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306 WINDWARD ISLAND RDPage a of 3 not vaiid without all three pages a b�.S. DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY National Flood Insurance Progmm ELEVATION CERTIFICATE IMPORTANT: Follow the i�structions on pages 1-9. SECTION A - PROPERTY INFORMATION A1. Building Owner's Name A2. ^Building Street Address (inciuding Apt., Unit, Suite, and/or Bldg. No.) or BO. Route and Box No. State OMB No. 1660-0008 Expiration Date: July 31, 2015 P Code A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) TAX PAR ID� 09-29-15-43362-000.9580 A4. Building Use (e.g., Residential, Non-Residentiai, Addition, Accessory, etc.) �SIDENTIAL A5. Latitude/Longitude: Lat. 27 58 50.3 N Long. 82 48 39.8 W Horizontal Datum: ❑ NAD 1927 � NAD 1983 A6. Attach at feast 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number �A A8. For a building with a crawlspace or enclosure{s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) 0 sq ft a) Square footage of at[ached garage 4$0 s ft 9 b) Number of permanent flood openings in the crawispace b) Number of permanent flood openings in the attached garage or enclosure(s) within 1.0 foot above adjacent grade Q within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b 0 sq in c) Totai net area of flood openings in A9.b Q sq in d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No SECTION B- FLOOD INSURANCE RATE MAP (FlRM) INFORMATION B1. NFIP Community Name & Community Number Name 84. Map/Panel Number 65. Suffix B6. FIRM Index Date 67. FIRM Panel Effective/ W B8. Rood Zone(s) 12103C-0106 H ���� Revised Date nc����nc AE B3. B9. Base Flood Elevation(s) (Zone AO, use base flood depth) 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: 611. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: 612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Othervvise Protected Area (OPA)? ❑ Yes � No Designation Date: / / ❑ CBRS ❑ OPA SECTION C- BUILDING ELE1/ATION INFORMATION (SURVEY REQUIRED) C1. Bui�ding 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: �+VD88 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 RFF a) Top of bottom floor (including basement, crawlspace, or enclosure floor) b) Top of the ne� higher floor c) Bottom of the Iowest 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) � 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 deck or stairs, including structural support 5 , 59 �- . 4$.- -5_ . 2�. 5 , fi0 Check the measurement used. � feet ❑ meters G�I feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters 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. 1 certify that the information on this Certificate represenis 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. � Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ❑ Check here if attachments. licensed land surveyor? ❑ Yes �] No FEMA Form 086-0-33 (Revised 7/12) See reverse side for continuation. Replaces all previous editions. (REV.O 1/22/2014) F'age 2 ot 3 not v�jd vnthout �I ihree pages i R�LEVATI�N CERTIFICATE, page 2 IMPORTANT: In thesc spaces, copy the corresponding Ir�formatlon 6om Sectlon A. Building Street Address (inciuding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. City State ZIP Code 1401.1523EC SECTION D- SURYEYOR, ENGINEER, OR ARCHITECT CERTIFlCATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments NOTE: C2.E = AC UNIT PAD. NOTE: THIS ELEVATION CERTIFICATE IS ONLY VALID FOR THE PERSON OR PERSONS NAMED ON THIS CFRTIFI('.ATF THIS (`FRTIFICATF IS FnR FI nOn INRt1RAt�C`F PI IRPOSFS nlvl Y THF II�FnR1��ATlOt� Ot� ThIS (`FRTIFI(`ATF SI,OUI f1 Nl1T RG USED FOR CONSTRUCTION OR PLANNING. Signature Date 1/22/2014 CENTERLINE ROAD FI Fvunna• e�n sECnvn E- Bu1LDING 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 IOMA 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 fioor (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 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the buiiding is . � feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of siab) is . � feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of piatForm of machinery and/or equipment servicing the building is . Q 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 eievated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local officiai must certify this information in Section G. SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFlCATION The proper[y owner or owner's authorized representative who completes Sections A, B, and E for Zone A(without a FEMA-issued or communit�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 Signature Comments City Date State ZIP Code Telephone ❑ 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 Sections A, B, C(or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measuremeni used in Items G8�10. 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(wiihout a FEMA-issued or communit�issued BFE) or Zone AO. G3. ❑ The following information (Items G4—G10) is provided for community floodplain management purposes. G4. Permit Number I 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 Community Name Signature Comments Title Telephone Date ❑ Check here if attachments. FEMA Form 086-0-33 (Revised 7/12) Replaces all previous editions. � � �LEVATI�N CERTIFICATE, page 3 BUILDING PHOTOGRAPHS Page 3 of 3 not valid without all three pages See I nstruCtions for' Item A6. 1401.1523EC IMPORTANT: in these spaces, copy the corresponding informatlon from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or PO. Route and Box No. Policy Number: 306 WINDWARD ISLAND ROAD City State ZIP Code Company NAIC Number: CLEARWATER BEACH FL 33767 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. � �� �, ..,�:�::��,�:.�:.,�-�a�...��.�-�,,.�..,� r;.,�..�,��,..�F,..��;:� 4 ,;:�fr'+�.` '�P/i;'.�#�` . .+"'�`^.. 0. „f..:-R..'� " t � �"."�r.� yc FRONT PROPERTY PICTURE 1 /2 212 0 1 4 � � , �- _ , � i'�.�, � � �� ����� � � �' �� � r .; \ � � 4;" � 4 . . R" � d . �,� 4 v.. �� ...�< . �'F�.•d:e �". ;,'�' ' �`:�` ��, �� '"°„ ��. �g ,��_ _ � � �� r 4y� i-.: ���2.'�. �a r � �� i' yE" � ; �'d a ' �.,� � : * �* � ' � ;�' � `� =i �'�� � — 5.�' i � r" ' �r 4°$ _ ��2 REAR PROPERTY PICTURE 1/22/2014 �. , � RIGHT PROPERTY PICTURE 1 /22/2014 LEFT PROPERTY PICTURE 1/22/2014 FEMA Form 086-0-33 (Revised 7/12) Replaces all previous editions. i ' �LEVATION CERTIFICATE, page 4 BUILDING PHOTOGRAPHS Continuation Page FEMA Form 086-0-33 (Revised 7/12) Replaces all previous editions.