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37 CAUSEWAY BLVDDEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency FLOODPROOFING CERTIFICATE FOR NON-RESIDENTIAL STRUCTURES C 4 r7JI(s OMB Control Number. 1660-0008 Expiration: 11/30/2018 Paperwork Burden Disclosure Notice Public reporting burden for this data collection is estimated to average 3.25 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. General: This information is provided pursuant to Public Law 96-511 (the Paperwork Reduction Act of 1980, as amended), dated December 11, 1980, to allow the public to participate more fully and meaningfully in the Federal paperwork review process. Authority: Public Law 96-511, amended; 44 U.S.C. 3507; and 5 CFR 1320. 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 being subject to higher premium rates for flood insurance. Information will only be released as permitted by law. Purpose of the Floodproofing Certificate for Non -Residential Structures Under the National Flood Insurance Program (NFIP), the floodproofing of non-residential buildings may be permitted as an altemative to elevating to or above the Base Flood Elevation (BFE). A floodproofing design certification is required for non-residential structures that are floodproofed. This form is to be used for that certification. A floodproofed building is a building that has been designed and constructed to be watertight (substantially impermeable to floodwaters) below the BFE and with structural components having the capability of resisting hydrostatic and hydrodynamic loads and effects of buoyancy. Before a floodproofed building is designed, numerous planning considerations, including flood waming time, uses of the building, mode of entry to and exit from the building and the site in general, floodwater velocities, flood depths, debris impact potential, and flood frequency, mint bj ddress_ed to ensstre thatdryi'loodproofingwill be a viable flnndplain mana__gement measure The minimum NFIP requirement is to floodproof a building to the BFE. However, when it is rated fofflood insurance one -foot is subtracted from the floodproofed elevation. Therefore, a building has to be floodproofed to one foot above the BFE to receive the same favorable flood insurance rates as a building elevated to the BFE. Additional guidance can be found in FEMA Publication 936, Floodproofing Non -Residential Buildings (2013), available on FEMA's website at https://www.fema.gov/media-library/assets/documents/34270. FEMA Form 086-0-34 (6/15) Page 1 of 4 FLOODPROOFING CERTIFICATE FOR NON-RESIDENTIAL STRUCTURES. Continued The floodproofing of non-residential buildings may be permitted as an alternative to elevating to or above the Base Flood Elevation; however, a floodproofing design certification is required. This form is to be used for that certification. Floodproofing of a residential building does not alter a community's floodplain management elevation requirements or affect the insurance rating unless the community has been issued an exception by FEMA to allow floodproofed residential basements. The permitting of a floodproofed residential basement requires a separate certification specifying that the design complies with the local floodplain management ordinance. BUILDING OWNER'S NAME ^� FOR INSURANCE COMPANY USE i2C BIW+` 1 5 l a.re Sb•1Z DC \ 14 L, POLICY NUMBER , STREET A DRESS (Including Apt., Unit, Suite, and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER 31 C-Au53w D. COMPANY NAIC NUMBER OTHER DESCRIPTION (Lot and Block Numbers, etc.) F, . ID ; C8-01-15--1. 60co —000 —013 j CITY C�� i-� � STATE Zip ao de C %— c'-1 SECTION I — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM: COMMUNITY NUMBER 1256%0 PANEL NUMBER 1210WOtOZ SUFFIX U DATE OF FIRM INDEX 0x1103`2003 FIRM ZONE JtyI2- BASE FLOOD ELEVATION (in AO Zones, Use Depth) 12 Indicate elevation datum used for Base Flood Elevation shown above: NGVD 1929 ANAVD 1988 Li Other/Source: SECTION II — FLOODPROOFED ELEVATION CERTIFICATION (By a Registered Professional Land Surveyor, Engineer, or Architect) All elevations must be based on finished construction. Floodproofing Elevation Information: Building is floodproofed to an elevation of rl, 0 . feet (In Puerto Rico only: . meters). NGVD 1929 gNAVD 1988 ❑ Other/Source: (Elevation datum used must be the same as that used for the Base Flood Elevation.) Height of floodproofing on the building above the lowest adjacent grade is 3,5 ' feet (In Puerto Rico only: meters). For Unnumbered A Zones Only: Highest adjacent (finished) grade next to the building (HAG) . feet (In Puerto Rico only: . meters). ___..[.NGVD 1999. • NAVD 1988 ❑Other/Source._ (NOTE: For insurance rating purposes, the building's floodproofed design elevation must be at least 1 foot above the Base Flood Elevation to receive rating credit. If the building is floodproofed only to the Base Flood Elevation, then the building's insurance rating will result in a higher premium. See the Instructions section for information on documentation that must accompany this certificate if being submitted for flood insurance rating purposes.) FEMA Form 086-0-34 (6/15) Page 2 of 4 I , ' Rw..rnu�neu uesign erevaeon intimated above, Is substantially Impermeable to the passage of water, and shall perform in accordance with the 44 Code of Federal Regulations (44 CFR 60.3(c)(3). FLOODPROOFING CERTIFICATE FOR NON-RESIDENTIAL STRUCTURES (Continued) Non -Residential Floodproofed Elevation information Certification: Section II 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 infomiation in Section 11 on this Certificate represents a true and accurate interpretation and determination by the undersigned using the available information and data. I understand than any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME TITLE ',la) 6-4v 4) -t wale. ADDRESS /30y 1.ICFNSE NUMBER (or Affix Seal) S 53 q2 C P�1NYNAME J / Cv,Ji('V CITY �J( STATE IZIP CODE Sew"Aibit SIGNATUR -.. DATE 335 PHONE SECTION Ili — FLOODPROOFED CERTIFICATION (By a Registered Professional Engineer or Architect Non -Residential Floodproofed Construction Certification: I certify the structure, based upon development and/or review of the design, specifications, es -buff drawings for construction and physical inspection, has been designed and constructed in accordance with the accepted standards of practice (ASCE 24-05, ASCE 24-14 or their equivalent) and any alterations also mocl those standards and the following provisions. The stricture, together with attendant utilities and sanitary facilities is watertight to the floodproofed design elevation indicated above, is substantially Impermeable to the passage of water, and shall perform in accordance with the 44 Code of Federal Regulations (44 CFR 60.3(c)(3). All structural components are capable of resisting hydrostatic and hydrodynamic: flood forces, including the effects of buoyancy, and anticipated debris impact forces. I certify that the information in Section lU on this certificate represents a true and eccuretc determination by the undersigned using the available information and data. 1 understand that any false statement may be punishable by line or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME f).ler- L - TITLE ADDRESS LICENSE NUMBER (or Affix Sel) A .tttt3(Z COMPANY NAME CITY STATE ZIP CODE 2Sr�i S &C).2 _L((( ,,aa{e_ SIGNA i RE DATE PHONE Qjs 51 gZ(D1-7_ 1Z'! 116154W Copy a Pages of this Hoosiproofing [; fior 't) community -ofHeiat� 21 and - building owner. PLACE SEAL HERE FEMA Form 086-0-34 (6/15) Page 3 of 4 FLOODPROOFING CERTIFICATE FOR NON-RESIDENTIAL STRUCTURES (Continued) Instructions for Completing the Floodproofing Certificate for Non -Residential Structures To receive credit for floodproofing, a completed Floodproofing Certificate for Non -Residential Structures is required for non-residential and business buildings in the Regular Program communities, located in zones A1—A30, AE, AR, AR Dual, AO, AH, and A with BFE. In order to ensure compliance and provide reasonable assurance that due diligence had been applied in designing and constructing floodproofing measures, the following information must be provided with the completed Floodproofing Certificate: • Photographs of shields, gates, barriers, or components designed to provide floodproofing protection to the structure • Written certification that all portions of the structure below the BFE that will render it watertight or substantially impermeable to the passage of water and must perform in accordance with Title 44 Code of Federal Regulations (44 CFR 60.3 (c)(3)) • A comprehensive Maintenance Plan for the entire structure to include but not limited to: • Exterior envelope of the structure • All penetrations to the exterior of the structure • All shields, gates, barriers, or components designed to provide floodproofing protection to the structure • All seals or gaskets for shields, gates, barriers, or components • Location of all shields, gates, barriers, and components as well as all associated hardware, and any materials or specialized tools necessary to seal the structure. FEMA Form 086-0-34 (6/15) Page 4 of 4 4 klar and klar ii 111 1 111:1Lfl il lifg$ 7'?.: LFt'..- iv' .47 .44 t_oor,FRooING FLAN 11 1 DRY FLOOD PROOFED AREAS. ALL DOOR OPENINGS TO HAVE FLOOD PANELS INSTALLED PER B/A0.2 REMAINING STORA6E AREAS BELCH DFE ARE EQUIPPED WITH FLOOD VENTS PER PLANE). architects Inc. SUM 1.1_ IS rk MEM'3781 OE -4( Xr l: (11 Ifl <• (y. in 4 111 4 r-- ez ulti II-tY LIl- o Pela•rla S. Slor Si Steven S. 3171 AA OOSSASI PretiminA, o PormIlling Sel Censlruction 0"1"I 5.8.201/ 03,031 TK SSA. A1.0 Of: Nro 1, s W o� S ,57 �h sm �`�ag. rr=ba1 ..b..!E• rR+e. /4iba y. r ' Oma! 8 a a O FLOODPROOFING CERTIFICATE FOR NON - RESIDENTIAL STRUCTURES (Continues! The floodproofing of non - residential buildings may be permitted as an alternative to elevating to or above the Base Flood Elevation: however, a floodproofing design certification is required. This form is to be used for that certification, Floodproofing of a residential building does not alter a community's floodp €airy management elevation requirements or affect the insurance rating unless the community hes been issued an exception by FEMA to allow floodproofed residential basements. The permitting of a floodproofed residential basement requires a separate certification specifying that the design complies with the local floodplain management ordinance. BUILDING OWNER'S NAME Greg Powers FOR INSURANCE COMPANY USE POLICY NUMBER STREET ADDRESS (Including Apt.: Unit. Suite. and /or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER 37 Causeway Blvd. COMPANY NAIC NUMBER OTHER DESCRIPTION (Lot and Block Numbers. etc.) PARCEL ID:08- 29- 15- 15606- 000 -0131 CITY Clearwater ; STATEFL I Zip Code 33767 SECTION I — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Prov,de the following from the proper FIRM: COMMUNITY NUMBER 125086 PANEL NUMBER 12103C0102 SUFFIX G DATE OF FIRM INDEX I FIRM ZONE I BASE FLOOD ELEVATION i 1 On AO Zones, Use Depth) 09/03/2003 ( AE 12 3 VE13 j 12.0 Indicate elevation datum used for Base Flood Elevation shown above. 0 NGVD 1929 Z NAVD 1988 ❑ Other /Source: SECTION 11— FLOODPROOFEb ELEVATION CERTIFICATION (fly a Registered Professional Land Surveyor, Engineer, or Architect) All elevations must be based Floodproofing Elevation Building is floodproofed to NGVD 1929 M NAVD (Elevation datum used must Height of floodproofing on the For Unnumbered A Zones Highest adjacent (finished) NGVD 1929 NAVD (NOTE: For insurance rating receive rating credit. If the premium. See the Instructions insurance rating purposes.) on finished construction. Information: an elevation of 14.0 feet (In Puerto Rico only. meters). 1988 [] OtherlSource: be the same as that building above the Only grape next to the building 1988 II i Other /Source: purposes, the building's building is floodproofed section for information used for the Base lowest adjacent (HAG) Flood Elevation.) grade is 3.5 feet (In Puerto Rico only: meters). feet (In Puerto Rico only: meters). floodproofed design elevation must be at least 1 foot above the Base Flood Elevation to only to the Base Flood Elevation, then the building's insurance rating will result in a higher on documentation that must accompany this certificate if being submitted for flood omi 086 -C -34 (6/15) Page 2 of 4 FLOODPROOFING CERTIFICATE FOR NON-RESIDENTIAL STRUCTURES (Continued) 37 Causeway 131v..i Form - 5) Page 3 of 4 Non•Residential Floodproofed Elevation Information Certification: Section 11 certification is to be signed and sealed by a !enc.,' surveyor engineer. or architect nthorized by law to certify elevation information I certify that the information in Section II on this Certircate represents a true and accurate interpretation and determination by the undersigned using the avalleoie infonnat,on and dare i ziodersta,vi ti7at any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001 r \ ' CERTIFIER'S NAME !LICENSE Kli..IMBERSeei i David Gtaves PSM 1Ls 5392 ' TIT COMPANY NAME f. v. , President , Ar,..7;,,:onsuitile !ix ' i /A151:WESS P4. Box 34 OiTY MATE -74,97 Sail 'VnIniii,i !Fiorida ' 333'6 .: :.• ' .1 1 - ' ' SIGNATURE -104106/2017 -4" 1 1 ---ii - I k-.. i2r AT F. ipHiDNE 1 , i + I 1:?.313) S03-3728 :1 1_....._ SECTION Hi — FLOOOPROOFED CERTIFICATION (By a Registered ProressIont Engineer or Archltec Non-Residentlal Floodproofed Construction Certification: 1 certify the $1ructure based upon development anctior revitt of The cl,..!7lgr. speolficaticLs. as-built drawings for construction and physicai inspection, has been designed and constructed in accordance yvith the accepted St.9-'3:1a,d,s of ...7irte (ASCE 24-05, ASCE 24-14 or their equivalent) and any alterations also meet those standards 5.9G The fr.38cyvng c7r9visio1 !,' The structure, together with attendant utAities and 3anItary faci■ities is watertight to the tlocdproofed design elevation indicated above, is substantially impermeable to the passage of water and shati rier'orm in acccgdance with the 44 Code of Federal Regulations (44 CFR 60.3(0)(3). All structural components are capable of resisting hydrostatic and hydrodynamic flood forces, including the effects of buoyancy, and anticipated debris impact forces. I certify that the information ,r7 Section ill on this caditcate represents a trc,e and accurate determination by the undersigned using the available information and data I understand that any fa/se staten7ent may be punishable cy fine or imprisonment under 18 U.S. Code, Section 10.01, CERTIFIER'S NAME iLICENSE NUMBER (cr Aff,x Seal) I S392 -i- TITLE COMPANY NAME ADDP.ESS !ci , iSTATE ZIP GUDE ; ) i --I SIGNATURE IDATE PHONE Copy all pages of this Floodproofing Certificate and all attachmen for 1) co 'unity offlctaf , insurance agenVcompany, and 3) building owner. Form - 5) Page 3 of 4 DEPARTMENT OF HOMELAND SECURITY Federal Emergency Atlanagement Agency FLOODPROOFING CERTIFICATE FOR NON-RESIDENTIAL STRUCTURES OMB Control Number. 1660-0008 Expiration: 11/30/2018 Paperwork Burden Disclosure Notice Public reporting burden for this data collection is estimated to average 3.25 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources. oatnefing and maintaining the data needee. 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 forrn, Send comments regarding the accuracy of the burden estimate and any suggest:one far reducing the burden to- Information Collections Management, •Department of Homeland Security, Federal Emergency Management Agency 1830 South Bel Street Arlingtara VA 20598-3005, Paperwork Reduction Project (1660-0008). NOTE: Do not send your completed form to this address. General. This information is provided pursuant to Public Law 96-511 the Paperwork Reduction Act of 1980. as amended), dated December 1. 1980, to allow the public to partiapate more fully and meaningfully in tne. Feder& paperwork rev ew process. Authority. Public Law 95-511 amended; 44 U. SC, 3507, and 5 CFR 1320. Privacy Act Statement Authority. Title 44 CFR § 61.7 and 61,8. Principal Purpose(s): This information is being collected fer the primary purpose of estinlating 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 forrn 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 DHS1FEMA-003— National Flood Insurance Program Files System Of Records Notice 73 Fed. Reg. 77747 (December 19. 2008); OH-S/FEMANFIPILOMA-1 — National Flood Insurance Program (NFIP) Letter of Map Amendment (LOMA) System of Records Notice 7 Fed. Reg. 7990 (February 15, 2005); and upon written request, written consent, by agreement. or as required by law. Disclosure: The disclosure cf 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 being subject to higher premium rates for flood insurance. Information wilt only be released as permitted by law. Purpose of the Floodproofing Certificate for lion.Residential Structures Under the National Flood Insurance Program (NFIP) the flooaprepang of non-residential buildings may be permitted as an alternative to levating to or above the Base Flood Elevation (BFE). A floodproofing design certification is required for non-residential structures that are floodpreofed. This form is to be used for that certification A floodproofed building is a building that has been designed and constructed to oe watertight (eubstantialiy impermeable to floodwaters) law the eFE and with structural components lavieu the capability of resisting hydrostatic and hydrodynamic loads and effects of ouoyancy. Before a floodproofed building is desioned. numerous elanning consalerations, including flood warning time, uses of the building, mode of entry to and exit from the building and the age in general. floodwater velocities. flood depths, debris impact potential, and flood frequency. must be addressed to ensure that dry floodproofng wit he a viable floodplair management measure. The minimum NFIP requirement is to flooderoof a building to the BFE However, when it is rated for flood insurance one-foot is subtracted from the floodproofed elevation. Therefore, a building has to be floodproofed to one foot above the BFE to receive the same favorable flood insurance rates as a building elevated to the BFE. Additional guidance can be found in FEMA Publication 936. Floodproofing Non-Residential Buildings (2013), available on FEMA's website at http/tw.fema.gov/rnedia-library/assets/docurne.nts1327o FEN% Form 086-0-34 (5115) RECEIVED APR 1 3 201? Creative Contractors, Ini Page 1 of 4 FLOODPROOFING CERTIFICATE FOR NON-RESIDENTIAL STRUCTURES (Continued) Instructions for Completing the Floodproofing Certificate for Non-Residential Structures To receive credit for floodproofing, a completed Floodproofing Certificate for Non-Reside.itial Structures is required for non-residential and business buildings in the Regular Program communities, located in zones Al—A30 AE. AR AR Dual, AO. AH, and A with BFE. In order to ensure compliance and provide reasonable assurance that due diligence had been applied in designing and constructing floodproofing measures. the following information must be provided with the completed Floodproofing Certificate, • Photographs of shields, gates, barr ers, or components designed to provide floodprooting protection to the structure • Written certification that all portions of the structure below the BFE that will render it watertight or substantially impermeable to the passage of water and must perform in accordance wth Title 44 Code of Federal Regulations (44 CFR 60.3 (c)(3)) • A comprehensive Maintenance Plan for the entire structure to include but no timited to. • Exterior envelope of the structure • All penetrations to the exterior of the structure • All shields: gates, barriers, or components designed to provde floodproofing protection to the structure • All seals or gaskets for shields, gates: barriers, or components • Location of all shields, gates barriers. and components as well as all associated hardware, and any materials or specialized tools necessary to seal the structure. FEMA Form 086-0-34 (6(15) Page 4 of 4 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 Greg Powers Policy Number: A2. Budding Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 37 Causeway Blvd. Company NAIC Number: City State ZIP Code Clearwater Florida 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) PARCEL 10:08- 29 -15- 15606- 000 -0131 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, Accessory, etc.) Lat. 27- 58'371" Long. -82- 49'391" Commercial Horizontal Datum: obtain flood insurance. 1.0 foot above adjacent above adjacent grade ❑ NAD 1927 grade x NAD 1983 0 2 photographs of the building if the Number 1B Certificate is being used to 0 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 enclosure(s): or enclosure(s) openings in the crawlspace in A8.b 0 sq or enclosure(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 x No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number Pinellas County, 125096 B2. County Name Pinellas County B3. State Florida B4. Map /Panel Number 12103C0102 B5. Suffix G B6. FIRM Index Date 09/03/2003 B7. FIRM Panel Effective/ Revised Date 09/03/2003 B8. Flood Zone(s) AE 12 & VE13 B9. Base Flood Elevation(s) (Zone AO, use Base Flood Depth) 12 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 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 6 w ELEVATION CERTIFICATE OMB No. 1660 -0008 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. 37 Causeway Blvd. 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* *A new Elevation Certificate will be required when construction of the C2. Elevations — Zones A1—A30, AE, AH, A (with BFE), VE, V1 —V30, V Complete Items C2.a —h below according to the building diagram specified Benchmark Utilized: 872 6724A TIDAL AG7196 Vertical • building (with Datum: Building Under Construction" x Finished Construction is complete. BFE), AR, AR/A, AR/AE, AR/A1—A30, AR/AH, AR/AO. in Item A7. In Puerto Rico only, enter meters. NAVD 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, crawispace, or enclosure floor) 5 5 the measurement used. p 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 8 5 c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) n/a e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 5. 0 g) Highest adjacent (finished) grade next to building (HAG) 5. 3 h) Lowest adjacent grade at lowest elevation of deck or stairs, including 5. 3 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? x Yes ❑ No III Check here if attachments. Certifier's Name License Number David P Graves LS 5392 1 , , , , , , ," e > 9 ` `.4 `%� L ` �`� r v' PI e c `, - s,- '� ca f b .. P� ,, �3F "'' • Title President Company Name AFN Consulting, Inc.' Address PO Box 445 City State ZIP Code San Antonio Florida 33525 Signature Date Telephone 03/14/2017 (813) 503 -3228 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) Building is built in flood zone "AE" only. A/C is on roof. FEMA Form 086 -0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 MOTN: Ihspcsoy te crepnig ifrain foeto. FR ISRNE CMAY UE ulig Sredrsicuig Atntut, ad olgo) o.. Rue ad Bx N. Plcubr 7 Cueald iy Sae ZP CdopnAC Nme lawtr Foia 377 SCIN E — BIDNLVTONOMTOSREOEURD OOE ANOE A (IHUF) ooeO ad A (ihuF)opee Ies E—5f te Criiae inedd tuprOA oOR F rqet opee Scin, Bad CotmlE, ue ntrl gaef aalbehchesrmnsdn Petio ol, etr mtr. E. Poie eeain ifrain fr te floig ad cek te aporae bxs thw wehr te eeain ibvr blw te hget ajcnrdHGnhoet ajcnrdLG. aof btoloicuig bsmn, aoe o rwsaer ecoues ❑ feees ❑ ❑eohA. bof btoloicuig bsmn, calpc, onlsr) iet ❑ mtr bvr ❑eohA. E. Fr Bidnigas 69 wtemnnlopnns poien Scin A Ies 8 adose pgs 1 2 ontutos, te nxihr for (lvto2b i higasf te bidns ❑ feees ❑ aoe oeohA. E. Atceaae (of sa) iet ❑ mtrbvr ❑ blw te HG 4of pafrf mciey adoqimn evcnhulig iet ❑ mtrbvr ❑ blw te HG 5oe Anyf nloetubr ivial, ihof te btololvtd icodne wthomnt' lopan mngmnriac? ❑ Ys ❑ Nnnw. Te lcl ofcaut criy tinomton Scin G ETORPRY ONR (R ONRS RPEETTV) CRIIAIN Te poetwer onrs atoieersnaie wo cmlts Scin, Bnooe A (ihuEA iser cmuiyiseF) ooe Aut sgeehttmns ietos A, ad E ae cret thet oy kolde rpry Onr owe'uhrzd Rpeettv'ae Ades CtttIoe Sgaue Dteehn omns ❑ Cek hrf atcmns ELEVATION CERTIFICATE OMB No. 1660 -0008 p Expiration Date: Nov 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. 37 Causeway Blvd. 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 Sections A, B, C (or E), and G of this Elevation used in Items G8 -G10. In Puerto Rico only, enter 01. ❑ 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. 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. 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 building: G9. BFE or (in Zone AO) depth of flooding at the G10. Community's design flood elevation: New Construction ❑ Substantial Improvement basement) ❑ meters Datum • feet ❑ 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 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. 37 Causeway Blvd. 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 Caption Southwest view Photo Two Photo Two Caption Northeast view 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. 37 Causeway Blvd. Policy Number: City State ZIP Code Clearwater Florida 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 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 . � �_ Z_� �l � � 3 ��►��c�N c��TiFica�r� oMB�,o. ,�8 U.S: Expires March 31,2012 Fed1 ..`�°..'.-.�-T--�� Im tt,ettt� Read the instructions on pagas 1-9. Natian"aT �ry lii�wratioe 1�o$ram #� �'!pM A=RROPERTY INFORMAT'iOhl Ai. B Owrre�s Name �E.E+0.�t`!"�R BEACH SEAF"t)ODS f42. Bu3�dir�3Weef Address{tn�ciudfng Apt..Unif.Surte.:andlot 81dg.No.)or P.O.Route and Box No. 37 CRUSE�A"M B4t1i.E�lARU Gt�r CLE�IR�NATER SEate Fl ZtP Cade 33767 y A3: i'roperl�t Descriptipn tU�t and 81Gdt Nt►er�brers,T�Par+Dei Number,t.e9al Oescription,etc.j PART{IF LO'T'S)2$l3�CiTY P'A�tK SUB�P,B.23�PG,37 A�. ��{s�.,��.�,�}�ntiai,qdditlon,qCCessory,etc.}R1f,1N-RESIQENTIAL Norfzonial Datum: � NAD 1927 � NAD 1983 A5. 181itutlo�o�+g�e:Lst.�?,,,,J'-','�� L4e�, t�',¢�,� �$ A��Z�}�p#�bU�d�Sg li q►e Ge�te is being used to Qbtain flood insurence. A9. 8uik�ng[�rans N� �! A9. For a building with an attached qarage; A8. Far s Ou�vv�h a t�ls{sace or enctc�u+re(s). a� gt��e fot�a ot Gr�Psce�tm�taure{6) Q sq ft a} Square faotage ot att8�►ed Qara9e 4 s�i ft b) No,+Qtps��o!Dd�?��4 P�� b) Dta.af pem�►�anent fload openiags in tha attached garage ��T. � within i3O fvct abova�djaCent;grade Q o) 'f Mik�G��`, � ' tr►A18.ti iD sq in c) Tatat net at`�at fl4od opan�n9s in A9.1s � sQ 1+t d) Engsnee�ed tlood 4penic►�'t CI Yes 1� � d) Engineered tload opertings9 [1 Yes �} No : 3ECi`It)N�-��.U�D INSUR'AANGE�ATE MAR(FtRMj tN�ORMATt�C1N B1.N ,:�N�rie�Gt�mntunilY N�nbot 82.County Neome ` B3.SEa�e GiTY�?F GtEA1�AT�R 125096 F'1NELtAS F10RfC}A 84.�Aap�u#e!Nh�bsr .Su� BB.Fi f�de�c B7.FIRM Panal 86.Ftood 89:�asse�k�sd Elevadan(s}(2or� 12903+CO1tYt � Dat�e EfifectivelRevised l7ate Zone{s) A0�uae base Aaod depth) ' 8..t8-�lQ� + 9-�-2003 VE 13' B40. Indic.s�ks ihe 3ouaC9��er�i�lood EievatiWt(�}da�e or base Aaad de�N'►en�red in Item B9, �j F)S P� � F�i�u1 Q C�ret►mtnkY Ae�'�tmined � Qther(Dsscribe) B�z. rn�etew�ar+d�+use��n nem aa: [3 n�vt��s2s }gl wav��ss� Cl aa►er coesc�e� Bfi2. {s EIt41)ttUFNng IpG►ted in a Coasta{8attiBr RBSOUrces System(CBRS)area or Otherwise Proteded Are�;OPA)? ❑ Yes Q No O�No�t[#ate ❑ GBRS ❑ OPA S�C7'tC1N C-8131LflINE�ELEVA'FtON'tNfbRMATION(3URVEY REQtf1RED} C:. Suikl��S#�.sed o^' � C4t�a#�uc#ion Littrw��s" �l Buddirag Under Construction• � Finisheti Construction "A fysw�levsiiol+Getti�fC�VAN be tAquked w?�en bt1t18it+uCki�af the bui�ding is COrnplete. G2. �i�s-�'�Snes A4-A30,AE.A�f,A(with BFq;VE,V1-1130,V(witfi BFf),AR.ARJA.ARIAE;ARlAt-A30.Aft�AH,ARiAO. Cor�iete items C2.a-h Dolow scz�o�t!#ri�i t4 t118 bu�din9 d�a$ram��It�n A'�. Use the s�+re�latwrr as ihe BFE ee�n�,►t�cic UtH�tea P►t�Ca D1�x auRAl.A v,�t�artunn E��v.= 1,@�NAVD ts8b ConxarsioNGac�meni� Gheck tlte tneasuremerk used. �r} „.� • r i,kr�{&�utl��as�r�m�c�Paoa,4r endusure floar)�,7 �feet []meters(Puertc Rlco anh+) bf �`c�r% ' �`t�rAoo¢ ., .. , �, �� , ;.., I�t fe�c C7�t�t�t��o"►Y3 c1 8atka�et aFl�e laarest i►on�oant�l�ru�►ailr��lier'N�nes anly) �.�, ° " I�I#,�# C��ara{F'u�ta R�lao oi+►Y} ._ : _ � d'} A�d 8'aT�9�i�P of slab) �. ❑t�! C�m�ers(P�rk+tZico onrY) 8? '1 s�t,�Of�iD�11#aG��G�1�ar�t.�p►9p�e kwildiitg $.i �i�t ��t►M�srs fPus�fio Rtoo�r� _ `{�bi�4iE�and hx�on k�G�nMts� � ;��#��r�cc to buad'�t�3 4:s f�te�t �meters tPs�rto Rioa anty) , . �l '��`9�e�t�b�9 cw�Cy �� taet p�tp�,to Rtco cu�� n> i.awr��M�at�t el�ratior►af d�c or�rs.��n� �$. Q�s�t CI�(�o Rico or�vy �tuo� _ �C"�#L��!Q-�UR'I�E�QR,ENGIN�Ef�,4R J�RCHITEGT 4�f�t'�flCA"Tti?N ` 't'�a p��t►ba�Sd ar�d a��t by a�rx�;sunFey�r,engtneer,or atcl+�+�ctauFhorized Dy#sw to oe�tty elev�ioa � a��c�Cr�. !#�o�!'6h�t��1a�on Cn�ts�tr�s mY 68sf�ts ta tnferpr+et ths��. ��L��, � i�8mf�uAt ar�'l�e��l+be p��r.�e bS'A�e or brrp�i�rr�t t»�cf�sr 18 U.S,Ct�6r,SsCitan 1d0i�. � Ch�dc I�+re ff c�x�rtts sst�Dnrnrid�d an hacic oE fiorm. 5�/ere la�c�de and�ong�ude in Sectian A provided by a '�'y 1��P L:�t�E 4icensad iar►d sunreYor? � Yss �1 � SEAi. CefRi�'s�LAtlR€N R. NNY License Number �t4931 HER� Tilia LA YOR GompBfly N�►rt8 L.R.PENNY ANQ SOCI�ITES,iMC. Addnsss 1 90 ArVENUE NUR'"fM CitY SEMINO�E State FL 21P G�Me 33778 s�u� � Date 5/18/2811 Teiephone 727-398-436Q �-/�i'-ZCl l./ �cs•..d..... �EAAA Form 81-31,M�r 09 See reverse side for corstinuatian. Replaces aU previous edit'cons $t,�l�f.�tl'I� ��1{)�t'��1"c'��"1� Se�fnstruetians fi!ar#tem A6. 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'.�__ "" �+ ,,� �� .,�� .- �� . / tm�' � �,� . _ t ,� � A�'� ....cs �� \ \ \*. �� ' :�� 1 �� -...� .. . *'� � �' . �I, _ _ _ .T.—, -- r �,� ` / //� ,. . � [��'' � '. �. '....�..'� 1 r� Y J `• `.`� ;. .` i.� .... . � .��j1�` , r[ .��', '�! ... ,�`t �f/�`� � ..r _ . �� . \ , . �` . \ � . :�G' •'�^ . . ,`R.,l� \ ��x'/ .y � ,..,� ,� ,. . . . .�5�� - . rr,��/t .a O 1 S 1��7 r'?,�'1/J �c;�/S 1 f-1�I Z/ 0 37 CAUSEINAY BLVD BCP2016-04187 CRABBY BILLS Zoning: Tounst �r»�q�s #: 267A ID �t�i�U Ul� AUG 2 1 20� P��I�G 8 E'�1�t.OPMENT pEpT rn,.�,�,.. ^---- l�.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 Policy Number: A1. Building Owner's Name Greg Powers A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number: Box No. 37 Causeway Blvd. State ZIP Code City Florida 33767 Clearwater A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) PARCEL ID:08-29-15-15606-000-0131 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Commercial A5. Latitude/Longitude: Lat. 2�-58'371" Long. -$2-49�391" Horizontal Datum: ❑ NAD 1927 0 NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number �B A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) 0 sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b 0 sq in d) Engineered flood openings? ❑ Yes � No A9. For a building with an attached garage: a) Square footage of attached garage � sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade c) Total net area of flood openings in A9.b 0 sq in d) Engineered flood openings? ❑ Yes �x No 0 SECTION B— FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 63. State 61. NFIP Community Name & Community Number 62. County Name Florida Pinellas County, 125096 Pinellas County B9. Base Flood Elevation(s) 64. Map/Panel 65. Suffix B6� Date �ndex 67. FIRM Panel 68. Flood Zone(s) �Zone AO, use Base Number Effective! Flood Depth) Revised Date 12103C0102 G 09/23/2003 09/23/2003 AE 12 & VE13 12 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: [] FIS Profile �x FIRM ❑ Community Determined ❑ Other/Source: 611. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 ❑x NAVD 1988 ❑ Other/Source: 612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes �x No Designation Date: ❑ CBRS ❑ 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. Policy Number: 37 Causeway Bivd. City State ZIP Code Company NAIC Number Clearwater Florida 33767 SECTION C— BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* x❑ Building Under Construction" � 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, AR/A1—A30, AR/AH, AR/AO. Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: 872 6724A TIDAL AG7196 Vertical Datum: NAVD 1988 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � 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, crawispace, or enclosure floor) 5. 5 �x feet � meters b) Top of the next higher floor 8. S �x feet � meters c) Bottom of the lowest horizontal structural member (V Zones only) . �x feet ❑ meters d) Attached garage (top of slab) n�a. ❑x feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building . � feet ❑ meters (Describe type of equipment and location in Comments) fl Lowest adjacent (finished) grade next to building (LAG) 5 � ❑x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 5 3 �x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including 5 3 ❑x feet � meters structural supFort 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. ! certify that the information on this Certificate represents my best efforts to interpret the data availab/e. 1 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 ❑ Check he[e if attachments. .�'��a�, Certifier's Name License Number ` �;.� . �'��. �} %,. �' David P Graves LS 5392 .•••� '' � Title � . �' President , j , o � • �y ' Company Name � �,; : u��a� ;+ �y � � AFN Consulting, Inc. � La ��'�e8 � � ��$?�` Address �'� �� ,�� ` ; PO Box 445 �'� „`� City State ZIP Code /' � , „'°�F; • .••+ , � San Antonio Florida 33525 ; . . ._< ��, Signature Date Telephone ^ - 08/18/2016 (813) 503-3228 ` � 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) FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 i DEPARTNitNT OF HOMELAND SECURITY Federal Emergency Management Agency FLOODPROOFING CERTIFICATE FOR NON-RESIDENTIAL STRUCTURES Paperwork Burden Disclosure Notice �'''`� {?lIIS �.� • .� OMB Control Number. 1660-0008 Expiration: 11 /30/2018 Public reporting burden for this data collection is estimated to average 3.25 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. General: This information is provided pursuant to Public Law 96-511 (the Paperwork Reduction Act of 1980, as amended), dated December 11, 1980, to allow the public to participate more fully and meaningfully in the Federal paperwork review process. Public Law 96-511, amended; 44 U.S.C. 3507; and 5 CFR 1320. Privacy Act Statement Titie 44 CFR § 61 _7 and 61.8. ipal Purpose(s): This information is being collected for the primary purpose of estimating the risk premium rates necessary to provide insurance for new or substantially improved structures in designated Special Flood Hazard Areas. utine 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, amended. This includes using this information as necessary and authorized by the routine uses published in DHS/FEMA-003 — Nationai od Insurance Program Files System or Records Notice 73 Fed. Reg. 77747 (December 19, 2008); DHS/FEMA/NFIP/LOMA-1 — National od Insurance Program (NFIP) Letter of Map Amendment (LOMA) System of Records Notice 71 Fed. Reg. 7990 (February 15, 2006); and m 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 being subject to higher premium rates for flood insurance. Information will only be released as permitted by law. Purpose of the Floodproofing CertiFcate for Non-Residential Structures Under the National Flood Insurance Program (NFIP), the floodproofing of non-residential buildings may be permitted as an alternative to elevating to or above the Base Flood Elevation (BFE). A floodproofing design certification is required for non-residential structures that are floodproofed. This form is to be used for that certification. A floodproofed building is a building that has been designed and constructed to be watertight (substantially impermeable to floodwaters) below the BFE and with structural components having the capability of resisting hydrostatic and hydrodynamic loads and effects of buoyancy. Before a floodproofed building is designed, numerous planning considerations, including flood warning time, uses of the building, mode of entry t� ar.d ex�t fCOm ths bu:lding and the si±e ;^ gene�2l, f!oodwat°r velocities, flocd depths, �ebris impac. pct2r�aal, a�� n�c� frequency must_be addressed_io_ensur_e_thatdry�lo.otlproofing_willbQaviablefloDdplaia.managemenimea'sure._ _____ _._ __ _ . _____ The minimum NFIP requirement is to floodproof a building to the BFE. However, when it is rated fofflood insurance one-foot is subtracted from the floodproofed elevation. Therefore, a building has to be floodproofed to one foot above the BFE to receive the same favorable flood insurance rates as a building elevated to the BFE. Additional guidance can be found in FEMA Publication 936, Floodproofing Non-Residential Buildings (2013), available on FEMA's website at https://www.fema.gov/med ia-library/assets/docu ments/34270. �'� _.'.� . . 37 CAUS�EWAY BLVD sc�.��a.��-ro ��" FLOOD PR�F9IVG � CRABBY B11LS Zoning: Touris# Atlas #: 267A FEMA Form 086-0-34 (6/15) ' _ Page 1 of 4 FLOODPROOFING CERTIFICATE FOR NON-RESIDENTIAL STRUCTURES (Continued) The floodproofing of non-residentiai buildings may be permitted as an aiternative to elevating to or above the Base Flood Elevation; however, a floodproofing design certification is requi�ed. This form is to be used for that certification. Floodproofing of a residential building does not alter a community's floodplain management elevation requirements or affect the insurance rating unless the community has been issued an exception by FEMA to allow floodproofed residential basements. The permitting of a fioodproofed residential basement requires a separate certification specifying that the design complies with the local floodplain management ordinance. BUILDING OWNER'S NAME FOR INSURANCE COMPANY USE �f'�� we�r5 , C�Ck�2-�-5�"Cst. �� 1r��, , STRE�RESS (Including Apt., Unit, Suite, and/or Bidg. Number) OR P.O. ROUTE AND BOX NUMBER 3�► C�r�� `i3wp. OTHER DESCRIPTION (Lot and Biock Numbers, etc.) #��-t.. i� � �-2'�-15-- l5�fxo �-o00-0131 POLICY NUMBER COMPANY NAIC NUMBER CITY I ST�TE Zip Code ��..�7.�4�-1�T� L u � 3� � � SECTION I– FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM: COMMUNITY NUMBER PANEL NUMBER SUFFIX DATE OF FIRM INDEX FIRM ZONE BASE FLOOD ELEVATION (in AO Zones, Use Depth) 1Z�bqt� {21d3Gojp2 � f�ilo3�ZOo3 �,�12 12 Indicate elevation datum used for Base Flood Elevation shown above: � NGVD 1929 �NAVD 1988 � Other/Source: 3ECTION il – FLOODPROOFED ELEVATION CERTIFICATION (By a I elevations must be based on finished construction. Floodproofing Elevation Information: � Building is floodproofed to an elevation of �, Q_ . feet (In Puerto Rico only: � NGVD 1929 �NAVD 1988 ❑ Other/Source: (Elevation datum used must be the same as that used for the Base Flood Elevation.) ai �ana surveyor, tngineer, or meters). Height of floodproofing on the building above the lowest adjacent grade is �,'� � feet (In Puerto Rico only: meters). For Unnumbered A Zones Only: Highest adjacent (finished) grade next to the buiiding (HAG) feet (In Puerto Rico only: meters). _ �i�IGVD_1929--�NAV_D 9988–�Otherl�our�e: ____— -_--_ __ _ -- ______ .__. __ _ ___ ___ _ _ _ __ __ For insurance rating purposes, the building's floodproofed design elevation must be at least 1 foot above the Base Flood Elevation to rating credit. If the building is floodproofed only to the Base Flood Elevation, then the building's insurance rating will result in a higher n. See the Instructions section for information on documentation that must accompany this certificate if being submitted for flood ;e rating purposes.) 5) Page 2 of 4 � FLQODPROOFING CERTlFiCAiE FOR NON-RESfDEN71AL STRUCTURES (Continued} Non-Residential �IoodprooEed Elevation lnformation CeRification: Sectiori (I cerlificafion is to he s:gned and sealed by a fand surveyor, engineer, or architect aufliorized 8y law to certify elevation informafion 1 certity that the infonr�ati��i in SecUor, !! on fhi� Cc:�f;fica.'e represetits a truc and ar.ci;rate it�terpret�tion ar�d determinaiion by the undersigned using the ev�ilable infom�atron and �afa. ! unrirrrsf:rnd IhF,f Hny f�lse stafement may be punishable by frne or imprisonmenf tmdvr 98 U. S. Code, Section i00t. ('^'C� ri.'Xt� � 2ESS - - --- - _ — �% �-� � 13;,`� Lf.��r' iE NUPtiBER {or Affix Seal} L. S 5"3 q2 1NY NAAdE -- . -- ---- �1 � u,� i;, l�, `� '� --�--. " _ _ �SiAi� ��' � ` L ' �� '��.- �N tBv a I �+ I _ P�ACF * SSAL �� " f9�RE �� .: nginoor or Architecti Non-Residentiai Floodproofed Canstruction Ccrtitication: 1 certi/y tire s(rur.ture, b�sed upon development antVor revicw ol the desi,qn, specifrcafrons, as-built dr�wings for construction and physical inspection, has been designe�' and construcl� in accerdance w;th the accepted siandards of practice (ASCE 24-05, ASCE 24-14 or therr equrvaleniJ and arry alterations a/sn mecl tlmsr, �landard, an� fhe foltowing provlsions. The siructure, together witfi a[ier�ciant uti!'s5es and sanitary facilities is �vatortic�hi io the flnodproofed design elevation indicated a6ova, is substantialty impermeabl� to the pass�ue of water, and s}ia(f perfnrm in acc:ordance with the 44 Code of Fedefal Regulations (44 CFR 6Q.3{c)(3}. All stntctural components are capable of resisting hydrostalic and t�ydrociynamic flcx�d forces, including ihe effeds of buoyancy, and arrticipaied debris impact forces. ! cariify fhat ihe irrtormation in Section !it an fhis ceriificate rapresent.s a trr�e arK� acr,!iralc deierminafion by the undersrgned using the ava�7able informa6on and daia. i undersiand fi�ai any fatse sfalernenf may bc� prmisfr�bte by frne or imprisonmenf under 18 U.S Code, Seciion i001. CERT1FIEf2'SNAME ---------------- -- �- - LICF.NSF. MLJti1�3EFi (or Aifix Seaf) ��.1�'r� L- �� Ub l 13 42 TITLE � -- - - CUMPANY NAf�IE � - ---- --- _�n �" �� __ �{,� A-�D �L�Z.- �G�!-1i.1Tc�T 5 � °LACE SGAI_ ADDRESS - -`.—. �CiTY - �- STATE I. C D� 11ERE ; . _2�1'� �,xt� ��2 ----- - ----1-��2,��— �z.. �33�c� 1 SlGNA RE !UATE IPHON� -- � lC�.--� � s� � i2��-� ��Z� ��, 5�� T- _. __ -- owner. FEMA Form 30#4 � FLOODPROOFING CERTIFICATE FOR NON-RESIDENTIAL STRUCTURES (Continued) Instructions for Completing the Floodproofing Certificate for Non-Residential Structures To receive credit for floodproofing, a completed Floodproofing Certificate for Non-Residential Structures is required for non-residential and business buildings in the Regular Program communities, located in zones A1—A30, AE, AR, AR Dual, AO, AH, and A with BFE. In order to ensure compliance and provide reasonabie assurance that due diligence had been appiied in designing and constructing floodproofing measures, the foilowing information must be provided with the completed Floodproofing Certificate: • Photographs of shields, gates, barriers, or components designed to provide floodproofing protection to the structure • Written certification that all portions of the structure below the BFE that wili render it watertight or substantially impermeable to the passage of water and must perform in accordance with Title 44 Code of Federal Regulations (44 CFR 60.3 (c)(3)) • A comprehensive Maintenance Plan for the entire structure to include but not limited to: • Exterior envelope of the structure • All penetrations to the exterior of the structure • All shields, gates, barriers, or components designed to provide floodproofing protection to the structure • All seals or gaskets for shields, gates, barriers, or components • Location of all shields, gates, barriers, and components as well as all associated hardware, and any materials or specialized tools necessary to seal the structure. rtmA rorm u��-u-;�4 �ei� 5� Page 4 of 4 � revlsion by 0 � � _. _".._.. .. — � ""_.".___"__.. _{___ n . ._.—.____ � _—_—_. 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