18419 US HWY 19 NU.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICATE
important: Read the instructions on pages 1-8.
SECTION A - PROPERTY INFORMATION
CLEARWATER RETAIL PARTNER, LLC
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
18419 US HIGHWAY 19 NORTH
City CLEARWATER State FL ZIP Code 33764
A3. Property Description (Lot and Blodc Numbers, Tax Parcel Number, Legal Description, etc.)
TAX PARCEL #: 20l29/16/00000/330/0400
OMB No. 1660-0008
Exqires Februarv 28. 2009
For Insurance Company Use:
Company NAIC Number
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) NON-RESIDENTIAL
A5. LatitudelLongitude: Lat. N27° 56' 23" Long. W82° 43' 47.2" 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 crawl space or enclosure(s), provide A9. For a building with an attached garage, provide:
a) Square footage of crawl space or enclosure(s) NA sq ft a) Square footage of attached garage NA sq ft
b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage
enclosure(s) walls within 1.0 foot above adjacent grade NA walls within 1.0 foot above adjacent grade NA
c) Total net area of flood openings in A8.b NA sq in c) Total net area of flood openings in A9.b NA sq in
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81. NFIP Community Name & Community Number 62. County Name B3. State
CITY OF CLEARWATER 125096 PINELLAS FL
64. Map/Panel Number 65. Su�x 66. FIRM Index 67. FIRM Panel B8. Flood 69. Base Flood Elevation(s) (Zone
Date Effective/Revised Date Zone(s) AO, use base flood depth)
0128 G 09-03-03 09-03-03 "AE" 9'
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 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other (Describe)
612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPAj? ❑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. Eleva6ons - 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-g
below according to the building diagram specified in Item A7.
Benchmark Utilized 408 Vertical Datum 88
Conversion/Comments
a) Top of bottom floor (including basement, crawl space, 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 in Comments)
� Lowest adjacent (finished) grade (LAG)
g) Highest adjacent (finished) grade (HAG)
9.0
N.A
N.A
N.A
N.A
7.7
8.8
Check the measurement used.
� feet ❑ meters (Puerto Rico only)
� feet ❑ meters (Puerto Rico only)
� feet ❑ meters (Puerto Rico only)
� feet ❑ meters (Puerto Rico only)
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SECTION D- SURVEYOR, ENGfNEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation il", " '?*.,�"' �
information. I certify that the information on this Certificate represents my best efforts to interpret the data available. " 5��.,r ; ,,, �
I understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. " ti, +� ..+ ;{,, �,
� Check here if comments are provided on back of form.
Certifier's Name Errol A. Ayuso License Number # 5955 �
Title President Company Name Ayuso Surveying, Inc.
Address 6269 Palma Del Mar Blvd So Unit 302 City St Petersburg State FL ZIP Code 33715
Signature Date 01-15-2008 Telephone 727-528-2399
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FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions
IMPORTANT: In these spaces, copy the corresponding information from Section A.
Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No.
18419 US HIGHWAY 19 NORTH
City CLEARWATER State FL ZIP Code 33764
For Insurance Company Use:
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 VERICAL DATUM OBTAINED FROM PINELLAS COUNTY ENGRN. DEPT., MAP # 408, STAMPED "CAMPUS G", EL = 7.081' N.G.V.D. 29
7.081' - 0.88' = 6.201' N.A.V.D. 88
nature Date 01-1
❑ 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, crawl space, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
b) Top of bottom floor (including basement, crawl space, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9(see page 8 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
Signature
Comments
City
Date
State ZIP Code
Telephone
❑ 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 inforrnation 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 etevation 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 communiry floodplain management purposes.
G4. Permit Number
G7. This permit has been issued for:
G5. Date Permit Issued
❑ New Construction
G6. Date Cert�cate Of Compliance/Occupancy Issued
❑ Substantial Improvement
G8. Elevation of as-built lowest floor (including basement) of the building: _0 feet ❑ meters (PR) Datum
G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters (PR) Datum
Local Official's Name
Community Name
Signature
Comments
Title
Telephone
Date
p Check here ff attachments
FEMA Form 81-31, February 2006 Replaces all previous editions