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Home My WebLink AboutELEVATION CERTIFICATERfcBIVEp I q Oq ro L- (/ ermit # 19U4°0425 COVER SHEET SCANNED By St. Lucie County 1) Under construction elevation certificate 2) Rough Survey (tie in) V !UN 12 2019 Permi",Iq 0 St. Luce Coi�rlmenr n 6-12-19 F U.S. DEPARTMENT OF HOMELAND SECURITY oMB No: 1660-008 Federal Emergency Management Agency Expiration Date: November 30, 2018 National Flood Insurance Program ELEVATION CERTIFICATE scBYED Important: Follow the instructions on Pages 1-9 St. Lucie County 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 (Note: Not valid to usefor any otherperson or entity). Policy Number: ROBIN&CARMELLAPIZZY 44058-87 A2: Building Street Address (Including Apt., Unit, Suite, and/or Bldg. No. or P.O. Route and Company NAIC Number: Box No. 1185 NETTLES BLVD. City State ZIP Code JENSEN BEACH FL 34957 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) PARCEL 1185, NETTLES ISLAND, INC, A CONDO -SECTION II (g4502-501-1372-000-6) A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat. 27°16'58.8252"N Long: 80'13'29.5392"W Horizontal Datum: ❑ NAD 1927 ® 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:8 A8. For a building with a crawlspace of enclosure(s): a) Square footage of crawlspace or enclosure(s) 0 sq. ft. b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b 0 sq. in. d)'Engineered flood openings? ❑ Yes ® No A9. For a building with an attached garage: a) Square footage of attached garage 0 sq. ft. b) Numberof permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0 c) Total net'area of flood openings in A9.b 0 sq. in. d) Eng'rneeced flood openings? ❑Yes ®No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Bl: NFIP'Comrfiunity Name & Community Number B2. County Name B3. State ST. UUCIE cTY. UNINC. AREAS 120285 ST. LUCIE FL B4. Map/Panel.....-. '135. Suffix B6. Firm Index B7. FIRM Panel B8. Flood Zone(s) B9. Base Flood Elevation(s) Number Date Effective/ (Zone AO, use Base l Revised Date Flood Depth) 12111CO311 1 02/16/12 02/16/12 AE 7.0 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9: ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other/Source: Bll. Indicate Elevation Datum Used for BFE in Item B9: ❑ NGVD 1929 ® NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date: _ ❑ CBRS ❑ OPA FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 1 of 6 ELEVATION CERTIFICATE OMB No: 1660-008 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: 1185 NETTLES BLVD. City State Zip Cade Company NAIC Number: JENSEN BEACH FL 34957 SECTION C—BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building Elevations are Based on: ❑ Construction Drawings* ® 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/Al — 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: 872 2312 G TIDAL Vertical Datum:NAVD 1988 Indicate elevation datum used for the elevations in Items a) through h) below. ❑ NGVD 1929 ® 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) 4.87 ® feet ❑ meters b) Top of Next Higher Floor 8.5 ® feet ❑ meters . c). Bottom of the lowest horizontal structural member (V Zones only) N/A._ ❑ feet ❑ meters d) Attached garage (top of slab) N/A._ ❑ 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) 4.53 ® feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 4.87 ® feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A._ ❑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 authorized by law to certify elevation information. 1 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. Cade, Section 1001. Were latitude and longitude in Section A provided by a licensed land surveyor? ® Yes ❑ No ® Chec ttachments. Certifier's Name: License Number: Stephen J. Brown, PSM L.S. 4049 Place '.. - Seal' i Title: Professional Surveyor and Mapper HeVe r , �• "" Company Name: _ Stephen ` n, PSM, L.S, o 61 Florida, Steph . Bro , Inc. Ad ess: 9 EAST 51h STR `'fit thouttheWatuorida Cit State: Zip Code: Y• P the on ' deond ri l roiseo "sea) of a Florida STUART FL 34994 Lic sed5umeyor&Mapper" Signature: Date: Telephone: Stephen J. Br S 06/11/19 (772) 288-7176 Copy all Page f levat'on Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comme i ding type of equipment and location, per C2(e), if applicable. FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 2 of 6 F ELEVATION CERTIFICATE OMB No: 1660-008 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: 1185 NETTLES BLVD. City State Zip Code Company NAIC Number: JENSEN BEACH FL 34957 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 and or LOMR-F request, complete Sections A, B, and C. For Items ES-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. El. 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, ❑feet ❑meters E] above or ❑below the HAG crawlspace, or enclosure) is b) Top of,bottom floor (including basement, E] feet E] meters ❑ above or ❑ below the LAG crawlspace, or enclosure) is -- 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 ❑ feet ❑ meters ❑ above or ❑ below the HAG the diagrams) of the building is �— E3. Attached Garage (top of slab) -- ❑ feet ❑ meters ❑ above or ❑ below the HAG E4. Top of platform of machinery and/or equipment ❑ feet ❑ meters ❑ above or ❑ below the HAG . servicing the building is -- E5. Zone AO only: If no flood depth number is available, is the top of the 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: Address City State Zip Code Signature Date Telephone Comments ❑ Check here if attachments FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 3 of 6 ELEVATION CERTIFICATE OMB No: 1660-008 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: 1185 NETTLES BLVD. City State Zip Code Company NAIC Number: JENSEN BEACH FL 34957 SECTION G—COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8—G10. In Puerto Rico only, enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below). G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA-issued or community issued BFE) or Zone AO. G3. ❑ The following information (Items G4—G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued G7. This Permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) ❑ feet ❑ meters Datum of the building: -- G9. BFE or (Zone AO) depth of flooding at the building site: -- ❑ feet ❑ meters Datum G10. Community's design flood elevation: _ _ ❑ feet ❑ meters Datum — 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. Local Official's Name Title Community Name Telephone Signature Date Comments ❑ Check here if attachments FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 4 of 6 BUILDING PHOTOGRAPHS OMB No: 1660-008 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: 1185 NETTLES BLVD. City State Zip Code Company NAIC Number: JENSEN BEACH FL 34957 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. - y 06107119 06107119 Photo One Caption: FRONT VIEW Photo Three Caption: SIDE/FRONT VIEW - 1 i L FORM R k+m rrLM i m e �� 06107119 06/07/19 Photo Two Caption: SIDE VIEW Photo Four Caption: SIDE/REAR VIEW FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 5 of 6 U.S. DEPARTMENT OF HOMELAND SECURITY OMB No: 1660-008 Federal Emergency Management Agency Expiration Date: November 30, 2019 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/companv, and (3) buildine owner. SECTION -A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name (Note: Not Valid to usefor any other person orentity). Policy Number: ROBIN&CARMELLAPIZZY #4058-87 A2. Building Street Address (Including Apt., Unit, Suite, and/or Bldg. No. or P.O. Route and Company NAIC Number: Box No. 1185 NETTLES BLVD. City State ZIP Code JENSEN BEACH FL 34957 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) PARCEL 1185, NETTLES ISLAND, INC, ACONDO-SECTIONII (N4502-501-1372-000-6) A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) RESIDENTIAL A5. Latitude/Longitude: Lat: 27`16'58.8252"N Long: 80`13'29.5392"W Horizontal Datum: ❑ NAD 1927 ® NAD 1983 AS. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number:8 A8. For a building with a crawlspace of enclosure(s): a) Square footage of crawlspace or enclosure(s) 0 sq. ft. b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b 0 sq. in. d) Engineered flood openings? ❑ Yes ® No ^ AS. For a building with an attached garage: a) Square footage of attached garage 0 sq. ft. b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0 c) 7otahnet"area of flood openings in A9.b 0 sq. in. s� d)Er,giaeered:floodopenings? ❑ Yes ® No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Bl. NFIP.CommUnity Name.& Community Number B2. County Name B3. State ST. LUCIE�CTY. UNINC. AREAS 120285 ST. LUCIE I FL B4. Map/Panel, •...... 95. Suffix B6. Firm Index B7. FIRM Panel B8. Flood Zone(s) B9. Base Flood Elevation(s) Number Date Effective/ (Zone AO, use Base Revised Date Flood Depth) 12111CO311 1 02/16/12 02/16/12 AE 7.0 1310. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69: ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other/Source: Bll. Indicate Elevation Datum Used for BFE in Item B9: ❑ NGVD 1929 ® NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date:_ ❑ CBRS ❑ OPA FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 1 of 6 ELEVATION CERTIFICATE OMB No: 1660-008 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: 1185 NETTLES BLVD. City State Zip Code Company NAIC Number: JENSEN BEACH FL 34957 SECTION C—BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building Elevations are Based on: ❑ Construction Drawings* ® 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 Vl—V30, V (with BFE), AR, AR/A, AR/AE, AR/Al —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: 872 2312 G TIDAL Vertical Datum:NAVD 1988 Indicate elevation datum used for the elevations in Items a) through h) below. ❑ NGVD 1929 ® 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) 4.87 ® feet ❑ meters b) Top of Next Higher Floor 8.5 ® feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) N A._ ❑ feet ❑ meters d) Attached garage (top of slab) r N A._ ❑ 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) 4.53 ® feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 4.87 ® feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including N/A. ` ❑ 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 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 ® Ch attachments. Certifier's Name: License Number: Stephen J. Brown, PSM L.S. 4049 Place Seal Title: Professional Surveyor and Mapper Her _ Company Name: Steph own, PS M L. 04 tate of Florida Stephen J. Brown, Inc. Address: 619 ST S`h STREET Not Vo wirhout,the signature and C State: Zip Code: Z the iginalraisedsealofa Florida TUART FL 34994 ticensedsurveyor&Mapper" Signature: Date: Telephone: Stephen J. Brown, PIV 06/11/19 (772) 288-7176 Copy all Pages of thi ation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (inc ype of equipment and location, per C2(e), if applicable. FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 2 of 6 ELEVATION CERTIFICATE OMB No: 1660-008 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: 1185 NETTLES BLVD. City State Zip Code Company NAIC Number: JENSEN BEACH FL 34957 SECTION G—COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8 —G10. In Puerto Rico only, enter meters. G1. ❑ The information in Section C,was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below).' G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA-issued. or community issued BFE) or Zone AO. G3. ❑ The following information (Items G4— G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued G7. This Permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) ❑ feet ❑ meters Datum of the building: -- G9. BFE or (Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum G10. Community's design flood elevation: ❑ feet ❑ meters Datum 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. Local Official's Name Title Community Name Telephone Signature Date Comments ❑ Check here if attachments FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 4 of 6 ELEVATION CERTIFICATE OMB No: 1660-008 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.b. Route and Box No. Policy Number: 1185 NETTLES BLVD. City State Zip Code Company NAIC Number: JENSEN BEACH FL 34957 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 -ES. If the Certificate is intended to support a LOMA and or LOMR-F request, complete Sections A, B, and C. For Items ES-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. El. 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, ❑ feet ❑ meters ❑ above or ❑ below the HAG crawlspace, or enclosure) is -- b) Top of bottom floor (including basement, ❑ feet ❑ meters ❑ above or ❑ below the LAG crawlspace, or enclosure) is -- 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 ❑ feet ❑ meters ❑ above or ❑ below the HAG the diagrams) ofthebuilding is -- E3. Attached Garage (top of slab) -- ❑ feet ❑ meters ❑ above or ❑ below the HAG E4. Top of platform of machinery and/or equipment ' ❑feet ❑ meters ❑ above or ❑ below the HAG servicing the building is -- E5. Zone AO only: If no flood depth number is available, is the top of the 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 AD must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner or Owner's Authorized Representative's Name: Address City State Zip,Code Signature Date Telephone Comments ❑ Check here if attachments FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 3 of 6 BUILDING PHOTOGRAPHS ELEVATION CERTIFICATE See Instructions for ItemA6 OMB No:1660-008 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: 1185 NETTLES BLVD. City State Zip Code Company NAIC Number: JENSEN BEACH FL 34957 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. //' 'mil 4 _~� � • i x a _tom- - .. • � y 0 � '....sac.. .: 06107119 06107119 Photo One Caption: FRONT VIEW Photo Three Caption: SIDE/FRONT VIEW i i r 3 OF, ' �y � 4 06107119 06/07/19 Photo Two Caption: SIDE VIEW Photo Four Caption: SIDE/REAR VIEW FEMA Form 086-0-33 (7/15) Replaces all previous editions Page 5 of 6