1000 BRUCE AVE ELEVATION CERTIFICATE O.M.B. No. 3067-0077
FEDERAL EMERGENCY MANAGEMENT AGiENCY Expires July 31, 1999
� NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of this certificate does not provide a waivar of the flood insurance purchase requirement.This form is used only to pro-
vide elevation information necessary to ensure compliance with applicable community floodplain management ordinances,to determine
the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR).You are not
�quired to respond to this collection of information unless a valid OMB control number is displayed in the uppe�right corner of this form.
Instructions for completing this form can be found on the following pages.
SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANV USE
BUILDING OWNER'S NAME POLICY NUMBER
JOANNE MANION
STREET ADDRESS(Including Apt..Unit,Suite and/or Bldg.Number)OR P.O.ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
1000 BRUCE AVENUE
OTHER OESCRIPTION(lot and Block Numbers,etc.)
LOT 15 BLOCK 267 CARLOUEL SUBDIVISION
'�CITY STATE ZIP CODE
� CLEARWATER FL.
SEC:10�B FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
Provide the foilowir.g fr�m the proper FIRM(See Instructions):
1.COMMUNiTY NUMBER 2.F�ANEL NUMBER 3.SUFFIX 4.D TE OF IR ND 5.FIRM 20NE 6.BASE FIOOD ELEVATION
� �� '�= � (in AO Zones,use depth)
125096 0003 D AE 11
7. Indicate the ele�ation datum system used on the FIRM for Base Flood Elevations(BFE): ❑NGVD'29 ❑Other(describe 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 community's BFE:�J.0 feet NGVD(or other FIRM datum—see Section B, Item 7),
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Certificate Instructions,indicate the diagram number from the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level 1
•(a). FIRM Zones A1-A30,AE,AH,and A(with BFE). The top of the reference level floor from the selected diagram is at an elevation
oi L��J.0 feet NGVD (or other FIRM datum—see Section B, Item 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�J.0 feet NGVD(or other FIRM datum—see Section B, Item 7).
(c). FIRM Zone A(without BFE). The floor used as the reference level from the selected diagram is W.0 feet 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�(check
one)the highest grade adjacent to the building. If no flood depth number is available,is the building's lowest floor(reference
level)elevated in accordance with the community's floodplain 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: !f the elevation datum used in measuring the elevations is different than that used on
the FIRM (see Section B, ltem 7J, then convert the elevations fo the datum system used on the FIRM and show the conversion
equation under Comments on Page 2.)
4. Elevation reterence mark used appears on FIRM: ❑ Yes �No (See Instructions on Page 4) �_ (5 a (�(] �
p L5 V
5.The reference level elevation is based on: � actual construction ❑ construction drawings
(NOTE: Use of construction drawings is only valid if the building does noi yet have the reference I or in place,in which
case thrs certilicate will only be valid for the building during the course of construction. A post-con r n E(�ior���e
wil!be required once construction is complete.)
6.The elevation of the lowest grade immediately adjacent to the building is:��.U feet N SVCS
Section B, Item 7). CITYOFCLEARWATER
SECTION D COMMUNITY INFORMATION
1. If the community official responsible for verifying building elevations specifies that the refere�ce Ievel indicated in Section C, Item 1
� is not the"�owest floor"as defined in the community's floodplain management ordinance,the elevation of the building's"lowest
floor"as defined by the ordinance is: L�J.0 feet 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 96 REPlACES ALL PREVIOUS EDIT10N5 SEE REVERSE SIDE FOR CONTINUATION
SECTION E CERTIFICATION ,�
This certitication is to be signed by a land surveyor,engineer,or architect who is authorized by state or local law to certify elevation
iniormation when the elevation information for Zones A1—A30,AE,AH,A(with BFE),V1—V30,VE,and V(with BFE)is required.
Community officials who are authori2ed by local law or ordinance to provide floodplain management information,may also sign the
certification. In the case oi Zones AO and A(without a FEMA or community issued BFE),a building official,a property owner,or an�
owner's representative may also sign the certification.
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 unfinished area Feature(s),then list the Feature(s)not
included in the certification under Comments below. The diagram number,Section C, Item 1, must still be entered.
1 certily that the inlormation in Sections B and C on this certificate represents my best eflorts to interpret the data availab/e.
1 understand that any false statement may be punishable by line or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIER'S NAME UCENSE NUMBER(or AHiz Seaq
GEORGE A. SHIMP I I 2512 ;� '�� '.�:;�;.`, '
TI��ESIDENT COMPANYNAME �,� qe° •,n �, � _
GEORGE A. SHIMP I I & ASSOC. .I1�`,s� ,,' �r,'; .,
Ao�3�1 DESOTO BLVD. cirv .- .•
PALM HARBOR --'�� �'' �f'�T c� ' '�- Z1P
°'' �`�'F� `�'► �34683
SIG -'.^ �La"
, •
� � 990023�_, �'•�', . 7��TE99 78� � ��•�-�:
Copies should be made of this Certificate for:1)community ofticial,2)insurance agenUcompany,a�d,3}4°bfutWl�g�owner. �
COMMENTS:
•
ON yynH
ON PILE3,
SLAB BASEMENT PIERS,OR COLUMNS
A V A A y.
ZONES ZONES 20NES 20NES ZONES
REFERENCE �
REFERENCE LEVEI pEFEqE►10E
LEVEI BASE
FLOOD IEVEI
EIEVATION .
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BASE :�;::;::,:;:?�:..+, ;.)°x��. BASE
F1000 ..i:;.'�'":.: ADJACENT :�::i�.:: REFERENCE FLOOD
ELEVI1Ti0N ' ....�'�5::
REFERENCE ADJACENT GRADE i.�t.: LEVEL EIEVATION
IEVEL ONAOE "�'� �
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The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones.
Elevations for all A Zones should be measured at the top of the reference level floor.
Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member.
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