130 DEVON STU.S. DE'F'ARTMENT OF HOMELAND SECURITY OMB No. 1660-0008
Federal Emergency Management Agency Expiration Date: November 30, 2018
National Flood Insurance Program
ELEVATION CERTIFICATE �610.0124EC
Important: Foliow the instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for (1) communiry official, (2) insurance agent/company, and (3) building owner.
SECTION A— PROPERTY INFORMATION FOR INSURANCE COMPANY USE
A1. Bui�ding Owner's Name Policy Number:
JOHN D. MARQUARDT AND MARCIA JOHANSSON
A2. Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Company NAIC Number:
Box No.
130 DEVON DRIVE
City State ZIP Code
CLEARWATER FLORIDA 33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
l0T 12, A REPIAT OF BAYSIDE SUBDIVISION ACCORDING TO THE PLAT THEREOF, AS RECORDED �N PLAT BOOK 23, PAGES 78 AND 19 OF THE PUBLIC RECORDS OF PINELLAS COUNTV, FIORIDA. TOGETHER WITH
THAT AREA IVING BETWEEN THE NORTHERLY PROJECTIONS OF THE EAST AND WEST BOUNDARIES OF THE ABOVE DESCRIBED PLOT, EXTENDED TO INTERSECT THE BOUNDARY OF S/UD PLAT AS'BULKHEAD LINE"
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. 2� 58 26.9 rv Long. 82 49 33.7 W Horizontal Datum: � NAD 1927 � NAD 1983
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 or enclosure(s):
a} Square footage of crawlspace or enclosure(s) pp sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade p
c) Total net area of flood openings in A8.b p sq in
d) Engineered flood openings? ❑ Yes � No
A9. For a building with an attached garage:
a) Square footage of attached garage 20o sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade o
c) Total net area of flood openings in A9.b o sq in
d) Engineered flood openings? � Yes ❑X No
SECTION B— FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number 62. County Name B3. State
CITY OF CLEARWATER 125096 PINELLAS FLORIDA
64. Map/Panel B5. Suffix 66. 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)
12103C - 0102 G 811812009 09/03/03 AE � �
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 ❑ Other/Source:
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? � Yes 0 No
Designation Date: � CBRS ❑ OPA
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6
ELEVATION CERTIFICATE OMB No. 1660-0008
161o.o12aEC 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:
130 DEVON DRIVE
City State ZIP Code Company NAIC Number
CLEARWATER FLORIDA 33767
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 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: L-NET GPS NETWORK ;• Vertical Datum: NAVD88
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) 4. 8 0 feet � meters
b) Top of the next higher floor 5, 2 � feet � meters
c) Bottom of the lowest horizontal structural member (V Zones only) . � feet ❑ meters
d) Attached garage (top of slab) 4. 7 � feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 4. 8 � feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 4. 4 � feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 5. 0 � feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including 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.
! certify that the information on this Certificafe represents my best efforts to interpret the data available. I understand that any fa/se
statement may be punishab/e 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 ❑ Check here if attachments.
Certifier's Name License Number � A, ST�p
KEITH A. STEPHENSON LS 6521 ,�Y'��G�RT � F IC9 �`�`Sp�
Title
No. 6521
PROFESSIONAL SURVEYOR AND MAPPER
Company Name
EXACTA LAND SURVEYORS, INC '9 `�
w
Address �o,� STATE OF ��
11940 FAIRWAY LAKES DRIVE SUITE 1 ��sf F � o x i o P ���
City State ZIP Code ��qL SuxvE`�°¢
FT. MYERS FL 33913 10I13I2016
Signature Date Telephone
r,�-c,� 10/13/2016 p; 866 735-1916
Copy all pages of this Elevation 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)
NOTE: C2.E = AC UNIT PAD. NOTE: THIS ELEVATION CERTIFICATE IS ONLY VALID FOR THE PERSON OR PERSONS NAMED ON THIS
CERTIFICATE. THIS CERTIFICATE IS FOR FLOOD INSURANCE PURPOSES ONLY. THE INFORMATION ON THIS CERTIFICATE SHOULD NOT BE USED FOR
CONSTRUCTION OR PLANNING. C2.A = SUNKEN LIVING ROOM
rtMA F-orm Ut3Fi-U-33 (7/15) Replaces all previous editions. Form Page 2 of 6
ELEVATION CERTIFICATE OMB No. 1660-0008
1610.0124EC 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:
130 DEVON DRIVE
City State ZIP Code Company NAIC Number
CLEARWATER FLORIDA 33767
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 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-issy��d �E) r Z ne AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge.
, � .
Pro ert,� Owr,�gr or w er's thorized Representative's Nar�e i.
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'$ignat�(�e ,/ ' Date Telephone
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❑ Check here if attachments.
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6
ELEVATION CERTIFICATE onnB No. �sso-000s
1610.0124EC 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 Bidg. No.) or P.O. Route and Box No. Policy Number:
130 DEVON DRIVE
City State ZIP Code Company NAIC Number
CLEARWATER FLORIDA 33767
SECTION G — COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodpiain management ordinance can complete
Sections A, B, C(or E), and G of this Elevation Certificate. Compiete the appiicable 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)
of the building: , ❑ feet � meters Datum
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
�LEV�►TION CERTIFICATE See Instructions for Item A6. �61o.o�2aEC Expiration Date: November 30, 2018
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Buifding Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number:
130 DEVON DRIVE
City State ZIP Code Company NAIC Number
CLEARWATER FLORIDA 33767
If using the Elevation Ce�tificate 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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Front View Date:10/6/2016 Rear View Date: 10/6/2016
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Right Side View:10/6/2016 �eft Side View: 10/6/2016
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6
�
ELEVATION CERTIFICATE
BUILDING PHOTOGRAPHS
Continuation Page
1610.0124EC
OMB No. 1660-0008
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:
130 DEVON DRIVE
City State ZIP Code Company NAIC Number
CLEARWATER FLORIDA 33767
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.
Photo One Photo Two
Photo Three Photo Four
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6