120 BRIGHTWATER DR UNIT 3 , � , FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
• NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
. ELEVATION CERTIFICATE
�j — � Im rtarrt: Read the instructions on a es 1•7.
SECTION A-PROPERTY OWNER INFORMATION Fa lnstxanoe Canpany Use:
BUILDING OWNER'S NAME Policy Number
MENNA DEVELOPMENT
BUILDING STREET ADDRESS(InGuding Apt,Unit,Suite,andlor BkJg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
120-3 BRIGHTWATER DRNE
CITY STATE ZIP CODE
CLEARWATER FL 34630
PROPERTY DESCRIPTION(Lot and Blodc Numbers,Tax Paroel Number,Legal Description,etc.)
LOT 3,BELLE AQUA VILLAS II
BUILDING USE(e.g.,Residential,Non-residential,Addition,Acxessory,eta Use a Comments area,'rf necessary.)
RESIDENTIAL
LATITUDFJLONGITUDE(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 CObWIUNITY NANIE&COMMUNITY NUMBER B2.COUNT`!NAME B3.STATE
CITY OF CLEARWATER 125096 PINELLAS FLORIDA
84.MAP AND PANEL B7.FIRM PANEL 89.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVEIREVISED DATE 88.FLOOD ZONE(S) (Zaie A0,use depih�flooding)
12509G0007 D 8J19/91 8/19�91 AE 11 ,
610.Indicate the sou�ce of the Base Flood Elevation(BFE)data or base flood depth entered in 89, ;
❑FIS Profile ❑FIRM ❑Community Detertnined ❑Other(Describe): I
B11.Indicate the elevation datum used for the BFE in B9,NGVD� 1929 ❑NAVD 1988 ❑Other(Desc,�ibe):_
B12.Is the building located in a Coastal Barrier Resources System(CBRS)area a Otl�ervuise Protected Area(OPA)? ❑Yes �No Designatiai Date
SECTION C•BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) �
C1.Buil�ing elevations are based on:❑Construcction Drawings' �Building Under Construction' ❑Finished Construction '
*A new Elevation Certificate will be required when construcction of the building is complete, ',
�2.Building Diagram Number 8(Select the building diagram most similar to the building fa which this oe�tificate is being completed-see pages 6 and 7. If no diagram
aocurately 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,AWAE,AWA1-A30,AWAH,AWAO �i,
Canplete Items C3.-a-i below according to the building diagram specified in Item C2.State the datum used.If the datum is different from ihe dalum used fa the BFE in
Sedion B,convert the datum to that used fa ihe BFE,Show fidd measurements and datum conve�ion ca�ulaqon, Use the space provided a the Comments area of
Section D or Section G,as appropriate,to document the datum oonversion.
Datum ConversiaUComments
Elevafion reference mark used LP 10 BM#1 Does the e�evation 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) �
a�
o c)Bottom of lowest horizontal stn�ctural member(V zones only) NA._ft.(m) �o
o d)Attached garage(top of slab) 7. 14 ft.(m) g g
o e)Lowest elevation�mad�inery andlor equipment W "
serviang the building(Desaibe in a Comments area) NA._ft.(m) E�
o�Lowest adjacer►t(finished)grade(LAG) 5.05 ft.(m) z N
o g)Highest adjacent(finist�ed)grade(HAG) 5. 08 ft.(m) � #2512 5/02/05
o h)No.of permanent openings(flood vents)within 1 ft.above ac�acent grade 7 J
o i)Total area o#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 surveyor,engineer,or architect authorized by law to certify elevation information.
1 certify that the information in Sections A,B,and C on this certificafe represents my best efforfs fo interpret the dafa available.
I undersfand that any false statemenf may be punishable by fine or imprisonmenf under 18 U,S.Code,Section 1001,
CERTIFIER'S NAME GEORGE A.SHIMP II UCENSE NUMBER 2512
TITLE PRESIDENT COMPANY NAME GEORGE A.SHIMP II&ASSOC.,INC
� ADDRESS CITY STATE ZJP CODE
3301 DESOT ULEVARD PALM HARBOR FL 34683
SIGNA DATE TELEPHONE
OB N0.050242-G 5105I05 727-784,5496
FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces all previous editions
MPORTANT: In these s ace�,co the cone� ondin information from Section A. "Fa�ns�uance Canpany�iJ�,�;"� ��"�
BUA.DWG STREETADDRESS(Indudhp Apt,Un�,Suife�arxifa BIdB.No,)OR P.O.ROUTE AND BOX N0. 'PoGc�i,N�Irnb9r •
120�3BRIGHTWATER DRIVE � i ��';- ��: ���:
� STATE ZIP CODE Comp�►Y;h,�►IG Ny�� , '; t;:
CIFMWATER n � h,„�i�� � �,-�ir
�. �� i 96.: k .M,��,o
_ SECTION D•SURVEYOR,ENOINEER,OR ARCHRECT CERTIFICATION(CONTINUED) •
�PY both sides of�is Elevalion Certlfi�ate fa(1)oarununity oifid��(2)insurance agenllcomPany�and(3)bu�ding owner.
COMMENTS
❑Chedc here If attadunents
__ SECTION E•BUIIDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WRMOUT BF�
For Zona AO and Zone A(wiVwut BFE),oanpete Items E1 tluough E4. If the Eleva�on CeA�Cate is intended fa use as supporting informatlon for a LOMA a LAMR-F,
SecUon C must be oompleted.
E1.Buiid�p Diapram Number_(Selectthe bu(Idin9 dia�am mostsirrWarto the bu�ding forwhich tfus cerfiflcate is befng oompleted—see paA�6 and 7. If no�a�ram acauetelY
rePresents the building,provkie a sketd�a qioto�ph.)
E2.The top of 1he bottom floor(induc�r�basement or endosure)of the bui�(s _ft(m)_indcm)O abova a ❑below(chedc one)the highest ac�acent prade. (Use
natural grada,if av�lable).
E3.Fa Bull�ng Diagrams 6.6 wlth openings(see page���e next higher floor or elevated floor(e�vatlon b)of ihe twilding is _fl,(m)_in,(cm)above the highest a�acent
grade. Cornpleie ite�r�s C3.h and C3.1 on f�t d fam.
EA.The iop of the pla�orm of mad�inery andlor equipment servidng the tw�ding fs _ft.(m1_�d�)O above or ❑below(check one)the highest ac�ac�nt grade. (Uea
naiural grade,if available).
E6.Fa Zone AO only: If no flood deptih number is ava�able,is the lop of the boUom floor�evated in aocadance wilh the community's�oodplain managernent or�nance?
❑Yes ❑No ❑Unkrwwn. The bc�al a(Qdal muet oertify this Irnfottt�atlon in SecUon G.
SECTION F•PROPERTY OWNER(OR OWNER'3 REPRESENTATIVE)CERTIFICATION
1'he property owmer or ownei's auttwrized representalhre who comple�Sectfony A,B,C(Items C3.h and C3,1 onlY),and E fa Zone A(withoul a FEMA�issued a conmuNty.
bsued BFE�or Zone AO must sien here. The staterrrenfs!n Sectlons A,B,G and E are cared to the besf olmy knowledge,
PROPERN OWNER'S OR OWNEfrS AUTHOWZED REPRESENTATIVE'S NAME •
���� CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
CAMMENTS
❑Chedc here if attachments
SECTION G•COMMUNRY INFORMATION(OPTIONAL)
1'he bal otbdal who�s autho�ized by law a orc�na�xe lo admiNsler fhe corrvnuNl�s floodplain management or�narxe c�n complete Sections A,B,C(or E),and G of Ihis Elevaifon
Certl6Cate.Complete U�e apPlicable item(s)and sign bebw.
G1.[J The fnfortnation in SecUon C uvas taken from other documentaQon that has been signed and embossed by a Gcensed surveyor,engineer,or arrhitect who is auUiorizad by stale
�local law to certl��elevalbn infamation. (In�Cate the souroe and dale of the elevaUon data in ihe Comments area below.)
G2.�A c�munitY offidal oanpleled Sedbn Efaa buiiding loated in Zone A(wiUaut a FEMA-issued orcorrimuniry�ssued BFE)or Zone A0,
G3.�The follo�uing infamatlon(Items G4�G9)is provided faoommunity floodplain manaAement Pu�ses•
04.PERIWT NUMBER G5.DA7E PFJiIiM'ISSUED G8.DATE CERTIFICATE OF COMPI.UWCFJOCCUPANCY 18SUED
G7,mis perrNt nas be��ssued ta:p New Constnx�ion p substant(a�Improvement
G8,Elev�lon of as-buili bwest floor(indu�ng basement)a�U�e buik�ng is, __ft.(m) Dalum:
G9.BFE or Qn Zor►e AO)depth of floodu�g at the buil�ng slte is: __�.(m) Datum
LOCALOFFICIAL'S NAME TITIE
� � �`°�
COMMUNIT`(NAME '�� �� TELEPHONE
SIGNATURE � � DATE �
���$
- ���`1� ���—z--��w�'
�"` � ; � (1 ° � i.r
� ❑Chedc here if elt�cachmments
FFMA Fnrm A1_Zi la..��a..,enn� _ . .. . ----
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
• NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
��t,�bloo�— ia�� ELEVATION CERTIFICATE
Important: Read the instn�ctions on p es 1-7.
•� SECTION A-PROPERTY OWNER INFORMATION F«msurance c«npany use:
BUILDING OWNER'S NAME Policy Number
MENNA DEVELOPMENT
BU�L ING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
120- BRIGHTWATER DRIVE ���—�'�j
CITY STATE ZIP CODE
CLEARWATER RF.�� FL 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parc:el Number,Legal Description,etc.)
LOT 3,BELLE AQUA VILIAS II
BUILDING USE(e.g.,Residential,Non-residential,Addition,Acoessory,etc. Use a Comments area,if neoessary.)
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
Bt.NFIP COMMUNITY NAME 8 COMMUNIiY NUMBER B2.COUNN NAME B3.STATE
CLEARWATER 125096 PINELIAS FLORIDA
B4.MAP AND PANEL (� B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER 85.SUFFIX 86.FIRM INDEX DATE EFFECTIVEIREVISED DATE 88.FLOOD ZONE(S) (Zone A0,use dep�of flooding)
�5995�TDT" G "5103103�"'� 9103103 AE 11
B10.Indiqte e rce o tl�e Base Flood Elevation(BFE)data or base Aood depth entered in B9.
❑FIS Profile �FIRM ❑Communily Determined ❑Ofher(Desaibe):_
B11.Indiqte fhe elevation datum used for the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Olher(Desaibe):_
B12.Is the building located in a Coastal Bartier Resources System(CBRS)area or Othervvise Protected Area(OPA)? ❑Yes �No Des' nation Date
SECTiON C•BUiLDiN�EL�A i iOiV iPiFORNWTI6N(SUitVEY REQUIREb)
C1.Building elevations are based on:�Construction Drawings* ❑Building Under Construction• �Finished Construdion
` 'A new Elevation Certificate will be required when construction of the building is complete.
�.Building Diagram Number 8(Select the lwilding diagram most similar to the building for which this certificate is being completed-see pages 6 and 7. If no diagram
accurately represents the buiiding,provide a sketch or photograph.)
C3.Elevations—Zones A1-A30,AE,AH,A(witt�8FE),VE,V1-V30,V(with BFE),AR,ARIA,ARIAE,AR/A1-A30,AR/AH,AR/AO
Canplete Items C3-a-i below according b the building diagram specfied 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 ihe BFE.Show fieid measuremenls and datum o�nversion cakxilation. Use the spac:e provided or the Comments area of
Sectia�D or Sec6on G,as appmpnate,to document me daWm conversion. _ _
DatumNGVD Conversion/Comments ,: < a'.�r'
Elevation reference mark used LP 10 BM#1 Does the elevaUon reference mark used appear on the FIRM? ❑Yes �No �p �p �x.� �`
o a To of bottom floor indudin basement or endosure 7. 14 ft m � , ��'� j �
) P ( 9 ) ( ) � ��r� +� ,� ,.�L� + '
� ,;
o b)Top of next higher floor 11.06 ft(m) � '�`�
o c)Bottom of lowest horizontal structural member(V zones only) WA._ft.(m) y� , � ` �,,
o d)Attached garage(top of slab) 7. 14 ft(m) E� � '�, �
o e)Lowest elevation of machinery andlor equipment w" �" ' , ' �` xx•�:���.
servia the buildin De�ibe in a Comments area rUA._ft.m �' � �� 3 : �, . ' r�'�
�9 9( ) � ) � � �s` hti�, ,�.
o �Lowest adjacent(finished)grade(LAG) 5.05 ft(m) z � -
o g)Highest adjacent(finished)grade(HAG) 5. 08 ft.(m) N� ` �s� �
o h No.of rmanent � � f
) Pe openings(flood venLs)within 1(t above adjacentgrade 7 J �s�� ,�`'s ; '� ;
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 surveyor,engineer,or architect authorized by law to ceRify eleva6on information.
1 ce�tify that fhe information in Sections A,8,and C on fhis certificate represents my besf efforfs to interpr�t the data available.
I understand that any ialse statement may be punishable by fine orimprisonmenf 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 DESO OULEVARD PALM HARBOR FL 34683
SIGN DATE TELEPHONE
JOB N0.050738 9IO2J05 727-784-5496
FEMA Form 81-31,January 2003 See reverse side for continuation. Ra�ia�p�au f1fPVif111C PlII�II1f1C
IMPoRTANT: In these spaces,copy the coResponding informatlon from Section A. �'For:lnswance ea�pany usa �� y-'
BU4.DWG STREFf ADDRESS(Indud'rp Apt,Und,Suite,ar�dfa Bldg.No.)OR P,O.ROUTE AND BOX N0. PoUc�Nurt�er' _ - .
120-3BRiGHTWATER DRIVE = = -
CIIY STATE ZIP COOE CompanY NAI&�tui�16F - '_
C1.EARWATER FL 34630 -= - _ �-
SECTION D•SllRVEYQR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTiNUED)
�PY both sides of this Elevafion CerGficate for(1)corrununity offiaal,(2)insurance agenVcanpany,and(3)fw��ing owner. •
COMMEMS
❑Chedc here if attachments
SECTION E•BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zone AO and Zone A(without BFE',canplete Items E1 fhrough E4. If the Elev�lon CerGficate(s intended fa use as supporting informatlon for a LOMA or LOMR-F,
Sedia�C must be canpleted.
Ei.Bu��ing Diagram Number_{Select the bu�ng�iagram most similar to the building for wh�h�is cerfificate is being canpleted—see pages 6 and 7. If no�agrmti accura�ly
represents the buikfing�Provkie a sketch a�.) .
E2 The top of the bo�Orn floa(indud'u�g basement or endosure)of the tx�ng is _it(m)_in.(cm)0 above or ❑below(check one)the highest a�acent grade. (Use
natural gtade,if available).
E3.For Bu�dng Diagrams 6�8 with openings(see page�,ihe next higt�r floor a elevated floor(elevation b)of the buil�ng is _ft,(m)_�.(cm)above the highest a�acent
gr�e. Compiete items C3.h aid C31 on front of form.
E4.The top�the platlortn of madiinery andlor equipment servidng the buikl'Ng is _ft.(m)_in•lcm)�above or ❑below(chedc one)fhe highest adjacent gr�e. (Use
nahual grade,if avalade).
E5.For Zone AO onty: if no flood depfi number is available,is the top of the bottom floor elevated in aaardarxa wiih fhe communiiy's floodplaln managert�ent or�inance?
❑Yes ❑No ❑Unknown. The laxi aflidai must cartlfy tl�s it�omration in Secbon G.
__ SECT'ION F•PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERT1FiCAT10N
11�e�operty owner or aw�ers authorized representative who canpl�es Sedfons A,B,C(Items C3.h and C3.1 onlyj,and E for Zone A(wilhout a FEMA-issued a cortunuNty-
issued BF�a Zone AO must sign here. The stetements in Seetiau A,8,�and F ere correct to the best of my knowledge.
PROPERTY OWNEf�S OR OWNER'S AUTHOWZED REPRESENTATIVE'S NAME �
��� CITY STATE ZIP CODE
SIGNATURE DATE TEtEPHONE
COMMENTS
❑Chedc here if attachments
_ SECTION G•COMMUNITY INFORMATION(OPTIONAL)
The local offiaa'wFw�aut�':�i by fav a or�nance to ad�rqniste�the canmuniiys Goodplain management or�nance can canplete Sectlais A,8,C(or E�,arui G of ihis EJeva�on
Certificate. Ccvr�plste fhe appliC�.'e ite�n(s)and sign below. •
G1.�The inf�atio�r„rf�ectlon�was 4aken from othe�documentation that has been signed and embossed by a licensed surveya,engineer,or arc��itect who is authorized by state
or bc�(aw toi��ii�:eleVafia�i�ortriaUon. (Inc�cate the source and date af the elevation data in the Conunents area bebw.)
G2.�A canc�wnity oifid�c�mplet�d Sedion E fa a buiiding located In Zone A(without a FEMA-+ssued or carununity�ssued BFE�or Zone A�,
G3.0 The foqo�wirr�'ut�imation(Ite�ris G4�9)is provided for cortununity floodplain management purposes.
G4.PF.RNUT NUMBER G5. OATE PERMfT ISSUED G6.OATE CERTIFICATE OF COtvB�IIANCFIOCCUPANCY 1SSUED
G7.rhis permit nas been issued t«:p rlew consUu�n a substantial improvement
G8.FJevation of as-bu�i lowest floor C�b�t)c�the bu�ding is: __ft.(m) Datum
G9.BFE or('�n Zone AO)depth�floo�ng at the buil�ng site is: _,_ft.(m) Datum:
LOCAL OFFICIAL'S NAME T��
COMMUNlTY NAME TELEPHONE
SiGNATURE DATE �
COMMENTS
❑Chedc here if attachments
FEMA Form 81-31,Je�UBfY 2003 Reoiar�s ali nrevious editiens
, �."` '�'� C ITY OF C LEARWATER
• DEVELOPMENT & NEIGHBORHOGD SERVICES DEPARTMENT
��.
4'"r,,°`, „ POST�FFICE BOX 4748� CLEAftWATER� F�oa►DA 33758-4748
� MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CLEARWATER,Fco�uDn 33756
TELEPxoNE(72� 562-4567 Fnx(72� 562-4576
MEMO OF REVIEW FOR CORRECTNESS & 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 ail 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 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 3
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❑Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
1.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME B3.STATE
64.MAP AND PANEL g5.SUFFIX 66.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
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item 89.
❑ FIS Profile ❑ FIRM ❑ Community Determined ❑ Other(Describe)
611. Indicate elevation datum used for BFE in B9:0 NGVD 1929 ❑ NAVD 1988 ❑ Other(Describe)
812. Is the building located in a Coastal Barrier Resources S stem(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 buiiding 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 ATTACHED DOCUMENTS FROM MDM MENNA DEVELOPMENT&MNGT INC.ADDRESSING ELEVATION FOR THE PROJECT.
Date of Review: Community Official:
�levation certificates shall be maintained by the community and copies with the attached memo made availab/e by request
FRANK HIRBARD,MAYOR
GEORGE N.CRE'CEKOS,COUNCILMEMBCR JOI W DORAN,COUNCILMEMBGR
PAUL F.GBSON,COUNCILMEMHER � CARL@N A.PE7'ERSEN,COUNCILMEMBGR
��EQUAL EMYLOYMENT AND Af'FIRMA'fIVE ACTION EMPLOYER��
� . • • FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
.
NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
�,�l003-- i a�� ELEVATION CERTIFICATE
Important: Read the instructions on a es 1-7.
SECTION A-PROPERTY OWNER INFORMATION Fa Insurance Canpany 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
120-3 BRIGHTWATER DRIVE
CITY STATE ZIP CODE
CLEARWATER BEACH FL 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Paroel Number,Legal Descnption,etc.)
LOT 3,BELLE AQUA VILLAS II
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
81.NFIP COMMUNITY NAME 8 COMMUNITY NUMBER B2.COUNTY NAME 83.STATE
CLFARWATER 125096 PINELLAS FLORIDA
B4.MAP AND PANEL 87.FIRM PANEL 89.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6.f IRM INDEX DATE EFFECTIVEIREVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depth of flooding)
12509E'i0102 G 9�03�03 9�03N3 AE 11
B10.tndiqte the source of fhe Base Flood Elevation(BFE)data or base flood depth enbered in 89.
❑FIS Profile �FIRM ❑Community Determined ❑Ofher(Describe):_
B11.Indicate the elevation datum used for the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Other(Describe):_
612.Is the building located in a Coastal Bamer Resources System(CBRS)area or Otherwise Prote�ed Area(OPA)? ❑Yes �No DesignaUon Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:�Construction Drawings* ❑Building Under Construction' �Finished ConsUuction
� 'A new Elevation Certificate will be required when construction of lhe 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.Elevations–Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AWA,AWAE,AR/A1-A30,AWAH,AR/AO
Compiete items C3:a-i below according to the building diagram specfied in Item C2.State the datum used.If ihe datum is different from the datum used for the BFE in
Section B,convert the datum to that used for the BFE.Show fieid measurements and datum conver�ion calculation. Use the space provided or the Comments area of
Section D or Section G,as appropriate,to document the datum conversion.
Datum NGVD ConversionlComments
Elevation referenoe mark used LP 10 BA�1 Does the eleva6on reference mark used appear on fhe FIRM? ❑Yes �No
o a)Top of bottom floor(induding basement or endosure) 7. 14 ft(m) � ,, ,� :
o b)Top of next higher floor 11.06 ft.(m) `� �'_.�,'",'
� � �� ..
o c)Boflom of lowest honzontal structural member(V zones only) WA._ft.(m) �' � -�''
o d)Attached garage(top'of slab) 7. 14 ft(m) E a } '`"'� '� � ?�
o e)Lowest elevation of machinery andlor equipment W� a�^`� , ;
serviang ihe building(Describe in a Comments area) N1A._ft.(m) � ' { � � `�
E m
, .s
c
�
� y;
o �Lowest adjacent(finished)grade(LAG) 5.05 it(m) z.� �, " ���
� ��
o g)Highest adjacent(finished)grade(HAG) 5. 08 ft(m) � '�`' �,, �`' `
o h)No.of permanent openings(flood venls)within 1 ft.above adjacent grade 7 J �S 1z :
o i)Total area of all permanent openings(flood vents)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 surveyor,engineer,or architect authorized by law to certify elevation information.
1 cerfify that the information in Sections A,8,and C on this ceRificate represents my besf efforts to interpret the data available.
1 understand that any false statement may 6e punishable by fine orimprisonment under 18 U S Code Section 1001
CERTIFIER'S NAME GEORGE A.SHIMP II LICENSE NUMBER 2512
-1TLE PRESIDENT COMPANY NAME GEORGE A.SHIMP II&ASSOC.,INC
-
ADDRESS CITY STATE ZIP CODE
3301 DESO OULEVARD PALM HARBOR FL 34683
SIGN DATE TELEPHONE
JOB N0.050738 9IO2I05 727-784-5496
FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces all previous editions
,
MPoRTANT: in these spaces,copy the coResponding fnformat(on f�om Sectfon A. =For insur�noe Ca�any uae. `< ���`
BUILDWG STREET ADDRESS(Induding Apt,UnG,Suite,andfa 8kig.No.)OR P,O.ROUTE AND BOX N0. Polfcy:Nwnber ' t
120-3BRIGHTWATER ORIVE -
CIIY STATE ZIP COOE ;CornpanY NAIGNWn4@r
C1F.ARWATER FL 34630 - - -
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) •
Copy both sides of this Devation Certificate for(1)canmunity offiaal,(2)insurance agenUcompany,and(3)lwd�ing ovmer.
COMMENTS
— ❑Chedc here if att�achments
SECTION E•BUILDING ELEVATION INFaRMAT10N(SURVEX NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zone AO and Zone A(without BFE�,canqete Items E1 ihrough E4. If the Elevatlon Certificate is intended for use as supporting infortnatlon for a LOMA a LOMR-F,
Sedion C must be competed.
E1.Building DiaAram Number_{Select the buil�ing diagram most similar to the building for which�is certificafe is being compieted–see pages 6 and 7. If no diagram accuraiely
represenls the building,provide a sketch a photogr�h.) �
E2.The top�ihe bottom floa(induding basement or endosure)of the buiiding is _�.(m)_in.(cm)0 above or ❑below(chedc one)the highest ac�acent grade. (Use
natural grade,if available).
E3.Fw Buiiding Diagrams 6�8 with openfngs(see page 7),ihe next higherit�oor or elevated floor(elevatlon b)of the buil�ng is _fl,(m)_in.(cm)above ihe highest adjacent
grade. Complete items C3.h and C3.1 on front�fortn.
E4.The top of 1he pla�orm of mad�inery andla equipment servidng the building is _ft.(m)_in.(cm)�above or ❑below(chedc one)lhe highest adjacent gr�ie. (Use
natural grade,if av�lable).
Ea.For Zone AO only: If no flood depth number 1s available,is the top of the bottom 800r elevated in aaardance with ihe community's�oodplain management ordinance?
__ ❑Yes ❑No ❑Unknown. The lopl affiaal must certlfy this infomiaHon in SecHon G.
_ SECTION F•PROPERTY OWNER(OR OWNER'S REPRESEMATIVE)CERTIFICATION
The p'operty owner or owne�s authorized representat(vve who completes Seclions A,B,C(Iterr�.s C3.h and C3.J only),and E for Zone A(without a FEMA-issued or community-
issued BFE�or Zone AO must sign he�e. The stetements in Sec�ons A,B,�and E ere conec,t to the best of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESEMATIVE'S NAME •
ADDRESS CITY STATE Z1P COOE
SIGNATURE DATE TELEPHONE
COMMENTS
. ❑Chedc here if attachments
_�
SECTION G•COMMUNITX(NFORMATION(OPTIONAL)
The la�l offici�'who is auihor' 2�i by ia�v or ordin�ce to administer the cortunuNi�s floodpl�n management orduiar�ce can complete Sectlons A,B,C(or E�,and G of�is Elev�fon
Certificate. G�:�e U,:.a�,�alica�'�item(s)and sign below. �
Gi.�Th€'.nfor,. atior �i aedior;wz�taken from other documentation that has been signed and embossed by a Gcensed surveyor,engineer,or arc,hitectwho is authorized by state
or la;al la�x!o�:n ir el�+��ion infortnation. (In�icate lhe source and date of tl�e elevation data in the Comments area below.)
�.C�A comr��unity of6dal�;;mpleteci Sedion E fw a building located in Zone A(without a FEMA-issued or community�ssued BFE)o�Zone A0,
G3.�The folbwi,�inf�tmatlon(Items G4G9)is provided for canmunity floodplain management purposes,
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6.DATE CERTIFICATE OF COMPLV�NCEJOCCUPANCY ISSUED
G7.This permit has been issued for:[�New ConsUuctbn ❑Substantlal Improvement
G8.aevation of as-built lowest floor(induding basement)of the building is: _._ft,(m) Datum:
G9.BFE or(in l.�ne AO)depfh of floo�ng at the building site is: _,_it(m) Datum:
LQCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPNONE
SIGNATURE pqTE i
COMMENTS
❑Chedc here if attachments
FEMA Form 81-31,J2r1UafY 2003 Reolaces all erevious edltinnn