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1024 PINEBROOK DRU.S.DEPARTh4EP�TOFHa4.1ELvNDSEGURiTY ELEVATIQN CERTIFiGATE 'EpERAI Et'ERGtNCY P1Ltt i+GEMEN i'KGENC i' ;.��„r� ,., ,��_ ,,- :�,-�,z� �, ;r.;,�� Iniportant: Read the instructions on paqes 1-4. SEGTI�PJ A - PROPERTY INFC}Rh1AT{ON 5 N�^.. C7,"a1B ��0, i:i;ati CC�`& FxF;irat�G�� Date: July 3?, �i:�5 FGR E'�.SUR4�GE �.�'.-,PANY USE Poi �y fr`u;��a A2 Eu' !�•�:;� 5t aet Ad.l ess 4it��i�.di��� Apt., l:!r::. S1:e 3,-�:;1-cr 5���t i�a ���r P.O. Rc�.,a : ntl 6ox �5�7. � Ce�:ncz«y NAIC !vnmber. � t124 ? Nt�Fit�C:i{ Jrtf:c __ C ty C L�-AnN�ATE� _ __ __ - 7* F� t!P C � i 337_:5 --- -- � l.Q.�-�,� f�:i. =1iJ__ �,.7e�71. 1,�;Ia� {E`:iF�_.h ... A. !3_.f._� ��i�17�' �_���..�'L-�,.E! �.�'i �?.. IAX P;1i?t;EL�> ii%: �"j: t' :',��iY4: CC�i�; vt3;; p.A Bu �il�'�:� ( ��e �2.i7 . � ir .�:=1�t i �.,, Py;�'- r ..r.a„�? j .�.'C:�ir� . ?,'Ce:;c F �- ; , - } ��_ I� iEt_�1TI_A.� N5. L�t�tuc.� l�1 ;�!zir��: Lat 27 �B'd2..;"L L���,c�. N2 :tr�a-�y', Ncriz�,;•�t�f C'a?un;. 0 NA� ��27 pp NAD'g�� r�G r1tF_. . 't �,.�. � �t ��, ,;�s ��fi . � . _�r-:'414,. tv� , ,.a., .: �.�- ?..,��d � crJ,,...',��d �:��. ..t��e. �; P„ ,�f,�� li ,c�ra!n �'<<.�7-,a� AF? r u� a �i �_t -:; �u�t! i c r�w1- ��_..�v c� e., -... u �;Pa' A�a t�:;r ,� Lui:�,a�*,g �.ro��ltt ar� ���t<=�, e.i _�;.t :g2: a: Sq�. ,r_ :u��?fl,� �i _,a�S . ��d: _ �_r ���� __.�r�.. . {) - � ft c,7 5��. �.� �. 1G�_L-'ts� '�` z,t_ .k;. _ ..f� >l� _ • bp \::rt t: � et patm.a�aia� #'z�_u1 ooei� ,.y:> in ihe crawla;�nc� bl N��*�ber �( ;��nr.ar,sn( {Is:�..d c�c:e i�����;. , t� ,e �1! a..ne�i c��3raae vs ?�. ,...r.:li:�-�{a, ., t}l�^ �.v?','�3i �t;� _ 3.�, . : ;j<<."� J .',It��. �_ . �i._i !±:_. <,J�,).? : ,��i.�?. - ::1"�'..::te 0 -. � at �! r_t :,roa J i��,:.1 r �� :ir.a� 'ti A.,. u sq iit ', 1 ot_, r.=�' are_, rt i.�t;c. ,,�e .i;;�s i,: R�.� D _.a i�< dt �tk` ,1 ?tE?ri #;� , 1 0(;^n' 1; �s7 ❑`!8S � id,, di E!'�ti 7� eret{ *I�0!1 ur,er i1gS? ❑ Yr-S 0'ti ` SECTION B- FLOOD iNSURANGE RATE t,AAP!FIR�1`) INF�RP,AATlON __ -- _ _ _ -- __ _ __- ----- _ _-- _-- _ -- __ _ _ __ _ ---_ __ �? r�'�`� �,f. 1� iL�P}I:y� � ii� ri .x l.,�iTllT'U'-ii"f R._.'��}'�; ��. T..GL Cl y'�c '!8 � S -���,iB � C;I � Y':,F C LENR?'JATEr�, 1�503r. � r'iNE� t_„S F_�K;L�,4 � � �4 '"i it�E a1 i�i �� -rlu,' b�` ?s J�Ct ( �6. Ci�i`r V1���'t �fi'8 � �i ��.•� uf �iL� � E'� � L�.:� �.l_ b!b t-tti:) � E t i�iD I4 �t;tlB �1��3 t e�.}L N � 1K �3 E`f ;,ti e 4 v�ae1 J.t? Zui��r y AO ii.e'.� +.>c7 c��}� i�; ---- — — _ ___ _—. _ i__ _ �-- _ I _ .�_ _._- I -- --�� --- - � - — _ � ___ _____a �?0 �r�d �;.;t2. tij� aur.�a c�i tf�e 83_ ,�I�•,oci "t�e✓�C;���� iSFE1 �fat3 cr i�a;a [Ic,o�i ci. �th �n:�rec: n� I:a�n B�+_ � ❑ .�5F7:t,:_a � `�4:^. ❑ :0'^.t'1�itl��Ct's)P:.(l�:i18Ci ❑ i.%'C?2Y:�i 7':. ''a' 1. it..i�.v�tl•? c� ;,�.I�;li1 C�I.II;'(l :i�_.� }0° �i't i:'. i2Brli �Q: ❑"�i�i'��✓ �ti�c`�) � Nf��✓U 1��7$ 0�:",p�r�� �Lirf,.�: �'�. ��'� k:' I�. ti., :;1'w;t£,'lj f(`;i _,.�i,_t:.� �'S3 .�f �:',..-,:(.... Jf .��1? .r.��f?-�_ i :i :�:i t _1c,st'^:I,::. �� :�:�._;1 r,.?;i t�_)t�:�l�' ❑ 'r,�.'.'� � ��i� �t� �i2:ft.:�.1 �.1:.:.. ,�:`_f� � v��•A� � L.�,``�f! SECTIaN C- 8UIL0lNG ELE�dATlON INFURr,hATiON (SURVEY REDUIRED) C i, E,,i: i�r;t: �i;-.�.t:,as are baseu ut;: ❑ Constru:,i�o� Gr ,�,: �Ms' � 3uilci� :,j Unu{er Ca�isiru�fion' ��-���i�ed Cu .:1-4�:[�ri �.t ,�.��t� � : ;�tc_ �� C �:t,':�ate G, ' �ie �et,. � _c .� ._ � . _ �..?��� �.: ,� v t i�. f �_ �i�.+.f�,n '�_ �cn7ul�te. �.::. E.�..._ ��, Z,�;,�, Ht ,.3;,. AE, AH. A �•rti-t��, �iFE�; V4 V 1?^ "� .:,?i; E��i AA, a�i,H. I�R�Ac. A�?-� i-r�3:i A��AN. ,�R�:�C7. Ccr:u.:,rt fte��,:� ��. �-h 6� �:,w �:;;co-� rsG (o t � bu��c: � �if �,r�em sp�cifie,l i�. .ie?�i P.i in �'uFrtti, l�ico �_ ,y. ai:9er r��p;'r•.r;. E���c?r��ar:n. ...:�zec: D-` V�;;ic; I ila;ir,t�: ;V,�,VD no,g � , iiC3iF_• ��. �Jc1:i011 c.7-,_.11�.fTl ,,�+�<1 (J! il12 ..�C'13i�::(�S fL it8;T15 31 . .f ill�t '. � .,�.4. ❑ �il�'�J� ;i,�2� � ?'�}1�1� i.��,$? ❑ %„Il?C�.,,t?,.d11:*:�: L� -.:.U;il i.1�f.Cj ``SJ.• b:f '.��.r�3 t'`£?V t��t �. . 1?li , i?? ti`,f:� ��I�l� �iS t . t�c.'�:;{ + r irn �:"'�. �,(iS::!� ;i'.,, n'.� .:lliJ`Ti=.III U£c;�. �3 �,��,?,�f Cc:ftotn f! -�r �irt�'�tl� .n ti,�er i. . I. c•�.��..:{�au3. � . �c!G�u e "1o�r:. 1, � CS'1 �i' (... � ft..'.�: r 9f I'::}�:( c� wc�ttom �f ,faa !c-..>_t hc.:zcnia' .tr,,. .ur�t cr:e:n�.ar iV ��n � t�-�yt c+s .4ti2,.h�•J ��;,r:n:: �1�; ;.t si:;,� F � L�:�ees, �,:v.,t�o;� u r�aci� r,r or . �,;e.�: �. �.;;a � �_ L.,.'� 'J �� �sc;', � �:.��� c,_ ���.��5�tis �t a ;1 !:3�3 �;s1'srs � m��as) t�, ����ys� �d Rc2n' 19 ,,,,i��,�i _�� :c+� ner� , f.�,; ;� ; ��AC;l c]s Hic�hest �3;iac�;•t �tu�:�.,h-�� U�; da r�axt ,�� i.ui? i�: �� ,�!AG} i. ..e3 ..d;, _�rit 7 .�� ai .e_ _ af�v .� _�f� u` i9 _ , � ��t r�, . .. , .. �7_� �;��„ ,...� a t •�r i r,.s2 '�?:. ii �J _f� Pt.A 9.'? p t,�= ❑ ,:�..ters ❑'.;_. ❑ n�,,,.- _ � f�?c.f � In�:��; ❑ `�._. ❑ ;?te?cr5 0 f2�.t ❑ met_rs 8.° � (3... � r�Ntars 1l`.Q ❑ f�t*, ❑ nt�?ers _ _ . � fr''' a •,19i�.... SEGTit)N Q- SURVEY�?R. ENGINEER. QR ARCHtTECT CERTIFIGATION i hi_ �..?i,,r:at :�r� i� fa t:_�_p c�ri .in_1 5eai�.. k�g ;r I.n�i surlay, r, an �� ,r. �. ;,f,�i _it .�.i niiU�is�r ��ri �r;� ia.r ir, .�ert tv -�;avation ltri�,�I .3u.�". i �.�. t�fi i�l..? (� _: ll?:�Vr ..t�.fJ.,' �: if �ti L87 7�L�i8+'Yf��a�P;tia � ✓ {.r,S( r?.IG %S i0'!)tP(:,ri; �??B ;.3� � eill. �aJ!`B. lU:"'rf?,._i:.:.=�7 t<�.co�iYft.�_�o,�n.-._,i ,'ci; U..4Td„'51�,�.ktw%Y�b?.._ i,•j.�,.,,..�.,,,�,-,..r,;,_ ,� C'.$.C�t%�:a...e.-fii:t, �{ti)., � C�^e�� t e� if e%;rr r��� n.s are priw:le�: ��: I,zch ��f ;crtr�. :Verz Ia.�,uJa arid r�c�iti,de ir7 `��:.: z aA r����t12d t,y � o c _:�:K ; � � :. �:t<<� � _�,:,. �u,,��,s �� :� �� � , :�� :F p y�. p :�,�� G�u . ��`'> �1art;� ELlLA6cTH K4�HLEc,i `aIE�TA Lt vr�sa �.: io�' L3G1 ! 3 �" _' S . ' i:i� � �.,. . ._;,r�� uy ;a!�� � . ,:t� Ja• JC; �Ur+� tYi;�.C; _LC -- �- __ ___ _.. _� --.. _ _. _.._ __ _ __ _ A�i�'.�c _ ,4, �R;aP�_ � ��� :�; C,LEAR'vtA �R �.:?a =L Z!PCc 3�.+,,;�.: ��,, ._._.. ......._ ... _._ __ . _.. . ... _ . L _.__. - ._..___ .._._ _..._. _.._. . _ _ _ _ ... __ ..__.._ __. _._.__ il,�fl�.U.:. � . '3:g ' i _ =�i� r?' �1{..��! _ 2?;�-�4 ;?% `. F�A.AA F�rt�� OEG U'u3 i7 121 S� e re��crs�v s c�� lo�� caniir;!:at;cn. F��p;ares aii o� e�✓io�ts e�i?ions. '� � M EL�VATION CERTIFlCATE, page 2 Ih9Pc�RTAt�i: in these spaces, copy the correspondin� information fram 5ection A, '�uil:jing :?•cF-. Ar„rea_� � a��uC.�i?c� ?.a: . f lrnt, ��� it_�. > >. .,r P,�',� "v�,..} c,r F.C�. ,, t:iv . �.�.� ��x `�.,. i02� P',tiE�Ri:�i)f<. Li,�iiVE _ _ _ _ _ __-- -- -_ _- - _ . _ _..- -_ _ - - - _ _ - - _ __ �.�1";l l! f�'���'titirF� 1 F�+`. . id.A . �.. G�P �...C�t�. �J.i! �:} FOP f1SURAi�i:_ CO'.1PA!VY US� ci��:Cj! �:}'11h�.': -- ���nY�ny tiF��c t�::m:..:r: SEGTION D- St)RVEYQR, ENGINEER. OR ARGHiTEGT GERTIFiCATIQN (CONTINUEt�I .�'rUO� Ji,.si aiC.... G; StiVS LrNlc.11�, t�: 1f�1..� I 4� f, �) i: it �;lii'i1V (� .. _., 1,�1 �..� c.;*c,,. .,c�� .;:�t.u�{ _:.t;y, i. .i ,: t: t�Gl��ki7 UWii2l. i:c,t?'tit� '_: •� P.; .''rl. i> ; N� A.�N�:��; ltt !'.),`J ��1;? � t ri 1 E i?k= f-Lfihl��ts, L;t'E,•JSEL� °h(. F_5ti;�)�;,4� til_!7 ��Y=� N r..lL '.tAa'�R. I�E �Lt 1,�.1 lC:�S ;t-Ct.,'�t I?v ', i t �i C,�ej 'S THc �;.AB i=0 ! h� :i;l? �_:�3trClilt^"�;I�;CS i_ �71i :,1 B� .:F:.�'AF�{ l i�Ev �:�tAti �-n riiitv4 -H� ��r�-i _ ti.�� GEt_ �:E i i{.' SUF�VEY Nd� BtiIT�- r"1PlC� i+A`f(;�t � r'+ �liQl 'S4 t�:� rl EVA I;i)?w C� �J �: � PdCtiTt� A� Fa�rAiJ VE�?T!CAL DA.T1,"+�' (iJAL'D i �'-N8. ;� :au�._ . __.. __ _ _ ___- -- -- --------- t�:t� , � :'��; > �..+..�«.: , . . : . , _ , . SEGTti?i�i �- B�iLU1�iU ELE'v'Hi1Giv iiv'rURihHiiuiv ��Ur�VEY NQT REQUIREQ} FOR ZONE AO ANQ ZQNE A(VJITHOUT BFE) :,i L�;i�� A�� :,::� =� 'tr�i�..;i.t BF ;.z•�;�r�.Ft.. �ter� � _!-�� '1 tP� �ert�� ...te :_ :��tsndaJ t�� �., .;�rt a LC1°:'4. c� �C� :'ft-� eu � ,� , � n . � _,= Se,�_w^,s A- B, ar�c, �� . �. .cr*�s c'-E4. i���E �; � �� : �r�.�3. i �r.,�,�r3'.. G„?r�. G-� �;�e2�,r_��^rt �,_�_.. ist ?.._�'c , _.. . .y ��. .�_r �_L�=��. Et _ P ��r�«'�> . � �� 3t�u„ !��:�na;� .i i : � �. � fc � v:iaiq 3i ti :h��ck ! _� a,.;�r��>j.r�_�t � !�� __. t�, at� ..� .v�.�:h , t �ie� a,i�n is �:t�.�ve� n- G�.�oti, t�� � i�L. ,t ,.�i;acc�it �tia i4'G �la t� ue�, d �• , d ii AL' �.� �. �c� c.� r, �,t.�.;a i.u., .i -;; � �+, <v, t,�s .,,,.�..�,, ::r«�.�:s,::.. � . � .±u,ir-e, Ir- -- -----_ C) reH'. p ,,,�:e�s ❑ .:U,,a� cr p ,,.! �.•r ,r��; N.A�;_ ��. ; �� , ra , ,:t� .": ? � . � �� ��:'� 1.;,�? w.c_ai..� � -.� l 1_, �.�:� � E-_-;!i���c�;e) is ❑ �eel ❑ mc��.:�� ❑ 1b. �. _ c r � l,efr_w it2a WG. _� __ _____ _�. �'fii iiVi t� �-'� =: � �ls �-� k'n?'i t:�fl(` ..,t.�,t �'�Uf �. t,�it?.'i'f'tJ . CfG.I(��.,.'� In �Pc.i � r� 1 °;?,.: ..�� ;i t�-t1f N ,...... : .,y�� ti—.=: t .. Sl'L1t.�..J;�;, 1i1P Il kf `'i�1f1_.� ��;lpi' (��el<:t;10?i i.`L.�) it1 i�?r �11d.3C_ilT.yl v"i jh�a Ult���':11!'�j jS �;�BI ❑!118i8��9 ❑:�VUY:? C.r � tiE;vW !t`�,H i'�H��, C,`�t. H � .i.r:. cl.; �...il .. :..[i: �S � fF?�. � !I."t�"(:i � ..v..vF .i � �,!rl:;;> (Pit' IIHiJ. __ 0. .i a�, t5ur�t� �ct n��,+ah�r,e r sr,u 3r �"„rp�3��r i�.,.�!r �_��r4u'rg i�; ❑`__,� ❑�_:_ � t:k�r,ve or �;>ela:�. t`�e H�IG. �=._ Z;���� (i�.t cr�F � i� n:� .iu��1 d .G:;h r,u;t�Lz_r � , •r.v�. �L� >. _ .I _ i=1F� ��I .I t. � ,. ,t, f.vr ��I:_, �.. �: u� _.,__�.�+.at : +,. C��, In� �o�cn�u�� tt 5 � �.��3 ��_..i �_a�� a��_rir���t �.�Sir,z:zt��a' ❑ Y:3s ❑ Nc; ❑ L; .�n�:�ta. �}.� r. _.a: � f� at rr�t, ; r �rt iy ,r ra +�;`r�°tn�_t,:!;'��t S���,�.r� C�. SEGTi�3t� F- PRUPERTY Q4NNER (OR OWPdER'S REPRESENTATtVE) CERTIFlGATiQN Tha ,r^p:�.�y cv,me� er n,v.�e�'s a:;lno-ize7 rt �xe�e^?at�t _;:i�n r�3.ip;�;s-a C^c•iia�s �i B. ::ri7 E!o; Zn :e A,�4ii�~c�;t a FEi.'A i� � ue�l r3; .�en?m�:i7:ty<is<ued B�Ei :;( z ,,;.. 4r) tt�. i > .,Iy. �. _:��;,. ? .� . --.I..��i1 .-t . L. � .. (:?.:3::'s .�. .�;, !-.��,.J � . . .,ufr:.:11 tu C .. .,�Ct �'. -.V k �,� :;���.��. . F,�ce<tv C��4�nar'_ :r �a;�i?,r.� Autit,;ii��ti R�;;�ese�:;i�t;... � Nr.�^.. __. _-- ____ __ . _---.__-----._ _____ ---- ---__-_ __ ____ _ ____._ ___ _---- ___ ___ ___---- A�,:i,t3, +�!?;r St�iT,P ZlE'VV:e 5'..)' :fl!'.. i:,:�.. ?"I�.'1.':..!E? l.tiili�llf:'i?S _ ❑ �.tl;%CK �:Ef2 ;f t11lui.�ll:io1;26. SECTION G- CQhRMiJN�TY lNFORP.4AT14N (QPTI4NAL) T`i� i�. :.� uf�u.:ai �vt. � iS <a ik ,r�z�i G..^. u� u��� „! �:� tu xd•�;i.'i.tG. [!-� c� �ur t<<iiv�� �� �..�.,>.'a n t �+;;� t.:.nt ord!a.��n�a ��<an .,.,,n., et� S+:ct ot�s A. $. t; (or E} arci tU �f 1=; ; �I_Vnt-i;:!. u. � �,I<:.�t . � v; �C':-._ ir_.:. ,.}iL �_.v.� ;t.= , . -;,�d ,t�l U��4:�. C.,�c,K'I2 r•c':i5i��...,2�.: �_v , , i?:�.�_a i»-�ai�. s'n �L��t� , ..0 i!?,��, ��.,,i.,! ,p�i���. �' . � Tfl� il�:C?f(ft�i,;-J . <<i 52::2'�� � C '.V�S i�i .. `t °YO?1 t�?h�°` :iC�..l iTl?11Sdi ..t1 i?;:,. 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