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38 LEEWARD ISLAND[ • 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 official, (2) insurance agent/company, and (3) building owner. SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Zoran Triin Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 38 Leeward Island Company NAIC Number: City State ZIP Code Clearwater Florida 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 4, Island Estates of Clearwater, Unit 1, Plat Book 44, Page 62, Parcel #08-29-15-43308-000-0040 A4. Building Use (e.g., A5. Latitude/Longitude: A6. Attach at least A7. Building Diagram A8. For a building with a) Square footage b) Number of permanent c) Total net area d) Engineered A9. For a building with a) Square footage b) Number of permanent c) Total net area d) Engineered Residential, Non -Residential, Addition, Lat. 27 58' 35.03" N Long. 82 Accessory, etc.) Residential 48' 52.08" W Horizontal Datum: ❑ obtain flood insurance. 1.0 foot above adjacent above adjacent grade NAD 1927 grade 0 NAD 1983 27 2 photographs of the building if the Certificate Number 7 is being used to 3,415 sq ft a crawispace of crawlspace flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? or enclosure(s): or enclosure(s) openings in the crawispace in A8.b 3,456 sq or enclosures) within in ft within 1.0 foot sq in 0 sq ❑ Yes © No garage: garage 0 openings in the attached garage in A9.b 0 ❑ Yes ❑x No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NFIP Community Name Community Number City of Clearwater 125096 B2. County Name Pinellas 83. State Florida B4. Map/Panel Number 12103C0102 B5. Suffix G B6. FIRM Index Date 08/18/2009 B7. FIRM Panel Effective/ Revised Date 09/03/2003 B8. Flood Zones) AE B9. Base Flood Elevation(s) (Zone AO, use Base Flood Depth) 11 feet B10. Indicate the source ❑ FIS Profile B11. Indicate elevation 812. Is the building Designation Date: of the Base Flood Elevation (BFE) ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ CBRS data 0 NGVD System or base flood depth entered in Item B9: ❑ Other/Source: x FIRM datum used located in a 1929 x❑ NAVD 1988 ❑ Other/Source: (CBRS) area or Otherwise Protected Area (OPA)? ❑ OPA ❑ Yes p No FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 RECEIVED BY: J.A.W. SEP 0 8 2020 PLANNING & DEVELOPMEN CITY OF CLEARWATER 38 LEEWARD ISL BCP2016-11417 ec ZORAN TRLIN Zoning: Island Estates Atb ELEVATION CERTIFICATE 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. 38 Leeward Island Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) 0 Finished Construction AR/A1—A30, AR/AH, AR/AO. Rico only, enter meters. Cl. Building elevations are based on: ❑ Construction Drawings* ■ Building Under 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, Vi V30, V (with BFE), AR, AR/A, ARAE, Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Benchmark Utilized: City of Clearwater Bench Mark Vertical Datum: "G-04.5", 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 a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 6. 3 the measurement used. x feet ❑ meters Q feet 0 meters J feet ❑ meters b) Top of the next higher floor 17 3 c) Bottom of the lowest horizontal structural member (V Zones only) N/A d) Attached garage (top of slab) N/A x feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 13 2 x feet In meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 5. 7 x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 6 0 x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including 5.8 p 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 I certify that the information on this Certificate represents my best efforts to interpret the data available. statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001. law to certify elevation information. I understand that any false 0 Check here if attachments. Were latitude and longitude in Section A provided by a licensed land surveyor? x Yes 0 No Certifiers Name License Number Donald E. Armstrong Jr. PLS #5083 So el / /lam s..ARMS?p t►F'> , CYNO. 5083 • 70 A STATE OF -. c+ � cet� Title Owner/Manager/Registered Land Surveyor Company Name Don Armstrong Land Surveying, LLC LAW Address 2187 N. Green Ridge Place #04 s 21 "3 / �� City State ZIP Code Palm Harbor Florida 34683 Signature Date Telephone /' 03/01/2018 (727) 772-8134 Copy all ages of this levation 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) Latitude and Longitude were determined using Google Maps. C2(e) is Air Conditioners on raised metal stands located on the North wall of building. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE 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. 38 Leeward Island Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIC Number 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 complete Sections A, B,and C. For Items El—E4, use natural grade, if available. Check the measurement enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑meters LOMA or LOMR-F request, used. In Puerto Rico only, the elevation is above or below ❑ above or ❑ below the HAG. ® above or ❑ below the LAG. 9 (see pages 1-2 of Instructions), 0 above or 0 below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is 0 feet ❑ meters E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or the next higher floor (elevation C2.b in the diagrams) of the building is ■ feet ❑ meters E3. Attached garage (top of slab) is [ feet ❑ meters ❑ above or ■ below the HAG. ❑ above or [] below the HAG. with the community's certify this information in Section G. _ _ . - E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet [l meters E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance floodplain management ordinance? [] Yes [; No ❑ Unknown. The local official must SECTION F — PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owners 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 ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE 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. 38 Leeward Island Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIC Number SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance Sections A, B, C (or E), and 0 of this Elevation used in Items 08—G10. In Puerto Rico only, enter to administer the community's floodplain management ordinance can complete Certificate. Complete the applicable item(s) and sign below. Check the measurement meters. from other documentation that has been signed and sealed by a licensed surveyor, by law to certify elevation information. (Indicate the source and date of the elevation E for a building located in Zone A (without a FEMA -issued or community -issued BFE) is provided for community floodplain management purposes. G1. III The information in Section C was taken engineer, or architect who is authorized data in the Comments area below.) G2 • A community official completed Section or Zone AO. G3. 0 The following information (Items (34—G10) G4. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued G7. This permit has been issued for: 0 G8. Elevation of as -built lowest floor (including of the building: G9. BFE or (in Zone AO) depth of flooding at the G10. Community's design flood elevation: New Construction El Substantial Improvement basement) 0 feet n meters Datum 0 meters Datum LII meters Datum building site: III feet feet Local Official's Name Title Community Name Telephone ,.. Signature Date Comments (including type of equipment and location, per C2(e), if applicable) 38 LEEWARD ISL BCP2016-11417 ec ZORAN TRLIN Zoning: Island Estates Atlas #: 267B 0 Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. 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. 38 Leeward Island Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIC Number 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. _ m 4k .e€ s `A.r yy " t • L rt I{ rpt Photo One Photo One Caption Front View 03/01/2018 A tt 11 l rt t. s amt g 'a 4 j 3 �'`{:K � a T iii � ,- � F , .�, •�' r '� �, . ti .. Photo Two Photo Two Caption Rear View 03/01/2018 FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS OMB No. 1660-0008 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. 38 Leeward Island Policy Number: City Clearwater State ZIP Code Florida 33767 Company NAIC Number 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 Caption Vent 03/01/2018 Photo Two Caption Vent 03/01/2018 Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 V ZONE DESIGN CERTIFICATE Name c7?AL SAN©S gESogr Policy Number (insurance Co. Use) Building Address or Other Description 41--e.) 5 . G U LF V I rw 13 Permit No.'2614-01425 City C�LIIA'i�"T? 2 State FL. Zip Code 337637 SECTION I: Flood Insurance Rate Map (FIRM) Information Community No. l2 C79(o Panel No.12-10Volortuffix _ FIRM Date *5115109 FIRM Zone(s)yE SECTION ll: Elevation Information Used for Design [NOTE: This section documents elevations used in the design - it does not substitute for an Elevation Certificate.] 1. Elevation of the Bottom of Lowest Horizontal Structural Member .... .16.6 feet (NAVD88) 2. Base Flood Elevation (BFE) Li.. D feet (NAVD88) 3. Elevation of Lowest Adjacent Grade ......4 G feet (NAVD88) 4. Approximate Depth of Anticipated Scour/Erosion used for Foundation Design feet (NAVD88) 5. Embedment Depth of Pilings or Foundation Below Lowest Adjacent Gradegip.- eet (NAVD88) SECTION III: V Zone Design Certification Statement (NOTE. This section must be certified by a registered engineer or architect.] I certify that: (1) I have developed or reviewed the structural design, plans, and specifications for construction and (2) that the design and methods of construction to be used are in accordance with accepted standards of practice for meeting the following provisions: • The bottom of the lowest horizontal structural member of the lowest floor (excluding piles and columns) is elevated to or above the BFE; and • The pile and column foundation and structure attached thereto is anchored to resist flotation, collapse, and lateral movement due to the effects of the wind and water Toads acting simultaneously on all building components. Water loading values used are those associated with the base flood. Wind loading values used are those required by the applicable State or local building code. The potential for scour and erosion at the foundation has been anticipated for conditions associated with the base flood, including wave action. SECTION IV: Breakaway Wall Design Certification Statement [NOTE. This section must also be certified by a registered engineer or architect when breakaway walls exceed a design safe loading resistance of24 pounds per square foot.] I certify that (1) I have developed or reviewed the structural design, plans, and specifications for construction and (2) that the design and methods of construction to be used for the breakaway walls are in accordance with accepted standards of practice for meeting the following provisions: • Breakaway wall collapse shall result from a water load less than that which would occur during the base flood; and • The elevated portion of the building and supporting foundation system shall not be subject to collapse, displacement, or other structural damage due to the effects of wind and water loads acting simultaneously on all building components (wind and water loading values to be used are defined in Section III). SECTION V: Certification and Seal This certification is to be signed and sealed by a registered professional engineer or architect authorized by law to certify structural designs. 1 certify the V Zone Design Certification Statement in Section 111 and the Breakaway Wall Design Certification Statement in Section IV (if applicable). i% Irart" .At,Pr1rY1E 4' -(S1 Certifier's Name License Number VF. M GC A4- E -T-1- A- S5 e' C. S t INC. Title Company Name 2 Nu ase -e)-(- Roc.. .1 e c. w-rg FL- 33 Coq - Ad• City State ZIP / '��+'�R Lt,,,,,,,_ j SiI t I /la 72.7 -53 ' -S772? Sign. Date elephone ELEVATION CERTIFICATE 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. 38 Leeward island Policy Number. City State ZIP Code Clearwater Florida 33767 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) ❑ Finished Construction AR/A1 A30, AR/AH, AR/AO. Rico only, enter meters, C1. Building elevations are based on: ❑ Construction Drawings* x Building Under 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, Complete Items C2_a—h below according to the building diagram specified in Item A7. In Puerto Benchmark Utilized: City of Clearwater Bench Mark Vertical Datum: "G- 04.5 ", NAVD -1988 Indicate elevation datum used for the elevations in items a) through h) below. 0 NGVD 1929 x NAVD 1988 ❑ Other /Source: Datum used for building elevations must be the same as that used for the BFE, a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 6. 3 Check the measurement used x feet 0 meters b) Top of the next higher floor 17 3 x feet [] meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A x feet ❑ meters d) Attached (top of slab) N/A x feet • meters garage Lowest of machinery or equipment servicing the building N/A x feet 0 meters e) elevation (Describe type of equipment and location in Comments) f) Lowest (finished) next to building (LAG) 6. 0 MI feet ❑ meters adjacent grade Highest adjacent (finished) grade next to building (HAG) 6. 2 x feet ❑ meters g) at lowest elevation of deck or stairs, including N/A. x feet ❑ meters h) Lowest adjacent grade 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 1 certify that the information on this Certificate represents my best efforts to interpret the data available. statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. law to certify elevation information. I understand that any false ❑ Check here if attachments. longitude in Section A by a licensed land surveyor? x Yes ❑ No Were latitude and provided Certifier's Name License Number Donald E. Armstrong Jr. PLS #5083 1, Q' ,.c soa3 STATE of sr steam J Title Owner /Manager /Registered Land Surveyor Company Name Don Armstrong Land Surveying, LLC LAS Address 2187 N. Green Ridge Place ���� /�, '4. /j%„ ez r f City State ZIP Code Palm Harbor Florida 34683 Signature / Date Telephone / 03/31/2017 (727) 772 -8134 Copy all sages of is Elevation 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) Latitude and Longitude were determined using Google Maps. Building under construction, no Machinery installed and Smart Vents not installed yet. C,....,-., D-,. 7 of R FEN1A Form 086 -0 -33 (7115) ces all previous editions. 9 ELEVATION CERTIFICATE OMB No. 1660 -0008 IMPORTANT: In these spaces, copy the corresponding information from Section A. .....rn ...VI uaic. wuVC111UCr 3U, LUI tS FOR INSURANCE COMPANY USE Building Street Address (including Apt, Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 38 Leeward Island Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIC Number 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 complete Sections A, B,and C. For Items E1—E4, use natural grade, if available. Check the measurement enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, LOMA or LOMR -F request, used. In Puerto Rico only, the elevation is above or below ❑ above or ❑ below the HAG. crawlspace, or enclosure) is ❑ feet • meters 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 the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters 9 (see pages 1 -2 of Instructions), • 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. with the community's this information in Section G. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance floodplain management ordinance? • Yes • No • Unknown. The local official must certify 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 ❑ Check here if attachments. FEMA Form 086 -0-33 (7/15) wlaces all previous editions, =orm Page 3 of 6 ELEVATION CERTIFICATE OMB No. 1660 -0008 Expiration Date: 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. 38 Leeward Island Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIC Number 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 ❑ feet ❑ feet ❑feet ❑ meters Datum G7. This permit has been issued for: • New Construction [] Substantial Improvement GS. Elevation of as -built lowest floor (including of the building: G9. BFE or (in Zone AO) depth of flooding at G10. Community's design flood elevation: basement) the building site: ❑ meters Datum ❑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 ELEVATION CERTIFICATE See Instructions for Item A6. 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. 38 Leeward Island City Clearwater OMB No. 1660-0008 Expiration Date: November 30, 2018 FOR INSURANCE COMPANY USE Policy Number. State ZIP Code Florida 33767 Company NAIC Number 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 03/31/2017 Photo Two Caption Rear View 03/31/2017 FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS OMB No 1660-0008 Continuation Page Expiration Date: November 30, 2018 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. 38 Leeward Island FOR INSURANCE COMPANY USE Policy Number: City Clearwater State ZIP Code Florida 33767 Company NAIC Number 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 One Caption Outside Vent 03/31/2017 Photo Two Photo Two Caption Inside Vent 03/31/17 FEMA Form 086 -0-33 (7/15) Replaces ail previous editions. Form Page 6 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 official, (2) insurance agent/company, and (3) building owner. SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Zoran Triin Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 38 Leeward Island Company NAIC Number. City State ZIP Code Clearwater Florida 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 4, Island Estates of Clearwater, Unit 1, Plat Book 44, Page 62, Parcel #08- 29 -15- 43308- 000 -0040 A4. Building Use (e.g., A5. Latitude/Longitude: A6. Attach at least 2 A7. Building Diagram A8. For a building with a) Square footage b) Number of permanent c) Total net area d) Engineered A9. For a building with a) Square footage b) Number of permanent c) Total net area d) Engineered Residential, Non - Residential, Addition, Lat. 27 58' 35.03" N Long. 82 Accessory, etc.) Residential 48' 52.08" W Horizontal Datum: ❑ obtain flood insurance. 1.0 foot above adjacent above adjacent grade NAD 1927 grade x NAD 1983 19 photographs of the building if the Certificate Number 7 is being used to 3,415 sq ft a crawispace of crawlspace flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? or enclosure(s): or enclosure(s) openings in the crawispace in A8.b 3,800 sq or enclosure(s) within in ft within 1.0 foot sq in 0 sq x Yes • No garage: garage 0 openings in the attached garage in A9.b 0 ❑ Yes x No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number City of Clearwater 125096 B2. County Name Pinellas B3. State Florida B4. Map /Panel Number 12103C0102 85. Suffix G B6. FIRM Index Date 08/18/2009 B7. FIRM Panel Effective/ Revised Date 09/03/2003 B8. Flood Zone(s) AE B9. Base Flood Elevation(s) (Zone AO, use Base Flood Depth) 11 feet B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation Date: of the Base Flood Elevation (BFE) ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ CBRS data or base flood depth entered in Item B9: ❑ Other /Source: p FIRM datum used located in a 1988 ❑ Other /Source: or Otherwise Protected Area (OPA)? • NGVD 1929 • NAVD System (CBRS) area ❑ OPA • Yes © No FEMA Form 086 -0 -33 (7/15) Replaces all previous editions. Form Page ? of 6 U.S. DEPARTMENT OF HOMELAND SECURITY OMB No_ 1660-0008 Federai Emergency Management Agency Expiration Date_ wovember 30, 2018 National Flood insurance Program ELEVATiON CERTIFiCATE lmportant: Follow the instructions on pages 1-9. Copy all pages of this Elevation Certficate and all attachments for (1) communitv official_ (2t insuranrp ar,p�r�r.,�„��.,�, ��,� ��� ti,.:�, .:.... ........._ - . . . .. _ _ _ _a_"_ __".'._..�, ...... �..� v..nv�ny vonc�. SECTION A— PROPERTY INFORMATION FOR INSURANCE COMPANY USE A1. Building Ovmer's Name Policy Number. Zoran Trlin A2. Building Street Address (inGuding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number. 38 Leeward Istand City State ZIP Code Clearwater Florida 33767 A3. Property Descxiption (Lot and Block Numbers, Tax Parcel IVumber, Legal Description, etc.) Lot 4, Island Estates of Glearvvater, Unit 1, Plat Book 44, Page 62, Parcel #0&29-15-43308-000-0040 A4. Building Use (e.g., Residential, Non-Residerrtial, Addition, Accessory, etc.) Residential A5. Latitude/Longitude: lat. 27 58' 35_03" N Long. 82 48' 52.08" W Horizontal Datum: � NAD 1827 [�x NAD 1983 A6. Attach at �east 2 photographs of the building if the Cefificate is 6eing used to obtain flood insurance. A7. Building Diagram Number 7 A8. For a building with a crawfspace or enGosure(s): a) Square footage of crawlspace or enclosure(s) 3,415 sq ft b) Number of permanent flood apenings in the crawlspace or endosure(s) within 1.0 foot above adjacerrt grade 19 c) Total net area of fl�d openings in A8.b 3.800 sq in d) Engineered flood openings? � Yes ❑ No A9. For a buiiding with an attached garage: a) Square footage of attached garage 4 sq ft b) Number of permanent flood apenings in the attached garage within 1_0 foot above adjacent grade 0 c) Total net area of fiood openings in A9.b 0 sq in d) Engineered flood openings? � Yes � No SECTION B— FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NFIP Communiry Name 8� Communiry Number 62. County Name 63. State City of Clearvwater 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) 12103C0102 G 08/18/2009 09/03/2�3 AE . 11 feet B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69: ❑ FIS Profile x� FIRM � Community Determined ❑ Other/Source: B11. Indiqte elevation datum used for BFE in Item B9: ❑ NGVD 1929 Q NAVD 1988 ❑ OtheNSource: 812. Is the building loc�ated in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected AreB {OPA)? [] Yes (�x No Designation Date: � CBRS ❑ OPA FEMA Form 086-0-33 (7i15) Replaces all previous editions. Form Page 1 of 6 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 Buiiding Street Address (inGuding Apt, Unit, Suite, and/or Bldg_ No.) or P.O. Route and Box No_ Policy Number: 38 Leeward Island City State ZIP Code mpany NA um r Clearvvater Florida 33767 SECTION C- BUiLDING ELEVATION INFORAAATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings' �x Building Under Construction` ❑ Finished Construdion 'A n�ro Elevation Certificate will be required when constrvetion of the building is complete. C2. Elevations - Zones A1-A30, AE, AH, A(with BFE), VE, V1 V30, V(witt� BFE), AR, AR/A, AR/AE, AR/A1�30, AR/AH, AR/AO. Complete Items C2.a-fi below according to the building diagram specified in Item A7. In Puerto Rico only, errter meters. Benchmark Utilized: City of Clearwater Bench Mark Vertical Datum: "G-04.5", NAVD-1988 Indicate elevation datum used inr 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_ Chedc the measurement used. a) Top of bottom floor (induding basement, crawlspace, or enclosure floor) 6 3 �x feet ❑ meters b) Top of the next higher floor ��. 3 Qx feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones onfy) N�A. � feet ❑ meters d) Attached garage (top of slab) N�A. � feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building N�A. �x feet ❑ meters (Describe type of equipment and IopUon in Comments) � Lowest adjaceat (flnished) grade next to building (LAG) 6 0 �x feet ❑ meters g) Highest adjaceM (finished) grade next to building (HAG) 6 2 Ox feet ❑ meters h) Lowest adjacerrt grade at lowest elevation of dedc or stairs, including ��A. Qx feet ❑ meters structurat support SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This c�ertification is to be signed and sealed by a land surveyor, engineer, or arc�itect authorized by faw to certify elevation infiormation. ! certify that the infomraSon on this Certifrcate represents my best efforts to inferp�t the data available. 1 understand that any fa/se statement may be punishable by fine or impri�'►ment under 18 U. S. Code, Sedion 1001. Were latitude and longitude in Section A provided by a licensed land surveyor'? � Yes ❑ No ❑ Check here if attachmertts. Certifier's Name License Number - Donald E. Armstrong Jr_ PLS #15083 �,. �tsF� .;. t, Title �c�;��'F � -" OvmedManagerlRegistered Land Surveyor � ; � �`',. � � � , -a 9, : Company Name �'�. � • ; � = Don Armstrong Land Surveying, LLC �`� ;'"` ��� � �+ . �� � � °�; � AC�dC25S ' .., �• " �`e� 2187 N. Green Ridge Place ,��� . '' '`,: °Jt` ��'�'����'r City State ZIP Code „t Patm Harbor Florida 34683 ,. -'� P�[ g sa B3 Signature Date Telephone " 03/31/2017 (727) 772-8134 Copy all ges of is Elevation Certficate and all attachments for (1) community official, {2) insurance ageirt/company, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) Latitude and Longitude were determined using G�gle Maps. Building under construction, no Machinery installed and Smart Vents not installed yet FEMA Form 086-0-33 (7/15) Replaces all previous ed+tions. rvnn r-age � or o OMB No. 1660-0008 ELEVATION CERTIFICATE Expiration Date: November 30, 2o�s IMPORTANT: tn ti�ese spaces, copy the cort�esponding information from Secfion A. FOR INSURANCE COMPANY USE Building Street Address (inctudi�g Apt, Unit, Suite, andlor Bidg. No.) or P.O. Route and Box No. Policy Number: 38 Leeward isiand City State ZIP Code Company NAIC Number Clean�vater Florida 33767 SECTION E— BUILDING ELEVATION lNFORMATlON (SURVEY NOT REQUtRED) FOR ZOWE 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, comptete Sections A, B,and C. For Items E1—E4, use natural grade, if available. Chedc the measuremerrt used_ In Puerto Ria� only, enter meters. E1 _ Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below riie highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (inGuding basement, crawlspace, or enGosure) is . ❑ feet ❑ meters ❑ above or ❑ befaw the HAG. b} Top of bottom floor (including basement, crawlspace, or endosure) 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 fl�r (elevafio� 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 andlor equipment servicing the bwlding is . ❑ feet ❑ meters ❑ above or ❑ betow the HAG. E5. Zone AO only: If no flvod depth number is availabfe, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? � Yes ❑ No ❑ Unknown_ The local officiat must certify this information in Sedi� G. SECTION F— PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owners authorized representative who completes Sections A, B, and E for Zone A(without a FEMA-issued or �mmuniry-issued BFE) or Zane AO must sign here. The statements m Sedions A, B, and E are correct to the best of my knowledge_ Property Owner or Ovmer's Authorized Represerrtative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments. FEMA Fortr� 086-0-33 (7115) Replaces af1 previous editions_ Form rage s or s OMB No. 1660-0008 ELEVATION CERTiFICATE Expiration Date: November 30, 20�s IMPORTANT: tn these spaces, copy the corresponding information from Section A. FOR INSURAIVCE COMPANY USE Buiiding Street Address {induding Apt, Unit, Suite, and/or Bidg. No_) or P.O. Route and Box No. Policy Number: 38 Leeward island C�ty State ZIP Code Company NAIC Number Clearwater Fiorida 33767 SECTION G - COMMUNITY INFORMATION (OPTIONAL) The la�l officiai 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 Certific�e. Complete the applicable item(s) arui sign belowr_ Checic the measurement used in Items G8-G10. In Puerto Rico only, ente� 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 belanr.) G2 � A COmmutidy offiCial compieted SeClion E for a building Voceted in Zone A(without a FEMA-issued or �mmunity-i�uoci BFE) or Zone AO. G3. ❑ The following information (ltems G4-G10) is provided fior community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certifiqte of Compliar►celOca�pancy Issued G7. This permit has been issued for. ❑ IVew Construction ❑ Substantial Improvement G8. Elevation of as-bui{t {owest floor (induding basement) �{�} � 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 �fficial's Name TiNe Community Name Tefephone Signature Date Comments {including type of equipment and Iocation, per C2(e), if applicable) ❑ Check here if attachments. C�.em C�nn d nf f. FEMA Fortn OSfrO-33 i7/15) rcepiac:es ai� p� �v�uus c„��.,� ��. BUILDiNG PHOTOGRAPHS o�ne No. �sso-oopa ELEVATION CERTIFICATE See tnstructions for Item A6. F�cpiration Date: November 30, 2018 IMPORTANT: in these spaces, copy the corresponding information ftom Section A. FOR INSURANCE COMPANY USE Buiiding StreetAddress {inGuding Apt., Unit, Suite, and/or Bldg. No.) or P_O. Route and Box No. Policy Number: 38 Leeward Island City State ZIP Code Company NAIC Number Clearwater Florida 33767 If using the Elevation Cefificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions fnr Item A6. Iderrtify all photagraphs with date taken; "Front Vewr" and "Rear Uew"; and, if required, "Right Side Vew" 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. �=. t-„r r �. � :,, _ �.�ua ° ��?w��'""'�" ..ri.;�''w �,�..� - �. .. � �,� '� � � � i :: � �' � ;� <�� ,a.:+; - _�'°- �. . ,� , j t , . � � � ;.: I Iq,l� i �I "i ki',� ,��,�.I , _.si� � ' . l.:�T`� T � '�l��ll s . � . � i � -sqk S i t . �. �°3s 9h � . , . . , � , . � ` " . �.� , �4 . � � , ,.,� � .. � , . �, �` - _. . . < < # r� i � . �,:�: ��L �' --y.'` -L. 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FOR INSURANCE COMPANY USE Building Street Address (inGuding Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No. Poliay Number: 38 Leeward Island C�tY 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 Vew" and "Left Side Vew." When applicable, photographs must show the foundation with represerrtative examples of the flood openings or vents, as indicated in Sedion A8. � _. � �� r _ , _,� .. , � �� ,�.� � _ � � - : - �._� v . _ - - � � '� � � .,`�� � ' � � y ;: �� } �, �_ ,y ,� ,� ° ` � ; :� �' '�' �� � � � -� � . ` �` �= �.,.�' A � . �� � '� ., `. � � �' ,� �� . �.,� � n � N � � �`� „ : . -- N. -;.�-y.,�+�"'�.�s.'�# � � � � _ �• - - - � , ,'._ , � _ . �.. �- _ ' _ �> a✓`. y �4. �.. 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