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646 GULFVIEW BLVD SU.S. DFpAR*ME�IT OK'HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY Natronal Flood Insurance Program Ai. Building Family ELEVATION CERTIFICATE Important: Read the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 646 S GULFVIEW BLVD City Clearwater State FL 21P Code 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Parcelld#17-29-15-05004-002-0220 OMB No. 1660-0008 Expiration Date: July 31, 2015 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Commercial A5. Latitude/Longitude: Lat. 27-58-010 Long. W82--49-320Horizontal 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 1b A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) n/a sq ft a) Square footage of attached garage n/a sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s) within 1.0 foot above adjacent grade n/a within 1.0 foot above adjacent grade n/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- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name g3, City of Clearwater, 125096 Pinellas FL B4. Map/Panel Number B5. u�x B6. FIRM Index Date B7. FIRM Panel B8. Flood 12103C0104G G 8/18/2009 Effective/Revised Date Zone(s) 9/3/2003 AE 11 610. 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: 612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? Designation Date: n/a ❑ CBRS ❑ OPA AO, use base flood 11.00 ❑ Yes � No 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. Benchmark Utilized: RTK Vertical Datum: navd 1988 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 ❑ OthedSource: Datum used for building elevations must be the same as that used for the BFE. a) Top of bottom floor (inGuding basement, crawlspace, or enclosure floor) b) Top of the next higher floor c) Bottom of the iowest horizontal structural member (V Zones oniy) d) Attached garage (top of slab) e) Lowest etevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) � 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 7.63 n/a. n/a. n/a. n/a. 5.5 6.3 Check the measurement used. � feet 0 meters ❑ feet ❑ meters ❑ feet ❑ meters ❑ feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters , ❑ 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. 1 certify that the information on this Cerfificate represents my best efforts to interpret the data available. v � I understand that any fa/se statement may be punishable by �ne or imprisonment under 18 U. S. Code, Section 1001. � , f„ G,Rj ❑ Check here if comments are provided on back of fortn. Were latitude and longitude in Section A provided by a �+ �= r{,r-. '- 0 Check here if attachments. licensed land surveyor? � Yes ❑ No ,�, .`� :'s�� �� Certifier's Name Title President Address P.O. BOX Signature /J,, FEMA Form 086-0-33 (7/12) Name AFN Consulting, Inc. �n Antonio 9/30/2015 e Number LS 5392 FL ZIP Code 33: ione 813-503-3228 See reverse side for continuation. t -. �'3 '..' fl�+�, �.�� �/ � ` f � 'u � �Lg�t€�A .-�. `.ti' ',ss `• • �v �� ''l�,.� �'. .:i.. ' r�;' .a .�� J�t� �il�� ,�\e erc�� Replaces all previous editions. LEVATIO�1 CERTiFICATE, page 2 IMPORTANT: In these spaces, copy the correspondir Building Street Address (including Apt., Unit, Suite, and/or Bldg. 646 S GULFVIEW BLVD City Clearwater information from Section A. �.) or P.O. Route and Box No. State FL ZIP Code 33767 SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments None � y/30/1U15 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. E1. Provide elevation information for the foilowing 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 (inciuding 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 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 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. Property Owner's or Owner's Authorized Representative's Name Address Signature Comments City Date State Telephone ZIP Code 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 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 buildin� 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: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-built lowest floor (including basement) of the building: ❑ feet G9. BFE or (in Zone AO) depth of flooding at the building site: G10. Community's design flood elevation: Local Official's Name Community Name Signature Comments FEMA Form 086-0-33 (7/12) ❑ feet ❑ feet r�(iC� Telephone Date ❑ meters Datum ❑ meters Datum ❑ meters Datum Check here if attachments. Replaces all previous editions. ELE�/AiION CERTlFICATE, page 3 guilding Photographs See lnstructions ior ftem A�. IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Sfreet Address (including Apt., Unit, Suite, and/or Bidg. No } or P.O. Route and Box No. 646 S GULFVIEW BLVD Gity Clearwater State FL ZIP Code 33767 FOR iNSURANCE COMPANY USE Poiicy hfumber Company NAfC !f using the Elevation Certificate to obtain NFlP flood insurance, a�x at least 2 buiiding photographs bsiow according to th� 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 app{icabfe, photographs must show the foundaiion with representat�ve exarrtpEes of tf�e f�oocf oper��r�gs oe vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. ,�.�;: ;� e.,�,�,� r�,n•�••�...° �.,,�.-�� � ��"°�� � ,�_,�-�,� -,��'' _,.�t� � r���.-. -�`` .. . �� Fa`-ii F . i � ..« j , , `�', , �.x, . , �,.�`°�: � � � � ■� ..: .�x�.�:.. �a�x�,,. �..., . ' `; . x �. aw�s �► w..�s�a ' ". �»_»m.... -r. �= � _ ... t� �. � t � �xwr - �.� ��wWM . 4� F� r� �a . .xnmrs�oc. r i �F � � , � �" , � �Is '?� ��� � �� � - t - - � I �".� ,� � «� � � z � � `� . .,..�.- �ri9 � ��iC�" ; i Ge".�; �_�a � .� � � ., �� c::: .M.�- �rc. ,�. - _ � . � -°- �'°- i . , � . . . ..y-„�...v.,. � � �..,�m. � .� w _ .. . `' ms� ,.,,a� , . _.. .... .. �. �;°,',+e�.1�'� 1..� ".'� � � � � �� z} �. r � . < -,� . ,.. ���� .�� .., , i � a �� _ .i, �. 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ELEVr4T1'ON�^ERTIFICATE, page 4 guilding Photographs Continuation t�age {MPORTAiVT: In thesc spaces, copy the ccrresponding informatior fram Section A. _._ _. _ _ __------- __ _--- - -. __ . _ - ------ __ —__--- --_ . _... _ Building Street Address (inGuding Apt., Unit, Suife, and/or Bidg. No.) or P.O. Route and Box No. 846 S GULFVIEW BLVD City Ciearwater State FL ZiP Code 337&7 FdR INSIiRr'1CJCE CO{ViPAi�fY USE Poiicy Number. !C i�Iumbe�: if submitting more photographs than wiil fit on the preceding page, affix the additional photographs beiow. identify all photographs with: date taken; °Front View" and "Rear View°; and, if required, "Right Side View" and "Left Side View." When applicable, phoYographs must show the foundation with res�resen#ative examples �f the flc�od openings or vents, as inclicated in Sectio�? 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