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1048 IROQUOIS STU.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE OMB No. 1660 -0008 Expiration Date: November 30, 2018 1708.2890EC 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 (3) building owner. SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name CTV CAPITAL LLC Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 1048 IROQUOIS STREET Company NAIC Number: City State ZIP Code CLEARWATER FLORIDA 33755 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOTS 28, 29 AND 30 IN BLOCK E OF REVISED PLAT NAVAJO PARK, ACCORDING TO THE MAP OR PLAT THEREOF AS RECORDED IN PLAT BOOK 7, PAGE 63 OF THE PUBLIC RECORDS OF PINELLAS COUNTY, FLORIDA. 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. 27.9856238 Long. - 82.7937981 Accessory, etc.) RESIDENTIAL Horizontal Datum: ❑ obtain flood insurance. 1.0 foot above adjacent above adjacent grade NAD 1927 grade 0 f7 NAD 1983 2 2 photographs of the building if the Certificate Number 8 is being used to sq ft a crawlspace of crawlspace flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? or enclosure(s): or enclosure(s) 720 openings in the crawlspace in A8.b 708 sq or enclosure(s) within in ft within 1.0 foot sq in sq ❑ Yes ri No garage: garage 0 openings in the attached garage in A9.b 0 ❑ Yes fl No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number THE CITY OF CLEARWATER 125096 B2. County Name PINELLAS B3. State FLORIDA B4. Map /Panel Number 12103C - 0106 85. Suffix H B6. FIRM Index Date 5/7/2005 B7. FIRM Panel Effective/ Revised Date 5/17/05 B8. Flood Zone(s) AE 89. Base Flood Elevation(s) (Zone AO, use Base Flood Depth) 11 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 data ❑ NGVD System or base flood depth entered in Item B9: ❑ Other /Source: ri FIRM datum used located in a 1988 ❑ Other /Source: or Otherwise Protected 1929 x NAVD (CBRS) area ❑ OPA Area (OPA)? ❑ Yes x No II CBRS FEMA Form 086 -0 -33 (7/15) Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE 1708.2890EC 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. 1048 IROQUOIS STREET Policy Number: City State ZIP Code CLEARWATER FLORIDA 33755 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* *A new Elevation Certificate will be required when construction of the C2. Elevations — Zones A1—A30, AE, AH, A (with BFE), VE, V1 —V30, V Complete Items C2.a —h below according to the building diagram specified Benchmark Utilized: L -NET REALTIME NETWORK (GPS) :: Vertical fl building (with Datum: Building Under Construction* ❑ Finished Construction is complete. BFE), AR, AR /A, AR /AE, AR /A1 —A30, AR /AH, AR/AO. in Item A7. In Puerto Rico only, enter meters. NAVD88 Indicate elevation datum used ❑ NGVD 1929 © for the elevations in items a) through h) below. 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) 10. 2 the measurement used. X feet ❑ meters El feet ❑ meters El feet ❑ meters El feet ❑ meters X feet ❑ meters X feet ❑ meters FA feet ❑ meters b) Top the next higher floor 12 8 of Bottom of the lowest horizontal structural member (V Zones only) NA c) d) Attached (top of slab) NA garage Lowest elevation of machinery or equipment servicing the building NA e) (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) next to building (LAG) 10. 1 grade Highest adjacent (finished) grade next to building (HAG) 10. 9 g) h) Lowest adjacent at lowest elevation of deck or stairs, including NA. X feet ❑ meters 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 law to certify elevation information. I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable 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 i7 No ❑ Check here if attachments. Certifier's Name License Number MARK A. JOHNSON 6572 fig. A. Jwhy ti t-c r1SE NU 2+ Title PROFESSIONAL SURVEYOR AND MAPPER v .P 6572 ° � c. w ,y Company Name EXACTA LAND SURVEYORS, INC Address 11940 FAIRWAY LAKES DRIVE SUITE 1 4,e, STATE A sro11. 0411 'IL suxVE't 8/30/2017 City State ZIP Code FT. MYERS FL 33913 Signature �_____ o, Date Telephone 8/30/2017 P: (866)735 -1916 Copy all pages of this 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) NOTE: C2.E = AC UNIT PAD. NOTE: THIS ELEVATION CERTIFICATE IS ONLY VALID FOR THE PERSON OR PERSONS NAMED ON THIS CERTIFICATE. FEMA Form 086 -0 -33 (7/15) Replaces all previous editions. orm rage o ELEVATION CERTIFICATE 1708.2890EC 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. 1048 IROQUOIS STREET Policy Number: City State ZIP Code CLEARWATER FLORIDA 33755 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, Band C. For Items El—E4, use natural grade, if available. Check the measurement enter meters. E1. 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. ❑ above or ❑ below the LAG. 9 (see pages 1 -2 of Instructions), crawlspace, or enclosure) is RI feet ❑ meters b) Top of bottom floor (including basement, crawlspace, or enclosure) is • 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 ❑ above or • below the HAG. ❑ above or ❑ below the HAG. ❑ above or ❑ below the HAG. with the community's certify this information in Section G. E3. Attached garage (top of slab) is x feet ❑ meters E4. Top of platform of machinery and /or equipment servicing the building is i7 feet ❑ 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 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) Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE 1708.2890EC 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. 1048 IROQUOIS STREET Policy Number: City State ZIP Code CLEARWATER FLORIDA 33755 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 G of this Elevation used in Items G8 —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. IN 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. ❑ The following information (Items G4 —G10) G4. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance /Occupancy Issued G7. This permit has been issued for: ❑ 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 ❑ Substantial Improvement basement) ❑ feet ❑ feet ❑ feet ❑ meters Datum 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 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. 1708.2890EC 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. 1048 IROQUOIS STREET Policy Number: City CLEARWATER State FLORIDA ZIP Code 33755 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. Front View Rear View Front View Date: 8/30/2017 Rear View Date: 8/30/2017 Right Side View Left Side View Right Side View: 8/30/2017 Left Side View: 8/30/2017 FEMA Form 086 -0 -33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Conti OMB No. 1660 -0008 • - - - -- - .7 - 1 /U8.ZOVUMU ^1./"0Own L.ICIL. I IV VCn WWI AU, LU 10 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. 1048 IROQUOIS STREET Policy Number: City State ZIP Code CLEARWATER FLORIDA 33755 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 Two Photo Three Photo Four FEMA Form 086 -0 -33 (7/15) Replaces all previous editions. Form Page 6 of 6