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2635 MCCORMICK DRU.S.DEPARTMENTOFHOMELANDSECURITY ELEVATION CERTIFICATE FEDERi4L EMERGENCY MANA6EMENT AGENCY Na�onal Flood Insumnu Program IMPORTANT: Follow the instructions on pages 1-9. SECTION A — PROPERTY INFORMATION A1. Building Owner•s rvame Lasalle Realty, LLC A2. Buildin Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No 2�35 McCormick Dr �'�' Ciearwater State F� OMB No. 1660-0008 Expiration Date: July 31, 2015 WR INSURANCE COMPANY USE Policy Number: Comparry A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 4, Prestige Park, Plat Book 110, Pager 35 A4. Building Use (e.g., Residential, Non-Residen�jal, Addition, Accessory, etc.) Comme�Cial A5. Latitude/Longitude: Lat. 2%'SG'.SZ. Z'� Long. �i ,�- �',i2- Ll 7 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 1A A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enciosure(s) N�A sq ft a) Square footage of attached garage N�A sq ft b) No. of permanent flood openings in the crawlspace or N�A b) Number of permanent flood openings in the attached garage enciosure(s) within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade Nl/�A c) Total net area of flood openings in A8.b N�A sq in c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No SECTION B— FZOOD INSURANCE RATE MAP (FlRM) INFORMATION 61. Number Name State B4. Map/Panel Number 65. Suffix 86. RRM Index Date B7. RRM Panel Effective/ 68. Flood Zone(s) B9. Base Flood Elevation(s) (Zone Revised Date AO, use base flood depth) 12103C0126 G 09/03/2003 AE 8� X 81.00 610.Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69: ❑ FIS Profile � FIRM ❑ Community Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes � No Designation Date: / / ❑ CBRS ❑ OPA SECTION C— BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* � 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. eenchmark Utilized: S.W.F.W.M.D. 22698B Vertical Datum: N.A.V.D.'88 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE_ a) Top of bottom floor (including basement, crawlspace, or enclosure floor) b) Top of the next higher floor c) Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) fl Lowest adjacent (finished) grade next to building (LAG) g) Highest adjacent (finished) grade next to building (HAG) h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 86 , 50 85 00 N/A N/A 86 26 85 . 00 86 , 12 85 . 10 Check the measurement used. � feet ❑ meters � feet ❑ meters ❑ feet ❑ meters ❑ feet ❑ meters ❑ teet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters SECTION D— SURVEYOR, ENGINEER, OR ARCHITECT CERTIFlCATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certity elevation " information. 1 Certify that the infoimation on this Certificate represenis my besi efforts to interpret [he data available. 1 /) 1 understand [hat any false sta[ement may be punishable by fine or imprisonment under 18 U.S. Code, Section 5001. `�'`Q �. w�� f%f� , ❑ Check here if comments are provided on back of form. Were latitude and longitude in ection A provided by a ti`` J�.-••'� �� u�' ✓��Tr,.. ` ❑ Check here if attachments. licensed land surveyoi? Yes ❑ No *:` ;`� $ T��.• � i �.. n Certifier's Name License Number d.+ �j J�� � ... �s David F. Peach _ LS 5931 _, xY,�.� , �_�' Title President Address 7408 Avonwood St. FEMA Form 086-Q33 (7/12) Company Name Impact Surv� City Tampa Date 07/18/2015 and Ma pin , Inc. =;� " �.����y'` ���� e"= State ZIP Code �' "-.'-. h`�'�� . a,1 FI 33625 '� ,e ...� ��/ �• �, ��' Telephone � �� � ��y [,�,�t �A (727) 433-0987 ����, � �, ,���, See reverse side for continuation. Replaces all previous editions. ELEVATION CERTIFICATE, page 2 IMPORTANT: In these spaces, copy the corresponding i�ormation from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P0. Route and Box No. 2635 McCormick Dr city Clearwater State ZIP Code FI FOR tNSURANCE COMPANY USE Policy Number: compa�y Nnic rvu�,e►: SECTION D— SURVEYOR, ENGINEER, OR ARCHITECT CERTIFlCATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments C2(e). Elevation of air conditioner pad located on East side of building. Signature oate ���� 8�2015 SECTION E— BUILDIPTG 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. 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 ❑ 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 fr9 with permanent flood openings provided in Section A Items S 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 ❑ 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? 0 Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F— PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFlCATION 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 Signature Comments City Date State ZIP Code Telephone ❑ 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-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 elevatio� 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 FEM{Nssued or community-issued BFE) or Zone A0. 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 Datum G9. BFE or (in Zone AO) depth of flooding at the building site: . ❑ feet ❑ meters Datum G10.Community's design flood elevation: Local Official's Name Community Name Signature Comments FEMA Form 086-Q33 (7/12) Title Telephone Date ❑ feet ❑ meters Datum ❑ Check here if attachments. Replaces all previous editions. ELEVATION CERTIFICATE, page 4 BUILDING PHOTOGRAPHS Continuation Page IMPORTANT: In these spaces, copy the corresponding iriformation from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or PO. Route and Box No. Policy Number: 2635 McCormick Dr City State ZIP Code Company NAIC Number: Clearwater FI If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify ail 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. �� $���'e� ��� �..,� �.: ���i,'`-� : �{���w„ .��' ��`-�`�-: � - _. i� - . -.� ��*� , � ��'-�"> � ,.� ' � �:, >-t .m.. �-`ga•. ; d§r �'��-. .�f .s '. ��,� ,z-4 . _ .� . �_-.. . v. ,Y� � �'2�efi.�„�','fi � � � . � _�.�m� ._ ..' �£Ma� �[.. t � � . .. ' .. . _. `� d ;6.}., . .x _ � � �� ..� ?� k . - - ` . ° �%��� � �- a � -+� . ... . , .� �.:�.. �'i'�-y+_ �. �: � yd '_"..: ;�- "" ,. r� ", ,�, ; _ _ � '�' � . ��"�� � -. � � '� . . "5.. �;;:r . ,�a� � - � � , � -�� ' � :- � .�`"-'_," . . ,� � �.,� , s . : -�' �E�o n ��� - .��°� ._� � � _. --.. '-'_:� 9..._ - = ::: - - - ` - " ° �?-� � REAR VIEW �_� .� � x ,� - „u. . � � �X � �� �: � �, R�f, ;`,.�°'..�.�.;.'..,x^�` `-„ -t '�, sz" -',�'„.. �_ < __ +��._ , �� : �' ���� ��4{ : .- .. _. -.,� '-=.> ' .. �� -;;, "'"•c.,. :' - '_� � :�. �*'� '- _ FEMA Form 086-Q33 (7/12) Replaces all previous editions. ELE�lATION CERTIFICATE, page 3 BUILDING PHOTOGRAPHS See Instructions for Item A6. IMPORTANT: In these spaces, copy the corresponding information hom Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P0. Route and Box No. Policy tvumber: 2635 McCormick Dr City State ZIP Code Company NAIC Number: Clearwater F� 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. ��'� � � �� ��� � ��` � '� � ��� � `�`� _�' � �' � � � � s" '' � �� �, �, � �e � r .>��__ xs � - � � "��j,r � ��'` �`. � �� �`,'� a`. + { +��, ��F ° � � -� sy+ � akt'"� ���F � ' �' �, � � "`,� ` ' t "�� �'- .� `: ,��' �.� a�.� ,,'�c. ��..,�,,_�: � � � �`- � �� � �� s� ��.`�, . u ... � i 's .� � � � � �; °�, � � '� � ., ����� � • ,� � ' .- � .� ' .�, �sc u. ��� . _ � _. — �.,:. f -#v}€wz � s ,. � �"� � � ���� - - .� m E �� �� � °' . - � .; ' i � , � � � _ �� � � �p ; %� " - . � '. 4 y „�, ' � b�. �a� F �� � k • � � �� "�,+ �. ' • � a rv �Yr� ,� .--.- ..,�y^` 4a-v "�' � �. �"�£ � �f� e{ '.t. . E — . .�. � � _ .�' '� � �` ' •�� .�����:�a� �_ �'�. � � � ,� 1 � ��$ � : . �"�; � � x _. � ��' a, °�"� ��`����-���`�, ��`�� �� FRONT VIEW FEMA Form 086-Q33 (7/12) Replaces all previous editions.