105 FREDRICA AVE NU.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
FREDRICA GREEN DEVELOPMENT, LLC
Policy Number:
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No.
105 NORTH FREDRICA AVENUE
Company NAIC Number:
City State ZIP Code
CLEARWATER FLORIDA 33755
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 2, FREDRICA TOWNHOMES - PARCEL # 15-29-15-29440-000-0020
A4. Building Use (e.g.,
A5. Latitude/Longitude:
A6. Attach at least
A7. Building Diagram
A8. For a building
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. 27.9671° N. Long.
Accessory, etc.) RESIDENTIAL
82.7828° W.
Horizontal Datum:
obtain flood insurance.
1.0 foot above adjacent
above adjacent grade
❑ NAD 1927
grade
x NAD 1983
N/A
2 photographs of the building if the
Number 1B
Certificate is being used to
N/A sq ft
with 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)
openings in the crawlspace
in A8.b N/A
sq
or enclosure(s) within
in
sq ft
within 1.0 foot
sq in
0
❑ Yes x No
garage:
garage 390
openings in the attached garage
in A9.b p
❑ 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 COUNTY
B3. State
FLORIDA
B4. Map/Panel
Number
12103C0108
B5. Suffix
H
B6. FIRM Index
Date
8-18-2009
B7. FIRM Panel
Effective/
Revised Date
5-17-2005
B8. Flood Zone(s)
X
B9. Base Flood Elevation(s)
(Zone AO, use Base
Flood Depth)
N/A
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
❑ NGVD
System
or base flood depth entered in Item B9:.
❑ Other/Source:
x FIRM
datum used
located in a
N/A
1929 IM NAVD 1988 • Other/Source:
(CBRS) area or Otherwise Protected
❑ OPA
Area (OPA)?
❑ Yes x No
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.
105 NORTH FREDRICA AVENUE
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* ❑ 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, AR/A1—A30,
Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only,
Benchmark Utilized: MAC DILL AFB 6 CORS ARP Vertical Datum: N.A.V.D. 1988
x
Finished Construction
AR/AH, AR/AO.
enter meters.
Indicate
elevation
•
datum
NGVD 1929
used
p
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
Top bottom floor (including basement, crawlspace, or enclosure floor) 24 . 85
x
the measurement used.
feet ❑ meters
a) of
b) Top the higher floor 34 90
x
feet ❑ meters
of next
the lowest horizontal structural member (V Zones only) N A
x
feet ❑ meters
c) Bottom of
Attached slab) 24 42
x
feet ❑ meters
d) garage (top of
equipment servicing the building 24 89
x
feet ❑ meters
e) Lowest elevation of machinery or
(Describe type of equipment and location in Comments)
Lowest next to building (LAG) 22 . 5
x
feet ❑ meters
f) adjacent (finished) grade
Highest (finished) next to building (HAG) 24 . 3
x
feet
•
meters
g) adjacent grade
lowest elevation of deck or stairs, including N . A
x
feet ❑ meters
h) Lowest adjacent grade at
structural support
SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect
I certify that the information on this Certificate represents my best efforts to interpret
statement may be punishable by fine or imprisonment under 18 U.S. Code, Section
Were latitude and longitude in Section A provided by a licensed land surveyor?
x
authorized by law
the data available.
1001.
Yes ❑ No
to
I understand
x
certify elevation information.
that any false
Check here if attachments.
Certifier's Name License Number
GEORGE A. SHIMP III 6137
Place
Seal
Here
1vv4' _/t lir J�
# 6137 Date: 5-18 2018
Title Job Number
VICE PRESIDENT 170390-B
Company Name
GEORGE A. SHIMP II & ASSOCIATES, INC.
3301 DeSOTO BOULEVARD, SUITE D
(Not valid unless embossed with
surveyor's original raised seal)
City State ZIP Code
PALM HARBOR FLORIDA 34683
Si 'ture
Date Telephone
5-18-2018 727-784-5496
—>�-
Aall
Copy pages es of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner.
g
Comments (including type of equipment and location, per C2(e), if applicable)
SEE ATTACHMENT PAGE 7 OF 7 FOR SURVEYOR'S NOTES AND COMMENTS. THIS
DOCUMENT IS NOT VALID UNLESS SIGNED AND EMBOSSED WITH THE SURVEYOR'S
ORIGINAL RAISED SEAL AND MUST CONTAIN ALL 7 PAGES.
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
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.
105 NORTH FREDRICA AVENUE
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, 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,
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),
•
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
this information in Section G.
E3. Attached garage (top of slab) is ❑ feet ❑ meters
E4. Top of platform of machinery and/or equipment
servicing the building is ❑ 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 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)
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.
105 NORTH FREDRICA AVENUE
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. ■ 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)
❑meters Datum
ill
feet
❑ feet
❑ feet
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.
omi Pag
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
105 NORTH FREDRICA AVENUE
., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
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.
Photo One
Photo One Caption FRONT VIEW
5-18-2018
Photo Two
Photo Two Caption REAR VIEW
5-18-2018
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 5 of 6
ELEVATION CERTIFICATE
BUILDING PHOTOGRAPHS
Continuation Page
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.
105 NORTH FREDRICA AVENUE
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 One Caption N/A
Photo Two
Photo Two Caption N/A
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
ELEVATION CERTIFICATE
Surveyor's Notes
Attachment Page 7
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.
105 NORTH FREDRICA AVENUE
Policy Number:
City State ZIP Code
CLEARWATER FLORIDA 33755
Company NAIC Number
SECTION D — SURVEYOR'S CERTIFICATION (CONTINUED FROM PAGE 2)
Al.) THIS ELEVATION CERTIFICATE WAS PREPARED EXCLUSIVELY FOR THE USE AND BENEFIT OF THE PARTY SPECIFIED IN
SECTION A, ITEM 1, FOR THE SPECIFIC PURPOSE OF OBTAINING FLOOD INSURANCE AND/OR VERIFYING FLOOD ZONE
COMPLIANCE WITH THE LOCAL GOVERNING AUTHORITY. THIS DOCUMENT SHALL NOT BE VALID AND BINDING AGAINST THE
SIGNING SURVEYOR WITHOUT THE ORIGINAL RAISED SEAL AND SIGNATURE OF THE FLORIDA LICENSED SURVEYOR AND
MAPPER. USE OF THIS DOCUMENT BY ANY OTHER PARTY OR FOR ANY OTHER PURPOSES IS STRICTLY PROHIBITED AND
SHALL RENDER THIS DOCUMENT INVALID FOR THOSE PURPOSES. UNAUTHORIZED COPIES ARE STRICTLY PROHIBITED AND
SHALL NOT BE VALID. REQUESTS FOR ANY ADDITIONAL OFFICIAL SIGNED AND SEALED COPIES MUST BE DIRECTED TO
GEORGE A. SHIMP II & ASSOCIATES, INC.
A4.) THE BUILDING USE WAS DETERMINED BY PHYSICAL OBSERVATIONS MADE ON THE DATE OF SURVEY.
A5.) THE LATITUDE AND LONGITUDE COORDINATES WERE OBTAINED USING A HAND HELD G.P.S. UNIT WHICH MEETS OR
EXCEEDS FEMA'S REQUIRED ACCURACY OF 66 FEET.
A7.) THE BUILDING DIAGRAM NUMBER WAS DETERMINED BY PHYSICAL OBSERVATIONS MADE ON THE DATE OF SURVEY.
CERTAIN STRUCTURAL FEATURES NOT VISIBLE TO THE SURVEYOR (PILINGS, GRADE BEAMS, ETC.) OR USE OF ANY AREAS
BELOW THE BASE FLOOD ELEVATION THAT DOES NOT COMPLY WITH FEMA REGULATIONS CAN AFFECT THIS
DETERMINATION.
A8.) FOR THE PURPOSE OF THIS DOCUMENT, A BUILDING ENCLOSURE IS DEFINED AS THAT PORTION OF AN ELEVATED
BUILDING, BELOW THE LOWEST ELEVATED FLOOR, THAT IS EITHER PARTIALLY OR FULLY SHUT IN BY RIGID WALLS. A
GARAGE BELOW OR ATTACHED TO AN ELEVATED BUILDING IS CONSIDERED AN ENCLOSURE. SUCH AREAS SHALL NOT
CONTAIN MORE THAN 20 LINEAR FEET OF FINISHED INTERIOR WALLS (PANELING, ETC.) OR IT WILL BE CONSIDERED A
FINISHED (HABITABLE) AREA.
IF APPLICABLE, THE STRUCTURE CONTAINS: ❑ CRAWLSPACE 0 ENCLOSURE ❑x ATTACHED GARAGE 0 N/A
IF APPLICABLE, THE CRAWLSPACE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER NIA SQ.
FT. PER OPENING (MANUFACTURER: N/A — MODEL: N/A ).
IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO
COVER N/A SQ. FT. PER OPENING (MANUFACTURER: N/A — MODEL: N/A ).
IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAINS: N/A
IF APPLICABLE, DOES THE BOTTOM FLOOR ENCLOSURE APPEAR TO CONTAIN BREAK -AWAY WALLS? 0 YES 0 NO ❑X N/A
A9.) IF APPLICABLE, THE ATTACHED GARAGE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER
N/A SQ. FT. PER OPENING (MANUFACTURER: N/A — MODEL: N/A ).
A8. & A9.) FOR THE PURPOSE OF THIS DOCUMENT, A FLOOD OPENING IS DEFINED AS A PERMANENT OPENING IN AN
EXTERIOR WALL THAT IS NO HIGHER THAN 1.0 FOOT ABOVE THE HIGHER OF THE EXTERIOR OR INTERIOR GRADE OR FLOOR
IMMEDIATELY BELOW THE OPENING.
B8.) UNLESS OTHERWISE NOTED IN SECTION B, ITEM 10, THE FLOOD ZONE WAS DETERMINED BASED ON THE FLOOD
INSURANCE RATE MAP. IN CERTAIN CASES WHERE AN ACCURATE DETERMINATION COULD NOT BE MADE FROM THE MAP,
FEMA'S INTERACTIVE MAP OR THE COUNTY'S G.I.S. OVERLAY MAY HAVE BEEN UTILIZED TO DETERMINE THE FLOOD ZONE.
NO SEARCH OF THE PUBLIC RECORDS WAS PERFORMED FOR LOMA'S, LOMR'S, ETC. WHICH MAY AFFECT THE SITE.
C2.e) AIR CONDITIONER LOCATED ON AN ELEVATED METAL PLATFORM.
Attachment Page 7 of 7