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708 SNUG ISLANDJ.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 agenUcompany and (3) buildi SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Neth, Thomas and Denise Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 708 Snug Island Company NAIL Number: City State ZIP Code Clearwater Florida 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 55, Island Estates of Clearwater Unit 7B (Plat Book 64, Page 70), 05-29-15-43457-000-0550 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°59'24.34" N Long. 82°49'07.06" etc.) Residential W 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 1.0 foot above adjacent in 528.00 sq ft ❑ Yes x No garage: garage openings in the attached garage within in A9.b N/A sq ❑ Yes x No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number CLEARWATER, CITY OF B2. County Name PINELLAS B3. State Florida B4. Map/Panel Number 12103C0102G B5. Suffix G B6. FIRM Index Date 08-18-2009 B7. FIRM Panel Effective/ Revised Date 09-03-2003 B8. Flood Zone(s) AE B9. Base Flood E evation(s) (Zone AO, use Base Flood Depth) 11 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 FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 • 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. 708 Snug Island 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* *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, Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only, Benchmark Utilized: CITY OF CLEARWATER "1-03.5" Vertical Datum: NAVD 1988 x Finished Construction AR/AH, AR/A0. enter meters. Indicate elevation datum ❑ NGVD 1929 used x for the elevations in items a) through h) below. 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) 7.97 x the measurement used. feet ❑ meters b) Top of the next higher floor N/A ❑ feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A ❑ feet ❑ meters d) Attached garage (top of slab) 7.33 x feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) 9.31 x feet meters f) Lowest adjacent (finished) grade next to building (LAG) 6.82 x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 7.26 x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 7.58 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 by law to certify elevation information. the data available. / understand that any false 1001. Yes ❑ No ❑ Check here if attachments. Certifier's Name License Number CHRISTOPHER MCLAUGHLIN LS 6614 ., r ' ' f I. . t cwt .4., ✓` . .., o `• * c� r.z"'k4;, ,� , �; � /c- . ; -- �` �.. • < . -' . J�tcf , ° r3 I1 i y' Title PRESIDENT Company Name MACSURVEY, INC. Address 22091 US HWY 19 NORTH City State ZIP Code CLEARWATER Florida 33765 Signature Date Telephone Ext. ale 03-20-2017 (727) 725-3269 Copy al ages 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) C2(e): AIR CONDITIONING COMPRESSOR - LOCATED ON NORTH SIDE OF HOUSE, ELEVATION IS TOP OF ELEVATED ALUMINUM SUPPORT RACK FOR COMPRESSOR. • FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 • IMPORTANT: In these spaces, copy the corresponding information from Section A. .-^I+••`•••,r•• .+.+.%.. ..vvcIn✓cl ✓0, c✓ 10 FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 708 Snug Island 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. ❑ 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 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 certify 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 • IMPORTANT: In these spaces, copy the corresponding information from Section A. r^ro"....1,04 1 ..+c.a,.. iwvcnwCI JV, GU 10 FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 708 Snug Island 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 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 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. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 708 Snug Island FOR INSURANCE COMPANY USE Policy Number: City Clearwater State ZIP Code 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. Photo One Photo One Caption FRONT OF HOUSE, FACING WEST Photo Two Caption REAR OF HOUSE, FACING NORTHEAST FEMA Form 086-0-33 (7/15) Replaces all previous editions. clear Photo Two J Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS OMB No. 1660-0008 Continuation Page Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 708 Snug Island Policy Number: City Clearwater State ZIP Code 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. Photo Three Photo Three Caption NORTH SIDE OF HOUSE, FACING SOUTHWEST (A/C COMPRESSOR) Photo Four Photo Four Clear Photo Three Photo Four Caption FEMA Form 086-0-33 (7/15) Replaces all previous editions. Clear Photo Four Form Page 6 of 6 J.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 Important Follow the instructions on pages 1-9. Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. SECTION A— PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Neth, Thomas and Denise Policy Number. A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 708 Snug Island Company NAIL Number. City State ZIP Code Clearwater Florida 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 55, Island Estates of Clearwater Unit 7B (Plat Book 64, Page 70), 05-29-15-43457-000-0550 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°59'24.34" N Long. 82°49'07.06" W Residential Horizontal Datum: insurance. above ❑ NAD 1927 adjacent grade grade N/A x NAD 1983 N/A 2 photographs Number with a crawlspace of crawlspace flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? of the building if the 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 528.00 sq ft ❑ Yes x No garage: garage openings in the attached garage within 1.0 in A9.b N/A sq ❑ Yes x No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number CLEARWATER, CITY OF B2. County Name PINELLAS B3. State Florida B4. Map/Panel Number 12103C0102G 65. 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) 11 B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation of the Base Flood Elevation ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ (BFE) data or base flood ❑ Other/Source: ❑ NGVD 1929 System (CBRS) CBRS ❑ OPA depth entered in Item B9: x FIRM datum used located in a Date: ❑ Other/Source: Protected x NAVD 1988 area or Otherwise Area (OPA)? ❑ Yes x No FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 708 Snug Island 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, Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Benchmark Utilized: CITY OF CLEARWATER "1-03.5" 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) 7.97 Check the measurement used. x feet ❑ meters b) Top of the next higher floor N/A ❑ feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A ❑ feet ❑ meters d) Attached garage (top of slab) 7.33 x feet 0 meters e) Lowest elevation of machinery or equipment servicing the building 931meters (Describe type of equipment and location in Comments) x feet ❑ f) Lowest adjacent (finished) grade next to building (LAG) 6.82 x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 7.26 x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 7.58 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 1 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? © Yes ❑ No Certifier's Name License Number CHRISTOPHER MCLAUGHLIN LS 6614 , 0 . ''pto R p,? . , ,,..4. ,•,„ +,,offi.,;,. • if,ig • .'s4e ' 3 1 s tir. !i .tom .•`M1., !.: J. C C. •1^„....'. Trtle PRESIDENT Company Name MACSURVEY, INC. Address 22091 US HWY 19 NORTH City State ZIP Code CLEARWATER Florida 33765 Signature Date Telephone Ext. . C 03-20-2017 (727) 725-3269 Copy al ages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. -Comments including 'type of -quipment-and location; perC2(e);1rappticabte) C2(e): AIR CONDITIONING COMPRESSOR - LOCATED ON NORTH SIDE OF HOUSE, ELEVATION IS TOP OF ELEVATED ALUMINUM SUPPORT RACK FOR COMPRESSOR. • 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. 708 Snug Island 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. ❑ 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. 708 Snug Island 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 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 Paoe 4 of 6 BUILDING PHOTOGRAPHS ELEVATION CERTIFICATE See Instructions for Item A6. IMPORTANT: In these spaces, copy the corresponding information from Section A. OMB No. 1660-0008 Expiration Date: November 30, 2018 FOR INSURANCE COMPANY USE Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 708 Snug Island Policy Number: City Clearwater State Florida ZIP Code 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. Photo One Caption FRONT OF HOUSE, FACING WEST Photo One Clear Photo One Photo Two Photo Two Caption REAR OF HOUSE, FACING NORTHEAST dear Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS OMB No. 1660-0008 Continuation Page Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 708 Snug Island Policy Number: City Clearwater State ZIP Code 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. Photo Three Photo Three Caption NORTH SIDE OF HOUSE, FACING SOUTHWEST (A/C COMPRESSOR) ':Clear Photo Three Photo Four Photo Four Photo Four Caption Clear Photo Four FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 rJ.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008 Federal Emergency Management Agency Expiration Date: November 30, 2018 National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. Copy all pages of this Elevation Certificate and all attachments for (11 communitv nffir.�ai r�� inci ir�nro �.,o.,*i ............... ....a ��� �...:�.,:__ _...___ . . . _-__, ._r ..___'�..__ _',............r,....�� c..... �v� uw�uu�y Vw��c�. SECTION A— PROPERTY INFORMATION FOR INSURANCE COMPANY USE A1. Building Owner's Name Policy Number: Neth, Thomas and Denise A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number: 708 Snug Island City State ZIP Code Clearwater Florida 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 55, Island Estates of Clearwater Unit 7B (Plat Book 64, Page 70), 05-29-15-43457-000-0550 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Residential A5. Latitude/Longitude: Lat. 27°59'24.34" N Long.82°49'07.06" W Horizontal Datum: � NAD 1927 �x 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 1A A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) N/A sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A8.b N/A sq in d) Engineered flood openings? ❑ Yes ❑x No A9. For a building with an attached garage: a) Square footage of attached garage 528.00 sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? � Yes 0 No SECTION B— FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number 62. County Name B3. State CLEARWATER, CITY OF PINELLAS Florida 64. Map/Panel 65. Suffix 66. FIRM Index B7. FIRM Panel 68. Flood B9. Base Flood Elevation(s) Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth) Revised Date 12103C0102G G 08-18-2009 09-03-2003 AE 11 610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69: � FIS Profile � FIRM ❑ Community Determined ❑ Other/Source: 611. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ❑x NAVD 1988 ❑ OthedSource: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? � Yes Ox No Designation Date: � CBRS � OPA rtnnH rorm utt�i-u-�3 (�i�5) 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. Policy Number: 708 Snug Island 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* � 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 "I-03.5" Vertical Datum: NAVD 1988 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 Ox NAVD 1988 ❑ OtheNSource: 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 enclosure floor) 7.97 0 feet ❑ meters b) Top of the next higher floor N/A � feet � meters c) Bottom of the lowest horizontal structural member (V Zones only) N/A � feet ❑ meters d) Attached garage (top of slab) 733 �x feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 9.31 x feet meters (Describe type of equipment and location in Comments) ❑ ❑ fl Lowest adjacent (finished) grade next to building (LAG) 6.82 � feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 7.26 �x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including 7,58 x� feet ❑ meters 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 info►mation on this Ce�tificate represents my best efforts to interpret the data available. I understand that any fa/se statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. Were latitude and longitude in Section A provided by a licensed land surveyor? ❑x Yes ❑ No ❑ Check here if attachments. Certifier's Name License Number CHRISTOPHER MCLAUGHLIN LS 6614 t, r'' ' s• a; , r}"�� �� ;�, .- Title x��r., rv � l ` `" PRESIDENT �� ,�,� �, Company Name .�.' �,,�� : � �3..V � .� �. ; �� �. MACSURVEY, INC. s���� *�����.�� , � - �'; ,� . Address � ✓� � � `i �� Er4,',;`. 22091 US HWY 19 NORTH �''��.' ��; .��,, � f��-"'� 3` �� �y ". "- a�'� 37y Y � F "7 : �` J,�' City State ZIP Code r'� ',� ��'�'�y:t5&� �° CLEARWATER Florida 33765 �° � � �� �i�+`���e��'��� � �:���"' Signature Date Telephone Ext. ���� 03-20-2017 (727) 725-3269 Copy al ages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agenUcompany, and (3) building owner. Comments (inGuding type of equipment and location, per C2(e), if applicable) C2(e): AIR CONDITIONING COMPRESSOR - LOCATED ON NORTH SIDE OF HOUSE, ELEVATION IS TOP OF ELEVATED ALUMINUM SUPPORT RACK FOR COMPRESSOR. 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. Policy Number: 708 Snug Island City 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 (including basement, crawlspace, or enclosure) 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 1-2 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 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 commurnty-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. rtnnH rorm uttb-U-33 (7/15) Replaces all previous editions. Form Page 3 of 6 ELEVQTION CERTIFICATE onn6 No. �sso-000s 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: 708 Snug Island City State ZIP Code Company NAIC Number Clearwater Florida 33767 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: ❑ 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 elevation: ❑ 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. r�rviH rorm utso-u-.s.s �ii�5) Fzeplaces all previous editions. Form Page 4 of 6 BUILDING PHOTOGRAPHS OMB No. 1660-0008 ELEVATION CERTIFICATE See Instructions for Item A6. FY,,;ra+��., n�+o� ��,,,,e.,,ho� �„ �,,,o 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: 708 Snug Island 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. Photo One Photo One Caption FRONT OF HOUSE, FACING WEST Cleat Photo' Photo Two Photo Two Caption REAR OF HOUSE, FACING NORTHEAST FEMA Form 086-0-33 (7/15) Replaces all previous editions. �".I�:�VE4 Form Page 5 of 6 BUILDING PHOTOGRAPHS OMB No. 1660-0008 ELEVATION CERTIFICATE c t� on inuation 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: 708 Snug Island 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 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. p �f F . %f \� �. �, . ��f� N �.. I �\" �� . � ' T x >. , x �.. \ �. ' � 2e .y ...WS.., ����� ft .� ':c. � � .� �. r :. � 3�' '� y, . : .. � � ��"������� ��� ' � `� ��r+� � ��_ ��= � i����������� �� ` � . � �� ��� ��� � l�il, {73� 3 � d �� 4 �p.;.*" o�+"'����"�.� ":' 6 . ����1���������� ���� �.� � � �� ���,'1(� �,' ����� � ��� � � �� s�;i� . � � � �� ����� �' � �� E � � e�� , �� �r,�l , , � � � � �� r � � (3'i� � i � +{ ( I ,� � V��`�,��� �, '� y N� 'i:1 :.# 3 lfr � � �������.1��� 3J� C � Y �� t6 . ' 9 � } . �3 �iYu, - vq ` .. n�`a" _ I. � . � I � Y �. +� .. . . -vm 3 �.,� � �. . � : � � i� 2 �� ��� � �:�€'�� �` � : �, � � � � ��� � , �;� � � %� � ��� n ° � . ,A x i� � , � �, � , S'&. � ��. . � H. :.,E�l , n" ::�a .xa .> 5" i' � �� � P' � � � �� ti ,.,�,. N : r... � °�z�� V'� � .. ,. ��� :� ..;� � � �� •�° ,,.:,,..r� �:-uz_ :e � : ...a �: ���; .. . -.�, _-.., I r .; � . - ,,..�w:�.cc����- m- .,. ; . Photo Three Photo Three Caption NORTH SIDE OF HOUSE, FACING SOUTHWEST (A/C COMPRESSOR) Clear PhotoThree ��C��C� ��3t7� Photo Four Photo Four Caption Glear Photo Four rciwH rorm uue-u-�s3 (i/�5) Replaces all previous editions. Form Page 6 of 6 U.S.PFe ARTMENTOF HOMELAND SECURITY ELEVATION CERTfFICATE ' �DEPAL EME�tGENCY pEANAGEMENT AGENCY , OMB NO. 1660-0008 ,Jational Flood Insurance Program {mportant: Read the instructions on pages 1-9. Expiration Date:July 31,2015 � . SECTION A-PROPERTY INFORMATt�N ��F1.I�iSUAiANC6�CbMPAI�t�iC������: A1. Bui�ding Owner's Name KENDELL,PATRICIA � ���Ftcy Namber , y;�.��� � �" ��'�� " " �'���` �� ��-; 3� A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. �Ct�tipt�nyNAIC�ttlmbet�'����������� 708 SNUG ISLAND , �� "' `'�x�"����`�����, City CLEARWATER State FL 21P Code 33767 A3. Property Description(Lot and Block Numbers,Tax Parcei Number,Legal Description,etc.} LOT 55,UNIT 7B ISLAND ESTATES OF CLEARWATER A4. Building Use(e.g.,Residential,Non-Residentiai,Addition,Accessory,etc.)RESIDENTIAL A5. Latitude/Longitude:Lat.27.59'24" Long.82.49'06" 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. Buiiding Diagram Number 1 B AB. For a building with a crawispace or enclosure(s): A9. For a building with an attached garage: a} Square footage of crawlspace or enclosure(s) sq ft a) Square:"�otage of attached garage sq ft b) Number of permanent flood openings in the crawlspace b} Number of permanent flood openings in the attached garage , or enclosure(s)within 1.0 foot above adjacent grade within 7�0 foot above adjacent grade c) Total net area of flood openings in AS.b sq in c) Total ne+area of flood openings in A9.b sq in d) Engineered flood openings? ❑ Yes ❑ No d) EngintE't:�flood openings? ❑ Yes ❑ No SECTION B:�FLOOD INSURANCE RATE MAP(FIRM) INFORMATION Bt.NFIP Communiry Name&Communiry Number B2.Counry Name B3.State CLEARWATEER 125096 PINELLAS FLORIDA B4.Map/Panel Number 65.Suffix 66.FI;M Index Date B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone 12103C0102 G �-03-03 Effective/Revised Date Zone(s) AO,use base flood depth) 9-03-03 AE 11 A B10. Indicate the source of the Base Flood Elevation`(BFE)data or base flood depth entered in Item 89. ❑ FIS Profile � FIRM ❑ Com�nunity Determined ❑ Other/Source: B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: B12. Is the building tocated in a Gastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes � No Designation Date:� �� ❑ CBRS ❑ OPA � SECTION C-BGJILOING ELEVATION INFORMATION(SURVEY REGIUIRED) C1. Building elevations are based on: ❑ Cons;ruction Drawings* ❑ Building Under ConrSruction* ' � Finished Construction *A new tievation Leriincate wiii be required wne r construction ofi the builtling is complete. � ' C2. Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,W V30,V(with BFE),AR,AR/A,AR/AE,AF;�A1-A30,AR/AH,AR/AO.Complete Items C2.a-h below according to the buildiny diagram specifie�in Item A7.In Puerto Rico only,enter meters. Benchmark Utilized:CLEARWATER H-4 Verticai Datum: NAVD'88 ELEV. 4�? Indicate elevation datum used for the elevations::��items a)through h)beiow. ❑NGVD 1929 �NA\%D 1988 ❑Other/Source: Datum used for bui�ding eleva�ions must be the s.:.�ne as that used for the BFE. • Check the measurement used. a)Top of bottom floor(inciudir•g basement,crawis�7ace,or enclosure floor) 8.44 �feet ❑meters b)Top of the next higher floor- N�A._ ❑feet ❑meters c) Bottom of the lowest horizontal structural mem-:ar(V Zones only) N A. ❑feet ❑meters d)Attached garage(top of slab) ;7.25 '�feet ❑meters e) Lowest elevation of machinery or equipment se:vicing the building 9.31 �feet ❑meters (Describe type of equipmenr and location in Cc aments) '} Lowest adjacent(finished)grade next to buildi� ,;(LAG) 7.1 �feet ❑meters g) Highest adjacent(finished)c�rade next to buildi� a(HAG) 7.2 �feet ❑meters h) Lowest adjacent grade at lowest elevation of d k or stairs,including structural support NL. �feet ❑meters SECTION D-�'JRVEYOR, ENGINEER,OR ARCHITECT C�RTIFiCATION This certification is to be signed and sealed by a land:surveyor,engineer,or architect authorized by law te certify elevation information.l certify ihat fhe information on this Certit,:ate represents my best efforts to interpref the data available. I understand ihat any false statemant may be punishr �le by fine or imprisonment under 18 U.S. Code,S::�.'�on 1001. - � Check here if comments are provided on back e `orm. Were latitude and longitude in Section n �rovided by a ' `. ❑ Check here if attachments. licensed land surveyor? � Yes ] No � t ,�� � ` " • �, _- Certifier's Name WILLIAM C.KEA i ING License Number 152� £�� Title LAND SURVEYOR Compa-y Name ALLIED SURVEYING ,��-�� , Address 1275 NO CHLAND A�/�1'� City C_ =ARWATER State FL ZIP Cod '."s755 Signature � Date ::J1-13 Telephone 727-446-'2�3 � _ . FEMA Form 086-0-33 (7/1 �� See reverse side for continuation. Replaces all previous editions. tNl�GiS�"AN7:�/t these spaces, copy the corresponding intormation trom Section A. Fa�rnisu�r�cE coMP,an,�us� .., Building Street Address(mcluding Apt.,Unit,Suite,and/or Bldg. No.)or P.O.Route and Box No. Palicy Number: f 708 SNUG ISLAND „�; City State Code =Company NAIC Number. ; CLEA�RWATER FLORiDA 3 3 7 6�P -, . -=E _' SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Efevation Certificate for(1)corrimunity official, (2)insurance agent/company,and (3)building owner. Comments C2 , � AIR COND ELEV, 9.31 � � , � _� Sign e � Date : SECTION E—BUILDING ELEVATI N INFORMATION(SURVEY NOT REGIUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),complete Items Ei—E5.It 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 o^ly,enter meters. E1. Provide elevation information for the foltowing and check the appropriate boxes to show whether the�levation is above or below the highest adjacent grade(HAG)and the lowest adjacent grade(LAG). a)Top of bottom floor(including basement,crawlspace,or enclosure)is ❑feet []meters ❑above or�below the HAG. b)Top of bottom floor(induding basement,craw�space,or enciosure)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(ste 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 0 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 information in Section G. SECTION F—PROPERIY OWNER(OR OWIdER'S REPRESEN'�ATIVE)CERTIFICATION The property owner or owner's authorized representati�ie 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 knowiedge. 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 a'dinance can�omplete 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. Gi.❑ The information in Section C was taken from cther documentation that has been signed and sealed by a licensed surveyor,engineer,or architeci who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the COmments area betow.) G2.❑ A community officiai completed Section E for 2 building iocated in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3.❑ The foliowing 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 batum G10.Community's design flood elevation: ❑feet ❑meters Datum Local Official's Name Title Communiry Name Telephone Signature Date Comments � ❑Check here if attachments. CC�AA c,,.w,�fla_n_�� ��n�� Replaces all previous editions.