162 BAYSIDE DR U.S=DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008
Faderal Eme�gency Management Agency Expires March 31,2012
�Jational Flood Insurance Program Important: Read the instructions on pages 1-9.
SECTION A-PROPERTY INFORMATION _, �i` ,. �""����9r ����
A1. Building Owner's Name David Bussey&Coreana Bussey ; �1 � °;
t� ��� Y� � �� � , ',�
A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. �s ,�L4TG�`N�I'�1b�M'o�=°;
162 Bayside Drive �'° _'
City Cleanvater State FL ZIP Code 33767
A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
Parcel ID#:0&29-15-0496&000-0160
A4. Building Use(e.g.,Residential,Non-Residentfal,Addition,Accessory,etc.)Residential
A5. LatitudelLongitude:Lat.27.970525 Long.-82.824847 Horizontal Datum: ❑ NAD 1927 � NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 1B
A8. For a building with a crawlspace or enGosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) N/A sq ft a) Square footage of attached garage 400 sq ft
b) No.of pertnanent flood openings in the crawlspace or b) No.of permanent flood openings in the attached garage
enclosure(s)within 1.0 foot above adjacent grade 0 within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b 0 sq in c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61.NFIP Community Name&Community Number 62.Counry Name B3.State
Ciry of Clearwater 125096 Pinellas FL
64.Map/Panel Number B5.Suffix B6.FIRM Index B7.FIRM Panel B8.Flood B9.Base Flood Eleva6on(s)(Zone
12103C0102 G Date Effective/Revised Date Zone(s) AO,use base flood depth)
&1&09 9-3-03 AE 11'
610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
❑ FIS Profile � FIRM ❑ Communiry Detertnined ❑ Other(Describe)
611. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other(Describe)
612. Is the building located in a Coastal Barrier Resources System(CBRS)area or Othervvise Protected Area(OPA)? ❑ Yes � No
Designation Date N!A ❑ CBRS ❑ OPA
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' � 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. Use the same datum as the BFE.
Benchmark Utilized LP-15 MAP#155 Vertical Datum ELEV=4.19'(N.A.V.D.)
Conversion/Comments N/A
Check the measurement used.
a) Top of bottom floor(including basement,crawlspace,or enclosure floor)�.8� �feet ❑meters(Puerto Rico only)
b) Top of the next higher floor IV.Q �feet ❑meters(Puerto Rico only)
c) Bottom of the lowest horizontal structural member(V Zones only) IV.A �feet ❑meters(Puerto Rico only)
d) Attached garage(top of slab) 5.;� �feet ❑meters(Puerto Rico only)
e) Lowest elevation of machinery or equipment servicing the building 6.� �feet ❑meters(Puerto Rico only)
(Describe type of equipment and location in Comments)
fl Lowest adjacent(finished)grade next to build(ng(LAG) �.2 �feet ❑meters�(Puerto Rico only)
g) Highest adjacent(finished)grade next to building(HAG) 5.6 �feet ❑meters(Puerto Rico only)
h) Lowest adjacent grade at lowest elevation of deck or stairs,including W.A �feet ❑meters(Puerto Rico only)
structural support
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer,or architect authortzed by law to cerdfy elevadon
information. I certlfy that the information on this Ce�cate represents my best efforts to interpret the data available.
I understand that any false statement may be punlshable by�ne or imprisonment under 18 U.S. Code,Section 1001.
� Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a
licensed land surveyor? � Yes ❑ No
Certifler's Name Philip C.Stock License Number RLS#3035
Title President Company Name Target Land Surveying,Inc. ��'/ ��7/2�/Z-
Address 516 Lakeside Place City largo State FL ZIP Code 33771 �����C'!7--`�
Signature�-�r _:. ____.. Date 2-7-12 Telephone (727)784-0573 // �C� "�
�f ��1�.,��� • c-
FEMA Form.�31, Mar 09 See reverse side for continuation. Replaces all previous editions
� ,
IM ORTAM,T: In these spaces,copythe corresponding information from Sectton A. ��,�"��il�f��p�n�',�I��dr.
�3uilding Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. pb11GyNUltlbel�'��+_.`� , f"�
162 Bayside Drive ?�'�����,���'�;�� t � ;F,.
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City Cleanvater State FL ZIP Code 33767 C�m��;(�q������;����.�
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SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)communiry o�cial,(2)insurance agenUcompany,and(3)building owner.
Comments
Job#120203.01
C.2.e)=A/C Unit
According to the Pinellas County Property Appraiser,this house was built in 1955. At that time,FEMA flood maps did not exist.
Signature ' Date 2-7-12
� �z�°�.--����� ❑ Check here if attachments
SECTION��UILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO and A(without BFE),complete Items E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B,
and C. For Items E1-E4,use natural grade,if available. Check the measurement used. In Puerto Rico only,enter meters.
E 1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent
grade(HAG)and the lowest adjacent grade(LAG).
a)Top of bottom floor(inGuding basement,crawlspace,or enGosure)is ❑feet ❑meters ❑above or❑below the HAG.
b)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or❑ below the LAG.
E2. For Building Diagrams 6-9 with pertnanent flood openings provided in Section A Items 8 and/or 9(see pages&9 of Instructions),the next higher floor
(elevation C2.b in the diagrams)of the building is ❑feet ❑meters ❑above or ❑below the HAG.
E3. Attached garage(top of slab)is ❑feet ❑meters ❑above or ❑below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is ❑feet ❑meters ❑above or❑below the HAG.
E5. Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management
ordinance? ❑Yes ❑ No ❑ Unknown. The local official must certify this informatlon in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owner's authorized representative who completes Sections A,B,and E for Zone A(without a FEMA-issued or community-issued BFE)
or Zone AO m ust sign here. The statements in Sections A,8,and E are correct to the best of my knowledge.
Property Owner's or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
❑Check here if attachments
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 and G9.
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 fn the Comments area below.)
G2.❑ A community o�cial completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO.
G3. ❑ The following infortnation(Items G4-G9)is provided for community floodplain management purposes.
G4.Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued
� �
G7. This permit has been issued for: ❑New Construction ❑Substantial Improvement
G8. Etevation of as-built lowest floor(inGuding basement)of the building: ❑feet ❑meters(PR)Datum
G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters(PR)Datum
G10.Community's design flood elevation ❑feet ❑meters(PR)Datum
Locai Official's Name Title
Community Name Telephone
Signature Date
Comments
❑Check here if attachments
FEMA Form 81-31, Mar 09 Replaces all previous editions
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Building Photographs
See Instructions for Item A6.
Por Insurance Company Use: !
i Building Street Address(including Apt., Unit,Suite, and/or Bldg. No.)or P.O. Route and Box No. Poiicy►vumber ;
162 Bayside Drive ;
� City Clearwater StBte FL ZIP COde 33767 CompenyNAlCNumber
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� If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two 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." If submitting more photographs than will fit on this page, use the Continuation Page on the �
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�62 Bayside Drive
City Cleanvater State FL ZIP COd2 33767 ComperryNAlCNumber !
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162 BAYSIDE DR
BCP2012-07340 �
ADDITION :
BUSSY, DAVID ,
Zoning: Low Medium Density Re Atlas#:276A ..
U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
oMS rvo. �ssa000s
Expiration Date: November 30, 2018
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for (1) community offrcial, (2) insuranc:e agenUcompany, and (3) building owner.
SECTION A— PROPERTY INFORMATION FOR INSURANCE COMPANY USE
A1. Building Owner's Name Policy Number.
AUGUSTINE 7 PATRICiA S. HOULIHAN
A2. Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No. Company NAIC Number.
162 BAYSIDE DRIVE
City State ZIP Code
CLEARWATER, Florida 33767
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 16, of BAYSIDE SUBDIVISION No. 4
A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) RESIDENTIAL
A5. Latitude/Longitude: Lat 27 deg. 58' 13.5" Long. 82 deg. 49' 29.4" Horizontal Datum: � NAD 1927 �x NAD 1983
A6. Attach at least 2 photographs of the building if the Certi�cate is being used to obtain flood insurance.
A7. Building Diagram Number 1A '
A8. For a building with a crawlspace or endosure(s):
a) Square footage of crawlspace or enclosure(s) 0 sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent g�ade 0
c) Total net area of flood openings in A8.b . 0 sq in
d) Engineered flood openings? ❑ Yes ❑x No
A9. For a building with an attached garage: �i�
a) Square footage of attached garage 400 S n
q •
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? �Yes �x No
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP Community Name & Community Number B2. County Name B3. State
ClTY �F' CL�ARWATER / 125096 `___ PINELLAS Florida
B4. MaplPane! B5. Suffix 66. FIRM Index B7. FIRM Panel B8. Flood Zone(s) B9. Base Flood Elevation(s)
Number Date Effective/ (Zone AO, use Base
Revised Date Flood Depth)
12103 C 0102 G 08/18/2009 09/03/2003 AE 11'
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9:
[J FIS Profile ❑X FIRM � Community Determined � OthedSource:
611. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 �x NAVD 1988 � Other/Source:
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? � Yes �x No
Designation Date: ___ � CBRS � OPA
FEMA Form OS6-0-33 (7/15) Replaces all previous editions.
Form Page 1 of 6
ELEVATION CERTIFICATE
onnB No. �ssa000s
FYnira}inn Il7tn• Nnunmhor 1!1 �7/11A
IMPORTANT: in these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address (inGuding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box Na Policy Number.
162 BAYSIDE DRIVE
City State ZIP Code Company NAIC Number
CLEARWATER, - Florida 33767
SECTION C— BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings' � Building Under Construction* �x Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations — Zones A1—A30, AE, AH, A(with BFE), VE, V1 V30, V(with BFE), AR, AR/A, AR/AE, AR/A1 A30, AR/AH, AR/AO.
Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: CITY OF CLEARWATER F-02 Vertical Datum: 4.06'
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.
Check the measurement used.
a) Top of bottom floor (including basement, crawlspace, or enGosure floor) 5. 9 �x 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. � feet � meters
d) Attached garage (top of slab) 5. 5 �x feet � meters
e) Lowest elevation of machinery or equipment servicing the building 6. � Ox feet � meters
(Describe type of equipment and Jocation in Comments)
� Lowest adjacent (finished) grade next to building (LAG) S. 6 Ox feet � meters
g) Highest adjacent (finished) grade next to building (HAG) 6 1 � feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, induding N�A � feet � meters
structural support . _ . .._,.. __, '
SEG�TION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land �surveyor, engineer, or architect authorized by law to certify elevation information.
/ certify that the information on this Certificate represents my best efforts to interpret the data avai/able. ! understand that any fa/se
statement may be punishable by, fine or imprisonment under 18 U.S. Code, Secfion 1009.
Were latitude and longitude in Section A provided by a licensed land surveyor? ❑x Yes ❑ No Q Check here if attachments.
Certifier's Name -- License Number �,{ r� �� � �.° i
LARRY L. fVANS i'� FL. LS No. 2937 °' ^�`
Title � �. �,��S�C "
LAND SURVEYOR - , �;� ,,�. ��� ,F� „
Company_Name 5.; : v ��e , _
_EVANS LAND SURVEYING, INC. ` L :. ���e ��� ='!^+ �d
Address €�,y( {,,`�
1460$ELTREES'STREET� STE 9 ���'i - �` t ��
��
City , . State ZIP Code ��`'� ` • `� ;�
�� a,��, ��� �, ,��,
DUNEDIN, ; . , ��.,, � _„ Florida 34698
Signature Date Telephone
,
10/18/2016 (727) 734-3821
Copy all page of t Ele atibn C�rtificate and all "attacFiments for (1) community official, (2) insurance agenUcompany, and (3) building owner.
Comments (includi g!type af equipmeht and location, per C2(e), if applicable)
_ .__ _ .
C2.e): IS AN EXTERIOR A/C,COMPRESSO, R ON GROUND LEVEL PAD.
. , �5 , � .. � . �
�.� , . � �. .. i �- . . . ., �..
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 2 of 6
❑
ELEVATION CERTIFICATE OMB No. 1660-0008
Fvnirotinn Il�fe• HI.........L.,.� �n nnw n
--.�........... ..a..w. .• ����I JV� GV 10
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number.
162 BAYSIDE DRIVE
C�Y State ZIP Code Company NAIC Number
CLEARWATER, Florida 33767
SECTION E— BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED)
FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO and A(without BFE), complete Items E1—E5. If the Certificate is intended to support a LOMA or LOMR-F request,
complete Sections A, B,and C. For Items E1—E4, use natural grade, if available. Check the measurement used. In Puerto Rico only,
enter meters.
E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below
the highest adjacent grade (HAG) and the lowest adjacent grade (LAG)_
a) Top of bottom floor (inGuding basement,
crawlspace, or enclosure) is . ❑ feet ❑ meters ❑ above or ❑ betow the HAG.
b) Top of bottom floor (including basement,
crawlspace, or enclosure) is . ❑ feet ❑ meters ❑ above or ❑ below the LAG.
E2. For Building Diagrams ('r9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 1-2 of Instrudions),
the next higher floor (elevation C2.b in
the diagrams) of the building is . ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E3. Attached garage (top of slab) is . ❑ feet ❑ meters ❑ above or ❑ below the HAG_
E4. Top of platform of machinery and/or equipment
servic�ng the building is . ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the communitys
floodplain management ordinance? � Yes ❑ No ❑ Unknown. The {ocal offiaal must certiiy this information in Section G.
SECTION F— PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A(without a FEMArissued or
commurnty-issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are corred to the best of my knowtedge.
Property Owner or Owners Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
❑ Check here if attachments.
rtmH rorm utsti-u-3� (inb) Replaces all previous editions. Form Page 3 of 6
ELEVATION CERTIFICATE
OMB No. 1660-0008
�.
�nNnauun ua�C. IVOV@fT1D@� 3U, 1U1S
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number.
162 BAYSIDE DRIVE
C�� State ZIP Code Company NAIC Number
CLEARWATER, Florida 33767
SECTION G — COMMUNITY INFORMATION (OPTIONAL)
The local offiaal 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. Chedc the measurement
used in Items G8—G10. fn 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�mmunity o�aal completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)
or Zone AO.
G3. ❑ The following information (Items G4—G10) is provided for community floodplain management purposes.
G4. Permit Number G5. Date Permit Issued G6. Date Certificate of
Compliance/Occupancy Issued
G7. This permit has been issued for: ❑ New Construction � Substantial Improvement
G8. Elevation of as-built lowest floor (including basement)
of the building: ❑ feet ❑ meters Datum
G9. BFE or (in Zone AO) depth of flooding at the building site: , ❑ feet ❑ meters Datum
G10. Community's design flood eleva6on: . � feet � meters Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments (including type of equipment and Iocation, per C2(e), if applicable)
❑ Check here if attachments.
r�iviH rorm uatru-3a (ii-i5) Keplaces all previous editions. Form Page 4 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE See Instructions for Item A6. Expiration Date: November 30, 2018
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number:
162 BAYSIDE DRIVE
City State ZIP Code Company NAIC Number
CLEARWATER, Florida 33767
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the
instructions for Item A6. Identify all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and
"Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or
vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page.
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rtnn�v rorm utt6-o-33 (//15) Repiaces all previous editions. Form Page 5 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30, 2018
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number:
162 BAYSIDE DRIVE
City State ZIP Code Company NAIC Number
CLEARWATER, Florida 33767
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs
with: date taken; "Front View" and "Rear View'; and, if required, "Right Side Vew" and "Left Side View." When applicable,
photographs must show the foundation with representative exampies of the flood openings or vents, as indicated in Section A8.
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Photo One Caption REAR VIEW / 10/18/2016
Photo Two
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rtmH rorm utst�-u-:s3 (i��b) Replaces ail previous editions. Form Page 6 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. Policy Number:
162 BAYSIDE DRIVE
C��' State ZIP Code Company NAIC Number
CLEARWATER, Florida 33767
If using the Elevation Certificate to obtain NF�P flood insurance, affix at least 2 building photographs below according to the
instructions for Item A6. Identify all photographs with date taken; "Front Vew" and "Rear Ve�nl'; 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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FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6
BUILDING PHOTOGRAPHS oMB No. �ssa000s
ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30, 2018
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number:
162 BAYSIDE DRIVE
City State ZIP Code Company NAIC Number
CLEARWATER, Florida 33767
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs
with: date taken; "Front View" and "Rear Vew"; and, if required, "Right Side Vew" and "Left Side View." When applicable,
photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section AS.
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FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6