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19353 US HWY 19 ELEVATION CERTIFICATE OMB No. 1660-0008 �C 1 r Expires March 31,2012 � �(/�, ��\� nportant: Read the instructions on pages 1-9. � ,: an Use: SECTION A-PROPERTY INFORMATION For Insurance Comp _y A1. Building Owner's Name Golden Shoreline Limited Partnership Policy Number A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number 19353 US Highway 19 City Clearwater State FL ZIP Code 33764 A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) Portion of Government Lot 2,Section 20,Township 29 South, Range 16 East(Parcel ID 20-29-16-00000-230-0100) A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Non-Residential A5. Latitude/Longitude:Lat.27°56'55.7" Long.82°43'30.3" 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 1A A8. For a building with a crawispace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) sq ft a) Square footage of attached garage 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 within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b 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 City of Clearwater 125096 Pinellas County Florida 64.Map/Panel Number B5.Suffix 66. FIRM Index 67.FIRM Panel 68.Flood B9.Base Flood Elevation(s)(Zone 12103C0128 G Date Effective/Revised Date Zone(s) AO,use base flood depth) 8-18-2009 9-3-2003 AE & X AE=9' X=N/A 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) B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other(Describe) B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes � No Designation Date ❑ 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 AG6376&AG7356 Vertical Datum NAVD 88 Conversion/Comments NGS Bench Marks Check the measurement used. a) Top of bottom floor(including basement,crawispace,or enclosure floor)11.29 �feet ❑meters(Puerto Rico only) b) Top of the next higher floor N/A.. ❑feet ❑meters(Puerto Rico only) c) Bottom of the lowest horizonta�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 13.55 �feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Comments) fl Lowest adjacent(finished)grade next to building(LAG) 10.6 �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 11.4 �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 SECTIOND-SURVEYOR, ENGINEER,ORARCHITECTCERTIFICATION �e�+i��1i�r�i/ This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation ' information. I cerfify that the information on this Certificate represents my best efforts fo interpret the data available. ,�.',� s�.- -•��• ,� „ �'; l understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001. ' ly •;;,di1g!�$J"F''.` C,* � �� `�'�.� , �Q"'�.,•. .e``,, `. � Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a q �,+ . ,�;, � , , � '�? • • licensed land surveyor? � Yes ❑ No ';;,=��; ��.rt : ��:b : a � µ� Certifier's Name Robert C.Wright,Jr. License Number 4965 M ` ` � A� - „�'�;�� Q� � .�� : Title Professional Surveyor and Mapper Company Name Florida Design Consultants,Inc. • �r '�t,. - �� ' ; ��9 . ,,�t Address 3030 St ey Boulevard ity New Port Richey State FL ZIP Code 34655 P`�� '•�• ••�k�z.�� '�� .�.� Signature Date 8-19-2011 Telephone 727-849-7588 FEMA Form 81-31, Mar 09 See reverse side for continuation. Replaces all previous editions IM OF�TA'iVT: 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 19353 US Highway 19 City ClearwaterState FL ZIP Code 33764 Company NAIG 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)Elevatio is the ttom of the electrical panel located inside the building.Date of field work was 8-17-2011. �-/ �'-// Signature Date 8-19-2011 � 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,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 statemenfs 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 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 inforrnation(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 i .n � ' R� .. . . � Building Photographs � See Instructions for Item A6. • For Insurance Company Use: Building Street Address(including Apt., Unit, Suite,and/or Bidg.No.)or P.O. Route and Box No. Poiicy Number 19353 US Highway 19 City Clearwater State FL ZIP COd2 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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