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1101 STEVENSON AVE• U.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 STEVEN AND MARIA VORAS Policy Number: A2. Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 1101 STEVENSON AVE. Company NAIC Number: City State ZIP Code CLEARWATER Florida 33755 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) PARCEL NUMBER 03-29-15-88110-004-0240 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, Accessory, etc.) Lat. 27* 59' 15.755" Long. 082* 47" 29.119" RESIDENTIAL Horizontal Datum: insurance. above ❑ NAD 1927 adjacent grade grade N/A x NAD 1983 N/A 2 photographs Number a crawlspace of crawlspace flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? of the building if the 1B Certificate is being used to obtain flood N/A sq ft or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b or enclosure(s) N/A sq in within 1.0 foot foot above adjacent in N/A sq ft ❑ Yes x No garage: garage openings in the attached garage within 1.0 in A9.b N/A sq ❑ Yes x No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number 125096 CITY OF CLEARWATER FLORIDA B2. County Name PINELLAS B3. State Florida B4. Map/Panel Number 12103C0106 B5. Suffix H B6. FIRM Index Date 05-17-2005 B7. FIRM Panel Effective/ Revised Date 05-17-2005 B8. Flood Zone(s) AE B9. Base Flood E evation(s) (Zone AO, use Base Flood Depth) 12' B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation of the Base Flood Elevation ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ (BFE) data ❑ NGVD System CBRS or base flood ❑ Other/Source: 1929 (CBRS) depth entered in Item B9: x FIRM datum used located in a Date: ❑ Other/Source: Protected x NAVD 1988 area or Otherwise Area (OPA)? • Yes x No ■ 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. 1101 STEVENSON AVE. 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* MI 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: NGS PID AG0303 Vertical Datum: NAVD 1988 AR/A1—A30, AR/AH, AR/AO. Rico only, enter meters. Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 MI 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, crawispace, or enclosure floor) 13.35 Check the measurement used. MI feet ■ meters b) Top of the next higher floor N/A • feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A ■ feet ■ meters d) Attached garage (top of slab) N/A ❑ feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) 13.25 p feet❑ meters f) Lowest adjacent (finished) grade next to building (LAG) 8.70 x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 11.00 MI feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including 9.20 structural support p feet meters ❑ 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? x Yes ❑ No Certifier's Name License Number DENNIS V. MOYLAN LS6115 s /I, 5: ('e'?.9" ''41. ac • - L : i' .., `p, cam' . f `'' 3 \_ rr Title PROFESSIONAL SURVEYOR AND MAPPER Company Name/ DENNIS MOYLAN PSM, INC Address 5342 BIRCHWOOD RD: City State ZIP Code SPRING HILL Florida 34608 Si nature Date Telephone Ext 9 � 4 /// 06-14-2019 (352) 684-5450 �, Copy all pages of this E= vatic,, = f'cate 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) C2 ELEVATION NGS DI2886. USING GPS TOPCON GR3 . C2 e A/C UNIT ON ELEVATED PLATFORM LEFT SIDE HOUSE. 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. 1101 STEVENSON AVE. 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. b) Top of bottom floor (including basement, crawispace, or enclosure) is ❑ feet ❑ meters ❑ above or • below the LAG. 9 (see pages 1-2 of Instructions), 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. E3. Attached garage (top of slab) is ❑ feet ❑ meters E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters ❑ above or • below the HAG. with the community's certify this information in Section G. 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 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. 1101 STEVENSON AVE. 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 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 04—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 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., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 1101 STEVENSON AVE. Policy Number: City State ZIP Code CLEARWATER Florida 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. 2D�gY614 Mae 1111 Photo One 1 _.. Photo One Caption FRONT VIEW Clear Photo One 2019 6 14' Isla "`mow,+._ r _L - Photo Two -0. _ - —�— _ S' Photo Two Caption REAR and RIGHT SIDE Clear Photo Two 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. 1101 STEVENSON AVE. 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. 1. •z a � _ ,,,, - .li T �r" 1 w Photo Three Photo Three Caption REAR LEFT SIDE A/C UNIT Clear Photo Three .4 2019 6 14 . 44 4` d6 . I - 1 ,r l ,t� y' Photo Four Photo Four Caption FRONT LEFT SIDE Clear Photo Four FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 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., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 1101 STEVENSON AVE. Policy Number: City State ZIP Code CLEARWATER Florida 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. .M 2019 . • - a, 6 14 t T� •.: I 1 1 _ - s r.. -ate Photo One Photo One Caption REAR VIEW Clear Photo One Photo Two Photo Two Caption Clear Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 7af ` (