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122, 126, 130, 132, 134, 136, 138, 140, 144 ISLAND WAYDEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency ELEVATION CERTIFICATE IMPORTANT: FOLLOW THE INSTRUCTIONS ON PAGES 9-16 E�I�uu��u��`j !�� ECEIVE� ,-- ��.�--� , � �-+, 1 � 20i1' Copy all pages of this Elevation Certificate and ali attachments for (1) community official, (2) insurance agen ��; � SECTION A- PROPERTY INFORMATION FOR INSURANCE COD �_�. _. � A1. Building Owners Name ��11VNINGt�D�VEtOPMECVTDE PUBLIX SUPER MARKETS, INC. Policy Number: �CiTY J�C1.EpRWATER A2. Building Street Address (including Apt.: Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number: 122, 126, 130, 132, 134, 136, 138, 140 144 ISLAND WAY City CLEARWATER BEACH State FL Zip Code 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) 08-29-15-00000-130-0100 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) NON-RESIDENTIAL A5. Latitude/Longitude: Lat.27°58'41.92" Long.82°49'01.61" Horizontal Datum: II 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) OSq ft a) Square footage of attached garage OSq ft b) Number of permanent flood openings in the b) Number of permanent flood openings crawlspace or enclosure(s) within 1.0 foot in the attached garage within 1.0 foot above adjacent grade 0 above adjacent grade 0 c) Total net area of flood openings in A8.b 0 sq in c) Total net area of flood openings in A9.b Osq in d) Engineered flood openings?. IIYes �No d) Engineered flood openings? II Yes � No SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NFIP Community Name & Community B2. County Name B3. State Number CITY OF CLEARWATER 125098 PINELLAS FL B4. Map/Panel 65. 66. FIRM Index B7. FIRM Panel Effective 68. Flood B9. Base Flood Elevation(s) (Zone Number Suffix Date Revised Date Zone(s) AO, use base flood depth) 12103C0102 G 8-18-2009 9-3-2003 AE 17 610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: IIFIS Profile �FIRM IICommunity Determined IIOther/Source: 611. Indicate elevation datum used for BFE in Item 69: IINGVD 1929 �,NAVD 1988 IIOther/Source: 612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? [lYes �No Designation Date: IICBRS IIOPA SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: IIConstruction Drawings* [1Building Under Construction* � Finished Construction 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. *A new Elevation Certificate will be required when construction of the building is complete. Benchmark Utilized: G-03.5 Vertical Datum: 1988 Indicate elevation datum used for the elevations in items a) through h) below. IINGVD 1929 �NAVD 1988 ❑OtheNSource: 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) 8.0 � feet ❑ meters b) Top of the next higher floor N/A. ❑ feet ❑ meters c) Bottom of the lowest horizontal structural member (V zones only) N/A. ❑ feet ❑ meters d) Attached garage (top of slab) N/A. ❑ feet ❑ meters e) Lowest elevation of machinery of equipment servicing the building 11.0 � feet ❑ meters (Describe type of equipment and location in Comments) � Lowest adjacent (finished) grade next to building (LAG) 7.7 � feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 7.8 � feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A. ❑ feet ❑ meters structural support FEMA Form 086-Q33 (7/15) Replaces all preaious editions. Page 3 of 15 Pr ELEVATION CERTIFICATE OMB Control Number: 1660-0008 Eupiration: 11 /30/2018 SECTION D-SURVEYOR, ENGINEER,ORARCHITECTCERTIFICATION 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. l understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. Were latitude and longitude in Section A a Check here if attachments. provided by a licensed land surveyor? ��at,. �Yes ❑ No ��s : '"'r, Certifier's Name License Number w'��°� � + t � '' � DAN H. RIZZUTO 5227 �*,, � y�yta,:>� � Aw �'�(, 1-^ Title Company Name � t�� _�F'��''�� W PROFESSIONAL SURVEYOR POLARIS ASSOCIATES, INC. ,, w � A-� � A �� 1�'4 ��V� �- "�4 ...1 � � . � ��`'. ! � r3w � � �'p1� ! 4� +v Address City State Zip Code ,�a �. h�� :,� a 1 SUNNYDALE BLVD, STE D CLEARWATER FL 33765 ';, �',� y`` .�p �� ..°e `�� ° ��' '� ° a � ` c, � �, � !.� lysr •��a�ccF � �� ; , ,. � .�:� . igna ure Date Telephone ,�, �. � ;`' ' 01-25-2017 727-461-6113 ��`'�t�rsafs"r�'�°� C both side his Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including type of equipment and location , per C2(e), if applicable) 1. SURVEY MAP AND REPORT OR THE COPIES THEREOF ARE NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. ADDITIONS OR DELETIONS TO SURVEY MAPS OR REPORTS BY OTHER THAN THE SIGNING PARTY OR PARTIES IS PROHIBITED. 2. POLARIS JOB #4514 3. EQUIPMENT IS ELECTRIC PANELS (A/C IS ON ROOF) �ZS`e� Sign e Date SECTION E B LDING 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. E.1 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 ❑ feet ❑ meters ❑ above or ❑ below the HAG or enclosure) is b) Top of bottom floor (including basement, crawlspace ❑ feet ❑ meters ❑ above or ❑ below the HAG or enclosure) is 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 II 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. Address City State ZIP Code Signature Date Telephone Comments ❑Check here if attachments. FEMA Form 086-0-33 /7/151 Re�laces all orevious editlons. t'aqe 4 Ot 'I b OMB Control Number: 1660-0008 Expiration: 11 /30/2018 FEMA Form 086-0-33 (7/151 Re�laces all orevious editions. Paqe 5 of 15 BUILDING PHOTOGRAPHS See instructions for Item A6 OMB Control Number: 1660-0008 Expiration: 11 /30/2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No. 122, 126, 130, 132, 134, 136, 138, 140 144 ISLAND WAY Policy Number: City Company NAIC CLEARWATER BEACH State FL Zip Code 33767 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 more pnotograpns tnan win tit on tnis page, use tne �ontinuation RIGHT SIDE( NORTH ) FEMA Form 086-0-33 (7/151 Reolaces all orevious editions. Paqe 6 of 15 BUILDING PHOTOGRAPHS Continuation Page OMB Control Number: 1660-0008 F�cp iration: 11130/2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No. 122, 126, 130, 132, 134, 136, 138, 140 144 ISLAND WAY Policy Number: City State Zip Code Company NAIC Number: CLEARWATER BEACH FL 33767 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 'oundation witn representanve exampies or me nooa opern U� vCnts, Gs mwcalcu u� .�cwvi� ��. REAR VIEW (WEST) FEMA Form 086-0-33 (7/151 Reolaces all orevious editions. Paqe 7 of 15