907 NARCISSUS AVEU.S.DEPARTMENTOFHOMELANDSECURITY ELEVATI4N CERTIFICATE
FEDERAL EMERGENCY MANAGEMENT AGENCY
VationalFloodlnsuranceProgran� importar�t: Read the instructions on pages 1-9
C14Q78 SECTION A- PROPEi2TY INFORMATION
A1. Building Owner's Name JOF VENTURES
A2. Building Street Address (inGuding Apt., Unit, Sufte, andfor Bidg. No.) or P.O_ Route and Box No.
9p7 NARCISSUS AVENUE
Gity CLEARWATER BEACH
State Fl ZIP Code 33767
OMB No. 1660-0008
E�cpiration Date: July 31, 2015
FOR il�tSURANCE GOM#�AN'1' tlSE
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Pohcy Numt�:
_.,...,.,...r . ......wa..
A3. Property Description {Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
The North 14.15 feet of lots 1 and 4, and the South 30.00 feet of Lots 2 and 3, together with a vacaYed 15 foot aliey adjaceM thereto, all in Block 47,
MANDALAY SUBDIVISION accordin to the Plat thereof as recarded in Plat Book 14 Paqe 3
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAI
A5. Latitude/Longftude: Lat. 27°59'52.55"N long. 82°49'25.86"W Horizontal Datum: ❑ NAD 7927 � NAD 1983
R6. Attach at least 2 photographs of the building if the CeRificate is being used to obtain flood insurance.
A7. Building Diagram Number 8
A8. For a building witn a crawlspace or enclosure{s): A9. For a building with an attached garage:
a) Square footage of cxawlspece or endosure(s) 479 sq ft a) Square footage of attached garage 2C�5 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 15 within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in AS.b SEE COMMENTS sq in c) Total net area of flood openings in A9.b 0 sq in
dj 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 B2. County Name 63. State
125096 PINELLAS Florida
64. MaplPanel Number 65. Suffix B6. FIRM Index Date B7. FIRM Panel B8. Flood B9. Base Flood Efevation(s) (Zone
t2103C0102 G 913(2003 EffectivelRevised Date Zone{s) AO, use base flood depth)
9/3/2003 AE 11
B10. I�dicate the source of the Base Flood Elevation (BFE) data or base ftood depth entered in Item B9.
0 FIS Profile � FIRM ❑ Community Determined ❑ OtherlSource:
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVQ 1929 � NAVD 1988 ❑ Otherl5ource:
B12. Is the buitding located in a Coastal Barrier Resources 5ystem (GBRS) area or Qtherwise Protected Area (OPA)? ❑ Yes � No
Designation Date: [] GBRS ❑ OPA
SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings• ❑ Building Under Construction* � Finished Construction
'A new Elevation Certificate will be reguired when canstruction of the building is complete.
C2. Elevations - Zones A1-A3Q, AE, AH, A(with BFE), VE, V1-V3Q, V(with BFE}, AR, ARlA, ARJAE, AR/A1-A30, ARIAH, 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: J-Q3 Verticai Datum: NAVD 1988
Indicate eievation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source:
Datum used for buitding elevations must be the same as that used for the BFE. -
a) Top of bottom floor {including basement, crawlspace, or enclosure floor)
b} Top of the next higher fioor
c) Bottom of the lowest horizontal structural member (V Zones only}
dj Attached garage {top of slab}
e) lowast elevation of machinery or equipment servicing the building
(Describe type of equipment and location in Comments}
f� Lowest adjacent {finished} grade next to building (LAG}
g} Highest adjacent {finished) grade next to building (FIAG}
h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support
6.87
N/A
N/A
4.40
5.42
4_0
5.4
N/A
Check the measurement used.
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
SECTION D- SURVEYOR, ENG{NEER, OR ARCHlTECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation
information. l certify that the information on tttis Cerfifrcate represents my best efforts to interpref the data available.
l under�and that any faJse statemant may be punishable by fine orimprisonment under i8 U.S. Code, Section 1009. � e`S H� F'�cs e o
� Check here if comments are provided on back of form. Were latitude and iongitude in Section A provided by a r�� �9 r g
'° � No.6415 F y
Check here if attachments. ticensed land surveyor? � Yes ❑ No � fi
Certifier's Name Kenneth J. Osborne
Title Registe�ed Professional Surveyor
Address 6250 N Miliiary Trait #1Q2
License Number 6415
Company Name TARGET SURVEYING, LLC
City West Palm Beach State FL ZIP Code 33407
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FEMA Form 086-0�3 (7l12) See reverse side for continuation. Replaces all previous editions.
AT10N CERTIFICATE, page 2
4078) IMPORTANT: in these spaces, copy the
information from Secti A
. .. on
Building Street Address (inciuding Apt., Unit, Suite, and/or Bldg. No.) or P.O_ Route and Box No.
907 NARGISSUS AVENUE
City CLEARWATER BEACH
State FL ZIP Code 33767
FOR INSURAtdCE COMPANY USE
Policy Number:
Gompany NAlG Number.
SECTION D— SURVEYOR, ENGINEER, OR ARCHiTECT CERTtFICATION (CONTINUED)
Copy both sides of this Elevation Gertificate for (1) community official, (2) insurance agenUcompany, and (3} building owner.
Gomments GRRAGE SQUARE FOOTAGE !S ROUNDEQ TO THE NEAREST 100 SQUARE FEET. ACCESS UNAVAILABLE. ELEVATtONS IN SECTION
C2-E ARE ELEVATIONS OF A/C SLAB.
VENTS IN SECTION A8: 14 ARE OVAL IN SHAPE — THEY ARE 1 FOOT IN LENGTH AN� APROX. 3.5 INGHES TALL IN THE WIDEST PART OF THE
OPENING.- UNRBLE TO APPROX THE SQ INCHES.
THE ONE OTHER VENT 1S 300 SQ INCFfES TOTAL
Signature
DaYe 06/27/2016
SECTION E— BUI�QING ELEVATION INFORMATiON (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO and A(without BFE}, complete Items E1—E5. )f the Certificate is intended to support a LOMA or LOMR-F request, complete 5ections A, B,
and C. For Items E1—E4, use naturai grade, if avaitable. 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 enGosure) is ❑ feet ❑ meters
b) Top of bottom flaor (including basement, cxawlspace, or endosure) is � � a�Ve or 0 below the HAG.
� ❑ 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 8-9 of Instructions), the next higher floor
(elevatio� C2.b in the diagrams) of the 6uilding is _❑ feet ❑ metets ❑ 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 andtor 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 vvith the community's floodplain management
ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in 5ection G.
SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authonzed representative who compietes Sections A, B, and E for 2one A(without a FEMA-issued or community-issued BFE)
ar 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 ZIP Code
Tefephone
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 ordmance qn complete Sections A, B, C(or E), and G
of this Elevation Certificate. Gomplete the applicable item(s) and sign below. Chedc the measurement used in Items G�G1 Q. 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 erohiteat who
is authorized by law to certify elevation informatio�. (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 R(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 ❑ Subst�aMial Improvement
G8. Elevation of as-built iowest 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: _ T ❑ feet ❑ mete�s
Local Official's Name
Community Name
Signature
Gomments
Tdle
Telephone
Date
Datum _,
Datum _
Datum _
Check here if attachments
FEMA Form 0$6-0-33 {7f12) Repfaces all previous editions.
ELEVATIOEI CERTiFiCATE, page 3 guilding Photographs
See Instructions for Item A6.
(G14Q78} iMP�RTANT: ln these spaces, capy the corresponding information from Section A. �OR INSURANCE C4MPANY USE
Buiiding Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
H07 NARGISSUS AVENUE Policy Number:
City CIEARWATER BEACN State FL ZIP Code 33767
Gompany NAiC Number:
If using the Elevation Gertificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions
for Item A6. Identify ali photographs with date taken; "Front VievJ' and "Rear View"; and, if required, "Right Side View" and "Left Side
View.° When applicable, photographs must shaw the foundation with representative exampies 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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�EMA Form 086-0-33 (7i12; Re�iau�s a!! �revious ed?iiar�s
` ELEVATIJN CERTIFICATE, page 4 guilding Photographs
Continuation Page
(C-14078} I�VIPORTANi': (n these spaces, copy the corresponding information from Section A.
8uilding Street Address {inciuding Apt., Unit, Suite, andlor Bidg� No.} or P.O. Route and Box No.
907 NARGISSUS AVENUE
� City CLEARWATER BEAGH State FL ZIP Code 33767
FQR INSURANCE COMPANY USE
Policy Number:
Company NAIC Number:
If submitting more photographs than will fd on t�e 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 applicabie,
photographs must show the founda#ion with representathre examples of the flood openings or vents, as indicated in Section A8.
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FEMA Form 086-Q-33 (i112) Repiaces al1 previaus edtions