1541 FLOURNOY CIR1541 FLOURNOY CIR GAI
BCP2016-07653D
ELEVATION CERTIFICATE01
VUE AT BELLEAIR
Zoning: Commercial Atlas #: 31 BA
RECEIVED BY: M.J.
MAY 0 3 2019
PLANNING & DEVELOPMEN1
CITY OF CLEARWATER
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
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.
1541 FLOURNOY CIRCLE EAST
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 GARAGE A (8 BAY)
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. 27°56'24.32"N Long. 82°4339.99"W
etc.) RESIDENTIAL
Horizontal
Datum:
insurance.
above
grade
❑ NAD 1927
adjacent grade
N/A
X NAD 1983
N/A
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
1A
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
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)
9.0
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
❑ Other/Source:
Protected
1929 X NAVD 1988
(CBRS) area or Otherwise
❑ OPA
Area (OPA)?
❑ Yes X No
al
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.
1541 FLOURNOY CIRCLE EAST
Policy Number:
City State ZIP Code
CLEARWATER Florida 33764
Company NAIC Number
SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations
*A new Elevation
C2. Elevations
Complete
Benchmark
Indicate elevation
❑
Datum used
a) Top of
b) Top of
c) Bottom
d) Attached
e) Lowest
(Describe
f) Lowest
g) Highest
h) Lowest
structural
are based on: ❑ Construction Drawings* ❑ Building Under Construction*
Certificate will be required when construction of the building is complete.
— Zones A1—A30, AE, AH, A (with BFE), VE, V1—V30, V (with BFE), AR, AR/A, AR/AE,
Items C2.a—h below according to the building diagram specified in Item A7. In Puerto
Utilized: B-14 CLEARWATER Vertical Datum: 1988
x Finished Construction
AR/A1—A30, AR/AH, AR/A0.
Rico only, enter meters.
datum used for the elevations in items a) through h) below.
NGVD 1929 X NAVD 1988 ❑ Other/Source:
for building elevations must be the same as that used for the BFE.
bottom floor (including basement, crawlspace, or enclosure floor) 10.41
Check the measurement used.
M feet ❑ meters
the next higher floor N/A ❑ feet ❑ meters
of the lowest horizontal structural member (V Zones only) N/A ❑ feet ❑ meters
garage (top of slab) N/A ❑ feet ❑ meters
elevation of machinery or equipment servicing the building
N/A feet meters
type of equipment and location in Comments) ❑ ❑
adjacent (finished) grade next to building (LAG) 10.08
X feet ❑ meters
adjacent (finished) grade next to building (HAG) 10.00
X feet ❑ meters
adjacent grade at lowest elevation of deck or stairs, including feet meters
support N/A ❑ ❑
SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification
I certify that the
statement may
Were latitude and
is to be signed and sealed by a land surveyor, engineer, or architect authorized by
information on this Certificate represents my best efforts to interpret the data available.
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.
longitude in Section A provided by a licensed land surveyor? 0 Yes ❑ No
Certifiers Name License Number
DAN H. RIZZUTO 5227
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Title
LAND SURVEYOR
Company Name
POLARIS ASSOCIATES, INC.
Address
2165 SUNNYDALE BOULEVARD
City
CLEARW TE
State ZIP Code
Florida 33765
1
Signatur
Date Telephone Ext.
04-25-2019 (727)461-6113
Copy all pa of this ion 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. NO VISIBLE OR ACCESSIBLE EQUIPMENT.
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.
1541 FLOURNOY CIRCLE EAST
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.
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) isfeet 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.
1541 FLOURNOY CIRCLE EAST
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
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.
1541 FLOURNOY CIRCLE EAST
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.
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# x
Photo One
Photo One Caption FRONT SIDE (NORTH) Clear Photo One
,.
s P
i ss. -:e ....--
.
Photo Two
Photo Two Caption RIGHT SIDE VIEW (WEST) 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.
1541 FLOURNOY CIRCLE EAST
Policy Number:
City State ZIP Code
CLEARWATER 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.
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Al
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Photo Three
Photo Three Caption REAR VIEW (SOUTH) Clear Photo Three
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Photo Four
Photo Four Caption LEFT SIDE VIEW (EAST) Clear Photo Four
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 6 of 6