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18421 US HWY 19_ _ _ ._ U.S. DE'pARTM�NT OF HOMELAND SECURITY ELEVATION CERTIFICATE �� �`� ��O OOt� n0 330 0 3 c� FED�RAL EMER!'�ENCY MANAGEMENT AGENCY OMB No. 1660-0008 Nationai Flood Insura:ce Program Important: Read the instructions on pages 1-9. Expiration Date: July 3t , 2015 SECTION A- PROPERTY INFORMATION F�R,li��3.li�P�;�ht11�A1��' ii�� :,,;: Ai. Building Owner's Name US 19 STRIP MALL LLC �`������� . A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Cc�ii��rty fiJ}�i� �ilirri�r- ; ; 21 HIGHWAY 19 City CLEARWATER State FL ZIP Code 33764 �°.r"'�..�� y y..:-.. ~��id�t �t�% � �`r i y i j A3. Property Descnption (Lot and Block Numbers, Tax Parcel Number, Legal Descnption, etc.) rj� ,�,; �r; ;�,�; *� SECTION 20-29-16 PINELLAS COUNTY A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) ����;.' i- i,�y;� °_�� COMMERCIAL A5. Latitude/Longitude: Lat. 27.9402 Long. -82.7296 Horizontal Datum: ❑ NAD 1927 ❑X NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. ,- � �,.�� w.; A7. Building Diagram Number 1A 'a�.b,�� � v�. 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) NA sq ft a) Square footage of attached garage NA 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 NA 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 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 62. County Name CLEAR�NATER 125096 ! 64. Map/Panel Number B5. Suffix 66. FIRM Index Date 67. FIRM Panel 12103C 0128 G 9-3-2003 Effective/Revised Date 9-3-2003 63. State FLORIDA B8. Flood B9. Base Flood Elevation(s) (Zone ZoAE(s) AO, use bas9 flood depth) B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69. ❑ FIS Profile 0 FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: 612. Is the building located in a Coastal Barrier Resources System CBRS) area or Otherwise Protected Area (OPA)? Designation Date: _ � CBRS ❑ OPA ❑ Yes ❑X No SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Ci. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction" ❑X Finished Construction "A new Elevation Certificate will be required when construction of the building is compiete. C2. Elevations - Zones Ai-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: COUNTY BENCHMARK Vertical Datum: 1929 Indicate elevation datum used for the elevations in items a) through h) below. �X NGVD 1929 ❑ NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. 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) Check the measurement used. 9.5 � feet NA._ � feet NA._ ❑X feet ❑ meters ❑ meters ❑ meters d) Attached garage (top of slab) NA._ � feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building NA._ ❑X feet ❑ meters (Describe type of equipment and location in Comments) � f) Lowest adjacent (finished) grade next to building (LAG) 9.1 ❑X feet ❑ meters s 1 g) Highest adjacent (finished) grade next to building (HAG) 9.4 0 feet ❑ meters �,i� h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support NA._ ❑X feet ❑ meters 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. I undersiand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section f 001. ❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ❑ Check here it attachments. licensed land surveyor? ❑X Yes ❑ No Certifier's Name JOHN WALKER Title REG LAND SURVEYOR Address 4175 S US 1 Signature FEMA Form 086-0-33 (7/12) License Number 5362 Company Name WALKER LAND SURVEYING City ROCKLEDGE State FL ZIP Code 32955 Date 2-13-14 Telephone 321-636-1055 See reverse side for continuation. 4���� ���� ���� Replaces all previous editions. ELEVATION�CERTIFICATE, page 2 IMWQ€iTANT.' In these spaces, copy the corresponding information from Section A. Building $treet Adc�ress (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 18421 US 19 City CLEARWATER State FL ZIP Code 33764 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 Signature Date 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 91see pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters ❑ above or Ll 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 Telephone ZIP Code 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—G10. In Puerto Rico only, enter meters. 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 buiiding 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: __ ❑ feet ❑ meters Datum _ G9. BFE or (in Zone AO) depth of flooding at the building site: __ ❑ feet ❑ meters Datum _ G10. Community's design flood elevation: __ ❑ feet ❑ meters Datum _ Local Official's Name Community Name Signature Comments Title Telephone Date ❑ Check here if attachments. FEMA Form 086-0-33 (7/12) Replaces all previous editions.