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1564 FLOURNOY CIRU.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE OMB No. 1660 -0008 Expiration Date: November 30, 2018 Important: Follow the instructions on pages 1 -9. 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 FDC CLEARWATER PSE, LLC Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 1564 FLOURNOY CIRCLE W Company NAIC Number City State ZIP Code CLEARWATER Florida 33764 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) VUE AT BELLEAIR MAINTENANCE BUILDING A4. Building Use (e.g., Residential, Non - Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude /Longitude: Lat. 27 °5622.16 "N Long. 82°43'45.60'W Horizontal Datum: ❑ NAD 1927 0 NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flnnri insuranrp_ A7. Building Diagram Number A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) 1A N/A sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1. c) Total net area of flood openings in A8.b N/A sq in d) Engineered flood openings? ❑ Yes © 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 abov c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes ® No 1564 FLOURNOY CIR M BCP2016- 07648D ELEVATION CERTIFICATE VUE AT BELLEAIR - MAINTENANCE Zoning: Commercial Atlas #: 318A 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 12103C0128 B5. Suffix G B6. FIRM Index Date 09 -18 -2009 B7. FIRM Panel Effective/ Revised Date 09 -03 -2003 B8. Flood Zone(s) AE B9. Base Flood E evation(s) (Zone AO, use Base Flood Depth) 9 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: ❑ 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 FEMA Form 086 -0-33 (7/15) Replaces all previous editions. Form Page 1 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. 1564 FLOURNOY CIRCLE W Policy Number: City State ZIP Code CLEARWATER Florida 33764 Company NAIC Number 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 Al A30, AE, AH, A (with BFE), VE, V1 —V30, V (with BFE), AR, AR /A, AR/AE, AR/A1 —A30, AR/AH, AR/A0. Complete Items C2.a —h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: B -14 CLEARWATER Vertical Datum: 1988 Indicate elevation datum used ❑ NGVD 1929 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 the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 10.11 Q feet ❑ meters b) Top of the next higher floor N/A ❑ feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A ❑ feet ❑ meters d) Attached garage (top of slab) N/A X feet ❑ meters feet ❑meters X feet ❑ meters X feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) 13.00 f) Lowest adjacent (finished) grade next to building (LAG) 9.90 g) Highest adjacent (finished) grade next to building (HAG) 10.00 h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support N/A ❑ 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. I certify that the information on this 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. Were latitude and longitude in Section A provided by a licensed land surveyor? 0 Yes ❑ No ❑ Check here if attachments. Certifier's Name License Number DAN H. RIZZUTO 5227 4q9 ws.`�' , t r',d, °,�� .,, g w ./ < ' .fi s i',x, <`, '+ ■ f- Mho °. i�. a <. ° fig C4 �� n �` ;, �` v Title LAND SURVEYOR Company Name POLARIS ASSOCIATES, INC. Address 2165 SUNNYDALE BOULEVARD City State ZIP Code CLEAR ,. Florida 33765 Signatu 1 Date Telephone Ext. ���� 11 -30 -2018 (727) 461 -6113 Copy all pa. of this :1L:117: tion 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) 1. SURVEY MAP AND REPORT OR THE COPIES THEREOF ARE NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. ADDITIONS OR DELETIONS TO SURVEY MAPS OR REPORTS BY OTHER THAN THE SIGNING PARTY OR PARTIES IS PROHIBITED. 2. POLARIS JOB #4552 3. ELECTRIC PANEL BOTTOM FEMA Form 086 -0-33 (7/15) Replaces all previous editions. Form Page 2 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. 1564 FLOURNOY CIRCLE W Policy Number: City State ZIP Code CLEARWATER Florida 33764 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. E1. 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. b) Top of bottom floor (including basement, crawlspace, or endosure) 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) 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. with the community's certify this information in Section G. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must 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. 1564 FLOURNOY CIRCLE W Policy Number: City State ZIP Code CLEARWATER Florida 33764 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 BUILDING PHOTOGRAPHS ELEVATION CERTIFICATE 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. Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. 1564 FLOURNOY CIRCLE W FOR INSURANCE COMPANY USE Policy Number: City State ZIP Code CLEARWATER Florida 33764 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. Photo One Photo One Caption FRONT VIEW (NORTH) Photo Two Photo Two Caption RIGHT SIDE (WEST) FEMA Form 086 -0 -33 (7/15) Clear Photo One Clear Photo Two Replaces all previous editions. Form Page 5 of 6 BUILDING PHOTOGRAPHS ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30, 2018 OMB No. 1660 -0008 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. 1564 FLOURNOY CIRCLE W FOR INSURANCE COMPANY USE Policy Number: City CLEARWATER State ZIP Code Florida 33764 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 REAR VIEW (SOUTH) Photo Four Photo Four Caption LEFT SIDE (EAST) FEMA Form 086 -0 -33 (7/15) Clear Photo Three Clear Photo Four Replaces all previous editions. Form Page 6 of 6