18675 US HWY 19 #243U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICATE
OMB No. 1660-0008
Expiration Date: November 30, 2018
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
Policy Number:
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No.
18675 U.S. 19 Lot 243
Company NAIC Number.
City State ZIP Code
Clearwater Florida 33982
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Lot 243 BAY ARISTOCRAT VILLAGE
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
c) Total net area
d) Engineered
A9. For a building with
a) Square footage
b) Number of
c) Total net area
d) Engineered
Residential, Non -Residential, Addition,
Lat. N27°56'34.54" Long. W82°43'32.46"
Accessory, etc.) Residential
Horizontal Datum:
obtain flood insurance.
1.0 foot above adjacent
above adjacent grade
❑ NAD 1927
grade
Q NAD 1983
0
2 photographs of the building if the
Number 5
Certificate is being used to
1,360 sq ft
with a crawlspace
of crawlspace
permanent flood
of flood openings
flood openings?
an attached
of attached
permanent flood
of flood openings
flood openings?
or endosure(s):
or enclosure(s)
openings in the crawlspace
in A8.b 0
sq
or endosure(s) within
in
sq ft
within 1.0 foot
sq in
0
❑ Yes X No
garage:
garage 0
openings in the attached garage
in A9.b 0
❑ Yes Q No
SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number
Clearwater, City of 125096
B2. County Name
Pinellas County
B3. State
Florida
134. Map/Panel
Number
FM12103C0128
B5. Suffix
G
B6. FIRM Index
Date
08/03/2003
B7. F RM Panel
Effective/
Revised Date
08/03/2003
B8. Flood Zone(s)
AE
B9. Base Flood Elevation(s)
(Zone AO, use Base
Flood Depth)
9'
B10. Indicate the source
❑ FIS Profile
B11. Indicate elevation
612. 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:
FA FIRM
datum used
located in a
1988 ❑ Other/Source:
or Otherwise Protected
18675 US
1929 0 NAVD
(CBRS) area
❑ OPA
Area (OPA)?
HIGHWAY
❑ Yes 0 No
19 24
FEMA Form 086-0-33 (7/15)
ELEVATION CERTIFICATE
BCP2O17-12686A Q 1/1/1q.,
Replaces all previous editionsLARK, MARK A
Zoning:
Atlas #: 318A
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.
18675 U.S. 19 Lot 243
Policy Number.
City State ZIP Code
Clearwater Florida 33982
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: 872-6689 1 Vertical Datum: NAVD 1988
Finished Construction
AR/AH, AR/A0.
enter meters.
Indicate elevation datum
❑ NGVD 1929
used
M
for the elevations
NAVD 1988
■
in items a) through h) below.
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, crawispace, or enclosure floor) 9. 30
M
the measurement used.
feet ❑ meters
b) Top of the next higher floor n/a
x
feet ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only) n/a
x
feet ❑ meters
d) Attached garage (top of slab) n/a
p
feet •
meters
e) Lowest elevation of machinery or equipment servicing the building 9 3
x
feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 4. 6
x
feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 4. 7
x
feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including 4. 7
x
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 information on this Certificate represents my best efforts to interpret the data available. I understand that any false
statement maybe 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 ❑ No ❑ Chet h if rhments.'
Certifiers Name License Number
Michael David Hutchinson 6280
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Title
Professional Surveyor and Mapper
Company Name
NIA/
Address
2313 Ray Road
City State ZIP Code
Valrico Florida 33594
Date Telephone
Signatu `�
�� j �� 03/26/2018 (813) 817-6151
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)
A8. Area under home is open
C2 -e Air Conditioner on platform
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.
18675 U.S. 19 Lot 243
Policy Number:
City State ZIP Code
Clearwater Florida 33982
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),
❑ 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.
b) Top of bottom floor (including basement,
crawlspace, or endosure) 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
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
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
i.
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.
18675 U.S. 19 Lot 243
Policy Number:
City State ZIP Code
Clearwater Florida 33982
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.
01. ❑ 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)
❑ 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
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.
18675 U.S. 19 Lot 243
Policy Number:
City State ZIP Code
Clearwater Florida 33982
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 and West side (with A/C unit) of home
Photo Two
Photo Two Caption Rear and East side of home
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 5 of 6
ELEVATION CERTIFICATE
GM, Itvvnw rnv 1 vvrvyrn.J
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.
18675 U.S. 19 Lot 243
Policy Number:
City State ZIP Code
Clearwater Florida 33982
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
Photo One Caption
Photo Two
Photo Two
Photo Two Caption
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 6 of 6