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309 LEBEAU STU.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important Read the instructions on pagr -.: SECTION A - PROPERTY INFORMA1 . Al. Building Owner's Name RICHARD ALLISON A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 309 LEBEAU STREET.. City CLEARWATER State FL ZIP Code 33755 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 7 & 1/2 OF LOT 8 , BLOCK "8" , NORTH SHORE PARK A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat.-27 59'10" Long. 82 47'53"" A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insura A7. Building Diagram Number 1 A8. For a building with a crawl space or enclosure(s), provide a) Square footage of crawl space or enclosure(s) N/A sq ft b) No. of permanent flood openings in the crawl space or enclosure(s) walls within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b sq in A9. For a bu a) SquE b) No. t walk I OMB No. 1660-0008 -Cutis; t ?R 74104 309 LEBEAU ST BCP2017-10348 rtc ALLISON HOME ADDITION Zoning: Low Medium Density ,A;;, RECEIVED NOV 1; 6 PANNING & DEVELOPMENT C> T 4CLEARWATER c) Tota SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name& Community Number CLEARWATER 125096 B2. County Name PINELLAS B3. State FLORIDA B4. Map/Panel Number B5. Suffix 66. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone Date Effective/Revised Date Zone(s) AO, use base flood depth) 12103C0106 G 9-03-03 9-03-03 AE 12.0 Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. 0 FIS Profile ►_ FIRM 0 Community Determined 0 Other (Describe) BI 1. Indicate elevation datum used for BFE in Item B9: 0 NGVD 1929 ® NAVD 1988 0 Other (Describe) B12. Is the budding located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑Yes No Designation Date 0 CBRS 0 OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: 0 Construction Drawings* 0 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-g below according to the building diagram specified in Item A7. Benchmark Utilized CLEARWATER "G-06" ***" Vertical Datum ***ELEV. 26.98 Conversion/Comrnents a) Top of bottom floor (including basement, crawl space, or enclosure floor)_ b) Top of the next higher floor c) Bottom of the lowest 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 in Comments) Lowest adjacent (finished) grade (LAG) Highest adjacent (finished) grade (HAG) f) g) Check the measurement used. 12.05 ® feet 0 meters (Puerto Rico only) N/A. ® feet 0 meters (Puerto Rico only) NA. 0 feet 0 meters (Puerto Rico only) 11..16 0 feet 0 meters (Puerto Rico only) 0 feet 0 meters (Puerto Rico only) 9.7 ® feet 0 meters (Puerto Rico only) 10.1 ® feet 0 meters (Puerto Rico only) 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. 0 Check here if comments are provided on back of form. Certifier's Name WILLIAM C. KEATING License Number LS #1528 Title LAND SURVEYOR AND MAPPER Company Name ALLIED SURVEYING Address 1275 NOR .' HLA ' AVE E City CLEARWATER State FL ZIP Code 33755 Signa_,r. 9 Date 12-20-07 Telephone 727-446-1263 Building Photographs See Instructions for Item A6. For Insurance Company Use: Aiding Street Address including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 309 LEBEAU STREET Policy Number ty State FI ZIP Code CLEARWATER FL. 33755 Company MSC Number using the Elevation Certificate to obtain NF(P flood insurance, affix at least two building photographs below according to e instructions for Item A6. Identify all photographs with: date taken; 'Front View" and Rear Vier"; and, if required, 'Right de View and 'Left Side View.' If submitting more photographs than will fit on this page, use the Continuation Page, flowing. FRONT PICTURES TARN : REAR 12/20/07 F U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFIC No. 1660-0008 ation Date: Novembe Important: Follow the instructions on pages 1 Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) i SECTION A — PROPERTY INFORMATION Al. Building Owner's Name RICHARD ALLISON A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route Box No. 309 LEBEAU STREET City State CLEARWATER FL A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Descriptio PARCEL ID: 04-29-15-61488-008-0070 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) A5. Latitude/Longitude: Lat. 27.9858426 Long. -82.7973246 Horizontal Datum: ❑ NAD 1927 0 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 5 309 LEBEAU ST BCP2017-10348 ADDITION ALLISON HOME ADDITION�� I V Zoning: Low Medium Density Ias #: 259B A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) 0.0 sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 0 c) Total 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 0.0 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 0.00 sq in d) Engineered flood openings? ❑ 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 FL B4. Map/Panel Number 12103C0106 B5. Suffix B6. FIRM Index Date 08/18/2009 B7. FIRM Panel Effective/ Revised Date 05/17/2005 B8. Flood Zone(s) AE B9. Base Flood Elevation(s) (Zone AO, use Base Flood Depth) 12.0 810. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: FIS Profile 0 FIRM ❑ Community Determined fl Other/Source: 811. Indicate elevation datum used for BFE in Item 89: NGVD 1929 NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 0 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 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. 309 LEBEAU STREET Policy Number: City State ZIP Code CLEARWATER FL 33755-1714 Company NAIL Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Rico C1. Building elevations are based on: ❑ Construction Drawings* ■ Building Under Construction* x 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, Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Benchmark Utilized: FDOT NETWORK Vertical Datum: NAVD88 AR/A1—A30, AR/AH, AR/AO. only, enter meters. 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. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 13.1 Check the measurement used. x feet ❑ meters b) Top of the next higher floor X feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) x feet • meters d) Attached garage (top of slab) x feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 11.4 X feet ❑ meters (Describe type of equipment and location in Comments) t) Lowest adjacent (finished) grade next to building (LAG) 9.9 X feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 10.3 Q 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 I 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. Were latitude and longitude in Section A provided by a licensed land surveyor? ❑ Yes X No Certifier's Name License Number MARK A. JOHNSON 6572-* -a.--_J°HN� / ���sE % / / 6572 , \, ' , 4 \ o\ STATE OF /q% F6 FLORIDA ,;,gf sr` �'11J / Title PSM Company Name Exacta Land Surveyors, Inc. Address 11940 FAIRWAY LAKES DRIVE SUITE 1 City State ZIP Code-AL'sURVE'i°¢% FT MYERS FL 33913 Signature Date Telephone 07/03/2017 (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. 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 3 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. 309 LEBEAU STREET Policy Number: City State ZIP Code CLEARWATER FL 33755-1714 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. 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, 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. b) Top of bottom floor (including basement, crawlspace, or enclosure) is 1:1 feet ❑ meters ❑ above or • below the LAG. 9 (see pages 1-2 of Instructions), ❑ 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. 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 X feet ❑ meters E3. Attached garage (top of slab) is ;i feet ❑ meters E4. Top of platform of machinery and/or equipment servicing the building is X 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, 8, 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, 201 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. 309 LEBEAU STREET Policy Number: City State ZIP Code CLEARWATER FL 33755-1714 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 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) ❑ meters Datum G1 feet ❑ meters Datum building site: F 1 feet ❑ meters Datum X feet 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. 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. 309 LEBEAU STREET Policy Number: City CLEARWATER State ZIP Code FL 33755-1714 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 7/3/2017 Photo Two Caption Rear 7/3/2017 FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 BUILDING PHOTOGRAPHS ELEVATION CERTIFICATE 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. 309 LEBEAU STREET Policy Number: City CLEARWATER State ZIP Code FL 33755-1714 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 Right 7/3/2017 Photo Two Caption Left 7/3/2017 FEMA Form 086-0-33 (7/15) Replaces all previous editions. 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