1550 FLOURNOY CIRU.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICATE
Important; Follow the instwctions on pages 1-9.
OMB No. 1O0Q-OOO8
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 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.
1550 FLOURNOY CIRCLE
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 POOL PAVILLION
A4. Building Use (e.g.,
A5. Latitude/Longitude:
A6. Attach at least
A7. Building Diagram
AS. 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
Remidentia|, Non -Residential, Addition, Accessory, etc.)
Lat. 27^5624.27^N Long. 82°43'41.72"W
RESIDENTIAL
Horizontal
Datum:
insurance.
[]NAD 1927
adjacent grade
grade N/A
EJNAD 1S83
N64
2 photographs of the building if the
Number 1A
Certificate is being used to obtain flood
N/A nqft
a crawlspace
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 crawispace
in A8.b
or enclosure(s)
N/A sq in
within 1,0 footabove
foot above adjacent
in
0Ye» Z No
garage:
garage N/A sq ft
openings in the attached garage within 1.0
in A9.b N/A sq
0Yeo 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.x8mp/Pmne}
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
0 FIS Profile
B11. Indicate elevation
812. Is the building
Designation
of the Base Flood Elevation
El FIRM 0 Community Determined
datum used for BFE in Item 69:
located in a Coastal Barrier Resources
Date: 0
(BFE) data or base flood
0 Other/Source:
[]mGvm1e29
System (CBRS)
CBRS [D OPA
depth entered in Item B9:
2]wAvm1988 D Other/Source:
area or Otherwise Protected
Area (OPA)? []Yes igiNu
FEMA Form 086-0-3 (7/15)
Replaces all previoueditions.
Form Page 1 of 6
RECEIVED BY: B.V.F.
APR 0 4 71118
PLANNING & DEVELOPMENT
CITY OF CLEARWATER
1550 FLOURNOY CIR POI
BCP2016-07647
00L- ELEV CERT
AT BELLEAIR
Koning:
Atlas #: 318A
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.
1550 FLOURNOY CIRCLE
Policy Number:
City State ZIP Code
CLEARWATER Florida 33764
Company NAIC Number
SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
❑ Finished Construction
AR/A1—A30, AR/AH, AR/A0.
Rico only, enter meters.
Cl. Building elevations are based on: ❑ Construction Drawings* • Building Under Construction*
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations — Zones Al A30, AE, AH, A (with BFE), VE, V1 V30, V (with BFE), AR, AR/A, AR/AE,
Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto
Benchmark Utilized: B-14 CLEARWATER Vertical Datum: 1988
Indicate elevation datum used for the elevations in items a) through h) below.
❑ NGVD 1929 • NAVD 1988 ❑ Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 10.09
Check 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) 9.50
• feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 9.70
• 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 authorized by
I certify that the information on this Certificate represents my best efforts to interpret the data available.
statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
law to certify elevation information.
I understand that any false
❑ Check here if attachments.
Were latitude and longitude in Section A provided by a licensed land surveyor? 0 Yes ❑ No
Certifier's Name License Number
DAN H. RIZZUTO 5227
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Title
LAND SURVEYOR
Company Name
POLARIS ASSOCIATES, INC.
Addressc
2165 SUNNYDALE BOULEVARD
City State ZIP Code
CLEA' R Florida 33765
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Sign. - / 1Date Telephone Ext.
If 11-02-2017 (727) 461-6113
Copy •ages bf '� =� vation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building 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
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.
1550 FLOURNOY CIRCLE
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 El -E5. If the Certificate is intended to support a
complete Sections A, B,and C. For Items El -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.
1550 FLOURNOY CIRCLE
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.
1550 FLOURNOY CIRCLE
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 Pfikto r0
Photo Two
Photo Two Caption RIGHT SIDE (NORTH) r T
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.
1550 FLOURNOY CIRCLE
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