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3480 MCMULLEN BOOTH RD NU.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 FLORIDA CONVALESCENT CENTERS, INC Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 3480 N MCMULLEN BOOTH ROAD Company NAIC Number: City State ZIP Code CLEARWATER Florida 33761 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) PARCEL # 16-28-16-282284-000-0020 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. 28°02'53" N Long. 82°42'38" W COMMERCIAL Horizontal Datum: insurance. above ❑ NAD 1927 adjacent grade grade 0 x NAD 1983 0 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 0.00 sq ft or endosure(s): or endosure(s) openings in the crawispace in A8.b or endosure(s) 0.00 sq in within 1.0 foot foot above adjacent in 0.00 sq ft ❑ Yes X No garage: garage openings in the attached garage within 1.0 in A9.b 0.00 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 COUNTY B3. State Florida B4. Map/Panel Number 12103C0087 B5. Suffix G Be. FIRM Index Date 08-18-2009 B7. FIRM Panel Effective/ Revised Date 09-03-2003 B8. Flood Zone(s) X & AE B9. Base Flood E evation(s) (Zone AO, use Base Flood Depth) 9.0' B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation Date: of the Base Flood Elevation (BFE) data ❑ NGVD System CBRS or base flood ❑ Other/Source: depth entered in Item 89: ■ FIRM x Community Determined datum used for BFE in Item B9: located in a Coastal Barrier Resources N/A 0 ❑ Other/Source: Protected 1929 x NAVD 1988 (CBRS) area or Otherwise ❑ OPA Area (OPA)? ❑ Yes x 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. 3480 N MCMULLEN BOOTH ROAD Policy Number. City State ZIP Code CLEARWATER Florida 33761 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations — Zones Al A30, AE, AH, A (with BFE), VE, V1 V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only, Benchmark Utilized: HATCHERY F Vertical Datum: N.AV.D. 88 DATUM x Finished Construction AR/AH, AR/AO. enter meters. Indicate elevation datum ❑ NGVD 1929 used IM 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) 12.50 x the measurement used. feet ❑ meters b) Top of the next higher floor N/A x feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A x 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) 12.30 x feet ❑ meters f) Lowest adjacent (finished) grade next to building (LAG) 11.80 x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 12.20 x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including 11.80 structural support❑ x 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 ERIC S SMITH PSM #6929 `` iii//', �� ,� �`�� •/T /''. * 6'��+ ' �. '� = r bra. I ': * 73 T.Eaa • e %� m-"•• <oRIDP.••*ay,:: .. asurve of a�`d``‘�� �/,�,, r, i � i t i N' Title OWNER, PSM Company Name TLS SURVEYORS AND MAPPERS, INC Address 13167 SPRING HILL DRIVE City State ZIP Code SPRING HILL Florida 34609 Signa re Date Telephone Ext. 01-28-2020 (352) 277-6550 C y all pag s of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) Data in C2.f-h is only accurate to 0.1'; ignore the second decimal place, as this is automatically added by the FEMA form. THERE ARE NO FLOOD VENTS. THE LOWEST UITLITY SERVICING THE BUILDING IS THE A/C LOCATED ON THE WEST SIDE OF THE BUILDING. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 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. 3480 N MCMULLEN BOOTH ROAD Policy Number City State ZIP Code CLEARWATER Florida 33761 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. k s3 .8µi fi py. ,t 'r i ! Photo e , �,�, One M1:a III h JI I?EN ,� Photo One Caption WEST SDE VIEW 24 -JANUARY -2020 Clear Photo One f gym_ - PIN[ity�� ;1� {{ Photo Two Photo Two Caption SOUTH SIDE VIEW 24 -JANUARY -2020 Clear Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 3480 N MCMULLEN BOOTH ROAD Policy Number: City State ZIP Code CLEARWATER Florida 33761 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. x§ � 7d,. wf ...—.____. F Photo Three Photo Three Caption WEST SIDE VIEW 24 -JANUARY -2020 Clear Photo Three i.r 'fb - '� b M1 z yp� S qy@ j Photo Four Photo Four Caption NORTH SIDE VIEW 24 -JANUARY -2020 Clear Photo Four FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE 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 FLORIDA CONVALESCENT CENTERS, INC Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 3480 N MCMULLEN BOOTH ROAD Company NAIC Number: City State ZIP Code CLEARWATER Florida 33761 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) PARCEL # 16-28-16-282284000-0020 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 c) Total net area d) Engineered Residential, Non -Residential, Addition, Accessory, Lat. 28°02'53" N Long. 82°42'38" W etc.) COMMERCIAL Horizontal Datum: insurance. above grade ❑ NAD 1927 adjacent grade 0 x NAD 1983 0 2 photographs Number with a crawlspace of crawlspace permanent flood of flood openings flood openings? an attached of attached permanent flood of flood openings flood openings? of the building if the 1A Certificate is being used to obtain flood 0.00 sq ft or endosure(s): or endosure(s) openings in the crawlspace in A8.b or endosure(s) 0.00 sq in within 1.0 foot 1.0 foot above adjacent in 0.00 sq ft ❑ Yes x No garage: garage openings in the attached garage within in A9.b 0.00 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 COUNTY B3. State Florida B4. Map/Panel Number 12103C0087 B5. Suffix G B6. FIRM Index Date 08-18-2009 B7. FIRM Panel Effective/ Revised Date 09-03-2003 B8. Flood Zone(s) X & AE B9. Base Flood E evation(s) (Zone AO, use Base Flood Depth) 9.0' B10. Indicate the source ❑ FIS Profile 811. Indicate elevation B12. Is the building Designation Date: of the ❑ FIRM datum used located in a N/A Base Flood Elevation (BFE) data ❑ NGVD System CBRS or base flood ❑ Other/Source: depth entered in Item B9: x Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ ❑ Other/Source: Protected 1929 x NAVD 1988 (CBRS) area or Otherwise ❑ OPA Area (OPA)? ❑ Yes x 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. 3480 N MCMULLEN BOOTH ROAD Policy Number: City State ZIP Code CLEARWATER Florida 33761 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations — Zones A1—A30, AE, AH, A (with BFE), VE, V1 V30, V (with BFE), AR, AR/A, AR/AE, AR/A1—A30, Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only, Benchmark Utilized: HATCHERY F Vertical Datum: N,AV.D. 88 DATUM x Finished Construction AR/AH, AR/A0. enter meters. 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) 12.50 x the measurement used. feet ❑ meters b) Top of the next higher floor N/A x feet • meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A x feet • meters d) Attached garage (top of slab) N/A x feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 12.30 (Describe type of equipment and location in Comments) x feet meters ❑ f) Lowest adjacent (finished) grade next to building (LAG) 11.80 x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 12.20 x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including 11.80 structural support x 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 the data 1001. Yes ■ by law to certify elevation information. available. I understand that any false No ❑ Check here if attachments. Certifier's Name License Number ERIC S SMITH PSM #6929 � 1 l tti� rr \\ „` "• "1��/'.� •* =a' ; ,Q,. aF, •, •.. sr'City �'.//,/ ti, ' i e arta, d``��` Title OWNER, PSM Company Name TLS SURVEYORS AND MAPPERS, INC Address 13167 SPRING HILL DRIVE State SPRING HILL Florida ZIP34609ode Sign r_______ Date (3Telephone) Ext. 01-26-2020 (352) 277-6550 C y all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) Data in C2.f-h is only accurate to 0.1'; ignore the second decimal place, as this is automatically added by the FEMA form. THERE ARE NO FLOOD VENTS. THE LOWEST UITLITY SERVICING THE BUILDING IS THE NC LOCATED ON THE WEST SIDE OF THE BUILDING. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 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. 3480 N MCMULLEN BOOTH ROAD Policy Number: City State ZIP Code CLEARWATER Florida 33761 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. F i fl = i, i Photo One •1r•ti'1, Photo One Caption WEST SDE VIEW 24 -JANUARY -2020 Clear Photo One �ar '$T Photo Two Photo Two Caption SOUTH SIDE VIEW 24 -JANUARY -2020 Clear Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page OMB No, 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 3480 N MCMULLEN BOOTH ROAD Policy Number: City State ZIP Code CLEARWATER Florida 33761 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. r Photo Three i Photo Three Caption WEST SIDE VIEW 24 -JANUARY -2020 Clear Photo Three ry' F 4, 4-1 Photo Four Photo Four Caption NORTH SIDE VIEW 24 -JANUARY -2020 Clear Photo Four FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1 -9. 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 Florida Convalescent Centers Inc. Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 3480 North McMullen Booth Road Company NAIC Number: City State ZIP Code Clearwater Florida 33761 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot "B" - Convalescent Centers Subdivision (PB 97, Pages 24 -25) : Tax Parcel No. 16-28-16-28284-000-0020 (Pinellas County, Florida) A4. Building Use (e.g., A5. Latitude /Longitude: A6. Attach at least A7. Building Diagram A8. For a building with a) Square footage b) Number of permanent c) Total net area d) Engineered A9. For a building with a) Square footage b) Number of permanent c) Total net area d) Engineered Residential, Non - Residential, Addition, Lat. N 28° 02' 52.9" Long. W Accessory, etc.) Residential (Nursing Home Facility) 82° 42' 36.8" Horizontal Datum: obtain flood insurance. 1.0 foot above adjacent above adjacent grade ❑ NAD 1927 grade x NAD 1983 2 photographs of the building if the Number 1A Certificate is being used to sq ft 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 sq or enclosure(s) within in sq ft within 1.0 foot sq in ❑ Yes • No garage: garage openings in the attached garage in A9.b • Yes ❑ No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number City of Clearwater / 125096 B2. County Name Pinellas County B3. State Florida B4. Map /Panel Number 12103C/0087 B5..Suffix G B6. FIRM Index Date 09/03/2003 B7. FIRM Panel Effective/ Revised Date 09/03/2003 B8. Flood Zone(s) AE B9. Base Flood Elevation(s) (Zone AO, use Base Flood Depth) 9 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: • FIS Profile B11. Indicate elevation B12. Is the building Designation Date: x FIRM • Community Determined datum used for BFE in Item B9: located in a Coastal Barrier Resources ❑ CBRS • Other /Source: /Source: • NGVD 1929 MI NAVD 1988 • Other System (CBRS) area or Otherwise Protected ❑ OPA Area (OPA)? U Yes x 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. 3480 North McMullen Booth Road Policy Number: City State ZIP Code Clearwater Florida 33761 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* x Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations — Zones A1—A30, AE, AH, A (with BFE), VE, V1 —V30, V (with BFE), AR, AR/A, AR/AE, AR/A1 —A30, AR/AH, AR/AO. Complete Items C2.a —h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: BM 231 2014 Vertical Datum: NAVD 1988 Indicate elevation datum used ❑ NGVD 1929 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) 12. 5 p p x p x p p x the measurement used. feet ❑ meters feet ❑ meters feet ❑ meters b) Top of the next higher floor N/A c) Bottom of the lowest horizontal structural member (V Zones only) N/A d) Attached garage (top of slab) N/A feet ■ meters e) Lowest elevation of machinery or equipment servicing the building 12 0 feet p meters feet ❑ meters feet ❑ meters feet ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 11. 3 g) Highest adjacent (finished) grade next to building (HAG) 12. 5 h) Lowest adjacent grade at lowest elevation of deck or stairs, including N /A. structural support SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. / certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. Were latitude and longitude in Section A provided by a licensed land surveyor? x Yes ❑ No ❑ Check here if attachments. Certifiers Name License Number Jared Rogers LS6687 �. ` t d tU�,� ` , , • .',` , ,,4p' ' „ °-t' Ptace t '► '' c ` : ur al K pc - • ='�L ' 0) Ica;- - ' 3. ' , .� %, 4.. ' ' ,Z,°,''',. ,' ,�)t Ors ,i `> `�, ‘ , r d a f t t ''‘" Title Director of Surveying Company Name eda engineers- surveyors- planners, inc. Address 2404 NW 43rd Street City State ZIP Code Gainesville Florida 32606 Signature Date Telephone 07/09/2017 (352) 373-3541 Copy pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Corn ents (including type of equipment and location, per C2(e), if applicable) 1. T e latitude /longitude provided in Item A5 was obtained using available aerial photography within our GIS and was confirmed using Go le Earth. 2. The benchmark is described as "BM 231 2014" which is a 4 "x4" concrete monument with FDOT brass disk stamped "BM 231 2014" with a published elevation of 25.651 feet (NAVD 88) as shown on a vertical control data sheet obtained from the Florida Department of Transportation (FDOT) on February 08, 2016. 3. The elevation shown in Item C2.e is a concrete pad beneath an air conditioner on the easterly side of the building. 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. 3480 North McMullen Booth Road Policy Number: City State ZIP Code Clearwater Florida 33761 Company NAIC Number SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items E1 —E5. If the Certificate is intended to support a LOMA or LOMR -F request, complete Sections A, B,and C. For Items E1 —E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is • feet ❑ meters ❑ above or • below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or • below the LAG. 9 (see pages 1 -2 of Instructions), E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and /or the next higher floor (elevation C2.b in the diagrams) of the building is • feet • meters • above or • below the HAG. E3. Attached garage (top of slab) is ❑ feet ❑ meters • above or • below the HAG. E4. Top of platform of machinery and /or equipment ❑ above or ❑ below the HAG. with the community's certify this information in Section G. 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. 3480 North McMullen Booth Road Policy Number: City State ZIP Code Clearwater Florida 33761 Company NAIC Number SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance Sections A, B, C (or E), and G of this Elevation used in Items G8 —G10. In Puerto Rico only, enter G1. ❑ The information in Section C was taken engineer, or architect who is authorized data in the Comments area below.) G2 ❑ A community official completed Section or Zone AO. to administer the community's floodplain management ordinance can complete Certificate. Complete the applicable item(s) and sign below. Check the measurement meters. from other documentation that has been signed and sealed by a licensed surveyor, by law to certify elevation information. (Indicate the source and date of the elevation E for a building located in Zone A (without a FEMA- issued or community- issued BFE) is provided for community floodplain management purposes. G3. • The following information (Items G4 —G10) 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) ❑meters Datum • feet ❑ meters Datum building site: • feet ❑ feet ❑ 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. orm Page BUILDING PHOTOGRAPHS ELEVATION CERTIFICATE See Instructions for Item A6. OMB No. 1660 -0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 3480 North McMullen Booth Road Policy Number: City Clearwater State Florida ZIP Code 33761 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 (Easterly Side) Date Taken: 07/09/2017 Photo Two Photo Two Caption Rear View (Westerly Side) Date Taken: 07/09/2017 FEMA Form 086 -0 -33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS OMB No. 1660 -0008 Continuation Page Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 3480 North McMullen Booth Road Policy Number: City State ZIP Code Clearwater Florida 33761 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 One Photo One Caption Right Side View (Northerly Side) Date Taken: 07/09/2017 Photo Two Photo Two Caption Left Side View (Southerly Side) Date Taken: 07/09/2017 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 Florida Convalescent Centers Inc. Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 3480 North McMullen Booth Road Company NAIC Number: City State ZIP Code Clearwater Florida 33761 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot "B" - Convalescent Centers Subdivision (PB 97, Pages 24 -25) : Tax Parcel No. 16- 28- 16- 28284 - 000 -0020 (Pinellas County, Florida) 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, Lat. N 28° 02' 52.9" Long. W Accessory, etc.) Residential (Nursing Home Facility) 82° 42' 36.8" Horizontal Datum: obtain flood insurance. 1.0 foot above adjacent above adjacent grade ❑ NAD 1927 grade p NAD 1983 2 photographs of the building if the Number 1A Certificate is being used to 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 enclosures) openings in the crawlspace in A8.b sq or enclosure(s) within in sq ft within 1.0 foot sq in ❑ Yes • No garage: garage openings in the attached garage in A9.b • Yes ■ No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number City of Clearwater / 125096 B2. County Name Pinellas County B3. State Florida B4. Map /Panel Number 12103C/0087 B5. Suffix G B6. FIRM Index Date 09/03/2003 B7. F RM Panel Effective/ Revised Date 09/03/2003 B8. Flood Zone(s) AE B9. Base Flood Elevation(s) (Zone AO, use Base Flood Depth) 9 B10. Indicate the source of the Base Flood Elevation (BFE) ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources data or base flood depth entered in Item B9: ❑ Other /Source: • FIS Profile B11. Indicate elevation B12. Is the building Designation Date: x FIRM datum used located in a 1988 ❑ Other /Source: or Otherwise Protected • NGVD 1929 p NAVD System (CBRS) area ❑ OPA Area (OPA)? • Yes p No • CBRS FEMA Form 086 -0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 E 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. 3480 North McMullen Booth Road Policy Number: City State ZIP Code Clearwater Florida 33761 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations — Zones 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 Rico Benchmark Utilized: BM 231 2014 Vertical Datum: NAVD 1988 x Finished Construction AR/A1—A30, AR/AH, AR/AO. only, enter meters. 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. Top bottom floor basement, crawlspace, or enclosure floor) 12. 5 Check the measurement used. x feet ❑ meters a) of (including higher floor N/A p feet • meters b) Top of the next lowest horizontal member (V Zones only) N/A X feet ❑ meters c) Bottom of the structural Attached slab) N/A El feet • meters d) garage (top of or equipment servicing the building 12 0 p feet • meters e) Lowest elevation of machinery (Describe type of equipment and location in Comments) f) Lowest next to building (LAG) 11. 3 El feet ❑ meters adjacent (finished) grade Highest (finished) next to building (HAG) 12. 5 x feet ❑ meters g) adjacent grade h) Lowest at lowest elevation of deck or stairs, including N /A. IM feet ❑ meters adjacent grade structural support 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. I understand that any false Were latitude and longitude in Section A provided by a licensed land surveyor? x Yes ❑ No ■ Check here if attachments. Certifier's Name License Number Jared Rogers LS6687 Place Seal He Title Director of Surveying Company Name eda engineers - surveyors- planners, inc. Address 2404 NW 43rd Street City State ZIP Code Gainesville Florida 32606 Signatur Date Telephone 07/09/2017 (352) 373 -3541 Copy II pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Co ments (including type of equipment and location, per C2(e), if applicable) 1. a latitude /longitude provided in Item A5 was obtained using available aerial photography within our GIS and was confirmed using G le Earth. 2. The benchmark is described as "BM 231 2014" which is a 4"x4" concrete monument with FDOT brass disk stamped "BM 231 2014" with a published elevation of 25.651 feet (NAVD 88) as shown on a vertical control data sheet obtained from the Florida Department of Transportation (FDOT) on February 08, 2016. 3. The elevation shown in Item C2.e is a concrete pad beneath an air conditioner on the easterly side of the building. FEMA Form 086 -0-33 (7/15) Replaces all previous editions. ELEVATION CERTIFICATE OMB No. 1660 -0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 3480 North McMullen Booth Road Policy Number: City State ZIP Code Clearwater Florida 33761 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. 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 9 (see pages 1 -2 of Instructions), the diagrams) of the building is ❑ feet • meters ❑ above or • below the HAG. E3. Attached garage (top of slab) is ❑ feet ❑ meters • above or • below the HAG. E4. Top of platform of machinery and /or equipment servicing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. with the community's certify this information in Section G. 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 TE 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. 3480 North McMullen Booth Road Policy Number: City State ZIP Code Clearwater Florida 33761 Company NAIC Number SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance Sections A, B, C (or E), and G of this Elevation used in Items G8 —G10. In Puerto Rico only, enter to administer the community's floodplain management ordinance can complete Certificate. Complete the applicable item(s) and sign below. Check the measurement meters. from other documentation that has been signed and sealed by a licensed surveyor, by law to certify elevation information. (Indicate the source and date of the elevation E for a building located in Zone A (without a FEMA- issued or community- issued BFE) is provided for community floodplain management purposes. G1. • The information in Section C was taken engineer, or architect who is authorized data in the Comments area below.) G2 ❑ A community official completed Section or Zone AO. G3. • The following information (Items G4 —G10) G4. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued ❑meters Datum G7. This permit has been issued for: • New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including of the building: G9. BFE or (in Zone AO) depth of flooding at the G10. Community's design flood elevation: basement) • feet ❑ feet building site: ❑ meters Datum • feet • 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. 01T11 age 4 0 BUILDING PHOTOGRAPHS ELEVATION CERTIFICATE See Instructions for Item A6. OMB No. 1660 -0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 3480 North McMullen Booth Road Policy Number: City State ZIP Code Clearwater Florida 33761 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 (Easterly Side) Date Taken: 07/09/2017 Photo Two Photo Two Caption Rear View (Westerly Side) Date Taken: 07/09/2017 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. 3480 North McMullen Booth Road Policy Number: City Clearwater State Florida ZIP Code 33761 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 One Photo One Caption Right Side View (Northerly Side) Date Taken: 07/09/2017 Photo Two Photo Two Caption Left Side View (Southerly Side) Date Taken: 07/09/2017 FEMA Form 086 -0 -33 (7/15) Replaces all previous editions. Form Page 6 of 6