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18573 US HWY 19 Ny,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 f this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. r, V 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 MAINTENANCE BUILDING 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°56'22.16"N Long. 82°43'45.60'W RESIDENTIAL Horizontal Datum: insurance. above ❑ NAD 1927 adjacent grade grade N/A • NAD 1983 N/A 2 photographs of the building if the Number 1A Certificate is being used to obtain flood N/A sq ft with 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 © No garage: garage 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 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: F2 FIRM datum used located in a Date: X NAVD 1988 • Other/Source: area or Otherwise Protected Area (OPA)? ❑ Yes • No FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 1564 FLOURNOY CIR MAI BCP2016-076480 ELEVATION CERTIFICATE VUE AT BELLEAIR Zoning: Commercial Atlas #: 318A UpmER CoNSTRcIc i ionl RECEIVED BY: M.J. MAR 262018 PLANNING & DEVELOPMENT riTv r'tiL re cnr Atn-rr7m 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) Cl. 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) 10.11 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) N/A F2 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 Q feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 10.00 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 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? E! authorized the data 1001. Yes • by law to certify elevation information. available. I understand that any false No ❑ Check here if attachments. Certifiers Name License Number DAN H. RIZZUTO 5227 4 �1a�� ' Q atl I, �: Qe°° `4 T _ ' ' " . < ° a, ;°1, `. ��i44"� 0'eJ PIG\ n rs� 4 y :�,, � j # 47; tn . " , f vs � " °�4 Title LAND SURVEYOR Company Name POLARIS ASSOCIATES, INC. Address 2165 SUNNYDALE BOULEVARD City State ZIP Code CLEARWAT Florida 33765 Signatur Date Telephone Ext. i 01-22-2018 (727) 461-6113 Copy a ges of this I i ,on Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including 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. NO VISIBLE OR ACCESSIBLE EQUIPMENT. orm 086-0-33 (7/15) 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. 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, 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. crawlspace, or enclosure) is • feet ❑ meters 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 • 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. GI. ❑ 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 • 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)tc0 Photo Two Photo Two Caption RIGHT SIDE (NORTH) DoT orm Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Pape 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) u,r rc 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 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 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 MAINTENANCE BUILDING A4. Building Use (e.g., A5. Latitude/Longitude: A6. Attach at least A7. Building Diagram A8. For a building a) Square footage b) Number of permanent c) Total net area d) Engineered A9. For a building with a) Square footage b) Number of permanent c) Total net area d) Engineered Residential, Non -Residential, Addition, Accessory, Lat. 27°56'22.16"N Long. 82°43'45.60'W etc.) RESIDENTIAL Horizontal Datum: insurance. above grade ❑ NAD 1927 adjacent grade N/A rd 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 N/A sq ft ❑ Yes X No garage: garage openings in the attached garage within 1.0 in A9.b N/A sq ❑ Yes M No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Bl. 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: FrA FIRM datum used located in a 1929 X NAVD 1988 ■ Other/Source: Protected (CBRS) area or Otherwise ❑ OPA Area (OPA)? ❑ Yes rj. No FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 iration 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 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 a building (with Datum: Building Under Construction* ❑ Finished Construction is complete. BFE), AR, AR/A, ARAE, AR/A1 A30, AR/AH, AR/AO. in Item A7. In Puerto Rico only, enter meters. 1988 Indicate elevation datum ❑ 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) 10.11 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 X 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 © feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 10.00 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? 0 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 ��s�� �,A SC . 'as eat* •� • '. .e` . ,w ,- u ` ; �a ' a ©.3 •;?r -� v•;�~ c i, !An, ., ti Title LAND SURVEYOR Company Name POLARIS ASSOCIATES, INC. Address 2165 SUNNYDALE BOULEVARD City State ZIP Code CLEARW ' R Florida 33765 Signatur_ I ) Date Telephone Ext. 1-4` 01-22-2018 (727) 461-6113 Copy all .• : • : _ a thi on Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building. owner. -- Comments (including of equipment and location, per C2(e), if applicable) PP ) 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. NO VISIBLE OR ACCESSIBLE EQUIPMENT. FEMA Form 086-0-33 (7/15) 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. 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 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 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 Owners 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 ❑ 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 • 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) aroto Photo Two Photo Two Caption RIGHT SIDE (NORTH) orm 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) Wi1'h' Photo Four Photo Four Caption REAR VIEW (WEST) r t Fo orm UtiEi-u- 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 for (1 OMB No. 1660-0008 Expiration Date: November 30, 2018 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 MAINTENANCE BUILDING 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°5622.16"N Long. 82°43'45.60"W etc.) RESIDENTIAL • Horizontal Datum: insurance. above grade ❑ NAD 1927 adjacent grade N/A i 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 encosure(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 0 garage: garage openings in the attached garage within 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 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: M FIRM datum used located in a ❑ Other/Source: Protected 1929 X NAVD 1988 (CBRS) area or Otherwise ❑ OPA Area (OPA)? ❑ Yes M No orm Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 rrcNuauun UdLe: iovempersu, ZUld 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 Q 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 tndicate 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) 10.11 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 X feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building N/A (Describe type of equipment and location in Comments) X 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) 10.00 Q 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? 0 authorized by law to certify elevation information. the data available. I understand that any false 1001. Yes ❑ No ❑ Check herd t tte4ments. .y, `'' Certifier's Name License Number DAN H. RIZZUTO 5227 �° .? °; �. `�' C°° °' 4 t, "" f Title LAND SURVEYOR "+ - z', r, r . �' r Company Name POLARIS ASSOCIATES, INC. �1, = 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 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. 0 above or 0 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 0 below the HAG. with the community's certify this information in Section G. b) Top of bottom floor (including basement, crawlspace, or enclosure) is 0 feet 0 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 0 feet D 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 [J feet D 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 1:1 Unknown. The local official must 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 0 Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE OMB No1600-0008 Expiration Date: November 30,201V IMPORTANT: In these spacescopy the corresponding information from Section A. FOR JNSURANCE 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 NACNumber SECTION G — COMMUNITY INFORMATION (OPTIONL) 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. 01. 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 b&ow.) G2. n A community official completed Section E for a budding located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. 03. D The following information (Items G4—G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certifiof Compliance/Occupancy Issued 07. This permit has been issued for: GO. Eevation of as -built lowestfloor (including Gg. BFE or (in Zone AO) depth of flooding at the Gb. Community's design flood elevation: New Construction D Substantial Improvoment basement) [��� �� 0 feet 0feet [l metersDatumof�hobuiid�ng� ^~ building sito: 0 meters Datum []meters Datum Local Official's Name Title h Community Telephone ep onm Signature Date Comments (including type of equipment and Iocation, per C2(e), if applicable) Fl Check here if attachments. FEMA Form O��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 FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 FOR INSURANCE COMPANY USE IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 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) 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 NAC 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 •4:,: ,''' '--- 6.:' - — Photo Four Caption REAR VIEW (WEST):.0 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 OMB No. 1660-0008 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 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 GARAGE (BY BUILDING 4) 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°5624.32"N Long. 82°43'39.99'W RESIDENTIAL Horizontal Datum: insurance. above ❑ NAD 1927 adjacent grade grade N/A Q. NAD 1983 N/A 2 photographs Number with a crawispace of crawispace 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 crawispace in A8.b or enclosures) 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 • 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 69. Base Flood E evation(s) (Zone AO, use Base Flood Depth) 9 610. 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: depth entered in Item B9: X FIRM datum used located in a Date: ❑ Other/Source: Protected • NGVD 1929 X NAVD 1988 System (CBRS) area or Otherwise CBRS ❑ OPA Area (OPA)? ❑ Yes • No FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 2625 FLOURNOY CIR GA BCP2016-07655C ELEVATION CERTIFICATE VUEAT BELLEAIR Zoning: Commercial Atlas #: 318A RECEIVED BY: M i MAR 262018 PLANNING & DEVELOP,;1_, CITY OF CLEA WA i L:: ELEVATION CERTIFICATE OMB No. 1660-0008 .-nrnauvn VaL. 1,1%11101 HUG, JV, LV 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 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 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) 10.41 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 0 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) 10.08 0 feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 10.00 Q 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 attachments. Certifier's Name License Number DAN H. RIZZUTO 5227`- '• -err, /, _ � r «.✓ Title LAND SURVEYOR . to r , l A. L -4 ay o^i... ',,' rtet s, Company Name . =c n cao� ay moi c �^ t� xm • .. Address 2165 SUNNYDALE BOULEVARD .may r $ , rt;_ r'/"g>�+ti CityState ZIP Code CLEARJo Florida 33765 ,� k?ret l'i `�gt�` /SES >� g y s ^";4 SignatuDate Telephone Ext. 01-22-2018 (727) 461-6113 Copy all o his -v. I-rtificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including typ_C• 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. NO VISIBLE OR ACCESSIBLE EQUIPMENT. Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 • v.r..auve I vaac. I UVOIuUci JV, LV 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 El—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, 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 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 ❑ 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 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. A 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. 01. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2 ❑ A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. G3. ❑ The following information (Items G4 -G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ G8. Elevation of as -built lowest floor (including of the building: G9. BFE or (in Zone AO) depth of flooding at the G10. Community's design flood elevation: New Construction ❑ Substantial Improvement basement) ❑ feet ❑ feet ❑ feet ❑ meters Datum building site: ❑ meters Datum ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. orm 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 ' ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. OMB No. 1660-0008 • 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) atwie • 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 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 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) lbµ 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 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/ SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name FDC CLEARWATER PSE, LLC Policy Number: A2. Budding 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 GARAGE (BY BUILDING 4) 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°56'24.32"N Long. 82'43'39.99'W etc.) RESIDENTIAL Horizontal Datum: insurance. above grade ❑ NAD 1927 adjacent grade N/A 0 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 encosure(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 M garage: garage openings in the attached garage within 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 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: © FIRM datum used located in a ❑ Other/Source: Protected 1929 1 NAVD 1988 (CBRS) area or Otherwise ❑ OPA Area (OPA)? ❑ Yes 0 No orm 086-0-33 (7/15) 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) 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, crawlspace, or enclosure floor) 10.41 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) N/A Q feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) N/A i feet ❑ meters f) Lowest adjacent (finished) grade next to building (LAG) 10.08 Q feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 10.00 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? . 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 t f t A Title LAND SURVEYOR� -, ' . , � '•.;e ��' Company Name, POLARIS ASSOCIATES, INC. :; ' " „ . :'u( y Address 2165 SUNNYDALE BOULEVARD f ' '4 Q; r .x" ci . ra -� � %`�' 0. e�a City CLEARWAT- * State ZIP Code Florida 33765 . f =.e°""�� Signature--= asp' // Date Telephone4Ext. ��i 01-22-2018 (727) 461-6113 Copy all p- . - : of this e .� ertificate and all attachments for(1)communityofficial,(2)insurance agent/company, andowner. �(3) building Comments (including typ . 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. NO VISIBLE OR ACCESSIBLE EQUIPMENT. 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. 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, 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 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 ❑ 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 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. A 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 ❑ feet ❑ meters Datum building site: ❑ meters Datum ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) Check here if attachments. orm 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. OMB No. 1660-0008 Expiration Date: November 30. 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 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) i ltt910,0ae Photo Two Photo Two Caption RIGHT SIDE (NORTH) j{q FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Pa 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) iwu�c 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. 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/compan and (3) buildi SECTION A — PROPERTY INFORMATION y, IIy vvrucl. FOR INSURANCE COMPANY USE Al. Building Owner's Name FDC CLEARWATER PSE, LLC Policy Number: A2. Budding 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 GARAGE (BY BUILDING 4) 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°56'24.32"N Long. 82°43'39.99'W etc.) RESIDENTIAL Horizontal Datum: insurance. above grade ❑ NAD 1927 adjacent grade N/A 0 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 F3 No garage: garage openings in the attached garage within in A9.b N/A sq ❑ Yes 0 No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. 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 89: 0 FIRM datum used located in a ❑ Other/Source: Protected 1929 0 NAVD 1988 (CBRS) area or Otherwise ❑ OPA Area (OPA)? ❑ Yes 0 No orm 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 • ELEVATION CERTIFICATE OMB No. 1660-0008 • ._..y+„cawII vaic. Iwvvn nice .w, LU 10 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 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, 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, crawlspace, or enclosure floor) 10.41 a 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 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) 10.08 a feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 10.00 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 false 1001. Yes ❑ No ❑ Check here if attachments. Certifier's Name License Number DAN H. RIZZUTO 5227 ties ?33J r feii rd, ese Title LAND SURVEYOR . 'mr rf y,1s --'� " `, -' y� jam® Company Name POLARIS ASSOCIATES, INC. ' . : U A t; 7. ,W t. • Vii•`, Address 2165 SUNNYDALE BOULEVARD :. '. �` cl: °e .-'1 City CLEAR FATE State ZIP Code Florida 33765 ar,=y"6 ,+ ,' a Signat re t Date Telephone Ext. 01-22-2018 (727) 461-6113 Copy all pages of t s : tion Certificate and alt attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including 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. NO VISIBLE OR ACCESSIBLE EQUIPMENT. orm 086-0-33 (7/15) 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. 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, 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. crawlspace, or enclosure) is ❑ feet ■ meters 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 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 • 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. 01. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who isauthorized 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) tes ahotu Otte Photo Two Photo Two Caption RIGHT SIDE (NORTH) r p FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuati OMB No. 1660-0008 • -.+- ._..r.....uvn .+aw. iwvcuI✓cI vv, cv 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) Cirlicst�rT� Photo Four Photo Four Caption REAR VIEW (WEST) tq 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 OMB No. 1660-0008 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 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 GARAGE (BY BUILDING 10) 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°56'28.47"N Long. 82°43'44.05'W RESIDENTIAL Horizontal Datum: insurance. above ❑ NAD 1927 adjacent grade grade N/A ej 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 endosure(s): or endosure(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 0 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 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: M FIRM datum used located in a ❑ Other/Source: Protected 1929 Q NAVD 1988 (CBRS) area or Otherwise ❑ OPA Area (OPA)? U Yes X No FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 1541 FLOURNOY CIR GAI BCP2016-07653C ELEVATION CERTIFICATE VUE AT BELLEAIR Zoning: Commercial Atlas #: 318A RECEIVED BY: M.J. MAR 2 6 2018 PLANNING & DEVELOPMENT CITY OF CLEA '..TATER 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) ❑ Finished Construction AR/A1—A30, AR/AH, AR/AO. Rico only, enter meters. Cl. Building elevations are based on: ❑ Construction Drawings* a 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, 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 X 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) 10.40 Check the measurement used. a 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 a feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) A N/feet ❑ meters f) Lowest adjacent (finished) grade next to building (LAG) 10.06 Xj feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 10.20 a feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, induding 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 maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001. law to certify elevation information. / understand that any false ❑ Check here if attachments. Were latitude and longitude in Section A provided by a licensed land surveyor? X Yes ❑ No Certifier's Name License Number DAN H. RIZZUTO 5227 y4a3d/s,{ 11 /�` eo e*�! o *� - � ' < e ' c : � ./ t` I ta s. k," *' : , r : Lt v s .. . ;7 •"'" .eaa e ,' ts.°�r o" �x` �� Title LAND SURVEYOR Company Name POLARIS ASSOCIATES, INC. F F.. Address 2165 SUNNYDALE BOULEVARD City State ZIP Code CLEA- • 'TER Florida 33765 Sign • - Date Telephone Ext. I / . I 01-05-2018 (727) 461-6113 Copy . •ages • . evation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (incl = g type of equipment and location, per C2(e), if applicable) 1. SURVEY MAP AND REPORT OR THE COPIES THEREOF ARE NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. ADDITIONS OR DELETIONS TO SURVEY MAPS OR REPORTS BY OTHER THAN THE SIGNING PARTY OR PARTIES IS PROHIBITED. 2. POLARIS JOB #4552 3. NO VISIBLE OR ACCESSIBLE EQUIPMENT. 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, 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, 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. crawlspace, or enclosure) isfeet • meters ❑❑above 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 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) arPb s One, Photo Two Photo Two Caption RIGHT SIDE (NORTH) beta 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) €PiiQ tepee Photo Four Photo Four Caption REAR VIEW (WEST) c ,,Itbto lout 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 OMB No. 1660-0008 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 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 GARAGE (BY BUILDING 10) 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°56'28.47"N Long. 82°43'44.05'W RESIDENTIAL Horizontal Datum: insurance. above ❑ NAD 1927 adjacent grade grade N/A 0 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 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: depth entered in Item B9: 0 FIRM datum used located in a Date: • NGVD 1929 0 NAVD 1988 • Other/Source: System (CBRS) area or Otherwise Protected CBRS ❑ OPA Area (OPA)? ❑ Yes Q 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) Cl. Building elevations *A new Elevation C2. Elevations — Zones Complete Items Benchmark Utilized: Indicate elevation ❑ NGVD Datum used for a) Top of bottom b) Top of the next c) Bottom of the d) Attached garage e) Lowest elevation (Describe type f) Lowest adjacent g) Highest adjacent h) Lowest adjacent structural support ❑ Finished Construction AR/A1—A30, AR/AH, AR/A0. Rico only, enter meters. are based on: ❑ Construction Drawings* X Building Under Construction* Certificate 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, ARAE, C2.a—h below according to the building diagram specified in Item A7. In Puerto B-14 CLEARWATER Vertical Datum: 1988 datum used for the elevations in items a) through h) below. 1929 X NAVD 1988 ❑ Other/Source: building elevations must be the same as that used for the BFE. floor (including basement, crawlspace, or enclosure floor) 10.40 Check the measurement used. feet ❑ meters feet ❑ meters feet ❑ meters feet ❑ meters feet ❑ meters feet ❑ meters feet ❑ meters feet ❑ meters 0 higher floor N/A ❑ lowest horizontal structural member (V Zones only) N/A ❑ (top of slab) N/A X of machinery or equipment servicing the building of equipment and location in Comments) N/A 0 (finished) grade next to building (LAG) 10.06 Q (finished) grade next to building (HAG) 10.20 a grade at lowest elevation of deck or stairs, including N/A ❑ SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to I certify that the information statement maybe punishable Were latitude and longitude be 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. I understand that any false ❑ Check here if attachments. in Section A provided by a licensed land surveyor? E! Yes ❑ No Certifiers Name License Number DAN H. RIZZUTO 5227 , f, �• . u �` % v, .7 B ¢ S"4t } ' ' , po ca .,: 7.: ; r te•`` ✓J 44 ;; A .;, a fi } t. s 9 Title LAND SURVEYOR Company Name'- POLARIS ASSOCIATES, INC. q Address 2165 SUNNYDALE BOULEVARD City State ZIP Code CLEAR ER Florida 33765 Signat - / Date Telephone Ext. 01-05-2018 (727) 461-6113 Copy all . _ges of hi ation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (includin• 1. SURVEY MAP AND RAISED SEAL OF A REPORTS BY OTHER 2. POLARIS JOB #4552 3. NO VISIBLE OR type of equipment and location, per C2(e), if applicable) REPORT OR THE COPIES THEREOF ARE NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL FLORIDA LICENSED SURVEYOR AND MAPPER. ADDITIONS OR DELETIONS TO SURVEY MAPS OR THAN THE SIGNING PARTY OR PARTIES IS PROHIBITED. ACCESSIBLE EQUIPMENT. 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) 0 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) • • Photo Two Photo Two Caption RIGHT SIDE (NORTH) toTwo 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) r6fE►+e Photo Four Photo Four Caption REAR VIEW (WEST) bfo l=ain_. 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 OMB No. 1660-0008 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 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 GARAGE (BY BUILDING 10) 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°56'28.47"N Long. 82'43'44.05'W RESIDENTIAL Horizontal Datum: insurance. above ❑ NAD 1927 adjacent grade grade N/A M 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 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 812. 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 ❑ Other/Source: Protected 1929 0 NAVD 1988 (CBRS) area or Otherwise ❑ OPA Area (OPA)? ❑ Yes M 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) 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) 10.40 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) N/A X feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) N/A Q feet ❑ meters f) Lowest adjacent (finished) grade next to building (LAG) 10.06 Q 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 thatthe 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? 0 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 �y& e , •//,�f A,O, i. tr Company Name POLARIS ASSOCIATES, INC. • �`: , r+`or""°°� ; i?; , s.'. f Address;;AP 2165 SUNNYDALE BOULEVARD y-,rs 4' City State ZIP CodeJt2.. CLEARW Florida 33765 • • 4 °tip Signatu/, / Date Telephone Ext. �� ' x' 01-05-2018 (727) 461-6113 Copy a ..ges of thisi'n Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (includinge of equipment and location,per C2 a if applicable) O. PP ) 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. NO VISIBLE OR ACCESSIBLE EQUIPMENT. 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 • 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 floodpjain 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 • 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) F a�tioto fie._ _.� ... �> Photo Two Photo Two Caption RIGHT SIDE (NORTH) orm 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Pa 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) rE�iS©tiT11r�, Photo Four Photo Four Caption REAR VIEW (WEST) t?r 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 Nationai'Flood Insurance Program ELEVATION CERTIFICATE OMB No. 1660-0008 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 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 CAR WASH 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°56'22.81"N Long. 82°43'45.60'W etc.) RESIDENTIAL Horizontal Datum: insurance. above grade ❑ NAD 1927 adjacent grade N/A 0 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 encosure(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 0 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 88. 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: 0 FIRM datum used located in a ❑ Other/Source: Protected 1929 0 NAVD 1988 (CBRS) area or Otherwise ❑ OPA Area (OPA)? ❑ Yes Q No orm 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 1560 FLOURNOY CIR BCP2016-07651C ELEVATION CERTIFICATE VUE AT BELLEAIR Zoning: Commercial Atlas #: 318A RECEIVED BY: M.J. MAR 2 6 2018 PLANNING & DEVELOPMENT CITY OF CLEARWATER 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) Cl. 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 a building (with Datum: Building Under Construction* ❑ Finished Construction is complete. BFE), AR, AR/A, ARAE, AR/A1—A30, AR/AH, AR/AO. in Item A7. In Puerto Rico only, enter meters. 1988 Indicate elevation datum ❑ 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, crawispace, or enclosure floor) 10.02 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 a feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) N/A a feet ❑ meters f) Lowest adjacent (finished) grade next to building (LAG) 9.90 a feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 10.00 b 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. / understand that any false 1001. Yes ❑ No ❑ Check here if attachments. Certifier's Name License Number DAN H. RIZZUTO 5227 t �, \41 4,0 Y �•e ' •�' ' •' :: - q� 4M', '' • ,' ; 0 . . ' . : n G�? Title LAND SURVEYOR Company Name POLARIS ASSOCIATES, INC. Addresso 2165 SUNNYDALE BOULEVARD City State ZIP Code CLEARW, R Florida 33765 Signatur /Date Telephone Ext. 11-06-2017 (727)461-6113 Copy all ' a• _ :!• t ^ ' . • n 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 AN ' 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. NO VISIBLE OR ACCESSIBLE EQUIPMENT. 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 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 this information in Section G. b) Top of bottom floor (including basement, crawispace, 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 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. orm Replaces all previous editions. Form Page 4 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A OMB No. 1660-0008 • ...nfr"auvn valc. IvlJVCI IIUCI JV, GU 16 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)tonne Photo Two Photo Two Caption RIGHT SIDE (NORTH) mar Rlret0 Twoo --- eplaces all previous editions. Form Page 5 of 6 'ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Contin OMB No. 1660-0008 -.,- �..F.uauvn vaLa. ivvvcnwcJ OU, 2010 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) 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 for (1) communi OMB No. 1660-0008 Expiration Date: November 30, 2018 SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name FDC CLEARWATER PSE, LLC Policy Number: A2. Budding 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 CAR WASH 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°56'22.81"N Long. 82°4345.60'W etc.) RESIDENTIAL Horizontal Datum: insurance. above grade ❑ NAD 1927 adjacent grade N/A Q. 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 No N/A sq ft ❑ Yes a garage: garage openings in the attached garage within 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 Date: of the Base Flood Elevation ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ (BFE) data or base flood depth entered in Item B9: • FIRM ❑ NGVD System CBRS • Other/Source: datum used located in a ❑ Other/Source: Protected 1929 • NAVD 1988 (CBRS) area or Otherwise ❑ OPA Area (OPA)? ❑ Yes • No orm Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 • •s1+.1a1.1vll vaLc. IYVVCI I1U01 0U, ZV 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 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 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 a 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 © 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) 10.02 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) N/A a feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments)N/A iTA 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) 10.00 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 1 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 attachments. Certifier's Name License Number DAN H.RIZZUTO 5227 ,' � (' ° �'� ,. 000......1..k.., ,"� ^ � ; b Title LAND SURVEYOR ham . ." L - ••', .. . Company Name POLARIS ASSOCIATES, INC. , . , /; i -. " g � ':, "=� y -'%' ` ` Address 2165 SUNNYDALE BOULEVARD * Q_ 'Li we ; �'" d 3„ �q � ����4 City State ZIP Code CLEARWAT : Florida 33765 1 ', 4 a Signatur: Date Telephone Ext. r 1, 11-06-2017 (727) 461-6113 Copy all p- •es of this : -- 'on Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including "•e 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. NO VISIBLE OR ACCESSIBLE EQUIPMENT. orm Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 • - �,ANnauvn vaw. 1,40ve111UC1 0U, N 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 FOR ZONE AO AND ZONE A (WITHOUT BFE) REQUIRED) 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 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 OWNERS 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 CERTIFICATE OMB No. 1OGV'OOOB Expiration Date: November 30, 2018 ' IMPORTANT: In these spacescopy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building StreeAddress (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 CLEARVVATER Florida 33764 Company NAIC Number SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administethe commufloodplain 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. 01. El The information inSo�ionCwas taken hnm�herdocume�aUnnthat has been �gnodand sealed byelicensed uumeyur � 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. Cl A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BEE) or Zone AO. G3. 0 Thohdlovinginfonnadon(KemeG4—G10iapnzvdadhoroommundy8uodplainmanogementpurpnodu. 04. Permit Number 05. Date Permit Issued G8. Date Certificate of Compliance/Occupancy Issued G7. This permit has been issued for: El 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 El Substantial Improvement basement) [7 feet 0 feet F7feet 0meters Datum building site: 0 meters Datum 0 meters Datum Local Official's Name Title 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) Photo Two Photo Two Caption RIGHT SIDE (NORTH) FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 'ELEVATIONCERTIFICATE 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 ' r0•••,-,05,,,---,,,----q- - Photo Three Caption REAR VIEW (WEST) '•,..,;,,,,,, „<0,05.1,,,,,,,.,-.., - Photo Four Photo Four Caption REAR VIEW (WEST) FEMA Form 086-0-33 (7115) Replaces all previous editions. Form Page 6 of 6 . U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency Nationar Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. Copy all pages of this Elevation Certificate and all attachments for. 1• comm OMB No. 1660-0008 Expiration Date: November 30, 2018 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 CAR WASH 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°56'22.81"N Long. 82°43'45.60'W etc.) RESIDENTIAL Horizontal Datum: insurance. above grade ❑ NAD 1927 adjacent grade N/A X 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 endosure(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 M garage: garage openings in the attached garage within 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 88. 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: a FIRM datum used located in a ❑ Other/Source: Protected 1929 X NAVD 1988 (CBRS) area or Otherwise ❑ OPA Area (OPA)? ❑ Yes a No orm Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 • �nrn auvn vatC. IYUVtlIIIUCI 0V, LV 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 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 © 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) 10.02 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 X 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 © feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 10.00 I 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 attachments. Certifier's Name License Number DAN H. RIZZUTO 5227 t.N., 4 ': Title LAND SURVEYOR n .• ...,,,, '� t iia Company Name POLARIS ASSOCIATES, INC. 4 � 4 jF c, a 0 ":.":",x- 4 Address 2165 SUNNYDALE BOULEVARD'. ta "~`� C' C ' City CLEARWATER State ZIP Code Florida 33765 / it i '? Zli 't „, � � pfli^ *° Signature Date Telephone Ext. 11-06-2017 (727) 461-6113 OP I '4 Copy all pag lev-ti• cate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. 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. NO VISIBLE OR ACCESSIBLE EQUIPMENT. Replaces all previous editions. Form Page 2 of 6 'ELEVATION OMB No. 1060-0008 Expiration Date: November 30,2U1M MPORTANT: In these spa s, copy the corresponding information from Section A.F�|N���CEC�P��E ' 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 CLEARWATER Florida 33764 Company NAIC Number SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones A0 and A BFE), comlete IteE1—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 boxeotoohmwwhetherthee|evationiuobovaorUclmw the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (induding basement, LOMA or LOMR-F request, used. In Puerto Rico only, D above or LI below the HAG. [labovenr 0 below the LAG. 9 (see pages 1-2 of Instructions), EJ above or below the HAG. [J above or [J beow the HAG. 0 above or []below tho HAG. with the community's certify this inforrnation in Section G. crawspace, or enclosure) is 0Meet • meters b) Top of bottom floor (including basement, mow|opmue.orenclosure) io Of t0 meters E2. For Bi}din Diagrams 6-9 with permanent8ondopeningopmvigedin8mctionA Items 8 and/or the next higher floor (elevation C2.b in the diagrams) of the building is Flfeet 0metom E3. Attached garage (top of slab) is Flfeet Flmeters E4. Top of platforrn of machinery and/or equipment servicing the building is 0 feet [J meters E5. Zone A0 onty: If no flood depth number is avadable, e, is the top of the bottom floor elevated in accordance floodplain managemont ordinance? Fl Yes No 0 Unknown. The Iocal official must SECT1ON F — PROPERTY OWNER (OR OWNERS REPRESENTATIVE) CERTIFICATION The property owner property owner or owners authonzed representative whoSections A, B, and E for Zone 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 Owners Authorized Represontative's Name Address City State ZIP Code Signature Date Telephone Comments 0 Check here if attachments. FEMA Form O86-0-3 (7/15) Replaces all p vious editions. Form Page 3 of 6 . ELEV.��0����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.)orP�Route and Box No. 185T3U.S.HIGHWAY 1gNORTH Policy Number: City State ZIP Code CLEARWATER Florida 33764 Company NA1C 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 anly, enter meters. G1. Fl 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. Fl A community official completed Section E for a building located in Zone A (without a FEMA -issued or com un -issued BFE) orZone AO. G3. 0 The foliowing information (Items G4—G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Pemiit Issued G6. Date Certiflcate of Compliance/Occupancy Issued G7. This permlt has been issued for G8. Elevation ofas-built lowest floor (including of the building: G9. BFE or (in Zone AO) depth of fiooding at the G10. Community's design fiood elevation: New Construction Substantial Improvement basement) Flfeet feet [] feet meters Datum building site:Fl 0 meters Datum [] meters Datum Local Offiaal's Name Title Community Name Telephone Signature Date Comments (including type of equipment and Iocation, per C2(e), if applicable) 0 Check herif attachments. FEMA Form D86-0-33(7/15) Replaces all previous editions. Form Page 4 of 6 ' ^ ELEVATION N BUILDING PHOTOGRAPHS See Instructions for Item A6. OMB No. 1660-0008 Expiration Date:November 30, 2018 ^ �PO�ANT:In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANUSE Buliding Street Address (inctuding Apt, Unit, Suite,and/or Bldg. No)nrP.[lRoute and Box No. 1OS73U.8.HIGHWAY 1BNORTH Policy Number City State ZIP Code CLEARWATER Florida 33764 Company NAIC Number If using the Elevation Certificate to obtain NHP 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^RoorView^ and, if required, "Right Side View" and "Left Side View." When |oume, photographs must show the foundation with representative examples of the flood openings or verits as indicatedin Section A8. If submitting mare 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) a 6 , FEMA Form 086-0-33(7Y15) Replaces alt previouseditions. Form Page 5 of 6 • ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation P OMB No. 1660-0008 • .., IMPokTANT: In these spaces, copy the corresponding information from Section A. •••••••tor• ....ay.. .....1,. 111,./ I/GOMM. VW, Zo‘l IV FOR INSURANCE COMPANY USE Building Street Address (including Apt, Unit, Suite, andior 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) -V,NI, •:3A,ka,,,,,,,,,,..1y-: Photo Four Photo Four Caption REAR VIEW (WEST) MA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6