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3400 GULF TO BAY BLVDU.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFIC? Important: Follow the instructions on pages 1 Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) ii SECTION A — PROPERTY INFORMATION Al. Building Owner's Name Drs. Kiran and Pallavi Patel Family Foundation, Inc. A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route a Box No. 3400 GULF TO BAY BLVD City Clearwater State Florida A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description "REVISED" PLANS RECEIVED BY J,A.VV JUL p3 239 PLANNING & DEVELOPMEN CITY OF CLEARWATER 3400 GULF TO BAY F BCP2018-05622D rtc ec DRKCOM Clearwater Parking Garage Zoning: Institutional Atlas# PARCEL NUMBER: 16-29-16-00000-110-0100 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, etc.) Lat. 27.96447deg Long. 82.96856deg Non -Residential Horizontal Datum: ❑ NAD 1927 insurance. above adjacent grade grade N/A F2 NAD 1983 N/A 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 1B Certificate is being used to obtain flood N/A sq ft or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b or enclosure(s) N/A sq in within 1.0 foot foot above adjacent in N/A sq ft ❑ Yes X No garage: garage openings in the attached garage within 1.0 in A9.b N/A sq ❑ Yes 0 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 12103C0129 B5. Suffix G Be. FIRM Index Date 09/03/2003 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) 9.0 B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation Date: of the Base Flood Elevation ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ (BFE) data ❑ NGVD System CBRS or base flood ❑ Other/Source: depth entered in Item B9: N/A X FIRM datum used located in a N/A ❑ Other/Source: N/A 1929 Cri NAVD 1988 (CBRS) area or Otherwise ❑ OPA Protected Area (OPA)? ❑ Yes X No 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. 3400 GULF TO BAY BLVD Policy Number: City State ZIP Code Clearwater Florida 33759 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 Al A30, AE, AH, A (with BFE), VE, V1 V30, V (with BFE), AR, AR/A, AR/AE, Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Benchmark Utilized: CONSTRUCTION BENCHMARK Vertical Datum: NAVD 1988 0 Finished Construction AR/A1—A30, AR/AH, AR/A0. Rico only, enter meters. Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 0 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) Check the measurement used. 5.3 X feet ❑ meters b) Top of the next higher floor 16.2 0 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 ❑ feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments)❑ 10.9 X feet meters f) Lowest adjacent (finished) grade next to building (LAG) 5.1 X feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 5.9 X feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 5.9 0 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 I certify that the information on this Certificate represents my best efforts to interpret the data available. statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. law to certify elevation information. I understand that any false ❑ Check here if attachments. Were latitude and longitude in Section A provided by a licensed land surveyor? X Yes ❑ No Certifier's Name License Number Robert E. Lazenby IV 6369 t..1#a7. ,' s w,'; "r j � >�� c„� ' r t . . t A fw y' , . ..., Title President Company Name Pesurv, Ina Address PO BOX 253 City State ZIP Code BARTOW Florida 33831 Signatur r---- Date Telephone Ext. iti 07-01-2019 (863) 800-3046 103 Copy all pages of this El vatio 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) A8 & A9 Stairways are on outside of building walls and open to surroundings as can be seen in the Building Photographs. Elevator shaft is designed to be weatherproof per applicable codes. C2e. ELECTRICAL SHUTDOWN BOX 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. 3400 GULF TO BAY BLVD Policy Number: City State ZIP Code Clearwater Florida 33759 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. b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters • above or ❑ below the LAG. 9 (see pages 1-2 of Instructions), 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 • above or ❑ below the HAG. ❑ above or ❑ below the HAG. ❑ above or ❑ below the HAG. with the community's certify this information in Section G. E3. Attached garage (top of slab) is ❑ feet ❑ meters E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters 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 N/A 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. 3400 GULF TO BAY BLVD Policy Number: City State ZIP Code Clearwater Florida 33759 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 ❑ meters Datum ❑ meters Datum building site: • feet ❑ 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) 3400 GULF TO BAY BLVD G BCP2018-05622D rtc ec DRKCOM Clearwater Parking Garage Zoning: Institutional Atlas #: 292B ❑ 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. 3400 GULF TO BAY BLVD Policy Number: City State ZIP Code Clearwater Florida 33759 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. 1 0 Photo One Photo One Caption WEST FACE LOOKING EAST Clear Photo One 4111111111 1111111 101111 4 Photo Two Photo Two Caption NORTH FACE LOOKING EAST Clear Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page 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. 3400 GULF TO BAY BLVD Policy Number: City State ZIP Code Clearwater Florida 33759 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. _. 1 1 ' yv , _ a Photo Three Photo Three Caption SOUTH FACE LOOKING EAST Clear Photo Three *S� i 1141 I It s . a Photo Four Photo Four Caption EAST FACE LOOKING NORTH Clear Photo Four FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 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 agent/company, and (3) building owner. SECTION A— PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Drs. Kiran and Pallavi Patel 2017 Foundation for Global Understanding, Inc. Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 3400 Gulf to Bay Blvd Company NAIC Number: City State ZIP Code Clearwater Florida 33759 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Parcel ID: 16-29-16-00000-110-0100 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, etc.) Lat. N027°57'46.99" Long. W082°41'52.68" Non -Residential Horizontal Datum: insurance. above ❑ NAD 1927 adjacent grade grade N/A x NAD 1983 N/A 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 18 Certificate is being used to obtain flood N/A sq ft or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b or enclosure(s) N/A sq in within 1.0 foot foot above adjacent in N/A sq ft ❑ Yes x No garage: garage openings in the attached garage within 1.0 in A9.b N/A sq ❑ Yes x No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number Clearwater, City of / 125096 B2. County Name Pinellas B3. State Florida B4. Map/Panel Number 12103C0129 B5. Suffix G B6. FIRM Index Date 08-18-2009 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) 9.0' B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation of the Base Flood Elevation ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ (BFE) data or base flood ❑ Other/Source: ❑ NGVD 1929 System (CBRS) CBRS ❑ OPA depth entered in Item B9: x FIRM datum used located in a Date: N/A ❑ Other/Source: Protected x NAVD 1988 area or Otherwise Area (OPA)? ❑ Yes x No 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. 3400 Gulf to Bay Blvd Policy Number: City State ZIP Code Clearwater Florida 33759 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 Al A30, AE, AH, A (with BFE), VE, V1—V30, V (with BFE), AR, AR/A, AR/AE, Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Benchmark Utilized: FDOT BM 42 Vertical Datum: NAVD 88 x Finished Construction AR/A1—A30, AR/AH, AR/A0. Rico only, enter meters. Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 x 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) 10.00 Check the measurement used. x feet ❑ meters b) Top of the next higher floor 25.92 x 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 ❑ feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 10 (Describe type of equipment and location in Comments) 27 x feet meters f) Lowest adjacent (finished) grade next to building (LAG) 5.3 x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 10.0 X feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 7.50 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 authorized by I certify that the information on this Certificate represents my best efforts to interpret the data available. statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001. law to certify elevation information. I understand that any false ❑ Check here if attachments. Were latitude and longitude in Section A provided by a licensed land surveyor? X Yes ❑ No Certifier's Name License Number Jared T. Patenaude L5 6971 7 Z _ i rf ;? / Vice r / Place ; i 'r �� Here ✓ L S !� 1-/ , Title President of Surveying Company Name Florida Design Consultants, Inc. Address( 20525 Amberfield Drive, Suite 201 City ,, State ZIP Code Land O L es(kFlorida 34638 Sign ur4' fDate Telephone Ext. I� I Z_i i (727) 849-7588 Co4 all &es o ' Elevation uel LifrOgre—ancTail 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) A5. Lat/Long from www.labins.org C2e. Lowest equipment measurement is to the top of the Switchboard Pad in the Electrical Room. C2e. Bottom of lowest elevator pit elevation = 5.96 feet C2h. Elevation at bottom of concrete steps on South side of building. Date of survey: 06-18-2019 FEMA Form 086-0-33 (7/15) Reolaces 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. 3400 Gulf to Bay Blvd Policy Number: City State ZIP Code Clearwater Florida 33759 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. ❑ above or ❑ below the HAG. with the community's certify this information in Section G. 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) is ❑ feet ❑ meters E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters 4E5. 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. 3400 Gulf to Bay Blvd Policy Number: City State ZIP Code Clearwater Florida 33759 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) 3400 GULF TO BAY BLVD BGP2O17-124681 ec DRKCOM Zoning: Institutional Atlas #: 292B ❑ 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. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 3400 Gulf to Bay Blvd Policy Number: City Clearwater State ZIP Code Florida 33759 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 Southwest corner of building, facing Northeast (06-18-2019) Clear Photo One Photo Two Photo Two Caption Southeast corner of building, facing Northwest (06-18-2019) 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. 3400 Gulf to Bay Blvd Policy Number: City Clearwater State ZIP Code Florida 33759 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 South side of building, facing North (06-18-2019) Clear Photo Three Photo Four Photo Four Caption North side of building, facing South into courtyard (06-18-2019) Clear Photo Four FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 "REVISED" PLANS RECEIVED BY J.A.W Mir JUL 0 3 2319 PLANNING & DEVELOPMENT 340�1XLI= `RC1 BI BCP2017-12468J DRKCOM Zoning: Institutional Atlas #: ,U.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 Drs. Kiran and Pallavi Patel 2017 Foundation for Global Understanding, Inc. Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 3400 Gulf to Bay Blvd Company NAIC Number: City State ZIP Code Clearwater Florida 33759 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Parcel ID: 16-29-16-00000-110-0100 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 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. N027°57'51.08" Long. W082°41'51.49" etc.) Non -Residential (Central Energy Plant) Horizontal Datum: insurance. above grade ❑ NAD 1927 adjacent grade N/A x NAD 1983 45 2 photographs Number with a crawlspace of crawlspace permanent flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? of the building if the 7 Certificate is being used to obtain flood 3450.00 sq ft or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b or enclosure(s) 2880.00 sq in within 1.0 foot 1.0 foot above adjacent in N/A sq ft ❑ Yes e 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 Clearwater, City of / 125096 B2. County Name Pinellas B3. State Florida 84. Map/Panel Number 12103C0129 B5. Suffix G B6. FIRM Index Date 08-18-2009 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) 9.0' B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation Date: of the Base Flood Elevation ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ (BFE) data ❑ NGVD System CBRS or base flood ❑ Other/Source: depth entered in Item B9: x FIRM datum used located in a N/A ❑ Other/Source: Protected 1929 x NAVD 1988 (CBRS) area or Otherwise ❑ OPA Area (OPA)? ❑ Yes x No 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. 3400 Gulf to Bay Blvd Policy Number: City State ZIP Code Clearwater Florida 33759 Company NAIC Number SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations *A new Elevation C2. Elevations - Zones Complete Items Benchmark Utilized: Indicate elevation ❑ NGVD Datum used for building a) Top of bottom b) Top of the next c) Bottom of the d) Attached garage e) Lowest elevation (Describe type f) Lowest adjacent g) Highest adjacent h) Lowest adjacent structural support are based on: ❑ Construction Drawings* ❑ Building Under Construction* Certificate will be required when construction of the building is complete. Al A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, C2.a-h below according to the building diagram specified in Item A7. In Puerto FDOT BM 42 Vertical Datum: NAVD 88 x Finished Construction AR/A1-A30, AR/AH, AR/AO. Rico only, enter meters. datum used for the elevations in items a) through h) below. 1929 x NAVD 1988 ❑ Other/Source: elevations must be the same as that used for the BFE. floor (including basement, crawlspace, or enclosure floor) 6.21 Check the measurement used. X feet ❑ meters higher floor N/A ❑ feet ❑ meters lowest horizontal structural member (V Zones only) N/A ❑ feet ❑ meters (top of slab) N/A ❑ feet ❑ meters of machinery or equipment servicing the building of equipment and location in Comments) 10.45 x feet ❑ meters (finished) grade next to building (LAG) 6.0 x feet ❑ meters (finished) grade next to building (HAG) 6.8 x feet ❑ meters grade at lowest elevation of deck or stairs, including N/A ❑ feet ❑ meters SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to I certify that the information statement may be punishable Were latitude and longitude be signed and sealed by a land surveyor, engineer, or architect authorized by on this Certificate represents my best efforts to interpret the data available. by fine or imprisonment under 18 U.S. Code, Section 1001. law to certify elevation information. I understand that any false ❑ Check here if attachments. in Section A provided by a licensed land surveyor? x Yes ❑ No Certifier's Name License NumberP Jared T. Patenaude LS 6971 LS g � ' V -,, e a *,"A°. - ..:: ' - ' fie t- n �'� r'� ° P�,�.. .,•.. r4ye .(r"° •aA ; �(, Z'_ef� a:" %.=• 9 Title Vice President of Surveying Company Namea Florida Design Consultants, Inc. Address 20525 Amberfield Drive, Suite 201 City State ZIP Code Land O :k-. I Florida 34638 Signatu e Date Telephone Ext. 7'24 Cr (727) 849-7588 Copy page- of is Elevation Certificate chments for (1) community official, (2) insurance agent/company, and (3) building owner. Com ents (including type of equipment and location, per C2(e), if applicable) A5. Lat/Long from obtained using global positioning system (GPS) methods with real time kinematics (RTK) sessions. A8c. There is a maintenance equipment gate at the entrance that is open at the bottom and sides to achieve an additional 576 square inches allowing for additional flow. The combined flood opening totals 3,456 square inches satisfying the requirement. C2a. This is a customer owned Central Energy Plant (CEP) power generator contained within a protective wall with flood openings. C2a. Power transformers are Utility owned set by Duke Energy. C2e. Lowest equipment measurement is to the bottom of Electrical outlet. Date of survey: 06-25-2019 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. 3400 Gulf to Bay Blvd Policy Number: City State ZIP Code Clearwater Florida 33759 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. ❑ above or ❑ below the HAG. ❑ above or ❑ below the HAG. with the community's certify this information in Section G. 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) is ❑ feet ❑ meters E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters 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. 3400 Gulf to Bay Blvd Policy Number: City State ZIP Code Clearwater Florida 33759 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) 3400 GULF TO BAY BLVD BCP2017-12468J ec DRKCOM Zoning: Institutional Atlas #: 292B ❑ 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. 3400 Gulf to Bay Blvd Policy Number: City State ZIP Code Clearwater Florida 33759 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. • \�lu II taili II. II , If � ►� _ � � � i i - ; e Photo One Photo One Caption North side of building facing South (06-25-2019) Clear Photo One fi, II IN = x l�. r F Photo Two Photo Two Caption South side of building facing North (06-25-2019) Clear Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page 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. 3400 Gulf to Bay Blvd Policy Number: City State ZIP Code Clearwater Florida 33759 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. —�� is air !fir`, ri. -- , ., T -sal - r - . _y ✓ w . Photo Three Photo Three Caption Southwest side of building facing Northeast (06-25-2019) Clear Photo Three 1 11 lid;, .. ^""' - .+s. - c' r 7F r +.c.r ._, . wr ` ry, `mss rt -, rKx'-_ Y Photo Four Photo Four Caption Northeast side of building facing Southwest (06-25-2019) Clear Photo Four FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 - t.5:'DEP'ARTMENT OF HOMELAND SECU Fedefal Emergency Management Agency {rational Flood Insurance Program vokID•1 - ' .tructions on pages 1 Copy all pagess Elevavet, ditll att'�CFim nt for (1 .mmunity official, (2) 1 IFICI' SECTION A — PROPERTY INFORM TION Al. Building Owner's Name Drs. Kiran and Pallavi Patel 2017 Foundation for Global Understanding, Inc. A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route Box No. 3400 Gulf to Bay Blvd City Clearwater State Florida RECEIVED BY: J.A.W. JUL 022019 PLANNING & DEVELOPMENT CITY,OF CLEARWATER .-.... . ,vY,y v.a.., ii...“n, vw. a,,u vwad.,\Lai WG, J, .an ra,..cl IYUI I IUriI, I-eydI LJebld IJJUUI I, CU:.) Parcel ID: 16-29-16-00000-110-0100 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 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. N027°57'51.08" Long. W082°41'51.49" etc.) Non -Residential (Central Energy Plant) Horizontal Datum: ❑ NAD 1927 insurance. A -PP TTM- above adjacent grad � �f..i0 rk , .IUj H'L � grade N/A x NAD 1983 *• FT. 2 photographs Numbers with a craw space of crawlspace permanent flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? of the building if the Certificate is being used to obtain flood A sq ft or enclose or enc sures) openings in the crawlspace or enclosure(s) in A8.b A sq inADD within 1.0 foot /l> /'�1> 1.0 foot above adjacent in N/A sq ft P. 10 .10 ❑ Yes ill 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 Clearwater, City of / 125096 B2. County Name Pinellas B3. State Florida B4. Map/Panel Number 12103C0129 B5. Suffix G B6. FIRM Index Date 08-18-2009 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) 9.0' B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation Date: of the Base Flood Elevation ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ (BFE) data or base flood ❑ Other/Source: ❑ NGVD 1929 System (CBRS) CBRS ❑ OPA depth entered in Item B9: x FIRM datum used located in a N/A ❑ Other/Source: x NAVD 1988 area or Otherwise Protected Area (OPA)? ❑ Yes x No FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 ATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 NCE COMPANY USE PORTANT: In these spaces, copy the corresp • i • , g ' fo om Section A. F Building Street Address (including Apt., Unit, Suite, a Tg. No.) or P. Route .. • Box i !i0,0q, 3400 Gulf to Bay Blvd „ mber: City State IP . Clearwater • t Florida 33759 Corn er 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, Complete Items C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico Benchmark Utilized: FDOT BM 42 Vertical Datum: NAVD 88 x Finished Construction AR/A1-A30, AR/AH, AR/A0. only, enter meters. Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 x 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) 6.21 Check the measurement used. x feet ❑ meters b) Top of the next higher floor V 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 ❑ feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 10.45 • (Describe type of equipment and location in Comments) x feet meters f) Lowest adjacent (finished) grade next to building (LAG) 6.0 x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 6.8 x feet ❑ meters 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 I certify that the information on this Certificate represents my best efforts to interpret the data available. statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001. law to certify elevation information. I understand that any false ❑ Check here if attachments. Were latitude and longitude in Section A provided by a licensed land surveyor? x Yes ❑ No Certifier's Name License Number Jared T. Patenaude LS 6971 _ 6 —Zi rg - rte' •'r; '. ? ace ' �r e(- ,r' 't L.5, -7;j " Title Vice President of Surveying Company Name Florida Design Consultants, Inc. Address 20525 Amberfield Drive, Suite 201 City State ZIP Code Land 0 es Florida 34638 Signat C. -,n• _r41 (727) 849-7588 tifr— Date Telephone Ext. Copy II is Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Co ents including'r of equipment and location, per C2(e), if applicable) 9Thist is a Central nergy Plant (CEP) power generator contained within a protective wall. 14I'T% i f LADOt' C l? (4 45 A5. Lat/Long from obtained using global positioning system (GPS) methods with real time kinematics (RTK) sessions. C2e. Lowest equipment measurement is to the bottom of Electrical outlet alive-bex. Date of survey: 06-25-2019 C2 it9, FOU3e11. TRAIA5 QRMtILA . MITI OW I C --V Stl- tall tuYe et, -ybk FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 { EVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. OMB No. 1660-0008 Expiration Date: November 30, 2018 NIPORTANT: 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. 3400 Gulf to Bay Blvd Policy Number: City State ZIP Code Clearwater Florida 33759 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. is - - - ` 111 , P.— � 'M t�a�_ h as No , NI III :.. '+•z'•, ,," �� tj ..+ ry^ { .hv§ - r a y Photo One Photo One Caption North side of building facing South (06-25-2019) Clear Photo One �` �—`' -„-- t - Photo Two Photo Two Caption South side of building facing North (06-25-2019) dear Photn Two "REVISED" PLANS RECEIVED BY JAW JUL 0 3 2019 PLANNING & DEVELOPMENT CITY OF CLEARVVATER 3400 GULF TO BAY E BCP2017-124681 ec DRKCOM Mas # Zoning: Institutional U.S. DEPARTMENT OF HOMELAND SECURITY Federaf 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 Drs. Kiran and Pallavi Patel 2017 Foundation for Global Understanding, Inc. Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 3400 Gulf to Bay Blvd Company NAIC Number: City State ZIP Code Clearwater Florida 33759 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Parcel ID: 16-29-16-00000-110-0100 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, etc.) Lat. N027°57'46.99" Long. W082°41'52.68" Non -Residential Horizontal Datum: insurance. above ❑ NAD 1927 adjacent grade grade N/A x NAD 1983 N/A 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 1B Certificate is being used to obtain flood N/A sq ft or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b or enclosure(s) N/A sq in within 1.0 foot foot above adjacent in N/A sq ft ❑ Yes x No garage: garage openings in the attached garage within 1.0 in A9.b N/A sq ❑ Yes x No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number Clearwater, City of / 125096 B2. County Name Pinellas B3. State Florida B4. Map/Panel Number 12103C0129 B5. Suffix G B6. FIRM Index Date 08-18-2009 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) 9.0' B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation of the Base Flood Elevation ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ (BFE) data ❑ NGVD System CBRS or base flood ❑ Other/Source: depth entered in Item B9: x FIRM datum used located in a Date: N/A ❑ Other/Source: Protected 1929 x NAVD 1988 (CBRS) area or Otherwise ❑ OPA Area (OPA)? ❑ Yes x No 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. 3400 Gulf to Bay Blvd Policy Number: City State ZIP Code Clearwater Florida 33759 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, ARAE, Complete Items 02.a—h below according to the building diagram specified in Item A7. In Puerto Benchmark Utilized: FDOT BM 42 Vertical Datum: NAVD 88 x Finished Construction AR/A1—A30, AR/AH, AR/AO. Rico only, enter meters. Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 x 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) 10.00 Check the measurement used. x feet ❑ meters b) Top of the next higher floor 25.92 x 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 ❑ feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 10 (Describe type of equipment and location in Comments) 27 x feet meters f) Lowest adjacent (finished) grade next to building (LAG) 5.3 x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 10.0 x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 7.50 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 authorized by I certify that the information on this Certificate represents my best efforts to interpret the data available. statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. law to certify elevation information. I understand that any false ❑ Check here if attachments. Were latitude and longitude in Section A provided by a licensed land surveyor? x Yes ❑ No Certifier's Name License Number Jared T. Patenaude LS 69711Nt4,`,��t 7_ ®or9oc ogooa,r '- °�"0. >> ..,\.:...4 1;0 , ', s 4 ° is '73Company 4'r , ; , . �� 4-,. _ °� , , y Title Vice President of Surveying Name Florida Design Consultants, Inc. Address 20525 Amberfield Drive, Suite 201 .. � l% ,, 9 rr:':. A ` "; ,' °� ° `e' ` .�` 4"' , °e ,fry ,r 'i. LS 6.1106e`.;8�w;"' Ext. City State ZIP Code Land 0 es Florida 34638. Sign. ur: Date Telephone "7-2-f i (727) 849-7588 Coall ..,es o Elevation a 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) A5. Lat/Long from www.labins.org C2e. Lowest equipment measurement is to the top of the Switchboard Pad in the Electrical Room. C2e. Bottom of lowest elevator pit elevation = 5.96 feet C2h. Elevation at bottom of concrete steps on South side of building. Date of survey: 06-18-2019 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. 3400 Gulf to Bay Blvd Policy Number: City State ZIP Code Clearwater Florida 33759 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. ❑ above or ❑ below the HAG. with the community's certify this information in Section G. 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) is ❑ feet ❑ meters E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters 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. 3400 Gulf to Bay Blvd Policy Number: City State ZIP Code Clearwater Florida 33759 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) 3400 GULF TO BAY BLVD BCP2017-124681 ec DRKCOM Zoning: Institutional Atlas #: 292B ❑ 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. 3400 Gulf to Bay Blvd Policy Number: City State ZIP Code Clearwater Florida 33759 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. ' I .ate --------------- s m:. Photo One Photo One Caption Southwest corner of building, facing Northeast (06-18-2019) Clear Photo One "IF litti* ,- - h t w 114114 MI it te, II I iijj1 11j�� 11 - in It • I1:PIII 1 • I 11 I I , Z i� fiiill I� Iliiu'''4 ' i ,I1� Ems: i'tiii . -„,A --- .. Photo Two Photo Two Caption Southeast corner of building, facing Northwest (06-18-2019) Clear Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page 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. 3400 Gulf to Bay Blvd Policy Number: City State ZIP Code Clearwater Florida 33759 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. 4 Air I I !F• --"-T—""'"'"'.....----- Y¢♦ c -"I. +. +.�r `z . .. w a.c - -ter. -. --+— Photo Three Photo Three Caption South side of building, facing North (06-18-2019) Clear Photo Three - �r�� 1 l' ---,ow" r .�. Iii .. ! if I :_ ti Li . _.__ �� I4 nil ii Photo Four Photo Four Caption North side of building, facing South into courtyard (06-18-2019) Clear Photo Four FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 .FVVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 tORTANT: In these spaces, copy the c • • - • • • • . - • rmation from Section A. FOR INSURANCE COMPANY USE uilding Street Address (including A• a - - ., • • • •. Route and Box No. 3400 Gulf to Bay Blvd Policy Number: City State ode Clearwater lorid 3375 Company NAIC Number SEC C — B IiiIAT N IN RMATIO RVEY REQUIRED) Cl. Building vation *A new atio C2. Elev- Corn• . e Benc - Indica el = a NGVD Datum u for a) Top of b • b) Top of the c) Bottom of the d) Attached garage e) Lowest elevation " (Describe type f) Lowest adjacent g) Highest adjacent h) Lowest adjacent structural support a n: ❑ st ction Drawl gs* uilding d Construction* erti will be required when construction of e ilding is • -te. • _ ' 1 30, AE, AH, A (with BFE), VE, V1 ( BFE), A• A, AR/AE, 2.a—h low according to th; a ilding di- , - s in Item 7 In Puerto Rico y, : F 0 BM 42 ical Da m: NAV x Finished Construction AR/A1 A30, AR/AH, AR/AO. only, enter meters. - • - um used for the elevati sin ite 'ugh h) low. 1929 x NAVD 1988 ❑ ►ther -: building elevations must be sa - as that used for - : F.. • p oor (including basement, crawlspace, or endre) - • r) 10.00 Check the measurement used. x feet ❑ meters ne ig oor 25.92 x feet ❑ meters lowes • izon a . . - mber (V es only) N/A ❑ feet 0 meters (top of sla• _N/A ❑ feet ❑ meters - of machinery or equipment servicing the building of equipment and location in Comments) 10.27 x feet • meters , (finished) grade next to building (LAG) 5.3 x feet ❑ meters (finished) grade next to building (HAG) 10.0 x feet [] meters grade at lowest elevation of deck or stairs, including 7.50 x feet ❑ meters SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is I certify that the information statement maybe Were latitude and longitude to be signed and sealed by a land surveyor, engineer, or architect authorized by on this Certificate represents my best efforts to interpret the data available. punishable by fine or imprisonment under 18 U.S. Code, Section 1001. law to certify elevation information. I understand that any false ❑ Check here if attachments. in Section A provided by a licensed land surveyor? x Yes ❑ No Certifier's Name License Number Jared T. Patenaude LS 6971 6//,/Z` !y A , it ',ace ./,1; !i •• I Title Vice President of Surveying Company Name Florida Design Consultants, Inc. 1t • -- iij 4k7/ Address 20525 Amberfield Drive, Suite 201City Land O La s State ZIP Code Florida 34638 Signatur Date Telephone Ext. ell26/(q (727) 849-7588 Copy page of th � levation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comn4ents (ncluding type of equipment and location, per C2(e), if applicable) A5. Lat/Long from www.labins.org C2e. Lowest equipment measurement is to the top of the Switchboard Pad in the Electrical Room. C2h. Elevation at bottom of concrete steps on South side of building. Bottom of lowest elevator pit elevation = 5.96 feet Date of survey: 06-18-2019 FEMA Form 086-0-33 (7/15) 17 Replaces all previous editions. Form Page 2 of 6 3400 GULF TO BAY BLV 3CP2017-12468 =INISHED ELEVATION CERT DRKCOM loning: Atlas #: 292B U.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 Drs. Kiran and Pallavi Patel Family Foundation, Inc. Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 3400 GULF TO BAY BLVD Company NAIC Number City State ZIP Code Clearwater Florida 33759 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) PARCEL NUMBER: 16-29-16-00000-110-0100 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, etc.) Lat. 27.96447deg Long. 82.96856deg Non -Residential Horizontal Datum: insurance. above ❑ NAD 1927 adjacent grade grade N/A X NAD 1983 N/A 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 1B Certificate is being used to obtain flood N/A sq ft or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b or enclosure(s) N/A sq in within 1.0 foot foot above adjacent in N/A sq ft ❑ Yes X No garage: garage openings in the attached garage within 1.0 in A9.b N/A sq ❑ Yes © 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 12103C0129 B5. Suffix G B6. FIRM Index Date 09/03/2003 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) 9.0 B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation of the Base Flood Elevation ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ (BFE) data or base flood ❑ Other/Source: ❑ NGVD 1929 System (CBRS) CBRS ❑ OPA depth entered in Item B9: N/A X FIRM datum used located in a Date: N/A ❑ Other/Source: Protected N/A © NAVD 1988 area or Otherwise Area (OPA)? ❑ Yes a No 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. 3400 GULF TO BAY BLVD Policy Number: City State ZIP Code Clearwater Florida 33759 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, Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Benchmark Utilized: CONSTRUCTION BENCHMARK Vertical Datum: NAVD 1988 X Finished Construction AR/A1—A30, AR/AH, AR/AO. Rico only, enter meters. Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 X 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) Check the measurement used. 5.3 X feet ❑ meters b) Top of the next higher floor 16.2 F2 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 ❑ feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) 10.9 feet meters ❑ f) Lowest adjacent (finished) grade next to building (LAG) 5.1 X feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 5.9 a feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 5.9 0 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 I certify that the information on this Certificate represents my best efforts to interpret the data available. statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001. law to certify elevation information. I understand that any false ❑ Check here if attachments. Were latitude and longitude in Section A provided by a licensed land surveyor? X Yes ❑ No Certifier's Name License Number Robert E. Lazenby IV 6369 . ,1 .: + + , , ,. ,:') :,%.i, or a �'' ` I = =, • y r`: ; . ;. : ; `�` Title• President Company Name Pesurv, Inc. Address PO BOX 253.,• City State ZIP Code BARTOW Florida 33831 Signature Date Telephone Ext. '---, 07-03-2019 (863) 800-3046 103 Copy all pages of this Elevatio ertificate 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) A8 Stairways are on outside of building walls and open to surroundings as can be seen in the Building Photographs. Elevator shaft is designed to be weatherproof per applicable codes. C2e. ELECTRICAL SHUTDOWN BOX 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. 3400 GULF TO BAY BLVD Policy Number: City State ZIP Code Clearwater Florida 33759 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. ❑ above or ❑ below the HAG. with the community's certify this information in Section G. 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) is ❑ feet ❑ meters E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters 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 N/A 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. 3400 GULF TO BAY BLVD Policy Number: City State ZIP Code Clearwater Florida 33759 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 05. 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. 3400 GULF TO BAY BLVD Policy Number: City State ZIP Code Clearwater Florida 33759 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. I IIIIIIIIIIIINNIIII LE. f1: Mk -tailik 1 fi -. ,. Photo One Photo One Caption WEST FACE LOOKING EAST Clear Photo One %IIsi Photo Two Photo Two Caption NORTH FACE LOOKING EAST Clear Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page 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. 3400 GULF TO BAY BLVD Policy Number: City State ZIP Code Clearwater Florida 33759 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. 11 1 t ,; 1 Photo Three Photo Three Caption SOUTH FACE LOOKING EAST Clear Photo Three r,/''y�1# A 1.,..1.r.„ ,,i,i sair } i-:\ k Photo Four Photo Four Caption EAST FACE LOOKING NORTH Clear Photo Four FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6