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967 ELDORADO AVE (3)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, 2022 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 MICHAEL F. CLARK AND KELLY M. CLARK Policy Number. A2. Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and . Box No. 967 El Dorado Avenue Company NAIC Number: City State ZIP Code Clearwater Beach Florida 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 7, Block 60 - Mandalay - Plat Book 14, Page 32 - Parcel #05-29-15-54666-060-0070 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, Accessory, etc.) Lat 27.00064°N Long. -82.82691°W Residential Horizontal Datum: insurance. above ❑ NAD 1927 adjacent grade grade b x NAD 1983 2 2 photographs Number with 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 6 Certificate is being used to obtain flood 381.00 sq ft or enclosure(s): or enclosures) openings in the crawlspace in A8.b or enclosure(s) 400.00 sq in within 1.0 foot above adjacent in 0.00 sq ft ❑ Yes x No garage: garage openings in the attached garage within T.OTaot in A9.b 0.00 sq ❑ Yes x No 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 12103C0064 . B5. Suffix G B6. FIRM Index Date 08-18-2009 B7. FIRM Panel Effective/ Revised Date 09-03-2003 B8. Flood Zone(s) AE AND VE • B9. Base Flood E evation(s) (Zone AO, use Base Flood Depth) 12.0' and 13.0' 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: depth entered in Item B9: x FIRM datum used located in a Date: ❑ Other/Source: Protected 1929 x NAD 1988 (C ). aswoc Otherwise El OPit Area (OPA)? ❑ Yes x No FEMA Form 086-0-33 (12/19) Replaces ail previous editions. FormPage 1 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2022 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. 967 El Dorado Avenue Policy Number. City State ZIP Code Clearwater Beach Florida 33767 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: City of Clearwater J-02 . Vertical Datum: NAVD 1988 x Finished Construction AR/AH, AR/AO. enter meters. Indicate elevation datum ❑ NGVD 1929 used 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, crawispace, or enclosure floor) 5.9 x the measurement used. feet ❑ meters b) Top of the next higher floor 17.5 x feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) 15.0 x feet ❑ meters d) Attached garage (top of slab) N/A x feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 16.1 x (Describe type of equipment and location in Comments)❑ feet meters f) Lowest adjacent (finished) grade next to building (LAG) 5.0 x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 5.6 x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 5.8 x feet ❑ meters 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 John O. Brendla 4601 . nkijit P ace Seal 60 / Here 1 t� �2���qq ��77 V3 - t,7�/' �/ Title Surveyor Company Name John C. Brendla & Associates, Inc. Address 4015 82nd Avenue North City State ZIP Code Pinellas Park Florida 33781 Signatu. 06ne,vveili Date Telephone Ext 03-30-2021 (727) 576-7546 None Copy al •ag s of this ElOation Certificate and all attachments for.(1) community official, (2) insurance agent/company, and (3) building owner. Com ents ( cluding type of equipment and location, per C2(e), if applicable) C2) a. ' -,- g and Storage, C2) . The Lowest Living Floor, C2) e. The A/C landing located on the North side of the House. NOTE: The Photos are the attachments - 3/30/2021 Revised C2) c. Benchmark City of Clearwater Map #J-02 Elev. 4.4385' NAVD - MSL = 0.00 FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2022 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. 967 El Dorado Avenue Policy Number. City State ZIP Code Clearwater Beach 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. 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 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 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 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 (12/19) Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2022 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. 967 El Dorado Avenue Policy Number. City State ZIP Code Clearwater Beach 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 (12/19) 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, 2022 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt 967 El Dorado Avenue ., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: City Clearwater Beach 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. FRONT a .4 Clear Photo One BACK Photo Two Caption Clear Photo Two FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS OMB No. 1660-0008 Continuation Page Expiration Date: November 30, 2022 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. 967 EI Dorado Avenue Policy Number: City Clearwater Beach 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, "Richt 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. RIGHT SIDE IPr.oto Four Caption LEFT SIDE :Clear Photo Four..; FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 6 of 6 Note: The V Zone design certificate is not a substitute for the NFIP Elevation Certificate (see Fact Sheet No. 1.4, Lowest Floor Elevation), which is required to certify as -built elevations needed for flood insurance rating. Name Michael & Kelly Clark V ZONE DESIGN CERTIFICATE Policy Number (Insurance Co. Use) Building Address of Other Description 967 El Dorado Ave. Permit No. BCP2019-100983 City Clearwater State FL Zip Code 33767 SECTION I: Flood Insurance Rate Map (FIRM) Information Community No. 125096 Panel No. 64 Suffix FIRM Date 09.0ti FIRM Zone(s) AE SECTION II: Elevation Information Used for Design (NOTE: This section documents the elevations/depths used or specified in the design — it does not document surveyed elevations and is not equivalent to the as -built elevations required to be submitted during or after construction.] 1. FIRM Base Flood Elevation (BFE) 13.0 feet' 2. Community's Design Flood Elevation (DFE) 15.0 feet' 3. Elevation of the Bottom of Lowest Horizontal Structure Member 15.0 feet* 4. Elevation of Lowest Adjacent Grade 5.2 feet* 5. Depth of Anticipated Scour/Erosion used for Foundation Design 5.0 feet 6. Embedment Depth of Pilings of Foundation Below Lowest Adjacent Grade 25.0 feet * Indicate elevation datum used in 1-4: 0 NGVD29 ® NAVD88 0 Other SECTION III: V Zone Design Certification Statement I certify that (1) I have developed or reviewed the structural design, plans, and specifications for construction of the above - referenced building and (2) that the design and methods of construction specified to be used are in accordance with accepted standards of practice" for meeting the following provisions: • The bottom of the lowest horizontal structural member of the lowest floor (excluding piles and columns) is elevated to or above the BFE. • The pile and column foundation and structure attached thereto is anchored to resist flotation, collapse, and lateral movement due to the effects of the wind and water loads acting simultaneously on all building components. Water loading values used are those associated with the base flood"". Wind loading values used are those required by the applicable State or local building code. The potential for scour and erosion at the foundation has been anticipated for conditions associated with the base flood, including wave action. SECTION IV: Breakaway Wall Design Certification Statement (NOTE This section must be certified by a registered engineer or architect when breakaway walls are designed to have a resistance of more than 20 psf (0.96 kN/m2) determined using allowable stress design] I certify that (1) I have developed or reviewed the structural design, plans, and specifications for construction of breakaway walls to be constructed under the above -referenced building and (2) that the design and methods of construction specified to be used are in accordance with accepted standards of practice" for meeting the following provisions: • Breakaway wall collapse shall result from a water load less than that which would occur during the base flood""". • The elevated portion of the building and supporting foundation system shall not be subject to collapse, displacement, or other structural damage due to the effects of wind and water loads acting simultaneously on all building components (see Section III). SECTION V: Certification and Seal This certification is to be signed and sealed by a registered professional engineer or architect authorized by law to certify structural designs. I certify the V Zone Design Certification Statement (Section III) and the Breakaway Wall Design Certification Statement (Section IV, check if applicable). Certifier's Name Rodney L Coltman AIA License Number AR 0008372 Title President Company Name SDG Architecture Inc. Address 793 - I hris *4 . 1 1 Age / 10r 0 4, City Dune‘ Signature State FL Zip Code 34698 04.22.2022 Telephone 727.736.5463 Place Seal Here 4/23/2021 FLORIDA DEPARhVEVr OP Business & Professional Regulation SCIS Home Log In I User Registration ( Hot Topics f �'eyucn ! OFFICE OF THE SECRETARY Product Approval USER: Public User Florida Building Code Online Submit Surcharge j Stats & Facts j Publications i Contact Us BCIS Site Map Links Search Product Approval Menu > Product or Application Search > Application List > Application Detail FL # FL5822-R8 Application Type Affirmation Code Version 2020 Application Status Approved *Approved by DBPR. Approvals by DBPR shall be reviewed and ratified by the POC and/or the Commission if necessary. Comments Archived Product Manufacturer Smart Vent Products, Inc. Address/Phone/Email 430 Andbro Dr Unit 1 Pitman, NJ 08071 (877) 441-8368 info@smartvent.com Authorized Signature Michael Graham info@smartvent.com Technical Representative Michael Graham Address/Phone/Email 430 Andbro Dr Unit 1 Pitman, NJ 08071 (877) 441-8368 info@smartvent.com Quality Assurance Representative Address/Phone/Email Category Subcategory Compliance Method Structural Components Products Introduced as a Result of New Technology Evaluation Report from a Florida Registered Architect or a Licensed Florida Professional Engineer 7 Evaluation Report - Hardcopy Received Florida Engineer or Architect Name who developed the Hermes F. Norero P.E. Evaluation Report Florida License PE -73778 Quality Assurance Entity Architectural Testing, Inc., an Intertek Company Quality Assurance Contract Expiration Date 12/31/2023 Validated By Locke Bowden P.E. C.' Validation Checklist - Hardcopy Received Certificate of Independence FL5822 R8 COI Smart Vent COI SS 2017-08-18 .pdf Referenced Standard and Year (of Standard) Equivalence of Product Standards Certified By Sections from the Code 1612.5(1)(1.2) 1708.2 httpsi/floridabuilding.org/pr/pr app_dtl.aspx?param=wGEVXQwtDgvMdF6zR4iHLm1meckcmccEdXH7G0Gk3yg%3d 1/3 4/23/2021 Florida Building Code Online I affirm that there are no changes in the new Florida Building Code which affect my product(s) and my product(s) are in compliance with the new Florida Building Code. Documentation from approved Evaluation or Validation Entity ` i Yes No N/A FL5822 R8 COC SA5822 SS 2020-12-07.pdf Method 2 Option B Product Approval Method Date Submitted Date Validated Date Pending FBC Approval Date Approved Summary of Products 12/16/2020 12/16/2020 12/28/2020 https://floridabuilding.org/pr/pr app_dtl.aspx?param=wGEVXQwtDgvMdF6zR4iHLm1meckcmccEdXH7G0Gk3yg%3d 2/3 FL # Model, Number or Name Description 5822.1 SmartVent Model #1540-510 Dual Function Flood and Ventilation Vent Limits of Use Approved for use in HVHZ: Yes Approved for use outside HVHZ: Yes Impact Resistant N/A Design Pressure: +100/-100 Other: One vent may be used for up to 200 sq. ft. of interior space (minimum 2). Installation Instructions FL5822 R8 II 1540-510 SS 2017-08-23.pdf Verified By: Hermes F. Norero, P.E. Florida P.E. 73778 Created by Independent Third Party: Yes Evaluation Reports FL5822 R8 AE PER5022 SS 2018-06-20.0f FL5822 R8 AE SmartVent - Imoact Requirements SS 2017- 08-23.pdf Created by Independent Third Party: Yes 5822.2 SmartVent Model #1540-511 Dual Function Flood and Ventilation Vent Limits of Use Approved for use in HVHZ: Yes Approved for use outside HVHZ: Yes Impact Resistant: N/A Design Pressure: +100/-100 Other: One vent may be used for up to 400 sq. ft. of interior space (minimum 2). Installation Instructions FL5822 R8 II 1540-511 SS 2017-02-28.pdf Verified By: Hermes F. Norero, P.E. Florida P.E. 73778 Created by Independent Third Party: Yes Evaluation Reports FL5822 R8 AE PER5022 SS 2018-06-20.0f FL5822 R8 AE SmartVent - Impact Requirements SS 2017- 08-23.01 Created by Independent Third Party: Yes 5822.3 SmartVent Model #1540-520 Insulated Flood Vent Limits of Use Approved for use in HVHZ: Yes Approved for use outside HVHZ: Yes Impact Resistant: N/A Design Pressure: +100/-100 Other: One vent may be used for up to 200 sq. ft. of interior space (minimum 2). Installation Instructions FL5822 R8 II 1540-520 SS 2017-08-23.pdf Verified By: Hermes F. Norero, P.E. Florida P.E. 73778 Created by Independent Third Party: Yes Evaluation Reports FL5822 R8 AE PER5022 SS 2018-06-20.pdf FL5822 R8 AE SmartVent - Impact Requirements SS 2017- 08-23.pdf Created by Independent Third Party: Yes 5822.4 SmartVent Model #1540-521 Insulated Flood Vent Limits of Use Approved for use in HVHZ: Yes Approved for use outside HVHZ: Yes Impact Resistant N/A Design Pressure: +100/-100 Other: One vent may be used for up to 400 sq. ft. of interior space (minimum 2). Installation Instructions FL5822 R8 II 1540-521 SS 2017-02-28.pdf Verified By: Hermes F. Norero, P.E. Florida P.E. 73778 Created by Independent Third Party: Yes Evaluation Reports FL5822 R8 AE PER5022 SS 2018-06-20.pdf FL5822 R8 AE SmartVent_- Impact Requirements SS 2017 08-23.pdf Created by Independent Third Party: Yes 5822.5 SmartVent Model #1540-524 16" Garage Door Flood Vent Limits of Use Approved for use in HVHZ: Yes Approved for use outside HVHZ: Yes Impact Resistant: N/A Design Pressure: N/A Other: One vent may be used for up to 200 sq. ft. of interior space (minimum 2). See Installation Instructions for allowable pressures per door construction. Installation Instructions FL5822 R8 II 1540-524 SS 2018-08-17.pdf Verified By: Hermes F. Norero, P.E. Florida P.E. 73778 Created by Independent Third Party: Yes Evaluation Reports FL5822 R8 AE PER5892SS 2018-08-17.pdf FL5822 R8 AE SmartVent - Impact Requirements SS 2017 - 08-23.pdf Created by Independent Third Party: Yes https://floridabuilding.org/pr/pr app_dtl.aspx?param=wGEVXQwtDgvMdF6zR4iHLm1meckcmccEdXH7G0Gk3yg%3d 2/3 4/23/2021 Florida Building Code Online 5822.6 !SmartVent Model #1540-570 Wood Wall Insulated Flood Vent Limits of Use Approved for use in HVHZ: Yes Approved for use outside HVHZ: Yes Impact Resistant: N/A Design Pressure: +100/-100 Other: One vent may be used for up to 200 sq. ft. of interior space (minimum 2). Installation Instructions FL5822 R8 II 1540-570 SS 2017-02-28.pdf Verified By: Hermes F. Norero, P.E. Florida P.E. 73778 Created by Independent Third Party: Yes Evaluation Reports FL5822 R8 AE PER5022 SS 2018-06-20.pdf FL5822 R8 AE SmartVent - Impact Requirements SS 2017- 08-23.odf Created by Independent Third Party: Yes 5822.7 SmartVent Model #1540-574 14.5" Garage Door Flood Vent Limits of Use Approved for use in HVHZ: Yes Approved for use outside HVHZ: Yes Impact Resistant: N/A Design Pressure: N/A Other: One vent may be used for up to 200 sq. ft. of interior space (minimum 2). See Installation Instructions for allowable pressures per door construction. Installation Instructions FL5822 R8 II 1540-574 SS 2018-08-17.p�1f Verified By: Hermes F. Norero, P.E. Florida P.E. 73778 Created by Independent Third Party: Yes Evaluation Reports FL5822 R8 AE PER5892 SS 2018-08-17.pdf FL5822 R8 AE SmartVent - Impact Requirements SS 2017 - 08-23.pdf Created by Independent Third Party: Yes Back Contact Us :: 2601 Blair Stone Road. Tallahassee FL 32399 Phone: 850-487-1824 The State of Florida is an AA/EEO employer. cQpvriaht 2007-2013 State of Florida.:: Privacy Statement :: Accessibility Statement :: Refund Statement Under Florida law, email addresses are public records. If you do not want your e-mail address released in response to a public -records request, do not send electronic mail to this entity. Instead, contact the office by phone or by traditional mail. If you have any questions, please contact 850.487.1395. 'Pursuant to Section 455.275(1), Florida Statutes, effective October 1, 2012, licensees licensed under Chapter 455, F.S. must provide the Department with an email address if they have one. The emalls provided may be used for official communication with the licensee. However email addresses are public record. If you do not wish to supply a personal address, please provide the Department with an email address which can be made available to the public. To determine if you are a Ncensee under Chapter 455, F.S., please click here . Product Approval Accepts: Credit Card Safe https://floridabuilding.org/pr/pr app_dtl.aspx?param=wGEVXQwtDgvMdF6zR4iHLmlmeckcmccEdXH7GOGk3yg%3d 3/3 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, 2022 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 MICHAEL F. CLARK AND KELLY M. CLARK Policy Number, A2. Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and . Box No. 967 El Dorado Avenue Company NAIC Number. City State ZIP Code Clearwater Beach Florida 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 7, Block 60 - Mandalay - Plat Book 14, Page 32 - Parcel #05-29-15-54666-060-0070 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 Residential, Non -Residential, Addition, Accessory, etc.) Lat 27.00064°N Long. -82.82691 °W Residential Horizontal Datum: ❑ NAD 1927 insurance. above adjacent grade x NAD 1983 2 2 photographs Number • with a crawispace of crawispace flood of the building if the 6 Certificate is being used to obtain flood 381.00 sq ft or enclosure(s): or enclosure(s) openings in the crawlspace or enclosure(s) within 1.0 foot c) Total net area of flood openings d) Engineered flood openings'? A9. For a building with an attached a) Square footage of attached b) Number of permanent flood c) Total net area of flood openings d) Engineered flood openings'? in A8.b 400.00 sq in T.0 Toot atrvve adjauerrt in graze 6 0.00 sq ft A Yes x No garage: garage openings in the attached garage within in A9.b 0.00 sq ❑ Yes x No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION • 131. NFIP Community Name & Community Number Clearwater - 125096 62. County Name Pinellas 63. State Florida B4. Map/Panel . Number 12103C0064 B5. Suffix G B6. FIRM Index Date 08-18-2009 67. FIRM Panel Effective/ Revised Date 09-03-2003 68. Flood Zone(s) AE AND VE • B9. Base Flood E evation(s) (Zone AO, use Base Flood Depth) 12.0' and 13.0' B10. Indicate the source ❑ FIS Profile B11. Indicate elevation 612. Is the building Designation of the Base Flood Elevation ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ (BFE) data or base flood ❑ Other/Source: ❑ NGVD 1929 System (CRB; CBRS Ef OLS depth entered in Item B9: x FIRM datum used located in a Date: ❑ Other/Source: Protected x NAS 1988 ).arawoc'C3therwise Area (OPA)? ❑ Yes x No FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2022 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. 967 El Dorado Avenue Policy Number City State ZIP Code Clearwater Beach Florida 33767 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 Al 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: City of Clearwater J-02 Vertical Datum: NAVD 1988 x Finished Construction AR/AH, AR/AO. enter meters. Indicate elevation datum ❑ NGVD 1929 used 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) 5.9 x the measurement used. feet ❑ meters b) Top of the next higher floor 17.5 p feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) 15.0 x feet ❑ meters d) Attached garage (top of slab) N/A x feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 16.1 x (Describe type of equipment and location in Comments) feet meters ❑ f) Lowest adjacent (finished) grade next to building (LAG) 5.0 x feet ❑ meters 5.6 g) Higl iesl ddjdt.ernl (Iinialred) yrade next Lu builtiitiy (HAG) ® _feet . ❑.meters h) -Lowest adjacent grade at lowest elevation of deck or stairs, including — structural support 5.8 x feet ❑ meters 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? © 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 John O. Brendla 4601 O• p Seal Here 03 ' . PlAuffill ace 14/_ 0 ) lid �7 l� '�vl Title Surveyor Company Name John C. Brendla & Associates, Inc. Address 4015 82nd Avenue North City State ZIP Code Pinellas Park Florida 33781 Signatur 1 f 0 TILIAiti Date Telephone Ext. 03-30-2021 (727) 576-7546 None Copy al •ag •s of this Ele ation Certificate and all attachments for.(1) community official, (2) insurance agent/company, and (3) building owner. Com ents (- eluding type of equipment and location, per C2(e), if applicable) C2) a. ' - i . g and Storage, C2) . The Lowest Living Floor, C2) e. The A/C landing located on the North side of the House. NOTE: The Photos are the attachments - 3/30/2021 Revised C2) c. Benchmark: City of Clearwater Map #J-02 Elev. 4.4385' NAVD - MSL = 0.00 FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2022 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. 967 El Dorado Avenue Policy Number. City State ZIP Code Clearwater Beach 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. 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 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 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 -who A(withoutaFEMA-issued or . __ _ to the best of my knowledge. The-property-ownerorowner'sauthorized representative -completes -Sections A, 8, and -E -for -Zone community -issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct 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 (12/19) Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2022 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. 967 El Dorado Avenue Policy Number. City State ZIP Code Clearwater Beach Florida 33767 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 huilding• ❑ feet ❑ meters_Daturw New Construction ■ Substantial Improvement basement) n meters Datum -_-----.-i------ G9. BFE or (in Zone AO) depth of flooding atthe building_site` D feet G10. Community's design flood elevation: ❑ feet ❑ 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 (12/19) 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, 2022 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. 967 El Dorado Avenue Policy Number: City Clearwater Beach State ZIP Code Florida 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. FRONT Clear Photo One BACK Photo Two Caption Clear Photo Two FEMA Form 086-0-33 (12/19) 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, 2022 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. 967 El Dorado Avenue Policy Number: City Clearwater Beach State ZIP Code Florida 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. FRONT Clear Photo One Photo Two Caption Clear Photo Two FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 5 of 6 BUILDING PHOTOGRAPHS ELEVATION CERTIFICATE Continuation Page OMB No. 1660-0008 Expiration Date: November 30, 2022 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. 967 El Dorado Avenue Policy Number: City Clearwater Beach 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 Four Photo Four Photo Four Caption Clear Photo Four FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 6 of 6 Continuation CERTIFICATE information from Section A- -rloN CE the corresponding or from P.O. Route and Box No. copy andlor Bldg. NO ) rciy El-E�A these spaces, t Suite, fMpORTpNj In ddress (including AP •, Unit, ZIP Code d n9 S{feet A State 33767 Bu do Avenue enue 967 V Dora Flori da below. Identify all photographs City the additional photographsen applicable, ater Beach e, affix View" and 'Left Side View." Cle arw the preceding page, „Right Side A8. s than will fit on and, if required, openings or vents, as indicated in Section o photographs Rear View' ; les of the flood P ►� submitting nbr",intaken; more a e St "Front the,f� foundation with representative examples date photographs mu FOR INSURANCE uuivirr,% Company NAIC Number Three RIGHT SIDE LEFT SI Photo Four Caption FEMA Form 066-4'33 (12119) Replaces all previous editions.