10 BAY ESPLANADE ��' � �7 ���l tLtVN11VIV l:tFi I lt-II:HI t . �.m.n. rvo..,suc,i-uu.��
� � '��� _ �-� 1 � J FEDERAL EMERGENCY MANAGEMENT AGENGY' �P1f°s�uly 3�� ti999
� NATIONAL FLOOD INSURANCE PROGRAM � - ��" �
ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase�eqliir, ; t o I ` pro- '
vide elevation info�mation�ecessary to ensure compliance with applicable community floodplain mari t �n a
the proper insurance premium rate,and/or to support a request for a Letter of Map Amendment or`,Re is� hpt
�quired to respond to this collection of information unless a valid OMB control number is displaye�!in tltg upper right cQ�er 42L.�k11�form;
Instructions fo�completing this form can be found on the followi�g pages ,
; ��° �
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SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE
BUILDING OWNER'S NAME ' POIICY NUMBER
PALM PAVILION OF CLEARWATER, INC.
STREET ADORESS(Includinq Apt.,Unit,Suite and/or Bldq.Number)OR P.O.ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
10 BAY ESPLANADE
OTHER OESCRIPTION(lol�nd Bbck Numbers,etc.)
LOTS 1, 2, 3, 4, 5, 14 & 15 BLOCK 8 REYISED MAP OF CLEARWATER BEACH �
CfTY • ' STATE ZIP CODE
GLE�ii�iRTER BEACH FL.
SEC;ION B FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
Provide the tollowing from the prope�FIRM(See Instructions):
1.COMMUNITY NUMBER 2.PANEI NUMBER 3.SUFFIX �.DATE OF FIRM INDEX 5.FIRM ZON� 6.BASE FI�OD ELEVATION
(.n AO Za»s.�d�lh)
125096 0007 D 8-19-91 VE 13
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations(BFE): ❑NGVD'29 �Other(desc�ibe on back)
8. For Zones A or V,where no BFE is provided on the FIRM,and the community has established a BFE for this building site,indicate
the communitys BFE:���.0 feet NGV�(or other FIRM datum–see Section B, Item 7),
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Certificate Instructions,indicate the diagram number irom the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level� .
•?(a). FIRM Zones A1-A30,AE,AH,and A(with BFE). The top of the reference level floor trom the selected diagram is at an elevation
of I I I I I I.(J teet NGVD(or other FIRM datum–see Section B, ttem 7).
(b). FIRM Zones V1-V30,VE,and V(with BFE). The bottom of the lowest horizontal structural member of the reference level from
the selected diagram,is at an elevation of���.0 feet NGVD(or other FIRM datum–see Section B, Item 7).
(c;. FIRM Zone A(without BFE). The tloor used as the reference level trom the selected diagram is W.0 teet above❑ or
below❑ (check one) the highest grade adjacent to the building.
(d). FIRM Zone AO. The floor used as the reference level from the selected diagram is W.0 feet above❑ or below�(checR
one)the highest grade adjacent to the building. If no flood depth number is available,is the building's lowest floor(reterence
level)elevated in accordance with the community's iloodplain management ordinance? ❑ Yes ❑ No ❑ Unknown
3. Indicate the elevation datum system used in determining the above reference level elevations:� NGVD'29 ❑ Other(describe
under Comments on Page 2). (NOTE: ll the elevation datum used in measuring the elevations is different than that used on
Ihe FIRM (see Section 8, Item 7J, then convert the elevations to the datum system used on the FIRM and show the conversion
eqvafion under Comments on Page 2.)
4. Elevation reference mark used appears on FIRM: ❑ Yes �No (See Instructions on Page 4)
5.The reference level elevation is based on: � actual construction ❑ construction drawings
(NOTE: Use ol construction drawings is only valid il the building does not yet have the re/erence/eve/floor in p/ace,in whlch
case this ceriilicate wi/l on/y be valid/or the bui/ding during the course o/construction. A post-construction E/evation Certi/icate
will be required once construction is complete.)
6.The elevatfon of the lowest grade immediately adjacent to the building is:�J.U feet NGVD(or other FIRM datum-see
Section B.Item 7).
SECTION D COMMUNITY INFORMATION
1. Ii the community oiticial responsible tor verifying building elevations specifies that the reference level indicated in Section C,Item 1
� is not the"lowest floor"as detined in the community's floodplain management ordinance,the elevation of the building's"lowest
tloor"as delined by the ordinance is: L�J.0 (eet NGVD(or other FIRM datum–see Section B, Item 7).
2. Date of the start of construction or substantial improvement ,
FEMA Form 81-31, AUG 98 REPlACES ALL PREVIOUS EDIiIONS SEE REVERSE SIDE FOR COIYTINUATION
SECTtON E CERTIFICATION
This certification is to be signed by a land surveyor,enginee�,ar architect who is authorized by state or local law to certity elevation
in(ormation when the elevation information for Zones A1—A30,AE,AH,A(with BFE),V1—V30,VE,and V(with BFE)is required.
Community ofiicials who are authorized by local law or ordinance to provide floodplain management information,may also sign the �
cehification. In the case ot Zones AO and A(without a FEMA or community issued BFE),a building ofiicial,a property owner,or an
owner's representative may also sign the certitication.
Reference level diagrams 6,7 and 8- Distinguishing Features—If the certifier is unable to certify to breakaway/non-breakaway wall,
enclosure size,location of servicing equipment; area use,wall openings,or uniinished area Feature(s),then list the Feature(s)not
included in ihe certification under Comments below. The diagram number,Section C, Item 1,must still be entered.
I ceriily that the information in Sections B and C on this certilicate represents my best elforts to interpret the data availa6/e.
I u�derstand thal any lalse statement may be punishable by line or imprisonmenl under 18 U.S. Code, Section 1001.
CERTIFIER'S NAME LICENSE NUMBER(or Aflix Seal)
GEORGE A. SHIf�P.I I 2512 ' '
T1PRESIDENT����•"'-� "'!`��`,, COMPANYNAME
, GEORGE A. SHIMP II & ASSOC. INC.
AODRESS � �,.r^ `f C�Ty �S`ATE
3301 :[���� � �0 `$Ll�d.��°: ;,���, � PALM HARBOR F 34683��
SKiN
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_ �. ;�0,6 #990047 1���99 ���"-�496
Coples slfduld'tis made d���i`fs_CertHlcate for:1)community c+t`flcfal,2)Insurance egent/company,and 3)bullding owner.
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COMMENTS:
- .
ON YN N a
SLAS BASE�!ENT PIERS,Oq�LCp{,UMNS
A V ,
ZONES � ZONES � � �
2C iES ZONES ZONES
nEiE1�1KE " '�.\\I REFERENCE
IEVEL C� �E IEVEI ����
F1000 � LEVEI
„ EIEVATION
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SASE :�'1�,J:.`..:�i. ::;,t.;'i'::���.: .,��L
f�� ..'.. .. AOJACENT�:; f+ REfEHENGE �E
EIEVAIpN .��EM 6RApE "�,i`yi LEVEL ���
REFERENCE
IEVEI GRADE ���. EIEVATpN
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The diagrams above illustrate the points at which the elevatioi�r,should be measured in A Zones and V Zones.
Elevations for aIl A Zones should be measured at the top of th� reference level tloor. �
Elevations for all V Zones should be measured at the bottom c+the lowest horizontal structural member.
P� �e 2