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505 GULFVIEW BLVD SU.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. OMB No. 1660-0008 Expiration Date: November 30, 2018 Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Decade Gulfcoast Hotel Partners Policy Number: A2. BuilBuildin No. Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and 505 South Gulfview Blvd Company NAIC Number: City State ZIP Code Clearwater Florida 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Parcel 17-29-15-00000-220-0200; Multi -Story Parking Garage A4. Building Use (e.g., A5. Latitude/Longitude: A6. Attach at least A7. Building Diagram A8. For a building a) Square footage b) Number of permanent c) Total net area d) Engineered A9. For a building with a) Square footage b) Number of permanent c) Total net area d) Engineered Residential, Non -Residential, Addition, Accessory, Lat. 27° 58' 06.04" N Long. 82° 49' 42.44" etc.) Non -Residential W Horizontal Datum: insurance. above grade ❑ NAD 1927 adjacent grade N/A x NAD 1983 0 2 photographs Number with a crawlspace of crawlspace flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? of the building if the 6 Certificate is being used to obtain flood 7985.50 sq ft or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b or enclosure(s) 0.00 sq in within 1.0 foot 1.0 foot above adjacent in N/A sq ft ❑ Yes x No garage: garage openings in the attached garage within in A9.b N/A sq ❑ Yes x No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number City of Clearwater & 125096 B2. County Name Pinellas B3. State Florida B4. Map/Panel Number 12103C0104 B5. Suffix G B6. FIRM Index Date 08-18-2009 B7. FIRM Panel Effective/ Revised Date 09-03-2003 B8. Flood Zone(s) AE & VE B9. Base Flood E evation(s) (Zone AO, use Base Flood Depth) 12, 13, 14, & 16 B10. Indicate the source of the Base Flood Elevation ❑ Community Determined for BFE in Item 139: Coastal Barrier Resources ❑ (BFE) data or base flood ❑ Other/Source: depth entered in Item B9: ■ FIS Profile x FIRM datum used located in a B11. Indicate elevation B12. Is the building Designation Date: ❑ Other/Source: Protected • NGVD 1929 x NAVD 1988 System (CBRS) area or Otherwise CBRS ❑ OPA Area (OPA)? ❑ Yes x No FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 :7 505 S GULFYIEW_OLVD BCP2014-1 EC GUEST HOUSE Zoning. Tourist #: 285A ELEVATION CERTIFICATE• OMB No. 1660-0008 .-nianctuvll vale. 19UVCI I IUCI )U, CU 10 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. 505 South Gulfview Blvd Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under 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, Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only, Benchmark Utilized: F-02 Vertical Datum: NAVD 1988 x Finished Construction AR/AH, AR/AO. enter meters. Indicate elevation datum ❑ NGVD 1929 used x for the elevations in items a) through h) below. NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 6.31 x the measurement feet • used. meters b) Top of the next higher floor 19.76 x feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) 17.40 x feet • meters d) Attached garage (top of slab) N/A x feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) 18.72 x feet meters ❑ f) Lowest adjacent (finished) grade next to building (LAG) 5.40 x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 6.47 ❑x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 3.93 x feet ❑ meters SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect I certify that the information on this Certificate represents my best efforts to interpret statement may be punishable by fine or imprisonment under 18 U.S. Code, Section Were latitude and longitude in Section A provided by a licensed land surveyor? x authorized by law to certify elevation information. the data available. I understand that any false 1001. Yes ❑ No ❑ Check here if attachments. Certifier's Name License Number M. Arnett LS6884 ,s,-°0," v ~` _ .- •0 � - t`ti 0;f. *'r I , ' `" ` /►• .- +k c,r);„ �'/, � n�4st rCharles w{ r ^' ,r r,fTitle �i� � ♦ r f `s , < <. ` b ��r Acs `—,,„,' Project manager Company Name Southeastern Surveying and Mapping Address 10770 N 46th St, Ste C-300 City State ZIP Code Tampa Florida 33617 Signature A Date Telephone Ext. `411 ri.lwrx*”' 06-30-2017 (813) 898-2711 Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) C2a) Be advised there is an elevator sump pit with a finished elevation of 2.39 C2b) Grade is at the east entry to parking garage structure. C2e) Grade is the bottom of electrical outlets in the storage areas near the east corner of the building. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: 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. 505 South Gulfview Blvd Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIC Number 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 complete Sections A, B,and C. For Items E1—E4, use natural grade, if available. Check the measurement enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters LOMA or LOMR-F request, used. In Puerto Rico only, the elevation is above or below ❑ above or ❑ below the HAG. above or ❑below the LAG. 9 (see pages 1-2 of Instructions), ❑ above or ❑ below the HAG. above or below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is❑ feet • meters E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters E3. Attached garage (top of slab) isfeet ❑ ❑meters 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 this information in Section G. floodplain management ordinance? • Yes ❑ No ❑ Unknown. The local official must certify 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 City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 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. 505 South Gulfview Blvd Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIC Number 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 building 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: ❑ G8. Elevation of as -built lowest floor (including of the building: G9. BFE or (in Zone AO) depth of flooding at the G10. Community's design flood elevation: New Construction ❑ Substantial Improvement basement) ❑ feet ❑ feet ❑ feet ❑ meters Datum building site: ❑ meters Datum ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) • Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. OMB No. 1660-0008 Expiration Date: November 30, 2018 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. 505 South Gulfview Blvd Policy Number: City State ZIP Code Clearwater Florida 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, use the Continuation Page. s ■ i 1 • .ae - Photo One Photo One Caption Front View Clear Photo One ...rimtl . 111 i„ kit1 I t p e e r ;; ,....._ 0\ II ., • \i‘ i• 1 pp •-,.. Photo Two Photo Two Caption Rear View Clear Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS OMB No. 1660-0008 Continuation Page Expiration Date: November 30, 2018 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. 505 South Gulfview Blvd Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIC Number If submitting more photographs than will fit on the preceding page, affix the additional photographs below. 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. Photo Three Photo Three Caption Finished Floor Clear Photo Three Photo Four Photo Four Caption Lowest Electrical Outlet Clear Photo Four FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 e ! Zone des glt certificateliS not a substitutetfor do NFP EI aeon 4 Lowsst Floor Elevatfonj, whk t is required to certify asbuilt elevation ne Name V ZONE DESIGN CERTIFICATE T Pol cyNumber( PT Buitding Address or Other Deauiption r3'2'I +:• gcle 9f�t3 Zgi44 . _ CITY OF CLEAgi xEo PermfNo jBC1o2er1L-WYO . City ll.. '>IX Start.-- '; Code 3374,_• SECTION I: Flood Insurance Rate Map (FIRM) Information, :-`M. Ate is Community Na ►fb u 7 ?? panel No 3 7 P Zi 1+7Jlt RAM Date IFBAZane(s) 100/14/ P is-t+tsr` SECTION II: Elevation Information Used for R ""esi/�gn MOTE This section docunrests the e/ewtions/depths aged ei apsctaed len the r1et —'R Eos* Mot doe srrvayrd. uUoIs and is not apdwlsat to the as.auat NsneMons iegakrd *0 sa8wdtbd s dwfi� er aft; esaow.] , ;,� 1. FIRM Base Flood Elevation (BFE).' ;` f• r 7-'�' a er feet• 2. Community's Design Flood Elevation (C)FE) ' ''=" ' " f a' .. ,,,,,,,• 3. 4. 5. feet Elevation of be Bottom of Lowest Ho►izon+tal Struchual Member » ,..»» .. » Elevation of lowest Adjacent Grade » Depth of Anticipaled Soour/Erosion used for Foundaton OesIgn .N Embedment Depth 01 PNIngs or Foundation Below lowest Adjact nt Grade hrdicateelei alton datum used In 14:.. ❑ NGVD29 jiff NAVD88 O Other SECTION 3II :V Zone Design Certification Statement 1 certty;that: (1)?1 have developed or reviewed the structural design. plans. and specifications for construction of the above - referenced building and (2) that the design and methods of construction specified to be used am in accordance with accepted standards of pracdce•• for meeting be following provision: • The bottom of the lowest horizontal structural member of the lowest floor (excluding pies and columns) is elevated 10 or above the BFE The pile y_;>a nd aOkinin and attached thereto is anchored to resist • move- ment due to the elects wind and water bads acting simultaneously on al buildingflotation, 'and lateral agues components. Water loading values used are those associated with the base flood—. Wind loading values used are those marked by the applicable State or local building code. potential for and erosion at the foundation has been anticipated for conditions associated with the base flood, including SECTION IV: Breakaway Wall Design Certification. Statement NOTE Ibis sem oast re eeraeed by a regttered smfneor er architect wine baakaway walla are deelaeed to law a resistance of mors *lean 20 pet (0.96 Vm2) detanateed asiag a9ewekle stress dodo] 1 certify that: (1) 1 have developed or reviewed the structural design. plans. and specifications for construction of breakaway wale to be constructed under the above -referenced building and (2) that the design and methods of contraction specified to be used are in accordance with accepted standards of practice" for meeting the blowing provisions: • Breakaway wal collapse shall result from a water load less than that which would occur during the base flood"*. • The elevated portion of the building and supporting foundation system shal not be subject to colapse. displacement. or Seer st us ctual damage due to the effects of wind and water loads acting simultaneously on all building components (see feet. feet feet SECTION V: Certification and Seal This certification Is to be signed and sealed by a registered professional engineer or architect,aotrb'diece6¢ m certify structural designs. 1 certify the V Zone Design Certification Statement (Section III) and `, Use pasign Certification Statement (Section IV. check if applicable). U • • • O 0 Certifiers Name �.ttuu-WUN YONG License Number 61016 TetteSTRUCTURAL ENGINEER company Name GENESIS ENGINEERING Address 2201 Cantu Ct, Suis 118 city Sarasota. Siptnahure State FL Zip Code Data 02/2512015 505 S GULFVIEW BLVD BCP2014-11452 GUEST HOUSE GUEST HOUSE Zoning: Tourist Atlas #: 285A 34232 •tleV. galla Here • • • * • e • STATE OF • Telephone (941 )444-218i_ 44 21ti9 .n • 'n lt] 4-Z '• • Q` 1 • • il• 5: V ZONE DESIGN ANO CONS+TtRtiG „1TI KATION HOME BUILDER'S GUIDE TO COASTAL CONSTRUCTION 0 U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. OMB No. 1660-0008 Expiration Date: November 30, 2018 Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agenUcompany, and (3) building owner. SECTION A— PROPERTY INFORMATION FOR INSURANCE COMPANY USE A1. Building Owner's Name Policy Number: Decade Gulfcoast Hotel Partners A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number: Box No. 505 South Gulfview Blvd City State ZIP Code Clearwater Florida 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Parcel 17-29-15-00000-220-0200; Multi-Story Parking Garage A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Non-Residential A5. Latitude/Longitude: Lat. 27° 58' 06.04" N Long. 82° 49' 42.44" W Horizontal Datum: ❑ NAD 1927 ❑x 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 crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) 7985.50 sq ft b) Number of permanent flood openings in the crawispace or enclosure(s) within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b 0.00 sq in d) Engineered flood openings? ❑ Yes ❑X No A9. For a building with an attached garage: a) Square footage of attached garage N/A sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? � Yes 0 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 64. Map/Panel B5. Suffix B6. FIRM Index B7. FIRM Panel 68. Flood 69. Base Flood Elevation(s) Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth) Revised Date 12103C0104 G 08-18-2009 09-03-2003 AE & VE 12, 13, 14, & 16 610. 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 69: ❑ NGVD 1929 0 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 FEMA Form 086-0-33 (7/15) Replaces all previous editions. 505 � ��J��VI�W BLVD BCP2014-11452E EC GUEST HOUSE Zoning: Tourist Atlas #: 285A - ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding informatio� 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: 505 South Gulfview Blvd City State ZIP Code Company NAIC Number Clearvvater Florida 33767 SECTION C— BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction" x� 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: F-02 Vertical Datum: NAVD 1988 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. Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 631 � feet ❑ meters b) Top of the next higher floor 19.76 � feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) 17.40 �x feet ❑ meters d) Attached garage (top of slab) N/A � feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 18.72 �x feet ❑ meters (Describe type of equipment and location in Comments) � Lowest adjacent (finished) grade next to building (LAG) 5.40 ❑x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 6.47 �x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including 3.93 � feet ❑ meters 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 this Certificate represents my best efforts to interpret the data availab/e. 1 understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. Were latitude and longitude in Section A provided by a licensed land surveyor? ❑X Yes ❑ No ❑ Check here if attachments. Certifier's Name License Number Charles M. Arnett LS6884 `i `�'�is1%�j�'y'-' f r` , � Tltle ,; �,'y�..' y4;'�rr ,, , . ,. Project manager „� 4� � ;� � `F .; Company Name `. � � � � � � /° Southeastem Surveying and Mapping `� f a� '� {�. �4 e; :: � -E� 6 $ � ; � :: Address ;i� ;!; � �,a , u= ; 10770 N 46th St, Ste C-300 ,'� �r �'`y,� � ��+ ;y tl � � City State ZIP Code .�, `�1'�,j A '�, �`\,' �;' Tampa Florida 33617 r'%, ��y� "� ~,"��*�� A�-` �r{. s� Signature Date Telephone E�. '�f�ari��ti��'' 06-30-2017 (813) 898-2711 Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) C2a) Be advised there is an elevator sump pit with a finished elevation of 2.39 C2b) Grade is at the east entry to parking garage structure. C2e) Grade is the bottom of electrical outlets in the storage areas near the east corner of the building. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Nage z ot 6 OMB No. 1660-0008 ELEVATION CERTIFICATE Expiration Date: November 30, 20�8 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: 505 South Gulfview Blvd City State ZIP Code Company NAIC Number Clearwater Florida 33767 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 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 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 1-2 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. Property Owner or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6 OMB No. 1660-0008 ELEVATION CERTIFICATE Expiration Date: November 30, 2o�s IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No. Policy Number: 505 South Gulfview Blvd City State ZIP Code Company NAIC Number Clearvvater Florida 33767 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 building 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 ❑ meters Datum G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum G10. Community's design flood elevation: ❑ feet ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 BUILDING PHOTOGRAPHS OMB No. 1660-0008 ELEVATION CERTIFICATE See Instructions for Item A6. Expiration Date: November 30, 2018 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: 505 South Gulfview Blvd City State ZIP Code Company NAIC Number Clearwater Florida 33767 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. 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', ��' { �' ` � � ){ � s � ..�,. � � � % . � `�I��il' I ' p � !t �� i. `-� •.�, !I I �� ' � � �.. � ��I�,� �; � � � � t� '+. e ` , � � _ , �'� f � � ��. � « t g�. > k � " #y- �. ,� �• ! �' • — k �w . _ ,p. � �� . ..-,,, ; ;�:.�i � I, � � v � Phoro Two Photo Two Caption Rear View Clear Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 BUILDING PHOTOGRAPHS OMB No. 1660-0008 ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30, 2018 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: 505 South Gulfview Blvd City State ZIP Code Company NAIC Number Clearwater Florida 33767 If submitting more photographs than will fit on the preceding page, affix the additional photographs below. 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. � �r: �;� { �� ,f � �,� �� .. , . .�°` z �� w�,, s ,,.::�r:, ,, : , � m � I�I,I M �; �� ,. _ .__.. - � � .... � a=�, . �u � &,�� u. _ .x . - � �...-.... �_ t , rt�,, � � '�� .� � y ,�' Photo Three Photo Three Caption Finished Floor Clear Photo Three � �� ir-� �" � �� _ ,� � _ '��". �' ' �� -�.-� - ♦ '_-- � � �} si �' ' � �� • � _ � � � �- .— � � , _ ��' av S ��- � Photo Four Photo Four Caption Lowest Electrical Outlet Clear Photo Four FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6