 11� H�G�{V1I�Y 191 �
BCP�►p� g_p8443
E/C
MOBILE HOME REPLACEMENT
Zoning:
Atlas #: 318A
LJ Check here if attachments.
r�iwta �V�IfI V80-V-33 �//-1�) tteplaces all previous editions. Form Page 3 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30, 20�8
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:
18675 US HWY 19 N#104
Ci�, State ZIP Code Company NAIC Number
CLEARWATER Florida 33764
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) � feet ❑ meters Datum
of the building: •
G9. BFE or (in Zone AO) depth of flooding at the building site: . ❑ feet ❑ meters Datum
G10. Community's design flood elevation: . ❑ feet ❑ meters Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments (including type of equipment and location, per C2(e), if applicable)
❑ Check here if attachments.
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEYATION CERTIFICATE See Instructions for Item A6. Expiration Date: November 30, 2018
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, andlor Bldg. No.) or P.O. Route and Box No. Policy Number:
18675 US HWY 19 N#104
City State ZIP Code Company NA�C Number
CLEARWATER Florida 33764
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.
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r�wir� rurrn vao-u-.s3 �ii i�) Keplaces all previous editions. Form Page 5 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30, 2018
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:
18675 US HWY 19 N#104
City State ZIP Code Company NAIC Number
CLEARWATER Florida 33764
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.
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Photo Two Caption LEFT SIDE VIEW - 10/24/2016
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6
U.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008
Federal Emergency Management Agency E,cpiration Date: November 30, 2018
Nationai Flood insurance Program
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agenUcompany, and (3) building owner.
SECTION A— PROPERTY INFORMATION FOR INSURANCE COMPANY USE
A1. Building Owner's Name Policy Number:
JOHN & MARY BRYSON
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number:
Box No.
18675 US HWY 19 N#104
City State ZIP Code
CLEARWATER Florida 33764
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 104, BAY ARISTOCRAT VILLAGE MOBILE HOME PARK (UNRECORDED)
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: �at. 27•94348 Long. -82.72699 Horizontal Datum: � NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of the building 'rf the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 8
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) �,�pg sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 10
c) Total net area of flood openings in A8.b 2,560 sq in
d) Engineered flood openings? ❑ Yes � No
A9. For a building with an attached garage:
a) Square footage of attached garage N�A sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade N/A
c) Total net area of flood openings in A9.b N�A sq in
d) Engineered flood openings? � Yes � No
SECTION e— FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81. NFIP Community Name 8� Community Number B2. County Name B3. State
CITY OF CLEARWATER - 125096 PINELLAS Florida
64. Map/Panel B5. Suffix B6. FIRM Index 67. FIRM Panel B8. Flood Zone(s) B9. Base Flood Elevation(s)
Number Date Effective/ (Zone AO, use Base
Revised Date Flood Depth)
12103C0128 G 05/17/2005 09/03/2003 AE 9
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 69: ❑ NGVD 1929 � NAVD 1988 � Other/Source:
B12. Is the buildi�g located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? � Yes � No
Designation Date: `_ � �gRS � OPA
�-EiVtA F�rr�a t�BFi-�-;33 (7�'?�1 �2e�;?aces all �;ravious aditiot�s. Form °age' c�f h
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30, 20�8
IMPORTANT: In these spaces, copy the corresponding intormation from Section A. FOR INSURANCE COMPANY U5E
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number:
18675 US HWY 19 N#104
City State ZIP Code Company NAIC Number
CLEARWATER Florida 33754
SECTION C— BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Buildir�y elevations are based 3n: C Constructior �, avrings' ❑ Buil�ing Under Construction" ❑ F;^ish°4 Constru�!;�r.
*A new Elevation Certificate will be required whe� 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.
I QP��hmark Utili?gri: Ff,�T PFRM. RFF. NFTWQRK Vartical Ilatiim; NA\/fl 1QRR
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 (including basement, crawlspace, or enclosure floor) 6 5 �x feet ❑ meters
b) Top of the next higher floor � �. � �x feet � meters
c) Bottom of the lowest horizontal structural member (V Zones only) ��A. 0 feet ❑ meters
d) Attached garage (top of slab) N�A. x0 feet U meters
e) Lowest elevation of machinery or equipment servicing the building 9. 6 � feet ❑ meters
(Describe type of equipment and location in Comments)
I f) Lowest adjacent (finished) grade next to building (LAG) 6 5 x❑ feet ❑ meters I
g) Highest adjacent (finished) grade next to building (HAG) �� x� feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including 6 5 � feet ❑ meters
structural support
SE�T�L`R' ^.� � ��.°•VEY2)P., E"!slt+l�E.°., ^D r".F:C:'lT��T ��°TlF:^.."�T:L'"!
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
f ceriify that the informafion on this Certificate represents my best efforts to interpret the data available. 1 understand that any false
statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? � Yes ❑ No ❑ Ch�ck here if attachments.
Certifier's Name License Number
JONATHAN S. BRANSON FL PLS 6845
Title
VIGC F�Fit51DEfV I
Company Name
HENDRA & ASSOCIATES, INC. LB 7648
I i-�dciress
5028 W LONGFELLOW AVE
�
City State ZIP Cods
TAMPA Florida 33629
Signatu Date Telephone
1 0128/20 1 6 (727) 403-4973
Copy all p g s of this EI �vatio Certificate and all attachments for (1) community official, (2) insurance agenUcompany, and (3) building owner.
Comments (including type of equipment and location, per C2(e), if applicable)
A5. COORDINATES ARE DETERMINED BY GEOREFERENCED IMAGERY.
C2. ELEVATIONS ARE REFERENGED TO THE FLORIDA DEPARTMENT OF TRANSPORTATION PERMANENT REFERENCE
NETWORK USING A LEICA GS14 GPS SENSOR.
C2e. IS ELEVP.TION OF BOTTOM OF DECK SUPPORTlNG AIR CONDITIONING UNIT.
HIGHEST CROWN OF ROAD ELEVATION AT THE LOT IS 6.1 (NAVD 1988)
FFMA Form 086-0-33 (7/15? Replaces all previous editions. Form Page 2 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30, 20�$
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:
18675 US HWY 19 N#104
City State ZIP Code Company NAIC Number
CLEARWATER Florida 33764
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 ❑ 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 1-2 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 on�y: 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 or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
�..�.,..__.._._.__.__�..___�n___.�.__ __ ..._.._.�_..._�. � -1 Checic here if �tiachrnents�
�-t���tA Forn� t�86-(7-33 !7,15j f'�plac�s all pre°�+c�.�s �clitions. �urrr3 °�ge 3 of� �
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30, 2o�s
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:
18675 US HWY 19 N#104
City State ZIP Code Company NAIC Number
GLEARWRI'ER- Florida 33764
SECTi�N G — COMMLiNITI( iNFORMATION (OPTIONAL)
The local official who is autharized by law or ordinance to administer the community's floodplain managemen# 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 ❑ F+communiiy oniciai wmpieied Seciion t Tor a puiiding iocaied in Zone H(wiinoui a rciviH-issued or communiiy-issued BrEj
or Zo�e 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) I
of the building: ❑ feet ❑ meters Datum
G9. BFE or (in Zone AO) depth of flooding at the building site: _ ❑ feet ❑ meters Datum
G1Q. �ommunity'� design fl�o� elevat�on: _ ❑ feet ❑ meters p�tum
Local Official's Name Title
Community Name Telephone
Signature Date
�
Comments (including type of equipment and location, per C2(e), if applicable)
I
� Check here if attachments.
FEMA Form 086-0-33 {7/15) Replaces all previous editions. Form Page 4 of 6
BUILDING PHOTOGRAPHS
ELEVATION CERTIFICATE see Instructions for �tem As.
IMPORTANT: In these spaces, copy the corresponding information from Section A.
Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No.
18675 US HWY 19 N#104
C ity
CLEARWATER
OMB No. 1660-0008
Expiration Date: November 30, 2018
FOR INSURANCE COMPANY USE
Policy Number:
State ZIP Code I Company NAIC Number
Florida 33764
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.
Photo One Caption FRONT VIEW - 10/24/2016
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Photo Two
Photo Two Caption REAR VIEW - 10/24J2016
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FEMA Form �86-�-33 l7l151 Repleces all previous editions. �orm P,-r; `
BUILDING PHOTOGRAPHS
ELEVATION CERTIFICATE Continuation Page
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.
18675 US HWY 19 N#104
OMB No. 1660-0008
Expiration Date: November 30, 2018
FOR INSURANCE COMPANY USE
Policy Number:
City State ZIP Code Company NAIC Number
CLEARWATER Florida 33764 - - -
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. identify all photographs
♦ ..I..L I . \ \ ' t • J ' \ /' 11I ' L
VJiu : uai2 taRer�, ��Fi�iii Jic'vV° and ��ri88i �/iZw"; B�G, ii iEtjUiiBu, "riiyiii �i�ie vieW" BiiCi °�Zit SiCie vf�W.�� vvii@ii SNNiiCaui�,
photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8.
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Photo One
Photo One Caption RIGHT SIDE VIEW - 10/24l2016
Pnoco Two
Photo Two Caption LEFT SIDE VIEW - 10/24/2016
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6