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814 LANTANA AVEU.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 EDWARD MITCHELL & SUSAN DECKER ROSS Policy Number: A2. Budding Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 814 LANTANA AVENUE Company NAIC Number: City State ZIP Code CLEARWATER FLORIDA 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) LOT 9, BLOCK 23, MANDALAY SUBDIVISION - PARCEL # 05- 29- 15- 54666- 023 -0090 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 a) Square footage b) Number of c) Total net area d) Engineered Residential, Non - Residential, Addition, Accessory, etc.) Lat. 27.9940° N. Long. 82.8254° W. RESIDENTIAL Horizontal Datum: obtain flood insurance. 1.0 foot above adjacent above adjacent grade ❑ NAD 1927 grade x NAD 1983 N/A 2 photographs Number with a crawlspace of crawlspace permanent flood of flood openings flood openings? with an attached of attached permanent flood of flood openings flood openings? of the building if the 1B Certificate is being used to N/A sq ft 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 4 ❑ Yes x No garage: garage 214 openings in the attached garage in A9.b *SEE NOTES x Yes ❑ 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 12103C0102 B5. Suffix G B6. FIRM Index Date 8 -18 -2009 B7. FIRM Panel Effective/ Revised Date 9- 3-2003 B8. Flood Zone(s) AE B9. Base Flood Elevation(s) (Zone AO, use Base Flood Depth) 11.0' 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 1988 ❑ Other /Source: or Otherwise Protected 1929 x NAVD (CBRS) area ❑ OPA Area (OPA)? ❑ Yes x No FEMA Form 086 -0 -33 (7/15) Replaces all previous editions. Form Page 1 of 8 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. 814 LANTANA AVENUE Policy Number: City State ZIP Code CLEARWATER FLORIDA 33767 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) 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 Al A30, AE, AH, A (with BFE), VE, V1 —V30, V (with BFE), AR, AR /A, AR /AE, AR/A1—A30, AR/AH, AR /A0. Complete Items C2.a —h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: BARTOW CORS ARP Vertical Datum: N.A.V.D. 1988 Indicate elevation datum used ❑ NGVD 1929 x 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) 4.69 the measurement used. x feet ❑ meters x feet ❑ meters x feet ❑ meters x feet ❑ meters x feet ❑ meters x feet ❑ meters x feet ❑ meters x feet ❑ meters b) Top of the next higher floor 15.47 c) Bottom of the lowest horizontal structural member (V Zones only) N/A d) Attached garage (top of slab) 4.27 e) Lowest elevation of machinery or equipment servicing the building 4.13 (Describe type of equipment and location in Comments) 0 Lowest adjacent (finished) grade next to building (LAG) 3.8 g) Highest adjacent (finished) grade next to building (HAG) 4.3 h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A 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? X Yes • No x Check here if attachments. Certifier's Name License Number GEORGE A. SHIMP II 2512 ' �, s r s" r , `.� ���1+;p ii ",,, iNT '' , ` ,� .11,../ � .Iy 9/.. . a E.1,- r� • - . ii ''"' 0 ''1 J I ,'' 4( ,.F — 2 t e 4 Title Job Number PRESIDENT 180308 -B R1 Company Name GEORGE A. SHIMP II & ASSOCIATES, INC. Address 3301 DeSOTO BOULEVARD, SUITE D City State ZIP Code PALM HARBOR FLORIDA 34683 ' 2s C used with (Not valid ui�1ei, 1ggo surveyor's origrrfJl raised seal) Signatu Date Telephone /, 14.--- 4 -3 -2019 727 - 784 -5496 Copy g O Y O� (3) building Co all es of this evation Certificate and all attachments for (1) community official, (2) insurance agent/company, and 3 buildin owner. Comments (including type of equipment and location, per C2(e), if applicable) SEE ATTACHMENT PAGES 7 AND 8 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 8 PAGES. FEMA Form 086 -0 -33 (7/15) Replaces all previous editions. Form Page 2 of 8 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. 814 LANTANA AVENUE 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. complete Sections A, B,and C. For Items E1 —E4, use natural enter meters. E1. Provide elevation information for the following and check the highest adjacent grade (HAG) and the lowest adjacent a) Top of bottom floor (including basement, crawlspace, or enclosure) is b) Top of bottom floor (including basement, crawlspace, or enclosure) is If the Certificate is intended to support a grade, if available. Check the measurement the appropriate boxes to show whether grade (LAG). ❑ 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 this information in Section G. ❑ feet ❑ meters E2. For Building Diagrams 6-9 with permanent flood openings the next higher floor (elevation C2.b in the diagrams) of the building is provided in Section A Items 8 and /or • 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 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 if attachments. RECEIVED BY: K.D. APR 0 2 2019 PLANNING & DEVELOPMENT CITY OF CLEARWATER 814 LANTANA AVE BCP2018- 060677B ELEVATION CERTIFICATE EDWARD MITCHELL Zoning: Low Medium Density Atlas #: 249A ❑ Check here FEMA Form 086 -0 -33 (7/15) Replaces all previous editions. Form Page 3 of 8 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. 814 LANTANA AVENUE 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 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 8 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. 814 LANTANA AVENUE Policy Number: City CLEARWATER State FLORIDA ZIP Code 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 Photo One Caption FRONT VIEW 4 -3 -2019 Photo Two Photo Two Photo Two Caption N/A 4 -3 -2019 FEMA Form 086 -0 -33 (7/15) Replaces all previous editions. Form Page 5 of 8 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. Building Street Address (including Apt 814 LANTANA AVENUE FOR INSURANCE COMPANY USE ., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. Policy Number: City CLEARWATER State FLORIDA ZIP Code 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 Three Caption REAR VIEW 1 3 -29 -2019 Photo Two Photo Four Caption REAR VIEW 2 3-29 -2019 FEMA Form 086 -0 -33 (7/15) Replaces all previous editions. Form Page 6 of 8 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. Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 814 LANTANA AVENUE FOR INSURANCE COMPANY USE Policy Number: City State ZIP Code CLEARWATER FLORIDA 33767 Company NAIC Number SECTION D — SURVEYOR'S CERTIFICATION (CONTINUED FROM PAGE 2) Al.) THIS ELEVATION CERTIFICATE WAS EXCLUSIVELY PREPARED FOR AND CERTIFIED TO 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. 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. THIS DOCUMENT SHALL NOT BE VALID OR BINDING AGAINST THE SIGNING SURVEYOR UNLESS IT IS SIGNED AND EMBOSSED WITH THE ORIGINAL RAISED SEAL OF THE FLORIDA LICENSED SURVEYOR AND MAPPER. UNAUTHORIZED COPIES IN ANY FORM OR BY ANY MEANS, INCLUDING PHOTOCOPYING OR OTHER ELECTRONIC OR MECHANICAL METHODS, ARE STRICTLY PROHIBITED, SHALL NOT BE CONSIDERED AS SIGNED AND SEALED 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. 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. IN REGARD TO ENGINEERED FLOOD OPENING(S), IF APPLICABLE, THE SURVEYOR DOES NOT KEEP COPIES OF EITHER THE INDIVIDUAL ENGINEERED FLOOD OPENINGS CERTIFICATION OR THE EVALUATION REPORT ISSUED BY THE INTERNATIONAL CODE COUNCIL EVALUATION SERVICE (ICC ES) ON FILE. CURRENT COPIES OF THESE DOCUMENTS SHOULD BE AVAILABLE FROM THE MANUFACTURER OF THE ENGINEERED FLOOD OPENING(S). 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. B9.) IF APPLICABLE, WHEN THE BASE FLOOD ELEVATION IS SHOWN AS A WHOLE NUMBER ON THE FIRM, IT HAS BEEN CONVERTED TO A DECIMAL AND ENTERED TO THE NEAREST TENTH OF A FOOT AS REQUIRED BY FEMA. IF APPLICABLE, THE STRUCTURE CONTAINS: ❑ CRAWLSPACE ❑ ENCLOSURE ID ATTACHED GARAGE ❑ N/A IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE CONTAINS: N/A IF APPLICABLE, DOES THE BOTTOM FLOOR ENCLOSURE APPEAR TO CONTAIN BREAK -AWAY WALLS? ❑ YES ❑x NO ❑ N/A IF APPLICABLE, THIS ELEVATION CERTIFICATE WAS PREPARED USING THE "HISTORIC" FLOOD MAP DATA AND DATUM (N.G.V.D. 1929) FOR POSSIBLE "GRANDFATHERING" PURPOSES: ❑ YES © NO Attachment Page 7 of 8 ELEVATION CERTIFICATE Surveyor's Notes Attachment Page 8 OMB No. 1660 -0008 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. 814 LANTANA AVENUE FOR INSURANCE COMPANY USE Policy Number: City State ZIP Code CLEARWATER FLORIDA 33767 Company NAIC Number SECTION D — SURVEYOR'S CERTIFICATION (CONTINUED FROM PAGE 7) IN REGARD TO ENGINEERED FLOOD OPENINGS, AS REFERENCED IN SECTIONS A8 AND A9 IF APPLICABLE, THE STRUCTURE'S: D CRAWLSPACE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER N/A SQ. FEET PER OPENING (MANUFACTURER: N/A — MODEL: N/A ) FOR A TOTAL OF N/A SQ. FEET OF COVERAGE AND N/A NON - ENGINEERED FLOOD OPENING(S) WITH A NET AREA OF N/A SQ. INCHES, PROVIDING COVERAGE FOR A TOTAL OF N/A SQ. FEET. ENGINEERED FLOOD OPENING(S) ARE: ❑INSTALLED 0 UNDER CONSTRUCTION ❑ PER PLAN El N/A NOTES: N/A 0 ENCLOSURE CONTAINS N/A ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER N/A SQ. FEET PER OPENING (MANUFACTURER: N/A — MODEL: N/A ) FOR A TOTAL OF N/A SQ. FEET OF COVERAGE AND N/A NON - ENGINEERED FLOOD OPENING(S) WITH A NET AREA OF N/A SQ. INCHES, PROVIDING COVERAGE FOR A TOTAL OF N/A SQ. FEET. ENGINEERED FLOOD OPENING(S) ARE: ❑ INSTALLED ❑ UNDER CONSTRUCTION ❑PER PLAN ❑p N/A NOTES: N/A ATTACHED GARAGE CONTAINS 4 ENGINEERED FLOOD OPENING(S) CERTIFIED TO COVER 200 SQ. FEET PER OPENING (MANUFACTURER: SMART VENT — MODEL: 1540 -510 ) FOR A TOTAL OF 800 SQ. FEET OF COVERAGE AND 0 NON - ENGINEERED FLOOD OPENING(S) WITH A NET AREA OF 0 SQ. INCHES, PROVIDING COVERAGE FOR A TOTAL OF 0 SQ. FEET. ENGINEERED FLOOD OPENING(S) ARE: El INSTALLED ❑UNDER CONSTRUCTION ❑ PER PLAN ❑ N/A NOTES: ENGINEERED FLOOD OPENING(S) ARE 8" x 16" AND CONTAIN A TOTAL PHYSICAL NET AREA OF 512 SQ. INCHES C2.e) AIR CONDITIONER LOCATED ON A CONCRETE SLAB ON THE SIDE OF THE STRUCTURE. Attachment Page 8 of 8