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744 ELDORADO AVEZONE V DESIGN CERTIFICATE Name AN 0/Q t~�Policy Number (Insurance Ca. Use) Building Address or Other Description 7 .. t✓ 012A1712 AVE. Permit No. � City ' t 1: f5sAe-` State Ft- Zip Code 33767 SECTION 1: Flood Insurance Rate Map (FIRM) Information Community Name & No. C I t- A lg Pan l Naa 4°.1Stiffix y FIRM Date FIRM Zone(s) Seaward of UMWA (Coastal A Zone) 0 Yes SECTION II: Elevation Information Used for Design (NOTE: This section documents elevations used in the design — it does not substitute for an as -built Elevation Certificate.) . ..0 NGVD NAVD 0 Other 2. Elevation of the Bottom of Lowest Horizontal Structural Member........ _... ,...... .... feet above datum 3. Base Flood Elevation (BFE) 13,e feet above datum 4. Elevation of Lowest Adjacent Grade ,_ feet above datum feet 6. Embedment Depth of Pilings or Foundation Below Lowest Adjacent Grade 1f°feet 5. Approximate Depth of Anticipated Scour/Erosion used for Foundation Design SECTION III: Zone V Design Certification Statement [NOTE. This section must be certified by a Florida licensed engineer or architect.] I certify: (1) I have developed or reviewed the structural design, plans, and specifications for construction and (2) the design and methods of construction to be used are in accordance with accepted standards of practice for meeting the following provisions: • The bottom of the lowest horizontal structural member of the lowest floor (with the exception of mat or raft foundations, piling, pile caps, columns, grade beams and bracing) is elevated to or above the BFE in accordance with the requirements of the Florida Building Code or local floodplain management regulations (manufactured homes and buildings exempt from the FBC, B); and • The pile and column foundation and building or structure to be attached thereto is designed in accordance with the Florida Building Code to be anchored to resist flotation, collapse, and lateral movement due to the effects of the wind and flood Toads acting simultaneously on all building components, and other load requirements of the Florida Building Code. The potential for scour and erosion at the foundation has been anticipated for conditions associated with the base flood, including wave action. SECTION IV: Breakaway Wall Design Certification Statement [NOTE. This section must also be certified by a Florida licensed engineer or architect when breakaway walls exceed a design safe loading resistance of 20 pounds per square foot. This requirement does not apply to open wood/plastic lattice/slats/louvers or insect screening.] I certify: (1) I have developed or reviewed the structural design, plans, and specifications for construction and (2) the design and methods of construction to be used for the breakaway walls are in accordance with the Florida Building Code, Building (ASCE 24) or Florida Building Code, Residential, as applicable, and accepted standards of practice. SECTION V: Certification and Seal This certification is to be signed and sealed by a Florida licensed professional certify structural designs. / certify the Zone V Design Certification Statement in Certification Statement in Section IV (if applicable). �. M. wtCA�TH Certitier's Name FE 2649 ENN Otvl I a,L%nsramber Title` _ Com any arrle giD p Vl 'A C ' 4IZ AT 11 FL Addr • t" fi t r2/ Z b c -T2 2.5 Signature e Florida Model Zone V Design Certificate (060915) Telephone engineer or architect authorized by law to Section 111 and the Breakaway Wall Design EL N61a3i0til l i,: �•� STATE OF 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, 2022 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 Anthony Nunn and Linda Nunn Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No, 744 Eldorado Avenue Company NAIC Number: City State ZIP Code Clearwater Beach Florida 33767 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 4, Block 3, Mandalay "The Isle of a Thousand Palms" (PB 14, PG 32) 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. 27.991425 N Long. 82.827801 W Residential Horizontal Datum: insurance, above ❑ NAD 1927 adjacent grade grade N/A x NAD 1983 0 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 7 Certificate is being used to obtain flood 2285.00 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 N/A 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 City of Clearwater, 125096 B2. County Name Pinellas I B3. State Florida B4. Map/Panel Number 12103C0102 B5. Suffix G B6. FIRM Index Date 09-03-2003 B7. FIRM Panel Effective/ Revised Date 09-03-2003 B8. Flood Zone(s) VE B9. Base Flood Elevation(s) (Zone AO, use Base Flood Depth) 13.0' 810. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation of the Base Flood Elevation ❑x FIRM ❑ Community Determined datum used for BFE in Item B9: located in a Coastal Barrier Resources Date: ❑ (BFE) data or base flood depth entered in Item B9: ❑ NGVD System CBRS ■ Other/Source: 1929 (CBRS) ❑ OPA ❑ Other/Source: Protected x NAVD 1988 area or Otherwise Area (OPA)? ❑ Yes © No FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2022 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. 744 Eldorado Avenue Policy Number: City State ZIP Code Clearwater Beach 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, ARIA, AR/AE, Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Benchmark Utilized: LOCAL Vertical Datum: NAVD88 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) Check the measurement used. 6.9 x feet ❑ meters b) Top of the next higher floor 16.6 x feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) 15.8 x feet ❑ meters d) Attached garage (top of slab) N/A ❑ feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 12.8 (Describe type of equipment and location in Comments) x feet meters f) Lowest adjacent (finished) grade next to building (LAG) 6.0 x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 6.3 x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including feet meters structural support N/A ❑ ❑ 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 Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. Were latitude and longitude in Section A provided by a licensed land surveyor? ❑ Yes ❑ No ❑ Check here if attachments. Certifier's Name License Number Joseph E. Williamson, PLS, CFM 6573/CFM US -16-08990 u yjijf„'gyri • s Ho eaza :. Title Licensed FL Surveyor Company Name Vision Land Service STATE OF -- rLORIDA *' -'-f';`'� Address 941 S Pennsylvania Ave City State ZIP Code Winter Park Florida 32789 Signature Date Telephone Ext. 03-17-2020 (888) 399-8474 Copy all pag 0 h El on Certificaof an ” ttattach for (1) community official, (2) insurance agent/company, and (3) building owner. Comments ''chiding type of equipment and location, per C2(e), if applicable) Item C2e s on the Air Conditioner This elevation cert was revised on 07-17-20 FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2022 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. 744 Eldorado Avenue Policy Number: City State ZIP Code Clearwater Beach 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, b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters 11 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. 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 (12/19) Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2022 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. 744 Eldorado Avenue Policy Number: City State ZIP Code Clearwater Beach Florida 33767 Company NAIC Number SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance Sections A, B, C (or E), and G of this Elevation used in Items G8—G10. In Puerto Rico only, enter to administer the community's floodplain management ordinance can complete Certificate. Complete the applicable item(s) and sign below. Check the measurement meters. from other documentation that has been signed and sealed by a licensed surveyor, by law to certify elevation information. (Indicate the source and date of the elevation E for a building located in Zone A (without a FEMA -issued or community -issued BFE) is provided for community floodplain management purposes. G1. ■ The information in Section C was taken engineer, or architect who is authorized data in the Comments area below.) G2 ❑ A community official completed Section or Zone AO. G3. ❑ The following information (Items G4—G10) 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) El Check here if attachments. FEMA Form 086-0-33 (12/19) 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, 2022 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, 744 Eldorado Avenue Policy Number: City State ZIP Code Clearwater Beach 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 Building Clear Photo One Photo Two Caption Rear of Building Clear Photo Two FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page OMB No. 1660-0008 Expiration Date: November 30, 2022 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, 744 Eldorado Avenue Policy Number: City State ZIP Code Clearwater Beach 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 Photo Three Caption Clear Photo Three Photo Four Photo Four Photo Four Caption Clear Photo Four FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 6 of 6 U.S DEPARFMENT OF HOMEIAND SECURtTY FEli�RAl EMERGENCY MANAGEMENT AGENGY Nntronal Flood Insurance Program 225779 A�. Buiiding Owneis Name RICHARD ELEVATION CERTtFICATE Important: Read the instructions on pages 1-9. SECTlON A - PROPERTY INFORMATION 3 TEREZA KEMP A2. Building Street Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.Q. Route and Box No. 744 EL DORAOQ AVENUE City GLEARWATER 5tate Fl ZtP Code 33767 A3. Property DescnpGon (Lot and Biock Numbers, Tax Parcel Number, Legal Description, etc.) OMB No. 1660-0008 � Expiration Date: July 31, 2015 FOR INSURANCE COMPANYUSE ' Poiicy Number: Company PtAiC Number: ' A4. Buiiding Use (e.g., Residential. Nan-Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27°59'29.20'N Lo�g. 82°49'40.30"W Horizontal Datum: ❑ NAD 1927 � NAD 1963 A6. Rttach at least 2 photographs of the buitding ii the Certificate is being used to obtain flood insurance. A7. Bullding Diagram Number 7 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attachQd garage: a) Square footage of crawlspace or enclosure{s) 396 sq ft a) Square footage of attached garage N/A sq ft b) Number of permanent f{ood openi�gs in the crawispace bj Number of permanent 800d openings in the attached garage or enGosure(s} within 1.0 foot above adjacent grade Q within 1.0 foot above adjacent grade 0 c} Total net area of flood openings in AB.b 0 sq in c) Total net area of flood openings in A9.b 0 sq in d) Engineered flood openings? ❑ Yes � No d} Engineered flooc! openings? ❑ Yes � No SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NFIP Community Name & Community Number 62. County Name B3. State 125t03 CITY OF C�EARWATER PINELLAS Flonda 64_ Map/Panei Number 85. Suffix B6. FIRM {ndex Date B7. FIRM Panei BS. Fbod B9. Base Fiood Elevation(s) (Zo�e 12103C0102 G 9i3/2003 EffectivelRevised Date Zone(s) AO, use base flood depth} 9/3/2003 VE 13 610. Indicate the source of the Base Ffood Elevation (BFE) data or base flood depth entered in Item B9. ❑ Ft5 Profiie � FIRM ❑ Community Determined ❑ Other/Source: _ B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD t988 ❑ Other/Source: _ 812. is the building bcated in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPAJ? ❑ Yes � No Designation Date: ❑ CBRS ❑ OPA SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C7. Building elevations are based on: ❑ Construction Orawings` ❑ Building Under Construction' � Finished Construction 'A new Elevation Certificate will be required when construction of [he building is complete. C2 Elevations - Zones A1-A30. AE. AH, A(with BFEj, VE, V1-V30, V(with BFE}, AR. AR/A, AR/AE, ARJRt-A30, ARIAH, AR/AO. Comptete Items C2.a-h below according to the building diagram spedfied in Item A7. in PueRo Rico only, enter meters. Benchmark Utilized: BM #J-03 Verticai Datum: NAVD 1988 {ndicate efevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 � OtheNSource: Datum used for buiiding eievations must be tfie same as that used for the BFE. Check the measurement used. a) Tap of bottom Floar (including basement, crawlspace, or enGosure floor) 7 6 � feet ❑ meters bj Tap of the ne� higher floor �7.g � feet ❑ meters c) Bottom of fhe fowest horizonfai structural member (V Zones onty) 16.9 � feet ❑ meters d) Attached garage (top of slab) N/q � feet ❑ metars e) Lowest elevation of machinery or equipment servicing the buiiding 14.0 � feet ❑ meters (Describe type ot equipmern and location in Comments) � Lowest adjacent (finishedj grade next to building (LAGj 6 6 � feet ❑ meters g) Highest adjacent (finished) grade next to buildmg (HAG) 7_0 � feei ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support N/A � feet ❑ meters SECTtON D- SURVEYOR, ENGINEER, OR ARCHITECT GERTIFICATION This certificatian is to be signed and sealed by a land surveyor, engineer, or architect authoriZed by law to certify elevation information. ! certity that the information on thrs Certificate represents my best ef/orts to interpret the data avaifable. 1 understand that any fatse statement may be punishable by irne or imprisonment under t 8 U.S. Code, Sectioo f 009. � Check here i( comments are provided on back of form. Weee Iatitude artd langiiude in Section A provided by a ❑ Check here if attachments. licensed land surveyor? � Yes ❑ No Certifier s Name Clyde O. McNeal License Number 2683 TiUe Registered Professional Surveyor Company Name TARGET SURVEYtNG, LLC Address 6250 N Mititary Trail #102 City West Palm Beach State FL ZIP Code 33407 ��f � � ��``�`6aY � . ' ; 'r.�� N�. zae� �\ �� ' ,� , � ' �� ` i'' � as�w�r Sgrea.tAr: ''�;�lyde �„a ��ti;: ok: c� _ cyjda % .-.._ _ STA'cO.l�M1C�1s�F'0{ �p� t FUSy / S/ --tiik 2�+s oa o3 Mcf�he�K�-��3, �.� Signature �� Date 3130I201 S Telephone (561)640-4800 ( I FEMA Form 086-0-33 (7/12} See reverse side for continuation. Replaces all previous editions. ELEVATIQN CERTIFIGATE, page 2 (225779) IMPQRTANT: In these spaces, copy the corresponding information from Section A. FOR 1NSURANCE GOMPANY USE Buikfing SUeet Address QnGuding Apt., Unit, Suite, a�d/or Btdg. No.) or P.O. Route and Boz No. PoliCy Number. 74a EL DORADO AVENUE Ciry CLEARWATER State FL ZiP Code 33767 � Company NAIC Number: SECTION D- SURVEYQR, ENGtNEER, OR ARCHlTECT CERT{FICATION (CONTINUED) Copy both sides of th'rs Efevation Certificate for (1) cwmmunity official, (2) insurance agenUcampany, and (3) buiiding owner. Comments ELEVATIONS IN SECTiON C2-E ARE ELEVATIONS OF A/C SIAB. LOWER LEVEL IS GARAGE/UTII.ITY SQUARE FOOTAGE BASED ON FOOTPRINT OF BUIIDING. Signature � f^� Date 3130Y2015 ----�_ SECTIQN 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 Et-E4, use naturat grade, if availaWe. Check the measurement used. In Puerto Rico oniy, enter meters. E 1. Provide elevation informaGon fa the ioliowing 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 ot bottom floor (induding basement, aawispace, or enclosure) is ❑ feet ❑ meters ❑ above or � beiow the HAG. b) Top of bottom floor (inciuding basement, crawispace, or enciosure) is _._ ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Buiiding Diagrams 6-9 with perma�ent flood openings provided in Section A Items 8 andlor 9(see pages 8-9 of Instructions), the neut higher floor (elevation C2.b in the diagrams) of the building is ❑ teet ❑ meters ❑ above or ❑ befow the HAG. E3. Attached garage (top af slab) is __ ❑ feet ❑ meters ❑ above or ❑ below fhe HAG. E4. Top of platform of machinery andlor equipment servicing the buifding is __❑ feet ❑ meters � above or Q bebw the HAG. E5. Zone Ad only: if no flood depth number is avaitab{e, is the top of the bottom Floor elevated in accordance with the community`s floodplain management ordinance? ❑ Yes ❑ No � Unknown. The local officiai must certify this information in Section G. SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATtVE) CERTIFICATION The property owner or owner's authorized represe�talive who compfetes Sections A, B. and E for Zone A(without a FEMA-issued or community-issued BFE} or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my know�edge. Property Owner's or Owner's Authonzed Representative's Name Address Signature Cammenks City Oate State ZIP Code Telephone ❑ Gheck here it attachments. SECTION G - COMMUNFTY lNFORMATION (ORTiONAL) The bcai offiaal who is authonzed by law or ordinance to administer the community's Ooodplain management ordinance can complete Sections A, B, C(or E). and G of th+s Eteva6on Certificate. Complete the applicable item(s) and sign below. Chedc the measurement used in Items G8-G10. In Puerto Rico only, enter meters. G1. ❑ The information in Section C was taken from other documentatron thai has treen signed and sealed by a licensed surveyor, engineer, or architect who is authorfzed by law to certity elevatron information. (Indicate the source and date of the elevation data in the Comments area beiow.) G2. Q A communiry 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 intormation (Items G4-G10) is provided for community tioodplain management purposes. G4. Permit Number ! G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued tor. ❑ New Gonstruction ❑ Substantiat Improvement G8. Elevation pf as-built lowest floor (induding basement) of the building: __ ❑ teet ❑ meters G9. 8FE or (in Zone AO) depth ot flooding at the buitding site: __ ❑ feet ❑ meters G10. Community's design flood elevation: __ ❑ feet ❑ meters Local Olfiaal's Name Community Name Signature Comments FEMA Form 086-0-33 (7112) Title Telephone Date Datum _ Datum _ Qatum i Gheck here it attachments. Replaces all previous editians. v ELEYATION CERTIFIGATE, page 3 guilding Photographs , See Instructions for Item A6. (225779j IMPORTANT: in these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Buildi�g Street Address (I�cluding Apt., Unit, Suite. andlor Bldg. No.) or P.O. Route and Box No. Policy Number. 744 EL DORAdO AVENUE City CLEARWATER State FL ZIP Code 33767 Company NAIC Number. (f using the Elevation Certificate to obtain NFIP flood insurance, a�x at least 2 buiiding photographs below according to the instructions for liem A8. fdentify all photographs with date taken, "Front VievJ' and "Rear View"; and, if required, "Right Side Viewl' and °Left Side View." When applicabie, phoiographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. if submitting more photagraphs than wiil fit on fhis page, use the Continuation Page. ' FRO�1T VIEW Sr�� l'tEG',�� ������������� REAR VIEW � .�����`, • f���, ;��� - , S�> ` � . ,- � i � , ` �� � �� �,. _, �:. �L. . . FEMA Form 086-0-33 (7112) Replaces ali previous editions. Y EI.EVATION GERTtFICATE, page 4 guiiding Rhotographs Confinuation Page (225779) IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (including Apt., Unit, Suite, and/or B{dg. No.) or P.O. Route and Box No. Policy Number. 744 EL OORADO AVENUE City CIEARWATER State FL ZfP Code 33767 Comparry M1U41C Number: If submitting more photographs than will fit on the preceding page, affix the additional photographs below. identify all photographs with: date taken; "Front Viev�' and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of khe Bood openings or vents, as indicated in Section A8. FEMA Form 086-0-33 (7/12) Replaces all previous editions.