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NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
AND
INSTRUCTIONS
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2015 EDITION
FILE COPY
OMB No. 1660-0008
Expiration Date: November 30, 2018
U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
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ELEVATION CERTIFICATE AND INSTRUCTIONS
Paperwork Reduction Act Notice
{ Public reporting burden for this data collection is estimated to average 3.75 hours per response. The burden estimate includes the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
submitting this form. You are not required to respond to this collection of information unless a valid OMB control number is
displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the
burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency,
1800 South Bell Street, Arlington, VA 20598-3005, Paperwork Reduction Project (1660-0008). NOTE: Do not send your
completed form to this address,
Privacy Act Statement
Authority:Title 44 CFR§61.7 and 61.8.
Principal Purpose(s): This information is being collected for the primary purpose of estimating the risk premium rates necessary
to provide flood insurance for new or substantially improved structures in designated Special Flood Hazard Areas.
Routine Use(s):The information on this form may be disclosed as generally permitted under 5 U.S.C. §552a(b)of the Privacy Act
of 1974, as amended. This includes using this information as necessary and authorized by the routine uses published in DHS/
FEMA-003—National Flood Insurance Program Files System or Records Notice 73 Fed. Reg. 77747 (December 19, 2008); DHS/
FEMA/NFIP/LOMA-1 —National Flood Insurance Program (NFIP) Letter of Map Amendment(LOMA)System of Records Notice 71
Fed. Reg. 7990(February 15,2006); and upon written request,written consent, by agreement, or as required by law.
Disclosure: The disclosure of information on this form is voluntary; however, failure to provide the information requested may
result in the inability to obtain flood insurance through the National Flood Insurance Program or the applicant may be subject to
higher premium rates for flood insurance. Information will only be released as permitted by law.
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Purpose of the Elevation Certificate
The Elevation Certificate is an important administrative tool of the National Flood Insurance Program (NFIP). It is to be used to
provide elevation information necessary to ensure compliance with community floodplain management ordinances, to determine
the proper insurance premium rate, and to support a request for a Letter of Map Amendment (LOMA) or Letter of Map Revision
based on fill(LOMR-F).
The Elevation Certificate is required in order to properly rate Post-FIRM buildings,which are buildings constructed after publication
of the Flood Insurance Rate Map (FIRM), located in flood insurance Zones Al—A30, AE,AH, A(with BFE), VE, Vl—V30, V (with
BFE),AR,AR/A, AR/AE, AR/A1—A30,AR/AH, and AR/AO. The Elevation Certificate is not required for Pre-FIRM buildings unless
the building is being rated under the optional Post-FIRM flood insurance rules.
As part of the agreement for making flood insurance available in a community,the NFIP requires the community to adopt floodplain
management regulations that specify minimum requirements for reducing flood losses. One such requirement is for the community
to obtain the elevation of the lowest floor (including basement) of all new and substantially improved buildings, and maintain a
{ record of such information.The Elevation Certificate provides a way for a community to document compliance with the community's
floodplain management ordinance.
Use of this certificate does not provide a waiver of the flood insurance purchase requirement. Only a LOMA or LOMR-F from the .
Federal Emergency Management Agency(FEMA) can amend the FIRM and remove the Federal mandate for a lending institution
to require the purchase of flood insurance. However, the lending institution has the option of requiring flood insurance even if a
LOMA/LOMR-F has been issued by FEMA.The Elevation Certificate may be used to support a LOMA or LOMR-F request. Lowest
floor and lowest adjacent grade elevations certified by a surveyor or engineer will be required if the certificate is used to support a
LOMA or LOMR-F request. A LOMA or LOMR-F request must be submitted with either a completed FEMA MT-EZ or MT-1
package,whichever is appropriate.
This certificate is used only to certify building elevations.A separate certificate is required for floodproofing. Under the NFIP, non-
residential buildings can be floodproofed up to or above the Base Flood Elevation (BFE).A floodproofed building is a building that
has been designed and constructed to be watertight(substantially impermeable to floodwaters) below the BFE. Floodproofing of
I residential buildings is not permitted under the NFIP unless FEMA has granted the community an exception for residential
floodproofed basements. The community must adopt standards for design and construction of floodproofed basements before
FEMA will grant a basement exception. For both floodproofed non-residential buildings and residential floodproofed basements in
icommunities that have been granted an exception by FEMA, a floodproofing certificate is required.
Additional guidance can be found in FEMA Publication 467-1, Floodplain Management Bulletin: Elevation Certificate, available on
FEMA's website at https://www.fema.gov/media-library/assets/documents/3539?id=1727.
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FEMA Form 086-0-33(Revised 7/15) Replaces all previous editions. F-053
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U,.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.
Ciopy 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 Policy Number:
i Sankara Rao&Rama Kothakota
A2. Building Street Address(including Apt., Unit, Suite,and/or Bldg. No.)or P.O. Route and Company NAIC Number:
Box No.
5116 Water Song Way
City State ZIP Code
Fort Pierce Florida 34949
A3. Property Description(Lot and Block Numbers, Tax Parcel Number, Legal Description,etc.)
Watersong South P.U.D. Plat No. One, Lot 5
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A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory,etc.) Residential
A5. Latitude/Longitude: Lat.27.2311 Long.-80.1529 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
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A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) 0.00 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 0.00 sq in
d) Engineered flood openings? ❑Yes X No
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A9. For a building with an attached garage:
a) Square footage of attached garage 537.00 sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 2
c) Total net area of flood openings in A9.b 41.16 sq in
d) Engineered flood openings? ❑x Yes ❑ No
SECTION B—FLOOD INSURANCE RATE MAP(FIRM) INFORMATION
B1. NFIP Community Name&Community Number B2. County Name B3. State
St Lucie County 120285 St. Lucie County Florida
IB4. Map/Panel B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s)
Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth)
i Revised Date
112111 C0194 J 02-16-2012 02-16-2012 AE 6&7
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 139:
❑ FIS Profile X❑ FIRM ❑ Community Determined ❑ Other/Source:
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B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ❑X NAVD 1988 ❑ Other/Source:
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? X❑Yes ❑ No
Designation Date: 10-01-1983 ❑X CBRS ❑ OPA
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 1 of 6
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OMB No. 1660-0008
ELEVATION CERTIFICATE 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:
5116 Water Song Way
City State ZIP Code Company NAIC Number
Fort Pierce Florida 34949
SECTION C—BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings* ❑x Building Under Construction* ❑ Finished 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,VI—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: B308 Vertical Datum: NAVD88
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 the measurement used.
a) Top of bottom floor(including basement, crawlspace, or enclosure floor) 7.77 x❑ feet ❑ meters
b) Top of the next higher floor 19.47 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) 6.75 ❑x feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building(Describe type of equipment and location in Comments) N/A ❑ feet ❑ meters
f) Lowest adjacent(finished)grade next to building(LAG) 5.50 x❑ feet ❑ meters
g) Highest adjacent(finished)grade next to building(HAG) 5.50 ❑x feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
structural support 5.50 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 law to certify elevation information.
1 certify that 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.
Were latitude and longitude in Section A provided by a licensed land surveyor? ❑x Yes ❑No ❑Check here if attachments.
Certifier's Name License Number
Christian Fenex 5102
Title
Surveyor %=
Company Name 'CICA
Christian Fenex and Associates = _ a[
Address
PO Box2533 Ore.
City State ZIP Code
Palm City Florida 34991
Signature Date Telephone Ext.
Christian Fenex go:oya:°,3�51 3-"Ca 05-23-2018 (772)283-2977
Copy all pages of this Elevation Certificate and all attachments for(1)community official, (2)insurance agent/company,and(3)building owner.
Comments(including type of equipment and location, per C2(e), if applicable)
Structure(residence),does not fall in"V'zone.
Second floor(Item C2b), is designed elevation based on plans.
This certificate is revised on 5-23-18 to correct the community name and the flood zones for the residence only. Original field date of
survey is 10-09-2017.
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 2 of 6
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OMB No. 1660-0008
ELEVATION CERTIFICATE 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:
5116 Water Song Way
City State ZIP Code Company NAIC Number
Fort Pierce Florida 34949
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 El—E5. If the Certificate is intended to support a LOMA or LOMR-F request,
complete Sections A, B,and C. For Items El—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.
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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 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
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
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Address City State ZIP Code
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Signature Date Telephone
Comments
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❑Check here if attachments.
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 3 of 6
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OMB No. 1660-0008
ELEVATION CERTIFICATE 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:
5116 Water Song Way
City State ZIP Code Company NAIC Number
Fort Pierce Florida 34949
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.
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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.)
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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.
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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
68. 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
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Community Name Telephone
Signature Date
Comments(including type of equipment and location, per C2(e), if applicable)
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❑ Check here if attachments.
FIEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 4 of 6
BUILDING PHOTOGRAPHS •
OMB No. 1660-0008
ELEVATION CERTIFICATE 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:
5116 Water Song Way
City State ZIP Code Company NAIC Number
Fort Pierce Florida 34949
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
events, 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 Left side looking southeast Clear Photo One
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Photo Two
Photo Two Caption Right side looking northeasts Clear Photo Two
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 5 of 6
• BUILDING PHOTOGRAPHS
OMB No. 1660-0008
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:
5116 Water Song Way
City State ZIP Code Company NAIC Number
Fort Pierce Florida 34949
d' page, affix the additionalphotographs below. Identify allphotographs
If submitting more photographs than will fit on the preceding p g fy
'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.
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Photo Three
Photo Three Caption Front view looking south Clear Photo Three
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Photo Four
Photo Four Caption Rear view looking West E Clear Photo Four
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 6 of 6
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�. RECEIVED,.....,....
CCCL ELEVATION CERTIFICA7,u
FLORMA DEPARTMENT OF ENVIRONMENTAL PRO' MAY O 3 2018
Thus certificate is required by section 3109 ofthe Florida.Building Code for habitable strt�C S 1 =LUCie�C0unty,:Permitting,
construction control line to ensure the lowest horizontal structural member of such
struq;y -_
one-hundred-year storm elevation as published in the Florida Department of Environmenrargro on s ocument ht ed' I- —-
"One-Hundred=Year Storm Elevation Requirements for Habitable Structures Located Seaward of a Coastal Construction
Control Line". The elevation of the lowest horizontal structural member is to be shown in relation to National Geodetic
Vertical Datum(N.G.V.D.,1929).
NOTICE: This certificate shall be completed as part of the permitting process and submitted to the building official who
will pote any deficiencies and notify the permit holder of any actions necessary to bring the structure into compliance
with the elevation requirement. Any deficiencies found by the building official shall be corrected by the permit holder
immediately and prior to proceeding with work. Any work undertaken prior to submission of this certification shall be
at the property owner's risk.
SECTION A Property Information
S PROPERTY OWNER'S NAME
Sankara Rao&Rama Kothakota
_ STREET ADDRESS(Including Apt,U it,Sa.av&.r Bldg.Number)OR P.O.BOX NUMBER '
5116 Watersong Way
OTEERDESCRIP 1ON(La w d BTh*Numbas,eta.)
Lot 5 Watersgng'South PUD Plat No. One, Plat book 53, Page 1
CITY - STATE ZIP CODE
Ocean Drive-St. Lucie County PIM2532-803-0012-000-2
SECTION B One-Hundred-Year Storm Elevation Information
1. Pursuant to the above document,the bottom of the lowest horizontal structural member must be located at or above.
feet N.G.V.D. -
2. The bottom of the lowest horizontal structural member or a building is 18 5 feet N.G.V.D.
3. Control elevation reference mark used:Benchmark ID B 306 BM elev ' n: 3.61 feet N.D.V.D.
Please refer to the diagrams on page 2 of this document for informatt0 on of the bottom of-the lowest
horizontal structural member.
! SECTION C Certification
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation
information and-be submitted to and approved by the building official prior to commencing any additional work
I certify that the information in Sections A,B,and C on this certificate represents my best efforts to interpret the data available.
CERTIFffit!s NAME: LICENSE NUMBER
Christian Fenex PSM 5102
! TITLE. COMPANYNAME:
President Christian Fenex And Associates,LLC
ADDRESS: CrM. - STATE: ZIP CODE:
PO Box 2533 'Palm City Florida 34991
SIGNATURE DATE: TELEPHONE:
Christian Fenex oWWr➢6gnedbycermftnFm 10/3/2017 772-283-2977
gate:2017.10.0315:31:45-0P00'
COMMENTS: Affix Seal:
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DEP Foam 73-501
. RECEIVED
MAY 31 2018
V ZONE DESIGN CERTIFICATE Permitting
LucieContyent
Name �a4� Ic 1 R,b N4 -o7 UAWAPolicy Number(insurance Co. Use)
Building Address or Other Description 5 1116 WA 5-oMA !,Lxy .
Permit No. City aE&K: State _ Zip Code 5 9
SECTION 1: Flood Insurance Rate Map(FIRM) Information
Cimmunity Nolf I202 a.5 � r-1aneINo. __Lq4 _Suffix J FIRM Date z 16 2412—FIRM Zone(s)
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SECTION II: Elevation Information Used for Design
(NOTE: This section documents elevations used in the design—it does not substitute for an Elevation Certificate.]
1. Elevation of the Bottom of Lowest Horizontal Structural Member................................11,01 feet(NAVD88)
2, Base Flood Elevation (BFE)...................................................... .......................... '1
feet NAVD88)
3. Elevation of Lowest Adjacent Grade ....................................................................__Jafeet (NAVD88)
4.Approximate Depth of Anticipated Scour/Erosion used for Foundation Design............... feet (NAVD88)
5. Embedment Depth of Pilings or Foundation Below Lowest Adjacent Grade.................. feet (NAVD88)
SECTION III:V Zone Design Certification Statement
[NOTE. This section must be certified by a registered engineer or architect.]
I certify that: (1) 1 have developed or reviewed the structural design,plans, and specifications for construction and (2)that 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(excluding piles and columns) is elevated
to or above the BFE; and
The pile and column foundation and structure attached thereto is anchored to resist flotation, collapse, and lateral
movement due to the effects of the wind and water loads acting simultaneously on all building components. Water
loading values used are those associated with the base flood. Wind loading values used are those required by the
applicable State or local 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 registered engineer or architect
when breakaway walls exceed a design safe loading resistance of 20 pounds per square foot.]
I certify that(1) 1 have developed or reviewed the structural design, plans, and specifications for construction and (2)that the
design and methods of construction to be used for the breakaway walls are in accordance with accepted standards of
practice for meeting the following provisions:
• Breakaway wall collapse shall result from a water load less than that which would occur during the base flood;and
• The elevated portion of the building and supporting foundation system shall not be subject to collapse, displacement,
or other structural, damage due to the effects of wind and water loads acting simultaneously on all building
components (wind and water loading values to be used are defined in Section 111).
SECTION V:Certification and Seal
This!certification is to be signed and sealed by a registered professional engineer or architect authorized by to certify
structural designs. I certify the V Zone Design Certification Statement in Section 111 and the Breakaway Wall Design
Certification Statement in Section IV(if applicable),
Certifier's Name License Number place Seal
Title) Company Name Here
Address City State ZIP
Signature Date Telephone
FILE Co"60 P
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U.S. DEPARTMENT OF HOMELAND OURITY 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) insuranc O per.
SECTION A-PROPERTY INFORMATION RECEIVED -1 SE
'Al. Building Owner's Name
Sankara Rao&Rama Kothakota j MAY 0 3 2010
A2. Building Street Address (including Apt., Unit,Suite, and/or Bldg. No.)or P.O. Route and I
ST. Lucie County, Permitting
Box No.
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5116 Water Song Way
City State ZIP Code
Fort Pierce Florida 34949
A3. Property Description(L t and Block Numbers T Parcel Tber, Legal -escription,etc.)
Watersong South P.U.D. PI No.One, Lot 5
A4. Building Use(e.g., Resi ential, Non-Residenti I,Ad 'on,A cessory, tc.) Residential
A5. Latitude/Longitude: Lat 27.2311 ong. 0 529 Horizontal Datum: ❑ NAD 1927 0 NAD 1983
A6. Attach at least 2 photogr phs of the building if the C ifi ate is b ng used to obtain flood insurance.
A7. Building Diagram Numbe 1
A8. For a building with a crawl pace r enclos e(s):
a) Square footage of craw space r enclosur (s) 0.00 sq ft
b) Number of permanent fl od ope ings in the crawlsp a or enclosure(s)within 1.0 foot above adjacent grade 0
c) \of
of flood o enings i A8.b 7 0.00 sq in
d) ood openin s? ❑ ❑x N t `-'-
A9. Forh an attache garage: L E15C
a) of attached arage 537.00 sq ff N6
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b) rma t flood enings in the attached garage within 1.0 foot above adjacent grade 2
c) Total net area of flood op in g in A9.b 41.16 sq in
d) Engineered flood openings? ❑x Yes ❑ No
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SECTION B-FLOOD INSURANCE E MAP(FIRM)INFORMATION
B1. NFIP Comi/radinity Name&Community Number 2.County ame B3. State
Fort Pierce 1 0286 �.� (uue Cr�c,n U� inCorp�f t. Lucie Co ty
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B4. Map/Panel B5.Suffix B6. FIRM Index B7. FIRM Panel B8. Floo . Base Flood Elevation(s)
Number Date Effective/ Zone(s) (Zone AO, use Base Flood pth)
Revise
12111C0194 J 02-16-2012 - 012 VE,AE VE(EL11),AE(EL7 (EL6)
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1310. Indicate the source of the Base Flood Elevation(BFE)data or base floo entered in Item
❑ FIS Profile x❑ FIRM ❑ Community Determined ❑ Other/Source:
Y-4 kaos -
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ❑x NAVD 1988 ❑ ther/Sour e:` t
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B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Pr tected Area(OPA)? ❑x Yes ❑ No
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Designation Date: 10-01-1983 x❑ CBRS ❑ OPA
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FEMA Form 086-0-33(7/15) 1 A&AETaii&viq e i• Form Page 1 of 6
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OMB No. 1660-0008
ELEVATION CERTIFICATE 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:
5116 Water Song Way
City State ZIP Code Company NAIC Number
Fort Pierce Florida 34949
SECTION C—BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings* ❑x Building Under Construction* ❑ Finished 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,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: B308 Vertical Datum:NAVD88
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 the measurement used.
a) Top of bottom floor(including basement, crawlspace,or enclosure floor) 7.77 x❑ feet ❑ meters
b) Top of the next higher floor 19.40 x❑ feet ❑ meters
c) Bottom of the lowest horizontal structural member(V Zones only) '+ .0 ❑x feet ❑meters
d) Attached garage(top of slab) 5 ❑x feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building N/A feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent(finished)grade next to building (LAG) 5.50 x❑ feet ❑ meters
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g) Highest adjacent(finished)grade next to building (HAG) 5.50 ❑x feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
structural support 5.50 ❑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 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? ❑x Yes ❑No ❑Check here if attachments.
Certifier's Name License Number
Christian Fenex 5102
Title
Surveyor
Company Name = _ IOC
Christian Fenex and Associates = % - W _
Address -
r Here
' PO Box 2533
City State ZIP Code
Palm City Florida 34991
Signature Date Telephone Ext.
Christian Fenex DigibHy signed byChnsbanFeuea 10-09-2017 (772)283-2977
gets:2017.10.0912:58:30-04'00'
Copy all pages of this Elevation Certificate and all attachments for(1)community official, (2)insurance agent/company,and(3)building owner.
Comments(including type of equipment and location, per C2(e), if applicable)
Structure(residence),does not fall in"V"zone.
Second floor(Item C2b), is designed elevation based on plans.
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 2 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE 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:
5116 Water Song Way
City State ZIP Code Company NAIC Number
Fort Pierce Florida 34949
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 El—E5. if the Certificate is intended to support a LOMA or LOMR-F request,
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omplete Sections A, B,and C. For Items El—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.
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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 information in Section G.
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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
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Comments
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❑Check here if attachments.
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 3 of 6
' � •
OMB No. 1660-0008
ELEVATION CERTIFICATE 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:
5116 Water Song Way
City State ZIP Code Company NAIC Number
Fort Pierce Florida 34949
SECTION G—COMMUNITY INFORMATION(OPTIONAL)
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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: ❑ 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
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Signature Date
Comments(including type of equipment and location, per C2(e), if applicable)
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❑ Check here if attachments.
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 4 of 6
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BUILDING PHOTOGRAPHS 0 OMB No. 1660-0008
ELEVATION CERTIFICATE 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:
5116 Water Song Way
City State ZIP Code Company NAIC Number
Fort Pierce Florida 34949
i 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 Left side looking southeast ; Clear Photo One
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Photo Two
Photo Two Caption Right side looking northeast i Clear Plioto Two
F!EMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 5 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
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:
5116 Water Song Way
City State ZIP Code Company NAIC Number
Fort Pierce Florida 34949
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.
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Photo Three
Photo Three Caption Front view looking south Clear Photo Three
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Photo Four
Photo Four Caption Rear view looking West Clear Photo Four
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 6 of 6
-2 �9®l
U.S. DEPARTMENT OF HOMELANOSECURITY
008
Federal Emergency Management Agency OMB No. 1 ate: Nov
9 Y 9 9 Y 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 agent/company,and(3)building owner.
SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name Policy Number.
Sankara Rao&Rama Kothakota
A2. Building Street Address(including Apt., Unit,Suite,and/or Bldg. No.)or P.O. Route and Box No. Company NAIL Number:
5116 Water Song Way
City State ZIP Code
Fort Pierce Florida 34949
A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,etc.)
Watersong South P.U.D.Plat No.One, Lot 5
A4. Building.Use(e.g., Residential, Non-Residential,Addition,Accessory,etc.) Residential
A5. Latitude/Longitude: Lat.27.2311 Long.-80.1529 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 1B
A8. .For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) 0:00 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 0.00 sq in
d) Engineered,flood openings? ❑Yes 0 No
A9.For a building with an attached garage:
a) Square footage of attached garage 537.00 sq ft
b) Number of permanent flood openings in.the attached garage within 1.0 foot above adjacent grade 2
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c) Total.net area of flood openings in A9.b 41.16 sq in
d) Engineered flood openings? ❑x Yes .❑ No
j SECTION B—FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1. NFIP Community Name&Community Number B2.County Name B3. State
Fort Pierce 120286 St.Lucie County Florida
B4.Map/Panel B5.Suffix B6. FIRM Index B7.FIRM Panel B8. Flood B9. Base Flood Elevation(s)
Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth)
Revised Date
12111 C0194 J. 02-16-2012 02-16-2012 VE,AE VE(EL11),AE(EL7),AE(EL6)
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 ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1920 ❑x NAVD 1988 ❑ Other/Source:
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Pro No
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Designation Date: 10-01-1983 ❑ CBRS ❑ OPA ���iiiiii r (Q%f❑
FEMA Form 086-0-3.3(7/15) Replaces all previous editions. Form Page 1 of 6
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ELEVATION CERTIFICATE OMB No. 1660-0008Expiration 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:
i5116 Water Song Way
,City State ZIP Code Company NAIC Number
(Fort Pierce Florida 34949
SECTION C—BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: ❑ Construction Drawings* ❑x Building Under Construction* ❑ Finished Construction
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*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,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: B308 Vertical Datum:NAVD88
Indicate elevation datum used for the elevations in items a)through h)below.
❑ NGVD 1929 0 NAVD 1988 ❑ Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
Check the measurement used.
a) Top of bottom floor(including basement,crawlspace,or enclosure floor) 7.77 0 feet ❑ meters
b) Top of the next higher floor, 19.40 Z feet ❑ meters
c) Bottom of the lowest horizontal structural member(V Zones only) 17.07 0 feet_ ❑meters
d) Attached garage(top of slab) 6.75 0 feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building(Describe type of equipment and location in Comments) N/A ❑ feet ❑ meters
f) Lowest adjacent(finished)grade next to building (LAG) 5.50 ❑x feet ❑ meters.
g) Highest adjacent(finished)grade next to building(HAG) 5.50 ❑x feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including 5.50 x feet ❑ meters
structural support
SECTION D—SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed b a land surveyor,engineer,or architect authorized b law to certifyelevation information.
I certify that the information on this Certificate by
my best efforts'to interpret the data available. I understand that any false
statement may be punishable b fine or imprisonment under 18 U.S. Code Section 1001.
Y p Y p
Were latitude and longitude in Section A provided by a licensed land surveyor? Z Yes ❑No ❑Check here if attachments.
Certifier's.Name License Number
Christian Fenex 5102
Title
Surveyor
i Company Name Place
Christian Fenex and Associates Seal
Address Here
PO Box 2533
City State ZIP Code
Palm City Florida 34991 .
I .
Signature Date Telephone .Ext.
DISWy signed by Cbdsgan F--
Christian Fenex 10-09-2017 (772)283-2977
,.-'Dew:zmam.os izse3s aa•oa
Copy all pages of this Elevation Certificate and all attachments for(1)community official,(2)insurance agent/company,and(3)building owner.
Comments(including type of equipment and location, per C2(e), if applicable)
fI Structure(residence),does not fall in"V"zone.
I Second floor(Item C2b),is designed elevation based on plans.
I
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 2 of 6
i
OMB No. 1660-0008
ELEVATION CERTIFICATE 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:
5116 Water Song Way
;City State ZIP Code Company NAIC Number
!Fort Pierce Florida 34949
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 El—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 accordancemith the community's
floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G..
SECTION F—PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
I 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
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❑Check here if attachments.
FEMA Form.086-0-33(7/15) Replaces.all previous editions. Form Page 3 of 6
i
. OMB No. 1660-0008
ELEVATION CERTIFICATE 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:
5116 Water Song Way
pty State ZIP Code Company NAIC Number
Fort Pierce Florida 34949
SECTION G—COMMUNITY INFORMATION(OPTIONAL)
The local official.who is authorized by law or ordinance to administer the community's flood plain 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.
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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
LVATION
BUILDING'PHOTOGRAPHS • OMB No. 1660-0008
E CERTIFICATE 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:
5116 Water Song Way
City State ZIP Code Company NAIC Number
Fort Pierce Florida 34949
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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 Left side lookingsoutheast
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Photo Two
Photo Two Caption Right side looking northeast Clear Photo Two
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 5 of 6
• BUILDING PHOTOGRAPHS
OMB No. 1660-0008
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:
5116 Water Song Way
City State ZIP Code Company NAIC Number
Fort Pierce Florida 34949
'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.
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Photo Three
Photo Three Caption Front view looking south ;Clear Photo Three
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Photo Four
Photo Four Caption Rear view looking West ; Clear Photo Four
FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 6 of 6