Loading...
1101 STEVENSON AVE (3)RECEIVED BY: S.A. NOV 0 8 2018 PLANNING & DEVELOPMENT CITY OF CLEARWATER 1101 STEVENSON AVE BCP2018-03831 C ELEV. CERT. VORAS Zoning: Low Medium Density Atlas #: 260A FEMA NATIONAL FLOOD INSURANCE PROGRAM ELEVATION CERTIFICATE AND INSTRUCTIONS 2015 EDITION OMB No. 1660-0008 Expiration Date: November 30, 2018 U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE AND INSTRUCTIONS Paperwork Reduction Act Notice Public reporting burden for this data collection is estimated to average 3.75 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting this form. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 1800 South Bell Street, Arlington, VA 20598-3005, Paperwork Reduction Project (1660-0008). NOTE: Do not send your completed form to this address. Privacy Act Statement Authority: Title 44 CFR § 61.7 and 61.8. Principal Purpose(s): This information is being collected for the primary purpose of estimating the risk premium rates necessary to provide flood insurance for new or substantially improved structures in designated Special Flood Hazard Areas. Routine Use(s): The information on this form may be disclosed as generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act of 1974, as amended. This includes using this information as necessary and authorized by the routine uses published in DHS/ FEMA -003 — National Flood Insurance Program Files System or Records Notice 73 Fed. Reg. 77747 (December 19, 2008); DHS/ FEMA/NFIP/LOMA-1 — National Flood Insurance Program (NFIP) Letter of Map Amendment (LOMA) System of Records Notice 71 Fed. Reg. 7990 (February 15, 2006); and upon written request, written consent, by agreement, or as required by law. Disclosure: The disclosure of information on this form is voluntary; however, failure to provide the information requested may result in the inability to obtain flood insurance through the National Flood Insurance Program or the applicant may be subject to higher premium rates for flood insurance. Information will only be released as permitted by law. Purpose of the Elevation Certificate The Elevation Certificate is an important administrative tool of the National Flood Insurance Program (NFIP). It is to be used to provide elevation information necessary to ensure compliance with community floodplain management ordinances, to determine the proper insurance premium rate, and to support a request for a Letter of Map Amendment (LOMA) or Letter of Map Revision based on fill (LOMR-F). The Elevation Certificate is required in order to properly rate Post -FIRM buildings, which are buildings constructed after publication of the Flood Insurance Rate Map (FIRM), located in flood insurance Zones Al A30, AE, AH, A (with BFE), VE, V1 V30, V (with BFE), AR, AR/A, AR/AE, AR/A1—A30, AR/AH, and AR/AO. The Elevation Certificate is not required for Pre -FIRM buildings unless the building is being rated under the optional Post -FIRM flood insurance rules. As part of the agreement for making flood insurance available in a community, the NFIP requires the community to adopt floodplain management regulations that specify minimum requirements for reducing flood losses. One such requirement is for the community to obtain the elevation of the lowest floor (including basement) of all new and substantially improved buildings, and maintain a record of such information. The Elevation Certificate provides a way for a community to document compliance with the community's floodplain management ordinance. Use of this certificate does not provide a waiver of the flood insurance purchase requirement. Only a LOMA or LOMR-F from the Federal Emergency Management Agency (FEMA) can amend the FIRM and remove the Federal mandate for a lending institution to require the purchase of flood insurance. However, the lending institution has the option of requiring flood insurance even if a LOMA/LOMR-F has been issued by FEMA. The Elevation Certificate may be used to support a LOMA or LOMR-F request. Lowest floor and lowest adjacent grade elevations certified by a surveyor or engineer will be required if the certificate is used to support a LOMA or LOMR-F request. A LOMA or LOMR-F request must be submitted with either a completed FEMA MT -EZ or MT -1 package, whichever is appropriate. This certificate is used only to certify building elevations. A separate certificate is required for floodproofing. Under the NFIP, non- residential buildings can be floodproofed up to or above the Base Flood Elevation (BFE). A floodproofed building is a building that has been designed and constructed to be watertight (substantially impermeable to floodwaters) below the BFE. Floodproofing of residential buildings is not permitted under the NFIP unless FEMA has granted the community an exception for residential floodproofed basements. The community must adopt standards for design and construction of floodproofed basements before FEMA will grant a basement exception. For both floodproofed non-residential buildings and residential floodproofed basements in communities that have been granted an exception by FEMA, a floodproofing certificate is required. Additional guidance can be found in FEMA Publication 467-1, Floodplain Management Bulletin: Elevation Certificate, available on FEMA's website at https://www.fema.gov/media-library/assets/documents/3539?id=1727. FEMA Form 086-0-33 (Revised 7/15) Replaces all previous editions. F-053 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) budding owner. SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name STEVEN AND MARIA VORAS Policy Number: A2. Budding 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 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. N27.9877* Long. W082.7912* RESIDENTIAL Horizontal Datum: insurance. above ❑ NAD 1927 adjacent grade grade N/A x NAD 1983 N/A 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 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: depth entered in Item B9: x FIRM datum used located in a Date: ❑ Other/Source: Protected 1929 x NAVD 1988 (CBRS) area or Otherwise ❑ 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. 1101 STEVENSON AVE. Policy Number: City State ZIP Code CLEARWATER Florida 33755 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) ❑ Finished Construction AR/A1—A30, AR/AH, AR/AO. Rico only, enter meters. C1. Building elevations are based on: ❑ Construction Drawings* p 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, 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 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 x NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 13.30 ❑x 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 feet metersbe type of equipment and location in Comments) ❑ ❑ f) Lowest adjacent (finished) grade next to building (LAG) 7.80 x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 12.65 x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support N/A ❑ 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 eC7)??,X f i k�C `, g�.�` ' Here Title PROFESSIONAL SURVEYOR AND MAPPER( Company Name DENNIS MOYLAN PSM, INC Address 5342 BIRCHWOOD RD City State ZIP Code SPRING HILL Florida 34608 Signature�% Date Telephone i�•s• s:���" 09-21-2018 (352) 684-5450 Ext. Copy all pages of this Elevation Certifica 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 . • 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. ❑ above or ❑ below the LAG. 9 (see pages 1-2 of Instructions), ❑ above or ❑ below the HAG. 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 ❑ above or • below the HAG. 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 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. 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 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 ❑ meters Datum ❑ meters Datum building site: • feet ❑ 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 (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. 2018 9 21 ,' ar, 4,'{t f. .yM#... M — ii r. s i. Photo One Photo One Caption FRONT VIEW Clear Photo One 2018911 S a k 4,.. . ... • : , ___I; .„ .... , , ,... . . ... ..... v, ..... _ _...._, ,r,:r.„,,...,, p. . .Y -�, '_amu=•'f ..� �.. ,� w.e. .. - , sAs Photo Two 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 with: date taken; "Front photographs must show than will fit on the preceding page, affix the additional photographs below. Identify View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." the foundation with representative examples of the flood openings or vents, as indicated all photographs When applicable, in Section A8. -.�. e>. , yam) '!i a :.___ may.. 'f, r { Photo Three Photo Three Caption FRONT AND LEFT SIDE Clear Photo Three Photo Four Photo Four Photo Four Caption Clear Photo Four FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6