678 GULFVIEW BLVD S U.S.DEPART�AENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB N0. 1660-0008
Federa�cmergency Management Agency Expires March 31, 2012
Natidnal Flood Insurance Program Important: Read the instructions on pages 1-9.
SECTION A-PROPERTY INFORMAT'^"'
A1. Building Owner's Name BAYWAY HOTEL HOLDINGS,LLC
A2. Building Street Address(including Apt., Unit,Suite,and/or Bldg.No.)or P.O. Route and Box No. �� �� �
678 C SOUTH GULFVIEW BOULEVARD
City CLEARWATER State FL ZIP Code 33767
A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.)
BAYSiDE SUBDIVISION NO.5 LOT 13 BLOCK B,PB 38 PG 38
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)NON-RESIDENTIAL
A5. LatitudelLongitude: Lat.N 27 58 02 Long.W 82 49 28 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 6
A8. For a building with a crawispace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) 1003 sq ft a) Square footage of attached garage 0 sq ft
b) No.of permanent flood openings in the crawlspace or b) No.of permanent flood openings in the attached garage
enclosure(s)within 1.0 foot above adjacent grade 0 within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in AB.b 0 sq in c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61.NFIP Community Name&Community Number B2.County Name 63.State
CITY OF CLEARWATER 125096 PINELLAS FLORIDA
B4. Map/Panel Number 65.Su�x B6.FIRM Index 67. FIRM Panel B8. Flood B9.Base Flood Elevation(s)(Zone
12103C0104 G Date Effective/Revised Date Zone(s) AO,use base flood depth)
8-15-09 9-3-03 AE 11'
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69.
❑ FIS Profile � FIRM ❑ Community Determined ❑ Other(Describe)
611. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other(Describe)
612. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes Q �
Designation Date ❑ CBRS ❑ OPA ` N
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SECTION C-BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) J � �
m � �
J R5
C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction' � Finished Co � U �
*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. Comple W C] z
below according to the building diagram specified in Item A7. Use the same datum as the BFE. �`'n pJp p
Benchmark Utilized PIN C.O. DISK AURAL A Vertical Datum NAV DATUM 1988 ELEV=11.82 '� N I- �
Conversion/Comments � p p J
Check the measurement used. _ � � W
a) Top of bottom floor(including basement,crawispace,or enclosure floor)6.5 �feet ❑meters(Puerto Rico only) � � O
b) Top of the next higher floor 16.4 �feet ❑meters(Puerto Rico only) � � � _
c) Bottom of the lowest horizontal structural member(V Zones only) N/A. ❑feet ❑meters(Puerto Rico only) (/) �y p Q �
d) Attached garage(top of slab) N/A. ❑feet ❑meters(Puerto Rico only) � a. � � �'
e) Lowest elevation of machinery or equipment servicing the building 10.5 �feet ❑meters(Puerto Rico only) � (� �.W- Q o
(Describe type of equipment and location in Comments) � m z m N
� Lowest adjacent(finished)grade next to building(LAG) 5.6 �feet ❑meters(Puerto Rico only)
g) Highest adjacent(finished)grade next to building(HAG) 6.2 �feet ❑meters(Puerto Rico only)
h) Lowest adjacent grade at lowest elevation of deck or stairs,including N/A. ❑feet ❑meters(Puerto Rico only)
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. 1 certify that the information on fhis 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. � ":�'��
� C h e c k h e r e i f c o m m e n t s a r e p ro v i d e d o n b a c k o f f o r m. W e r e l a t i t u d e a n d l o n g i t u d e i n S e c t i o n A p r o v i d e d b y a i''�93� �a���r 3', ,+ �=,i`�.
licensed land surveyor? � Yes ❑ No �° �. ,''�,�����-� '
Certifier's Name LAUREN R.PENNY License Number #4931 �`�'4���' _
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Title LAND SURVEYOR Company Name L. R.PENNY&ASSOCIATES, INC. � `K "`'
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Address 10730 102 AVE N City SEMINOLE State FL ZIP Code 33778 ,•°"
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Signature Date�_ Telephone 727-398-4360 d?;?6_F�/C�"'`�
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FEMA Form 81-31, Mar 09 See reverse side for continuation. Replaces all previous editions
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.
678 C SOUTH GULFVIEW BOULEVARD
City CLEARWATER State FL ZIP Code 33767
SECTION D -SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for(1)community o�cial,(2)insurance agenUcompany,and(3)building owner.
Comments LOWEST ELEVATED MACHINERY IS AN ELECTRICAL OUTLET
� 2- 6-2aia
Signature Date
❑ Check here if attachments
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 oniy,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,crawlspace,or enclosure)is ❑feet ❑meters ❑above or 0 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 9(see pages 8-9 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 0 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 officiai 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, 8, and E are correct to the best of my knowledge.
Property 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 officiai who is authorized by law or ordinance to administer the community's floodplain management ordinance can compiete 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 CompliancelOccupancy 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
G10. Community's design flood elevation ❑feet ❑ meters(PR) Datum
Local Officiai's Name Title
Community Name Telephone
Signature Date
Comments
❑Check here if attachments
FEMA Form 81-31, Mar 09 Replaces all previous editions
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Building Photographs
See Instructions for Item A6.
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Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No.
678 C SOUTH GULFVIEW BOULEVARD
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Clty CLEARWATER State FL ZIP Code 33767
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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 on the
reverse.
SEE ATTACHED SHEET OF PHOTQGRAPHS
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