445 GULFVIEW BLVD S` U.S. DEPARTMENT OF HOIMELAND SECURtTY ELEVATION CERTIFICATE
FEDERALEMERGENCYIIAANAGEMENTAGENCY
National F7oodlnsurance Program Important: Read the instructions on pages 1-9
SECTION A - PROPERTY INFORMATION
A1. Building Owner's Name PELICAN POINTE ON CLEARWATER BEACH ASSN INC
A2. Building Street Address (induding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
445 S GULFVIEW BLVD
City CLEARWATER State FL ZIP Code 33767
oMB No. �ssa000s
Expiration Date: July 31, 2015
F�2INSURANCE COIUPANY USE
A3. Property Desaip6on (Lot and Blodc Numbers, Tax Parcel Number, Legal Descxiption, etc.)
PELICAN POtNTE ON CLEARWATER BEACH, A CONDOMINIUM, CONDO PLAT BOOK 735, PGS 1-13
A4. Building Use (e.g., Resider►tial, Non-Residential, Addition, Accessory, etc.) COMM R IAi
A5. Latitude/Longitude: lat. �.,96956 Long. -82.82912 Horizontal Datum: ❑ NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of the buitding if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number .�
A8. For a building with a crawlspace or endosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or endosure(s) I�/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 endosure(s) within 1.0 foot above adjacent grade �A within 1.0 foot above adjacent g�ade !�/A
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
81. NFIP Community Name & Community Number 62. County Name
CITY OF CLEARWATER - 125096 PINELLAS
64. Map/Panel Nu ber B5. Suffix 66. FIRM Index Date B7. FIRM Panel
,` 12103C010� G 05/17/2005 Effective/Revised Date
09/03/2003
810.
811
B8. Flood
Zone(s)
AE
Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9.
❑ FIS Profile Q FIRM ❑ Community Determined ❑ Other/Source:
Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 0 NAVD 1988 ❑ Other/Source:
63. State
FL
B9. Base Flood Elevation(s) (Zone
AO, use base flood depth)
12
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612. Is the building located in a Coastal Barrier Resources System CBRS) area or Othenvise Protected Area (OPA)? ❑ Yes � No µ�--->
Designation Date: � CBRS ❑ OPA
SECtION C- BUI�DING ELEVATIOM INFORMATION (SURVEY REQUIRED) '
C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction` � Finished Construction �'
;A new Elevation Certificate wilt be required when construction of the building is complete. f�,
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-h
below according to the building diagram speafied in Item A7. In Puerto Rico only, enter meters. �
Benchmark Utilized: CLEARWATER BM "F-02" Vertical Datum: NAVD 1988 _, �
Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ OtherlSource: :�
Datum used for buitding elevations must be the same as that used for the BFE. Chedc the measurement used. -._
a) Top of bottom floor (including basement, crawlspace, or endosure floor)
b) Top of the next higher floor
c) Bottom of the lowest horizontal strvctural member (V Zones only)
d) Attached garage (top of slab)
e) Lowest elevation of machinery or equipment serviang the building
(Describe rype of equipment and location in Comments)
� Lowest adjacent (finished) grade next to building (LAG)
g) Highest adjacent (finished) grade next to building (HAG)
h) Lowest adjacent grade at lowest etevation of dedc or stairs, induding structural support
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SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certificaUon is to be signed and sealed by a land surveyor, engineer, or archited authorized by law to cer tify elevation - --,
information. l ce►tily that the informafion on this Certificate represents my best efforts lo inteqwet the data availab/e. '' ;
I understand that any fa/se statement may be punishable by fine or imprisonment under 18 U S. Code, Section 1001. ��P.N S B/.�
� Chedc here if comments are provided on badc of fortn. Were latitude and longitude in Sedion A provided by a � Q�� ., e�se ��,,,r ����
❑ No �0���� �;" �s4� � � _ �
❑ Chedc here if attachments. licensed land surveyoh ❑X Yes �
Certifier's Name JONATHAN S. BRANSON
TiUe LAND SURVEYOR
Address 2 19 N F INT T
Signature
FEMA Form 086-0-33 (7/12)
License Number FL PlS 6845
Company Name JONATHAN BRANSON PRF LAND SURVEYOR
City PALM HARBOR State FL ZIP Code 34683
Date 03/19/2014 Telephone 81�785-1913
See reverse side for continuation.
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Replaces all previous editions.
:��vN� �vn a.��c� �r�vAl C� page z
IMPORTANT: In these spaces, copy the corresponding information from Section A
Building Street Address (indudmg Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No.
445 S GULFVIEW BLVD
City CLEARWATER State FL ZIP Code 33767
FOR INSURANCE COMPANY USE
Pdicy Number:
Comparry NAIC Number.
SECTION D— SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) communiry offiaai, (2) insurance agenUcompany, and (3) building owner.
Comments C2E IS ELEVATION OF SLAB SUPPORTING ELECTRIC TRANSFORMER
MECHANICAL ROOM FOR THE STRUCTURE IS 5.5, ELEVATOR IS ITYDRAULIC PASSENGER ANO HAS ELEVATION 7.3 WHEN PARKED AT 1 ST
FLOOR
Signature � r��� ; � Date 03/19/2014
E— BUILDI�iIG ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A
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 ftems E1—E4, use natural grade, if available. Chedc the measurement used. In Puerto Rico only, enter meters.
E1. Provide elevation iriformation for the following and chedc 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, cravNspace, or endosure) is ❑ feet ❑ meters ❑ above or 0 below the HAG.
b) Top of bottom floor (induding basement, crawlspace, or endosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Sedion A Items S and/or 9(see pages �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 stab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E4. Top of platform of machinery and/or equipment serviang the building is ❑ feet ❑ meters ❑ above or � below the HAG.
E5. Zone AO onty• 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 certity 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 2one A(without a FEMA-issued or community-issued BFE)
or Zone AO must sign here. The statements in Sedions 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
Ciry
Date
State
Telephone
ZIP Code
Chedc here if attachmentc_.
SECTION G — COMMUNITY INFORMATION (OPTIONAL)
The local offiaal who is authorized by law or ordinance to administer the communityr's floodplain management ordinance can complete Sedions A, B, C(or E), and G
of this Elevation Certificate. Complete the applicable item(s) and sign below Chedc the measurement used in kems G&-G10. In Puerto Rico only, enter meters.
G1. ❑ The information in Sedion 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 elevaUon infortnation. (Indicate the source and date of the elevation data in the Comments area below.)
G2. ❑ A community offiaal 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 (ttems 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. Elevatian of as-built lowest floor (induding basemerrt) of the building: ❑ feet ❑ meters
G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters
G10. Community's design flood elevation: ❑ feet ❑ meters
Local Offiaal's Name
Community Name
Signature
Comments
Title
Telephone
Date
Datum
Datum
Datum
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445 S GULFVIEW BLVD
BCP2014-02545
DOOR, WINDOW, ELECTRIC
PELICAN POINTE RESORT AND HOTEL
Zoning: Tourist Atlas #: 276A
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 (induding Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No.
445 S GULFVIEW BLVD
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 Vew" and "Rear Veud'; and, if required, "Right Side Vevd' and "Left Side
Vew." 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.
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FEMA Form 086-0-33 (7/12) Replaces all previous editions.
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ELEVATION CERTIFICATE, page 4 guilding 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:
445 S GULFVIEW BLVD
City CLEARWATER 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 vevd' and "Rear vevd'; and, if required, "Right Side �evd' and "Left Side Vew." When applicable, photographs
must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8.
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