300 GULFVIEW BLVD . •
U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
Federal Emergency ManagementAgency Expires MarCh 31,2012
National Fiood Insurance Program 1►11P^rtant• Raari thA inctrur.tinnc nn nanec 1-9
3 0 0 S G U L F V I E W B LV D For Insurance Company Use:
A1. Building Owner's Name NJR DEVELOPMENT BCP2009-06512 Policy Number
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. Company NAIC Number
S.GULFVIEW BOULEVARD
City CLEARWATER State FL ZIP Code 33767
A3. Property Description(Lot and Blodc Numbers,Tax Parcel Number,Legal Description,etc.)
NEW GAZEBO AT AQUALEA (PARCEL iD NUMBERS 07/29/15/52380/000/0570 8�07/29/15/52380/000l0580 8 07/29/15/52380/000/1050)
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)NON-RESIDENTIAL
A5. Latitude/Longitude:Lat.N27°58'26.1" Long.W82°49'46.4" Horizontal Datum: ❑ NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of the building if the Cert�cate is being used to obtain flood insurance.
A7. Building Diagram Number 1�
A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) N/A sq ft a) Square footage of attached garage N/A sq ft
b) No.of permanent flood openings in the crawlspace or b) No.of permanent flood openings in the attached garage
enclosure(s)within 1.0 foot above adjacent grade N/A within 1.0 foot above adjacent grade N/A
c) Total net area of flood openings in AB.b N/A sq in c) Total net area of flood openings in A9.b N/A sq in
d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)11��Q�t�NrA�W�l�1;; .
_ . .
B1.NFIP Communky Name 8�Community Number B2.County Name � �B3'' e� '
CITYOFCLEARWATER 125096 PINELLAS ._�.� r'.��:�'•;.. ;FE.�� , �;�`� � � � � �� �
64.Map/Panel Number 65.Su�x 66.FIRM Index 67.FIRM Panel �� .'F16 ti ' B �Base 1DOd iev8tion s)(Zone
12103C0102 G Date Effective/Revised Date Zone(s) AO,use base flood depth)
MAY 17,2005 JANUARY 28,2009 AE 13'
610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9;';_ ...._.._.. . ,. __ _ _ _ . ._
❑ FIS Profile � FIRM ❑ Community Determined ❑ Other(Describe)
�,_-.- . c1 - , . r �
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 [�"Other(#)escribe} --
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Proteded Area(OPA)? ❑ Yes � No
Designation Date N/A ❑ CBRS ❑ OPA
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings* � Building Under Construdion' ❑ 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 specfied in Item A7. Use the same datum as the BFE.
Benchmark Utilized Clearwater Benchmark G-02Vertical Datum NAVD 1988 ��
Conversion/Comments NONE � �,0 )
Check the measurement used. �-.{Z ����
a) Top of bottom floor(including basement,crawlspace,or enclosure floor) 5.46 �feet ❑meters(Puerto Rico only) -G� �
b) Top of the next higher floor N/A. ❑feet ❑meters(Puerto Rico only) O r,� �. �
c) Bottom of the lowest horizontal structural member V Zones onl N/A. �
( y) ❑feet ❑meters(Puerto Rico only) �n� � �--.•--
d Attached ara e to of slab NlA. �" ` � ���1�
) 9 9 ( p ) ❑feet ❑meters(Puerto Rico only) �; t,1 �
e) Lowest elevation of machinery or equipment servicing the building N/A. ❑feet ❑meters(Puerto Rico only) b� ����
(Describe type of equipment and location in Comments) '���ts Q .„�
� Lowest adjacent(finished)grade next to building(LAG) 5.1 �feet ❑meters(Puerto Rico only) �q O �' �
g) Highest adjacent(finished)grade next to building(HAG) 5.5 �feet ❑meters(Puerto Rico only) ;�3 P:
h) Lowest adjacent grade at lowest elevation of dedc or stairs,including N/A. ❑feet ❑meters(Puerto Rico only) �rn
structural su ort �'� ��
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 - a' •� - °
information. I certify that the information on this Certifrcate riepresents my best efiorts to interpiet the data aveilable.l :`�y .;���, "
understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.� �, Cy_ • -' .
Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a � � ` �� ,a -�
licensed land surveyor? � Yes ❑ No � ' +Ls r ; �' `
{ , ' +�-�,'�,r,'��, � y, r. �
Certifier's Name JEFFERY A.COPELAND License Number 5279
-. �-�"�`�L 5������.:.
Title REGISTERED LAND SURVEYOR Company Name SUNCOAST IAND SURVEY�NG,INC. � �'�'' ' � `'+� �
.� �' �°�t� .
Address 111 FOREST LAKES BLV . City OLDSMAR Stete FL ZIP Code 34677 ''••�'�c if��•���` '
Signature Date 3/23/10 Telephone 813-854-1342
�
IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use:
Buildang Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number
S�GULFVIEW BOULEVARD
City CLEARWATER State FL ZIP Code 33767 Company NAIC Number
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community o�cial,(2)insurance agenUcompany,and(3)building owner.
Comments C2.UTILIZED CITY OF CLEARWATER BENCHMARK G-02 ELEVATION=4.923'(NAVD 1988)
��
Signature Date 3/23/10
❑ Chedc here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND 20NE A(WITHOUT BFE)
For Zones AO and A(without BFE),complete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B,
and C. For Items E1-E4,use natural grade,if available. Check the measurement used. tn Puerto Rico only,enter meters.
E1. Provide elevation information for the following and chedc the appropriate boxes to show whether the elevation is above or below the highest adjacent
grade(HAG)and the lowest adjacent grade(LAG).
a)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or Q below the HAG.
b)Top of bottom floor(including basement,crawlspace,or enGosure)is ❑feet ❑meters ❑above or❑ below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions),the next higher floor
(elevation C2.b in the diagrams)of the building is ❑feet ❑meters ❑above or ❑below the HAG.
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 0 below the HAG.
E5. Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management
ordinance? ❑Yes ❑ No ❑ Unknown. The local official must certify this information in Section G.
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,8,and E are co�ct to the best of my knowledge.
Property Owner's or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Qate Telephone
Comments
❑Check here ff attachments
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. Chedc the measurement used in Items G8 and G9.
G1.❑ The infortnation 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-G9)is provided for community floodplain management purposes.
G4.Permit Number G5. Date Permit Issued G6. Date Cert�cate Of Compliance/Occupancy Issued
G7. This permit has been issued for: ❑New Construction ❑Substantial Improvement
G8. Elevation of as-buik lowest floor(including basement)of the building: ❑feet ❑meters(PR)Datum
G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters(PR)Datum
G10.Community's design flood elevation ❑feet ❑meters(PR)Datum
Local Official's Name Title
Community Name Telephone
Signature Date
� "
Comments
' MAR 3 1 2010
..I V 1..:! �;X ..s�
CITY c7f°1'��1�Y+NT6t�chm nts
, .
U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATIQN CERTIFICATE OMB No. 1660-0008
Federal Emergency MienagementAgency Expires March 31,2012
National�Flood lnsurance Program Important: Read the instructions on pages 1-9.
SECTION A-pRnoG�T""'�^^•"--'-'� For Insurance Company Use:
A1. BuildingOwner'sName NJRDEVELOPMENT 300 S GULFVIEW BLVD F'o�icyNumber
A2. Building StreetAddress(including Apt.,Unit,Suite,a gCP2009-06512 Company NAIC Number
S.GULFVIEW BOULEVARD
City CLEARWATER State FL ZIP Code 33767
A3. Property Description(Lot and Blodc Numbers,Tax Percel Number,Legal Descriptio�,etc.)
NEW GAZEBO AT AQUALEA (PARCE�ID NUMBERS 07/29/15/52380/000/0570&07/29/15/52380/000/0580&07/29/15/52380/000/1050)
A4. Building Use(e.g.,Residential,Non-Residential,Addftion,Accessory,etc.)NON-RESIDENTIAL
A5. Latitude/Longitude:Lat.N27°58'26.1" Long.W82°49'46.4" Horizontal Datum: ❑ NAD 1927 � 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 1
A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) N!A sq ft a) Square footage of attached garage N!A sq ft
b) No.of permanent flood openings in the crawlspace or b) No.of permanent flood openings in the attached garage
enclosure(s)within 1.0 foot above adjacent grade N/A within 1.0 foot above adjacent grade N!A
c) Total net area of flood openings in AB.b N!A sq in c) Total net area of flood openings in A9.b N/A sq in
d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP Community Name 8 Community Number 62.County Name ?.',f ' , i� _,_ 63.Stgte
CITY OF CLEARWATER 125096 PINELLAS Fi�,,
64.Map/Panel Number B5.Suffix 66. FIRM Index B7.�Ik? I�Zir�eF :�lootl '- 69�Base Flood Elevation(s)(Zone
12103C0102 G Date EffedivelR6M�Sed'p�tp ; %�one(s�..: AO,use base flood depth)
MAY 17,2005 JANUARY 28,2009 AE 13'
610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. �j''�
❑ FIS Profile � FIRM ❑ Community Determined [] Other{Describe) ,
611. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other(Describe) �.�-�L'' � v
612. Is the building located in a Coastal Barrier Resources System(CBRS)arear Qi�mtki@rwise Protec�Qd Area,(OPA)? ❑ Yes p9 No
Desig�ation Date N/A ❑ CBRS ❑ OPA
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construdion Drawings* � Building Under Construction` ❑ Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete. �------------I
C2. Elevations-ZonesA1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,ARlA1-A30,AR/AH,AR/AO. Co plet0 It�.e�h-i 1
below according to the building diagram specified in Item A7. Use the same datum as the BFE. �rp ��.`=�
Benchmark Utilized Clearwater Benchmark G-02Vertical Datum NAVD 1988 z ,-�;-i
Conversion/Comments NONE ��
Check the measurement used. �G? � ��'�'
a) Top of bottom floor(inGuding basement,crawlspace,or enclosure floor) 5.46 �feet ❑meters(Puerto Rico only) ��° �,,� r�t°3
b) Top of the next higher floor N/A. ❑feet ❑meters(Puerto Rico only) rn m �-► .._��
c) Bottom of the lowest horizontal structural member(V Zones oniy) N/A. ❑feet ❑meters(Puerto Rico only) D< N
d) Attached garage(top of slab) NlA. ❑feet ❑meters(Puerto Rico only) �rO o `-�
e) Lowest elevation of machinery or equipment servicing the building N/A. ❑feet ❑meters(Puerto Rico only) �-�
(Describe type of equipment and location in Comments)
� Lowest adjacent(finished)grade next to building(LAG) 5.1 �feet ❑meters(Puerto Rico only) p Z 0
g) Highest adjacent(finished)grade next to building(HAG) 5.5 �feet ❑meters(Puerto Rico only)
h) Lowest adjacent grade at lowest elevation of deck or stairs,including N/A. ❑feet ❑meters(Puerto Rico only)
structural support '
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION � y� ; �
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 interp�t the data availableJ :�ue°�.� �- �° ��
understand that any false statement may be punishable by fine or imp►isonment under 18 U.S. Code, Section 1001.� ' �y ,:� '�'r��� .
Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a '//,'' �,.-�-•
licensed land surveyor? � Yes ❑ No Tp y�. ; ������:L : � -
s,._ ,�""r�' C� �i =-
Certifier's Name JEFFERY A.COPELAND License Number 5279 �� �� '� ,�.�"..i ;
Title REGISTERED LAND SURVEYOR Company Name SUNCOAST LAND SURVEYING,INC. ,r,'��: �¢�P�
, . ,
Address 111 FOREST LAKES B VD. City OLDSMAR State FL ZIP Code 34677 � :���;���. �
Signature Date 3/23/10 Telephone 813-8541342
�
IMPORTAI�T: 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
S.GULF'�/IEW BOULEVARD
City CLEARWATER State FL ZIP Code 33767 Company NAIC Number
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agenUcompany,and(3)building owner.
Comments C2.UTILIZED CITY OF CLEARWATER BENCHMARK G-02 ELEVATION=4.923'(NAVD 1988)
Signature Date 3/23/10
❑ Chedc here if attachments
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 CeRificate is intended to support a LOMA or LOMR-F request,complete Sedions A,B,
and C. For Items E1-E4,use natural grade, if available. Chedc the measurement used. In Puerto Rico only,enter meters.
E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent
grade(HAG)and the lowest adjacent grade(LAG).
a)Top of bottom floor(including basement,crawlspace,or enGosure)is ❑feet ❑meters ❑above or�below the HAG.
b)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or❑ below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions),the next higher floor
(elevation C2.b in the diagrams)of the building is ❑feet ❑meters ❑above or ❑below the HAG.
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.
E5. Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management
ordinance? ❑Yes ❑ No ❑ Unknown. The local official must certify this information in Section G.
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,8,and E are correct to the best of my knowledge.
Property Owner's or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
❑Check here ff attachments
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 ftem(s)and sign below. Chedc the measurement used in Items G8 and G9.
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 o�cial 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-G9)is provided for community floodplain management purposes.
G4.Permit Number G5. Date Permit Issued G6. Date Cert�cate Of Compliance/Occupancy Issued
G7. This pertnit has been issued for: ❑New Construction ❑Substantial Improvement
G8. Elevation of as-built lowest floor(including basement)of the building: ❑feet ❑meters(PR)Datum
G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters(PR)Datum
G10.Community's design flood elevation ❑feet ❑meters(PR)Datum
Local Official's Name Title
Community Name Telephone
Signature Date =�"'� � Z�1'" +`'
_r, f�� �` t �
Comments �°°"`"" �'
MAR 31 2010
PLAN�!IP,���T:� ���p,,��,�T
CITY :���,G�_.Ri�wA
atta hments
. +
� Building Photographs
See Instructions for Item A6.
For insurance Company Use:
Building Street Address(including Apt, Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Poticy Number
S.GULFVIEW BOULEVARD
Clty CLEARWATER State FL ZIP COd@ 33767 Company NAIC Number '
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to
the instructions for Item A6. Identify all photographs with: date taken; "Front Viev�' and "Rear Viev�'; and, if required, "Right
Side View" and "Left Side View." If submitting more photographs than will fit on this page, use the Continuation Page,
following.
SIDE VIEW LOOKING WEST 3/23/10
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�IAR 312010
�i�C?^.:�:.o1�LaPMENT
PLAN��� t.,�: , l�..;aRWATER
CIT`�
U'S.D�PARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB NO. 1660-0008
.Federal Emergency Management Agency Expires March 31,2012
National Flood Insurance Program Important: Read the instructions on pages 1-9.
SECTION A-PROPERTY INFORMATION For Insurance Company Use:
A1. Buifding Owner's Name NJR DEVELOPMENT Po{icy Number
. Buiiding Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. Compar�y NAIC Number
�S.GULFVIEW BOULEVARD
•,,,..:...
City C�EARWATER State FL ZIP Code 33767 '�`'��'•••" `"' '' """ `.'� '°�-;,., `` ,
f`!�"'v' !"1�" /`; C.,;C'���o r n-r r-�n
A3. Property Description(Lot and Blodc Numbers,Tax Parcel Number,Legal Description,etc.) °"A.:;"°;�'; f��{'.��=(' + � p;V.
NEW GAZEBO AT AQUALEA (PARCEL ID NUMBERS 07/29/15/52380/000/0570&07/29/15/52380/000/Ob�p 8�07/29/15/52380/0t7"0�
A4. Building Use(e.g.,Residential,Non-Residential,Add'Rion,Accessory,etc.)NON-RESIDENTIAL "�" � ��
A5. Latitude/Longitude:Lat.N27°58'26.1" Long.W82°49'46.4" Horizontal Datum:"�
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 1
A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) N/A sq ft a) Square footage of attached garage N/A sq ft
b) No.of permanent flood openings in the crawlspace or b) lVo.of peRnanent flood openings in the attached garage
enclosure(s)within 1.0 foot above adjacent grade N/A within 1.0 foot above adjacent grade N/A
c) Total net area of flood openings in AB.b N/A sq in c) Total net area of flood openings in A9.b N/A sq in
d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP Community Name&Community Number 62.County Name 63.State
CITY OF CLEARWATER 125096 PINELIAS FL
B4.Map/Panel Number B5.Suffix B6.FIRM Index B7.FIRM Panel 68.Flood 69. Base Flood Elevation(s)(Zone
12103C0102 G Date Effective/Revised Date Zone(s) AO,use base flood depth)
MAY 17,2005 JANUARY 28,2009 AE 13'
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69.
❑ FIS Profile � FIRM ❑ Community Detertnined ❑ Other(Describe)
611. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other(Describe)
612. Is the building Ipcated in a Coastal Barrier Resources System(CBRS)area or Otherwise Proteded Area(OPA)? ❑ Yes � No
Designation Date N/A ❑ CBRS ❑ OPA
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construdion Drawings* ❑ 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,ARlAE,ARIA1-A30,AR/AH,AR/AO. Complete Items C2.a-h
below according to the building diagram specified in Item A7. Use the same datum as the BFE.
Benchmark Utilized Clearwater Benchmark G-02Vertical Datum NAVD 1988 � ��--���
Conversion/Comments NONE
c. C.=�.=J
Check the measurement used. ; �: ^
a To of bottom floor inGudin basement,crawls ace,or enclosure floor 5.4 U U U
) p ( g p )_� �feet ❑meters(Puerto Rico only) ! '�'� D
b) Top of the next higher floor N/A. ❑feet ❑meters(Puerto Rico only) j � � �
c) Bottom of the lowest horizontal structural member(V Zones only) N/A. ❑feet ❑meters(Puerto Rico only) ; . ;.a o ' n
d) Attached garage(top of slab) N/A. ❑feet ❑meters(Puerto Rico only) ; � �p �
e) Lowest elevation of machinery or equipment servicing the building N/A. ❑feet ❑meters(Puerto Rico only) � � �,
(Describe type of equipment and location in Comments) i � ° �'
� Lowest adjacent(finished)grade next to building(LAG) 5.1 �feet ❑meters(Puerto Rico only) � m ° t�_
g) Highest adjacent(finished)grade next to building(HAG) �.5 �feet ❑meters(Puerto Rico only) , V' U U'�
h) Lowest adjacent grade at lowest elevation of dedc or stairs,induding N/A. ❑feet ❑meters(Puerto Rico only) � m • -
structural su ort a ��"'-�
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION .
This certification is to be signed and sealed by a land surveyor,engineer,or archited authorized by law to certify elevation '"' '
information. I certify that the information on this Ce�tificate represents my best efl`orts to interpret the date available.l ��,A � ba
understand that any felse statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001� ,. , .. ,
Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a•` .+ '9 x � � '
licensed land surveyor? � Yes ❑ No ' ' ` ��
� � �. �� � � -.,
Certifier's Name JEFFERY A.COPELAND Li c en s e N um b er 5 27 9 ±�� �i�,��� .;
Title REGISTERED LAND SURVEYOR Company Name SUNCOAST LAND SURVEYING,INC. • �--s: (' ..,. �; � �� -
��. b'�� �. �' /V. � b •G
Address 111 FOREST LAKES B D. City OLDSMAR State FL ZIP Code 34677. V�' �� ��� �.�a :
� f�
Signature Date 3/31/10 Telephone 813-854-1342 `;'<•"`,•,,•••`.9�;'�
«
�^�:• ;,�
300 S GULFVIEW BLVD
BCP2009-06512
IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use:
Buildine Street Address(including Apt.,Unit,Suite,and/or Bidg.No.)or P.O.Route and Box No. Policy Number
- S.GULFVIEW BOULEVARD
City CLEARWATER State FL ZIP Code 33767 Company NAIC Number
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(7)community official,(2)insurance agent/company,and(3)building owner.
Comments C2.UTILIZED CITY OF CLEARWATER BENCHMARK G-02 ELEVATION=4.923'(NAVD 1988)
�--��
Signat Date 3/31/10
❑ Check here if attachments
SECTIO -BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFEj
For Zones AO and A(without BFE),complete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B,
and C. For Items E1-E4,use natural grade,'rf available. Check the measurement used. In Pueho Rico only,enter meters.
E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent
grade(HAG)and the lowest adjacent grade(LAG).
a)Top of bottom floor(inGuding basement,crawlspace,or endosure)is ❑feet ❑meters ❑above or❑below the HAG.
b)Top of bottom floor(including basement,crawlspace,or endosure)is ❑feet ❑meters ❑above or❑ below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions),the next higher floor
(elevation C2.b in the diagrams)of the building is ❑feet ❑meters ❑above or ❑below the HAG.
E3. Attached garage(top of slab)is ❑feet ❑meters ❑above or ❑below the HAG.
E4. Top of platform of machinery andlor equipment servicing the building is ❑feet ❑meters ❑above or❑below the HAG.
E5. Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management
ordinance? ❑Yes ❑ No ❑ Unknown. The local o�cial must certify this information in Section G.
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,8,and E are correct to the best of my knowledge.
Property Owner's or Ownets Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
❑Check here if attachments
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. Chedc the measurement used in Items GS and G9.
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-G9)is provided for community floodplain management purposes.
G4.Permit Number G5. Date Permit Issued G6. Date Cert'fiicate Of Compliance/Oxupancy Issued
G7. This permit has been issued for: ❑New Construction ❑Substantial Improvement
G8. Elevation of as-built lowest floor(including basement)of the building: ❑feet ❑meters(PR)Datum
G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters(PR)Datum
G10.Community's design flood elevation ❑feet ❑meters(PR)Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments
fl Check here if attachments