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940 COURT ST ' ��' LEVATION CERTIFICATE OMB No. 1660-0008 r1 �\ Exoires Februarv 28.2009 �J � � v �/J v � rtant: Read the instructions on pages 1-8. ` �C/ � � � SECTION A-PROPERTY INFORMATION For insurance Company Use: A1. Building Owner's Name Clearwater Hospitaliry Properties,LLC Policy Number 2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number 940 Court Street City Clearwater State FI ZIP Code 33756 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) 15/29/15/16830/003/0010 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) Commercial roadwav Inn-Permit#BCP2006-11582 A5. Latitude/Longitude:Lat.27°57'42.38"N Long.82°47'36.02"W Horizontal Datum: ❑ NAD 1927 � NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 1 A8. For a building with a crawl space or enclosure(s),provide A9. For a building with an attached garage,provide: a) Square footage of crawl space or enclosure(s) NA sq ft a) Square footage of attached garage NA sq ft b) No.of permanent flood openings in the crawl space or b) No.of permanent flood openings in the attached garage enclosure(s)walls within 1.0 foot above adjacent grade NA walls within 1.0 foot above adjacent grade NA c) Total net area of flood openings in A8.b NA sq in c) Total net area of flood openings in A9.b NA sq in SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 61.NFIP Community Name&Community Number B2.County Name 63.State Clearvvater,City of 125096 Pinellas Florida B4. Map/Panel Number 65.Suffix 66. FIRM Index B7. FIRM Panel 68.Flood B9.Base Flood Elevation(s)(Zone Date Effective/Revised Date Zone(s) AO,use base flood depth) 12103C0108 H 5/17/05 5/17/05 X NA B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile � FIRM ❑Community Determined ❑Other(Describe) B11. Indicate elevation datum used for BFE in Item B9: ❑NGVD 1929 � NAVD 1988 ❑Other(Describe) 812. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No � Designation Date NA ❑CBRS ❑OPA � SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: ❑Construction Drawings' ❑ Building Under Construction* � Finished GOnstruction *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. Corw�lete Items,C2�.a-g below according to the building diagram specified in Item A7. �'"'a= > Benchmark Utilized Citv of Clearvvater E-06 Vertical Datum NAVD 88 � Q � �p Conversion/Comments Citv of Clearwater Benchmark E-06 Elevation=22.63 feet NAVD 88 � p � Check the measurement used. � � f=- � a) Top of bottom floor(including basement,crawl space,or enclosure floor)_ 27.48 �feet ❑meters(Puerto Rico only) �; � � �' b) Top of the next higher floor 39.36 �feet ❑meters(Puerto Rico only) � � � � c) Bottom of the lowest horizontal structural member(V Zones only) NA. ❑feet ❑meters(Puerto Rico only) �0 - d) Attached garage(top of slab) NA. �feet ❑meters(Puerto Rico only) � � o � �W e) Lowest elevation of machine ry or e qui pment servicin g the building 28.07 �feet ❑meters(Puerto Rico only) � �-� -� -, f (Describe rype of equipment in Comments) �, - f) Lowest adjacent(finished)grade(LAG) 27.13 �feet ❑meters(Puerto Rico only) �r� g) Highest adjacent(finished)grade(HAG) 27.61 �feet ❑meters(Puerto Rico only) _�, 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. 1 certify that the information on this Certificate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishab/e by fine or imprisonment under 18 U.S. Code,Section 1001. ``"````�>-• ., � ' �,, r;�' � Check here if comments are provided on back of form. i ,- �� -- ,rM ��. +�+�,�� ' 'F�M Certifier's Name Terry D.Ferguson License Number LS4535 •�' � � �tle Professional Surveyor and Mapper Company Name Compass Point Surveyors,LLC ° ;, �-° �` 7�:G 7�°� �� Hddress 50 S.Belceher Road,Suite 114 City Clearvvater State FI ZIP Code 33765 % ��'�( , ' ,k!n��,+ ;.�' -• ., ;;• � Sig e Date 08/20/08 Telephone (727)230-9606 ''�,:"�: `'` ' ,� '�� _';d�.�:i, . , �; •,t �s FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces ali previous editions � 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. Policy Number 940 Corart Street City Cleanvater State FI ZIP Code 33756 Company NAIC Number SECTION D-SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agenUcompany,and(3)building owner. Comments C2.e) Electrical Transformer concrete pad. Last field survey date for FEMA Elevation Certificate:8/20/08 Si � Date 08/20/08 � Check here if attachments SECTION E-BUILDING LEV TION 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. E1. 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,crawl space,or enclosure)is ❑feet ❑meters ❑above or 0 below the HAG. b)Top of bottom floor(including basement,crawl space,or enclosure)is . ❑feet ❑meters ❑above or❑ below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9(see page 8 of Instructions),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 servicing the building is ❑feet ❑meters ❑above or❑below the HAG. E5. Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. 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. �operty Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑Check here if attachments 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.and G9. 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.-G9.)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: ❑ New Construction ❑Substantial Improvement G8.Elevation of as-built lowest floor(including basement)of the building: _❑feet ❑meters(PR)Datum G9.BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters(PR)Datum Local Official's Name Title Community Name Telephone Signature Date mments ❑Check here if attachments FEMA Form 81-31, February 2006 Replaces all previous editions � Building Photographs See Instructions for Item A6. For Insurance Company Use: uilding Street Address(including Apt., Unit,Suite, and/or Bldg. No.)or P.O. Route and Box No. Poi�cy Number 940 Court Street City Clearwater State FI ZIP COd2 33756 Company NAIC Number If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two 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." If submitting more photographs than will fit on this page, use the Continuation Page, following. Photo Date: 8/20/08"Front View"or North Elevation of Residence Inn ��--- �,. � � � � � ��-��. �� !�"" � ��; .. ��.�� `��;., . ..,,R �' ��-`.�� M% � �i �� ; . �! �� .r , =-..� �� ` �a, �■ � ■■ �' =�- � ""�r �� `M, 4!� �. r ■■ } �■ � , �� -__ _ . �� ,r ,_ �� ''�: -,�.-,��'`�� "�� .�- , ,-�.._,�_'� ��/ lA� ,�' � _ � .::� %f ■■ �� a �."' ._.-._.-_. . 1' A � ; �- _ __ b� ,. � < �t�l �� I� . . �.�,�—�� 1 ; �� ■■ ■R ■■ �■ � �� s, <. _ ■� �I��! —7-�� t « • � . � . � �r ��. � �� ., --_ �! S t � , �� * '-, :�� i11R=� � �� : � ?�� _ � �■ � , . . .,.r �� ; .�`.�; �, ,�_ _ c � ■■ . : � ., `��;. _' ,� �� . . , , , + - �t , ffi , ._. � . 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