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667 HARBOR IS\scpm't* `3cPa?c U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICA' Important: Follow the instructions on pages 1-i Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) in: SECTION A - PROPERTY INFORMATION Al. Building Owner's Name William G. Wright and Heidi S. Wright A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route ar Box No. 667 Harbor Island Ci State RECEIVED BY: J.A.W. APR 0 7 2020 PLANNING & DEVELOPMENT CITY OF CLEARWATER 667 HARBOR ISL BCP2019-0306258 COMP EC WILLIAM G WRIGHT Zoning: Island Estates Clearwater Florida 34683 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 16, Unit 7-C, Units 6D, 7A, 7C Island Estates of Clearwater. Plat Book 64, Pages 1 and 2 Public records of Pinellas County 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°59'21.13"N Long. 82°48'58.51"W Residential Horizontal Datum: ❑ NAD 1927 insurance. above adjacent grade grade 4 x NAD 1983 1 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 1B Certificate is being used to obtain flood 45.00 sq ft or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b or enclosure(s) 200.00 sq in within 1.0 foot foot above adjacent in 793.00 sq ft x Yes ❑ No garage: garage openings in the attached garage within 1.0 in A9.b 800.00 sq x Yes ❑ No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number City of Clearwater 125096 B2. County Name Pinellas B3. State Florida B4. Map/Panel Number 12103C0102 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) 11.0' 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: N/A ❑ Other/Source: x NAVD 1988 area or Otherwise Protected 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. 667 Harbor Island Policy Number: City State ZIP Code Clearwater Florida 34683 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, ARAE, Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico Benchmark Utilized: City of Clearwater 1-04 Vertical Datum: NAVD 88 ELEVATION x Finished Construction AR/A1—A30, AR/AH, AR/AO. only, enter meters. = 5.2452 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) 13.10 Check the measurement used. 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 x feet ❑ meters d) Attached garage (top of slab) 7.53 x feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 13.43 (Describe type of equipment and location in Comments) x feet ❑ meters f) Lowest adjacent (finished) grade next to building (LAG) 6.00 x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 6.70 x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 7.50 x feet ❑ meters SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by I certify that the information on this Certificate represents my best efforts to interpret the data available. statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. law to certify elevation information. I understand that any false ❑ Check here if attachments. Were latitude and longitude in Section A provided by a licensed land surveyor? x Yes ❑ No Certifier's Name License Number JEFF M. HARTLEY #7123 )��� : 5 ' .?.? x?�� t�3x. u ?fes gN. � try ,x , 4� y ,, n� ��� `R n rrCaa f�4y`3� ;,n�a a r "."" Title PLS Company Name INITIAL POINT LAND SURVEYING, LLC. Address 1708 WATER OAK DRIVE City State ZIP Code TARPON SPRINGS Florida 34689 Sig r 1 u • Date Telephone Ext. �,/ 3/2y1 (727) 831-1990 / , • ,ages of this El tion Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Com ents (including type of equipment and location, per C2(e), if applicable) Data in C2.f-h is only accurate to 0.1'; ignore the second decimal place, as this is automatically added by the FEMA form. C2(e) = A/C on cantilever platform on right side of building Flood vents "Smart vents" Model 1540-510 200 S.F per vent (4) vents in garage Storage area at back left of building with smart vent model 1540-510 (1) vent 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. 667 Harbor Island Policy Number: City State ZIP Code Clearwater Florida 34683 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, Band 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. 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 ❑ above or • below the HAG. with the community's certify this information in Section G. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must SECTION F — PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA -issued or community -issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner or Owner's Authorized Representative's Name lG .7 ft ,/,/, , ' / seitA,r' lie �7 337 Address / // City State ZIP Code _ 'WV.7Z 717 %��?� Sig = ure 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. 667 Harbor Island Policy Number: City State ZIP Code Clearwater Florida 34683 Company NAIC Number SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8—G10. In Puerto Rico only, enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2 ❑ A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. G3. ❑ The following information (Items G4—G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ G8. Elevation of as -built lowest floor (including of the building: G9. BFE or (in Zone AO) depth of flooding at the G10. Community's design flood elevation: New Construction ❑ Substantial Improvement basement) ❑ feet ❑ feet ❑ feet ❑ meters Datum building site: ❑ meters Datum ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 667 Harbor Island Policy Number: City State ZIP Code Clearwater Florida 34683 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. lv' j - 1 k.. IN 1111 l•� 1■ _._ .T':w _.�p7E�r�''s .. s I S _ _ moi, _ s y .. -. ` Photo One Photo One Caption FRONT VIEW Clear Photo One _ \ 1 /i Of 1 ."' / t'i m.e 1 Photo Two Photo Two Caption REAR VIEW Clear Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 667 Harbor Island Policy Number: City State ZIP Code Clearwater Florida 34683 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. )4 t;\ air i '{ - • tl , -* na Photo Three Photo Three Caption LEFT SIDE VIEW Clear Photo Three 1 'tlr)tp 1 Photo Four Photo Four Caption RIGHT SIDE VIEW Clear Photo Four FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. OMB No. 1660-0008 Expiration Date: November 30, 2018 Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owners Name William G. Wright and Heidi S. Wright Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 667 Harbor Island Company NAIC Number: City State ZIP Code Clearwater Florida 34683 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 16, Unit 7-C, Units 6D, 7A, 7C Island Estates of Clearwater. Plat Book 64, Pages 1 and 2 Public records of Pinellas County 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°59'21.13"N Long. 82°48'58.51'W Residential Horizontal Datum: insurance. above ❑ NAD 1927 adjacent grade grade 4 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 1B 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 636.00 sq ft ❑ Yes x No garage: garage openings in the attached garage within 1.0 in A9.b 480.00 sq ❑ Yes x No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number City of Clearwater 125096 B2. County Name Pinellas B3. State Florida B4. Map/Panel Number 12103C0102 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) 11.0' 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: N/A ❑x NAVD 1988 ❑ Other/Source: area or Otherwise Protected 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. 667 Harbor Island Policy Number: City State ZIP Code Clearwater Florida 34683 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) ❑ Finished Construction AR/A1—A30, AR/AH, AR/AO. Rico only, enter meters. = 5.2452 Cl. Building elevations are based on: ❑ Construction Drawings* x Building Under Construction* *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations — Zones Al A30, AE, AH, A (with BFE), VE, V1—V30, V (with BFE), AR, AR/A, AR/AE, Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Benchmark Utilized: City of Clearwater 1-04 Vertical Datum: NAVD 88 ELEVATION 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 a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 13.10 the measurement used. 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 x feet ❑ meters d) Attached garage (top of slab) N/A x feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) N/A x feet meters ❑ f) Lowest adjacent (finished) grade next to building (LAG) 6.20 x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 6.60 x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 6.50 x feet ❑ meters SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by I certify that the information on this Certificate represents my best efforts to interpret the data available. statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. law to certify elevation information. I understand that any false ❑ Check here if attachments. Were latitude and longitude in Section A provided by a licensed land surveyor? x Yes ❑ No Certifiers Name License Number JEFF M. HARTLEY #7123 r . rr' ^'� %f t , Title PLS Company Name INITIAL POINT LAND SURVEYING, LLC.' Address 1708 WATER OAK DRIVE City State ZIP Code TARPON SPRI GS Florida 34689 Signat :� ate Telephone Ext. / It./ I 7/11 It? (727) 831-1990 Co �� sof this icate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. �-"'s r • (includingtype of equipment and location,per C2(e),if a applicable) PP ) Data in C2.f-h is only accurate to 0.1'; ignore the second decimal place, as this is automatically added by the FEMA form. C2(e) = No equipment servicing building currently installed Flood vents to be "Smart vents" Model 1540-510 or equal ICC -ES certified to ventilate 200 S.F of Floor area per construction plans Garage floor not poured Current flood openings 8"x15" (4) in garage Storage area at back left of building with flood opening 8"x15" (1) 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. 667 Harbor Island Policy Number: City State ZIP Code Clearwater Florida 34683 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 El—E4, use natural grade, if available. Check the measurement enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, LOMA or LOMR-F request, used. In Puerto Rico only, the elevation is above or below ❑ above or ❑ below the HAG. ❑ above or ❑ below the LAG. 9 (see pages 1-2 of Instructions), ❑ 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. crawlspace, or enclosure) is • feet ❑ meters b) Top of bottom floor (including basement, crawlspace, or enclosure) is • feet ❑ meters E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters 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 owners 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. 667 Harbor Island Policy Number: City State ZIP Code Clearwater Florida 34683 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) 667 HARBOR IBL BCP2019-030625A under const WILLIAM G WRIGHT Zoning: Island Estates Atlas #: 258B ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 667 Harbor Island Policy Number: City State ZIP Code Clearwater Florida 34683 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. r • r,t. *" 1 fir�/ t♦/ i , ,e..- y T' . f . t `_ litir lima.- i _ .Wi i, Jill 'TS Photo One Photo One Caption FRONT VIEW Clear Photo One Photo Two Photo Two Caption REAR VIEW Clear Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page OMB No. 1660-0008 Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 667 Harbor Island Policy Number: City State ZIP Code Clearwater Florida 34683 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. .wa 4 q t .l; yJ'• -co .. - Photo Three Photo Three Caption LEFT SIDE VIEW Clear Photo Three x II I 4111* 1nn�c Photo Four Photo Four Caption RIGHT SIDE VIEW Clear Photo Four FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6