The URL can be used to link to this page

18573 US HWY 19 N, 1524, 1532, 1535 FLOURNOY WAY, 1523, 1551, 2622, 2641 FLOURNOY CIR; 1515 FLOURNOY LOOPU.G. DEPARTMENT OF HOMELAND SECURITY Federal EManagement Agency National FlooInsurance Program ELEVATION CERTIFICATE OMB No1660'0008 Expiration Date: November 30, 2018 Important: Follow the instructions on pages 1-9. 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 Owners Name FDC CLEARWATER PSE, LLC Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 18573 U.S. HIGHWAY 19 NORTH Company NAIC Number: City State ZIP Code CLEARWATER Florida 33764 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) VUE AT BELLEAIR BUILDING 4 A4. Building Use (e.g., A5. Latitude/Longitude: AO. Attach at least A7. Building Diagram A8. For a building with a) Square footage b) Number of permanent u> Total net area d) Engineered A9. For a building with a) Square footage b) Number of permanent c) Total net area d) Engineered Res(denUo|, Non -Residential, Addition, Accessory, etc.) Lat.27^5624.58N Long. 82°43'38.95"W RESIDENTIAL Horizontal Datum: insurance. above 0 NAD 1927 adjacent grade grade N/A Ej NAD 1983 N/A 2 photographs of the building if the Number 1A Certificate is being used to obtain flood N/A sq ft a crawispace of crawispace flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b or enclosure(s) N/A sq in within 1.0 foot foot above adjacent in 0 Yes Z No garage: garage N/A sq ft openings in the attached garage within 1.0 in A9.b N/A sq Yes 00 No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Bi. NFIP Community Name & Community Number CITY OF CLEARWATER 125096 B2. County Name PINELLAS B3. State Florida B4. Map/Panel Number 12103C0128 B5. Suffix G B6. FIRM Index DateEffective/ 03-18-2009 B7. FIRM Panel Revised Date 09-03-2003 B8. Flood Zone(s) AE B9. Base Flood E evation(s) (Zone AO, use Base Flood Depth) 9 B10. Indicate the source U FIS Profile B11. Indicate elevation B12. Is the building Designation of the Base Flood Elevation U Community Determined for BFE in Item B9: Coastal Barrier Resources El (BFE) data or base flood 0 Other/Source: 0 NGVD 1929 System (CBRS) CBRS 0 OPA depth entered in Item B9: la FIRM datum used located in a Date: N/A ElmAVD1988 [] Other/Source: area or Otherwise Protected Area (OPA)? 0 Yes lZmo FEMA Form 086-0- 3 (7/15) Replaces all previous editions. Form Page 1 of 6 "REVISED" PLANS RECEIVED BY: T.V. JAN 052018 PLANNING & DEVELOPMENT CITY OF CLEARWATER 1535 FLOURNOY CIR BCP2016-07635E RTC O11 � VUE AT BELLEAIR Zoning: Commercial Atlas #: 318A ELEVATION CERTIFICATE OMB No. 1660-0008 • .-..p...uL.vu VPLG. IVVVGIIIUCI JV, LV I° 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* *A new Elevation Certificate will be required when construction of the C2. Elevations — Zones A1—A30, AE, AH, A (with BFE), VE, V1—V30, V Complete Items C2.a—h below according to the building diagram specified Benchmark Utilized: B-14 CLEARWATER Vertical X 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 ❑ NGVD 1929 used X 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, crawispace, or enclosure floor) 10.20 X the measurement used. 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 or equipment servicing the building (Describe type of equipment and location in Comments) N/A ❑feet ❑meters f) Lowest adjacent (finished) grade next to building (LAG) 9.00 X feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 9.90 X feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support N/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? X authorized by law the data available. 1001. Yes ❑ No to I understand • certify elevation information. that any false Check here if attachments. Certifier's Name License Number DAN H. RIZZUTO 5227 -er Title LAND SURVEYOR ••oa e`��'s�= •'�' , Company Name POLARIS ASSOCIATES, INC. : �' ; E `. r y,' . ti �` Address 2165 SUNNYDALE BOULEVARD � "� ' n � < � > City CLEARjp State ZIP Code Florida 33765 -0 � � �� t'' ��" �,� v� Signatu Date Telephone Ext. , * 11-02-2017 (727) 461-6113 .tion Copy all •::sof " Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (includi • 1 pe 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 #4552 3. AIR CONDITIONING PADS HAVE NOT BEEN CONSTRUCTED AND WHEN CONSTRUCTED WILL BE ABOVE GRADE 9.0 orm Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 • .-nrnauvii vale. IIUVCIIIUCI Jt.), LU -I0 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 Company NAIC Number SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT FOR ZONE AO AND ZONE A (WITHOUT BFE) REQUIRED) 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. El. 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), ❑ above or ❑ below the HAG. ❑ above or ❑ below the HAG. ❑ above or ❑ below the HAG. with the community's this information in Section G. 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 E3. Attached garage (top of slab) is ❑ feet ❑ meters 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 owners 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 or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments. orm 086-0 -33 (7/15) Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 • �nruauvn vaLC. IvuvCIIIUCI .)U, 201u 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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. omi 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 • 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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 Photo One Caption FRONT VIEW (EAST) clean o to Photo Two Photo Two Caption RIGHT SIDE (NORTH) Two orm 086-0- Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Paae OMB No. 1660-0008 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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) Cieariroto?tut e, Photo Four Photo Four Caption REAR VIEW (WEST) Cfear Photo Four orm oss-o- Replaces all previous editions. Form Page 6 of 6 U.S. DEPARTMENT OF HOMELAND SECUI Federal Emergency Management Agency National Flood Insurance Program ELE Imp Copy all pages of this Elevation Certificate and all "REVISED" PLANS RECEIVED BY: T.V. JAN 052018 16 No. 1660-0008 Diration Date: November 30, 2018 it/company, and (3) building owner. SECTION A — PROI PLANNING & DEVELOPMENT CITY OF CLEARWATER )R INSURANCE COMPANY USE Al. Building Owner's Name FDC CLEARWATER PSE, LLC dicy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 18573 U.S. HIGHWAY 19 NORTH Company NAIC Number: City State ZIP Code CLEARWATER Florida 33764 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) VUE AT BELLEAIR BUILDING 3 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, etc.) Lat. 27°56'21.73"N Long. 82°43'41.73"W RESIDENTIAL Horizontal Datum: insurance. above ❑ NAD 1927 adjacent grade grade N/A ® NAD 1983 N/A 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 1A Certificate is being used to obtain flood N/A sq ft or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b or enclosure(s) N/A sq in within 1.0 foot foot above adjacent in ❑ Yes ® No garage: garage N/A sq ft openings in the attached garage within 1.0 in A9.b N/A sq ❑ Yes © No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number CITY OF CLEARWATER 125096 B2. County Name PINELLAS B3. State Florida 64. Map/Panel Number 12103C0128 B5. Suffix G B6. FIRM Index Date 09-18-2009 67. FIRM Panel Effective/ Revised Date 09-03-2003 68. Flood Zone(s) AE 69. Base Flood E evation(s) (Zone AO, use Base Flood Depth) 9 B10. Indicate the source ❑ FIS Profile B11. Indicate elevation 612. Is the building Designation Date: of the Base Flood Elevation © FIRM ❑ Community Determined datum used for BFE in Item 69: located in a Coastal Barrier Resources N/A ❑ (BFE) data or base flood ❑ Other/Source: ❑ NGVD 1929 System (CBRS) CBRS ❑ OPA depth entered in Item B9: © NAVD 1988 ❑ Other/Source: area or Otherwise Protected Area (OPA)? ❑ Yes ❑x No FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No1660'0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the correspondininformation 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 18573 U.S. HIGHWAY 19 NORTH Number: City State ZIP Code CLEARVVATER Florida 33764 Company NAIC Number SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building *A C2. Elevations Complete Benchmark Indicate Datum a) b) c) d) e) f) g) h) elevations are based on: J Construction Drawings* 0 Building Under Construction* El Finished Construction new Elevation Certificate will be required when constrction of the building is complete. - Zones A1 -A30, AE, AH, A(with . VE, V1-V30.V BF AR/AE, AR/A1-A30, AR/AH, AR/AO. Items C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Utilized: 8-14 CLEARWATER Vertical Datum: 1988 elevation datum used for the elevations in items a) through h) below 0 NGVD 1929 0 NAVD 1988 []Other/Oource: used for building elevations must be the same as that used for the BEE. Check the measurement used. Top of bottom floor (including basement, crawlspace, or enclosure floor) 10.10 El feet 0 meters Fl[� Top ofthe n�dN/A feet metershi�her�oor ^~ Bottom of the lowest horizontal structural member (V Zones only) N/A EI feet 0meters Attached garage (top of slab) N/A WN feet meters Lowest elevation of machinery or equipment servicithe building N/A [] feet Fl meters<Demohbatypecf equipment and |ocodoninCommnnb4 �~ Lowest adjacent (finished) grade next to building (LAG) 9/30 Ej feet meters Highest adjacent (finished) grade next to building (HAG) 10.00 IZ feet meters gradeotkmveote|em�|onc�deckorincluding `~~-`^-stairs, structural support N/A Flfeet 0 meters SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification / architect un. 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 /8 U.S. Code, Section 1001. Were latitude and longitude in Section A provided by a licensed land surveyor? 21 Yes El No FlChoc�her��mt�xhmen�. __ Certifiers Name License Number DAN H. RIZZUTO 5227 � � ^ y• ' �'� *�^ *- ''^ �"' Title LAND SURVEYOR Company Name .`, � POLARIS ASSOCIATESINC. . Address��, 2165 SUNNYDALE BOULEVARD City State ZIP Cnde�) CLEAR , Florida 33765 Signa Date Telephone 11-02-2017 O27 481-6113 Copy all pages of vation Certificate and all attachments for (1) community official, (2) insurance agent/company, an(3) bulding owner. Comments (includi pe 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 #4552 3. AIR CONDITIONING PADS HAVE NOT BEEN CONSTRUCTED AND WHEN CONSTRUCTED WILL BE ABOVE GRADE 9.0 FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 • ...awn ouvn vola. IYUVZIIIUt9 JU, GU 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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. El. 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. b) Top of bottom floor (including basement, crawispace, 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 the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters 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 this information in Section G. E3. Attached garage (top of slab) is ❑ feet ❑ meters 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, 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. orm Replaces all previous editions. Form Page 3 of 6 ` ELEVATION CERTIFICATEExpiration Date: November 30, 2018 OMB No1600-0008 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. 18573U.S.HIGHWAY 1BNORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 Company NAIC Number SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community'sfloodplain 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 onty, enter meters. G1. D The information in Section C was taken from other documentation that has been signed and sealed by a Iicensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data iri the Comments area betow.) 82. 0 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. [l The following information (Items G4—G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate of Cnmpliance/Ocoupenry|oeuad G7. This permit has been issued for. 0 G8. Elevation of as -built Iowest floor (including of the building: G9. BFE or (in Zone AO) depth of flooding at G10. Community's design flood elevation: New Construction E Substantial Improvement basement) [] feet 0feet E feet Fl meters Datum the buliding site: Flmeters Datum 0 meters Datum Local Official's Name Tide Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) . 0 Check here if attachments. FEMA Form 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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 Photo One Caption FRONT VIEW (EAST) ClashP oto`in Photo Two Photo Two Caption RIGHT SIDE (NORTH) Ph�tttwo orm 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page OMB No. 1660-0008 • - IMPORTANT: In these spaces, copy the corresponding information from Section A. _..�.. �...,..._...................... .� v v FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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) ar Photo Three Photo Four Photo Four Caption REAR VIEW (WEST) fr Photo four Replaces all previous editions. Form Page 6 of 6 "REVISED" PLANS RECEIVED BY: T.V. JAN 052018 PLANNING & DEVELOPMENT CITY OF CLEARWATER 1532 FLOURNOY WAY BCP2016-07656E RTC 01416141 VUE AT BELLEAIR Zoning: Commercial Atlas #: 318A 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 Coov 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 FDC CLEARWATER PSE, LLC Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 18573 U.S. HIGHWAY 19 NORTH Company NAIC Number: City State ZIP Code CLEARWATER Florida 33764 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) VUE AT BELLEAIR BUILDING 6 A4. Building Use (e.g., A5. Latitude/Longitude: A6. Attach at least A7. Building Diagram A8. For a building with 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, etc.) Lat. 27°56'25.57"N Long. 82°43'40.34'W RESIDENTIAL Horizontal Datum: insurance. above ❑ NAD 1927 adjacent grade grade N/A © NAD 1983 2 photographs of the budding if the Number 1A Certificate is being used to obtain flood N/A sq ft N/A a crawlspace of crawlspace flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b or enclosure(s) N/A 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 N/A sq ❑ Yes X No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number CITY OF CLEARWATER 125096 B2. County Name PINELLAS B3. State Florida B4. Map/Panel Number 12103C0128 B5. Suffix G B6. FIRM Index Date 09-18-2009 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) 9 B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation of the Base Flood Elevation ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ (BFE) data or base flood ❑ Other/Source: ❑ NGVD 1929 System (CBRS) CBRS ❑ OPA depth entered in Item B9: X FIRM ❑ Other/Source: Protected Area (OPA)? datum used located in a Date: N/A X NAVD 1988 area or Otherwise ❑ Yes X No FEMA Form 086-0-33 (7/15) Replaces all previous editions. 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations *A new Elevation Certificate C2. Elevations — Zones Complete Items C2.a—h Benchmark Utilized: Indicate elevation datum ❑ NGVD 1929 Datum used for building a) Top of bottom floor b) Top of the next c) Bottom of the lowest d) Attached garage e) Lowest elevation (Describe type of f) Lowest adjacent g) Highest adjacent h) Lowest adjacent structural support ❑ Finished Construction AR/A1—A30, AR/AH, AR/AO. Rico only, enter meters. are based on: ❑ Construction Drawings* © Building Under Construction* will be required when construction of the building is complete. A1—A30, AE, AH, A (with BFE), VE, V1 V30, V (with BFE), AR, AR/A, AR/AE, below according to the building diagram specified in Item A7. In Puerto B-14 CLEARWATER Vertical Datum: 1988 used for the elevations in items a) through h) below. X NAVD 1988 ❑ Other/Source: elevations must be the same as that used for the BFE. (including basement, crawlspace, or enclosure floor) 10.50 Check the measurement used. ❑ meters ❑ meters ❑ meters ❑ meters ❑ meters ❑ meters ❑ meters ❑ meters X feet higher floor N/A ❑ feet horizontal structural member (V Zones only) N/A ❑ feet (top of slab) 10.09 © feet of machinery or equipment servicing the building N/A feet equipment and location in Comments) ❑ (finished) grade next to building (LAG) 10.00 0 feet (finished) grade next to building (HAG) 10.30 X feet grade at lowest elevation of deck or stairs, including N/A ❑ feet SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be I certify that the information statement may be punishable Were latitude and longitude signed and sealed by a land surveyor, engineer, or architect authorized by on this Certificate represents my best efforts to interpret the data available. by fine or imprisonment under 18 U.S. Code, Section 1001. law to certify elevation information. 1 understand that arty false ❑ Check ,_, = J. 'a ; in Section A provided by a licensed land surveyor? f:! Yes • No Certifier's Name License Number DAN DAN H. RIZZUTO 5227 -1 -lc" n ' r lj � { { ' s , Title^ LAND SURVEYOR s _` • x * o ' . Company Name POLARIS ASSOCIATES, INC. Address 2165 SUNNYDALE BOULEVARD City CLEARWAT R State ZIP Code Florida 33765 Signature Date Telephone Ext. .l 11-02-2017 (727) 461-6113 Copy all pages is El ertificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. v-;ill Comments (including type • -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 #4552 3. AIR CONDITIONING PADS HAVE NOT BEEN CONSTRUCTED AND WHEN CONSTRUCTED WILL BE ABOVE GRADE 9.0 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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. El. 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), ❑ 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. 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 E3. Attached garage (top of slab) is ❑ feet ❑ meters 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 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 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 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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 ❑ meters Datum building site: ❑ meters Datum ❑ meters Datum ■ feet 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 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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 Photo One Caption FRONT VIEW (EAST) Ctear.Photo f Photo Two Photo Two Caption RIGHT SIDE (NORTH) C PhotaTwo FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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) t rPhoto t rue; Photo Four Photo Four Caption REAR VIEW (WEST) Clear Phco Fcux , ................... _ ...... FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 "REVISED" PLANS RECEIVED BY: T.V. JAN 052018 PLANNING & DEVELOPMENT CITY OF CLEARWATER 1524 FLOURNOY WAY BCP2016-07637D RTC VUE AT BELLEAIR Zoning: Commercial office Atlas #: 318A U.S.D RQY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE OMB No1660'0008 Expiration Date: November 30, 2018 Important: Follow the instructions on pages 1-9. 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 !NSURANCE COMPANY USE Al. Buliding Owners Name FDC CLEARWATER PSE, LLC Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 18573 U.S. HIGHWAY 19 NORTH Company NAIC Number: City State , ZIP Code CLEARWATER Florida 33764 A3. Property Description (Lot and Biock Numbers, Tax Parcel Number, Legal Description, etc.) VUEATBELLEA|RBUILDING 7 A4. Building Use (e.g., A5, Latitude/Longitude: A6. Attach at Ieast A7. Builthng Diagram A8. For ubuilding 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°5626.72"N Long. 82°43'40.36'W etc.) RESIDENTIAL Horizontal Datum: insurance. above grade 0NAD 1927 adjacent grade N/A ZNAD 1g83 N/A 2 photographs Number with ocro"Wspooeoranclonure(o): of crawspace flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? of the buliding if the 1A Certificate is being used to obtain flood N/A sq ft or enclosure(s) openings in the crawlspace in A8.b or endosure(s) N/A sq in within 1.0 foot fooabove adjacent in ,_,E1 Yeo 111 No garage: garage N/A sq ft openings in the attached garage within 1.0 in A9.b N/A sq 0Yan Z No SECTION B — FLOOD tNSURANCE RATE MAP (FIRM) INFORMATION Bi. NFIP Community Name & Community Number CITY OF CLEARWATER 125096 82. County Name PINELLAS B3. State Florida 84. Map/Panel Number 12103C0128 B5. Suffix G 88. FIRM Index Date 09-18-2009 B7. FIRM Panel Effective/ Revised Date 09'03-2003 138. Flood Zone(s) AE B9. Base Flood E U (Zone A0, use Base Flood Depth) 9 B10. Indicate the source FIS Profile B11. lndicate elevation B12. Is the building Designation Date: of the Base Flood Elevation Z FIRM [] Community Determined datum used for BFE in ltem B9: located in a Coastal Barrier Resources N/A [] (BFE) data or base flood 0 Other/Source: 0NGVD1928 System (CBRS) CBRS Ei OPA depth entered in Item B9: ZN/YVD1g08 Fl Other/Source: area or Otherwise Protected Area (OPA)? Yes 0 N FEMA Form ��0-3(7M5) Replaces alt previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 _ . fl talIVI I vaLV. PIUVCnILMI 3U, LUIS 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number. City State ZIP Code CLEARWATER Florida 33764 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: B-14 CLEARWATER Vertical X building (with Datum: Building Under Construction* ❑ Finished Construction is complete. BFE), AR, AR/A, AR/AE, AR/A1—A30, AR/AH, AR/AO. in Item A7. In Puerto Rico only, enter meters. 1988 Indicate elevation datum ❑ NGVD 1929 used X 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) 10.50 0 the measurement used. 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) 10.13 © feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) N/A ❑feet ❑meters f) Lowest adjacent (finished) grade next to building (LAG) 10.00 Q feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 10.30 a feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support N/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? X authorized by law to certify elevation information. the data available. I understand that any false 1001. Yes ❑ No ❑ Check here if attachrrnts Certifiers Name License Number DAN H. RIZZUTO 5227 t' j aeofl L : Title LAND SURVEYOR e°°': ' a3 4' Company Name POLARIS ASSOCIATES, INC. ` e F Address 2165 SUNNYDALE BOULEVARD ., --, _T, City State ZIP Code CLEAR R Florida 33765 -, '. 1� Signat Date Telephone Ext. 11-02-2017 (727) 461-6113 A• Copy all • - •es oft i �i a on Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (includin. pe 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 #4552 3. AIR CONDITIONING PADS HAVE NOT BEEN CONSTRUCTED AND WHEN CONSTRUCTED WILL BE ABOVE GRADE 9.0 orm Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 IMPORTANT: In these spaces, copy the corresponding information from Section A. --.. ... .. •..... vvw. t W V .I I wc1 JV, cc I V FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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, Band 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), ❑ above or ❑ below the HAG. ❑ above or ❑ below the HAG. ❑ above or ❑ below the HAG. with the community's this information in Section G. 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 E3. Attached garage (top of slab) is ❑ feet ❑ meters 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 owners 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 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 CERTIFICATE OMB No. 1660-0008 ..4'.... 1'1..4.. •-•.tali auvn Liam. 19wcnILJ 130, GU 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. OMB No. 1660-0008 �..p...cwuv.. vaa. flvvIIuI CI JV, LU (0 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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 Photo One Caption FRONT VIEW (EAST) Clear photo One Photo Two Photo Two Caption RIGHT SIDE (NORTH) Clear Photo Two ............ ...............:. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Con OMB No. 1660-0008 ----- - -- ,nNnauvn vale. uluverrIuer 3U, ZU"Ie 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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) CfearPhirtc� Tri Photo Four Photo Four Caption REAR VIEW (WEST) Clear Photo Four orm 086-0-33 (7/15) Replaces all previous editions. Form Page 6 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 agenUcompany and (3) buildi SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name FDC CLEARWATER PSE, LLC Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 18573 U.S. HIGHWAY 19 NORTH Company NAIL Number. City State ZIP Code CLEARWATER Florida 33764 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) VUE AT BELLEAIR BUILDING 9 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 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°56'28.36"N Long. 82°4341.75'W etc.) RESIDENTIAL Horizontal Datum: insurance. above grade ❑ NAD 1927 adjacent grade N/A a NAD 1983 N/A 2 photographs Number with a crawlspace of crawlspace permanent flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? of the building if the 1A Certificate is being used to obtain flood N/A sq ft or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b or enclosure(s) N/A sq in within 1.0 foot 1.0 foot above adjacent in N/A sq ft ❑ Yes 0 No garage: garage openings in the attached garage within in A9.b N/A sq ❑ Yes K No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number CITY OF CLEARWATER 125096 B2. County Name PINELLAS B3. State Florida B4. Map/Panel Number 12103C0128 B5. Suffix G B6. FIRM Index Date 09-18-2009 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) 9 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 ❑ NGVD System CBRS or base flood ❑ Other/Source: depth entered in Item B9: X FIRM datum used located in a N/A 1929 © NAVD 1988 • Other/Source: (CBRS) area or Otherwise Protected ❑ OPA Area (OPA)? ❑ Yes X No • FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 "REVISED" PLANS RECEIVED BY: T.V. JAN 05 2018 PLANNING & DEVELOPMENT CITY OF CLEARWATER 2641 FLOURNOY CIR BCP2016-07642E ce, RTC VUE AT BELLEAIR Zoning: Commercial Atlas #: 318A ELEVATION CERTIFICATE OMB No. 1660-0008 .-..rn ouvn ,am. u'Iuv lllucl Jv, LO I0 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* *A new Elevation Certificate will be required when construction of the C2. Elevations — Zones A1—A30, AE, AH, A (with BFE), VE, V1 V30, V Complete Items C2.a—h below according to the building diagram specified Benchmark Utilized: B-14 CLEARWATER Vertical X building (with Datum: Building Under Construction* ❑ Finished Construction is complete. BFE), AR, AR/A, AR/AE, AR/A1 A30, AR/AH, AR/AO. in Item A7. In Puerto Rico only, enter meters. 1988 Indicate elevation datum ❑ NGVD 1929 used X 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) 10.60 the measurement used. M 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 or equipment servicing the building (Describe type of equipment and location in Comments) N/A ❑feet ❑meters f) Lowest adjacent (finished) grade next to building (LAG) 9.70 I feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 10.20 X feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support N/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 maybe punishable by fine or imprisonment under 18 U.S. Code, Section Were latitude and longitude in Section A provided by a licensed land surveyor? X authorized by law to certify elevation information. the data available. I understand that any false 1001. Yes ❑ No ❑ Check here if attachments. Certifier's Name License Number DAN H. RIZZUTO 5227 ',`" '- Title LAND SURVEYOR .^��.' Company Name POLARIS ASSOCIATES, INC. r- r. ,�` Address 2165 SUNNYDALE BOULEVARD 1 t `� City State ZIP Code CLEARW , Florida 33765 Signatur ' Date Telephone Ext. 1 /A"11-02-2017 (727) 461-6113 f �N'6 Copy all p- • -. oft s - ertificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. a Comments (including . of equipment and location, per C2(e), if applicable) 1. SURVEY MAP AND - EPORT 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 #4552 3. AIR CONDITIONING PADS HAVE NOT BEEN CONSTRUCTED AND WHEN CONSTRUCTED WILL BE ABOVE GRADE 9.0 orm 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 • A Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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, Band C. For Items E1—E4, use natural grade, if available. Check the measurement enter meters. El. 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), ❑ above or ❑ below the HAG. ❑ above or ❑ below the HAG. ❑ above or ❑ below the HAG. with the community's this information in Section G. 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 E3. Attached garage (top of slab) is ❑ feet ❑ meters 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 owners 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 or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments. A Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 mirUN 1 ANT: 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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 Photo One Caption FRONT VIEW (EAST) Clear Photo One Photo Two Photo Two Caption RIGHT SIDE (NORTH) Clear Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page 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, 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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) etguy Photo Three Photo Four Photo Four Caption REAR VIEW (WEST) Clear Photo Four FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 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. Copy all pages of this Elevation Certificate and all attachments fc OMB No. 1660-0008 Expiration Date: November 30, 2018 Id (3) building owner. SECTION A — PROPERTY INFOF p C) RECEIVED LJ 1 T.V. AA��, y� 1� JAN 0 5 2010 PLANNING & DEVELOPMENT CITY OF CLEARWATER 3E COMPANY USE Al. Building Owners Name FDC CLEARWATER PSE, LLC A2. Building Street Address (including Apt., Unit, Suite, and/i Box No. 18573 U.S. HIGHWAY 19 NORTH Number: City CLEARWATER A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) VUE AT BELLEAIR BUILDING 8 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 c) Total net area d) Engineered A9. For a building a) Square footage b) Number of c) Total net area d) Engineered Residential, Non -Residential, Addition, Accessory, Lat. 27°56'28.16"N Long. 82°43'40.34'W etc.) RESIDENTIAL Horizontal Datum: ❑ NAD 1927 insurance. above adjacent grade grade N/A i2 NAD 1983 N/A 2 photographs Number with a crawlspace of crawlspace permanent flood of flood openings flood openings? with an attached of attached permanent flood of flood openings flood openings? of the building if the 1A Certificate is being used to obtain flood N/A sq ft or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b or enclosure(s) N/A sq in within 1.0 foot 1.0 foot above adjacent in No N/A sq ft ❑ Yes X garage: garage openings in the attached garage within in A9.b N/A sq ❑ Yes a No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number CITY OF CLEARWATER 125096 B2. County Name PINELLAS B3. State Florida B4. Map/Panel Number 12103C0128 B5. Suffix G B6. FIRM Index Date 09-18-2009 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) 9 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 ❑ NGVD System CBRS or base flood ❑ Other/Source: depth entered in Item B9: X FIRM datum used located in a N/A ❑ Other/Source: 1929 X NAVD 1988 (CBRS) area or Otherwise ❑ OPA Protected Area (OPA)? ❑ Yes a No orm Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 • 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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 A1 -A30, AE, AH, A (with BFE), VE, V1 V30, V Complete Items C2.a-h below according to the building diagram specified Benchmark Utilized: B-14 CLEARWATER Vertical X building (with Datum: Building Under Construction* ❑ Finished Construction is complete. BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO. in Item A7. In Puerto Rico only, enter meters. 1988 Indicate elevation datum ❑ NGVD 1929 used X 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) 10.50 M the measurement used. 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) 10.15 M feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) N/A ❑ feet ❑ meters f) Lowest adjacent (finished) grade next to building (LAG) 9.90 X feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 10.30 X feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support N/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? © authorized by law to certify elevation information. the data available. I understand that any fal e 1001. Yes ❑ No Check here `r1`trents. Certifier's Name License Number DAN H. RIZZUTO 5227 " ' 'r r.; - t f f '. Title LAND SURVEYOR b °� ,°§ ° r °* . �`�t' `4 ` j:•C Company Name POLARIS ASSOCIATES, INC.; .d k.,° e. 4, Addressc� 2165 SUNNYDALE BOULEVARD h ? �' `a �° City State ZIP Code CLEAR Florida 33765 , `-' ? `� Signat i, 4 Date Telephone Ext. r` A 11-02-2017 (727) 461-6113 Copy a • -ges o th - hl -vation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (includi 1. SURVEY MAP AND RAISED SEAL OF REPORTS BY OTHER 2. POLARIS JOB #4552 3. AIR CONDITIONING • pe of equipment and location, per C2(e), if applicable) REPORT OR THE COPIES THEREOF ARE NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL A FLORIDA LICENSED SURVEYOR AND MAPPER. ADDITIONS OR DELETIONS TO SURVEY MAPS OR THAN THE SIGNING PARTY OR PARTIES IS PROHIBITED. PADS HAVE NOT BEEN CONSTRUCTED AND WHEN CONSTRUCTED WILL BE ABOVE GRADE 9.0 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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 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. El. 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. 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. 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 ❑ feetmeters ❑ E3. Attached garage (top of slab) is ❑ feet ❑ meters 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 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 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 CERTIFICATE OMB No. 1660-0008 Expiration Date: 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. OMB No. 1660-0008 1—.y..., .......ye., , ...o I.G. r N V J 1 I IJ 1 30, cU 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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 Photo One Caption FRONT VIEW (EAST) Gear Photo One Photo Two Photo Two Caption RIGHT SIDE (NORTH) Clear Pf>ota two orm - Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page OMB No. 1660-0008 • ".r,1..uv,. vuw. ,.v.CnIL/GI .w, LV IV 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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 Photo Four Caption REAR VIEW (WEST) Clear. to Four orm 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CER1 Important: Follow the instructions Copy all pages of this Elevation Certificate and all attachments for (1) community SECTION A — PROPERTY INFORMATION Al. Building Owner's Name FDC CLEARWATER PSE, LLC A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or F Box No. 18573 U.S. HIGHWAY 19 NORTH City CLEARWATER State Florida A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal VUE AT BELLEAIR BUILDING 11 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc A5. Latitude/Longitude: Lat. 27°56'27.68"N Long. 82°43'46.51'W OMB No. 1660-0008 Expiration Date: November 30, 2018 "REVISED" PLANS RECEIVED BY: um Y— JANS2018 PLANNING & DEVELOPMENT CITY OF CLEARWATER 1515 FLOURNOY LOOP BCP2016-07644E RTC VUE AT BELLEAIRW Zoning: Commercial Atlas #: 318A 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 endosure(s): a) Square footage of crawlspace or endosure(s) N/A sq ft b) Number of permanent flood openings in the crawlspace or endosure(s) within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b N/A sq in d) Engineered flood openings? ❑ Yes © 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 N/A c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes © No ner. SE SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number CITY OF CLEARWATER 125096 B2. County Name PINELLAS B3. State Florida B4. Map/Panel Number 12103C0128 B5. Suffix B6. FIRM Index Date 09-18-2009 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) B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: ❑ FIS Profile El FIRM ❑ 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)? 0 Yes Designation Date: ❑ CBRS ❑ OPA 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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: B-14 CLEARWATER Vertical • (with Datum: Building Under Construction* ❑ Finished Construction building is complete. BFE), AR, AR/A, AR/AE, AR/A1—A30, AR/AH, AR/AO. in Item A7. In Puerto Rico only, enter meters. 1988 Indicate elevation datum ❑ NGVD 1929 used • 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) 10.60 I• the measurement used. 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 or equipment servicing the building (Describe type of equipment and location in Comments) 4.70 ❑feet meters f) Lowest adjacent (finished) grade next to building (LAG) 9.70 • feet p meters g) Highest adjacent (finished) grade next to building (HAG) 10.20 © feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including feet meters structural support N/A ❑ ❑ 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? X authorized by law to certify elevation information. the data available. I understand that any false 1001. Yes ❑ No ❑ Check�)11erd1f attachments. ! Certifiers Name License Number H. RIZZUTO 5227 31 1;4';DAN 1"4 . • • .../e ,,4'-.*, `f• #Ap,I� ;` tags :iv.R :@u',r a r Viz: ra z, ,- 0: ' ' Z .� a•�' �f '�^ �? r�� o •e �: erg?° " '1,' ds<� TiEG\ �..‘� 1yta4t=4Ys Title LAND SURVEYOR Company Name POLARIS ASSOCIATES, INC. Address 2165 SUNNYDALE BOULEVARD City CL TER 1 State ZIP Code Florida 33765 Sig = - Date Telephone Ext. ♦�, 11-02-2017 (727) 461-6113 Cop - •ages of t S le ation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (includ 1. SURVEY MAP RAISED SEAL OF REPORTS BY OTHER 2. POLARIS JOB 3. C2E IS A SUMP 4. AIR CONDITIONING • type of equipment and location, per C2(e), if applicable) AND REPORT OR THE COPIES THEREOF ARE NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL A FLORIDA LICENSED SURVEYOR AND MAPPER. ADDITIONS OR DELETIONS TO SURVEY MAPS OR THAN THE SIGNING PARTY OR PARTIES IS PROHIBITED. #4552 FOR THE ELEVATOR PIT. ELEVATOR PIT ELEV = 4.70 PADS HAVE NOT BEEN CONSTRUCTED AND WHEN CONSTRUCTED WILL BE ABOVE GRADE 9.0 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, 201 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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), ❑ 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. 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 E3. Attached garage (top of slab) is ❑feet ❑meters 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 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 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 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 Company NAIC Number If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 budding 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 Photo One Caption FRONT VIEW (EAST) Photo Two Photo Two Caption RIGHT SIDE (NORTH) P to FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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) ter • Photo Four Photo Four Caption REAR VIEW (WEST) FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICA Important: Follow the instructions on pages 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 FDC CLEARWATER PSE, LLC A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route ai Box No. 18573 U.S. HIGHWAY 19 NORTH City CLEARWATER State Florida A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, VUE AT BELLEAIR BUILDING 2 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESID fOMB No. 1660-0008 I Expiration Date: November 30, 2018 "REVISED" PLANS RECEIVED BY: lip JAN 112018 PLANNING & DEVELOPMENT CITY OF CLEARWATER 2622 FLOURNOY CIR BCP2016-07632E Lks‘v RTC VUE AT BELLEAIR Zoning: Commercial Atlas #: 318A A5. Latitude/Longitude: Lat. 27°56'20.86"N Long. 82°43'43.86'W Horizontal Datum: ❑ 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 endosure(s): a) Square footage of crawlspace or enclosure(s) N/A sq ft b) Number of permanent flood openings in the crawlspace or endosure(s) within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b d) Engineered flood openings? 0 Yes A9. For a building with an attached garage: a) Square footage of attached garage N/A sq in Z No N/A sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes © No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number CITY OF CLEARWATER 125096 62. County Name PINELLAS 63. State Florida B4. Map/Panel Number 12103C0128 B5. Suffix 66. FIRM Index Date 09-18-2009 67. 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) B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: ❑ FIS Profile © FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: p 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)? 0 Yes © No Designation Date: 0 CBRS ❑ OPA FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: N 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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: B-14 CLEARWATER Vertical Ur building (with Datum: Building Under Construction* ❑ Finished Construction is complete. BFE), AR, AR/A, AR/AE, AR/A1—A30, AR/AH, AR/AO. in Item A7. In Puerto Rico only, enter meters. 1988 Indicate elevation datum ❑ NGVD 1929 used Q 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) 10.60 el the measurement used. 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 or equipment servicing the building (Describe type of equipment and location in Comments) 4.72 .1 feet ❑ meters f) Lowest adjacent (finished) grade next to building (LAG) 10.00 Q feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 10.50 0 feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support N/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? a authorized by law to certify elevation information. the data available. I understand that any false 1001. Yes ❑ No ❑ Check here if attachments. Certifier's Name License Number DAN H. RIZZUTO 5227 tts•4.•rf��r y� .� r /r, ` ; t. , °, ;` '` = 4 • / ' f-,. _,-, ,; 4v .: 7 biQ o •^? �, ' ' 47v.: j , .<y1.., :;t' . �®lr9�rot� �'�� Title!q LAND SURVEYOR Company Name POLARIS ASSOCIATES, INC. AddressZ. 2165 SUNNYDALE BOULEVARD City State ZIP CLEARW Florida 33765ode Signatur / Date Telephone Ext. 11-02-2017 (727) 461-6113 / Copy all sof t is ' le : . ertificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including ty • - 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 #4552 3. C2e IS ELEVATOR SUMP ELEVATOR = 4.72 4. AIR CONDITIONING PADS HAVE NOT BEEN CONSTRUCTED AND WHEN CONSTRUCTED WILL BE ABOVE GRADE 9.0 FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: Nov 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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), ❑ 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. 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 E3. Attached garage (top of slab) is ❑ feet • meters E4. Top of platform of machinery and/or equipment servicing the building is ■ feetmeters ❑ 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 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 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 CERTIFICATE OMB No. 1660-0008 Expiration Date: November 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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 ❑ feet ❑ meters Datum G7. This permit has been issued for: • New Construction ❑ Substantial Improvement 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: basement) ❑ meters Datum building site: ■ feet ❑ meters Datum • feet 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 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. OMB No. 1660-0008 Expiration Date: November 30 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 Company NAIC Number If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 budding 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 Photo One Caption FRONT VIEW (EAST) Photo Two Photo Two Caption RIGHT SIDE (NORTH)piTsp:_ FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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) P;.1 Photo Four Photo Four Caption REAR VIEW (WEST) Cott% FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICA Important: Follow the instructions on pages 1 - Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) it SECTION A — PROPERTY INFORMATION Al. Building Owner's Name FDC CLEARWATER PSE, LLC A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route a Box No. 18573 U.S. HIGHWAY 19 NORTH City State CLEARWATER Florida A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Descriptioi VUE AT BELLEAIR BUILDING 10 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESII OMB No. 1660-0008 Expiration Date: November 30, 2018 "REVISED" PLANS RECEIVED BY: e. JAN 62018 T 10 PLANNING & DEVELOPMENT CITY OF CLEARWATER 1523 FLOURNOY CIR BCP2016-07643E RTC VUE AT BELLEAIR Zoning: Commercial Oc6te° Atlas #: 318A A5. Latitude/Longitude: Lat. 27°56'27.04"N Long. 82°43'44.11'W Horizontal Datum: ❑ 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): a) Square footage of crawlspace or enclosure(s) N/A sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b N/A sq in d) Engineered flood openings? 0 Yes El 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 N/A c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes © No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number CITY OF CLEARWATER 125096 B2. County Name PINELLAS B3. State Florida B4. Map/Panel Number 12103C0128 B5. Suffix B6. FIRM Index Date 09-18-2009 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) B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: 0 FIS Profile Z FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: 0 NGVD 1929 ® NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 0 Yes ® No Designation Date: 0 CBRS ❑ OPA 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are ❑ Finished Construction based on: ❑ Construction Drawings* 0 Building Under 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 below according to the budding diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: B-14 CLEARWATER Vertical Datum: 1988 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 Cl 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) 10.60 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) 10.10 Q feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 0 feet ❑ meters (Describe type of equipment and location in Comments) 4.50 f) Lowest adjacent (finished) grade next to building (LAG) 9.70 0 feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 10.20 0 feet ❑ meters h) Lowest adjacent structural support grade at lowest elevation of deck or stairs, including feet meters N/A ❑ ❑ 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 hereltachmerits. Certifier's Name License Number1 11/4rai DAN H. RIZZUTO 5227 �1 :,rr� �..0 Title '' • /`*,fie �`.. `s,';'' dr i' LAND SURVEYOR •.w •-f;. u' ~� Company Name POLARIS ASSOCIATES, INC. '= �: ''i, Address ' mei �J w 2165 SUNNYDALE BOULEVARD }' k a , < �dac° 5.4" I' City State ZIP Code �FJf S -Y t>M•"\�'`�v CLEA A ER Florida 33765 /r,jrrj)4ta`4�Rro® Sign ure Date Telephone Ext. 4 11-02-2017 (727) 461-6113 Cop I p es of t is El; i i. Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3)-buildirig owner. Comments (including ,i• 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 #4552 3. C2e IS ELEVATOR SUMP. ELEVATOR = 4.50 4. AIR CONDITIONING PADS HAVE NOT BEEN CONSTRUCTED AND WHEN CONSTRUCTED WILL BE ABOVE GRADE 9.0 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, 201 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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 ❑ metersabove LOMA or LOMR-F request, used. In Puerto Rico only, the elevation is above or below or ❑ ❑below the HAG. ❑ above or ❑ 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. 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 E3. Attached garage (top of slab) is ❑feet meters 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 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. 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 CERTIFICATE OMB No. 1660-0008 • 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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 ❑ meters Datum building site: ❑ meters Datum ❑ meters Datum • feet 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 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. OMB No. 1660-0008 Expiration Date: 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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 Photo One Caption FRONT VIEW (EAST) p O Photo Two Photo Two Caption RIGHT SIDE (NORTH) �. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Paae OMB No. 1660-0008 • 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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) Photo Four Photo Four Caption REAR VIEW (WEST) FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICA Important: Follow the instructions on pages 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 FDC CLEARWATER PSE, LLC A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route ai Box No. 18573 U.S. HIGHWAY 19 NORTH OMB No. 1660-0008 Exoiration Date: November 30, 2018 "REVISED" PLANS RECEIVED BY1111111111 1. TA�vJ JAN IN2018 PLANNING & DEVELOPMENT CITY OF CLEARWATER City State 1551 FLOURNOY C!R CLEARWATER Florida BCP2016-07629E 00110 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description RTC VUE AT BELLEAIR BUILDING 1 VUE AT BELLEAIR Zoning: Commercial Atlas #: 318A A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) REST A5. Latitude/Longitude: Lat. 27°56'24.47"N Long. 82°43'42.79"W Horizontal Datum: ❑ 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): a) Square footage of crawlspace or enclosure(s) N/A sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b N/A sq in d) Engineered flood openings? El Yes © 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 N/A c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? 0 Yes ® No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number CITY OF CLEARWATER 125096 B2. County Name PINELLAS B3. State Florida B4. Map/Panel Number 12103C0128 B5. Suffix B6. FIRM Index Date 09-18-2009 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) B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: ❑ FIS Profile Z FIRM ❑ 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 © No Designation Date: 0 CBRS ❑ OPA 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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: B-14 CLEARWATER Vertical 0 building (with Datum: Building Under Construction* ❑ Finished Construction is complete. BFE), AR, AR/A, AR/AE, AR/A1 A30, AR/AH, AR/AO. in Item A7. In Puerto Rico only, enter meters. 1988 Indicate elevation datum ❑ NGVD 1929 used X 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) 10.50 Q the measurement used. 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 or equipment servicing the building (Describe type of equipment and location in Comments) 4.56 0 feet ❑ meters f) Lowest adjacent (finished) grade next to building (LAG) 10.00 a feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 10.40 a feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including feet meters structural support N/A ❑ ❑ 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 ,3rsnaaiie `y \)' 0 si'r,, °° } `' °. ° �; a =" ; . •a ' 3 : % •(Y* , HSA _,. :.-4. , % : • ,% 1 • i,/ ,?4. ,� ✓ 's sura t r I r r S e: �eb4` Title' LAND SURVEYOR• Company Name POLARIS ASSOCIATES, INC. Address 2165 SUNNYDALE BOULEVARD City State ZIP Code CLEARW Florida 33765 Signatur Date Telephone Ext. .1 11-02-2017 (727) 461-6113 Copy all p f this Elevati'$ ertificate and aII attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including type oil 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 #4552 3. C2e IS THE ELEVATOR SUMP. ELEVATOR = 4.56 4. AIR CONDITIONING PADS HAVE NOT BEEN CONSTRUCTED AND WHEN CONSTRUCTED WILL BE ABOVE GRADE 9.0 FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: Nov 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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. ❑ above or ❑ below the HAG. ❑ above or ❑ below the HAG. with the community's certify this information in Section G. E3. Attached garage (top of slab) is ❑ feet ■ meters 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 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 or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments. FEMA Fomi 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: Nov 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. OMB No. 1660-0008 Expiration Date: November 30 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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 Photo One Caption FRONT VIEW (EAST) Photo Two Photo Two Caption RIGHT SIDE (NORTH) Cesar Ties FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page 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. 18573 U.S. HIGHWAY 19 NORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 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) Photo Four Photo Four Caption REAR VIEW (WEST) tlhE FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6