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200 ISLAND WAYU.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICA Important: Follow the instructions on pages 1-1 Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) in; SECTION A — PROPERTY INFORMATION Al. Building Owner's Name PUBLIX SUPER MARKETS, INC. A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route an Box No. 200 ISLAND WAY City CLEARWATER BEACH State Florida A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, 08-29-15-00000-130-0100 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) NON -RI IOMB No. 1660-0008 I Expiration Date: November 30, 2018 200 ISLAND WAY BCP2016-03334E EC UNDER PUBLIX Zoning: Commercial Atlas RECEIVED BY: J.A.W. NOV 0 2 2017 PLANNING & DEVELOPMENT CITY OF CLEARWATER A5. Latitude/Longitude: Lat. 27°58'43.96" Long. 82°49'01.77" Horizontal Datum: 0 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 6 A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) 36190.00 sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b 0.00 sq in d) Engineered flood openings?❑ Yes 0 No A9. For a building with an attached garage: a) Square footage of attached garage N/A sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A9.b 0.00 sq in d) Engineered flood openings? ❑ Yes 0 No 0 SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number CITY OF CLEARWATER 125098 B2. County Name PINELLAS B3. State Florida B4. Map/Panel Number 12103C0102 B5. Suffix G B6. FIRM Index Date 08-18-2009 B7. FIRM Panel Effective/ Revised Date 09-03-2003 B8. Flood Zone(s) AE B9. Base Flood E evation(s) (Zone AO, use Base Flood Depth) 11 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: ❑ FIS Profile ® FIRM 0 Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ® NAVD 1988 0 Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes Designation Date: ❑ CBRS ❑ OPA ❑X No FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 • 1-..14.1 ouvn vaL . ivuveIrIu l ..)U, Lula 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. 200 ISLAND WAY Policy Number: City State ZIP Code CLEARWATER BEACH Florida 33767 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* *A new Elevation Certificate will be required when construction of the C2. Elevations — Zones Al A30, AE, AH, A (with BFE), VE, V1—V30, V Complete Items C2.a—h below according to the building diagram specified Benchmark Utilized: G-03.5 Vertical a building (with Datum: Building Under Construction* ❑ Finished Construction is complete. BFE), AR, AR/A, ARAE, AR/A1—A30, AR/AH, AR/AO. in Item A7. In Puerto Rico only, enter meters. 1988 Indicate elevation datum used ❑ NGVD 1929 a for the elevations in items a) through h) below. NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 8.25 a the measurement used. feet ❑ meters b) Top of the next higher floor 26.98 0 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 or equipment servicing the building (Describe type of equipment and location in Comments) 0.90 feet meters f) Lowest adjacent (finished) grade next to building (LAG) 6.10 X feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 6.90 X feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 6.90 a feet ❑ meters SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect I certify that the information on this Certificate represents my best efforts to interpret statement may be punishable by fine or imprisonment under 18 U.S. Code, Section Were latitude and longitude in Section A provided by a licensed land surveyor? 0 authorized by law to certify elevation information. the data available. I understand that any false 1001. Yes ❑ No ❑ Check here if attachments. Certifiers Name License Number DAN H. RIZZUTO 5227 ,),0. ;447,44, �'' r��"`�,` ,'.0 Title PROFESSIONAL SURVEYOR ����///...•.. *U +''w. =', Company Name POLARIS ASSOCIATES, INC @ * -^ .<-% F s°:, Address 2165 SUNNYDALE BLVD, STE D e�• , : �' • [ •w. -(X., ,°E City State ZIP Code CLEA- R Florida 33765 :��, f•H \'� 1111 ' 'os. §'11tIII Signat - ' t •: Date Telephone Ext. ♦ 08-14-2017 (727) 461-6113 Copy all - : of this I -v- ,1e ficate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including type 1. SURVEY MAP AND REP S RAISED SEAL OF A FLORIDA REPORTS BY OTHER THAN 2. POLARIS JOB #4514-01. C2e. EQUIPMENT IS ELEVATOR BOTTOM OF ELECTRIC ipment and location, per C2(e), if applicable) RT OR THE COPIES THEREOF ARE NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL LICENSED SURVEYOR AND MAPPER. ADDITIONS OR DELETIONS TO SURVEY MAPS OR THE SIGNING PARTY OR PARTIES IS PROHIBITED. PIT LOCATED IN THE NORTHWEST CORNER OF THE BUILDING. PANEL IS 9.18. orm Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 • v.ruau.... vaw. Iwv.I1IUGI 0u, LU 10 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. 200 ISLAND WAY Policy Number: City State ZIP Code CLEARWATER BEACH Florida 33767 Company NAIC Number 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 complete Sections A, B,and C. For Items E1 -E4, use natural grade, if available. Check the measurement enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters LOMA or LOMR-F request, used. In Puerto Rico only, the elevation is above or below ❑ above or ❑ below the HAG. ❑ above or ❑ below the LAG. 9 (see pages 1-2 of Instructions), b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 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. ❑ above or ❑ below the HAG. with the community's this information in Section G. E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify 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, 8, and E are correct to the best of my knowledge. Pr rty Owner or Owner's Authorized Represe tative's Name -ole- O' MSirri4 E Address City �d� City, �� State ZIP Code ? �j Ftcbkr� l.0rprO�G tf W �- kdon( PL 3 iI Signatu(!� Q U Date Telephone � 10 -2_0 - I I— Comments ❑ Check here if attachments. orm Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 • 4..."1.Maaw11 vaLc. l VCI7lUC1 OU, cv 10 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. 200 ISLAND WAY Policy Number: City State ZIP Code CLEARWATER BEACH Florida 33767 Company NAIC Number 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 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 permit has been issued for: ❑ G8. Elevation of as -built lowest floor (including of the building: G9. BFE or (in Zone AO) depth of flooding at the G10. Community's design flood elevation: New Construction ❑ Substantial Improvement basement) ❑ feet ❑ feet ❑ feet ❑ meters Datum building site: ❑ meters Datum ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. orm 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. OMB No. 1660-0008 Expiration Date: November 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 Bldg. No.) or P.O. Route and Box No. 200 ISLAND WAY Policy Number: City State ZIP Code CLEARWATER BEACH Florida 33767 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 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 submitting more photographs than will fit on this page, use the Continuation Page. •,� TO ' I —_ -' Photo One Photo One Caption RIGHT SIDE( NORTH) Clear Photo One _ t Photo Two Photo Two Caption LEFT SIDE (SOUTH) Clear Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. OMB No. 1660-0008 Expiration Date: November 30, 2018 Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name PUBLIX SUPER MARKETS, INC. Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 200 ISLAND WAY Company NAIC Number: City State ZIP Code CLEARWATER BEACH Florida 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., A5. Latitude/Longitude: A6. Attach at least A7. Building Diagram A8. For a building a) Square footage b) Number of permanent c) Total net area d) Engineered A9. For a building with a) Square footage b) Number of permanent c) Total net area d) Engineered Residential, Non -Residential, Addition, Accessory, Lat. 27°58'43.96" Long. 82°49'01.77" etc.) NON-RESIDENTIAL Horizontal Datum: insurance. above grade • NAD 1927 adjacent grade 0 • NAD 1983 0 2 photographs Number with a crawlspace of crawlspace flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? of the building if the 6 Certificate is being used to obtain flood 36190.00 sq ft or enclosure(s): or endosure(s) openings in the crawlspace in A8.b or endosure(s) 0.00 sq in within 1.0 foot foot above adjacent in N/A sq ft ❑ Yes X No garage: garage openings in the attached garage within 1.0 in A9.b 0.00 sq ❑ Yes p No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number CITY OF CLEARWATER 125098 B2. County Name PINELLAS B3. State Florida B4. Map/Panel Number 12103C0102 B5. Suffix G B6. FIRM Index Date 08-18-2009 B7. FIRM Panel Effective/ Revised Date 09-03-2003 B8. Flood Zone(s) AE B9. Base Flood E evation(s) (Zone AO, use Base Flood Depth) 11 B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation Date: of the Base Flood Elevation ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ (BFE) data or base flood ❑ Other/Source: depth entered in Item B9: FIRM datum used located in a ■ NGVD 1929 M NAVD 1988 I. Other/Source: System (CBRS) area or Otherwise Protected CBRS ❑ OPA Area (OPA)? ❑ Yes • No FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 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 Bldg. No.) or P.O. Route and Box No. 200 ISLAND WAY Policy Number: City State ZIP Code CLEARWATER BEACH Florida 33767 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* a Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations — Zones Al 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: G-03.5 Vertical Datum: 1988 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 a NAVD 1988 ❑ Other/Source: 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) 8.25 Xi feet ❑ meters b) Top of the next higher floor 26.98 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 or equipment servicing the building (Describe 0.90 meters type of equipment and location in Comments) feet ❑ f) Lowest adjacent (finished) grade next to building (LAG) 6.74 X feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 8.00 0 feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 6.90 0 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 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 provided by a licensed land surveyor? 0 Yes ❑ No ❑ Check here if attachments. Certifier's Name License Number 9 * DAN H. RIZZUTO 5227i' J /a Title PROFESSIONAL SURVEYOR A . y, ''h Company Name 4. ► POLARIS ASSOCIATES, INC , . . ; " Address 2165 SUNNYDALE BLVD, STE D 114 City State ZIP Code CLEARWA Florida 33765 Signature 1 Date Telephone Ext. 4 11-14-2017 (727) 461-6113 Copy all p es a ificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. his El- a 1�' ii Comments (including type o :,quipment 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 #4514-01. C2e. EQUIPMENT IS ELEVATOR PIT LOCATED IN THE NORTHWEST CORNER OF THE BUILDING. BOTTOM OF ELECTRIC PANEL IS 9.18. 3. BUILDING IS FLOOD PROOFED TO AE -12 PER BCP 2016-03334E. PER CLIENT. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 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 Bldg. No.) or P.O. Route and Box No. 200 ISLAND WAY Policy Number: City State ZIP Code CLEARWATER BEACH Florida 33767 Company NAIC Number SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without complete Sections A, B,and enter meters. El. Provide elevation information the highest adjacent grade a) Top of bottom floor crawlspace, or enclosure) b) Top of bottom floor crawlspace, or enclosure) E2. For Building Diagrams the next higher floor (elevation the diagrams) of the building E3. Attached garage (top E4. Top of platform of machinery servicing the building is E5. Zone AO only: If no flood floodplain management BFE), complete Items E1—E5. If the Certificate is intended to support a C. For Items E1—E4, use natural grade, if available. Check the measurement for the following and check the appropriate boxes to show whether (HAG) and the lowest adjacent grade (LAG). (including basement, is ❑ feet ❑ meters LOMA or LOMR-F request, used. In Puerto Rico only, the elevation is above or below ❑ above or ❑ below the HAG. ❑ above or 0 below the LAG. 9 (see pages 1-2 of Instructions), ❑ above or ❑ below the HAG. ❑ above or ❑ below the HAG. ❑ above or ❑ below the HAG. with the community's certify this information in Section G. (including basement, is ❑ feet ❑ meters 6-9 with permanent flood openings provided in Section A Items 8 and/or C2.b in is ❑ feet • meters of slab) is ❑ feet ❑ meters and/or equipment ❑ feet ❑ meters depth number is available, is the top of the bottom floor elevated in accordance ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must SECTION F — PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's community -issued BFE) or authorized representative who completes Sections A, B, and E for Zone A (without a FEMA -issued or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner or Owner's Authorized Representative's Name Address City State ZIP Code • Signature Date Telephone Comments ❑ Check here if attachments. FEMA Form 086-0-33 (7/15 Replaces all previous editions. Form Page 3 of 6 ELEVATION CERT! ICATE OMB No. 1660-0008 Expiration Date: November 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 Bldg. No.) or P.O. Route and Box No. 200 ISLAND WAY Policy Number: City State ZIP Code CLEARWATER BEACH Florida 33767 Company NAIC Number 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 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 permit has been issued for: ❑ G8. Elevation of as -built lowest floor (including of the building: G9. BFE or (in Zone AO) depth of flooding at the G10. Community's design flood elevation: New Construction ❑ Substantial Improvement basement) ❑ feet ❑ feet ❑ feet ❑ meters Datum building site: ❑ meters Datum ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 BUILDING PHOTOGRAPHS ELEVATION CERTIFICATE See Instructions for Item A6. OMB No. 1660-0008 Expiration Date: November 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 Bldg. No.) or P.O. Route and Box No. 200 ISLAND WAY Policy Number: City CLEARWATER BEACH State Florida ZIP Code 33767 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 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 submitting more photographs than will fit on this page, use the Continuation Page. Photo One Caption RIGHT SIDE( NORTH Clear Photo One Photo Two Photo Two Caption LEFT SIDE (SOUTH) FEMA Form 086-0-33 (7/15) Replaces all previous editions. Clear Photo Two Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS OMB No. 1660-0008 Continuation Page Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 200 ISLAND WAY FOR INSURANCE COMPANY USE Policy Number: City CLEARWATER BEACH State ZIP Code Florida 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 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. Photo Three Photo Three Caption REAR VIEW (WEST) Clear Photo Three Photo Four Caption FRONT VIEW (EAST) Clear Photo Four FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 Building Diagrams DIAGRAM 3 Alt split-level buildings that are slab -on -grade, either detached or row type (e.g., townhouses); with or without attachedgarage. Distinguishing Feature— The bottom floor (excluding garage) is at or above ground level (grade) on at least side,*' DIAGRAM 4 Alt split-level buildings (other than slab -on -grade), either detached or row type (e.g., townhouses); with or without attached garage. Distinguishing Feature The bottom floor (basement or underground garage) is below ground level (grade) on all sides.* Kr HIGH FLOOR All buildings rated floor. GRAM 5 on piers, posts, piles, columns, ctions below the Distinguishing Feature — For alt zones, the ares elevated floor is open, with no obstruction to flow of floodwa (open lattice worts and/or insect screening is permissible). DIAGRAM 6 All buildings, elevated on piers, posts, piles, columns, or parallel shear walls with full or partial enclosure below the elevated floor: rated flow is enclosed, either partially or fatty. In A Zones, the partially or fully enclosed area below the elevated floor is with or without openings" present in the walls oft the enclosure, Indicate information about enclosure size and openings in Section A — Property information. A floor that is betowrground levet (grade) ort alt An "opening" is a pernnarteni opening that allows for the free passage of water:automaticatty in both directions without hurrean intervention. Under the NEP, a minimum of 2 openings is required for enclosures or crawtspeces. The openings shall provide a totat net area of not less than 1 square inch for every square foot of area enclosed, excluding any bars, louvers, or other covers of the opening, PJternativety, art Individual Engtrreered'Flood Openings Certification or an Evaluation Report issued by the International Code Council Evaluation Service (ICC ES) must be submitted to document that the design of the openings will allow for the automatic equalization of hydrostatic flood forces on exterior walls, A window, a door, or a garage door is not considered an opening; openings may be installed in doors, Openings shall be on at least 2 sides of the enclosed area. If a building has more than 1 enclosed area, each area must have openings to allow floodwater to directly enter_ The bottom of the openings must be no higher than 1.0 foot above the higher of the exterior or interior grade or floor immediately below the opening. For more guidance on openings, see NFIP Technical Bulletin 1. NFIP Elevation Certificate Instructions — Page 8 of 9 DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency FLOODPROOFING CERTIFICATE FOR NON - RESIDENTIAL STRUCTURES OMB Control Number. 1660 -0008 Expiration: 11/30/2018 Paperwork Burden Disclosure Notice Public reporting burden for this data collection is estimated to average 3.25 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting this form. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 1800 South Bell Street, Arlington, VA 20598 -3005, Paperwork Reduction Project (1660- 0008). NOTE: Do not send your completed form to this address. General: This information is provided pursuant to Public Law 96 -511 (the Paperwork Reduction Act of 1980, as amended), dated December 11, 1980, to allow the public to participate more fully and meaningfully in the Federal paperwork review process. Authority: Public Law 96 -511, amended; 44 U.S.C. 3507; and 5 CFR 1320. Privacy Act Statement Authority: Title 44 CFR § 61.7 and 61.8. Principal Purpose(s): This information is being collected for the primary purpose of estimating the risk premium rates necessary to provide flood insurance for new or substantially improved structures in designated Special Flood Hazard Areas. Routine Use(s): The information on this form may be disclosed as generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act of 1974, as amended. This includes using this information as necessary and authorized by the routine uses published in DHS /FEMA -003 — National Flood Insurance Program Files System or Records Notice 73 Fed. Reg. 77747 (December 19, 2008); DHS /FEMA/NFIP /LOMA -1 — National Flood Insurance Program (NFIP) Letter of Map Amendment (LOMA) System of Records Notice 71 Fed. Reg. 7990 (February 15, 2006); and upon written request, written consent, by agreement, or as required by law. Disclosure: The disclosure of information on this form is voluntary; however, failure to provide the information requested may result in the inability to obtain flood insurance through the National Flood Insurance Program or being subject to higher premium rates for flood insurance. Information will only be released as permitted by law. Purpose of the Floodproofing Certificate for Non - Residential Structures Under the National Flood Insurance Program (NFIP), the floodproofing of non - residential buildings may be permitted as an alternative to elevating to or above the Base Flood Elevation (BFE). A floodproofing design certification is required for non - residential structures that are floodproofed. This form is to be used for that certification. A floodproofed building is a building that has been designed and constructed to be watertight (substantially impermeable to floodwaters) below the BFE and with structural components having the capability of resisting hydrostatic and hydrodynamic loads and effects of buoyancy. Before a floodproofed building is designed, numerous planning considerations, including flood warning time, uses of the building, mode of entry to and exit from the building and the site in general, floodwater velocities, flood depths, debris impact potential, and flood frequency, must be addressed to ensure that dry floodproofing will be a viable floodplain management measure. The minimum NFIP requirement is to floodproof a building to the BFE. However, when it is rated for flood insurance one -foot is subtracted from the floodproofed elevation. Therefore, a building has to be floodproofed to one foot above the BFE to receive the same favorable flood insurance rates as a building elevated to the BFE. Additional guidance can be found in FEMA Publication 936, Floodproofing Non - Residential Buildings (2013), available on FEMA's website at https://www.fema.gov/media-library/assets/documents/34270. 200 ISLAND WAY BCP2016- 03334E flood PUBLIX Zoning: Commercial Atl FEMA Form 086 -0 -34 (6/15) Page 1 of 4 RECEIVED BY: J.A.W. NOV 0 8 2017 PLANNING & DEVELOPMENT CITY OF CLEARWATER FLOODPROOFING CERTIFICATE FOR NON - RESIDENTIAL STRUCTURES (Continued) The floodproofing of non - residential buildings may be permitted as an alternative to elevating to or above the Base Flood Elevation; however, a floodproofing design certification is required. This form is to be used for that certification. Floodproofing of a residential building does not alter a community's floodplain management elevation requirements or affect the insurance rating unless the community has been issued an exception by FEMA to allow floodproofed residential basements. The permitting of a floodproofed residential basement requires a separate certification specifying that the design complies with the local floodplain management ordinance. BUILDING OWNER'S NAME Publix Super Markets, Inc. STREET ADDRESS (Including Apt., Unit, Suite, and /or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER 200 Island Way, Clearwater, FL OTHER DESCRIPTION (Lot and Block Numbers, etc.) 08- 29 -15- 00000 -130 -0100 CITY Clearwater STATE Zip Code 33767 SECTION I — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM: COMMUNITY NUMBER 125096 PANEL NUMBER 12103C0102 SUFFIX G DATE OF FIRM INDEX 09 -03 -2003 FIRM ZONE AE BASE FLOOD ELEVATION (in AO Zones, Use Depth) 11.0' Indicate elevation datum used for Base Flood Elevation shown above: NGVD 1929 ® NAVD 1988 ❑ Other /Source: SECTION II — FLOODPROOFED ELEVATION CERTIFICATION (By a Registered Professional Land Surveyor, Engineer, or Architect) All elevations must be based on finished construction. Floodproofing Elevation Information: Building is floodproofed to an elevation of 12 . 0 feet (In Puerto Rico only: meters). ❑ NGVD 1929 ® NAVD 1988 ❑ Other /Source: (Elevation datum used must be the same as that used for the Base Flood Elevation.) Height of floodproofing on the building above the lowest adjacent grade is 5.90 feet (In Puerto Rico only: meters). For Unnumbered A Zones Only: Highest adjacent (finished) grade next to the building (HAG) 6 . 9 feet (In Puerto Rico only: meters). ❑ NGVD 1929 ® NAVD 1988 ❑ Other /Source: (NOTE: For insurance rating purposes, the building's floodproofed design elevation must be at least 1 foot above the Base Flood Elevation to receive rating credit. If the building is floodproofed only to the Base Flood Elevation, then the building's insurance rating will result in a higher premium. See the Instructions section for information on documentation that must accompany this certificate if being submitted for flood insurance rating purposes.) FEMA Form 086 -0 -34 (6/15) Page 2 of 4 200 Island Way, Clearwater, FL FLOODPROOFING CERTIFICATE FOR NON - RESIDENTIAL STRUCTURES (Continued) Clearwater Florida 33767 Non - Residential Floodproofed Elevation Information Certification: Section II 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 in Section 11 on this Certificate represents a true and accurate interpretation and determination by the undersigned using the available information and data. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME LICENSE NUMBER (or Affix Seal) 0010829 t *;-t'e„, t. TITLE COMPANY NAME ADDRESS CITY STATE Florida ZIP CODE SIGNATURE DATE PHONE SECTION I11— FLOODPROOFED CERTIFICATION (By a Registered Professional Engineer or Architect) Non - Residential Floodproofed Construction Certification: I certify the structure, based upon development and/or review of the design, specifications, as -built drawings for construction and physical inspection, has been designed and constructed in accordance with the accepted standards of practice (ASCE 24 -05, ASCE 24-14 or their equivalent) and any alterations also meet those standards and the following provisions. The structure, together with attendant utilities and sanitary facilities is watertight to the floodproofed design elevation indicated above, is substantially impermeable to the passage of water, and shall perform in accordance with the 44 Code of Federal Regulations (44 CFR 60.3(c)(3). All structural components are capable of resisting hydrostatic and hydrodynamic flood forces, including the effects of buoyancy, and anticipated debris impact forces. I certify that the information in Section 111 on this certificate represents a true and accurate determination by the undersigned using the available information and data. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME William Joe Fisher LICENSE NUMBER (or Affix Seal) 0010829 TITLE President COMPANY NAME Fisher and Associates, LLC !-EA, -'= RF ADDRESS 2315 Belle. it R. ■lli■ �.-411. CITY Clearwater STATE Florida ZIP CODE 33764 SIG. '�V� ��airi DATE Nov 8, 2017 PHONE +1 (727) 443 -4436 Copy all pages is Flo - dproofing Certificate and all attachments for 1) community official, 2) insurance building ow r. agent/company, and 3) Page 3 of 4 FLOODPROOFING CERTIFICATE FOR NON - RESIDENTIAL STRUCTURES (Continued) Instructions for Completing the Floodproofing Certificate for Non - Residential Structures To receive credit for floodproofing, a completed Floodproofing Certificate for Non - Residential Structures is required for non - residential and business buildings in the Regular Program communities, located in zones A1—A30, AE, AR, AR Dual, AO, AH, and A with BFE. In order to ensure compliance and provide reasonable assurance that due diligence had been applied in designing and constructing floodproofing measures, the following information must be provided with the completed Floodproofing Certificate: • Photographs of shields, gates, barriers, or components designed to provide floodproofing protection to the structure • Written certification that all portions of the structure below the BFE that will render it watertight or substantially impermeable to the passage of water and must perform in accordance with Title 44 Code of Federal Regulations (44 CFR 60.3 (c)(3)) • A comprehensive Maintenance Plan for the entire structure to include but not limited to: • Exterior envelope of the structure • All penetrations to the exterior of the structure • All shields, gates, barriers, or components designed to provide floodproofing protection to the structure • AD seals or gaskets for shields, gates, barriers, or components • Location of all shields, gates, barriers, and components as well as all associated hardware, and any materials or specialized tools necessary to seal the structure. FEMA Form 086 -0 -34 (6/15) Page 4 of 4