635 GULFVIEW BLVD'�..:
DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
ELEVATION CERTIFICATE OMB Control Number: 1660-0008
IMPORTANT: FOLLOW THE INSTRUCTIONS ON PAGES 9-16 Expiration: 11/30/2018
opy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agenUcompany, and (3) building owner.
SECTION A- PROPERTY INFORMATION FORM INSURANCE COMPANY USE
A1. Building Owner's Name
CLEARWATER GRANDE DEVELOPMENT, LLC Policy Number:
A2. Building Street Address (inciuding Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Company NAIC
Box No.
635 S. GULFVIEW BLVD. (PARKING GARAGE/HOTEL BUILDING) Number:
City CLEARWATER State F� Zip Code 33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
TAX PARCEL ID # 17-29-15-05004-003-0080, LOTS 8, 9, 10 8� 11, BLOCK C, BAYSIDE SUBDIVISION PB 3S PG 38
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Non-Residential
A5. Latitude/Longitude: Lat. 27 °58'01.0 "N Long. 82°49'33.6"V1�'�orizontal Datum: 6^ 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 C
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) 1574 sq ft a) Square footage of attached garage N/A sq ft
b) Number of permanent flood openings in the b) Number of permanent flood openings
crawlspace or enclosure(s) within 1.0 foot in the attached garage within 1.0 foot
above adjacent grade � above adjacent grade N/A
c) Total net area of flood openings in A8.b 0 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 t�' No
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number 62. County Name 63. State
CITY OF CLEARWATER 125096 Pinellas FL
B4. Map/Panel Number 65. Suffix B6. FIRM Index Date 67. FIRM Panel Effective/ B8. Flood Zone(s) Bg. Base F►ood Elevation(s)
Revised Date (Zone AO, use base flood
depth
12103C0104 G 08/18/2009 09/03/2003 AE 8 VE AE 12, VE 13
B10. Indicate the source of the Base Fiood Elevation (BFE) data or base flood depth entered in Item B9:
R"' FIS Profile (�° FIRM P"' Community Determined (' Other/Source:
B11. Indicate elevation datum used for BFE in Item B9: �"' NGVD 1929 �" NAVD 1988 tr" Other/Source:
612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? �'"' Yes �' No
Designation Date: tf"' CBRS f OPA
SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ("' Construction Drawings' �'"" Building Under Construction' P�" Finished Construction
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.
A new Elevation Certificate will be required when construction of the building is complete.
Benchmark Utilized: CITY OF CLEARWATER "F-02" Vertical Datum: ELEVATION 4.0574' NAVD88
Indicate elevation datum used for the elevations in items a) through h) below. E" NGVD 1929 (� 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) 7' 3 ('�'- feet t"°' meters
b) Top of the next higher floor 16 - 0 � feet (� meters
c) Bottom of the lowest horizontal structural member (V Zones only) 15 - 3 �:'' feet � meters
d) Attached garage (top of slab) N�A - � feet C' meters
e) Lowest elevation of machinery or equipment servicing the building 17 - 0
(Describe type of equipment and location in Comments) � feet C` meters
f) Lowest adjacent (finished) grade next to building (LAG) 5- 9 (% feet k�' meters
g) Highest adjacent (finished) grade next to building (HAG) 7- 3 (: feet �' meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including 6- 0
structural support �' feet � meters
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Page 3 of 15
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PLANNING 8 DEVELOPMENT DEPT
635 S GULF1/IE1A/ BLYD
BCP2014-07307
NEW
HAMPTON INN
Zoning: Tourist Atlas #: 285A
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SECTION D -
ELEVATION CERTIFICATE
OMB Control Number: 1660-0008
Expi ration: 11 /30/2018
certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify
the information on this Certificate represents my best efforts to interpret fhe dafa availab/e. i understand that any fals�,s�atement.,�nay be
shable by fine or imprisonment under 18 U.S. Code, Section 1001.
� Check here if attachments.
Certifier's Name
ALBERT P. CARRIER
Title
PSM
Address
565 S. HERCULES AVE.
Signature � /�
Were latitude and longitude in Section A
provided by a licensed land surveyor?
�' Yes �°' No
License Number
PSM 6488
Company Name
DEUEL 8 ASSOCIATES
City State Zip Code
CLEARWATER FL 33764
Date Telephone
Field: 9/OS/2016 (727) 822-4151
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:.opy both sides of this Elevation Certificate for (1) community official, (2) insurance agenUcompany, and (3) building owner.
Comments (including type of equipment and location , per C2(e), if applicable)"
A5: Latitude and longitude were determined by using Google Earth.
A8 Enclosure areas consist of several stairwells 8 elevator shafts
C2a) Elevation is ground floor
C2b) Elevation is floor of 2nd level
C2e) Elevation is bottom of domestic water pump electric motors on 2nd level. Air conditioner platForm is at elevation
20.2 feet.
Additional information: bottom of elevator shaft elevation = 2.3 feet
NOTE: Plansl�nce "shear wall" along west wall of northwest corner enclosure (not fieid verified by this firm).
- . . . �
�nature � Date
SECTION E- BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BF
For Zones AO and A(without BFE), complete Items E1 -E5. If the Certificate is intended to support a LOMA or LOMR-F request, comple
Sections A, B,and C. For Items E1 -E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters.
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
b) Top of bottom floor (including basement, crawlspace,
or enclosure) is
- r" feet �'"' meters
- (' feet �" meters
� above or � below the HAG.
� 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 - G� feet �' meters � above or � below the HAG.
E3. Attached garage (top of slab) is
� feet 6'° meters � above or � below the HAG.
E4. Top of platform of machinery and /or equipment
servicing the building is - (•" feet P' 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
Property Owner or Owner's Authorized Representative's Name:
Address
Signature
Comments
FEMA Form 086-0-33 (7/15)
City
Date
State
Telephone
Replaces all previous editions.
ZIP Code
� Check here if attachments.
Page 4 of 15
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BUILDING PHOTOGRAPHS
See instructions for Item A6 OMB Control Number: 1660-0008
Expiration: 11 /30/2018
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE GC�MPANY USt
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
635 S. GULFVIEW BLVD. (PARKING GARAGE/HOTEL BUILDING) Policy Number:
City CLEARWATER State �L Zip Code 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. u�e the C�ntinua?ion F��t
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FRONT VIEW (NORTH SIDE) 9/13/2016
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REAR VIEW (SOUTH SIDE) 9/13/2016
LEFT VIEW (EAST SIDEI 9%1312016
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FEMA Form 086-0-33 (7/15) Replaces all previous editions. Page 6 of 15
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A
V ZONE DESIGN CERTIFICATE
Name Policy Number (Insurance Co. Use)
Building Address or Other Description: 655 S. GULFVIEW BOULEVARD
Permit No.: 2014-06256 City: CLEARWATER State: FLORIDA Zip Code: 33767
SECTION I: Flood Insurance Rate Map (FIRM) Information
Community No.: 125096 Panel No.: 12103C0104 Su�x: G FIRM Date: 9/03/2003 FIRM Zone(s): AE VE
SECTION 11: Elevation Information Used for Design
[NOTE: This section documents elevafions used in the design - it does not substitute for an as-built Elevafion Certificate.J
1. Datum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... � NGVD X NAVD ❑ Other
2. Elevation of the Bottom of Lowest Horizontal Structural Member .................. .............. 15.25 feet above datum
3. Base Flood Elevation (BFE) ................................................................................ 13 feet above datum
4. Elevation of Lowest Adjacent Grade ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..... 5.75 feet above datum
5. Approximate Depth of Anticipated Scour/Erosion used for Foundation Design ... ...... ...... 4.2 feet above datum
6. Embedment Depth of Pilings or Foundation Below Lowest Adjacent Grade ... ... ............ -45 feet above datum
SECTION III: V Zone Design Certification Statement
(NOTE. This section must be certified by a Florida licensed engineer or architect.J
I certify: (1) that I have developed or reviewed the structural design, plans, and specifications for construction and (2) that the
design and methods of construction to be used are in accordance with accepted standards of practice for meeting the
following provisions:
• The bottom of the lowest horizontal structural member of the lowest floor (with the exception of mat or raft
foundations, piling, pile caps, columns, grade beams and bracing) is elevated to or above the BFE in accordance
with the requirements of the Florida Building Code and local floodplain management regulations; and
• The pile and column foundation and building or structure to be attached thereto is designed in accordance with the
Florida Building Code to be anchored to resist flotation, collapse, and lateral movement due to the effects of the wind
and flood loads acting simultaneously on all building components, and other load requirements of the Florida
Building Code. The potential for scour and erosion at the foundation has been anticipated for conditions associated
with the base flood, including wave action.
SECTION IV: Breakaway Wall Design Certification Statement
[NOTE. This section must also be certified by a Florida licensed engineer or architect when breakaway walls exceed a design safe loading
resistance of 20 pounds per square foot. This requi�ment does not apply to open wood/plastic lattice/slats/louvers or insect screening.]
I certify: (1) that I have developed or reviewed the structural design, plans, and specifications for construction and (2) that the
design and methods of construction to be used for the breakaway walls are in accordance with the Florida Building Code,
Building (ASCE 24) or Florida Building Code, Residential, as applicable, and accepted standards of practice.
SECTION V: Certification and Seal
This certification is to be signed and sealed by a Florida licensed professional engineer or architect autho ��Q
certify structural designs. l certify the V Zone Design Certification Statement in Section lll and the Breaka���[3��n
Certification Statementin Section IV (ifapplicable). ,``,`,��������r���,''
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Florida Model V Zone Design Certificate (April 16, 2012)