18167 US HWY 19 N #102 d
U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
Federal Emergency ManagementAgency Expires MBrCh 31,2012
National Flood Insurance Program Important: Read the instructions on pages 1-9. 3 c(' - �,
SECTION A-PROPERTY INFORMATION For Insurance Corripany Use:
A1. Building Owner's Name A H C METRO HARBOURSIDE LLC Policy Number
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number
18167 US HIGHWAY 19 N �p
City Clearwater State FL ZIP Code 33764
A3. Property Description(Lot and Block Numbers,Tax Parcei Number,Legal Description,etc.)
Property ID#29-29-16-36709-000-0010 located in Section 29-29-16
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Non-Residential-O�ce Buildinq
A5. Latitude/�ongitude:Lat.27°56'15.2" Long.82°43'44.7" 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) 0 sq ft a) Square footage of attached garage 0 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 0 within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b 0 sq in c) Total net area of flood openings in A9.b 0 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 B3.State
Pinellas County 125139 Pinellas Florida
64.Map/Panel Number B5.Suffix B6.FIRM Index 67.FIRM Panel 68.Flood B9.Base Flood Elevation(s)(Zone
12103C0128&0136 G Date Effective/Revised Date Zone(s) AO,use base flood depth)
9/3/2003 9!3/2003 AE g
B10. 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)
611. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other(Describe)
B12. Is the building located in a Coastal Barrier Resources System{CBRS)area or Othenvise 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. Use the same datum as the BFE.
Benchmark Utilized Camqus G Vertical Datum NAVD 88
Conversion/Comments N/A
Check the measurement used.
a) Top of bottom floor(including basement,crawlspace,or enclosure floor)9.3 �feet ❑meters(Puerto Rico only)
b) Top of the next higher floor 20.8 �feet
❑meters(Puerto Rico only)
c) Bottom of the lowest horizontal structural member(V Zones only) N/A. ❑feet ❑meters(Puerto Rico only)
d) Attached garage(top of slab) N/A. ❑feet ❑meters(Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building 9.6 �feet ❑meters(Puerto Rico only)
(Describe type of equipment and location in Comments)
� Lowest adjacent(finished)grade next to building(LAG) 9.0 �feet ❑meters(Puerto Rico only)
g) Highest adjacent(finished)grade next to building(HAG) 9.3 �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
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. aa � '
I 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 • ,
licensed land surveyor? � Yes ❑ No � : . W .'� ''"'''`
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Certifier's Name Richard C.Hinson,PSM License Number LS3840 � ^
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Titl Vice Presiden Company Name Hamilton Engineering and Surveying, Inc. ��� '_(.�'"l .
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Addr s 311 N. e City Tampa State F� ZIP Code 33606 "' �'�, � ��� -:'i`�,�'
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Signatu ' hard C so PSM Date 9-13-12 Telephone 813-250-3535
FEMA Form 1-31, Mar 09 See reverse side for continuation. Replaces all previous editions
IMPORTANT: In these spaces,copy the corresponding information from Section A. For lnsurance Company Use:
Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O.Route and Box No. Policy Number
18167 US HIGHWAY 19 N
City Clearwater State FL ZIP Code 33764 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.
Com ents La ong Coordinates obtained by GPS Methods.Flood Studies have not been researched. Elevations based on NGS Benchmark AG00429-
Ca us"G"havi a pu 'shed elevation of 6.30 feet(NAVD 88).The lowest mechanical equipment is elevator equipment located in the mechanicai room on
the fi st floor level N/A i tes" o pplicabie". Not valid without embossed seal.
Signature ic ard C. nso M Date 9-13-12
� Check 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 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 fioor
(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 officiai 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 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. Check 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 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 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: ❑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
❑Check here if attachments
FEMA Form 81-31, Mar 09 Replaces all previous editions
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. Po�icy tvumber
18167 US HIGHWAY 19 N
City Cleanvater Stat2 FL ZIP COde 33764 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 View" and "Rear View"; and, if required, "Right
Side View" and "Left Side View." If submitting more photographs than will fit on this page, use the Continuation Page on the
reverse.
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Building Photographs
Continuation Page �i
For Insurance Company Use:
Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Poiicy tvumber
18167 US HIGHWAY 19 N
Clty Clearwater State FL ZIP Code 33764 CompanyNAlCNumber '
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."
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