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2005 CALUMET STU.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 (1) community official. (2) insurance aaenUcomoanv. and (31 buildina owner_ SECTION A— PROPERTY INFORMATION FOR INSURANCE COMPANY USE A1. Building Owner's Name Policy Number: Church of Scientology Flag Serv Org Inc. � BoxdNo Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number: 2005 Calumet Street City State ZIP Code Clearwater Florida 33755 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 20, Clearvvater Industrial Park (PB 44 PG 46), Parcel #01-29-15-16488-000-0200, Pinellas County A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Non-Residential A5. Latitude/Longitude: Lat. 27°59'04"N Long. 82°45'13"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 1 B A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) 0 sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b 0 sq in d) Engineered flood openings7 ❑ Yes � No A9. For a building with an attached garage: a) Square footage of attached garage � sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade p c) Total net area of flood openings in A9.b 0 sq in d) Engineered flood openings? � Yes 0 No SECTION B— FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name 63. State City of Clearwater / 125096 Pinellas Florida B4. Map/Panel B5. Suffix B6. FIRM Index 67. FIRM Panel B8. Flood Zone(s) B9. Base Flood Elevation(s) Number Date Effective/ (Zone AO, use Base Revised Date Flood Depth) 12103C0107 H 05/17/2005 05/17/2005 X& AE 50' B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: ❑ FIS Profile �x FIRM � Community Determined ❑ OthedSource: 611. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 �x NAVD 1988 � Other/Source: 612. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? � Yes �x No Designation Date: � � �CBRS ❑ OPA U�.�-t.-.� L' . FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 200� c��uMET ST bcp2014-03343L ELEVATION CERT FINISHED CHURCH OF SCIENTOLOGY Zoning: Industrial Research and Atlas a � ELEVATION CERTIFICATE IMPORTANT: In these apaces, copy the corresponding information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No. 2005 Calumet Street Clearwater scate ZIP Code Florida 33755 OMB No. 1660-0008 Expiration Date: November 30, 2018 FOR INSURANCE COMPANY USE Policy Number: SECTION C— BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings" � Building Under Construction' �x Finished Construction "A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations — Zones A1 A30, AE, AH, A(with BFE), VE, V1—V30, V(with BFE), AR, AR/A, AR/AE, AR/A1—A30, AR/AH, AR/AO. Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: 15 74 B 03 FLDT Vertical Datum: NAVD 1988 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 �x NAVD 1988 � OtheNSource: Datum used for building elevations must be the same as that used for the BFE. a) Top of bottom floor (inGuding basement, crawlspace, or enclosure floor) 51 50 b) Top of the ne� higher floor N/A c) Bottom of the lowest horizontal structural member (V Zones only) N/A. d) Attached garage (top of slab) N/A e) Lowest elevation of machinery or equipment servicing the building 51 51 (Describe type of equipment and location in Comments) fl Lowest adjacent (finished) grade next to building (LAG) 47 3 g) Highest adjacent (finished) grade next to building (HAG) 51 0 h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A structural support Check the measurement used. Qx feet � meters �x feet � meters �x feet � meters �x feet � meters Ox feet � meters 0 feet � meters �x feet � meters []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 law to certify elevation information. I certify that the information on this Certi�cate 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? 0 Yes ❑ No ❑ Check here iPattachments. Certifier's Name ' " License Number < ��y �, ; � �M Walter C. Sherrill, Jr. 4803 �.�: ;:�e..sN�_ �..�y � � `. � � � � .r . �` : " �; o�y : ;°J�.�� � �p�� q�'Lt � ' �: �! '� w , ��� � � .�. � `� y ��� � �' , �t� ,'., : �e� <: � , ,� Signature Date Telephone i.l.�,a.12.,�.., CG _ , 12/14/2016 (813) 345-4270 Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agenUcompany, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) Lowest elevation of machinery or equipment servicing the building was taken at the top of the A/C pad on the north side of the building. PSM W.C. Sherrill and Company, LLC Address P. O. Box 203 City Odessa „�,,���._ , . r n : „�� � g�8q �� � � � . � . �'� � T .� a� ; ' S ` S q: r�` �� � ��S Y4 State ZIP Code �,�J�t � � Florida 33556 ��' "' � � � ��� � FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 c.xp�rat�on uaie: rvovember 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: 2005 Calumet Street City State ZIP Code Company NAIC Number Clearwater Florida 33755 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 certiy 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. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 �N��auv�� uaie: rvovemoer �su, zu�t� 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: 2005 Calumet Street City State ZIP Code Company NAIC Number Clearvvater Florida 33755 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. fn Puerto Rico only, enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2 ❑ A 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 communiry 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. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 BUILDING PHOTOGRAPHS OMB No. 1660-0008 LEVATION CERTIFICATE See Instructions for Item A6. �.._:__.:__ �_._ .. �nNnauvii vatC. �vVVef7lpef.SU, ZUlrS IMPORTANT; In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (inGuding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: 2005 Calumet Street C�ty State ZIP Code Company NAIC Number Clearwater Florida 33755 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 Uew" 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. � ,,�A., . � � � � �� .<,� ..;�r.. , �� ��� � � u_. F ! � � �.�,. �x � ; , ' � � �� � �� , , � .... �� � � � f_ _ __ .... . _ .�, , : �. , � : � . . . . " � _ �"° �. �d? _R , �� �. � :c� . . ^+lt*"" , . . , . . . ri , "�";�:A � �' ��'�a'ffi. � ..n ^ �.- . � ' '�'i�,.:.:� ....- . � ss�,, �, � ��,�'� .�,a� `"� . : � _. F,?a:�y r�a. : � �' a� r,° . . _ . '^�� ;�;� . ..,. .+�_� a -. . ��.. _, �� �s.. �. ,. . :_ . .. . ...v .� a,�,���� " �' ::: � ��; � �` �'-' � .e;�,. � 3 �"���+zr,�;;�`:,c��, � . . � � . �'�°u,�"��c,. ���' . . , ,'�i.'�^} �;�`„^� � - '� �'r' � � � �,�.., �, �1.r r� . .. . . . ... ,. x. �%.'�:. Photo One Photo One Caption � f � tX � ! Y i. i ! � � ,� � v,.: � � �, � �' ' ���� � o � � �'� 3 3� � ? ,�,�� �� i �;,�.. :� ?� �,. �� ..\.;;,.�; . Photo Two . .. . ... . .. . .. . . . ..�. Photo Two Caption FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 BUILDING PHOTOGRAPHS oMB rvo. �ssa000s ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number: 2005 Calumet Street City State ZIP Code Company NAIC Number Clearwater Fiorida 33755 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 "Rea� 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. � � � � _ � i ( ! ; � i � i"�b 31'w!��`^�� �+ y#� `a� � .>2i � `.� h �� � h � � �� ' it� 4 ��`h @ � . � S � SW e €r �� , � a• �' � +ks�;� '� � y � � ��#�� � � V, �� . Ey�Nn`' t� . ��r 3 � �7���u . k 4 �.`.�r��y�'1.`�' •,.`�' tu. Photo One Photo One Caption �� "�t �, , - �Cay .: - � �i : �".'�. 1E � ±j � �� ;(� � �S�u A' ��"�' � 4� � . ��� ""� i� ' �, 9` � -� K � �. � � ;� � �� 4 � ,� ; ¢ � � ._ � � �' �' " �'y �; ' ,��, �;� a �t;�r, . '� v � ,,,a r :r:,�,�`� .�� ,��..,< . � �, � � � a: s: . ,�� � �. � 4� � i. i�' .. ���, & ��"���s°��`�°��t ��������5� ��`g� .�; �f ���� ����. � �� ������ U � �.''� t��s� `-�. J'-��ii-`3��� `� ; '� ��' ✓ y �i k Y;'�I� � il % i ��i4j �� 'i,�,�" j , � U4 a��'� � �'^�"'` � a�` � � � a, ��3 F � i �t �r ��eFv``.-. � �.�� ,y��'��'\"��.�r�4� . I � ,s�,� € : � �. � . . . _ _ . � . . . . �F��� .n� �� � , . .. . . . � � . . � � � ...� ,�-F�. . . . . . . . . d ,: � rt # . frA "G"A �'�_ y � � � ��.� _ � ;�: ' � � �5 : .e'�.:.m.�: . .T? Pnao Two Photo Two Caption FEMA Form 086-0-33 (7l15) Replaces all previous editions. Form Page 6 of 6 U.S. DEPARTMENT OF HOMELANO SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY National Flood Insurance Program �mportant: Read the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION A1. Building Owner's Name Church of Scientology Flag Serv Org Inc. A2. Building Street Address (inGuding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No 2005 Calumet Street City Clearwater State FL ZIP Code 33755 OMB No. 1660-0008 Expiration Date: July 31, 2015 FOR INSURANCE COMPANY USE Company A3. Property Description (Lot and Blodc Numbers, Tax Parcel Number, Legal Description, etc.) Lot 20, Clearwater Industrial Park.(PB 44 PG 46), Parcel #01-29-15-16488-000.0200, Pinellas County A4. Building Use (e.g., Residential, Non-Residentiai, Addition, Accessory, etc.) Non-Residential A5. Latitude/Longitude: Lat. 27°59'04"N Long. 82°45'13"W Horizontal Datum: ❑ NAD 1927 � NAD 1983 A6. Attach at least 2 photographs of the building if the Cert�cate is being used to obtain flood insurance. A7. Building Diagram Number 1A A8. For a building with a crawispace 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 N/A 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 N/A within 1.0 foot above adjacent grade N/A c) Total net area of flood openings in AB.b N/A sq in c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No SECTtON B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number I 62. County Name I 63. State CRy of Clearwatterl125096 Pineltas Florida B4. Map/Panel Number B5. Su�x B6. FIRM Index Date B7. FIRM Panel B8. Flood 69. Base Flood Elevation(s) (Zone 12103C0107 H 5/17/2005 Effedive/Revised Date Zone(s) AO, use base flood depth) 5/17/2005 X & AE 50' 610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69. ❑ FIS Profile � FIRM ❑ Community Determined ❑ OthedSource: 811. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Othervvise Proteded Area (OPA)? ❑ Yes � No Designation Date: ❑ CBRS ❑ OPA SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings' � Buildi�g 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. Benchmaric Utilized: Local TBM Vertical Datum: NAVD 1988 Indicate elevation datum used for the elevations in items a) through h) below. 0 NGVD 1929 � NAVD 1988 ❑ OthedSource: 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) b) Top of the next higher floor c) Bottom of the Iowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) � lowest adjacent (finished) grade next to building (LAG) g) Highest adjacent (finished) grade next to building (HAG) h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 51..50 N.A N.A N.A N.A 48.9 50.5 N.A Chedc the measurement used. � feet ❑ meters ❑ feet ❑ meters ❑ feet ❑ meters ❑ feet ❑ meters ❑ feet ❑ meters � feet ❑ meters � feet ❑ meters ❑ feet ❑ meters SECTtON D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authonzed by law to certify elevation information. 1 certify fhat the information on this Certificate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. ❑ Check here if comments are provided on badc of form. Were latitude and longitude in Section A provided by a � Check here if attachme�ts. licensed land surveyor'� � Yes ❑ No Certifier's Name Walter C. Sherrill Jr. License Number 4803 Title PSM Company Name W. C. Sherrill and Company, LLC Address P. O. Box 203 City Odessa State FL ZIP Code 33556 Signature�` C � te � t4�t5 Telephone 813-345-4270 .;'''°" �,3 �� �' � �{' ��B>�����5���i � '": � �°� +��,�,�, " �, � �' �'� " � � �y�� v�..:�; {h[ 1 c �- � ' � ��,-��` � � ' ; p6�� -� � E � f� orr e ' � �P� �'':��� a,c�,:���ty�"��. r... ����� FEMA Fo�m 086-0-33 (7/12) See reverse side for continuation. Replaces all previous editions. ELEVATION CERTIFICATE, paae 2 IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt., UnR, Su�e, and/or Bidg. No.) or P.O. Route and Box No. 2005 Calumet Street City Clearwater State FL ZIP Code 33755 FOR INSURANCE COMPANY USE Policy Number: Company NAIC Number: 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 Signature � C i Date 1�ec,�cs SECTION E- BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE}, complete ttems 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. Chedc 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 adjaoent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enGosure) is ❑ feet ❑ meters ❑ above or � below the HAG. b) Top of bottom floor (including basement, crawispace, or enGosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 andlor 9(see pages 8-9 of Instructions), the next higher floor (elevation C2.b in !he 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 infortnation in Section G. SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or ownePs 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's or Owners Authonzed Representative's Name Address Signature Comments City Date State Telephone ZIP Code 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 ordi�ance can complete Sections A, B, C(or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Chedc the measurement used in Items GS-G10. In Puerto Rico only, errter 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 certiry elevation infortnation. (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 infonnation (Items G4�10) is provided for community floodplain management purposes. G4. U G5. Date G6. Date Certificate Of Compliance/Occupancy Issued G7. This perrnit has been issued for: ew Construc�ion �❑ Substantial Improvement G8. Elevation of as-built lowest floor (incl ding basement) of the buitding: ❑ fee meters G9. BFE o� (in Zone AO) depth of flooding at the building site: � feet ❑ meters G10. Community's design flood elevation: ❑ feet ❑ meters Local �cial's Name Community Name Signature Comments Title p C �S Telephone Date n �. . �� Datum Datum Datum Check here if attachments. FEMA Form 086-0-33 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 3 Building Photographs See Instructions for Item A6. 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: 2005 Calumet Street City Clearvvater State FL ZIP Code 33755 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 �a j � t� f � � .� �. �._ _ _ _ _,�.:.. r E ��� ��. �� ���.� � �;:. FEMA Form 086-0-33 (7/12) Replaces all previous editions. ELEVATION CERTIFICATE, page 4 guilding Photographs Continuation Page IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No. Policy Number: 2005 Calumet Street City Clearwater State FL ZIP Code 33755 Company NAIC Number: If submitting more photographs than will fit on the preceding page, affix the additionai photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side VievW' 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. � ,� ��� ;.., � �� �.� . ��?,�! ►r--�.,� ' � � � _ , �:i.,< �Hra � M i`.' � �__� a,� � - .._. -. G. �.'.-''�.�9r e A^ .. .. ��.� . FEMA Form 086-0-33 (7/12) : a. [ � , Replaces all previous editions. �