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1040 MANDALAY AVE U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB NO. 1660-0008 Federal,Emergency ManagementAgency Expires March 31,2012 National Flo�d Insurance Program Important: Read the instructions on pages 1-9. SECTION A-PROPERTY INFORMATION �,�a;, .� A1. Building Owner's Name David C.Carc �� i; ..:.. '��.. �i"✓�m�_.�:; A2. Buiiding Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. �"�� ;� 1040 Mandalay Avenue � � �" ' '��' � �.��` ,*� �a�ti � City Clearvvater State FL ZIP Code 33767 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) � Mandalay Sub,Biock 68,Lots 15&16 A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential • A5. �atitude/Longitude:Lat.28.003229 Long.-82.825726 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 16 A8. For a building with a crawlspace or enclosure(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 625 sq ft b) No.of permanent 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 N/A within 1.0 foot above adjacent grade 0 c) Totai net area of flood openings in A8.b 0 sq in c) Total net area of flood openings in A9.b Q 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 8 Community Number B2.County Name B3.State City of Clearwater 125096 Pinellas FL 64.Map/Panel Number B5.Suffix 66.FIRM Index B7.FIRM Panel B8.Flood 69.Base Flood Elevation(s)(Zone 12103C0064 G Date Effective/Revised Date Zone(s) AO,use base flood depth) 8-18-09 9-3-03 VE 11'&12' 610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69. ❑ FIS Profile � FIRM ❑ Community Determined ❑ 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 ARUAL"1976" Vertical Datum ELEV.=5.40'(N.A.V.D.I Conversion/Comments N/A Check the measurement used. a) Top of bottom floor(inGuding basement,crawlspace,or enclosure floor)4.96 �feet ❑meters(Puerto Rico only) b) Top of the next higher floor N.A �feet ❑meters(Puerto Rico only) c) Bottom of the lowest horizontal structural member(V Zones only) N.A �feet ❑meters(Puerto Rico only) d) Attached garage(top of slab) 4.Q� �feet ❑meters(Puerto Rico only) e) Lowest elevatioFl of machinery or equipment servicing the building 5.22 �feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Comments) � Lowest adjacent(finished)grade next to building(LAG) 4.0 �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 4.5 �feet ❑meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of dedc or stairs,including N.A �feet ❑meters(Puerto Rico oniy) structural support SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information. 1 certify that the information on this Certi�cate represents my best efforts to interpret the data available. ` � ' I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001. " _a �� :: :'�J�'F: � Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ,.°� `'�•''�i''��`�C; �>•; licensed land surve or? �� "'� "``Jr � y � Yes ❑ No �' � Certifier's Name Philip C.Stock License Number RLS#3035 � """"'�'"'� � . {y Title President Company Name Target Land Surveying.Inc. - 'G-�'��t`-��' �'. ., �.t. _ Address 516 Lakeside Place City Largo State FL ZIP Code 33771 �°.�,�,��1''� ` � Signature , ^ � - Date 9-2410 Telephone (727)7840573 � y�� `�.�u,�'-� �< - � FEMA Form 8 - 1, Mar 09 See reverse side for continuation. Replacesalf previous editions IF-.1POitTANT: In these spaces,copy the corresponding information from Section A. �Fo��i�st�ra�ce Company�lJse`.� B—ui d g Street Address(including Apt.,Unit,Suite,and/or Bidg.No.)or P.O.Route and Box No. �Roll` N�ra'tt5e��"��+ ""�"_�� *� 1040 Mandalay Avenue �x��°�� x "' ""�' „.� ; . ' Ciry Clearwater State FL ZIP Code 33767 ��orY��'ainy'NAIG�Number `� � � ,��r�� , SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED} Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agenUcompany,and(3)building owner. Comments Job#100922.02 C.2.e)=A/C Unit � According to the Pinellas County Property Appraiser,this house was built in 1953. At that time.FEMA Flood Maps did not exist. Signature �/_ -- Date 9-24-10 � �..1'� Co' � '� ❑ Check here if attachments SECTIOlJ -BU(LDING ELEVATION INFORMATION(SURVEY NOT REGIUIRED)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(incfuding 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 permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 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 avaiiable,is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑Yes ❑ No ❑ Unknown. The local o�cial must certify 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 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 know/edge. Property Owner's or Owners Authorized Representative's Name Address City State ZIP Code Signature Date Telephone ('nmmonfe ❑Check here if attachments SECTION G-COMMUNITY INFORMATION(OPTIONAL) 'he local o�ciai who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B,C(or E), #nd G of this Elevation Certificate. Complete the applicable item(s)and sign below. Check the measurement used in Items G8 and G9. 31.❑ 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.) 32.❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. 33.❑ The following information(Items G4-G9)is provided for community floodplain management purposes. G4.Permit Number ' G5. Date Permit Issued G6. Date Certificate Of Compiiance/Occupancy Issued 37. This permit has been issued for: ❑ New Construction ❑Substantial Improvement 38. Elevation of as-built lowest floor(including basement)of the building: ❑feet ❑meters(PR)Datum 39. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters(PR)Datum �10.Community's design flood elevation ❑feet ❑meters(PR)Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑Check here if attachments =EMA Form 81-31, Mar 09 Replaces all previous editions � ' �i� Rwwl,�y� 1'�:.�u i ...v 1..�� F � �. 4' :; R { � 1, 1 � (�`�� i' � 1 f� Front of 1040 Mandalay Ave:�p;�ons��ct�o�i i��Q Vie�'v�bf?where toilet addition is being added for , g this area. `�� 1040'IV��ndalay Ave. � � �� , �`��ti�� 4 ��.:�lV�+,^d; �t � �., � ,� �' . � ,: ��, �g-�-�� q �.�rr� . �� . � � s .a.< '.��a"�k .�`, _,._.._,..._�.. .#i.,'lk.�4�,;,;. _,_._ �, � n , �� .� '�� # � Y ti" � �� rW �et�_ �"jP' W �?1i �} , t _ ,d' ,.� *�;,. � �� m £�.. d'� �� 4;�, �*$�� .''��t �� . �5 "� � ��s�� ;'s� �` ��> �" � ,v �,`i,:; y �� r . � ". >� ,� ,c � �7".f c i�, , >f�� .�h � �� ` ;.�� ' �� y�.....^ *',�� * �� '� 3 �'�t ._. ';r��. � #."`r� . 'K �'� ;�e=, �'° �A .. ..�... � , �� t } _ I �� .. ^" T';�Mma L '�� j� 4,� 'd'f' Y e . . . � �'' �? � c .. �� . �, „°`. o.r #f ^�'"�. , .:.,.. �`.� �s. �..�, ;� _ 's,. �,�^»�a � . '� �'� �"`��+ ,,��-�,ti _ �, �1'��tI�t i' � �+�� u. s � ,.��. o ��;'#�. � � ��,� ��e.. �,� .� � ��,,�;- ; � ; 1, x�'' ,,.., x� r , . � .. 1 � �.. �> . "��.�.��'�."�.�e.�'� "` �' '.:a�,'�''��".�:�e�'�� '�M1��. . a ..``ys T�'`�"�w.r "�' .±a L =�� ..��. �, �� , . " _ �,�� Y�,�:�, a a �.� North Side of 1040 Mandalay Ave. Where Door is South West side of 1040 Mandalay Ave. no being added and window removed construction in this area � �• .� "� :�� „µ,.r, . .,_ � ° t ....,°"^^.... ... � � ) �.� �,..,��.:.-.". .yy,,,.�p,��_� , }� �f� f , -.w.!'r.." ¢ . „ w i _ . a �y� "�a'� ,�, ,�"�"''„ - e �, . , — . a a�. .«�...o ..,._ �' . � .. � .�K -r � u'x: . .,.-�,: ^..._._ ..�"`�`. ,�, � :... _._ - .�.._._...... ��" _ � , � ____ ._ ,�- ... ,_..,.......-- ",,, ,_.. _ —'- "" . :,�:. .� �� . , �. � � �j ��t �� {� , � � �� ; � �� o, i Z, � �i��, � � ; ti;, � � � � ,, ,ir.�.��d� �� ` '1 �,� ` �"i '".'_.z:.-,;,��..:" P��_. � ' ��;� � � . �. ,� :»-�; m�.'� .�-� ......�_ .,.��.. .. .�««�, n . ,.�. �` � �„� �: ��, � � x= � � �� . �. �: �� e � fi - � . � � - . � � , "��' � �� .�� ..� �� a> .� �n,: �m;�� '� � �A��:� . North West Side of 1040 Mandalay Ave. Where West side of 1040 Mandalay Ave. no construction toilet addition glass block replaces window. in this area �. _� ��.'- '�.��, � ~�, � .. � 3 �r. A, p .. � . . v � � ' �� .�.�.- . �� `�s �� ,,� ,. . y � Y, � 'rm`�.m„.e,.. �., ,r �.� i a g s a .. ' . �.....-: t i, , . , �.,. -:; � �s�.. �,,,�..Mw`»��"""�'_..,..„�..,, e. � , . � ` �..,_ � �. �, � � �� ..�.�— '� t',�.�� ' �.t »�,., —^- r � �* � '. ,. � ' j � i ��4 � } .� �, ., �e i. , �i .'�"�'�, ,8�.�;�. . . �';�, ; •� �� kr : • �;..� r�� .�.,,�b ��-.. .,....r^.".• � .,,_�� ' � ��# '��: F., i .�, . ,. .. ,+a��' �� .�,*�.,. }w ^'.AI f�f.�� . ^ .• -m� �•. �. �. � �:. . f �,. . <. ui . . tiAg .•«� _ F y * ,,�. � ^f.-?s �rtw �as e "` �� 'w, � "�«_ '.�:"' r ,�� ,� . ��.�� r ;� � yr� . : :�" � � �.Yr� �y.,.crA,Aa,atv.� . :r�ti� ,�� '� r w��`� . , '.tei . .. s' .. � '�',N� 6' -��i�R � 'R,�",+�G �iG �� . . 4 x.'i K r � .. .�•�. .�.�'.� �1�� x � .. U.S.DEPARTNIENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Fedecal Emergency Management Agency Expires MarCh 31,2012 National Flood Insurance Program Important: Read the instructions on pages 1-9. � SECTION A-PROPERTY INFORMATION � '�,'��;rri A1. Building Owner's Name David C.Carr ��:: � f�� A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. "9f,>- s 1040 MandalayAvenue � �,, ,�� k �k- A` � ��,� Ciry Clearwater State FL ZIP Code 33767 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Mandalay Sub,Block 68,Lots 15 8 16 A4. Building Use(e.g.,Residentiai,Non-Residential,Addition,Accessory,etc.)Residential A5. Latitude/Longitude:Lat.28.003229 Long.-$2.825726 Horizontal Datum: ❑ NAO 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 1 B A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawispace or enclosure(s) N/A sq ft a) Square footage of attached garage 625 sq ft b) No.of permanent 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 N/A within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in AB.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 B1.NFIP Community Name&Community Number 62.County Name B3.State City of Clearwater 125096 Pinellas FL 64.Map/Panel Number B5.Suffix 66.FIRM Index 67.FIRM Panel B8.Flood B9.Base Flood Elevatlon(s)(Zone 12103C0064 G Date Effective/Revised Date Zone(s) AO,use base flood depth) 8-18-09 9-3-03 VE 11'&12' 610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69. ❑ FIS Profile � FIRM ❑ Community Determined ❑ 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 ARUAL"1976" Vertical Datum ELEV.=5.40'(N.A.V.D.) Conversion/Comments N/A Check the measurement used. a) Top of bottom floor(inGuding basement,crawlspace,or enclosure floor)4.9¢ �feet ❑meters(Puerto Rico only) b) Top of the next higher floor N.A �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) 4.0� �feet ❑meters(Puerto Rico only) e) Lowest elevatioFl of machinery or equipment servicing the building 5.2� �feet ❑meters(Puerto Rico only) (Describe type of equipment and location in Comments) � Lowest adjacent(finished)grade next to building(LAG) 4.0 �feet ❑meters(Puerto Rico only) g) Highest adjacent(finished)grade next to building(HAG) 4.5 �feet ❑meters(Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs,including IV.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 authorized by law to certify elevation information. I certify that the information on this Certi�cate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishable 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 ^��• `� .••f�;,��!"��;f1+:1� licensed land surveyor? � Yes ❑ No .: � C�' ��9 p f Certifier's Name Phili C.Stock * J "� *""�'-? ' p License Number RLS#3035 ,� Title President Company Name Target Land Surveying, Inc. �;J/!r��.�,< ;:� ,. . J'(c,;�.": - Address 516 Lakeside Place City Largo State FL ZIP Code 33771 /'.��'`�� .•''+�;�J �.,�.�.:..:�..',• Signature , �_ Date 9-2410 Telephone (727)7840573 ,y��-�t . �` • FEMA Form 8'r31, Mar 09 See reverse side for continuation. Replaces all previous editions IF�IPQRT�NT: In these spaces,copy the corresponding information from Section A. :��,,p�'�[�.I�r,a�Ice�ip�qy.Us�; Building'Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. �;pb 4N�1'Itlgf"'�� 1040 Mandalay Avenue t�,.� "��g �� r,� Ctty Clearvvater State FL ZIP Code 33767 � � �,.�?Y.�1A��k.,.�ber• SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community o�cial,(2)insurance agenUcompany,and(3)building owner. Comments Job#100922.02 C.2.e)=A/C Unit According to the PineFlas County Property Appraiser,this house was built in 1953. At that time,FEMA Flood Maps did not exist. 't� ;t '• , . Signature ,/,,.......,,�,�:� • �.. i _.._. Date 9-24-10 ' ❑ Check here if attachments SECTION �BU�D ' � ATLON INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) F. : f) �` ' S"p _ �' � For Zones A�nf1�A��wit�outpjf��,;cQmplet�:ltems E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B, ` and C ��r It@rps�1-E�;,usg�n�tur�l grade;'if,�vailable. Check the measurement used. In Puerto Rico only,enter meters. .�r. E 1. Prbuidq eFeyation infori7a$trcjn for the foNdwtng and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade,(I-�A.Gj'�nd•th�ltiwest,adjacent gr�de(LAG). a)Top'of,bi5ttom flob�(inpN.iding basement,crawlspace,or enclosure)is ❑feet ❑meters ❑above or❑below the HAG. b)Top of tidt�orm flooe(inclUding.6a�ement,crawlspace,or enGosure)is ❑feet ❑meters ❑above or❑ below the LAG. E2. For Building Diagrarr�s.6�9 vi�ith permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions),the next higher floor (elevation C2.b in the diayrams)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 infortnation 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 must 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 Sectlon 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 G4G9)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 buiiding: ❑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 Local Official's Name Title Community Name Telephone Signature Date Comments ❑Check here if attachments FEMA Form 81-31, Mar 09 Replaces all previous editions f Building Photographs See instructions for item A6. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number 1040 Mandalay Avenue City Clearvvater State FL ZIP COde 33767 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 reverse. "Front View" (Pictures Taken 9-23-10) , . . �:`% r , . ..� Building Photographs Continuation Page Forinsurance Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Numbe� 1040 Mandalay Avenue City Gearwater St2t2 FL ZIP COde 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 Viev�'; and, if required, "Right Side View" and "Left Side View."