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505 GULFVIEW BLVD S (2)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 Decade Gulfcoast Hotel Partners Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 505 South Gulfview Blvd Company NAIC Number: City State ZIP Code Clearwater Beach Florida 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Parcel 17-29-15-00000-220-0200 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 58 06.04 N Long. 82 49 42.44 W Multi -Story Structure Horizontal Datum: insurance. above ❑ NAD 1927 adjacent grade grade 0 x NAD 1983 N/A 2 photographs of the building if the Number 1A Certificate is being used to obtain flood N/A sq ft with a crawlspace of crawlspace flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? 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 41266.00 sq ft ❑ Yes X No garage: garage openings in the attached garage within 1.0 in A9.b 0.00 sq ❑ Yes x No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Bl. NFIP Community Name & Community Number City of Clearwater & 125096 B2. County Name Pinellas 83. State Florida B4. Map/Panel Number 12103C0104 B5. Suffix G B6. FIRM Index Date 09-03-2003 B7. FIRM Panel Effective/ Revised Date 09-03-2003 B8. Flood Zone(s) AE & VE B9. Base Flood E evation(s) (Zone AO, use Base Flood Depth) 12, 13, 14, & 16 810. 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: ❑ Other/Source: Protected © 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 Iv) MAR 2 q 2017 1 PLANNING & DEVELOPMENT DEPT CITY OF CLEARWATER 505 S GULFVIEW BLVD BCP2014-11452E ELEVATION CERTIFICATE ‘L GUEST HOUSE Zoning Tourist Atlas #: 285A ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 505 South Gulfview Blvd Policy Number: City State ZIP Code Clearwater Beach Florida 33767 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations — Zones A1—A30, AE, AH, A (with BFE), VE, V1—V30, V (with BFE), AR, AR/A, AR/AE, Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Benchmark Utilized: F-02 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) 6.35 Check the measurement used. x feet ❑ meters b) Top of the next higher floor 18.61 x feet II meters c) Bottom of the lowest horizontal structural member (V Zones only) 17.95 x feet ❑ meters d) Attached garage (top of slab) 5.35 x feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) 5.44❑ meters x feet f) Lowest adjacent (finished) grade next to building (LAG) 4.55 x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 6.35 x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 3.88 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 Charles M. Arnett LS6884 ,; <,.. -' tir P I a c p • -A. '`' " Seat :,r' ` 1,t„` Title Project manager Company Name Southeastern Surveying and Mapping Address 10770 N 46th St, Ste C-300 City State ZIP Code Tampa Florida 33617 S Date Telephone Ext. 03-23-2017 (813) 898-2711 opy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) Transformer on concrete pad at Northwest corner of boundary. Parking garage on 1st floor. 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. 505 South Gulfview Blvd Policy Number: City State ZIP Code Clearwater Beach Florida 33767 Company NAIC Number SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BEE), 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. 505 South Gulfview Blvd Policy Number: City State ZIP Code Clearwater Beach Florida 33767 Company NAIC Number SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8—G10. In Puerto Rico only, enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2 ❑ A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. G3. ❑ The following information (Items G4—G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ G8. Elevation of as -built lowest floor (including of the building: G9. BFE or (in Zone AO) depth of flooding at the G10. Community's design flood elevation: New Construction ❑ Substantial Improvement basement) ❑ feet ❑ feet ❑ feet ❑ meters Datum building site: ❑ meters Datum ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 505 South Gulfview Blvd Policy Number: City State ZIP Code Clearwater Beach Florida 33767 Company NAIC Number If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. o r i IP di __ Photo One Photo One Caption Front View Clear Photo One . In ilii" Nig y i Photo Two gl N. \i‘' 4 Photo Two Caption Rear View Clear Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS 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. 505 South Gulfview Blvd Policy Number: City State ZIP Code Clearwater Beach Florida 33767 Company NAIC Number If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable. photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. -: ,sem t 1 Photo Three Photo Three Caption Finished Floor Clear Photo Three rr ref ''''/ .: 1 r: e Y y, � +'E. F o ` A ' r t. , Photo Four Photo Four Caption Lowest Elevation of Equipment Servicing Building - Transformer on Concrete Pad 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 Decade Gulfcoast Hotel Partners Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 505 South Gulfview Blvd Company NAIC Number City State ZIP Code Clearwater Florida 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Parcel 17-29-15-00000-220-0200; Multi -Story Parking Garage A4. Building Use (e.g., A5. Latitude/Longitude: A6. Attach at least A7. Building Diagram A8. For a building with 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° 58' 06.04" N Long. 82° 49' 42.44" Non -Residential W Horizontal Datum: insurance. above ❑ NAD 1927 adjacent grade grade N/A x NAD 1983 0 2 photographs of the building if the Number 6 Certificate is being used to obtain flood 7985.50 sq ft a crawlspace of crawlspace flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b or enclosure(s) 0.00 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 61.1NFIP Community TNanie & Community Number Cit of Clearwater & 125095 B2. County Name Pinellas B3. State Florida B4. Map/Panel Number 12103C0104 B5. Sutfx S, B6. FIRM Index Date 08-18-2009 B7. FIRM Panel Effective/ Revised Date 09-03-2003 B8. Flood Zone(s) AE & VE B9. Base Flood E evation(s) (Zone AO, use Base Flood Depth) 12, 13, 14, & 16 B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation Date: of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: x FIRM • Community Determined datum used for BFE in Item B9: located in a Coastal Barrier Resources ❑ ❑ NGVD System CBRS ■ Other/Source: 1929 (CBRS) ❑ OPA ❑ Other/Source: Protected Area (OPA)? © NAVD 1988 area or Otherwise ❑ Yes x No FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 505 S GULFVIEW BLVD BCP2014-11452E ec GUEST HOUSE Zoning: Tourist Atlas #: 28` RECEIVED BY; WA MAY 1 1 2Q1`r PLANNING & DEVELOPMLN CITY OF CLEARWATER ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 505 South Gulfview Blvd Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIC Number SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ■ Building Under Construction* x Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations - Zones A1 -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: F-02 Vertical Datum: NAVD 1988 Indicate elevation datum used for the elevations ■ NGVD 1929 p NAVD 1988 • in items a) through h) below. Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 6.31 x the measurement used. feet ❑ meters b) Top of the next higher floor 19.76 x feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) 17.40 x feet ❑ meters d) Attached garage (top of slab) N/A p feet ■ meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) 10.30 x feet ■ meters f) Lowest adjacent (finished) grade next to building (LAG) 5.40 x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 6.47 © feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 3.93 p feet meters SECTION D -- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect I certify that the information on this Certificate represents my best efforts to interpret statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section Were latitude and longitude in Section A provided by a licensed land surveyor? authorized the data 1001. © Yes by law to certify elevation information. available. I understand that any false • No ❑ Check here if attachments. Certifier's Name License Number Charles M. Amett LS6884' ;' i• ✓:. • -- 1 2 ' :� ter' 11.- ��',, -I's ': J• .: << : . f 1 *-- ;rt.' ��, t o'' N, Title Project manager Company Name Southeastern Surveying and Mapping Address 10770 N 46th St, Ste C-300 City State ZIP Code Tampa Florida 33617 SigC�4,`, Date Telep8o8e Ext. �+M1Y4++r 05-02-2017 (813)898-2711 Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) C2a) Be advised there is an elevator sump pit with a finished elevation of 2.39 C2b) Grade is at the east entry to parking garage structure. C2e) Grade is the bottom of electrical outlets in the storage areas near the east corner of the building. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 505 South Gulfview Blvd Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIC Number SECTION 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), ❑ above or ❑ below the HAG. 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. 505 South Gulfview Blvd Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIC Number SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8—G10. In Puerto Rico only, enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2 ❑ A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. G3. ❑ The following information (Items G4—G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued ❑ meters Datum G7. This permit has been issued for: • New Construction ■ Substantial Improvement 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: basement) ■ feet ❑ feet ❑ feet building site: • meters Datum • meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) • Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 505 South Gulfview Blvd Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIC Number If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View," When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page tP ig"v3 if .41 tp- 1 ,. 1 Pnao One Photo One Caption Front View Clear Photo One 1111111mici r.wA1r°1 lip ..e. IF a' ?'av _ . iR Photo Two Photo Two Caption Rear View Clear Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS 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 505 South Gulfview Blvd Bldg. No.) or P O Route and Box No Policy Number: City Clearwater State ZIP Code Florida 33767 Company NAIC Number If submitting more photographs than will fit on the with: date taken; "Front View" and "Rear View"; photographs must show the foundation with representative preceding page, affix the additional photographs below. Identify all photographs and, if required, "Right Side View" and "Left Side View." When applicable, examples of the flood openings or vents, as indicated in Section A8. J Photo Three e �> u Photo Three Caption Finished Floor Clear Photo Three 1`.. O mir- Photo Fci,r , SIM rime Photo Four Caption Rear View 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 Decade Gulfcoast Hotel Partners Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 505 South Gulfview Blvd Company NAIC Number City State ZIP Code Clearwater Florida 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Parcel 17-29-15-00000-220-0200; Cold Dark Shell Retail Space 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° 58' 06.04" N Long. 82° 49' 42.44" Non -Residential W Horizontal Datum: insurance. above ❑ NAD 1927 adjacent grade grade NIA 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 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 I B1. NFIP:Community Nafria&Community Number City of Clearwater & 125096 B2. County Name Pinellas B3. State Florida 84. Map/Panel Number 12103C0104 85. 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) 12 B10. Indicate the source ❑ FIS Profile B11. Indicate elevation BI2. Is the building Designation Date: of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: x FIRM datum used located in a • Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ NGVD System CBRS • Other/Source: 1929 (CBRS) p NAVD 1988 • Other/Source: Protected area or Otherwise Area (OPA)? ❑ Yes x No • • 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. 505 South Gulfview Blvd Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. 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, AR/A1—A30, Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only, Benchmark Utilized: F-02 Vertical Datum: NAVD 1988 x Finished Construction AR/AH, AR/AO. enter meters. Indicate elevation datum used for the elevations in items a) through h) below. • NGVD 1929 p NAVD 1988 • Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 6.35 x the measurement used. feet ❑ meters b) Top of the next higher floor N/A x feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A p feet ❑ meters d) Attached garage (top of slab) N/A x feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) 7.52 x feet ❑ meters f) Lowest adjacent (finished) grade next to building (LAG) 5.38 © feet ■ meters g) Highest adjacent (finished) grade next to building (HAG) 6.30 x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including 3.93 structural support x feet • meters SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect I certify that the information on this Certificate represents my best efforts to interpret statement may be punishable by fine or imprisonment under 18 U.S. Code, Section Were latitude and longitude in Section A provided by a licensed land surveyor? x authorized the data 1001. Yes by law available. • No to 1 understand • certify elevation information. that any false Check here if attachments. Certifier's Name License Number Charles M. Arnett LS6884 4., /, •-^ .' • '}) , . . ) '' \ ` , Title Project manager Company Name Southeastern Surveying and Mapping_ Address 10770 N 46th St, Ste C-300 City State ZIP Code Tampa Florida 33617 Signs%pEy�/ Date Telephone Ext. G/ Ir05-02-2017 (813) 898-2711 Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) C1) Per City of Clearwater and Cold Dark Shell Standards C2e) Grade is the rim of a commode servicing the building. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding Information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 505 South Gulfview Blvd Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIC Number SECTION 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, 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), crawlspace, or enclosure) is ❑ feet • meters 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 ❑ 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 Address City State ZIP Code Signature Date Telephone Comments ■ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 505 South Gulfview Blvd Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIC Number SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8—G10. In Puerto Rico only, enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2 ❑ A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. G3. ❑ The following information (Items G4—G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued ❑ meters Datum G7. This permit has been issued for: • New Construction • Substantial Improvement 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: basement) • feet ❑ feet building site: • meters Datum ■ feet ■ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) • Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Fomi 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.0 Route and Box No 505 South Gulfview Blvd Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIL 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. • OPE is' 1 i r / -r III 1.°p/ Photo One Photo One Caption Front View Clear Photo One 41117lit It Photo Two Photo Two Caption Interior View ::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 505 South Gulfview Blvd Policy Number: City State ZIP Code Clearwater Florida 33767 Company NAIC Number If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. t Z .- '41 r Y 4.i; yt Photo ''4 Three Photo Three Caption Finished Floor Clear Photo Three . Photo Fou' Photo Four Caption Lowest Elevation of Equipment Servicing Building - Transformer on Concrete Pad Clear Photo Four FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6