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421 GULFVIEW BLVD S �L�VATION CERTIFICATE O.M.B. No. 3067-0077 FEDERAL EMERGENCY MANAGEMENT ACaENCY �P�res July 31, 1999 , NATIONAL FLOOD INSURANCE PROGRAM ATTENTION: Use ot this certificate does not provide a waiver of the f�ood insurance purchase requirement.This form is used o�ly to pro- vide elevation intormation necessary to ensure compliance with applicable community floodplain management ordinances,to determine the prope�insurance premium�ate,and/or to support a request for a Letter of Map Amendme�t or Revision(LOMA or LOMR).You a�e not �equired to respond to this collection of information unless a valid OMB control number is displayed in the upper right comer oi this torm. instructions fo�completing this form csn be found on the following pages. SECTION A PROPERTY INFORMATION FOR INSURANCECOMPANY USE BUIIDINCi OWNER'S NAME POLICY NUMBER CANTERBURY PROPERTY MANAGEMENT INC. STREET ADDRESS(Indudinp Apt.,Unit,Suita and/or Bldp.Number)OR P.O.ROUTE AND BOX NUMBER COMPANY NAIC NUMBER 421 S. 6ULFYIEW BLYD. OTHER DESCRIPTION(Lot�nd Blodc Numbsrs,eta) LOTS 76 & 125 LLOYD—WHITE SKINNER SUB. (WEST 4 STORY BLDG.) '•CITY STATE ZIP CODE ' CLEARIrATER BEACH FL. SEC'�ION B FLOOD INSURANCE RATE MAP(FIRM)INFORMATION P�ovide the tollowing from the proper FIRM(.See Instructions): 1.COMMUNITY NUMBER 2.PANEI NUMBER 3.SUFFIX 4.DATE OF FIRM INDEX 5.FIRM ZONE 8.BASE fLOOD ELEVATION (in AO Za»s,ua d�ptl�) 125096 0007 D . 8-19-91 AE 11 7. Indicate the eie�ration datum system used on the FIRM for Base Flood Elevations(BFE): ❑NGVD'29 ❑ ��r�� 8. For 2ones A or V�where no BFE is provided on the FIRM,and the community has established a BFE for this bui din s ,i di�t the community's BFE:��J.0 feet NGVD(or other FIRM datum-see Section B, Item 7), ��'� 2 1 �qo SECTION C BUILDING ELEVATION INFORMATION NN�Nt; � �� - *�— . � � 1.Using the Elevation Certiticate Instructions,indicate the diagram number from the diagrams found on Pag�sl�'�r��6 �WATE describes the subject building's reference level 1— . R •2(a).FIRM Zo�es A1-A30,AE,AH,and A(with BFE). The top of the reference level floor from the selected diagram is at an elevation ot I I I I I7 I.(J feet NGVD(or other FIRM datum-see Section B,Item 7). (b).FIRM Zones V1-V30,VE,and V(with BFE). The bottom of the lowest horizontal structural member of the reference level from the selected diagram,is at an elevation of�J.(J feet NGVD(or other FIRM datum-see Section B,Item 7). (c). FIRM Zone A(without BFE). The iloor used as the reference level from the selected diagram is W.0 feet above❑ or ' below❑ (check one) the highest grade adjacent to the building. (d). FIRM Zone AO. The tloor used as the reference level from the selected diagram is w.0 feet above❑ or below�(check one)the highest�rade adjacent to the building. Ii no tlood depth number is available,is the building's lowest floor(reterence level)elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown 3. Indicate the elevation datum sysfem used in determining the above refe�ence level elevations:� NGVD'29 ❑ Other(describe under Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different than that used on Ihe FIAM (see Section B, Item 7), then convert the elevations to the datum system used on the F/RM and show the conversion equation under Comments on Page 2) 4.Elevation reference mark used appears on FIRM: ❑ Yes �No (See Instructions on Page 4) 5.The reference level elevation is based on: � actual construction ❑ construction drawings (NOTE: Use ol construction drawings is only valid il the building does not yef have the reference level floor in place,In which case lhis ceriilicate will only be valid for the building during the course of construction. A post-construction E/evafion Certilicate will be required once construction is complete.) 6.The elevation oi the lowest grade immediately adjacent to the building is:��U.0 feet NGVD(or other FIRM datum-see Section B,Item 7). SECTION D COMMUNITY INFORMATION 1. H the community otiicial responsible for verifying building elevations specifies that the reference level indicated in Section C,Item 1 • is not the"lowest iloor"as defined in the community's floodplain management ordinance,the elevation of the building's"lowest tloor"as defined by the ordinance is: ��LJ.0 feet NGVD(or other FIRM datum-see Section B,Item 7). 2. Date of the start of construction or substantial improvement . FEMA Form 81-31.AUG 96 REPIACES All PREVIOUS EDfTIONS SEE REVERSE SIDE FOR COMINUATION �. . SECTION E CERTIFICATION This certitication is to be signed by a land surveyor,engineer,or architect who is authorized by state or local law to cemfy elevation , information when the elevation information for Zones A1—A30,AE,AH,A(with BFE),V1—V30,VE,and V(with BFE)is required. Community otiicials who are authorized by local law or ordinance to provide floodplain management information,may also sign the cehification. In the case of Zones AO and A(without a FEMA or community issued BFE),a buildi�g official,a property owner,or an � owner's rep�esentative may also sign the certification. Reference level diag�ams 6,7 and 8-Distinguishing Features—If the certifier is unable to certify to breakaway/non-breakaway wall, enclosure size,location of servicing equipment,area use,wall openings,or unfinished area Feature(s),then list the Feature(s)not included in the certification under Comments below. The diagram number,Section C, Item 1,must still be entered. l ceriily thaf the inlormation in Sections B and C on fhis certilicate represents my best ellorts to interpret the data availab/e. I understand thal any lalse statement may be punishable by line or imprisonment under i8 U.S. Code, Section 1001. ' CERTIFIER'S NAME LICENSE NUMBER(or ABix Seal) � 6EOR6E A. SHIMP I I � : .;'i • : . 2512 _.. � : T�ne ,.� ._, . PRESIDENT �PANY NAME GEORGE A. SHIMP II & A�SOC. INC ` �ooaess . cirv � : .� 3301 D OTO BLVD. _ � SuTe; .�� ,�P _ PALM HARBOR � �� , ,�. ;,;,�. s�c 34583`: � #990548.A DATE P�FiON6: �, , y, ,-.° 11-12-99 784f5496;�;•. r Coplea ahould be made ot thls Certlficate for:1)communtty offlcfal,2)insurance agenUcompany,and��)�i`Ullding ovmer.' � COMMENTS: ,:..,�� F:� r. , • °" . MnT" oN nn.ES. s��A�� SAS[MENT MERS.Oq pOlUM1iS A y A A V, . ZONES ZONES ZONES ZONES 20NES NESEIIlNCE f1EfERENCE IEYEI �gE IEVEI �{�� RO00 LEVEI �ElEV11TION � , \< ��f . �r;�:�.:'.��".3:�c ... �,:S,d•:�?; . :j..�;y,�+:�,7; ' ' ' MSE ��'� ''i•;:•:. i::�i?•;;�;?:�.."..::;�q� EIEV TA�ipi .:�::�'�;?:: .AOJIICENT�:�:`•�F REfERENCE fL0�00 REFERENGE �p,��E� � 6RADE ' .:i LEVEI ELEVATqN IEVEI �RAOE , i .� e'•?� .�� .�. i�y'?�. . :?.:�'.: i=.y"C':'e • ' .;,i::�;i);��s':°'�'Yi�;'' 2'i�2} :� 'i•tlysL+i•N`,r,C :��, .:�:j6;•k?i: 'i.:' '%^Y'•':. �i:�:•. �i�k;tja�t�y�1j�.t�Sry�� ti . t; •.a•:.,.t.:�.};;ti;�''�� '; . �'i:�•, �.:.t;9`.i '��;.AOd�CEN��. � ..'i e�.��n��:.'..f�4•:.Y:�4ti;i•i�,It, a� �. •Y. The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones. Elevations for all A Zones should be measured at the top of the�eference level floor. Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural membe�. • Paye 2 � U. EPARTMENT OF HOMELAND SECURITY PEDERAL EMERGENCY MANAGEMENT AGENCY National Flood lnsurance Program ELEVATION CERTIFICATE Important: Read the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION A1. Building Owner's Name ALANIK PROPERTIES, LLC A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 421 SOUTH GULFVIEW BOULEVARD City CIEARWATER State FL ZIP Code 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) (PARCEL # 07-29-15-52380-000-0760) OMB No. 1660-0008 Expiration Date: July 31, 2015 FOR INSURANCE COMPANY USE Policy Number. Company A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) NON-RESIDENTIAL A5. Latitude/Longitude: Lat. 27.97050° Long. 82.82931° 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 3 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) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or 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 A8.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 61. NFIP Community Name & Community Number B2. County Name CITY OF CLEARWATER 125096 PINELLAS 64. Map/Panel Number 65. Suffix 66. FIRM Index Date 67. FIRM Panel Effective/Revised Date 12103C-0102 G 8-18-09 9-3-03 B3. State FL B8. Flood Zone(s) 69. Base Flood Elevation(s) (Zone AO, use base flood depth) AE&VE 12'&13' B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69. ❑ FIS Profile � FIRM ❑ Community Determined ❑ Other/Source: 611. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected 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 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: GSA 980609-A 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. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) fl Lowest adjacent (finished) grade next to building (LAG) g) Highest adjacent (finished) grade ne� to building (HAG) h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 4.94 6.80 N/A N/A 4.68 4.52 5.28 N/A Check the measurement used. � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters � 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 law to certify elevation information. I certify that the information on this Certificate represents my best efforts to interpret the data available. 1 understand that any false 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 � Check here if attachments. licensed land surveyor? � Yes ❑ No Certifier's Name GEORGE A. SHIMP III Job Number 120249A License Number 6137 Title VICE PRESIDENT Company Name GEORGE A. SHIMP II 8� ASSOCIATES, INC. Address 3301 DeSOTO BLVD., SUITE D City PALM HARBOR State FL ZIP Code 34683 re FEMA Form 086-0-33 (7/12) Date 10-9-13 Telephone 727-784-5496 See reverse side for continuation. `� �r ;'�`� F'# 1 d � y/�rA . � �" tl0. 6187��`} � ', � t ,•J ' l��%�( �p�1�/a�� 1: • I ;.;"'U'�.i{ ,��'/+� i �'�s.,��,�Y��a °1�13 �,, i Replaces all previous editions. ELEVATION CERTIFICATE, page 2 IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 421 SOUTH GULFVIEW BOULEVARD City CLEARWATER State FL ZIP Code 33767 -, FOR INSURANCE COMPANY USE Policy Number. 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.e) AIR CONDITIONER ON GROUND Signature � Date 10-9-13 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 LOMA or LOMR-F request, complete Sections A, B, and C. For Items E1—E4, use natural grade, if available. Check 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 enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawispace, 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 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, B, and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address Signature Comments City Date State Telephone ZIP Code Check here if attachments. SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local o�cial 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: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-built lowest floor (including basement) of the building: G9. BFE or (in Zone AO) depth of flooding at the building site: G10. Community's design flood elevation: Local Official's Name Community Name Signature Comments ❑ feet ❑ meters Datum ❑ feet ❑ meters Datum ❑ feet ❑ meters Datum Title Telephone Date Check here if attachments. FEMA Form 086-0-33 (7/12) Replaces all previous editions. . ELEVATION CERTIFICATE, page 3 guilding Photographs See Instructions for Item A6. IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 421 SOUTH GULFVIEW BOULEVARD City CLEARWATER State FL ZIP Code 33767 FOR INSURANCE COMPANY USE Policy Number: Company NAIC Number: If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs betow 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. � ~ _ _ —�! � I �: ;; ' — � � �,,_ ---_ __ _ � --- �� FRONT VIEW Picture taken on: 10-9-13 �� FEMA Form 086-0-33 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 4 guilding Photographs Continuation Page IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 421 SOUTH GULFVIEW BOULEVARD City CLEARWATER State FL ZIP Code 33767 FOR INSURANCE COMPANY USE Policy Number: 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. �= �..�'�� ` � - � .� .�r?;, ...--- . s,--- � � � ' i �� i 7` -��y � �. i} x �� , � � ��rz�,��m, ,, i 3a �'�'�� i� ,uq � �� u . I�� ,! �I��IIIII III i � I �� d� -, ,,,1 � '- % �l \L �.. �. ��. :��. � 3�i, �..,'C=.�. __.___ � . �^ `+�a� �. iq J I ..` . 5 i t'�. � � �� _ � Z •4, � �, �� -. t � � t� �� uh � � v e� '` 'r �, ' :; � �,`e�� ,�„ . t\�;� � � r ��R , � '7 � �� ` � � � },�" E 'a I� �4,�� i � ` � � �i � �! �r q, (iii ir i ' �'�� 'rl]'f� � li ��i � �i l� ��I �� I�� , f � , '�` '�`��_� > �.` ". . , �� - � �.. - � ... � ... j ,. � ... � '��` , � -� �� . ,I' I , I �, ' i,�'.�: � � �' � ,� .• � 4 � _. � : "oT- ��Jc� A�q:i i_.J,...�G �v� t�a ; L"F .:�;�iu`tl!� I , _'.. �_ , _:e�__� ..�,F, '. �� ,. � ��..., _ � ; r � �� .__ _ �:a�?. �� ; . �I � �. k.�.��u _ �� `� ,�, � � � �� `i_ �� . I �`' '�� i�, �� , ' � , ' --s�= � °`�� -�x..nl'I�IIIII,� IIIIIIII� ,^I �'I' iIIII� 1 . C— � � �""t f�'3L �'ET��t �. .. /� . ° � � I I h� .,..c i��, II III i � � � 1 � .�s, - • �. _"� ,I ` N�-�`,� '� � �li�lt �� !i �t � a � . �I�� I��III�� r.,:,,t 't� -r-°�� REAR VIEW Picture taken on: 10-9-13 � "�� x _ � ��,. � _ � � ___�'--��,_� �. ___-_.______� FEMA Form 086-0-33 (7/12) Replaces all previous editions.