1 CAUSEWAY BLVDU.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
OMB No. 1660-0008
Expiration Date: November 30, 2018
Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner.
SECTION A — PROPERTY INFORMATION
FOR INSURANCE COMPANY USE
Al. Building Owner's Name
CITY OF CLEARWATER
Policy Number:
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No.
1 CAUSEWAY BOULEVARD
Company NAIC Number:
City State ZIP Code
CLEARWATER Florida 33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
SUBMERGED LAND LEASE #520010893 CITY PIER; PARCEL ID #08-29-15-00000-230-0300
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°5839.1" N Long. -82°49'51.9"
etc.) NON-RESIDENTIAL
W Horizontal
Datum:
insurance.
above
grade
0 NAD 1927
adjacent grade
0
0 NAD 1983
0
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
5
Certificate is being used to obtain flood
0.00 sq ft
or enclosure(s):
or enclosure(s)
openings in the crawlspace
in A8.b
or enclosure(s)
0.00 sq in
within 1.0 foot
1.0 foot above adjacent
in
1-11_, Yes E No
garage:
garage 0.00 sq ft
openings in the attached garage within
in A9.b 0.00 sq
0 Yes 0 No
SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number
CITY OF CLEARWATER; 125096
82. County Name
PINELLAS
B3. State
Florida
B4. Map/Panel
Number
12103C0102
B5. Suffix
G
86. FIRM Index
Date
08-18-2009
B7. FIRM Panel
Effective/
Revised Date
09-03-2003
B8, Flood
Zone(s)
VE
89. Base Flood E evation(s)
(Zone AO, use Base Flood Depth)
17
B10. Indicate the source
0 FIS Profile
B11. Indicate elevation
B12. Is the building
Designation Date:
of the Base Flood Elevation
0 FIRM 0 Community Determined
datum used for BFE in Item 89:
located in a Coastal Barrier Resources
0
(BFE) data or base flood
depth entered in Item B9:
0 NGVD
System
CBRS
• Other/Source:
1929
(CBRS)
0 OPA
0 NAVD 1988 0 Other/Source:
area or Otherwise Protected
Area (OPA)? 0 Yes ID 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.
1 CAUSEWAY BOULEVARD
Policy Number:
City State ZIP Code
CLEARWATER Florida 33767
Company NAIC Number
SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: 0 Construction Drawings* 0 Building Under Construction' Ef Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations — Zones A1—A30, AE, AH, A (with BFE), VE, V1—V30, V (with BFE), AR, AR/A, AR/AE, AR/A1—A30, AR/AH, AR/AO.
Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: 872 6724 A TIDAL (PID AG7196) Vertical Datum: NAVD 1988 (MARK ELEV = 3.95)
Indicate elevation datum used for the elevations in items a) through h) below.
0 NGVD 1929 0 NAVD 1988 0 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) 13.13 0 feet 0 meters
b) Top of the next higher floor N/A 0 feet 0 meters
c) Bottom of the lowest horizontal structural member (V Zones only) 8.93 JJ feet 0 meters
d) Attached garage (top of slab) N/A 0 feet 0 meters
e) Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment and location in Comments) 13.03 0 feet 0 meters
f) Lowest adjacent (finished) grade next to building (LAG) N/A 0 feet 0 meters
g) Highest adjacent (finished) grade next to building (HAG) N/A 0 feet 0 meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
structural support N/A 0 feet 0 meters
SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false
statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? 0 Yes El No 0 Check here if attachments,
Certifier's Name License Number
Elizabeth Kathleen Merta LS6113
.c.6E ki/y.,/
1'
1
(p,/3
STATE OF
FLORIDA
/
Title
Professional Surveyor & Mapper
Company Name
Deuel & Associates
Address
565 South Hercules Avenue
City State ZIP Code
Clearwater Florida 33764
Date Telephone Ext.
Signature i.v......___
01-15-2018 (727) 822-4151 212
Copy all pag o is levii&grMte and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments (including type of equipment and location, per C2(e), if applicable)
A5: LATITUDE AND LONGITUDE WERE DETERMINED USING GOGGLE EARTH
C2e: ELEVATION SHOWN IS THE BOTTOM OF THE AIR CONDITIONING UNIT SERVICING THE BUILDING.
C2f & C2g: LOWEST AND HIGHEST ADJACENT GRADES ARE SUBMERGED. ELEVATION OF SUBMERGED GRADE ADJACENT
TO BUILDING IS -7.9 FEET.
DATE SHOWN IS THE DATE OF THE FIELD SURVEY.
FEMA Form 086-0-33 (7115)
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.
1 CAUSEWAY BOULEVARD
Policy Number:
City State ZIP Code
CLEARWATER Florida 33767
Company NAIC Number
SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED)
FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zones AO and A (without BFE), complete Items E1—E5. If the Certificate is intended to support a
complete Sections A, 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 0 feet 0 meters
LOMA or LOMR-F request,
used. In Puerto Rico only,
the elevation is above or below
0 above or 0 below the HAG.
b) Top of bottom floor (including basement,
crawlspace, or enclosure) is 0 feet • meters
0 above or • below the LAG.
9 (see pages 1-2 of Instructions),
0 above or 0 below the HAG.
0 above or 0 below the HAG.
0 above or below the HAG.
with the community's
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 0 feet 0 meters
E3. Attached garage (top of slab) is 0 feet 0 meters
E4. Top of platform of machinery and/or equipment
servicing the building is 0 feet 0 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? 0 Yes 0 No 0 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
0 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.
1 CAUSEWAY BOULEVARD
Policy Number:
City State ZIP Code
CLEARWATER Florida 33767
Company NAIC Number
SECTION G — COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement
used in Items G8—G10, In Puerto Rico only, enter meters.
G1. El 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 El 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. 0 The following information (Items G4—G10) is provided for community floodplain management purposes,
04. Permit Number
05. Date Permit Issued
G6. Date Certificate of
Compliance/Occupancy Issued
G7. This permit has been issued for: 0
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 0 Substantial Improvement
basement)
0 feet
0 feet
D feet
D meters Datum
building site:
0 meters Datum
0 meters Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments (inc)uding 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.
1 CAUSEWAY BOULEVARD
Policy Number:
City State ZIP Code
CLEARWATER Florida 33767
Company NAIC Number
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the
instructions for Item A6. Identify all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and
"Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or
vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page.
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Photo Ono
Photo One Caption FRONT VIEW (SOUTH SIDE) - PHOTO TAKEN 1-15-2018 Clear Photo One
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Photo Two
Photo Two Caption REAR VIEW (NORTH SIDE) - PHOTO TAKEN 1-15-2018 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.
1 CAUSEWAY BOULEVARD
Policy Number:
City State ZIP Code
CLEARWATER Florida 33767
Company NAIC Number
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs
with: date taken; "Front View" and "Rear View" and, if required, "Right Side View" and "Left Side View." When applicable,
photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8.
� F
Photo Three
Photo Three Caption LEFT SIDE VIEW (WEST SIDE) - PHOTO TAKEN 1-15-2018 Clear Photo Three
..
II
111 111
1 I I •
-Torn -oc.
Photo Four Caption RIGHT SIDE VIEW (EAST SIDE) - PHOTO TAKEN 1-15-2018 Clear Photo Four
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 6 of 6