120 BRIGHTWATER DR UNITS 1-6 __.—..__---- .�/�.
_._--. __ _ A� 1 �at�� ---_ _
.� : �_� n
` , ��E�rc4(.�h1'r�G'c�lCY 11ANAuc�I1�NT AGcNCY
r � NA�IONA:.F�000.It�1R.4NC�PROGRAht G.,�'-�. �c- �e�?-oc�; �
�c�_z�°�- 1 a r g� ELF1/AT10t�1 CER�'1�ICATE `'x�'re` '-1�-�'7iDF?��� ��e,:
I - .. ..�.,... , � , � '
� �mRor�t Fc�d the ins�*uctians on paaes 1-7,
ScCT1QN A.pROPErZTY OWNEtZ INFORMA710N
3UIl.DiNG OWNE�'S NAME 'a insu2rr.4 Carfay 11m:
MENt� DEV�!OPMEN- =�icy Nur,,ber
9UIl.�WG S7RE=!ADDr2ESS(!n:udin^y?r�,l;ni4 5ui�,and/or�idg.Nc.)G^n P.G.RG`U�;.ANC 3GX NC.
t2G1 3RIGh�NAT=;=c pR�VE
C!�Y C`=mF��1'NPJG Nurrc�
GL..4n^4VA i c� ��'�'= �P COpE
PROPER?Y pE5Cr21?:iCN{Lct ana BI�Num�S,12x P3.�I�Vtit�Cp�� ^'?'7
�OT 1,BEL'_.E AQUA.VIL:A�li �,a!�esciotl.^.n.e's.} .
SUILJiNG i,'Sc(e-9_,Resiagnca(,Ner.-resid��uai,Aciaiuor,Ac..essay,e'.�, Use a��emrr�nis a
RESIDENTIq� '��r���ry�?
LArTUD�,�LCNGiTJDE(CFTIONAL)
( �°-�'-�.,T ar ;�. NOrZlZONTA�C+ATJM: SOURCE; ❑G?S
�� f',_.1'NAD 9�17 ❑NAD?96� RYRel�
❑ US�Quaa Map ❑Qther:
SEC10N 6-FL�00 WSURIW�E�T�ry�q������NF��TION
� 91,NFIP CCkA1UN�NAME&;,CbtMtJN(1Y NUiNBER
QiY C���RWA�i2�96 � �`'�.1M'!�
� ,q �I � ?..�.SiATc �
�.��P�� I ����A I
I `n.,^�' �.:�=uc I �.F� a7.r�n�ar�
t�� RM JJOEX DA t t EF�'r-_'Gf14E,•r�c',R S c�'t,D A T E �"°�`�c"Lxp�.�.`1/ATl C N(S�
' D I 3�F!O C O Z�I E(S} (Zrne A0,:ae dea��tboc�c�
370.Inaica�fhe scurtx orihs 3�e=' �1 F� ?l1PF1 .
�d Eievaeon � '� � �,
�e��bas�flc�d de.�fh°r�in 99. i
❑FIS?rdie �FfRM �]Canmuni
511.I�drca��he�vation dah�m us�inrU�e BFc In a ; ��(�rrined ❑Otl�er(Oesci�el:
.-9 (�NGM 1�1'9 !,i�,�^,1?88
612 is�e bcnldna bcaied in a Coas�f 3arrier Rescur�; ' fC8RSl a�ea cr Otl�erwise r'rotec�c,a�a pPA17❑Olh�(Desai�e)=-_.
SE�TIOAI C-3UILb(NG��^1/ATION INFORMA7lON(S1IRVEY QUiRED)No Desion�on�aie____
Ci.9ui)cnng�ev�ons arz i�cn:(]�orsuudron DravdiraSs" ❑6uoain U
• 'A new 8evalion Cermxate w�l be Jeauirsd w�en c�ns6udion 9 �`4�0�� �Finrshd C�,sl�an
C2 Bunc5n Di ��'����-
9 ��am Num�er 1(SNec;th�buiiding c�aoram me�sirniiar ie�e bu�dno br wiii��fi���being cxripletr�:i-s�oaues 5 and 7. If rro dagram
a�ra�ly reorese�ts the buiictinq prwi�B a sice�t cr Pnotccraph.;
C3.Eev�tians-Znnes A1-4,�p,p=,,41-i.A(with EFc�,VE,W-�?0,V(wilh��)�{�pR/a,,q}�pt,qrJA1•A?Q�AR/AN,ARlAO
Corr�pe�It�ms Cy.-�-i bebw ac.�rtfmg ta the huii�ng ai�ram s�Aed in itan C2 SI��he daa�m t�sd.If the da�m is�rfferent from 1he oaa�
�ian E,convert the cfah,m+�tl�ai usad fnr tt�e 9FE�ow neld me.as�.irem��3nd dafum Wnve.Sion m used ior+,�e 9FE in
�on C or�ion G,as�towiai2,fo da:umenf�e . �aiaticn. Usa�e sAa�P�ded x the C.,^mmen6 area ar
C�m NGVD 2g Canv�io�/��,n� °�m�v�on.
Eevation reir��c�mar�c usen iF ib atvt�l !��e�evaticn�eie��rr�c usad
o a)Top�t bcd�m fioa(�;dudng^as�r,ent or ehdcsure; 7 t�°n 1he r�RM? ❑Yes �Nc I
o hj Top of ne:t hiaher flmr l ) R
c c)5at�xn of lowest ha¢cni�struczr�l mert� t7.02 R(mj :� �
(�zcx�as�nN) NA._;��m) �a i �
o d)Afta�ed gar�oe(fcn of s+ao) 7, 151t('m) �
o e)Lavvesi��evancn of machinery andlor�uiom�t � i
s��ong t�e bu�lain4(Des�oe in a C�nmen's araa) NA � w' m
o �L�sC��f(finrsn —R��1 $' �
�9�(L4G) 5.�R;m} z'�
0 9)h��es aaia�:nt(fmisn�)g�(F{qG�
o h)rvo.of�rrrianent oc�nings(flooa v��),,�;�,�n 1 ft ai,�ove ? 18 tLim) �� I
aala�t grae�7 � #2512 12/i 41Q5
o i)Toia�arsa m a11 a =
P�.'Tn�e°�t oc�rings fflocd rents)in .C'".s.h 12(k?_ n.� �
�s9• is9.�-�tij
ScCT10N�•Si1RVEY0R,E�IGtMF�,ORARCHiTi-�T
��s�mfica6on s lo be;igned and sEaied'ay a land surveyor,encinesr,or ac,hiiecf authoriZd+b ia�nr��A�ON
!carfify that the inl�rmafron ir,Sacfions A,B,and C on thls�r�incare rapresarns my5e�etldRs(o�i�erprsf t�he aara avarlable.rnaoon.
I:tndersTand that an false staternani ma De punishable b nRe or rmorisonmer�unde.�i8 L�.S. Code,S�ion 1�01.
���'��'�� GcJRGc a.S�i1MP II
UC'"c�NUMBE� 2512
TiTi� PRESfDE?�(i
COMPANY NAME Gc��RGc,A Sr,'fMP II&A.�,Si.C.,INC
.a�DRESS
�R?Jt5010 EC'Jlt�IARD "� �iA� ZIF.^ADE
S1- JOB NC�. �'�<42-=. z��� ���.;CNE �
'�'-7?�54...'�
_��,.. , _� o. ,. ,__..__....,,,.,
ncrn_J . -n r�:-�,� �o� T - . .. ..
` ' ��AL 3�1�GcNC'!NIANAG.r'�1�i AGc�VCY I ^.tv1"�. Nc. 3�6�-�C i i
NATIONAI.FLOQC INSURr1N�PRJG�.aM '
�i�s Dec�mber 31, 2G05 '
ELFVATION CERT1FiCA i E �-�'� �_�n.+t-�
• lmc�o� R�ac,+the inssuuctiors on pa es 1-7. �
ScCT7QN A�PROP��DyyNE,�1MF��MATIOh� �
3UILDf NG OWNE�S Nf.h1E ��i�cty�'�
M�NNA DEVF�OPMEivT P�ocy NLZr,cer
BUIL;ING STRE=?'ADRRE�S;!r.duding Apt,UrR 5uiie,andlor 3fdg,No.;�,R r.�.ap��i�,v,�p�OX Np. r,
12GE 3ft1G�?VYAT�DRJV= ..�,rn;,�r�y NA1C N�mb�
CITY
C�.=ARWA!_R S�A"� �P CCDE
?R�FE�iY DESCWP;ION(L�anc 31oc�Numbe;s,? "'E�
LOT 5,Bc_LE AQUA VILLAS II 3x,°arrPi Num'ter�!e�ai�escripnon,�.;
BUtLDING�5�(e.g.,Resiae�roai,Non-resiaenrial,�,ddiocn,Acessa
R�5IDENTIAL ry�°tc. Use a�nmens are9,if re�.ssary.;
LA�Ti UDE/LONGi�.1DE(OP1lOf�WL) HORiZ4N�
( �°-�'-i�.� or �.�Y##°j AL DATJM: SOURCc: ur S�,i
J`�D 1527 ❑NAD?963 [l L'SGS Quao'Mac
❑Ofher.
S�CTt�N B-�'�OOD IN�URAjJCE RqTE MAP(FRM)INFORhdAAT14N `
81.NFIF COMMIR`IfTY��IAME&w^�Iv1AqJNfIY�lUF�F- I BL 0.1•I.INTY NAME
CIT"OF CL:ARWAi t�t t?�96 � ��,�� E�'i.57Ai t
I 84.Au+P AND?ANE. I
I F�CR10A
I NUMEE�i I �.�.J�p; i 96.�¢'tM!NCIX GA�c �87.FG�M FA1V�: I CCO-_FVAl1CN(S)
! 12�7 p � E,:CTNE�E'JL�:.�QA7E �-°.3AS"c,=1_ u
3�18i52 �.F_�Zc�E(s� �2aie A0,use de�oF�5)
$�1991 I �r 11
B1�.Incrca�fhe sour�z of tlie 3as2 Floorl Be�rafion j6F=}d�a or bags flo�d depth��r�in E9.
❑F1S Pron1e ��1RM ❑Carnmun'riy Ds�min� t;
B11.Indca��e�eraocn dst�m u�for the�in�:�NGVG?SZQ ������—
612 Is�he��ldi laafed in a C.:ast�Barrier F�esaarc�a ❑f v A.V D 1988 ❑Ofh���._
(C8RSl area or Qfherwige Prnie�.�fCPA)? ❑Yes �A!o Desi4na�n D�e
SECl10N C-BUILDING�-�'.�/AT10N INF�RMATIDN(SURVEY RFQ{,►lRE�)
C'f.�i�ing�ev�rns are�ased on:�Cc�shucvon Otawirtes` ❑P�nl�' ng Urxier Cons�c6cn•
'?.new Je�fion Cerufi�wiQ t�required wne, �FinBned:sisoucuon
�af(�e buiiaing is c�mpiefe.
'2 Eui1ang Diagrarn Num6zr i{Sel��he lwridin4�agr-atn rt�sirt�iar io Ihe buil�rm ttx which ihis
�uratelY rer��Ihe taa�ina�?rovide a ske¢�or phot�raph.; �`��;nS��•�oaoes 6 and 7. If n�dia?ram
�."'"��..'�evatiorts-Zones Ai-A30,AE,�H,A{�vith BFcI,VE�V"1-V3ti,�(�ndtlt 3�,AR,AWA,ARIAE,AFJA�-.;3Q,.kR/AH,.4WA0
Ccmole�IEgns�.-a;�low ac_.^rding to dte bui7oin9�ia�ram so�8ed in Item CZ SI�{e the daium us�c,+.If�e oaa�m is aiifarar��rram tl1e�um t:sad for 1}�e 8Fc irt
Ss�on B,�mrert the dahurn�tliai us�for ff�e 3F=�ow fie!d me�urema��and datum convason dculanor: t�se f�e s�ar�provided or fhe C..'�mrr�.nts�rae af
�icn D or�o�G,as aooroonafe,io�menfi�e�m�+�ion.
Davm NG�/C�29 Com!e:s+on/Commerre �
E�tion�aer�x4 maric us�+L�'�0 Eh�i i.bes the�eva&m reieran�madc usad aD
o a}Too cr beCom�Cor(nd�cfino 6ase:r�ent or endesurs) 7.14�mon�e=1RM? ❑Y�s �Nc �
o b)Too or ne�d hrgher flocr � � a
o c Bot9�n af 17.06 ft(ml �
) bwest ha¢orita�'struc�ra!memoet(�/�nes oniY) NA._�,(m) m�
c d)Atl�ftEd gar�e(top of sla�) 7, 14 ft.(m) �°
o °)Lowe�elevation ef rnachine.y anc+/o�equlpment w� � ,
se.tiiang+�e b�idng(Des�ice in d Commens area) ' .
o fl i.,."wesz a�ax�t(finatte�gra�e(L,q�� N?.,—ft,(m) � m
x� 5 _� I
� _ .
o S)H�ada�nt(finishe��e(f-tqC;) — z�
5. 0&ft(m) '" I
o h)N e.�f permaneni cpenings(fl�y���µ,��in 1 It�.e a��,.��7 = i #2 512 i 2!14/05
o i)i ota araa a�t permanen't xenir�s(flocd�Ls)in C3.n 12�.'?� i , _' �-- �
sq. n (�,�tt!
SECriON D•SURVEYOR.EIVGINEE�,OR ARC}�tTE�I'CE�tTiFiCA710N
T�his�rtitiqtion!s lo be signed and sealed hy�land surveyor,sngineer,er ar�i�.c authQr��.r+by law��tiN ele�ra6or�in{��;�;�on.
I�r6ry�ai the inmrmaticn in Se�ons A,8,and C on,hrs csriincaia reoresartis my bes��orrs to inletp�e!fhe dais availa6le.
l understand that an iarse aafemerrf ma be unu,yai�le bynns orim�ri�nme�rt�nae.�',8 U.S. Coae,:Se�lon 1001.
CE.RiIF�R'S NAME GECf2G'c a�NIMP[I
JC=NSc NUMBE,�i 2512
�'�L= PRFSlDEYT
i,GMPANr,�lAME ts�RG�4_S'r;IMP II d�.i,.,�,�,�C.,INC
ADGRESS
�01 DE501^ 80UL�/ARD j� STAi t Z�F CODE
SlGAIA i� .AI.M HAREC�C 1 34&�
/''� �A.� 1�.=HC�VE
�cE�vo.�r�� �z����
72%-?°4,'i45e
�"1C�� .' ,-n�:;��� ...nn� . -
`' �EnA�319E�Gc�3VCY tv�ANAGc`�lQ�(j'ACcNC7
• ►�W.?iCNAi.-LJOD INSiJFc.4NC�PR'�',FcAM � �,�b4.�. �Vc. 3067-OC�? �
���v��,��� Ci��� �F�C�y I � r.•��ires �ec�mner 3', 2^u0o �
lmooriant r'�Q ths insttttcfiorts on es 1-7.
� Sc':,"'i1�N A•PRDPEnTY OWNE'rZ INF�RNWTION
BUILDING OWNE�'S NA�� r��rts„anca�„-�ay��;
1vi.�.NNA DEVEiOPMEM' ;��c�Numnar
°UIL�fNG S?�E_i ADGRE�S fl;�uaing Ac�, Un2 Suite,andlcr 3�C5,Nc,)OP,F.�J.r�OLC?'c p,MD 6GX NC.
i2C�.5 3RlGH�YA.?_.�DRIV� Ccnoar.y NAIC Numi�
C1TY
C�..�1RWArr-2 SA�t Z1P COOE
°ROP�RIY QESCRIFiION �� :?.3'67
�5,3E?!=AQUA VI!!��^i ana 31c�c Number,,Ta:Par=!Nlimcer,i.�ai i7esai�iicn;�tc)
3UILDING U5c(ag„Rsi'c„,°rtnai,Non-residenoal,Addi�or,?c.?�a +-�
RESIDENiIAL y,�., Use a Comnents araa,r ne;�ry,)
1..4!�TUDcJLONC�?UQE(OP'iIONAL) �
,^ HOR(ZOKTA„pA!JM:
( �..,- -�'-��' or �#.�.� L..'NAD 15Z7 ❑NAD 1983 S�URCc: L,GP5 C�YPe):
G l.'SGS Quad Map ❑Other,
SECTION 3-F'LOOD INSURqNC�RATc M,qp(F1R�INFORMATION
I61.NFlP COMtv1UNRY Np�ME&C��1m•��UMBF.tZ
CfIY CF�"aFZWAT�125096 �'�N?Y NANE
I ?INE.[.95 i 33�At:
64.MPP AnlC P,A� F-L'JR.Dl+.
NUMB� I c,�r c�� �� r'B7�=3�M?.4NE 69.c�ASc'ri..00D G-VATICN(
� ��� i �iRM IN�EX DA7E E� _^ .+R.MScD DATE �(,t.,c�
: � , $118r92 'JCO ZCN�SI (Z�ne A0,u�deph of�.roain g�
B i0.ind��tl�e scum of the B�F�c�vation(BFE)cia�or���,,d deoB�en�d inrts�91 AE ti
]F�S F�om`e �rfRM ❑Community Geiermined (1
311.:ndicate�e�eva�on dalum t:s�i�r the BFc v�E„°:(�NGV�1� ��e�ibs):�
E i 2 Is 5�e buiu�r,Q!a�in a��,i� ❑NA�iD 1988 �]rJiher(C�sctbe):_
� m(CBRS}arsa cr(�he�wise?rol�d Area OPA1? ❑Yzs �No De� nation Date
SE�TION C-BU1LDlNG E1�yATlON INFflRMq710N(SilaVEY r'2Ei1UtR�b
C7.Euilang eleva6ons aie b2�1 ort[�Ccnstr�aat Ora�rin5s' ❑8udr�rx�Ur�� R )
'A new EievsGon C�rlm"�afe�nll be `'Of1�� �Fr�hc�C�slnxgon
required Wr�1 G7ts�UC�on of 1he�tdittma is�npie�,
CZ Bu;id'uig Diagrarn Number 1(Se�ec fhe a�ud' cG
�9 �mcst sirrular to fhe bund�ng�wn�this�e��n9 c�npe�i-see pages 6 and 7. If no diagram
acarr�y��the buuding,provide a skeicfr or p'rpta�rapn-)
ca.t!evatons-z�nes A�-�,aE,AH,a(witt,sF�;�vE,v1-V".jo,�,wwiir»&�)�aR AR/A,awAE,.awA�-a�,A�/aH,aEVae
Com�e�Iia ns C3.-al below a�rmng 1c tlie bu�ding d�gr�n s�e:l in li�n C2 S�e�e datum tts�1.If fhe�m���from tl�e datur�use4(or tt�e BF�in
�on B,�nven me�m to tt;ai use�ier t�e B�.Show Reld messur�.me��ar�;:�o�m arnesi�rala.,isticn. ltse 3�e space pravided w the Cammens area of
�°..._.5-'on D or�on G.�s aporooria�,�dm,meni the daa:m c�varsion.
Da4�m NGVD 29 Conversmn/C�un�s�
c'.evatior,refe�nce mark t�sed LP 1 G BA�LbPS ihe c�e�cn re�earx�ma�ic usad acpear on ihe FiRM? ❑Yas ��o
o a)Top of b�tmrn floor(utdt�ng haserr�ent or encasure
o h)Top of,nexi ha�er gc� � i. 13 R(m) m
t1.oE�(mj �
° '=)��-att�m cr lan�esi hor¢cnei su�ral member(V za�es onryl NA._Rim) � m
o d)Aftached gara5e(top cr�b) ��
7. 13}trm) �� �
o e)l-owesc�levaaon o�rtmctvne,y anc(lor equiomen't —
serviang�re buii w � I
�(Des�be in a Camments a2a) I�IA._ft{m) �m
o PJ Lowest�ac�nt(finis�ec�gra�e(LAG) 5.C5(t(m) Z �
c g)Higr,esi ada�r�(fini5;��r�d e(hiA G) s �
o n No.d ? OH ft.(mj �
) ,�em ocenings @oai v�i�)�Md�in 1 R abo�e adia�x,!y�6; - � #2512 '12/74l�5
o Q?otal area or all��e�{�(�',,�s)irt C3.h 12Cr3.�sG.j�. �
(sc'+•cm)
ScCT10N D•SURVEYOR,pVG1NE';�pR,,�•�}.��.`�.�.C�..�iCAT10N
r��s�tificaaon is to�e signed and sealed by a iand surve,yo�,sr�inee��o����i�;��o,.�pY�aw'to c�fi'ry e)esrg�on infcrmafien.
1�°+�1'�m`J�e inrormarion in Sections A,a,and'C on this carWrcare��%.ser��,y�E�e�o�ie ir�ierorai fhe data av�ilaole.
/urn�ersiand rhai an falsa raiemera ma ba punisit�le 6v ane o�irnorisbnmanf unaer'd v.S. Code,Se..,�fron 1001.
Cc."�TIF1E,�'S NAME GEORGc.4 SH�Mp It
UCcNSE NUM6E2 2{12
�i i � FRE510E�
��'��� �OF?Gc A.SiiIMP il&AS"�Ga!�!C
ADDRE�S
�01 QE50T0 �OULt�ARD � �'a,—= �CC�E
Sii�`1G�?1 ?Ai:bl�-iAFt�30R ;; � �3
DAiE
.1Cfl;JC�..��2= ^:J14� i�?7CNE
"�-�3�?-54aE
nc"�n - _-a ?r�n ,-'n�n ,
� "�c��%L`_�Yi IE�Cc�lCY MAN.qGc�l�!'i AG�VCY I
' T!A?iQt�fA1.�_rJQO(PtSURANC�PROGKAM i '�-M.�C. �ia 3�67-0G�77 :
EL�'VAT10N CE}�?1FiCATE I `'x°�r=s Decamber3': �1��� ;
�
� �ao�artc R�rc.+�e irzs�t�c�ons on ces 1 •7.
5c'CiQN�,•PRCPF*'c?Y OWNEtC INFORHfAT10�
3UILDING OWNE.�:VAIv� 'x n�rdr��,.ar�•a,v�_ss:
MENNP,DE'�ipPM�N i r..uc�N�ne�
3UILDING S�R�_i p,�D�c�S llndudinc Ac�,!jn�,���,andlcr 91�g_Nc.;OR?.p.:�p(,M',qND 3GX NO.
120-a 3R1Gi-:"WA.'R GRIV� C;mcany NAIC NL�ni�
�..��
c�=��w,:.r� sr�.r �P c"c=
PRpPER'1Y DESCRIP7IQN'Lai ane Bf � "� 3:767
LOT 4; BE1�,aQUA VIL�..�S II �(Numoas.-ax, at�'Number,LPy��e�ipti�,etc.;
BUIL�ING L5E(°.g.,Resicenaal�Nor,-+eside.�lial,Aaoition,.4��ry,gic. Usz a r„^mmer�araa.;T n�ary,)
RESiDENT1AL
L4TUDEn 4NGI?UDE(OPTI�hiAL) '-1pR1Zpr(1'qL DA?UM:
� ?�°-�'-�.�' or �.�"°? ❑NAD 1°�'7 SOUR� ❑G?S�YPeI:
❑NAD�983 �USGS Cuad tvtac ❑CC�er;
SE�„TION 6-r-LOOD 1NSiJRANC�RA?E Mqp(�'[��NFORMATION 1
31.Nr�P COMMUNf1Y;IA1v1E�C�JNI'Y NUMBER I 32 C.,^{.Ni`(NARAE
� CI?Y OF C�dRWAr 1�03E ?PIEllAS �.S�Ai r
� F�CRIOA I
34.�WiP�WD PJWEi
NUMBER I 87,�3�1N PAN� �.P�4Sc FLCCfl�"YATICN{S)
12�9"a0L�71 35.SiJF=IX BE.rRM INC�EX DAT I c-_CTNFIRE'vl�Dq'1 r B8.F�OCfl ZCNE/51 I �7,�,,�
� ��� �q�� t , l`-�`QI��.U��QIOf��
010.IndKate fhe s�1r�e cf�e�ase r?o�cJeration ��� � i i t
(� .ase flocc deoth ent�in��.
❑r'IS?ronle ��iR1v1 ❑Commu ' Ce
311,Indicate the�eva6m "'�Y �rninad []p��p�J._
datum used ferthe BFc in 59:�NGV�1�� ���,��
612 Is f�e buiidi �c�ted in��cast�l�ltier r�esourt� CoRSI area cx Gthetwise P�Ar�a OP,4 G���)��
L��Yes �No D�cn Qa�
ScC i K}N C-BUlLDING E..�/ATlpl�!INF�RMATIDN(SU��EY RE{�(,Il�)
� C�.eu�ing�evatiau are based orc(��m,����. ❑9u�c�ng Underf�nstr�x�cn� �
`A new Elevaf�cn Certifica�will be �Finisna�i„rnsttt�SOn
r�quired wh��nsuucarn a�Bie�.oltling is compleie
�.Buiioing Dia3ram Number 1(Select�e bu�nS a�aoram rrx�simiiario fhe ot:ridng forwniai tha�rtii�cate's�g�P{�1-sze pages 6 and 7. If no maorarn
a�xtra�ly rep�zsenis ihe budoing,pmvide a ske�or�ohz�rapr�,) _
C3.F�ev�ans—Zones A1�.?0,AE,AI-�A(witt�BF�,VE,V1-V30,V(wiih cF�,pR.AR/A,ARIAE,A2Ai-A.'A,ARlAI-t.ARL40
Cemolet�I tans C.i.�-:�elow a�uding la fhe bu�ding dia�rdm sneGired in l�n C2�fhe r.aturrr used i�the davm is dtffer�nt tinm i�e dahim usd for the e�in
�c5on 6,�unventhe d�m�Ihst us�'I tor ihe EF�,S?tow fie�d measu2meits and o�m c�nversion caleui�uon. Usa fhe spac�prwiced or tte Commenis area ar
S�tion D a 5ecban 6,as aperooriaie,m c�menf Ihe�m xnversieri.
�m NGVD 29 Canv�scnlCamments
°evation r�er�mark us�; 10 BAhk'Oo��e elE+raticn r�r'��mark us�:aooaar on the F3RM7 ❑Yes �)No
o a)700 of bct�m ibor ii��Sernent cr�dcsu2) 7. 1 b R,m) -
c 6)Top ai next highert7�oa 11.00 ft.(m} m
o cj Botiern of ia�n�st hor�mtal s�r�J mem�(V zones cnly) NA._1t m �—
o d]Aff�ed y�e(toP ofs�ab} 7. 15 ftfm) ( ) �� ��
p °)��west elevafirn of mac�irrery and/oreGuiort�enf ,���-,�
servidng ihe 6u1�ng(�ce in a�:ommer�arm) NA._��(�) `R:�
o �Lowest adac�t(fini���Q(�q�� 5.QS tt m =�
o g)H;ches;ad�eni(finist�dl ora�e(1-iAG) � ) z °� � �
o h)No.or�i�,ings;fimd vemsl within 1�t aoovs�,�t�e� 5. ��lm� 8� � #2512 12/14/05 !
o )T o�a r�o f�oertn2n e�t�e.rones(flaod�ents)in G"�h 12�.29 sq.i�.;sc.an) � � �
S��T10N D-SllRY�YOR,ENG1NE�r'Z OR ARCHlTE�'i G�T1FiCAT}ON
Tnis,;e.�tification is f�bs signed and seale:i by a lanc surveyor,enoin�r,or ar�,;�����Z,�yy law io'ce,�ii{y elevation inrorraaon.
1°e�ti�'J�af ine mromravon in SecSons A, 6, and C on fhis cer6ficaiE,�epr�e�,�y oe�s�foris fo iniemr�i the data avaiiabre,
i urMe.�rand thar arr �ise stst�,nent,�ra �puRisnaDle py nne cr rmarrsonmani under 12 J.� Code, Se�on�pp�,
::cR?IFiE��S NAME GEORGc A.S-IAyP II
UCc3�l�MJM6Er^t 2i2
• �� f'RE��DENT
C�MPANI'NAME ��RGe�Shltv}P II�ASSOC.,fNC
AQdF�3S
:s�'I DE�?�� 90Jl.�.�ARD ��'T( , STA i c Z��.,CA:E
SIGPiA '4!.lvS i-�ARBOR R 340&'.'.
�r T�=�-';CNE
.1C$NC�.05�242-� ;�i}y��
��'-'84y'..c"o
. F��E-cAl�Icr2Gc'�+1CY MANAGc.�rlr.ili A.vc�tCY
�h,f)�i�-�0����J��'Yp,NC�?RJC-RAl�S I �'-��-?. NC. .SO6%–OC�
ELEVATlfl�1 CcRTIFlCAT� � ;�✓�r=� ���m�r�,, ��`�1V '
� �mportarrt �ead the i�c�ons o� es 1 -7.
Sc�'i'}ON q•Pft�P��7`(OW►r�INF�Rh4,qT10N
BUILDlNG OWNC.�'S NAME ��'�'�mt�^arr�y!:�:
MENNA DEVELOPMENT �7icy N�„ber
BUIt,JING S?��'-A„�r DRE3,S(Induding�,,,�r,rt,S�i�,and/or 3kig.Nc.l OR P.O.�cOl,�i cANO jOX NO.
12C.:�3RIGi-fNJA��DR1V� C�t�anY NAIC Nur�t.�
Cx1'
GLAr�NA�cR S 'a-= Zl P w0E
'� :a76?
r'ftOPER7l'pc5CF2tP?lOrv(!.�tand 31c�k Number,,�az Far;r;�VUmber,L„�ca1 L�*io��, ,��
:OT 3,BE1��AQUA VILAS I!
�UILDING USc(e.g.,�esider�,Ncn-r�ide�al,Adaiocr:, •
RE51DEN1'iAL r'�Y•°ic. Use a;:cmmen6 ar�,if n�,�y,)
LAiI?UDE�LONGI7UDE(OP j�O�p,�) ;-IORIZpPn-qL t��UM: c.
� +^�-�'-�.,±,. or �.�».r""� ❑ NA�1527 ❑(V�1G 198' SOURC�. J GPS�Type;
❑USuS Quad ARap ❑Ofier
s�cnoN 3��t000 u�su�c��a,rE r�aF�fiw�uvFawwar�oN
81.NF1P COMMUt�t(n'NqME�COtitMUNI-fY NUMEE�i � 32 r,��,��
� CRY C�CI�ARWATE�1�� PNE�1,� �i.�,AT'c
F"��2�4
I 64.MAP AntO FPt� �
. 6�.FiRM?,ANE. EG.B45E rL00L'=�!�/ATiON(Sj
NUMBF" �.�.lFFIX , 86.FIRM INDEX DFIi c r_'F�r�_JTIVE�E'V1S�OATE I I
12.��07 D 3'?8� d!'15�91 68.F�OCG 2CNE(S) (Z�e R�.usa fdegfi of�ing)
�10.indica�the scur,�d tlte Pa�Floai Eievaeon(BF�dara a'bESe;'�«,+ en R , I
❑FiS Prome �'j FiRM � ��`�'
❑C�r`,tnuni'ry L�mand j; ,,
B11.i��te the aieva6o�davm uszd f��e 5FE in 89:�rFGVD 1� ���'�--
6121s�he hutlain lo�ted in a Coa�-d Bam�R�ourtrs ' L1 NAYG 1985 ❑�er�oei.`
C3RS)area or C.�pro}�d Ar2s OFA)? �1 Yes �No Desianr�n�aie
S'cCT)ON C�BUiLDW��yATiON WF�RM,qTI(}N(SiJf�Y Ft�,�iR�D�
C1,&�il�ng elev�4iora�e�ed on:Cl Consutc�irn Drawincs` ❑3u�" Ur�der r
"A.new�ev�on CerSfic�wi4 be � '"0�°� �F���on
�equuad tivt�en�ns�vrn o;'se 5ufiduiq Q�.
C2 Build�na�iagrdm Number 1(Sdedthe budding dtaatan rt�est sirriiiar to�a bwl�ir�g f�rwi�ictt his�����d-s�pages n'�d 7. If no cfia�-a�n
�rePr�ents 9�e b�lciing,prnvide a siceic*i cr pfmi�-aph,) -
Gi Jevations—Z�s A1-A30,,�,AH�A jwt�h 8��VE,V1'J30,V(wilh 6Fc;,a1R,qr�JA ARIPE,AW��1-A3D,ARIAr,AR/AQ
C�npleie Items�,�,,-�below a�ng a�Ifie bu�c5ng c5a��m speGi�ec in ltem CZ�fhe c�m used lf the�ahan�df�;�ryt from the�m usad fa ths 8�"in
�6on B,c�nvert the dah�m�th.�t used ior 6�e 9FE.�rnv fieid rr��u2m�Ls and +w�an crrve�;on ra�iaoon. i,�se tl�e s^race Provided or the Cemmenfs ar�.s of
5�5on D or Seaion G,as�oriaie,m dccum�t�e daa,m ca,ve�sion.
Oaa�m NGVC 29 C�rrveSioNC�rnr�
�evatinn re�,�ce maric use:f LP 10 BA�'•1 Coas the�levaac�rPreren,,;,meric�i�an�e FIRlv1? ❑Yes �Ne
o �)ToP of�tbm flcor(ndudmG 6asPlnertt or endcstue!
7, 1d�,(ml �
o b)?cp�nsxt high�fiaar 11.�.�E Riml y
o c)Eo�om ai'owest i�oriz�nrai � r
sbu-xaral memtx.r(V�r��'tY) NA._t�(mj y?� - �
o �Atta�i qara�a(h�o oP sJao) 7. 14 fr.lm) F a
o e)!.�elEVa6cn of mac�inery and�or�,ip�,t w w`
servidng the bu�c5ng(Des�be a�a Ccnvnents araaj �Va.._R{m) a �
° ���+�acp�ni(fmished)gtade(LAG °W
� �.w ft.IRt� '
�
� 9 ^ItaflBS�c 2��&1t�IfttSi'l�i 9f'c3C1°�,(�y� z—
o h No.of �� -'r ��(m; °y #ZG 12 12/�4/Q5
� � °P�''�^�(e��)wi�in 1 tt aDove�a�r,t graie J � �
o �)�of�area of�1 permaieni ooc�ings(flwd�nts)in C3.h 12,�9,_29 —'
s4 in•(sG.�)
SEi.?lON D-SiJRYEYOR�E3YGIN�}Z,OF'c AR�N(i�'CF�T1FiCAT10N
Th�s certification s;�be signed and sealed by a land surveyor,e�oinee�,or�rc��i�;z��orit�by Iaw te�.^fiiy�!evanon inTC^na6on.
l:�rii"ry�rai the iniamatlon in Secvons A,E, and C on fhu ce.�ncaie r�presanfs my bPS 9rlolis[Q h��{�e��g�ilable.
I undsrsand th,a[anv;Qlss si�tement ma be auni�ha6ie oy iu�e�r,mpr�nmerrf unde�13 G'.S, Code_s�on T pp�.
���F�'S NAME GcORG�A SN(MP il
L'Ca"VSc Mut�E� ?S12
. ��'
• � r�Dc�iAi.�+1�Gc"?JCY M;NAut�i qE�'AC-c�C7
' NA7lCt�EAL�D�D fNSiJrZANC�Ff�OGRAM � O.M.�. No. 306�-OQ77 �
ELEVATfON CERTl�1GATE j �x�i2s De;,amoe�31: �OOS �
� �mPor,ant i�ad the instrucfions on es 1•7.
SEC C 1QN k-RROP� i Y OWNE�INF�I�q;lON
BUI�INu rJWNE�'S NP�1E �or in�,�ran��y��
MENNA DEVE!pPMENT �i;c�Ntn-,oe;
BUILDING S�'R�_:.qpp��(1��,�ng,,��,UnPti 5urte;an:rcr 5�;g,Nc,)OP.'r.0.ROI,�?rtD 3QX Np.
�2J-2 3R1G�1!�NAT?pRl�/E C.:nCarn NAIC Nirmoer
CI'Y
C�,r2�nlA;�� �T"^ ZIP C.�OE
�ROPEri1'DESCRIF'IpN(f.nt and c�icck N�vn�rs,?a:r ar�l Numcer.L �� ^ .33787
L'�� 2,BE�!=AQIJA ViL�',S Il �.�_-�ic6on,�,)
5UtLDINC USc(e.g.,Residert�l,Non.r�.siaencal,Addmon,Ac�s
RESIDEN?lA� �y,=tc. Use a Ccrs�ments ar�,���y.) -
LATI i UDEILONGITUO�(OP�O�j G�y�pO��TAL DATJM: �
( ik�'°-#�-�#.� or „�.�j ❑NAD 19E„ SOUP.CE ❑G?S(TYPe)�
❑USG5 Quad Map ❑Omet
S�CT10N B•FL000 MSURAIVCE RQ7t MqP(F�Rh��NFaRMATidN
B1.NFIP COMMIJNrv��lAME 3 C.."MtvtUNf("NUMBFi2 �2�MY NAME
CtIY CF�.;GRWATF�125096 PI�Ifl1AS 63.�A,i C
F�CFIDA.
3�-MaF AND PANE �
i �N� �.SUF�'IX I H�.F�M PANE - �.3aSc RCCD=�VATICN(5) i
C'6.FR�M(ND�DA!� I E�ECT(1��REV�''DAlE �.F�000�lE'S'
� 8�1�9'1 �� i I (Zone AO,t�se deoQ�af n000ir�g)
61 G.inaicate tlie scur�cf fhe B�a�ood Eevanon(BF�ra�or bass ttoc��h en�in B9. � ?1
� �FiRJN
� riS P�'pE „
311.IncG�te the aevancxi da�um � ❑�rmnuruty Defermined ❑O�her(besaroel:
�.sed(orihe 5F�in B.. �'j NGVD 1� ❑NAVD 15B$
312 l�ihe bwlai laatied in a C�stal 5artier Res�ur�s�n!G2?Sl arsy�q��p�� �O�er(Descioe}:`
�ea(OPAj? ❑Yes �No �;ion�n Da�
SECTiQN C.HU1L�(NG�NAT�ON 1NFDR1�lq710N(St1RVEY REQUIF�) —
Ci.Buud�ng el�vaoons are b�}on:�Constrtx�on Drawir�gs" ❑W�'�ing Under Cor�s�•
'A new�ieva6m�Cerliflcaie witl be i I�Fin�ed Cansfruc�on
�equ red wr�sn c�r+sQtx�at cF f�e 6uik5ng's cc�.
CL Bui�n9�f�rarn Numb�1(Sale�the hudding�i�rarn,mst sim�,r to�e bu�laing�r whic�this�rtin�aie�beinr,wmcleted-sse pac,es&and?, IF no daxarn
�raielY+��s the buiiang,provide 3 ske¢si orpnotograph.} _
C3.Elevations-Z�nes A?-A,30,AE-A}�A(wrih 5Ft?�y�'d1-V?0,V(wifh 6F�]�p,R Ar�!/L AR/AE,AR/Ai-A3D,AR/AN,AF2/AO
CampieU�items i.3.-a-i���[o ihe�t,ik�mg cfr�ram s�-�„-ireC in I1�m C2 Sfa�the ci�-t�m us2d.If tl�e dalUm is
Section E,nnvertthe datum to fi�set used for ihe 9�E.Show neJd mee�r�nen��d d�m csive5ion calCuiaoon. �arent�m the d�tum used ior+he 3F�in
�5cn D or�caon G,���x��,�d�meni�e dah,m ca�version. Uss me��e providNJ or tl�e Camments are�cf
Oaa.tm NGVD 2° Canvers,'oNCommer�ts
E3evao�rzfer��;ar1c us�i�1Q�i Do�the eiev-.ocn�m�ic�
.isad aoCSaf at�e r 1R1vi? ❑Yes �No (�'�-- �
o a)Top of tnt�m flar(n�ng b�e�tt or enc�ur�) , ,
o b)Top or next highe,��locr �. �4��ml � I
o c)5ottom or Iow�t i,crrz�nti s�u�ura�mem��V:�es cniy) 11.00 R(m) m � I
�IA.._t(mj �ro �
o �Atl�ned garage(�a(�a°) o. Z9;t(m) . �°
o e)Lawesz elevanon�ma�.-vnery and�or equipment E D � I
servic5ng fhe ba7cf�g(D�uib�in a Cammer�acaa) kA, fl.m ��
� O��lj�,cent(finisne�orade(�q,G F — � j � m �
� .,.��t,ml =.� (
o 4)���st aaacen�(fir,isnd)grace(FiAG) 5 08 t(m) „�'
o n)Ne,�i���,(flcr�d ve�LS)wiihin 1 it�ac3a�wt�raie' � i #2512 i�l141Q5 �
o i)To�area ofa6 oertn�ent ooen'rn�(flood vens)in�.�.h 1�C3.29 sq,in. J �
�sc'i•cn)
SE�T10N D•SURVEYOR,�VGiNE�,OR AfZCH(rL�C�1FiCAT10tY
T'iis��5ncauon(s�c 6e signe;f and szaled by a iand surveyor,engirt�r,or araiii�f auihorizsd by law te cerbfy eievaaon inf�nnanon,
!r°�Y��t�e iniormaHon rn Saciinns a, R enc C on fhis carirficat��ep�sertts m bes;stfcrts:o ir�te ret%
1�nde�anC fhaf any False sar8manl ma be punisnable by frne or rmpr.',�nme,ri under;g!/,�.��re,��on d��3�7a61e.
Cc"r�'i tFiE'�'S NAME G�ORG�A:t�iIMF II
JC�?V�NUMBEr�. Z�i2
+�'= �E51DE�
COMP.ANY NAME C-E�JRGcA,Si-:IMP II&���,C..UJC
ADCREaS
�Qi�E�?0 30ULVARD �'.M i�AnBQF ��A�` ?�P CApE
.,i�tA ' ��
�' ��?NCNE
� J�NG.Q�7242-� ; ��
� � � 2'� .7-?�#54Sc
_�.., �__o, .,. ,__..--- �..,.
ryc'�!a .7 c.-n?--.� - nnn ' . . . . �
_ _. __ _ :�.:.�: <�Y.,,,�.�- _ _
IMPORTANT: In these s aces,co the corres ndln Informatlon from Sectfon A. '!For�ns�u�nceCanpanyUse `
' BUILDWG STREET ADDRESS(IndudhA Mt,UruT,Suib�andlor Bklg.No.)OR P.O.RWTE AND BOX N0. PoGcy Nwiber �
�120-1 BRIGHTWATER DRIVE er
� STATE ZIP CODE � h � �i�
� CIFARWATER FL 3463p ,�Y�.������h����.,,,�F. .' ...,".:R
__ _
SECTION D•8URVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUEO)
�PY bdh si�s of thls Elevafbn Ce�tiflcate for(1)carunuNty oi�l�(2)insurance agenUoompanY�and(3)lw8ding owner. �
COMMENTS
❑Chedc here if eqa�m�ts
SECTION E•BUILDING ELEVATION INFORMATION(8URVEY NOT RE4UIRED)FOR ZONE AO AND ZONE A(WITHOUT 6F�
ForZone AO and Zone A(without BFE),car�plete Iterris E1 Uuough E4. If the Elevatlon Ce�ticate is intended for use as suppaiing infortnation for a LOMA a LON�-F,
Sedion C must be com�eted.
E1.B�didi�Diagram Number_(Selectthe buU�diaaram most similarto the bu�ding forwhich this certliicate is being compieted—see papes 6 and 7. If no c9a�ram axuratelY
tepreeeMs the building,provfde a sketch a photo8raph.)
E2.me top�u�e bouom noa(induduig be�nc or er►dow�e)of the bui�ng is _ft(m)_In.(«n)O above or ❑below(chedc one}the highest ac�aoent�de.(Use
natural gra�,if av�lable).
q.For BuGdinng DiaBrams 6�8 with opeNn9s(see Page 71�the next higher fba a elevated floor(�eva�on b)of the buil�ng is _(t.(m)_in.(cm)above the h�t�eat adjaoent
9�ade.Co�lele items C3.h and C31 on iront of fam.
E4.The top�the plaffam of mad�inery andla equipment servkang the tw�din9 is _ft(m)_indcm)0 above or ❑below(chedc one)ihe highest a�acent�le. (Usa
nat�ual grade,if available�.
E5.Fa Z:one AO only: If no flood depth number is av�lat�e,is fha top d ihe bo�om flaor elevated fn aocordance with ihe cammuNty's�oodplain manage�nt o�dfn�ce?
❑Yes ❑No ❑Unknown. The local o�fld�must c�tify lhis iMortr�aUon in SecUon G
SECTION F•PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner a o�m�'s autl�orized reExesentatNe who c�rr�letes S�ons A,B,C(Items C3.h and C3.f oNY),and E for Zone A(without a FEMA�asued a oormwNty-
issued BFk�or Zone AO must sign hera ihe st�eme�nts 1n Secdians q,8,G anal E ara carect to the best ol my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZEp REpRESENTATIVE'S NAME
ADORESS CITY STATE ZIP COpE •
SIGNATURE pATE TELEPHONE
COMMENTS
❑Chedc here if a�achments
8ECTION G-COMMUNtTY INFORMATION(OPTIONAL)
Thelopl offldal who is aufhor(zed by law aadnanoe to admin�sterthe oanmurnty's 800dplain mar�agement ordfnance can wmplete Sections A,B,C(a E)�and G of iMs Elevatlon
Certlflate. Corr��lete fhe app�cable iten�s)and sign below.
G1.�The Inf�maUon 1n SecUon C was iaken from otl�er documentatlon ihat has bean signed and embossed by a Uoensed surveYor�en9ineer�or architect who is auUwdzed by afate
a local law io oe�fy elev�iai ir�forrnatbn. (Ir�c�te the souroe and date of the devaUon data in ihe Corrvrients area bebw.)
�O A cortuiwNry o�dai�I�ed��fa a lwq�ng b�ted in Z�e q(��t a FENIA-issued a corrurwNry�issued BFE)or Zone A0.
G3.L�Tt�foUowing informatbn(Items G4�G9)is provkled fa oonurux�ity floodplain managerr�nt P�rposes•
G4.PERANT NUMBER G5. DATE PERANT ISSUED G6.OATE CERTIFICATE OF COMPIJANCElOCCUPANCY ISSUED
G7.rhis,�rmc nas be�►�sued r«:�rlew const�(a,� a sut�tan�al M�rn,�r�enc
G8.�evatlon of as-buUt buuest flaa(induding basement)of the building is: _,._ft,(m) Datum:
G9.BFE or(in Zone AO)dapth of�oo�nng at the bu�ing sUe is: __fi.(m) DaUun.
LOCAI.OFFICIAL'S NAME TITLE
� a e�
�
COMMUNITY NAME TEIEPHONE
E
SIGNATURE � '� DATE �
COMMENTS
���J�I t���o��°i`��`�" �;t�t` '
�i`d�Y '�F ��..��,�tVV�4TE�
FFMA Fnrm A4_z1 Ie..��e..,enn� Ch6�h�9�8�1i118�t6
� FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
� NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005 .
ELEVATION CERTIFICATE
c�0�� — �c�� � Im ortant: Read the instructions on a es 1-T.
SECTION A-PROPERTY OWNER INFORMATION Fa�nsuranoe Canpany use:
BUILDING OWNER'S NAME Policy Number
MENNA DEVELOPMENT
BUILDING STREEf ADDRESS QnGuding Ap�,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
120-1 BRIGHTWATER DRIVE
CITY STATE ZIP CODE
CLFARWATER FL 34630
PROPERTY DESCRIPTION(Lot and Biodc Numbers,Tax Parcel Number,Legai Description,etc.)
LOT 1,BELLEAQUAVILLAS II
BUILDING USE(e.g.,Residential,Non-residendal,Addition,Acoessory,etc. Use a Comments area,if necessary.)
RESIDENTIAL
LATITUDElLONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS(Type):
(##°-##'-##.##" or ##.�� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME&CONMUNITY NUNBER 82.COUNTY NAME 63.STATE
CITY OF CLEARWATER 125096 PINELLAS FLORIDA
B4.MP�P AND PANEL B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER 65.SUFFIX B6.FIRM IND DATE EFFECTIVFJREVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depth of flooding)
125096�0007 D '�� 8119191 G�2` 8119191 AE 11
B10.Indicate the souroe of the Base Flood Elevation(BFE) e flood depth entered in 69.
❑FIS Profile ❑FIRM ❑Community Determined ❑Other(Describe):
B11.Indicate the elevation datum used for the BFE in 69:�NGVD 1929 ❑NAVD 1988 ❑Other(Describe):
812.Is the building located in a Coastal Barrier Resources System(CBRS)area or Othervvise Protected Area(OPA)? ❑Yes �No Designation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevafions are based on:�Construction Drawings' �Buii�ng Under Construction' ❑Finished Construction
*A new Elevation Certificate will be�equired when consUuction of the building is complete.
•C2.Building Diagram Number 8(Select the building diagram most similar to the building for which this cer6ficate is being completed-see pages 6 and 7. If no diagram
accurately represents the building,provide a sketch or photograph.)
C3.Elevations—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AWA,AR/AE,ARIA1-A30,ARIAH,ARIAO
Complete Items C3,-a-i below acco�ding to the building diagram specfied in Item C2.State the datum used.If the datum is different fran the datum used for the BFE in
Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion calculation. Use the space provided a the Comments area of
Section D or SecGon G,as appropriate,to document the datum conversbn.
Datum ConversioNComments
Eleva6on reference mark used LP 10 BM#1 Does the eleva6on reference mark used appear on the FIRM? ❑Yes �No
o a)Top of boUan floor(induding basement or endosure) 7. 15 ft.(m) �
o b)Top of next higher floor 11.01 ft.(m) �
o c)Bottom of lowest horizontal sVuctural member(V zones only) NA,_ft.(m) o 0
o d)Attached garage(top of slab) 7. 15 ft.(m) E� /
o e)Lowest elevation of machinery andlor equipment W v
seroiang the building(Describe in a Comments area) NA._ft.(m) ��
o fl Lowest adjacent(finished)grade(LAG) 5.05 ft.(m) z'N
o g)Highest adjacent(finished)grade(HAG) 5. 08 ft.(m) � #2512 5/02/05
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 7 �
o i)Total area of all permanent openings(flood vents)in C3.h 120329 sq.in.(sq,cm)
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 in Sections A,B,and C on this cerfi�cate represents my besf efforfs fo interpret the data available.
1 understand that any false sfatemenf may be punishable by�ne or imp�sonment under 18 U.S,Code,Section 1001.
CERTIFIER'S NAME GEORGE A.SHIMP II LICENSE NUMBER 2512
TITLE PRESIDENT COMPANY NAME GEORGE A.SHIMP II&ASSOC.,INC
� ADDRESS CITY STATE ZIP CODE
3301 DESOTO BOULEVARD PALM HARBOR FL 34683
SIG DATE TELEPHONE
r.. JOB N0. 050242-A 5l02/05 727-784,5496
FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces all previous editions
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
� � NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
���.- �a,���( ELEVATION CERTIFICATE
Important: Read the instructions on pa es 1-7.
SECTION A-PROPERTY OWNER INFORMATION For Insurance Canpany Use:
BUILDING OWNER'S NAME Policy Number
MENNA DEVELOPMENT
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,andlor Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
120-1 BRIGHTWATER DRIVE
CITY STATE ZIP CODE
CLEARWATER BEACH FL 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Paroei Number,l.egal Description,etc.)
LOT 1,BELLEAQUAVILLAS 11
BUI�DING USE(e.g.,Residen6al,Non-residential,Addition,Accessory,etc. Use a Comments area,if necessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):
( ##°-##'-##.##" or ##.#�##� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME 8 COMMUNITY NUMBER B2.COUNTY NAME 83.STATE
CLEARWATER 125096 PINELLAS FLORIDA
84.MAP AND PANEL B7.FIRM PANEL B9.B,4SE FL000 ELEVATION(S)
NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVEIftEVISED DATE 88.FLOOD ZONE(S) (Zone A0,use deplh of flooding)
1250960102 G 9103I03 9ro3r03 AE 11
B10.Indicate the souroe of ihe Base Flood Eleva6on(BFE)data or base flood depth entered in B9.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Desaibe):
B11.Indicate the elevation datum used for the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Other(Desaibe):_
612.Is the building located in a Coastai Bartier Resources System(CBRS)area or Othervvise ProtecUed Area(OPA)? ❑Yes �No Desi nation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:�Conshuction Drawings* ❑Building Under Construction` �Finished Construction
. *A new Elevation Cer�ficate will be required when constniction of the building is complete.
Building Diagram Number 8(Seiect the building diagram most similar to the building for which this certificate is being completed-see pages 6 and 7. If no diagram
accurately represents the building,provide a sketch or photograph.)
C3.Eleva6ons—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AWA,AR/AE,AR/A1-A30,AWAH,AR/AO
Complete Items C3.-a-i below accorciing to ihe building diagram specified in Item C2.State the datum used.If the datum is different irom the datum used for the BFE in
Section B,convert the datum to that used for the BFE.Show field measuremenfs and datum conversion calculation. Use the space provided or the Comments area of
Section D or Sec6on G,as appropriate,to document the datum conversion.
Datum NGVD ConversionlComments
Elevation reference maric used LP 10 BNF�1 Does the elevation reference mark used appear on the FIRM? ❑Yes �No
o a)Top of bottom floor(induding basement or endosure) 7. 12 ft(m) �
o b)Top of next higher floor 11.02 ft.(m) `�
�
o c)Boltom of lowest horizontal struclural member(V zones only) WA._ft.(m) °' �'
o d)Attached garage(top of slab) 7. 15 R(m) E�
o e)Lowest eleva6on of machinery andlor equipment w 1O
serviang the buiiding(Describe in a Comments area) WA._ft.(m) E�
o �Lowest adjacent(finished)grade(lAG) 5.05 ft.(m) z'.m
��
o g)Highest adjacent(finished)grade(HAG) 5. 08 R(m) �
o h)No.of permanent openings(Hood vents)within 1 ft.above adjacent grade 7 � ,tS ii 1 a����t
o i)Total area of all pertnanent openings(flood vents)in C3.h 1203.29 sq.in.(sq.cm)
SECTION D•SURVEYOR,ENGINEER,OR ARCHfTECT 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 in Sections A,8,and C on this certificate represents my 6est efforts to interpret the data available.
1 understand that any false statement may be punishable by fine or imprisonmenf under 18 U S.Code Section 1001.
CERTIFIER'S NAME GEORGE A.SHIMP II LICENSE NUMBER 2512
.ITLE PRESIDENT COMPANY NAME GEORGE A.SHIMP II 8 ASSOC.,INC
ADDRESS CITY STATE ZIP CODE
3301 DESOT OULEVARD PALM HARBOR FL 34683
SI�NAT DATE TELEPHONE
JOB N0.050738 9/02105 727-784-5496
FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces all previous editions
IMPORTANT: In these spacas,copy the corrasponding information from Section A `For�nsi,r�nce c,anpany use: -:`
BUIIDING STREET ALDRESS(Irx:udir�g Apt,Unit Suite,andla Bidg.No.)OR P.C.ROUTE AND 90X N0. Po�Cy_Nwtber
124-1 BRIGHTWATER DRIVE �
�� STATE ZIP CODE
CLE�RWATER � � ��Y;�+IC�IWpbQ�
, .:.
SECTiON D•SURVEYOR,ENGINEER,OR ARCHITECT CERTIFiCATION(CONTINUEO) •
Copy both sides of this�evation Cerfificate for(1)canmunity offidal,(2)insurance agenUcompany,and(3}lwading owner.
CAMMENTS
❑Chedc here if attacttments
SECTION E•BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FflR ZONE AO AND ZONE A(WITHOUT BFE}
For Zone AO and Zone A(vnthout BF�,canpiete Items E1 fhrough E4. If the Eieva�on Certificate is intended for use as suppo�ing infoRnatlon for a LOMA or LOMR-F,
SecUai C mus#be competed.
E1.Building piagram Number_(Select the building diagram mast similar to the building for which fhis certificate is being completed—see pages 6 and 7, If no diagram accurately
represants ihe building,provide a sketch or photograph.) '
E2.The top of the bottom floor(induding basement or�dosure)of the buildin9 is _ft.(m1_in,(cm)�above or ❑be�ow(checic one}the highest adjacent grade. (Use
natural grade,if available).
E3•Fw B�ildin9�ia9rarns 6-8 with openings(see page 7),the next higherfloor or eievated floor(elevation b)of fhe building is _ft.(m)_in.(cm)above the highest adjacent
grade. Compiete items C3.h and C3.(on frait of form.
E4.The top of ihe pla�orm of machinery ancUor equipment senridng the buikiing is _ft{m)_in,(cm)�ahove or ❑below(checic one)lhe highesi adjacent grade. (Use
natural grade,'rf available).
E5.For Zone AO�ly: If no flood depth number is av�lable,is fhe top of the bo�om floor elevated in acco�dance wiih the commuNtys noodplain management ordinance?
❑Yes ❑No ❑Unknown. The local oifidai must certify this infortna6on in Section G
SECTION F•PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFiCATION
The property a�uner a�ownei's author¢ed representatnre who completes Sedions A,8,C(Items C3.h and C3.f only),and E for Zone A(wifhout a FEMA-lssued or cammuNtq-
issued BF�or Zone AO must sign here. The statements in Sections A,8,C,end E are correct to the besf of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESEMATIVE'S NAME •
ADORESS CITY STATE ZJP CODE
51GNATURE OATE TELEPHONE
COMMEMS
❑Chedc here if attachments
��:.
SECTION G•COMMUNITY INFORMATION(OPTIONAL)
The la�l cffi�ai who is aufhcrized by!aw or ondinance to administer the carmunii�s floodq�n management ordinance pn complete Sections A,B,C(or E),and G of ihis Deva�on
CerUficate. Com�;ete�,a�pptic��le it���(s)and sign below.
G1.�Tt',^infc.-�natic� u��ecfic;;C w�s taken ftom other da�mentation that has been signed and embossed by a Gcensed surveyor,engineer,or architect who is authorized by state
or local!�v 1c;��:iiy elev�io�?iniamaiion. (In�icate the source and date of the etevaGon data in the Comments area below.)
G2.�A cemmunity o�fidai�:�mpl�;4�1 Section E for a tw�ding la�ted fn Zone A(without a FEMA-issued or communityissued BFE�or Zone A0.
G3.�The foilowing information(Items G4-G9)is provided for community floodplain management purposes.
G4.PERMIT NUNr�ER G5. DqTE pERMIT ISSUED G6. DATE CERTIHCATE OF COMPWWCFJOCCUPANCY ISSUED
G7.This pem�it has been issued for.�New Construc�ion� ❑Substantlal Improvernent
G8.�evatio�of as-bu�t lowest floor(induding basement}of the building is: ._ft.(m) Datur�:
G9.BFE or(in Zone AO)depth of flooding at the building site is: _,_ft.(m) Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE �
COMMENTS
❑Chedc he�e if attachments
FEMA Form 81-31,January 2003 Raolacea ail orevious editinnsc
4s�B���r��°�
��' �°`" ���a C ITY OF C LEARWATER
,,� �a r�€ a
�d���v''� �e'!� �,
� ��� �!� �;���
@�m'�ti+��r ,!
�� �_ ��k DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
�
��� � �✓ +°+����+y� POST OFFICE BOX 474H� CLEARWATER� FLOa�DA 33758-4748
�� 'j y _«,� 'ar 4�
`�i�.�Q���� �� MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CI.F.ARWATER,FLO�unn 33756
���"�������� TELEPHONE�72� 562-4567 Fnx(72� 562-4576
MEMO OF REVIEW FOR CORRECTNESS 8� COMPLETION
In accordance with participation in the NFIP/CRS program,all elevation certificates are required to be reviewed for corrc_ �ompletion prior to
acceptance by the community. This complete form shall be attached to all elevation certificates maintained on file and proe �wit�. �uestea. �pies of
elevation certificates.
The attached elevation certificate requires corrections by the surveyor of section(s) prior to acceptance by the commu�,���r
The attached elevation certificate is complete and correct
X Minor corrections have been made in the below marked sections by Community Official
SECTION A-PROPERTY INFORMATION For Insurance Company Use:
A1. BUILDING OWNER'S NAME Policy Number
A2.BUILDING STREET ADDRESS(including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
120 BRIGHTWATER DRIVE-UNIT 1
CITY CLEARWATER STATE ZIP CODE
A3. PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
A4. BUILDING USE(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)
A5. LATITUDE/LONGITUDE(OPTIONAL): HORIZONTAL DATUM: SOURCE:�GPS(Type):
��°_��_�,��� or ##.#####°) ❑ NAD 1927 ❑ NAD 1983 ❑USGS Quad Map 0 Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME 63.STATE
64.MAP AND PANEL g5.SUFFIX B6.FIRM INDEX DATE B�•FIRM PANEL gg.FLOOD ZONE(S) B9•BASE FLOOD ELEVATION(S)
NUMBER 5/17/05 EFFECTIVE/REVISED DATE (Zone AO,use depth of flooding)
12103C0102
810. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69.
❑ FIS Profile ❑ FIRM ❑Community Determined ❑Other(Describe)
611. Indicate elevation datum used for BFE in 69:❑ NGVD 1929 ❑ NAVD 1988 ❑Other(Describe)
612. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes ❑No Designation Date
SECTION C -BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. 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. Building Diagram Number (Select the building diagram most similar to the building for which this ceRificate is being completed-see pages 6 and 7. If no
diagram accurately represents the building,provide a sketch or photograph.)
C3. 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/AO.
Complete Items C3.-a-i below according to the building diagram specified in Item C2.State the datum used.If the datum is different from the datum used for the
BFE in Section B,conveR the datum to that used for the BFE.Show field measurements and datum conversion calculation. Use the space provided or the Comments
area of Section D or Section G,as appropriate,to document the datum conversion.
Datum Conversion/Comments
Elevation reference mark used Does the elevation reference mark used appear on the FIRM? ❑Yes ❑No
e) Lowest elevation of machinery or equipment servicing the building(Describe in Comments area) ft.(m)
h) No.of permanent openings(flood vents)1ft.above adjencent grade
i) Total area of all permanent openings(flood vents)in C3.h sq.in.(sq.cm)
Comments: PLEASE SEE ATT HED DO MENT OM MDM MENNA DEVELOPMENT&MNGT .ADD ESSI VATION FOR THE PROJECT.
Date of Review: Community Official:
�ation certificates sha/l be maintained by th community and copies with the attached memo made availab/e by request
FRANK HIBBARD,MAYOR
GEORGE N.CRE7'EKOS,COUNCILMEMBGR JOIIN DORAN,COUNCILMEMBER
PAUL F.GIBSON,COUNC[LMEMRER � CARI.EN A.PE7'ERSEN,COUNC[LMBMBER
��EQUAL EMYLOYMENI'AND AFFIItMA1'IVE ACTION EMYLOYER��
' , FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
. ' NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
� ' � ELEVATION CERTIFICATE
� Im ortant: Read the instructions on a es 1•7.
SECTION A-PROPERTY OWNER INFORMATION Falnsu�anoeCanpanyUser
BUILDING OWNER'S NAME Policy Number'
MENNA DEVELOPMENT
BUILDING STREET ADDRESS(Including Apt.,Unit,SuRe,and/or Bldg.NoJ OR P.O.ROUTE AND BOX NO. Company NAIC Number
12a2 BRIGHTWATER DRIVE '
CITY STATE ZIP CODE
CLEARWATER FL 34630
PROPERTY DESCRIPTION(Lot and Blodc Numbers,Tax Paroel Number,Legal Description,etc.)
LOT 2,BELLE AQUA VILLAS II
BUILDING USE(e.g.,Residential,Non-residenGal,Addition,Accessory,etc. Use a Comments area,if necessary.)
RESIDENTIAL
LATITUDFJLONGITUDE(OPTIONAL) HORiZONTAL DATUM: SOURCE: GPS(Type):
( ##°-71#'-##.##" or ##.#f�##� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B•FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMNK1NfTY NAME&COMMUNITY NUW�ER 62.COUNTY NAME B3.STATE
CITY OF CLEARWATER 125096 PINELLAS FL�tIDA
B4.MAP AND PANEL 87.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX 86.FIRM INDEX DATE EFFECTIVEIREVISED DATE B8.FLOOD ZONE(S) (Za�e A0,use depth of flood�g)
12509G-0007 D 8�19/91 8119/91 AE 11
B10.Indicate the source of the Base Flood Elevation(BFE)data a base flood depth entered in 69.
❑FIS Profile ❑FIRM ❑Community Determined ❑Other(Describe);
B11.Indicate the elevabon datum used for the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Other(Desaibe):
B12.Is the building located in a Coastal Barrier Resources System(CBRS)area or Othervuise Protected Area(OPA)? ❑Yes �No Des' nation Date
SECTION C•BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:❑Construction Drawings* �Budding Under Construction* ❑Finished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
�2.Building Diagram Number 8(Select the building diagram most similar to the building for which this certificate is being completed-see pages 6 and 7. If no diagrarn
accurately represents the building,provide a sketch or photograph.)
C3.Elevations—Zones A1�30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AWA,ARIAE,AWA1-A30,ARIAH,AWAO
Complete Items C3:a-i below aocording to the building diagram specified in Item C2.State the datum used.If the datum is d'rfferent from the datum used for the BFE in
Section B,convert the datum to that used for the BFE.Show field measurements and datum conve�ion ca�ulation. Use the space provided a the Comments area of
Section D or Sedion G,as appropriate,to document the datum conve�ion.
Datum ConversionlCanments
Elevation reference mark used LP 10 BM#1 Does the elevation reference mark used appear on the FIRM? ❑Yes �No
o a)Top of bottom floor(induding basement or endosure) 7. 14 ft.(m) �
o b)Top of next higher floor 11,00 ft.(m) `� �
�
o c)Bottom of lowest haiwntal structural member(V zones only) NA._ft.(m) o 0
o d)Attached garage(top of slab) 7. 14 ft,(m) ��
o e)Lowest eleva6on of machinery andlor equipment W�
senriang the building(Desaibe in a Comrnents area) NA._ft.(m) �;
o fl Lowest adjaca�t(finished)grade(LAG) 5.05 ft.(m) z'm
o g)Highest adjacent(finished)grade(HAG) 5. 08 ft.(m) �N � #2512 5/02/05
o h)No.of permanent openings(flood vents)within 1 ft,above adjacent gratle 7 �
o i)Total area of all permanent openings(flood vents)in C3.h 1203.29 sq.in.(sq.cm)
SECTION D-SURVEYOR,ENGINEER,OR ARCHRECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to ceRify elevation information.
I certify that the information in Sections A,B,and C on this cerfificate represents my best e(forts to interpret the data available.
I understand thaf any false statemenf may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001 -
CERTIFIER'S NAME GEORGE A.SHIMP II LICENSE NUMBER 2512
TITLE PRESIDENT COMPANY NAME GEORGE A.SHIMP II&ASSOC.,INC
• ADDRESS CITY STATE 7JP CODE
3301 DE BOULEVARD PALM HARBOR FL 34683
SIG DATE TELEPHONE
JOB N0.050242-B 5102105 727-784,5496
FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces all previous editions
IMPORTANT: In these s aces,cop the corres ondin information from Section•A. 'For insu�anae'GoinPany us�: '
BUILDUVG STREETADDRESS(IndudinB Mt�U►�t Suib,andla Bldp.No.)OR P,O.ROUTE AND BOX N0, <p�r Nu�r ' .
120-2 BRIGHTWATER ORIVE � , ; , ,
CCLEARWATER �TAT� ZIP CODE r����AI�
``^'�'Y^"Il f* b i�.
FL 3rs�p i��,�� �..,5�
SECTION D-SURVEYOR,ENGINEER,OR ARCHRECT CERTIFICATION(CONTINUED)
', Copy both sides of this Elevation Certificate fa(1)oanmunity offidal,(2)insurance agenVoomPanY�and(3)buUding owner. .
COMMENTS
❑Chedc here if attachments
SECTION E•BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WRHOUT BFE)
FarZone AO and Zone A(without BFE�,oomplete Iterne E1 throuph E4. If the qev�lon Certl�pte is intended for use as suPpo�in9 intortnatbn tor a LOMA or LAMR-F,
SecUon C must be oompieted.
E1.Bu��ing Dia�ram Number_(Se�CtUie buil�np�a�am most sim�arto fhe lw�dir�g fawhich this ce�tificate is being cbmpleted—see pagea 6 and 7. If no�egram aocuratdy
represents the buil�ng�Provide a sketch a photograph.)
E2.The top�the bo�om floa(indudir�basement or endoeure)of the buU��9 is _ft,(m)_indcm)�above or ❑below(chack one)tha highest ac�acent grede. (Use
natural grade,�av�lable).
�.Fa�8�8���►opeNngs(see page�,the next higher ibor or elevated floor(eleva6on b)of the buiiding is _ft.(m)_in,(cm)�ove ihe highest a�aoent
9rade. Complete items C3.h and q�on front of form.
E4.The top of the pla�orm of mad�inery andlaequipmentservidng the building is _ft(m)_indcm)L7 above a ❑below(check one)the highest adjacentgrade. (Use
natural grade,if av�lable).
E5.Fa ZoneAO only: If noflood depth numberis available,is the top of the boUom Qoorelevated in aooadanoe wlfh 1he communitys�oodplain managementord(nanoe?
❑Yes ❑No ❑Unknawn. The local offidal mustoe�ti(y ttds infom�atlo�in Se�or��
SECTION F•PROPERTY OWNER(OR OWNER'S REPRESENTATNE)CERTIFICATION
�P�Pe�Y�'�°�ner's auf�►aized representath►e who oompletes SecUons A,6,C(Items C3.h and C3J oNy),and E for Zone A(without a FEMA-issued a car�muNly.
issued BFEj a Zone AO must sign here. The sfetemenls!n SecBons q,B,�anal E are carec�fo the best o(my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZEO REpRESENTATIVE'S NAME •
���� ��N STATE ZIP COpE
SIGNATURE DATE TELEPHONE
COMMENTS
❑Chedc here if attachmen�
_SECTION 6•COMMUNtTY INFORMATION(OPTIONAL)
The la�o�dal who is aulhonzed by law or or�nanoe io adrNnister tl�e oonurwrui�s floodpl�n management ordinance can com�ete SecQons A,B�C(or�j,and G of tl�s EJevatlon
Ce�tlflcate. Canplete ihe applk�ble 1k�ri(s)and sign below.
G1.Q The infamabon in Sedlon C was taksn from oiherdocumentatlon U�at has been signed and embossed by a uoensed surveyor,engineer,or architectwho ts auihaized by atate
or local law to ce�fy elevatla�►InforrriaUon. (In�Cate ther sou�e�d date of ihe elerratlon data in the Comments area below.)
�O A oorrunur�ry offid�oanpleted Saq(on Efor a bu�g br�ted in�eA(wilhout a FEMA-issued acommuNtyassued BFE)or Zone A0,
G3.[J Thefouow(ng�fortnation(Items G4�G8)is provkied facorrurnu�ity floodpl�n mana�ement purposes.
�.P��� G5. DATE PEWNIT ISSUED G6.pATE CERTIFICATE OF COMPLUVJCEIOCCUPANCY ISSUFA
G7.Tt�s perrNt has been issued tor:p New co�stnx�lon p sut�tar,�al Improverr,et,t
G8.Elev�ia�of as-built lowest floor pnduding basement)�the building is: __ft.lm) DaGim:
G9.BFE or(�Zone AO)depth�floodir�g at ihe b�dl�in s�e is: � _,_it,(m) D�um
..�
LOCAL OFFICIAL'S NAME �� ° ' TITLE
COMMUNITY NAME '"-`� � TELEPHONE
�;;�� r� �; � � ��4�� ��� �
SIGNATURE DATE
COMMEWTS [��? ,; � � —
�
FEMA Form 81-31..laniiarv 9f1f1z ❑Chedc here ifatt�hments
. FEDERAL EMERGENCY MANAGEMENTAGENCY O.M.B. No. 3067-0077
' NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
�a���- ��2��'"' ELEVATION CERTIFICATE
important: Read the instructions on pa es 1-7.
SECTION A•PROPERTY OWNER INFORMATION F«Insuranoe car�anyuse:
•BUILDING OWNER'S NAME Policy Number
MENNA DEVELOPMENT
BUIL ING STREET ADDRESS(Including Apt.,U t,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
120- BRIGHTWATER DRIVE
CIN STATE ZIP CODE
CLEARWATER 8546H�- FL 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Paroel Number,Legal Description,etc.)
LOT 2,BELLE AQUA VILLAS il
BUILDING USE(e.g.,Residen6al,Non-residential,Addition,Accessory,etc. Use a Comments area,if necessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):
( ##°-##'-##.�!#" or ##.##�#°) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61.NFIP COMMUNITY NAME&COMMUNITY NUMBER 82 COUNTY NAME B3.STATE
CLFARWATER 125096 PINELLAS FLORIDA
B4.MAP AND PANEL 67.FIRM PANEL B9.BASE ROOD ELEVATION(S)
NUMBER 85_SUFFIX B6.FIRM INDEX DATE EFFECTIVEIREVISED DATE 88.FLOOD ZONE(S) (Zone A0,use deplh of flooding)
d26659�0102 G �93-�-J I I 9N3�03 AE 11
B10. n i rce of ihe Base Flood Eleva6on(BFE)data or base flood depth enGered in B9.
❑FIS Profile �FIRM ❑Community Detertnined ❑Other(Desaibe):_
611.Indicate the elevation datum used for the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Olher(Desaibe):_
B12.Is the building located in a Coastai Bamer Resourc;es System(CBRS)area or Olherwise Protected Area(OPA)? ❑Yes �No Designa6on Date_
SCI.TIUIV l:-tiVILUI1VCi tLtVAI IUIV INF�KMA1 I(�N(SURV�Y�EQUI�E��
C1.Building elevations are based on:❑Construc6on Drawings* ❑Building Under Construction' �Finished Construction
`! *A new Elevation Certificate will be required when conshucbon of the building is complete.
2.Buiiding Diagram Number 8(Select the building diagrarn most similar to the building for which this oer6ficate is being completed-see pages 6 and 7. If no diagram
aocurately represents the building,provide a sketch or photograph.)
C3.ElevaUons—Zones A1 A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,ARIA,AR/AE,ARIA1-A30,ARIAH,ARIAO
CompfeUe Items C3.-a-i below aocording D�ihe building diagram speafied in Item C2.State the datum used.if the datum is different from the datum used for the BFE in
Section B,convert the datum to that used for fhe BFE.Show field measuremenis and datum oonversion calculation. Use the space provided or the Comments area of
Section D or Section G,as appropriate,to doaument the da6�m conversion _._ ___ _ _ .�_, 4 '.
_ . , :
Datum NGVD Conversion/Comments ' �'� -
;t�:.�r t � -, } ,
Elevation reference m�ic used LP 10 BNt�1 Does the elevation reference mark used appear on the FIRM? ❑Yes �No K� � -
o a)Top of bolt�m floor(induding basement or endosure) 7. 14 ft.(m) � � x��a,� �, ���� ; `��
o b)Top of next higher floor 11.00 ft.(m) a k �'�; ��;���'� �° _
� �
� =�l, � � ��;.
o c)Bo�om of lowest horizontal structural member(V zones only) tJIA._ft.(m) o o ° * '.``�: '�' �,,�`
o d)Attached garage(top of slab) 6. 29 ft(m) E� ��' � ��' ;`':
o e)Lowest elevation of machinery ancUor equipment W � f '�'��a ° ,� ""
serviang the building(Describe in a Comments area) WA._ft.(m) E ; ��r�� �' �y�
o f}Lowest adjacent(finished)grade(LAG) 5.05 ft(m) z� ti �. ` ,� �k� � ���
o g)Highest adjacent(finished)grade(HAG) 5. 08 ft(m) � t �"�r � 5�����
o h)No.of pertnanent openings(flood vents)within 1 ft above adjacent grade 7 � � '`�312 ,�,�f► '`,',���
o i)Total area of all permanent openings(flood vents)in C3.h 1203.29 sq.in.(sq.cm) ; '^�� ' �'""
SECTION D•SURVEYOR,ENGINEER,OR ARCHtTECT CERTIFICATION
This certification is to be signed and sealed by a land suNeyor,engineer,or architect authorized by law to certify eleva6on information.
1 certify that the informafion in Sections A,B,and C on this certificate r�presenfs my 6est efforts to inte�pret the data available.
1 undersfand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001.
CERTIFIER'S NAME GEORGE A.SHIMP II LICENSE NUMBER 2512
�ITLE PRESIDENT COMPANY NAME GEORGE A.SHIMP II&ASSOC.,INC
/
ADDRESS CI1Y STATE ZIP CODE
3301 DESOTO BOULEVARD HARBOR FL 34683
SIGNA TELEPHONE ,
JOB N0.050738 9/02/05 727-784-5496
FEMA Form 81-31,January 2003 See reverse side for continuation. Reolaces all orevious editions
IMPORTANT: In fhese spaces,capy the corresponding information from Sectlon-A. Forj,ui„a,�a °
eui�wcsr��rr�ss �'� ` .
(�nduda�g APt,U►ut Sui�,andla Bkig.No.)OR P.O.ROUTE AND BOX N0. Poficy;IJumher `-
120-2 BRIGHTWATER DRIVE _. � ,: ,;_ ; � •
crrr _ -:
CIPARWATER �ATE Zl�E ComPan}�NlU�N[uph6F-
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTiNUED) �
�PY bofh sides ofthis Devation Certificate for(1)canmunity afl'iaal,(2)insuranca agent/comPanY�and(3)bu��ing owner. •
CAMMENTS
❑Chedc here if attachments
SEC710N E-6UIlDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE�
For Zone AO and Zone A(without BFE),complete It�ns E1 through E4. If the Eiev�lon Certificate�s intendecl fw use as support(ng Informatlon for a LOMA or LDMR-F,
Sec�C must be campleted.
El.Bu��ng Di�gr�n Numbe�_(Selec�the buii�ng�agram most similar to the bu�ding for which fhis ce�tifiqte is being canpleted—see pages 6 and 7. if no�iagram accurately
r�sents the bui�ng�P�ovide a slcetch or pltotograph,) '
E2.The top d ll�e bottom fbor(Induc9ng basement or enclosurej af the bui�ng is _ft.(m)_(n•�cm)0 above w ❑belcn�v(chedc one)ihe highest a�acent grade. (Usre
natural grade,�availabtej.
E3.For Buildu�g Diagrarns fi-8 with openings(see Page���ie next higher floa or elevaled floor(elevation b)of the building is _ft.(m}_in,(cm)above 1he high�st adjacent
grade. Complete items C3.h and C3a on front of form.
E4.The top�the pla�ortn of mactunery andlor equipment serviang the twilding is _it(m)_in•(cm)I]above a ❑below(chedc one)the highest a�jacent grade. (Use
natural grade,�availab�e).
Ea.F�Zone AO only: If no flood depth number is av�labfe,is the top of tha bottan floor elevated in a�ordance wiih the communitys floodplain m�apement or�inance?
C❑Yes ❑No ❑Unknown. The bca!offid�must ce�fy t�s i�amation in Sec6on G
SECTION F PROPERTY OWNER(OR OWNER'S REPRESEiV7ATIVE)CERTIFICATION
��y°N�'�°iN��s�r�r�taWe who carnP��es Sec�a�s A,B,C(Items C3.h and C3.1 c�Ny),and E for Zone A(wilhout a FEMA-issued or corrununily-
issued BFq or Zone AO nwst sign here. The sfeteme�ds in Sectia�s A,B,��d E me carsct fo the best of my knowledge.
PR�PERTY QWNER'S OR OWNER'S AUTHOR1ZEp REpREgENTATIVE'S NAME �
���� ��n STATE Z!P CODE
SiGNATURE pqTE TELEPHONE
C�MMENTS
❑Chedc here ff att�hments
` SECTlON G-COMMUNtTY INFORMATION OPTIONAL)
The loc�off�al.who is Qutl�,;��i'by law or on�nance to administer the communi s
Ce�ficate. � �' 1�dp�n managert�ent ordnance,can complete Sedions A,B,C(�E�,and G of ihis BevaBon
Com�e Iha�pik;at,�i�p(s�and�gr�b�r.
G1.[]The�nfonna+�on.�i Sei��,nras.��������h��signed and embossed by a Ga3nsed surveyor,engineer,or architectwho is aufhotized by state
or locai law to ec�Jry el���on jnformaflon. (In�icate th�source and date of 1he elevation data in fhe Comments area below.)
G2[]A canr^uru1Y o�id�ccxnp�eted-Section E for a bu�d'ing bcated in Zone A(witimut a FEMA-issued or community-issued BFE�or Zone A0,
G3.[]The foUowing:infi.orr;tafiat(items G4-G9)is p ro v ided for coRmuni ty fl o o d p l a i n m a n a gemen t purposes.
G4.PERflNT NUivIBER G5. DATE PERMIT ISSUED G6.DATE CERTIFICATE OF COMPWWCElOCCUPANCY ISSUED
c7.T►,is peRnic has t�een iss�,ed for p nlew cons�ion p substantial Improvement
G8.Elev�ion of as-tnult lawest floa('indu�ng basemen�of the lwil�ing�: _._ft.(m) Datum:
G9.BFE a(in Zone AO)depth�flooding at the bu��ng site is: __ft.(m) Datum:
LOCAL OFF1ClAL'S NAME T1TLE
COMMUNIT`(iVAME TELEPHONE
SIGNATURE DATE .
COMMENTS
FEMA Form 81-39_Jan��ati�nn�
❑Chedc here ifi a�achments
Y' ' e' �f � � CITY OF CLEARWATER
���� �
• ���
�` " ��,`� A DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
hgr�`
"�'' • POST QFFICE BOX 4748� CLEARWATER� F�o�Dn 33758-4748
MUNICIPAL SERVICES BUILDING, lOO SOUTH MYRTLE AVENUE,CLEARWATER,FLOwDn 33756
TELEexoNE(72� 562-4567 Fnx(72� 562-4576
MEMO OF REVIEW FOR CORRECTNESS 8� COMPLETION
In accordance with participation in the NFIP/CRS program, all elevation certificates are required to be reviewed for correctness and completion prior to
acceptance by the community. This complete form shall be attached to all elevation certificates maintained on file and provide with requested copies of
elevation certificates.
The attached elevation certificate requires corrections by the surveyor of section(s) prior to acceptance by the community
The attached elevation certificate is complete and correct
X Minor corrections have been made in the below marked sections by Community O�cial
SECTION A-PROPERTY INFORMATION For Insurance Company Use:
A1. BUILDING OWNER'S NAME Policy Number
A2.BUILDING STREET ADDRESS(including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
120 BRIGHTWATER DRIVE-UNIT 2
CITY CLEARWATER STATE ZIP CODE
A3. PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
A4. BUILDING USE(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)
A5. LATITUDE/LONGITUDE(OPTIONAL): HORIZONTAL DATUM: SOURCE:❑GPS(Type):
(##°-##'-##.##" or ##.####It°) ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map❑Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME 63.STATE
B4.MAP AND PANEL 67.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER g5.SUFFIX B6.FIRM INDEX DATE EFFECTIVE/REVISED DATE B$•FLOOD ZONE(S) �Zone AO,use depth of flooding)
12103C0102 5/17/05
610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 69.
❑ FIS Profile ❑ FtRM ❑Community Determined ❑Other(Describe)
611. Indicate elevation datum used for BFE in 69:0 NGVD 1929 ❑ NAVD 1988 ❑Other(Describe)
612. Is the buiiding located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes ❑No Designation Date
SECTION C -BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. Building elevations are based on: ❑Construction Drawings' ❑Building Under Construction* ❑ Finished Construction
*A new Elevation CeRificate will be required when construction of the building is complete.
C2. Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed-see pages 6 and 7. If no
diagram accurately represents the building,provide a sketch or photograph.)
C3. 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/AO.
Complete Items C3.-a-i below according to the building diagram specified in Item C2.State the datum used.If the datum is different from the datum used for the
BFE in Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion calculation. Use the space provided or the Comments
area of Section D or Section G,as appropriate,to document the datum conversion.
Datum Conversion/Comments
Eievation reference mark used Does the elevation reference mark used appear on the FIRM? ❑Yes ❑No
e) Lowest elevation of machinery or equipment servicing the building(Describe in Comments area) ft.(m)
h) No.of permanent openings(flood vents)1ft.above adjencent grade
i) Total area of all permanent openings(flood vents)in C3.h sq.in.(sq.cm)
Comments: PLEASE SEE ATTACHED DOCUMENTS FROM MDM MENNA DEVELOPMENT&MNGT INC.ADDRESSING ELEVATION FOR THE PROJECT.
Date of Review: Community Official:
�evation cerfificates shall be maintained 6y the community and copies with the atfached memo made available by request
FRANK HIBAARD,MAYOR
GEORGE N.CRE'1'EKOS,COUNCILMEMAER JOIIN DORAN,COUNCILMEMBER
PAUL F.GIBSON,COUNCILMEMBER � CARI,EN A.PE"I'ERSEN,COUNCILMEMBGR
��EQUAL EMYLOYMENT AND AFFIRMA'I'IVE ACTION EMPLOYER��
, . FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
. • ' NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
�'��b��- �1Z��" ELEVATION CERTIFICATE
important: Read the instructions on pa es 1-7.
SECTION A-PROPERTY OWNER INFORMATION For Insurance car�any use�
BUILDING OWNER'S NAME Policy Number
MENNA DEVELOPMENT
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
120-2 BRIGHTWATER DRIVE
CITY STATE ZIP CODE
CLEARWATER BEACH FL 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
LOT 2,BELLE AQUA V�LLAS II
BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,if necessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS(Type):
( ##°-##'-##.##" or ##.�) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
81.NFIP COMMUNIiY NAME&COMMUNITY NUMBER B2.COUNTY NAME B3.STATE
CLEARWATER 125096 PINEUAS FLORIDA
B4.MAP AND PANEL B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER 85.SUFFIX B6.FIRM INDEX DATE EFFECTIVEIREVISED DATE BB.FLOOD ZONE(S) (Zone A0,use deplh of flooding)
12509G0102 G 9N3103 9ro3103 AE 11
B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depfh entered in B9.
❑FIS Profile �FIRM ❑Community Detertnined ❑Other(Desaibe):
611.Indicate the elevation datum used for lhe BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Other(Describe):_
B12.Is the building located in a Coastal Bamer Resources System(CBRS)area or Othen,vise Protected Area(OPA)? ❑Yes �No Designation Date_
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:❑Construction Drawings* ❑Building Under Conshuc6on* �Finished Construction
� 'A new ElevaUon Certibcate will be required when consUuction of the building is complete.
.Building Diagram Number 8(Select the building diagram most similar to the building for which this certificate is being completed-see pages 6 and 7. If no diagram
accurately represents the building,provide a sketch or photograph.)
C3.Eleva6ons—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,ARIA,AR/AE,ARIA1-A30,AR/AH,AR/AO
Comple�e Items C3:a-i below according to the building diagram specfied in Item C2.State the datum used.If the datum is different from the datum used for the BFE in
Sec6on B,convert the datum to that used for the BFE.Show field measuremenis and datum conversion calculation. Use the space provided or the Commen�area of
Section D or Section G,as appropnate,to document the datum conversion.
Datum NGVD ConversioNComments
Elevation reference mark used LP 10 BNf�1 Does the elevation reference mark used appear on the FIRM? ❑Yes �No
o a)Top of bottom floor(induding basement or endosure) 7. 14 ft(m) � ' i
o b)Top of next higher floor 11 .00 ft.(m) � �='�''
o c)Bottom of lowest horizonfal struclural member(V zones oniy) WA._ft.(m) o o � � ,
o d)Attached garage(top of siab) 6. 29 ft(m) E g -
w m �,
o e)Lowest elevation of machinery and�or equipment -„ - �;
sennang the building(Descnbe in a Comments area) WA._ft.(m) E; '�~ '
o �Lowest adjacent(finished)grade(LAG) 5.05 ft(m) z'� ��'
�
o g)Highest adjacent(finished)grade(HAG) 5. 08 ft(m) � ;�,��. �� A
o h)No.of permanent openings(800d vents)within 1 ft.above adjacent grade 7 � 231� h�l•�e�t
o i)Total area of all permanent openings(flood venLs)in C3.h 1203.29 sq.in.(sq.cm)
SECTION D•SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land suNeyor,engineer,or architect authorized by law to certify elevation information.
I certify that the information in Sections A,B,and C on this certificate r�presents my best efforts fo interpret the dafa available.
I understand fhat any false stafement may be punishable by fine orimprisonment under 18 U.S.Code,Section 1001.
CERTIFIER'S NAME GEORGE A.SHIMP II LICENSE NUMBER 2512
.ITLE PRESIDENT COMPANY NAME GEORGE A.SHIMP II&ASSOC.,INC
ADDRESS CITY STATE ZIP CODE
3301 DESOTO BOULEVARD PALM HARBOR FL 34683
SIGNAT DATE TELEPHONE
JOB N0.050738 9/02I05 727-784-5496
FEMA Form 8131,January 2003 See reverse side for continuation. Replaces all previous editions
IMPORTANT: In these spaces,copy the corresponding informatlon from Sectlon-A. F�'�;��,a„��,�,� : p
BUILDWG STREET ADDRESS(Ir�dir�g qpt,Urut,Suihe,andlor Bldg.No.)OR P,O.ROUTE AND BOX N0. �
124-2 BRIGH7WATER DRIVE PoGcyNu[r� ' _ '
:
CTiY
CIEARWATER �ATE ZI�P C`�ODE ComPan�NAl�NurI1�9G
SECTlON D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
�PY�s�des ofthis aevation Certificate for(1)canmunity offidal,(2)insurance agenUcompanY,and(3)bu�ding owner. •
CAMMENTS
❑Chedc here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO ANQ ZONE A(WITHOUT BFE)
For Zone AO and Zone A(w�thout BFE},compi�e It�ns Ei Uuough E4. If the Qevatlon Certlfipte is�ntended for use as suppo�ing Informa�on for a LOMA or LAMR.�,
Sectlon C must be compieted.
E1.Buiiding Di�rarn Number_(Selecx the buiic�ny�iagram most similar to the bu�ding for which this certificate is being completed—see pages 6 and 7. If no cGagrarr�accurateiy
represents fhe building�Provide a sketch or photo9raph•) �
E2.The top�the bottom floa(indudl�g basement or endosure)of the buiiding Is _R(ml_(n,(cm)�above or ❑below(chedc one)Ihe highest adJacent grade. (Use
natural grade,if available).
�•�g��9����ith openings(see page�,flie next higherfloor w elevated floor(eleva�on b)of the building is _fl.(m}_in,(cm)above ihe high�st�Jacant
grade. Complete iterns C3.h and C3�on front of foRn.
E4.The top of tha pladortn of machinery andlor equipment servidng the fwilding is _ft.(m)_in.(cm)�above or ❑below(chedc one)ihe highest adacent grade. {Use
natural grade,if available).
E5.For Zone AO only: if no flood depth number is available,is the iop of the bottan floor elevated in acoordance wiih ihe communitys floodplain management ordinance?
❑Yes ❑No ❑Unknown. The la�l offidal must ' this i�ortnatlon in Secfion G.
SE�'T10N F•PROPERTY OWNER OR OWNER'S REPRESENTATIVE CERTiFICATION
The property owner or owner's authorized rep�esentatiye who comqetes Sections A,B,C(Items C3.h and C3.i only),and E for Zone A(without a FEMA-issued or community_
issued 8F�o�Zone AO must sign here. The sfatemenis in Sections A,B,�and E are correc�to the besf of my knowledge,
PROPERTY QWNER'S OR OWNER'S AUTHORIZED REpRESENTATiVE'S NAME •
ADDRESS CITY STATE Z!P CODE
SIGNATURE pATE TELEPHONE
COMMEiVTS
SECTION G-COMMUNI'TY INFORMATION OPTIONAL) ❑Chedc here if attachments
The lopl offic;al who is�u±hrn;���by I.w�r�rdinanc�to�minista the canmunii�s noodpiain management or�inance,can compiete Sections A,B,C(or E��and G of U�is ElevaUon
Certlficate. ComF:ete U�e ,.��<,iier,!s)and sign b�ow.
G1•0 The�nfor:,a5o�:..�Sedion::;was;aken from othe�documentation that has been signed and embossed by a Gcensed surveyor,engineer,or arohilea who Is authorized by state
or local law to�-rx;;y e!s�;�ion,,:pm�atlon. (indipte fh�sou�ce and date of the elevation data in fhe Comrnents area below.)
�•�A comr�"�nity offid�completeii Section E for a bu�ding located in Zone A(without a FEMA-issued a communiiy-issued BFE)or Zone A0.
G3.[]The fouowiry in�ama�on(Items G4-Gg)is provided for cammunity floodplain management purposes.
G4.PERMIT NUMBER G5, pqTE pERMIT�SSUEp G6,pqTE CERTIFICATE OF COMPUANCElOCCUPANCY 15St1ED
G7,This pennit has been issued for.[]New Construc�Ion ❑Substantial Improvement
GS.Elev�ion of as-budt lowest floor(indu�ng basement)of the twilding is:
G9.BFE a(in Zone AO)depfh of floodng at the buiiding s�e is: —,—�.�m) Datum:
—���m) Datum
LOCAL OFFICIAL'S NAME T�.�
COMMUNIT`(NAME TELFPHONE
SIGNATURE DATE �
COMMEMS
❑Chedc here ifi attachments
FEMA Form 81-31.Januarv 20�3
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