120 BRIGHTWATER DR UNIT 4 ; a � FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. NO. 3067-0077
NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
�°�� ��a� ��I ELEVATION CERTIFICATE
Important: Read the instructions on pa es 1-7.
SECTION A-PROPERTY OWNER INFORMATION For msurance car�r,y 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
120-4 BRIGHTWATER DRIVE
CITY STATE ZIP CODE
CLEARWATER BEACH FL 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Par�el Number,Legal Description,etc.)
LOT 4,BELLE AQUA VILLAS II
BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,if necessary.)
RESIDENTIA�
LATITUDE/LONGITUDE(OPTIONAL) HORI20NTAL 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&COMMUNITY NUMBER B2.COUNTY NAME 63.STATE
CLEARWATER 125096 PINELLAS FLORIDA
B4.MAP AND PANEL B7.FIRM PANEL 69.BASE FLOOD ELEVATION(S)
NUMBER 85.SUFFIX B6.FIRM INDEX DATE EFFECTIVEIREVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depih of flooding)
125096d102 G 9ro3103 9ro3�03 AE 11
810.Indicate the souroe of the Base Flood Elevation(BFE)data or base flood depth entered in B9.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Describe):_
B11.Indicate the eleva6on datum used for the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Ofher(Descxibe):_
B12.Is the building located in a Coastal Bamer ResourGes System(CBRS)area or Otherwise ProtecOed Area(OPA)� ❑Yes �No Desiqna6on Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:0 Construction Drawings' ❑Building Under ConsUuction' �Finished Construction
� *A new E�eva6on Certificate will be required when construction of ihe building is complete.
1.Building Diagram Number 8(Select the building diagram most similar to fhe building for which this oertificate is being complebed-see pages 6 and 7. If no diagram
accurately represents the building,provide a sketch or photograph.)
C3.E�evations—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,ARIA1-A30,AR1AH,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 tl�e 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 Comment�area of
Sec�on D or Sec;6on G,as appropriate,to document the dah�m conversion.
Datum NGVD ConversioNComments
Elevation referenoe mark used LP 10 BNqt1 Does the elevation reference mark used appear on fhe FIRM? ❑Yes �No
o a)Top of bottom floor(induding basement or endosure) 7. 15 fL(m) � ki;^"°'y+'�'�`',��'� :°
o b)Top of ne�higher floor 11.00 ft.(m) � �:r t'� �� • ,
o c)Boflom of lowest horizontal struch�ral member(V zones only) WA._ft.(m) N� ' °o ��'�,� � ' '�
o d)Attached garage(top of slab) 6. 15 ft(m) E� �, � � �
o e)Lowest elevation of machinery andlor equipment 11!`° �'�� s
serviang the building(Descnbe in a Comments area) WA._ft.(m) �� _.�� � �
o �Lowest adjacent(finished)grade(lAG) 5.05 ft(m) z.m ; ,.�'�,�������
o Hi hest ad�acent finished rade HAG �' �r, � ��' �� �
9) 9 1 � )9 � ) 5. 08 ft(m) �� �,,-m�
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 7 � �rr2�'!.l���os'
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.
f certify that the informafion in Sections A,B,and C on this certificate represents my best efforts fo interpret the data available.
I understand 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
�TITLE PRESIDENT COMPANY NAME GEORGE A.SHIMP II&ASSOC.,INC
ADDRESS CITY STATE ZIP CODE
3301DESOTO BOULEVARD PALM HARBOR FL 34683
SIGNATU DATE TELEPHONE
JOB N0.050738 9/02/05 727-7gq.5qgg
FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces all previous editions
lMPORTANT: In thesa spaces,copy the corresponding informatlon from Section A Forinswancacorr�panyuse:
BUILDWG STREET ADDRESS(Induding Apt,UnA,Suite,arxllor Sldg.No.)OR P.O.ROUTE AND BOX N0. PoGcy Num6e� � ��
124-4 BRIGHTWATER DFtiVE -
Cf]Y 5TATE Z!P CODE Company t�AI�Ntu�jbe[ `
CLEARWATER F1 34630
SECTION D-SURVEYOR,ENGINEPR,OR ARCHITECT CERTIF1CATlON(CONTINUED) �
Copy both sides of this Dev�fon Certificate for(1)c�rnmunity offiaai,(2)(nsurance agenUcompany,and(3)buq�ing owner.
COMMENTS
❑Chedc here if attachments
SECTiON E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
Fw Zone AO and Zone A(without BF�,complete Items E1 through E4. If ihe qevatlon CeNficate(s fntended for use as suppoNng informaUon for a.LOMA a tAMR-F,
Seclion C must be c�mpleted.
E1.Building Diagram Number_(Seled the buil�ing di�ram most sirrular to ihe building fw which lhis cer6ficate is being cwnpleted—see pages 6 and 7. If no diagram accurately
tep�esents ihe buiiding,provide a sketch a photogr�h.) ,,
E2.The top�the bottom floa(induding basement or enc�osure)of the buil�ing is �ft(m)_fn.(cm)O�ve or ❑below(chedc one)the highest adjacent grade. (Use
natural grade,if available).
E3.For Bu�ding D(agrams 6�8 with openings(see page�,fhe ne�higherfloor or eievated tloor(elevaGon b)of ihe buil�ing is _fl.(m)_in.(cm)above the highest adjacent
grade. Complete itertis C3.h and C3a on front of fortn.
E4.The iop of the�a�orm of machinery andlor equipment sarvicing the lwilding is _ft.(m)_in.(cm)�above w ❑below(check one)the highest a�jacent grade. (Use
naturai grade,if avallable).
E5.For Zone AO a�iy: If no flood deplh number is available,is fhe top of the bottan floor elevated in acco�dance wilh the communit�s floodplain management ordinance?
❑Yes ❑No ❑Unknown. The bcal offidal must certify this ir�ortnation in Seciion G.
SECTION F•PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owne�s author¢ed representa�ve who comaetes Sec�ions A,B,C(Items C3.h and C3r only),and E for Zone A(wiihout a FEMA-issued or cornmunity-
issued BF�or Zone AO must�gn here. The statemer�s in SecBons A,8,C,and E ere consct fo the besf of my knowledge.
PROPERT`(OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME .
ADORESS CITY STATE Z1P COOE
SIGNATURE DATE TELEPHONE
COMMENTS
❑Chedc here if attachments
_ SECTION G•COMMUNITY INFORMATION(OPTIONAL)
The local offi��l who is�u'�orz�i by IGw or o�inance to administe�tha communii�s floodplain management ordinance can complete Sec�ons A,B,C(or E),and G of this ElevaUon
C�Caie. Can�ie+,�e:�plicar!sita�ls)and sign below.
Gi.�The�nfcx�;,atic:��,Secfiw°�C was talcen from othe�documentation fhat has been signed and embossed by a licensed suroeyor,engineer,or architect who is authorized by state
or loc�law`.c��rti"ry e!evafion infortnation. (Indicate ih�sou�e and date of ihe elevation data in the Comments area below,)
�2.�A comm��nity ofl'raal completed Section E for a bui�'u�g locaied in Zone A(wifihout a FEMA-issued or c�mmunity-issued BFE)or Zone A0.
G3.0 The fouowir,g intc�rnatio�{Items G4-G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPUANCFJOCCUPANCY ISSUED
G7.This pemut has been issued for.�New Construc�ton ❑Substantial lmprovement
G8.E]evation of as-buat lowest floor(induding hasement)of the(�ilding is: _._ft.(m) Datum:
G9.BFE or('u�Zone AO)depth of floodi�ng at fhe buiiding site is: __f�(m) Datum:
LOCALOFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SiGNATURE DATE .
COMMENTS
❑Cnecic here if attachments
FHMA Form 81-31,Januarv 2003 Reolaces all�revious editions
+• � FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
� NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
�Pa�� "ia1 �� ELEVATION CERTIFICATE
Important: Read the instructions on pages 1-7.
y SECTION A•PROPERTY OWNER INFORMATION Foa ms�rance c,qnpany use:
BUILDING OWNER'S NAME Policy Number
MENNA DEVELOPMENT
BUILDING STREET ADDRESS(Including A t., ni,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
12 IVE
CiTY STATE ZIP CODE
CLEARWATE�:�;�;�;--. FL 33767
PROPERTY DESCRIPTION(Lot and Biock Numbe�s,Tax Parcel Number,Legal Description,etc.)
LOT 4,BELLE AQUA VtLLAS II
BUILDING USE(e.g.,Residential,Non-residen6al,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&COMMUNIIY NUMBER B2.COUNTY NAME 83.STATE
CIEARWATER 125096 PINEILAS fLORIDA
B4.MAP AND PANEL 5 Q B7.FIRM PANEL B9.BASE FLOOD ELFVATION(S)
NUMBER B5.SUFFIX 86.FIRM INDEX DATE EFFECTIVEIREVISED DATE B6.FLOOD ZONE(Sj (Z.one A0,use deplh of flooding)
G 9�62Aa2--- 9iO3r03 AE 11
810.Indicate the source of fhe Base Fbod Elevation(BFE)data or base flood depth entered in B9.
❑FIS Profile �FIRM ❑Community Detertnined ❑Other(Desaibe):_
B11.Indicate the elevation datum used for the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Ofher(Desaibe):_
612.Is the building located in a Coastal Bamer Resources System(CBRS)area or Otherwise Proteched Area(OPA)? ❑Yes �No Designation Date
SEC i i��i�-�i.iiLDiN��LEVATION INF�RMATION(SURVEY REQUIRED)
C1.Buiiding elevations are based on:❑Construuc6on Drawings' ❑Building Under ConsUuction' �Finished Construction
�� "A new Elevabon Certifiqte will be required when construction of ihe building is complete.
�.Building Diagram Number 8(Select tlie building diagram most similar to fhe building for which tl�is certificate is being complefied-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,ARIA1-A30,ARIAH,ARIAO
Complete Items C3-a-i bebw according fio 1he building diagram spea6ed in Item C2.State the datum used.If the datum is different from the datum used for tl�e BFE in
Section B,convert ihe datum to that used for the BFE.Show field measurements and datum conversion ca�ulation. Use the space provided or the Commenls area of
Section D or_SecUon G}as ap�mpnate,la�ncume�t the dahim cawersion. _ _ ---- __
Datum NGVD Conve�ioNComments � ���
Elevation reference mark used LP 10 Blv�#1 Does the elevation reference mark used appear on fhe FIRM? ❑Yes �No ,,k �,° �°'� ,.
o a)Top of bot�m floor(nduding basement or endosure) 7. 15 ft(m) �
�.��S F �' �' {�`:
� r. .
y i �! !'
o b)Top of next higher floor 11.00 ft.(m) � ��'� �� � ` r -
o c)Bo�om of lowest horizontal struchual membe�r(V zones only) WA._ft.(m) N� �'�' �� �� .
b � > `
o d)A t t a c h e d garage(top o f s la b) 6. 15 ft.(m) �a F� � � -� ` �
o e)Lowest elevaUon of machinery andlor equipment W� �� `'�
servidng the building(Describe in a Comments area) WA._ft.(m) E� ' t. + . � i�*'�
""�T�
o �Lowest adjacent(finished)grade(LAG) 5.05 ft(m) z'� g�" ;�: r.t �'�
o g)Highest adjacent(finished)grade(HAG) 5. 08 ft(m) �� �� � ��g��
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 7 '
� 4tr2;�.�.i+ �;'.:,
o i)Total area of all permanent openings(flood ven4s)in C3.h 1203.29 sq.in.(sq.an) 'k
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land suroeyor,engineer,or architect authorized by law to certify elevation information. �
1 certify fhat the information in Sections A,B,and C on this certificate represents my best efforts to interpret fhe data available.
1 understand that any false statement may be punishable by 5ne or imprisonment under 18 U.S.Code Section 1001.
CERTIFIER'S NAME GEORGE A.SHIMP 11 LICENSE NUMBER 2512
�j ITLE PRESIDENT COMPANY NAME GEORGE A.SHIMP II&ASSOC.,INC
!
� ADDRESS CITY STATE ZIP CODE
3301 DESOTO BOUIEVARD PALM HARBOR FL 34683
SIGNATU DATE TELEPHONE
JOB N0.050738 9102/05 727-784-5496
FEMA Form 81-31,January 2003 See reverse side for continuati�n Rnnl�rcc�u.,�e,,;.,���e,��t�.,��
IMPORTANT: In these spaces,copy the corresponding informatlon from Section A For insurancacornpany use: =
BUU.DWGSTREETADORESS Indud. . _ ,
( rg Apt,Unrt,Swte,andla 8klg.No.)OR P.O.ROIJTE AND BOX N0. Po�,y Number `
120-4 BRIGHTWATER DRIVE � -
C1TY STATE Z!P CODE =
CLEARWATER � 34�p ��X�N� '.
_ �-= _
-,. ..: . . .. _..-....
SECTION 0-SURVEYOR,ENGINEER,OR ARCHlTECT CERTIFiCAT10N(CONTlNUED) ,
CopY both�des of this Devatio�Certificate for(1�canmunity offiaai,(2)insurance agenUcampany,and(3)bu��ing owner. .
COMMENTS
❑Chedc he�e if attachments
__ SECTION E•BUILDING ELEVATiON INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
Fa Zone AO and Zone A(without BFE�,oanplete items E1 through E4. If the Elevatlon Certlfipte Is intended for use as suppoNng Informatlon fa a LOMA a IAMR-F,
Sectlon C must be canpleted.
E1.Bu�ding Diagram Number_(Select the bu��ng di�ram most sirtu1ar to the bu�ding fw which lhis cerfit'icate is being completed—see pages 6 and 7. If no diagram accuratety
repre.se�ts ihe buikGng�Provide a sketch or�otograph.) .
E2 The top�the boUom floa(induc�r�g basement or endosure)of the bu�n9 is _�,(m)_in•(cm)�above w ❑belax(checic one)the highest�'�aCent grade. (Use �
naturai grade,if available).
E3.Fa Buiiding Diagrart�s 6-8 with openin95(see Pa9e�,the next higher tbor or elevaied floa(elevation b)of 1he buii�ng is _�,(m)_in.(cm)above the highest adacent
gr�e. Complete ite�ns C3.h and C3�on front�fam.
E4.The top�the plaiform of madvnery andlor equipment servicicig the txu7din9 is _fl.(m)_In.(cm)�above w ❑below(check one)ihe highest a�acent grade. (Use
natural grade�if avallable).
E5.For ZAne AO only: If no�ood depth number is available,is tfie top�f the bottom floa devated in�ordance with tlie community's 800d��n management orci'inar�e?
Q Yes ❑No ❑Unknown. The bc�offidal must certify this information in Sedion G. �
SECTION F•PROPERTY OWNER(OR OWNER'S REPRESEM'ATiVE)CERTIFICATION
Tt�property owner or oNmer's authorized representaUve who completes Sections A,B,C(Items C3.h and C3a onlY),and E for Zone A{without a FEMA-issued a'cfltrununity-
Issued BFf�or Zone AO must sign here. The statemenis in Secfions A,�C,ar►d E are conec,�t to the best of my knowledge.
PROPERIY OWNEI�S OR OWNER'S AUTHOWZED REPRESENTATiVE'S NAME �
���� CITY STATE Z1P COOE
SIGNATURE DATE TELEPHONE
COMMENTS ,
❑Chedc here ifi attachments
SECTiON G•CqMMUNITY INFORMATION(OPTIONAL)
The la�offiaai who�s au?h�a.�d by k,w a orduiar�ce to administer the canmunit�/s flooc�lain managerr�rit ordnance pn complete Sections A,B,C(a E�,and G of ihl,s Elev�ion
Ce�tificaie. Canpl�ie:,�e,appUc�ts item(s)and sign below.
Gi.0 The.icifar��+era�Sedion,t;was faken from othe�document�ion t�t has b�n signed and embossed by a Gcensed surveya,engineer,or arc,hitect who is aulhaized by st�e
or locai law;o cei�"ry�e�iafia��nfom�ation. (Incficate thasour�e and date of the eaevation data in the Comments area bebw,)
G2.�A cann��nity of�i�aal canqeted Se�On E for a bu�d'ing bcated in Zone A(wiit�ut a FEMA-issued or community-issued BFE)or Zaie A0.
G3.�The idlowirig infaRriaUon(lte�ns G4-G9)is provided for canmunity floodplain management purposes.
G4.PERtvUT NUM�ER G5. DATE PFRMIT ISSUED G6.DATE CF.RTIFiCATE OF COtv�UANCFJOCCUPANCY ISSUED
G7.This permit has been issued fa:0 New Construdiai ❑Substanfi�Mprove.ment
GS.EJev�ion of�-buiit lowest i�or(indudng basement)of the bu�dn9 is: _._ft,(m) Datum
G9.BFE or(�n Zone AO)depth of floodng at the twilcGng site is: _._ft(m) Datum:
LOCAL OFFiCIAL'S NAME TR�
COMMUNITY NAME TELEPHONE
SIG�IATURE DATE .
COMMENTS
❑Check here'rf attachments
FEMA Fnrtn R1�31 .lannarv 9nf13 00„�.,,,e�„ii,,.o,.�„�.�sa�+�.,,,�
1 a
� �� � x( -
������` k 5� CITY OF CLEARWATER
a��.� b ..:
� ��� } ,
���, � � � � �����? DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
��"��"^ POST OFFICE BOX 4748 CLEARWATER FLO�DA 33758-4748
.;��, � w � , >
� MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CLEARWATER,FLO�unn 33756
TELEPHONE�72� 5�2-4567 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 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 4
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
B4.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
610. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
❑ FIS Profile ❑ FIRM ❑ Community Determined ❑Other(Describe)
611. Indicate elevation datum used for BFE in B9: ❑ 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 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
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)1 ft.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 O�cial:
�levation certificafes shall be maintained by the community and copies with the attachedmemo made available by request
FRANK HIRBARD,MAYOR
GEORGE N.CRE7'EKOS,COUNCILMEMRER J011N DORAN,COUNCILMEMBER
PAUL F.GIBSON,COUNCILMEMftER � CARI.EN A.PE7'ERSEN,COUNCILMEMRER
��EQUAL EMYLOYMENT AND AFFIRMA"1'IVE ACfION EMPLOYEK�
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
• ' ' � ' NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
• . ELEVATION CERTIFICATE
— a Im rtant: Read the inst�uctions on a es 1•7.
SECTION A•PROPERTY OWNER INFORMATION Fa Insu�anoa CanpAny Uae:
BUILDING OWNER'S NAME Policy Number
MENNA DEVELOPMENT
BUILDING STREETADDRESS(InGuding Apt,Unit,Suite,and/or Bklg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
120-4 BRIGHTWATER ORIVE
CITY STATE ZIP CODE
CLEARWATER FL 34630
PROPERTY DESCRIPTION(Lot and Blodc Numbers,Tax Paroel Number,Legai Description,etc.)
LOT 4,BELLE AQUA VILLAS II
BUILDING USE(e.g.,Residential,Non-residential,Addition,Axessory,etc. Use a Comments area,'rf neoessary.)
RESIDENTIAL
LATITUDFJLONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS(fype):
( ##°-##'-##.##" or ##.#!1�#� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B•FLOOD INSURANCE RATE MAP�FIRM)INFORMATION
B1.NFIP COMA4UNITY NAN1E&CONWIUNITY NUMBER B2.COUMY NAME 83.STATE
CIIY OF CLEARWATER 125096 PINEU.AS FLORIDA
B4.MAP AND PANEL 67.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUIv�ER B5.SUFFUC B6.FIRM INDEX DATE EFFECTIVEIREVISED DATE B8.FLOOD ZONE(S) (Zaie A0,use depth of floodkg)
12509fr0007 D 8119�J1 8J19r91 AE 11
B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9.
❑FIS Profile ❑FIRM ❑Community Determined ❑Other(Describe):
811.Indicate the elevaUon datum used fa the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Other(Describe);
B12.Is the building Iocated in a Coastal Bartier Resouroes System(CBRS)area a Otherwise Protected Area(OPA)? ❑Yes �No Designation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:�Construc6on Drawings' �Building Under Construcfion' ❑Fnished Construction
"A new Elevation Cerfificate will be required when constniction o�the building is complete.
•C2.Building Diagram Number 1(Select the buikiing diagram mast similar to the building for which this cerfificate is being canpleted-see pages 6 and 7. If no diagram
aa;urately represents the building,provide a sketch a photograph.)
C3.Elevations—Zones A1 A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AWA,AR/AE,AR/A1-A30,AR/AH,AWAO
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 the datum used for the BFE in
Secfion B,convert the datum to that used for the BFE.Show field measurements and datum oonversion ca�ulation. Use the space provided a the Comments area of
Section D or Secfion G,as appropriate,to document the datum conversion.
Datum ConversionlCanments
Elevation referenoe marlc used LP 10 BM#1 Does the eleva6on reference marlc used appear on the FIRM? ❑Yes �No
o a)Top of bottom floa(induding basement or endosure) 7. 15 ft.(m) � ,_ .. , A; � ,
o b)Top of next higher floor 11.00 ft.(m) ;
o c)Bottom of lowest haizontal structural member(V zones only) NA._ft.(m) a o `" .%
o d)Attached garage(top of slab) 6. 15 ft.(m) E� , .
o e)Lowest elevation of machinery andlor equipment W `0 � ' �
_� (�Y "�~..
servicing the building(Desaibe in a Comments area) NA._ft.(m) E� „ , ; ,,,;'x
o fl Lowest adjacent(finished)grade(LAG) 5,05ft,(m) z.�`� n;;, ,' . ,,
o g)Highest adjacent(finished)grade(HAG) 5. 08 ft.(m) � #2512�� � 5/D2�Q5 � . .�
o h)No.af permanent openings(flood vents)within 1 ft.above adjaoent grade 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 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 cerfify that the information in Sections A,B,and C on this certificate represents my best efforts to interpret fhe data available.
1 undersfand fhat eny 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
TITLE PRESIDENT COMPANY NAME GEORGE A.SHIMP II&ASSOC.,INC
ADDRESS CITY STATE ZIP CODE
3301 DESOT OULEVARD PALM HARBOR FL 34683
SIGNA DATE TELEPHONE
.050242-D 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 Informatlon from Section A. For InsuranaeCornpeny use: � ''
BUUDING STREETADORESS(IndudinA Mt�Un�,St�te,andlor 81�lp.No.)OR P.O.ROUTE ANO BOX N0. Pol�y Numqe� • ,
120�4 BRIGHTWATER DRIVE "' �
CITY STATE ZIP CODE W�6t ��:���,
'.cor►�PanY(�I�N i
CLEARWATER Fl 34630 �ca 6 N ��.� �'�u,; a;;
8ECTION 0•SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) _ �
�PY both sides of this Elevatlon Certi�Cate fa(1)oommuNty offidal,(2)Insurance agenVoanpany�and(3)buq�ng owner.
CAMMENTS
-- �Ch�, ff�ts
.
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO ANQ ZONE A(WRHOUT BFE�
For Zone AO and Zone A(wifhout BFE),aanpl�e iterns E1 Uuough E4. If ihe EJeva�on CeN�Cate is intended fa use as suppor�ng InfortnaUon for a fAMA a LOMR-F,
Sedlon C must be completed.
E1.Buik�ng Diagram Number_(Select the buUdng�a�ram most sMpar to ihe buUding fa wh�h U�is cerUficate is being oanpleted—see pages 6 and 7. If no c�a8ram aocurately
represents the buikiing�Provlde a ske6d�a phoiograph.j ,
E2.The top�the bouom Aoor pndudr�p basement a endosure)oi the buudine is _fl.(m)_in.(cm)O above or O below(check ona)the hfghwt ac�acent grade. (Use
natural grade,�avallab�).
p.For BuU�ng Di�rams 8�8 wiih opeNn9s(see Page��the next higher floor or elevated Aoor(elevaUon b)of the buil�ng is _fl.(m)_in,(cm)above ihe highest ac�aoeM
grade, Compiete iterns C3h and C3.i on front d(am.
E4.The 1op�tha platlam of machinery andla equlpment se�vk�ng the lwildin9 is _ft.(m)_indcm)❑above or ❑below(check one)ihe highest adjaoent grade. (Use
nawral 9rade�If av�lable).
E6.For Zone AO only: if no flood depth number is av�lable,is the lop of fhe bottan floor elevated in accordanoe with ihe communil�s�oodplain managemeni orcqnance?
❑Yes ❑No ❑Unknown. The local oiNdal mustcertffy tt�s i�ortnatian in Sedion G.
__ 8ECTION F•PROPERTY OWNER(OR OWNER'S REPRESENTATNE)CERTIFICATION
Tha Property owner or oumers authoriied representaUve who oompetes SeGions A,8,C(Items C3.h and C3J onlY),and E fa Zone A(wifhout a FEMA-Issued a oarurwnity.
issued BFE�or Zone AO muat sign here. The steterneu�ts!n Ss�ons A,B,�and E are conec,t fo fhe best ofmy knowledga.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME •
��� CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
— ❑Chedc here if attachments
8ECTION G•COMMUNITY INFORMATION(OPTIONAL)
Theloal o�d�who is auU�rized by law a or�nance to ac�ninisterthe corrununiry's floodpl�n management adinarx;e can complete SecUons A,B,C(a E�,and G of it�s EleveUon
Ce�flcate.Canplete the appUcable ltem(s)and sfgn below.
G1.0 The information!n SecU�C was talcen from othe�dxumentation that has baen signed and embossed by a Qcensed surveya,anginaer,or arohitec!who b authorized by stala
or local law io cerlify elevaUon udorrr�aUon. (In�cate ihasou�oe and date of ihe elevaUon data in the Convnents area below.)
GZ�Aaomnx�Nty offldal completed Sec�ion E faa builidinng bcated in Zone A(wiUiout a FEMAissued aoorruiwnity�ssued BFE)or Zone A0.
G3.�Thefdlawing infortna0ai pierns G4�G9)is provfded foroanmunUy floodplain mana�ement pu�pOSes.
(#.PFRhNT NUt�ER G5.pATE pERMIT ISSIIEp G6.pATE CERTIFICATE OF COMPLIANCFJOCCUPIWCY ISSUED
G7.This pe�rnit has been issued ra:�►Veuv consln,c�la, []SubstanUal Impro,►err,ent
G8.Eleva�on of as�buGt lowest flooc(induding basement)of the buUding is: __�.(m) DaUim
G9.BFE a(in Zone AO)depth of floo�ing at the buudiing site i�: ,�_ft.(m) D�um:
LOCAL OFFICIAL'S NAME ;�,. , y TITLE
.. ��
COMMUNITY NAME ,;'',, TELEPHONE
`'`;s: �r �
SIGNATURE ,`:� � DATE
COMMENTS
���1E:L�r-'s1r°"���T �i�
�;6�f+y �� �l,.. -
❑Chedc here if attachments
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