1261 GULF BLVD #109u.s. �PatrwEaer oF H�o secuRmr ELEVATIOI� CEIZTB�ICIeliE
FEDERAI. EME1tGENCY MANAGEMENT AGENCY
National Flood Insurance Program I111�Oi�11t: R@8(� � IB9Stl'98Ct10B'98 Ofl ��S '��.
SECTION A - PROPEi3TV IWFORIIAATIOHB
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box fVo.
1261 GULF BLVD, SUITE 109
City CLEARWATER State FL ZIP Code 33767
A3. Property Description (Lot and Block fVumbers, Tax Parcel Number, Legal Description, etc.)
PART OF LOT 1, SUBDIVISIOfV OF RADISSON BAYSIDE HOTEL - PARCEL # 20-29-15-73427-000-0010
OMB No. 1660-0008
Expiration Date: July 31, 2015
A4. Building Use (e.g., Residential, IVon-Residentiai, Addition, Accessory, etc.) COMMERCIAL
A5. Latitude/Longitude: Lat. 27.9522°PI Long. 82.8300°W Horizontal Datum: ❑ FIAD 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 fVumber 1 B
A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawispace or enclosure(s) N/A sq ft a) Square footage of attached garage FI/A sq ft
b) Flumber of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage
or enclosure(s) wi4hin 1.0 foot above adjacent grade PI/A within 7.0 foot above adjacent grade IV/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 filame & Community Plumber 62. County Plame B3. State
CITY OF CLEARWATER 125096 PINELLAS FLORIDA
64. Map/Panel Number B5. Suffix B6. FIRM Index Date B7. FIRNi Panel B8. Flood Zone(s) B9 Base Flood Elevation(s) (Zone
Effective/Revised Date AO, use base flood depth)
12103C-0104 G 8-18-09 9-3-03 AE 11'
610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69.
❑ FIS Profile � FIRAA ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ OthedSource:
612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes � IVo
Designation Date: iv/A ❑ CBRS ❑ OPA
SECTION C- BUILDING ELEVATSON INFORMATION (SURVEX REQUIRED) rC1
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 M
below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. �
Benchmark Utilized: BROOKSVILLE CORS Vertical Datum: NAVD 1988 --
Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � P1AVD 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) 9.92
b) Top of the ne� higher floor IV/A
c) Bottom of the lowest horizontal structural member (V Zones only) PI/A
d) Attached garage (top of slab) N/A
e) Lowest elevation of machinery or equipment servicing the building fil/A
(Describe type of equipment and location in Comments)
� Lowest adjacent (finished) grade next to building (LAG) 4_1
g) Highest adjacent (finished) grade next to building (HAG) 9_1
h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support FI/A
Check the measurement used
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
� feet ❑ meters
SECTBON D- SURVEYOR, EWGINEER, OR AI2CIiBTECT CERTIFICATIOIV
This certification is to be signed and sealed by a land suroeyor, engineer, or architect authorized by law to certify elevation
information. I certify that the information on this Certi�cate represents my best efforts to interpret the data availa6le.
! understand that any false statement may be punishable by frne 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
� Check here if attachments. licensed land surveyor? � Yes ❑ No
Certifier's Name GEORGE A. SHINNP III Job Number 140339 License Number 6137
Title VICE PRESIDEMT Company Name GEORGE A. SHI11�P II & ASSOCIATES, IfiIC.
Address 3301 DeSOTO BLVD., SUITE D City PALAA HARBOR State FL ZIP Code 34683
Si t re Date 12-10-2014 Telephone 727-784-5496
����,� � �-�;� ,-�-
��
J
-�..
�
�
v
4 -�
�<r�����'�;R����i,• i� �.
c3 ; � ,�'� �
'� ,
idu. ti#3Y
�°'�'} �
���C?f�'�
��, �'S- L CB C2 � i3s�. �.
#'61�fDate.`'1�� � �
�ffft'Je * •
�.,
FEIVIA Form 086-0-33 (7/12) See reverse side for con4inua4ion. Replaces all previous editions.
�LEV/l�NC1N CERT1FICpTE, pag� 2
IN9PORTAWT: In these spaces, copy the correspmnding 6nformat�on from Section A.
Building Street Address (including Apt., Unft, Suite, and/or Bldg. Flo.) or P.O. Route and Box No.
1261 GULF BLVD, SUITE 109
City CLEARWATER State FL ZIP Code 33767
SECTION D— SUliVEYOR, EFIGINEEtt, OR ARCHITEC� CERTIFIC,�TIOIN (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments SEE PAGE 5 FOR SURVEYOR'S COMAIYENTS (THIS DOCUMEfVT IS NOT VALID WITHOUT ALL 5 PAGES)
Date 12-10-2014
SECT801V E— BUILDING ELEVATION IPIFORMATIOPI (Sl1RVEY IVOT REQUIRED) FOIi ZONE AO AND ZOPIE A(WITHOUT �FE,
For Zones AO and A(without BFE), complete Items E1—E5. If the Certificate is intended to support a LOAAA 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 showr whether the elevation is above or below the highest adjacen4
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 4he HAG.
E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E4. Top of platfortn 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 ❑ Flo ❑ Unknown. The local official must certify this information in Section G.
SECTION F— PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATIOIV
The property owrner 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 Plame
Address City State ZIP Code
Signature Date Telephone
Comments
❑ Check here if attachments.
SECTIOFI G — COMMUNITIf INFORMATION (OPTIONAL)
The local offiaal 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 vuho
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 permi4 has been issued for: ❑ New Construction ❑ Substantial Improvement
G8. Elevation of as-built lowest floor (including basement) of the building: ❑ feet ❑ meters
G9. BFE or (in Zone AO) depth of flooding at the building si4e: ❑ feet ❑ meters
G10. Community's design Flood elevation:
Local Official's iVame
Community fVame
Signature
Comments
❑ feet ❑ meters
Title
Telephone
Date
Datum
Datum
Datum
Check here if attachments.
FEIIAA Form 086-0-33 (7/12) Replaces all previous editions.
�V��1�dA°�8�6� �EFaTB�@��a��9 ��9� � �uilcieng Pt�otograph�
. See Instructions for Item A6.
BN@PORTAtVT: I�n these spaces, copy tF�e c�a��sponding arefo�atio� ��om Seega�w �.
Building Stree4 Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
1261 GULF BLVD, SUITE 109
City CLEARWATER State FL ZIP Code 33767
Ft?R IFdS�URAN�GE CE?�9PAtd`1° U5E
Pr�ficyr Numr�r:
CO�mjiOi�' P9t�eiG hlUn7f�P:
If using ihe Elevation Certificate to obtain iVFIP flood insurance, affix at leas4 2 building photographs belovu according to 4he instructions
for Item A6. Identify all photographs with date 4aken; "Front View" and "Rear View"; and, if required, "Righ4 Side View" and "Left Side
View." V�lhen applicable, photographs must show the foundafion wi4h representative examples of the flood openings or vents, as
indica4ed in Section A8. If submitting more photographs than vuill fi4 on this page, use the Con4inuation Page.
� �.
t
� `s�i
�,
' ,
�����P���� ,!.
� � ---
_ _...— -_- ..__.____d.
�.a,-...��;� -
,�. ,.... �•
�� � R
+ �r-
"u,;;
�' *� ''s'� ��-* �� i
�� t'. � � si,�t���t
dr�:
� ' �._� .
�.�. �� - � � �!
_� � +- �
� t
�,,. , .
1 �' f
', . ' �':� ; �� :. �
.o.: �.-�r..,,,..;� -r,�.. ..,�.;..�.�.+� _ , � � .. _ --�
.�. - .�-......� a . ; . . ., . _..
. . : .... � .. �;. �. �m �� �,.. .�,.snc.k'# ,,._-..�.� �,. -,_:a;� .. a�. ... _�...a �<. �., - . ., ' `. �:�:_�._�+� ;. _ .. , :.
.;.,,_��.. ,. . . ,� �
. _;... ..:�; .
... � ,..aX. ' ......,. . ��.
���tl`6 0 W ��tl6
Picture 4aken on: 12-10-2014
FEMA Form 086-0-33 (7/12) Replaces all previous editions.
���a���a�� ��a�re�'����, ���� � ������t�g �hOtog�°�phs
Continuation Page
@I1AP012Ye�eIVT: I� these spaces, copy �e ca�rt�sg�mnc9ie�g infor�sration frorn Section A.
Building Street Address (including Apt., Unit, Suite, and/or Bldg. IVo.) or P.O. Route and Box filo.
1261 GULF BLVD, SUITE 109
City CLEARWATER State FL ZIP Code 33767
Ff�12 IIcESURRtJGE t:E�Irr1FAP�d1' USE �
Palcy kE�be�:
Crampc�� Fl�.IG fUumber.
If submitting more photographs 4han wrill 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." V1/hen applicable,
photographs must show the foundation uvith representative examples of the flood openings or vents, as indica4ed in Section A8.
� �Ia���XY I's.'�F... ."""��.:
}.r t
�'A, `'.'1� 1[ p�' , ,.
� '��4 F�Y YE 'q , x �..
ba 'cp , �
�.; ,., -�' �
� � 3
�`
`r
4�Ei4F� 91'���'id
Picture taken on: 12-10-2014
u.....�.. _ ,
E_._. ,�•��f .V_�TM'l '"'=..5$�.,.Rr+ _,..
.�........� „ .. =,.. ,. , .�
. r .., i•-.,._�_ .. . � . . ...
.. ,. 9�i � �.�.. e+�..ti�'�c'T
x«3s "�F
, °,*m.....
�
FEIViA Form 086-0-33 (7/12) Replaces all previous editions.
ELE@P/lTOON �ER'il�i�lA'�, �age 5
IIWPORTANBT: In the�e spaces, copy the
Sut°oieyor°9s �lotes
Continuation Page
inforre�ation irom Section �,.
Building Street Address (including Apt., Unk, Suite, and/or Bidg. Flo.) or P.O. Route and Box fVo.
1261 GULF BLVD, SUITE 109
City CLEARINATER S4ate FL ZIP Code 33767
SECTION D— SYIRVEYOR'S CERTIFICATION (CONTIPIl9ED FROWY PAGE 2)
A1. ) THIS ELEVATION CERTIFICATE WAS PREPARED EXCLUSIVELY FOR THE USE AfVD BEiVEFIT OF SAPID KEY DONUTS, 9PlC. FOR
THE SPECIFIC PURPOSE OF OBTAINING FLOOD INSURANCE AND/OR VERIFYING FLOOD ZONE COMPLIANCE WITH THE LOCAL
GOVERfVIfVG AUTHORITY. THIS DOCUMENT SHALL NOT BE VALID AIVD BINDING AGAINST THE SIGNING SURVEYOR VVITHOUT
THE ORIGINAL RAISED SEAL AfVD SIGNlATURE OF THE FLORIDA LICENSED SURVEYOR AND MAPPER. USE OF THIS DOCUnAENT
BY AiVY OTHER PARTY OR FOR ANY OTHER PURPOSES IS STRICTLY PROHIBITED AND SHALL RENDER THIS DOCUMENT
INVALID FOR THOSE PURPOSES. UNAUTHORIZED COPIES ARE STRICTLY PROHIBITED AiVD SHALL fVOT BE VALID. REQUESTS
FOR AfVY ADDITIONAL OFFICIAL SIGIVED AND SEALED COPIES MUST BE DIRECTED TO GEORGE A. SHIflIIP II & ASSOCIATES, IMC.
A4.) THE BUILDING USE WAS DETERfVIIi�IED BY PHYSICAL OBSERVATIONS fVIADE ON THE DATE OF SURVEY.
A5.) THE LATITUDE AIVD LOfVGITUDE COORDIVATES WERE OBTAIIVED USING A HAND HELD G.P.S. UIVIT WHICH MEETS OR
EXCEEDS FENIA'S REQUIRED ACCURACY OF 66 FEET.
A7.) THE BUILDING DIAGRAIVI iVUMBER VVAS DETERMINED BY PHYSICAL OBSERVATIOfVS fVIADE Oi�l THE DATE OF SURVEY.
CERTAIN STRUCTURAL FEATURES IVOT VISIBLE TO THE SURVEYOR (PILINGS, GRADE BEAMS, ETC.) CAN AFFECT THIS
DETERMINATION.
A8.) FOR THE PURPOSE OF THIS DOCUMENT, A BUILDING ENCLOSURE IS DEFINED AS THAT PORTIOiV OF AfV ELEVATED
BUILDIfVG, BELOW THE LOWEST ELEVATED FLOOR, THAT IS EITHER PARTIALLY OR FULLY SHUT IIV BY RIGID WALLS. A
GARAGE BELOW OR ATTACHED TO AiV ELEVATED BUILDING IS CONSIDERED Ai�l ENCLOSURE. SUCH AREAS SHALL NOT
CONTAIN flAORE THAN 20 LINEAR FEET OF FIfVISHED INTERIOR WALLS (PANELING, ETC.) OR IT WILL BE CONSIDERED A
FINISHED (HABITABLE) AREA.
IF APPLICABLE, THE STRUCTURE COfVTAINS: ❑ CRAWLSPACE ❑ ENCLOSURE � IV/A
IF APPLICABLE, THE CRAWLSPACE CONTAINS N/A SIVIART VENT(S) CERTIFIED TO COVER N/A SQ. FT. PER VEIVT.
IF APPLICABLE, THE BOTTOM FLOOR ENCLOSURE COfVTAINS N/A SMART VENT(S) CERTIFIED TO COVER IV/A SQ. FT. PER
VENT.
IF APPLICABLE, DOES THE BOTTOM FLOOR EIVCLOSURE APPEAR TO COfVTAIfV BREAK-AWAY V�IALLS? ❑ YES ❑ NO � N/A
A9.) IF APPLICABLE, THE ATTACHED GARAGE CONTAINS N/A SMART VEfVT(S) CERTIFIED TO COVER IV/A SQ. FT. PER VEfVT.
,48. & A9.) FOR THE PURPOSE OF THIS DOCUMEfVT, A FLOOD OPEfVING IS DEFIIVED AS A PERMANEIVT OPENING IN AfV
EXTERIOR WALL THAT IS iV0 HIGHER THAfV 1.0 FOOT ABOVE THE HIGHER OF THE EXTERIOR OR INTERIOR GRADE OR FLOOR
IMMEDIATELY BELOW THE OPENING.
B8.) UNLESS OTHERWISE iUOTED IN SECTION B, ITEI1� 10, THE FLOOD ZONE WAS DETERIVIINED BASED ON THE FLOOD
IfVSURANCE RATE IViAP. IfV CERTAIfV CASES WHERE AN ACCURATE DETERMINATIOfV COULD NOT BE IViADE FRO�A THE IVIAP,
THE COUNTY'S G.I.S. OVERLAY MAY HAVE BEEN UTILIZED TO DETERfVIIME THE FLOOD ZOi�IE. iV0 SEARCH OF THE PUBLIC
RECORDS WAS PERFORMED FOR LOMA'S, LOMR'S, ETC. WHICH MAY AFFECT THE SITE.
C2.e) AIR CONDITIONER IS LOCATED OfV THE ROOF.