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PARTMENT OF HOMELAND SECURITY OMB No. 1660-0008
• Federal Emergency Management Agency Expiration Date: November 30, 2018
National 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 agent/company, and (31 buildinp owner.
SECTION A— PROPERTY INFORMATION FOR INSURANCE COMPANY USE
A1_ Building Owner's Name Policy Number:
MARION COSTER
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box Na Company NAIC Number:
1025 ELDORADO AVENUE
City State ZIP Code
CLEARWATER Florida 33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 7, BLOCK 68, MANDALAY, PLAT BOOK 14, PAGE 32, PINELLAS COUNTY, FLORIDA.
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat. 28°00'10.3" Long.82°49'34.8" Horizontal Datum: ❑ NAD 1927 �x 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 buiiding with a crawlspace or enclosure(s):
a} Square footage of crawlspace or enclosure(s) p sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 0
c) Tota� net area of flood openings in A8.b 0 sq in
d) Engineered flood openings? ❑ Yes ❑x No
A9. For a building with an attached garage:
a) Square footage of attached garage 351 sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? � Yes Ox No
SECTION B— FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number B2. County Name B3. State
CITY OF CLEARWATER/ 125096 PINELLAS Florida
B4. 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)
12103C0064 G 09/03/2003 08/18/2009 VE 13
610. Indicate the source of the Base Flood Elevation (BFE} data or base flood depth entered in Item B9:
� FIS Profile [jx FIRM � Communiry Determined [J 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 �x No
Designation Date: � CBRS � OPA
r �rvin rv��n UOO�V-JJ �// I�) rcepiaces au previous editions. Form Page 1 of 6
ELEVATION CERTIFICATE
. � �"
OMB No. 1660-0008 1
Expiration Date: November 30, 2018
IMPQRTANT: In khese 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:
1025 ELDORADO AVENUE
City State ZIP Code Company NAIC Number
CLEARWATER Florida 33767
SECTION C— BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevatians are based on: ❑ Construction Drawings" ❑ Building Under Construction' 0 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, ARlA1—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: CITY OF CLEARWATER J-3, Vertical Datum: ELEV.=2.595' NAVD 1988
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 80 Qx feet ❑ meters
b) Top of the next higher floor N�A. � feet ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only) 5. 3 �x feet ❑ meters
d) Attached garage (top of slab) 5. 67 0 feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building �. 5 xQ feet ❑ meters
(Describe type of equipment and location in Comments)
� Lowest adjacent (finished) grade next to building (LAG) 5 5 x� feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) S 8 �x feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including N�A. 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 Certificate represents my best efforts to interpret the data availab/e. 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'i � Yes ❑ No ❑ Check here if attachments.
Certifier's Name License Number
GUY D. HALE PLS 4626
Title
PROFESSIONAL LAND SURVEYOR
Company Name ���
GUY HALE, LAND SURVEYING s ���
Address � �
1166 KAPP DRIVE
Ciry State ZIP Code
CLEARWATER Florida 33765
Signature Date Telephone
1� 01/16l2017 (727) 734-4266
Copy all pages of this EI ation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments (including type of equipment and location, per C2(e), if applicable)
THE LOWEST EQUIPMENT IS THE AIR CONDITIONER
FEMA Form 086-0-33 (7/15) Replaces all previous editions. ������ rayc c vi �
.:
�" ; BUILDING PHOTOGRAPHS
ELEVATfON CERTIFICATE See Instructions for Item A6. OMB No. 1660-0008
Expiration Date: November 30, 2018
9MPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Buiiding Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No. Policy Number:
1025 ELDORADO AVENUE
Gity
CLEARWATER
State ZIP Code Company NAIC Number
Florida 33767
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 buiiding 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 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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Photo One Caption FRONT WEST SiDE TAKEN 01/17/2017
rnoto i wo c;aption KtAK EAST SIDE TAKEN 01117/2017
FEMA Form 086-0-33 (7/15) Replaces all oreviou� editions Form Paqe 5 a` 6