1260 ENGMAN ST BLDG BuJ
FEB 2 3 2017
PLANNING & DEVELOPMENT DEPT
CITY OF CLEARWATER
1260 ENGMAN ST, BLDG
BCP2017-01073
ELEVATION CERT
-IEP BATY VILLAS (BUILDING A)
?oning: Commercial Atlas #: 269B
U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergencylvlanagemeflt Agency
National Flood Insurance Program
!�
�
ELEVATION CERTIFICATE
Important: Follow the instructionon pages 1-9
OMB No. 1660-0008
Expiration Date: Noveniber 30, 2018
Co all a es 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. Buliding Owners Name
EVERYBODY'S TABERNACLE INC
Policy Number:
A2. Building Street Address (including Apt., Unit, Sulte, andlor BIdg. No.)orp.O.Route and
Box No.
1260 ENGMAN STREET, BUILDING B
company NAIC Number
City State ZIP Code
CLEARWATER Florida 33755
' A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOTS 1 & 2, BLOCK A, FAIRBURN SUBDIVISION, PLAT BOOK 9, PAGE 97, PINELLAS COUNTY, FLORIDA
A4. Building Use (e.g.,
A5. Latitude/Longitude:
A6. Attach at Ieast
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
c) Total net area
d) Engineered
Residential, Non -Residential, Addition,
Lat. 27O58'4R'N Long. 82D47'O6^VV
Accessory, etc.) RESIDENTIAL
Horizontal Datum:
obtain flood irisurance.
1.0 foot above adjacent
---- ' ----
adjacent grade
0 NAD 1927
grade
-
0NAD 1gB3
8
2 photographs of the building if the
Number 8
Certificate is being used to
3.819 sq ft
with a crawlspace
of crawlspace
perrnanent flood
of fiood openings
flood openings?
an attached
of attached
perrnanent flood
of flood openings
flood openings?
or endosure(s):
or enclosure(s)
openings in the crawlspace
in A8.b 2,511
sq
or enclosure(s) within
in
--- - ------
sq ft
within 1.0 footabove
sq in
—' -- ' —
�� Yes 0 No
garage:
-----'
garage
openings in the attached garage
in A9.b
[lYes FlNo
SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Bi. NFIP Community Name & Community Number
CITY OF CLEARWATER, 125096
B2. County Name
PINELLAS
B3. State
Florida
84. Map/Panel
Number
12103C0108
B5. Suffix
H
B6. FIRM Index
Date
09X03/2003
B7. F RM Panel
Effective/
Revised Date
05/17/2005
E38. Flood Zone(s)
AE
B9. Base FlElevation(s)
(Zone AO, use Base
Flood Depth)
10
B10. Indicate the source
FIS Profile
811. Indicate elevation
B12. Is the building
Designation Date:
of the Base Flood Elevation (BFE)
EiF|RM Community Determined
datum used for BFE in Item B9:
located in a Coastal Barrier Resources
[] CBRS
data
0 NGVD
System
or base flood depth entered in Item B9:
D Other/Source:
1929 0N/YVO1988 [7 Other/Source:
(CBRS) area or Otherwise Protected
0 OPA
Area (OPA)? Yes 0 N
FEMA Form 086-0-33 (7/15)
Replaces all previous editions
Form Page 1 of 6
ELEVATION CERTIFICATE
OMB No. 1660-0008
Ex iration Date:
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.
1260 ENGMAN STREET, BUILDING B
Policy Number:
City State ZIP Code
CLEARWATER Florida 33755
Company NAIC Number
SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: 0 Construction Drawings* 0 Building Under Construction* El 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/A0.
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 "G-07" Vertical Datum: NAVD 88
Indicate elevation datum used for the elevations in items a) through h) below.
0 NGVD 1929 El NAVD 1988 0 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) 11 48
Check the measurement used.
El feet 0 meters
b) Top of the next higher floor 21 23 Ei feet 0 meters
c) Bottom of the lowest horizontal structural member (V Zones only) 0 feet 0 meters
d) Attached garage (top of slab) 0 feet 0 meters
e) Lowest elevation of machinery or equipment servicing the building 10 0 0 feet 0 meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 8 1
. [} feet 0 meters
g) Highest adjacent (finished) grade next to building (HAG) 8 6 E] feet 0 meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including 8 9
. 0 feet 0 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.
- '
_vmftify_thatme_infofniedien-oft-thi .. , . . . — . -efforts-to - . - - . : . : , . : . -. • nderstand 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? 0 Yes 0 No 0 Check here if attachments.
Certifiers Name License Number
JOHN J. BELAND 7004
•
Place ,
Seal
Here
'Title
PROJECT MANAGER
Company Name
SUNCOAST LAND SURVEYING
Address
111 FOREST LAKES BLVD.
City State ZIP Code
OLDSMAR Florida 34677
•
Signatu :. Date Telephone
09/22/2016 (813) 854-1342
Copy all pg; ;: o i ij levation Certifica e and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments (incl "g type of equipment and location, per C2(e), if applicable)
NC UNIT ON WOOD PLATFORM ON NORTH SIDE OF BUILDING. THERE ARE ALSO VENT UNITS AT GRADE LEVEL ON FOUR
CORNERS OF BUILDING TO VENT AIR IN CRAWL SPACE.
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 2 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.
1260 ENGMAN STREET, BUILDING B
Policy Number:
City State ZIP Code
CLEARWATER Florida 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.
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Photo One
Photo One Caption LOOKING NORTHEAST
4 .....>--11111T..„.„..,.---,,,..,...-
'.../..-------_...---
USW mg'
F ' /'
F S r 1� i { 3q , xpj ��
A
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Photo Two
Photo Two Caption LOOKING NORTHWEST
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 5 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 agenUcom an and 3 b Id'
P Y. O u IIIy uwII I.
SECTION A — PROPERTY INFORMATION
FOR INSURANCE COMPANY USE
Al. Building Owner's Name
EVERYBODY'S TABERNACLE INC
Policy Number:
A2. Building Street Address (including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No.
1260 ENGMAN STREET, BUILDING B
Company NAIL Number:
City State ZIP Code
CLEARWATER Florida 33755
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOTS 1 & 2, BLOCK A, FAIRBURN SUBDIVISION, PLAT BOOK 9, PAGE 97, PINELLAS COUNTY, FLORIDA
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
a) Square footage
b) Number of
c) Total net area
d) Engineered
Residential, Non -Residential, Addition, Accessory, etc.)
Lat. 27058'46" N Long. 82D47'06" W
RESIDENTIAL
Horizontal Datum:
obtain flood insurance.
1.0 foot above adjacent
above adjacent grade
❑ NAD 1927
grade
x NAD 1983
8
2 photographs
Number
with a crawlspace
of crawlspace
permanent flood
of flood openings
flood openings?
with an attached
of attached
permanent flood
of flood openings
flood openings?
of the building if the
8
Certificate is being used to
3,819 sq ft
or endosure(s):
or enclosure(s)
openings in the crawlspace
in A8.b 2,511
sq
or endosure(s) within
in
sq ft
within 1.0 foot
sq in
x Yes ❑ No
garage:
garage
openings in the attached garage
in A9.b
❑ 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
12103C0106
B5. Suffix
H
B6. FIRM Index
Date
09/03/2003
B7. F RM Panel
Effective/
Revised Date
05/17/2005
68. Flood Zone(s)
AE
B9. Base Flood Elevation(s)
(Zone AO, use Base
Flood Depth)
10
B10. Indicate the source of the Base
Flood Elevation (BFE)
❑ Community Determined
for BFE in Item B9:
Coastal Barrier Resources
❑ CBRS
data
❑ NGVD
System
or base flood depth entered in Item B9:
❑ Other/Source:
• FIS Profile
x FIRM
B11. Indicate elevation
B12. Is the building
Designation Date:
datum used
located in a
1988 ❑ Other/Source:
or Otherwise Protected
1929 x NAVD
(CBRS) area
❑ OPA
Area (OPA)?
❑ Yes x No
orm 086 0 33 (7/15
Replaces all previous editions.
Form Page 1 of 6
ELEVATION CERTIFICATE
OMB No. 1660-0008
•
epiaces all previous editions.
Form Page 2 of 6
LANu atm), 1 vale. iluvernoer 3U, Iwo
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.
1260 ENGMAN STREET, BUILDING B
Policy Number:
City State ZIP Code
CLEARWATER Florida 33755
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 Al 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 "G-07" Vertical Datum: NAVD 88
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) 11 48
x
the measurement used.
feet ❑ meters
b) Top of the next higher floor 21 23
x
feet ❑ meters
c) Bottom of the lowest horizontal structural member (V Zones only)
x
feet ❑
d) Attached garage (top of slab)
❑x
meters
feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the budding 10. 0
x
feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG) 8. 1
x
feet ❑ meters
g) Highest adjacent (finished) grade next to building (HAG) 8. 6
x
feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including 8. 9
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
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. I understand that any false
1001.
Yes ❑ No ❑ Check here if attachments.
Certifier's Name License Number
JOHN J. BELAND 7004
``� o s i o , a , i , i 1 .-
,
Title
PROJECT MANAGER
; , tdy6i
.` "
1 t
Iwr
Company Name
SUNCOAST LAND SURVEYING
" C�
-. Plarar. Y 'c� f3 ':Tu.,
' c3 ; -= `8 = '
'Seal tr �. x.
Address
111 FOREST LAKES BLVD.
z Hie c; -.a
�" 1C
! °
®`
City
OLDSMAR
State ZIP Code
Florida 34677
.^ %, PRO A•
`
'l i, r,, ti t,. % -
Signatur
Date Telephone
09/22/2016 (813) 854-1342
Copy all p
g o i levation Certifica e and all attachments for (1) community official, (2) insurance agent/company, and -(3) building owner.
Comments (incl g type of equipment and location, per C2(e), if applicable)
A/C UNIT ON WOOD PLATFORM ON NORTH SIDE OF BUILDING. THERE ARE ALSO VENT UNITS AT GRADE LEVEL ON FOUR
CORNERS OF BUILDING TO VENT AIR IN CRAWL SPACE.
epiaces all previous editions.
Form Page 2 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.
1260 ENGMAN STREET, BUILDING B
Policy Number.
City State ZIP Code
CLEARWATER Florida 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.
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Photo One Caption LOOKING NORTHEAST
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Photo Two
Photo Two Caption LOOKING NORTHWEST
FEMA Form 086-0-33 (7/15)
Replaces all previous editions.
Form Page 5 of 6
U.S. DEPARTMENT OF HONlELAND SECURITY
Federal Emergency�Management Agency OMB No. 1660-0008
National Flood Insurance Program Expiration Date: November 30, 2018
,/! � 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 agenUcompany, and (3) building owner.
SECTION A— PROPERTY INFORMATION FOR INSURANCE COMPANY USE
A1. Building Owner's Name Policy Number:
EVERYBODY'S TABERNACL.E INC
A2. Building Street Address (inGuding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and
Box No. Company NAIC Number:
1260 ENGMAN STREET, BUILDING B
City State ZIP Code
CLEARWATER Florida 33755
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOTS 1& 2, BLOCK A, FAIRBURN SUBDIVISION, PLAT BOOK 9, PAGE 97, PINELLAS COUNTY, FLORIDA
A4. Building Use (e.g., Residential, Non-Residential, Addition, Aocessory, etc�) RESIDENTIAL
A5. Latitude/Longitude: Lat 27D58'46" N Long. 82D4T06" W Horizorrtal Datum: � NAp 1g27 �x NAD 1983
A6. Attach at least 2 photographs of the building if the Certifipte is being used to obtain flood insurance.
A7. Building Diagram Number 8
A8_ For a building with a crawlspace or endosure(s):
a) Square footage of crawlspace or endosure(s) 3,819 sq ft
b) Number of permanent flood openings in the cxawlspace or endosure(s) within 1.0 foot above adjacerrt grade g
c) Total net area of flood openings in A8.b 2,511 sq in
d) Engineered flood openings? � Yes ❑ No
A9. For a building with an attached garage:
a) Square footage of attached garage -
-- --- ------- ----- _. _ _ ..
---- --_ _
S4� _ _— ----_ _ -_ _ _ _._
b) Number of permanerrt flood openings in the attached garage within 1.0 foot above adjacent grade
c) Total net area of flood openings in A9.b sq in
d) Engineered flood openings? � Yes � No
SECTION B— FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
61. NFIP Community Name & Community Number B2. CouMy Name 63. State
CITY OF CLEARWATER, 125096 PINELLAS Florida
B4. Map/Panel B5. Suffix B6. FIRM Index B7. FIRM Panel 68. Flood Zone(s) B9. Base Flood Elevation(s)
Number Date EffectiveJ (Zone AO, use Base
12103C0106 H Revised Date Flood Depth)
09/03/2003 05/17/2005 AE 10
610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9:
� FIS Profile �x FIRM � Communit�r Determined � Other/Source:
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 x0 NAVD 1988 � OtheNSource:
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? � Yes �x No
Designation Date: � CBRS ❑ OPA
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6
ELEVATION Ce12TIFICATE
IMPORTANT: In these spaces, copy the corresponding information from Section A.
Building Street Address (inGuding Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.
1260 ENGMAN STREET, BUILDING B
CLEARWATER
state ZIP Cc
Florida 33755
OMB No. 1660-0008
Expiration Date: November 30, 2018
FOR INSURANCE COMPANY USE
Policy Number:
SECTION C— BUILDING ELEVATION INFORMATION (SURVEY REQUfRED)
C1. Building elevations are based on: ❑ Construction Drawings"` � Building Under ConstructionY Ox Finished Construction
*A new Elevation Certificate will be required when construdion of the building is complete.
C2. Elevations — Zones A1-y430, AE, AH, A(with BFE), VE, V1 V30, V(with BFE), AR, AR/A, AR/AE, AR/A1�130, AR/AH, AR/AO.
Complete Items C2.afi below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: CITY OF CLEARWATER "G-07" Vertical Datum: NAVD 88
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 (induding basement, crawlspace, or enclosure floor) 17 48
b) Top of the next higher floor 27 23
c) Bottom of the lowest horizontal structural member (V Zones only) .
d) Attached garage (top of slab)
e) Lowest elevation of machinery or equipment senricing the building 10 0
(Describe type of equipmerrt and location in Commerrts) �
fl Lowest adjacent (finished) grade next to building (LAG) 8. 1
g) Highest adjacent (finished) grade next to building (HAG) 8 6
h) Lowest adjacerrt grade at lowest elevation of dedc or stairs, induding $. 9
structural support
Chedc the measurement used.
� feet � meters
� feet ❑ meters
�x feet � meters
Ox feet ❑ meters
�x feet �] meters
0 feet ❑ meters
Ox feet [� meters
� 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.
statement may be punishable by fine or imprisonment under 18 U�� Section 1001. nd that any fa/se --
Were latitude and longitude in Section A provided by a licensed land surveyor? 0 Yes ❑ No
❑ Check here if attachments.
JOHN J. BELAND
Title
PROJECT MANAGER
Company Name
SUNCOAST IAND SURVEYING
111 FOREST LAKES BLVD.
OLDSMAR
Copy all
License tVumber
7004
State
Florida
Date
09/22I2016
ZIP Code
34677
Telephone
(813) 854-1342
Pla�e
Seal
Here
and all attachments for (1) community official, (2) insurance agenUcompany, and (3) building owner.
Comments (inGu�r(�g type of equipment and location, per C2(e), if applicable)
, A/C UNIT ON WOOD PLATFORM ON NORTH SIDE OF BUILDING. THERE ARE ALSO VENT UNITS AT GRADE LEVEL ON FOUR
CORNERS OF BUILDING TO VENT AIR IN CRAWL SPACE.
FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Pa e 2 I
g of 6
ELEVATION CE'�2TIFICATE BUILDING PHOTOGRAPHS
See Instructions for Item A6.
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.
1260 ENGMAN STREET, BUILDING B
City
CLEARWATER
�tate ZIP G
Fiorida 33755
OMB No. 1660-0008
Expiration Date: November 30, 2018
FOR INSURANCE COMPANY USE
Policy Number:
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 aIl photographs with date taken; "Front vew" and "Rear Vew'; and, if required, "Right Side Vew" and
"Left Side Vew." 1Nhen 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 LOOKING NORTHEAST
Photo
� �apnon wUKING NORTHWEST
FEMA Form 086-0-33 (7/15) Replaces all previous editions.
Form Page 5 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CEI�TIFICATE See Instructions for Item A6. 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:
1260 ENGMAN STREET, BUI�DING B
City 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 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.
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FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6