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499 MANDALAY AVEN ' 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, 2022 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 CENTRAL PROPERTIES INC TRE 21-76522 Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 499 MANDALAY AVE Company NAIC Number: City State ZIP Code CLEARWATER Florida 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) PARCEL ID- 08-29-15-16416-002-0440 NOT FOR CONSTRUCTION, DESIGN OR TITLE TRANSFER 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°58'55.2" N Long. 82°49'36.7" W etc.) COMMERCIAL Horizontal Datum: insurance. above grade ❑ NAD 1927 adjacent grade N/A x 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 3621.00 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 x No 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 131. NFIP Community Name & Community Number CITY OF CLEARWATER - 125096 B2. County Name PINELLAS B3. State Florida B4. Map/Panel Number 12103C-0102 B5. Suffix G B6. FIRM Index Date 08-18-2009 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) 11.0' 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 ❑ NGVD System CBRS or base flood ❑ Other/Source: depth entered in Item B9: x FIRM datum used located in a Date: ❑ Other/Source: Protected 1929 x NAVD 1988 (CBRS) area or Otherwise ❑ OPA Area (OPA)? ❑ Yes x No FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 1 of 6 499 MANDALAY A' BCP2017-09126M FINISHED EC HOGAN'S HANGOUT Zoning: Tourist Al ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2022 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. 499 MANDALAY AVE Policy Number: City State ZIP Code CLEARWATER Florida 33767 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ 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: E254 Vertical Datum: NAVD 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. Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 5.1 x feet ❑ meters b) Top of the next higher floor 17.6 x feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A p feet ❑ meters d) Attached (top of slab) N/A p feet ❑ meters garage the building e) Lowest elevation of machinery or equipment servicing type and location in Comments) 12.1 x feet ❑ meters (Describe of equipment f) Lowest adjacent (finished) grade next to building (LAG) 4.2 x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 4.9 x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 5.0 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 authorized by law to certify elevation information. I certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. Were latitude and longitude in Section A provided by a licensed land surveyor? © Yes ■ No ❑ Check here if attachments. Certifier's Name License Number PLS 3859 LELAND F. DySARD 3859 Title P.L.S.:Place i Company Name FLA SURVEYS CORP. Seal Address 3884 PROGRESS AVE., #104 City State ZIP Code NAPLES Florida 34104 Leland F d DySard Signature Date Telephone Ext. /�.�C� ./ gas J. 05-12-2021 (239) 404-7129 Copy 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) GPS COORDINATES WERE TAKEN FROM GOOGLE EARTH. THE EQUIPMENT USED IS GPS. THERE EXISTS A 0.2' (TWO TENTHS) PLUS OR MINUS PRECISION. THE REAL TIME NETWORKS USED ARE FDOT AND TOPCON. ITEM LISTED IN C2(e), IF ANY, IS THE RAISED AIR CONDITIONING UNIT ON THE LEFT/REAR SIDE OF THE BUILDING. THE NUMBER 3,621 IN LINE A8(a) WAS PROVIDED BY THE LOCAL BUILDING DEPARTMENT WITH REFERENCE TO THE FLOODPROOFING OF THE BUILDING AS DETAILED ON THE ATTACHED. DATE OF FIELD WORK IS 05-12-2021. FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 2 of 6 ' ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2022 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. 499 MANDALAY AVE Policy Number: City State ZIP Code CLEARWATER Florida 33767 Company NAIC Number SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items E1—E5. If the Certificate is intended to support a complete Sections A, 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 (12/19) Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2022 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. 499 MANDALAY AVE Policy Number: City State ZIP Code CLEARWATER Florida 33767 Company NAIC Number SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8—G10. In Puerto Rico only, enter meters. G1. ❑ 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: 0 G8. Elevation of as -built lowest floor (including of the building: G9. BFE or (in Zone AO) depth of flooding at the G10. Community's design flood elevation: New Construction ❑ 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) 499 MANDALAY AVE BCP2017-09126M FINISHED EC HOGAN'S HANGOUT Zoning: Tourist Atlas #: 267A ❑ Check here if attachments. FEMA Form 086-0-33 (12/19) 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, 2022 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. 499 MANDALAY AVE Policy Number: City State ZIP Code CLEARWATER Florida 33767 Company NAIC Number If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. ■ • 1' ,� PeM f ii 51* . e� • ) ' Om1%/;%111 N Photo One Photo One Caption FRONT VIEW PHOTO DATE: 05-12-2021. Clear Photo One i t il,�I��N 11 11 IH l'4 max. " tl'Ir zi► 1'�" r 444 . 41 A ■ 1 4111 li�ii '!,' I i% ill: III! ill��lllll Photo Two Photo Two Caption LEFT SIDE VIEW PHOTO DATE: 05-12-2021. Clear Photo Two FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 5 of 6 • ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page OMB No. 1660-0008 Expiration Date: November 30, 2022 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. 499 MANDALAY AVE Policy Number: City State ZIP Code CLEARWATER Florida 33767 Company NAIC Number If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. r . rtiiiifw,; *� 111111111s. 'Cc:•` '.moi >iliiii"1 Jim, Photo Three 1 F. ; 'r'. X r Li 1 1 ■■iiri. 11111111111r. •1F.--._ nummw.- NEN Photo Three Caption RIGHT VIEW PHOTO DATE: 05-12-2021. Clear Photo Three t t. . s .�, I 1 i` +.- 'SG 1 �� • 11 1 i�OGL its+. • X11 a9ii` � ���^9�` �s onF Photo Four Photo Four Caption ENTRANCE VIEW PHOTO DATE: 05-12-2021. Clear Photo Four FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 6 of 6 DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program FLOODPROOFING CERTIFICATE FOR NON-RESIDENTIAL STRUCTURES OMB No.: 1660-0008 Expiration: 11/30/2022 Paperwork Burden Disclosure Notice Public reporting burden for this data collection is estimated to average 3.25 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting this form. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street SW, Washington, DC 20742, Paperwork Reduction Project (1660-0008). NOTE: Do not send your completed form to this address. General: This information is provided pursuant to Public Law 96-511 (the Paperwork Reduction Act of 1980, as amended), dated December 11, 1980, to allow the public to participate more fully and meaningfully in the Federal paperwork review process. Authority: Public Law 96-511, amended; 44 U.S.C. 3507; and 5 CFR 1320. Privacy Act Statement Authority: Title 44 CFR § 61.7 and 61.8. Principal Purpose(s): This information is being collected for the primary purpose of estimating the risk premium rates necessary to provide flood insurance for new or substantially improved structures in designated Special Flood Hazard Areas. Routine Use(s): The information on this form may be disclosed as generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act of 1974, as amended. This includes using this information as necessary and authorized by the routine uses published in DHS/FEMA-003 — National Flood Insurance Program Files System or Records Notice 73 Fed. Reg. 77747 (December 19, 2008); DHS/FEMA/NFIP/LOMA-1 — National Flood Insurance Program (NFIP) Letter of Map Amendment (LOMA) System of Records Notice 71 Fed. Reg. 7990 (February 15, 2006); and upon written request, written consent, by agreement, or as required by law. Disclosure: The disclosure of information on this form is voluntary; however, failure to provide the information requested may result in the inability to obtain flood insurance through the National Flood Insurance Program or being subject to higher premium rates for flood insurance. Information will only be released as permitted by law. Purpose of the Floodproofing Certificate for Non -Residential Structures Under the National Flood Insurance Program (NFIP), the floodproofing of non-residential buildings may be permitted as an alternative to elevating to or above the Base Flood Elevation (BFE). A floodproofing design certification is required for non-residential structures that are floodproofed. This form is to be used for that certification. A floodproofed building is a building that has been designed and constructed to be watertight (substantially impermeable to floodwaters) below the BFE and with structural components having the capability of resisting hydrostatic and hydrodynamic loads and effects of buoyancy. Before a floodproofed building is designed, numerous planning considerations, including flood warning time, uses of the building, mode of entry to and exit from the building and the site in general, floodwater velocities, flood depths, debris impact potential, and flood frequency, must be addressed to ensure that dry floodproofing will be a viable floodplain management measure. The minimum NFIP requirement is to floodproof a building to the BFE. However, when it is rated for flood insurance one -foot is subtracted from the floodproofed elevation. Therefore, a building has to be floodproofed to one foot above the BFE to receive the same favorable flood insurance rates as a building elevated to the BFE. Additional guidance can be found in FEMA Publication 936, Floodproofing Non -Residential Buildings (2013), available on FEMA's website at https://www.fema.gov/media-library/assets/documents/34270. FEMA Form 086-0-34 (12/19) Page 1 of 4 DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program FLOODPROOFING CERTIFICATE FOR NON-RESIDENTIAL STRUCTURES OMB No.: 1660-0008 Expiration: 11/30/2022 The floodproofing of non-residential buildings may be permitted as an altemative to elevating to or above the Base Flood Elevation; however, a floodproofing design certification is required. This form is to be used for that certification. Floodproofing of a residential building does not alter a community's floodplain management elevation requirements or affect the insurance rating unless the community has been issued an exception by FEMA to allow floodproofed residential basements. The permitting of a floodproofed residential basement requires a separate certification specifying that the design complies with the local floodplain management ordinance. BUILDING OWNER'S NAME BAYMONT TRUST FOR INSURANCE COMPANY USE POLICY NUMBER STREET ADDRESS (Including Apt, Unit, Suite, and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER 499 MANDALAY AVE COMPANY NAIC NUMBER OTHER DESCRIPTION (Lot and Block Numbers, etc.) CITY CLEARWATER STATEFL Zip Code 33767-2045 SECTION I — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM: COMMUNITY NUMBER 125096 PANEL NUMBER 0102 SUFFIX G DATE OF FIRM INDEX 8/18/2009 FIRM ZONE AE BASE FLOOD ELEVATION (in AO Zones, Use Depth) 11.0 Indicate elevation datum used for Base Flood Elevation shown above: fl NGVD 1929 ►� NAVD 1988 ❑ Other/Source: SECTION II — FLOODPROOFED ELEVATION CERTIFICATION (By a Registered Professional Land Surveyor, Engineer, or Architect) All elevations must be based on finished construction. Floodprooflng Elevation Information: Building is floodproofed to an elevation of 12 . 10 feet (In Puerto Rico only: . meters). NGVD 1929 / NAVD 1988 ❑ Other/Source: (Elevation datum used must be the same as that used for the Base Flood Elevation.) Height of floodproofing on the building above the lowest adjacent grade is 7.85 feet (In Puerto Rico only: meters). For Unnumbered A Zones Only: Highest adjacent (finished) grade next to the building (HAG) . feet (In Puerto Rico only: . meters). [� NGVD 1929 [j NAVD 1988 ❑ Other/Source: (NOTE: For insurance rating purposes, the building's floodproofed design elevation must be at least 1 foot above the Base Flood Elevation to receive rating credit. If the building is floodproofed only to the Base Flood Elevation, then the building's insurance rating will result in a higher premium. See the Instructions section for information on documentation that must accompany this certificate if being submitted for flood insurance rating purposes.) FEMA Form 086-0-34 (12/19) Page 2 of 4 DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program FLOODPROOFING CERTIFICATE FOR NON-RESIDENTIAL STRUCTURES OMB No.: 1660-0008 Expiration: 11/30/2022 Non -Residential Floodproofed Elevation Information Certification: Section II certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation int ation 1 certify that the information in Section 11 on this Certificate represents a true and accurate interpretation and determinaf n by the undersigned using the available information and data. 1 understand that any false statement may be punishable b fine or imprisonment under 18 U.S. Code, Section 1001. ;4.' CERTIFIER'S NAME Paul Orr LICENSE NUMBER (or Affix Seal) FL PE 64898L .1 -- • =. = •'G°0 1 rt : " r >, -1°-,, _ :: c^ �t� is, TITLE Professional Engineer COMPANY NAME= Nutek Engineering ADDRESS 421 Federal CITY Dania Beach STATE Florida ZIP CODE 33044 SIGNAT eg-- ateD/A,Nov DATE 3, 2020 PHONE +1 (305) 725-1991; SECTION 11I — PLOODPROOFED CERTIFICATION (By a Registered Professional Engineer or Architect) Non -Residential Floodproofed Construction Certification: 1 certify the structure, based upon development and/or review of the design, specifications, as -built drawings for construction and physical inspection, has been designed and constructed in accordance with the accepted standards of practice (ASCE 24-05, ASCE 24-14 or their equivalent) and any alterations also meet those standards and the following provisions. The structure, together with attendant utilities and sanitary facilities is watertight to the floodproofed design elevation indicated above, is substantially impermeable to the passage of water, and shall perform in accordance with the 44 Code of Federal Regulations (44 CFR 60.3(c)(3). All structural components are capable of resisting hydrostatic and hydrodynamic flood forces, including the effects of buoyancy, and anticipated debris impact forces. 1 certify that the information in Section Ill on this certificate represents a true and accurate determination by the undersigned using the available information and data. i understand that any false statement may be punishable by fine or imprisonment under 18 .S. Code, Section 1001. ,\o' • ,, - f• -k,; CERTIFIER'S NAME Paul Orr LICENSE NUMBER (or Affix Seal) FL PE 64898 _ , -_ - ' - - . %., it 71-: '",� 'S'T� ? i"0`� ryCr '7 • TITLE Professional Engineer COMPANY NAME Nutek Engineering ADDRESS 421 Federal H CITY Dania Beach STATE Florida ZIP CODE- E 33044 SIGNATUR f',j' DATE Nov 3, 2020 PHONE Copy all pages of this Floodproofing Certificate and all attachments for 1) community official, 2) insurance agent/company, and 3) building owner. FEMA Form 086-0-34 (12/19) Page 3 of 4 DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program FLOODPROOFING CERTIFICATE FOR NON-RESIDENTIAL STRUCTURES OMB No.: 1660-0008 Expiration: 11/30/2022 Instructions for Completingthe Floodproofing Certificate for Non -Residential Structures To receive credit for floodproofing, a completed Floodproofing Certificate for Non -Residential Structures is required for non-residential and business buildings in the Regular Program communities, located in zones Al A30, AE, AR, AR Dual, AO, AH, and A with BFE. In order to ensure compliance and provide reasonable assurance that due diligence had been applied in designing and constructing floodproofing measures, the following information must be provided with the completed Floodproofing Certificate: • Photographs of shields, gates, barriers, or components designed to provide floodproofing protection to the structure. • Written certification that all portions of the structure below the BFE that will render it watertight or substantially impermeable to the passage of water and must perform in accordance with Title 44 Code of Federal Regulations (44 CFR 60.3 (c)(3)). • A comprehensive Maintenance Plan for the entire structure to include but not limited to: • Exterior envelope of the structure • All penetrations to the exterior of the structure • All shields, gates, barriers, or components designed to provide floodproofing protection to the structure • All seals or gaskets for shields, gates, barriers, or components • Location of all shields, gates, barriers, and components as well as all associated hardware, and any materials or specialized tools necessary to seal the structure. FEMA Form 086-0-34 (12/19) Page 4 of 4 1A, ELECTRICAL TROUGH #1 ELECTRICAL TROUGH #2 DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program FLOODPROOFING CERTIFICATE FOR NON-RESIDENTIAL STRUCTURES OMB No.: 1660-0008 Expiration: 11/30/2022 Paperwork Burden Disclosure Notice Public reporting burden for this data collection is estimated to average 3.25 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting this form. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 500 C Street SW, Washington, DC 20742, Paperwork Reduction Project (1660-0008). NOTE: Do not send your completed form to this address. General: This information is provided pursuant to Public Law 96-511 (the Paperwork Reduction Act of 1980, as amended), dated December 11, 1980, to allow the public to participate more fully and meaningfully in the Federal paperwork review process. Authority: Public Law 96-511, amended; 44 U.S.C. 3507; and 5 CFR 1320. Privacy Act Statement Authority: Title 44 CFR § 61.7 and 61.8. Principal Purpose(s): This information is being collected for the primary purpose of estimating the risk premium rates necessary to provide flood insurance for new or substantially improved structures in designated Special Flood Hazard Areas. Routine Use(s): The information on this form may be disclosed as generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act of 1974, as amended. This includes using this information as necessary and authorized by the routine uses published in DHS/FEMA-003 — National Flood Insurance Program Files System or Records Notice 73 Fed. Reg. 77747 (December 19, 2008); DHS/FEMA/NFIP/LOMA-1 — National Flood Insurance Program (NFIP) Letter of Map Amendment (LOMA) System of Records Notice 71 Fed. Reg. 7990 (February 15, 2006); and upon written request, written consent, by agreement, or as required by law. Disclosure: The disclosure of information on this form is voluntary; however, failure to provide the information requested may result in the inability to obtain flood insurance through the National Flood Insurance Program or being subject to higher premium rates for flood insurance. Information will only be released as permitted by law. Purpose of the Floodproofing Certificate for Non -Residential Structures Under the National Flood Insurance Program (NFIP), the floodproofing of non-residential buildings may be permitted as an altemative to elevating to or above the Base Flood Elevation (BFE). A floodproofing design certification is required for non-residential structures that are floodproofed. This form is to be used for that certification. A floodproofed building is a building that has been designed and constructed to be watertight (substantially impermeable to floodwaters) below the BFE and with structural components having the capability of resisting hydrostatic and hydrodynamic Toads and effects of buoyancy. Before a floodproofed building is designed, numerous planning considerations, including flood waming time, uses of the building, mode of entry to and exit from the building and the site in general, floodwater velocities, flood depths, debris impact potential, and flood frequency, must be addressed to ensure that dry floodproofing will be a viable floodplain management measure. The minimum NFIP requirement is to floodproof a building to the BFE. However, when it is rated for flood insurance one -foot is subtracted from the floodproofed elevation. Therefore, a building has to be floodproofed to one foot above the BFE to receive the same favorable flood insurance rates as a building elevated to the BFE. Additional guidance can be found in FEMA Publication 936, Floodproofing Non -Residential Buildings (2013), available on FEMA's website at https://www.fema.gov/media-library/assets/documents/34270. FEMA Form 086-0-34 (12/19) RECEIVED BY. 499 MANDALAY AVp 3 j- BCP2017-09126 FINISHED EC HOGAN'S HANGOUT - Zoning: Tourist Atlas #: 267A Page 1 of 4 DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program FLOODPROOFING CERTIFICATE FOR NON-RESIDENTIAL STRUCTURES OMB No.: 1660-0008 Expiration: 11/30/2022 The floodproofing of non-residential buildings may be permitted as an alternative to elevating to or above the Base Flood Elevation; however, a floodproofing design certification is required. This form is to be used for that certification. Floodproofing of a residential building does not alter a community's floodplain management elevation requirements or affect the insurance rating unless the community has been issued an exception by FEMA to allow floodproofed residential basements. The permitting of a floodproofed residential basement requires a separate certification specifying that the design complies with the local floodplain management ordinance. BUILDING OWNER'S NAME BAYMONT TRUST FOR INSURANCE COMPANY USE POLICY NUMBER STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER 499 MANDALAY AVE COMPANY NAIC NUMBER OTHER DESCRIPTION (Lot and Block Numbers, etc.) CITY CLEARWATER STATEFL Zip Code 33767-2045 SECTION I — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM: COMMUNITY NUMBER 125096 PANEL NUMBER 0102 SUFFIX G DATE OF FIRM INDEX 8/18/2009 FIRM ZONE AE BASE FLOOD ELEVATION (in AO Zones, Use Depth) 11.0 Indicate elevation datum used for Base Flood Elevation shown above: n NGVD 1929 NAVD 1988 ❑ Other/Source: SECTION II — FLOODPROOFED ELEVATION CERTIFICATION (By a Registered Professional Land Surveyor, Engineer, or Architect) All elevations must be based on finished construction. Floodproofing Elevation Information: Building is floodproofed to an elevation of 12 . 10 feet (In Puerto Rico only: . meters). [NGVD 1929 /1 NAVD 1988 1 1 Other/Source: (Elevation datum used must be the same as that used for the Base Flood Elevation.) Height of floodproofing on the building above the lowest adjacent grade is 7.85 feet (In Puerto Rico only: meters). For Unnumbered A Zones Only: Highest adjacent (finished) grade next to the building (HAG) . feet (In Puerto Rico only: . meters). C NGVD 1929 n NAVD 1988 ❑ Other/Source: (NOTE: For insurance rating purposes, the building's floodproofed design elevation must be at least 1 foot above the Base Flood Elevation to receive rating credit. If the building is floodproofed only to the Base Flood Elevation, then the building's insurance rating will result in a higher premium. See the Instructions section for information on documentation that must accompany this certificate if being submitted for flood insurance rating purposes.) FEMA Form 086-0-34 (12/19) Page 2 of 4 DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program FLOODPROOFING CERTIFICATE FOR NON-RESIDENTIAL STRUCTURES OMB No.: 1660-0008 Expiration: 11/30/2022 Non -Residential Floodproofed Elevation Information Certification: Section II certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation inf mation 1 certify that the information in Section 11 on this Certificate represents a true and accurate interpretation and determina ' n by the undersigned using the available information and data. I understand that any false statement may be punishable b fine or imprisonment under 18 U.S. Code, Section 1001. ,,\ X51.. CERTIFIERS NAME Paul Orr LICENSE NUMBER (or Affix Seal) FL PE 64898 .� A� - C�c-� "• • r, g i ~ `` S Wil,. TITLE Professional Engineer COMPANY NAME Nutek Engineering ADDRESS 421 Federal " r. , .. CITY Dania Beach STATE Florida ZIP CODE 33044:y J-• -r. "•: OA •:., ; SIGNAT PLOODPROOFED DATE Nov 3, 2020 PHONE +1 (305) 725-1991 SECTION III — CERTIFICATION (By a Registered Professional Engineer or Architect) Non -Residential Floodproofed Construction Certification: 1 certify the structure, based upon development and/or review of the design, specifications, as -built drawings for construction and physical inspection, has been designed and constructed in accordance with the accepted standards of practice (ASCE 24-05, ASCE 24-14 or their equivalent) and any alterations also meet those standards and the following provisions. The structure, together with attendant utilities and sanitary facilities is watertight to the floodproofed design elevation indicated above, is substantially impermeable to the passage of water, and shall perform in accordance with the 44 Code of Federal Regulations (44 CFR 60.3(c)(3). All structural components are capable of resisting hydrostatic and hydrodynamic flood forces, including the effects of buoyancy, and anticipated debris impact forces. I certify that the information in Section 111 on this certificate represents a true and accurate determination by the undersigned using the available information and data. 1 understand that any false statement may be punishable by fine or imprisonment under 18 1/. S. Code, Section 1001. \. \ \ \ ` ' CERTIFIERS NAME Paul Orr LICENSE NUMBER (or Affix Seal) FL PE 64898 :; .' C}' .•' -" 5 - ;-; "•--t'S'T� r,, . 0A LF;^. t , c ' ' 0 TITLE Professional Engineer COMPANY NAME --T)_; Nutek Engineering - Il ADDRESS 421 Federal H CITY Dania Beach STATE Florida ZIP COD 33044'0'<' SIGNATOR , / DATE July 12, 2021 PHONE•' Copy all pages of this Floodproofing Certificate and all attachments for 1) community official, 2) insurance agent/company, and 3) building owner. FEMA Form 086-0-34 (12/19) Page 3 of 4 DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program FLOODPROOFING CERTIFICATE FOR NON-RESIDENTIAL STRUCTURES OMB No.: 1660-0008 Expiration: 11/30/2022 Instructions for Completingthe Floodproofing Certificate for Non -Residential Structures To receive credit for floodproofing, a completed Floodproofing Certificate for Non -Residential Structures is required for non-residential and business buildings in the Regular Program communities, located in zones Al A30, AE, AR, AR Dual, AO, AH, and A with BFE. In order to ensure compliance and provide reasonable assurance that due diligence had been applied in designing and constructing floodproofing measures, the following information must be provided with the completed Floodproofing Certificate: F ME Form 086-0-34 (12/19) • Photographs of shields, gates, barriers, or components designed to provide floodproofing protection to the structure. • Written certification that all portions of the structure below the BFE that will render it watertight or substantially impermeable to the passage of water and must perform in accordance with Title 44 Code of Federal Regulations (44 CFR 60.3 (c)(3)). • A comprehensive Maintenance Plan for the entire structure to include but not limited to: • Exterior envelope of the structure • All penetrations to the exterior of the structure • All shields, gates, barriers, or components designed to provide floodproofing protection to the structure • All seals or gaskets for shields, gates, barriers, or components • Location of all shields, gates, barriers, and components as well as all associated hardware, and any materials or specialized tools necessary to seal the structure. 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