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400 EAST SHORE DR __ __ �3� P�c�� o�/� �c U.S.DEPARTMENT 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. Building Owner's Name Walgreens Policy Number ' A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number ' 400 East Shore Drive City Clearwater State FL ZIP Code 33767 A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.) Parcel ID#08-29-15-02592-002-0120 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Non-Residential A5. Latitude/Longitude: Lat.N27-58-42 Long.W082-49-35 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 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 enciosure(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 B2.County Name 63.State Clearwater,Cty/Pinellas Co. 125096 Pinellas Florida 64.Map/Panel Number B5.Suffix 66.FIRM Index 67.FIRM Panel B8. Flood B9.Base Flood Elevation(s)(Zone 12103C012 G Date Effective/Revised Date Zone(s) AO,use base flood depth) August 18,2009 September 3,2003 AE 11' 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 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 G-03Vertical Datum NAVD 1988 Conversion/Comments None Check the measurement used. a) Top of bottom floor(including basement,crawispace,or enclosure floor)6.0 �feet ❑meters(Puerto Rico only) b) Top of the next higher floor N/A. ❑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) 5.3 �feet ❑meters(Puerto Rico only) 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) 4.4 �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 4.7 �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. 1 certify that the information on this Certificate represents my best efforfs to interpret the data available. : 1 understand that any fa/se 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 T� licensed land surveyor? � Yes ❑ No ,,; �' � .�` � _ °w' e�'�� Certifier's Name Mark S.Lischalk,PLS License Number 5727 °-�, .���-.���Z��� Title President Company Name Zarra Boyd,Inc. �� � '" ` °� �. �,�� l� a� Address 1480 Beltrees Street Suite 3 City Dunedin State FL ZIP Code 34698 °'>��'��"_` �� .`J 1L Signature Date 2-19-13 Telephone 727-738-9010 ° FEMA Form 81-31, Mar 09 See reverse side for continuation. Replaces all pr�vrous editions � IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insu�ance Company Use: Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. Policy Number 400 East Shore Drive 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 Building under construction,slab poured.The elevation listed in item C2.d is the lowest slab elevation of the Trash Staging Area. It will be enclosed within the building. C�� Signature Date 2-19-13 ❑ 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,crawispace,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 Q 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 fioodplain 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 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 _ ./�'' CY�1 c:l,�.--�;7/�c(� U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal Emergency ManagementAgency 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. Building Owner's Name Walgreens Policy Number A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number 400 East Shore Drive City Clearwater State FL ZIP Code 33767 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Parcel ID#08-29-15-02592-002-0120 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Non-Residential A5. Latitude/Longitude: Lat.N27-58-42 Long.W082-49-35 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 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 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 B1. NFIP Community Name&Community Number B2.County Name 63.State Clearwater,Cty/Pinellas Co. 125096 Pinellas Florida B4.Map/Panel Number B5.Suffix 66.FIRM Index B7.FIRM Panel 68.Flood 69.Base Flood Elevation(s)(Zone 12103C012 G Date Effective/Revised Date Zone(s) AO,use base flood depth) August 18,2009 September 3,2003 AE 11' 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(Describe) B11. 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 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. Use the same datum as the BFE. Benchmark Utilized G-03Vertical Datum NAVD 1988 Conversion/Comments None Check the measurement used. a) Top of bottom floor(including basement,crawispace,or enclosure floor)6.0 �feet ❑meters(Puerto Rico only) b) Top of the next higher floor N/A. ❑feet ❑meters(Puerto Rico only) c) Bottom of the lowest horizontal structural member(V Zones only) N/A. ❑feet ❑meters(Puerto Rico onty) d) Attached garage(top of slab) 5.3 �feet ❑meters(Puerto Rico only) 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) 4.4 �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 4.7 �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. 1 certify that the information on this Certificate represents my best efforts to interpret the data available. 1 understand that any fa/se 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 4 �`� licensed land surveyor? � Yes ❑ No � � �`; '• �.. Certifier's Name Mark S. Lischalk,PLS License Number 5727 a: �������,', Title President Company Name Zarra Boyd, Inc. ��� ``�'� �� Address 1480 Beltrees Street Suite 3 City Dunedin State FL ZIP Code 34698 `�'� � � � . Signature L Date 2-19-13 Telephone 727-738-9010 FEMA Form 81-31, ar 09 See reverse side for continuation. Replaces all previous editions 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 400 East Shore Drive 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 Building under construction,slab poured.The elevation listed in item C2.d is the lowest slab elevation of the Trash Staging Area. It will be enclosed within the building. ��L��'Z _ � Signature Date 2-19-13 ❑ 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 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 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 U.S�t�EPARTi�IENTOFHOMELANDSECURITY ELEVATION CERTIFICATE FEDEkAL E!UfERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 NationalrloodlrrsuranceProgram Important: Read the instructions on pages 1-9. Expiration Date: July 31, 2015 SECTION A- PROPERTY INFORMATION FOR tNSI�RANCE GflMPANY US� ' A1. Building Owner's Name Walgreens POIiCy �itt�}ber.. A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Compin�t I�AIC Number. 400 East Shore Drive City Clearvuater State FL ZIP Code 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) 08-29-15-02592-002-0120 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Non-Residential A5. Latitude/Longitude: Lat. N27-58-42 Long. W082-49-35 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 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 1.453 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 B1. NFIP Community Name & Community Number 62. County Name B3. State Clearwater, Cty / Pinellas Co. 125096 Pinellas FLorida B4. Map/Panel Number B5. Suffix 66. FIRM Index Date 67. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone 12103C012 C August 18, 2009 Effective/Revised Date Zone(s) AO, use base flood depth) September 3, 2003 AE 11' 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/Source: B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ OthedSource: 612. 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. In Puerto Rico only, enter meters. Benchmark Utilized: G-03 Vertical Datum: NAVD 1988 Indicate elevation datum used for the elevations in items a) through h) below. O 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, 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) � Lowest adjacent (finished) grade ne� to building (LAG) g) Highest adjacent (finished) grade next to building (HAG) h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 6.0 23.2 N/A. 5.3 7.9 5.1 5.8 5.1 � 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 authonzed by law to certify elevation information. 1 certify that the information on this Certi�cate represents my best efforts to interpret the data available. 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 longttude in Section A provided by a � Check here if attachments. licensed land surveyor? � Yes ❑ No Certifier's Name Mark S. Lischalk, PLS Title President Address 1480 Beltrees Street Signature �' FEMA Form 086-0-33 (7/12) Company Name Zarra Boyd, Inc. City Dunedin License Number 5727 State FL ZIP Code 34698 10/01/13 Telephone 727-738-9010 See reverse side for continuation. �; y°� �� �' � ,�. � <. � d. �• : n� � P , ��:.:����� � � ��� , ��� a� ' � & °s�'�w�s�,;:� �^ , y�, c' , � � �''��`�� ._ �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. 400 East Shore Drive City Clearwater State FL ZIP Code 33767 FOR INSURANGE COMPANY USE Policy Numbec 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 The elevation listed in item C2.e is the elevation of the bottom of the interior fuse panel. The item listed as the attached garage slab is denoted on the construction plans as "an enclosed receiving area". The building is reported to be flood proofed. See attached picture of flood panels. Signature Date 10/01/13 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 0 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 ❑ abc ^'--'--� "- �A° E3. Attached garage (top of slab) is . ❑ feet ❑ meters ❑ above or ❑ belo� � E4. Top of platform of machinery and/or equipment servicing the building is . ❑ feet � j i n � J G �1� � E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in � �� �� ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in S � � �• SECTION F— PROPERTY OWNER (OR OWNER'S REPRESE� �� �� �) � j ( The property owner or owner's authorized representative who completes Sections A, B, and E for Zc -�� ,' ` {' C 1 or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my krn � ,= L� �� � � Property Owner's or Owner's Authorized Representative's Name " � Address City � Signature Date �� Comments A_ � �� ���2d�z �� SECTION G— COMMUNITY INFORMATION ( C�D Y The local official who is authorized by law or ordinance to administer the community's floodplain managerr� of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8—G10. In Puerto Rico orny, enter me�C�s. 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. . EL�VATiON 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. 400 East Shore Drive 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 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. Front and Side View ,� ' � �� � � �.. � � �� i: � � �19�►��ld� , � 4 , �)� � M� ��:��■ ; ��` � t i��� � . , � � � � � �; � � . ��, ��r// �� i� 10� � � '� �_ ��.:. i � �� ,�`..-:_.�- :, ___,-�.__--- -- E �-=-- � ---- I _ - , — __- � � F Y� C� � i _.a.:�° s ��,�' x �6 w�:: ����� ��' _ 9On09 G'�4�`��'s • ,. �.. e =,.er '����; , ; � ee � � � � a..,. Side and Rear View �� �� FEMA Form 086-0-33 (7/12) Replaces all previous editions. , ELEVATION CERTIFICATE, page 4 '* Building Photographs Continuation Page 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: 400 East Shore Drive City Clearvvater State FL ZIP Code 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. � T��"`:, N _ _ __�_ • � .. � __..� . �.. � Flood Panels FEMA Form 086-0-33 (7/12) �_ Replaces all previous editions.