120 BRIGHTWATER DR UNIT 5 � ' ,. FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
' )�f�� NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
�1�� � ELEVATION CERTIFICATE
Important: Read the instructions on pa es 1-7.
SECTION A-PROPERTY OWNER INFORMATION Fa Insuranoe Company Use�
BUILDING OWNER'S NAME Policy Number
MENNA DEVELOPMENT
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bidg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
120-5 BRIGHTWATER DRIVE
CITY STATE ZIP CODE
CLEARWATER BEACH FL 33767
PROPERTY DESCRIPTION(Lot and Biock Numbers,Tax Paroel Number,Legal Description,etc.)
LOT 5,BELLE AQUA VILLAS II �
BUILDING USE(e.g.,Residential,Non-residential,Addi6on,Accessory,etc. Use a Comments area,if necessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS(Type):
( ##°-##'-##.##" or ##.###lJ#� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME 8 COMMUNITY NUMBER B2.CWNTY NAME B3.STATE
CLEARWATER 125096 PINELLAS FLORIDA
64.MAP AND PANEL 87.FIRM PANEL 89.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVEJREVISED DATE B8.FLOOD ZONE(S) (Zone A0,use depC�of flooding)
12509G0102 G 9r031'03 9/03N3 AE 11
610.Indicate the source of the Base Fiood Elevation(BFE)data or base flood depth entered in 69.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Describe):_
611.Indicate the elevation datum used for the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Other(Describe):_
B12.Is the building located in a Coastal Bartier Resources System(CBRS)area or Othervvise Protected Area(OPA)? ❑Yes �No Designa6on Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building eleva6ons are based on:❑Construction Drawings' ❑Building Under Construction' �Finished Construction
� *A new Elevation Certificate will be required when consUuction of the building is complete.
.Buitding Diagtam Number 8(Select the building diagram most similar to the building for which this oe�tificate 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,ARIA,ARIAE,ARIA1-A30,AR/AH,ARIAO
Complete ttems C3.-a-i below aocording to the building diagram speci6ed 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 ihe Commenfs area of
Section D or Section G,as appropriate,to document the datum conve�sion.
Datum NGVD Conversion/Comments
Eleva6on reference mark used LP 10 BNqt1 Does the elevation reference mark used appear on the FIRM? ❑Yes �No
o a)Top of bottom floor(induding basement or endosure) 7. 13 ft(m) � �' '
o b)Top of next higher floor 11.06 ft.(m) � ; f ' ,
o c)Boltom of lowest honzont�structural member(V zones only) �UA._ft.(m) o o ,��,� .�;,
o d)Altached garage(top of slab) 7. 13 ft(m) E� � .
o e)Lowest eleva6on of machinery andlor equipment w;
serviang fhe building(Descnbe in a Comments area) WA._ft.(m) E � M '
o f}Lowest adjacent(finished)grade(LAG) 5.05 ft(m) z'.� ''
o g)Highest adjacent(finished)grade(HAG) 5. 08 ft(m) N� �� 1
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 7 � �S�� �olro(os'
o i)Total area of all permanent openings(800d venL�)in C3.h 1203.29 sq.in.(sq.cm)
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This ceRification 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 certificafe represents my best efforts to interpr�t 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
�ITLE PRESIDENT COMPANY NAME GEORGE A.SHIMP II&ASSOC.,INC
ADDRESS CITY STATE ZIP CODE
3301 DESO BOULEVARD PALM HARBOR FL 34683
SIGN DATE TELEPHONE
JOB N0.050738 9/02/05 727-7845496
FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces all previous editions
IMPORTANT: ln these spaces,copy the coResponding InfoRnation frvm Section A. Fo�i�,��„y�� :
BUILDWG STREET ADQRESS ll�ud'n9 APt,Unil Suite,ar�dlor 8k1g,No.)OR P,O.RCUTE AND BOX N0. Po�Nu[t�er � `
12a5 BRIGHTWATER DRIVE
CftY STATE Z1P CODE
CLEARWATER � � ,;��nYN�UCNufr�er
SECTION D�SURVEYOR,ENGINEPR,OR ARCHITECT CERTIFICATION(CONTINUED)
CopY both sides of this�evaUon Certlfipte fa(1)cc�rtunwity c�fiaal,(2)insurar�ce agenUcomPanY,and(3)buUding owner. •
COMMENTS
❑Chedc here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SiJRVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE�
ForZone AO and Zone A(uuithout BFE),complete Items E1 through E4. If the Elevabon CerUficate is(ntended for use as suppor�ng infoRnation for a LOMA a LOMRf,
Sectlon C must be canpleted.
E1.Building Diagram Number_(Select the buii�ing diagram mast sirraiar to fhe building for which fhis certificate is(�eeing completed—see pages 6 and 7. If no diagram accurately
rep�esents the lwildin9�Provide a sketch a photograph.) .
E2.The top of the bottom floor(induding basement or endosure)of the buUd(ng is _ft.(m)_in.(cm)�above or ❑below(chedc one)the highest adJacent grade. (Use
natu�l grade,if available).
�•�B►�IdittS aa9�►s 6-8 wiih opettings(see page 7�,ihe ne�ct higher floor or elevated hoor(eleva6on b)of the building is _ft.(m)_in,(cm)above fhe highest adjacent
grade. Complete items C3.h�d C3r on front�form.
E4.The top of the pfafffomi of mad�iinery andlor equipment serviang the building is _ft,(m)_In.(cmj[]above or ❑below(chedc one)ihe highest adjacent grade. (Use
naturai grade,!f avaiiable).
E5.For Zone AO oniy: if no flood depth number is available,is fhe top of the boaom 800r elevated in accordance wifh fhe community's floodplain management ordnance?
❑Yes ❑No ❑Unknown. The local offiaal must certify this infart�aGon in Secfion G
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFiCATION
The property owner or owner's authonzed representabye who oompletes Seaons A,8,C(Items C3,h and C3�only),and E for Zone A(wiihout a FEMA-issued or commuNty-
issued BF�or Zone AO must sign he�e. The st�ements in gections q,g,C and F are�to the best of my knowledge,
PROPERTY OWNEf�S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME •
ADORESS C1TY STATE ZJP CODE
SiGNATURE DATE TELEPHONE
COMMENTS
❑Chedc he�e if aitachments
���_ SECTION G•COMMUNITY INFORMATION(OPTIONAL)
The la�offid�who is authcxizec+bv iaw or o�n�ce to admnister the conmurnt�s floodpla�n management or�inance c�n complete Sec�ons A,B,C(w E�,and G of Ihis Elerratlon
CeNficate. Compiefe tfie ap�:".icat�'�.em(sj and sign below.
G1.�The inforrnaLon ir,�ec�ion C.vas taken irom other documentaUon that has been signed and embossed by a licensed surveyor,engineer,or arct�ilect who is authorized by state
or la�l law,c:e�6ay�evation infom�ation. (Indipte the source�d date�the elevation data in fhe Commeni�area below.)
G2.�A community offiaal cnmpleied Sectiwi E for a bu�ding iocated in Zone A(without a FEMA�ssued or community�ssued BFE)or Zone A0.
G3.0 The foibwing(7formaGon(Iterns G4�9)is provided for community floodplain management pu�pOSes.
�4•PERMIT NUMBER G5. pA1'E pERMIT ISSUED G6. DATE CERTIFICATE OF COMPUANCEIOCCUPANCY ISSUED
G"!.This pemtit has been issued for:[J New Cons� ❑SubstanUal Improverr�ent
G8.Elev�ion of as-bu�t lowest floor pnduding basernent)of 1he building is: _,_ft.(m) O�um:
G8.BFE or(in Zone AO)depth af flooding at the b�iding site is: _._ft,(m) Datum:
LOCAL OFFICIAL'S NAME ��
COMMUNITY NAME TELEPHONE
SiGNATURE DATE i
COMMEMS
❑Chedc here if attachments
FEMA Form 81-31.Januarv 2�03 ^--�---- -�---•.r-- - -�. _
, , FEDERALEMERGENCYMANAGEMENTAGENCY O.M.B. No. 3067-0077
� �r- ��(�O NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
���`T"'�� ELEVATION CERTIFICATE
Important: Read the instructions on pa es 1-7.
�} SECTION A-PROPERTY OWNER INFORMATION For Insuranoe Corripany Use:
BUILDING OWNER'S NAME Policy Number
MENNA DEVELOPMENT
BUILDING STREET ADDRESS(Includi�t t Unit,Suite�d/or Bldg.No.)OR P.O.ROUTE AND BOX N0. Company NAIC Number
12a BRIGHTWATER DRIVE
CIN STATE ZIP CODE
CLEARWATER B�fcCFT—' FL 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
LOT 5,BELLE AQUA VILLAS 11 '
BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,if necessary.)
RESIDENTIAL
LATITUDElLONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS(Type):
( ##°-##'-##.##" or ##.#�F°) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME&COMMUNITY NUMBER 82.CWNTY NAME B3.STATE
CLEARWATER 125096 PINELLAS FLORIDA
84.MAP AND PANEL �j f B7.FIRM PANEL 89.&4SE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX 86.FI INDEX ATE EFFECTIVEIREV�SED DATE B8.FLOOD ZONE(S) (Zone A0,use d�ih of flood�g)
� --�3�3-� 9I03/03 AE 11
61 . iq e souroe of the Base Flood Elevation(BFE)data or base flood depth entered in B9.
❑FIS Profile �FIRM ❑Community Determined ❑Olher(Descnbe):_
B11.Indicate ri�e elevation datum used for the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Olher(Describe):_
612.Is the building located in a Coastal Bamer Resourt�s System(CBRS)area or Othervuise Protected Area(OPA)? ❑Yes �No Des' ation Date
SECTivti�-SuiL^vii:u Ei.�vl�i ii�iv ii�FGriRRATi�Fi(SiiK'vtr REcliiit"�"uj
C1.Building elevations are based on:�Conshuction Drawings` ❑Building Under Construction' �Finished Construction
` `A new Elevation Certificate will be required when oonstruction of the building is complete.
�'1.Building Diagram Number 8(Selecx the building diagr�n most similar to the building for which this oer�ficate is being complehed-see pages 6 and 7. If no diagram
accurately represents the buikling,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,AR/AH,AR/AO
Complete Items C3:a-i below aocording ho the building diagram speafied in Item C2.State the datum used.If the datum is difterent from the datum used for ihe BFE in
Section B,convert the datum to that used for the BFE.Show field measuremenls and datum conversion caiculation. Use the space provided or the Commenfs area of
Section D or Section G,as a�ropnate,to da:ument ihe dah�m conversion. __ _ _
_ ---- -- _ __ . _
Datum NGVD CornersionlComments ���� .
Elevation reference mark used LP 10 BNf�1 Does the elevation reference mark used appear on the FIRM? ❑Yes �No �" {i � ��� ,;
o a)Top of botbm floor(induding basement or endosure) 7. 13 ft.(m) �; ��`���t�'�, ,�.,'�
o b)Top of next higher floor 11.O6 ft(m) `� "'F-
o c)Boltom of lowest horizontal structural member(V zones only) �UA._ft.(m) °1 °' A� .
o d)Attached garage(top of slab) 7. 13 R(m) �� `��. , ���.
o e)Lowest elevabon of machinery andlor equipment �� °, 'r. { ^ �
servicing the building(Desaibe in a Comments area) WA._ft(m) a '
o �Lowest adjacent(finished)grade(LAG) 5.05 ft(m) z' � �"� �'�'
`� �.
o g)Highest adjacent(finished)grade(HAG) 5. 08 f t(m) �� r:s� " ; � k,,,
�.:.�,
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 7 J ZS�� �o
o i Total area of all rmanent ni s fiood vents in C3.h 120329 �=
) Pe � �9 � ) 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 certify that the information in Sections A,8,and C on this certificate represenfs my best efforts to inte�pret the data availa6le.
i undersfand thaf any false sfatement may be punishable by fine or imprisonmenf 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 BOULEVARD PALM HARBOR FL 34683
SIGN DATE TELEPHONE
JOB N0.050738 9/02/05 727-7845496
FEMA Form 81-31,January 2003 See reverse side for continuation. Reolaces all�revious editinns
IMI'URTANT: in thesa spaces,copy the coResponding information from Section A. For�nswancaCatnpanyuse -"
BUILDWG STREET ADDRESS(Ir�udin9 APt�Unk,Sui�,ar�/or 61dg.No.)OR P.O.R011T'E AND 80X N0, Po�c,y Nur�er • .
120-5 BRIGHTWATER DRIVE -- _
CiIY STATE Z!P CODE
CLEARWATER � � CompanYl�AIGNtur�ber - -
— ,_�,. ,..;.,_:,.._;
SECTiON D•SURVEYOR,ENGINEER,OR ARCHITECT CERT1FiCATION(CONTINUED)
�PY both sides of this E3evaUon Ce�ificate fa(1)cortununity offiaal,(2)fnsurance agenUcomPanY�and(3)bu�ding owner. �
COMMEMS
❑Chedc here i€attachments
SECTION E-BUIIDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE�
For Zone AO and Zone A(without BFE),complete Items E1 through E4. �the Dev�ion Ce�tifipte is intended fa use as supporting infoRnation for a LOMA a LOMRf,
Sectlon C must be canpleted.
E1.Building Diagram Nwnber_(Select the building�agram rr�t sirrWar to fhe bu�ding for which ihis certificate is being completed—see pages 6 and 7. if no diagr�n accurately
represents the buiiding�Arovide a sketch a photograph.) -
E2.The top�the bottpm tb�(i�lu�g base�t�endosure)�ihe buiidfn9ls _ft.(m)_in•(cm)Q above or ❑below(chedc one)the highest a�acent grade. (Use
natUfal grade,�aV�lable).
a.For Buil�n9 Dia9rams 6�8 with openings(see page�,(he next higher floor o�elevated tbor(elevation b)of fhe build(ng is _ft.(m)_in.(cm)above fhe highest�acent
9rade. Complete items C3.h and C31 on frnnt of fam
E4.The top of 1he plalfam of machinery andlor equipment serviang the bu�ding is _ft.(m)_In,(cm)[]above a' ❑below(chedc one)the highest ad�ace�tt grade. (Use
naturai grade,if av�labfe).
E5.For Zone AO only: If no flood depth number is available,is fhe top of the bottan fbor devated in acmrdance wifh fhe commwitys noodpiain management ordnance7
❑Yes ❑No ❑Unknovm. The local of�ial must ce�iiy this i�ormation in Section G
_ SECTION F•PROPERTY OWNER(OR OWNER'S REPRESENTATNE)CERT1FiCATION
�W°P�Y°'��a'°�"�ei's authausd reExesenl�ve who completes Sedions A,B,C(Ite.ms C3.h and C3J only),and E for Zone A(without a FEh1A-issued or canmuNty-
issued BFE)o�Zone AO must sign he�e. The st�emeMs in Sectrons A,8,C ar�d E are cwrect fo the 6est of my knowledge.
PROPERTY OWNE�S OR OWNER'S AUTHORIZED REpRESENTATIVE'S NAME
ADORESS CITY STATE Z1P CODE �
SIGNATURE D,qTE TELEPHONE
COMMENTS ,
❑Chedc he�e if attachments
SECTION G-COMMUNITY INFORMATION(OPT(ONAL)
The bal offiaal who is authorizad by iaw a ordnance to administer the carmurut�s floodptain management ordnance can canplete Seciions A,B,C(a E���d G af Uus Elevatla�
CerGficats.Compiete�is applicabls a�ern(s�and sign below.
G1.C�The infamatiai u�+�Seclio�i C�,was taken from otl�documentation that has been signed and embossed by a Gcensed surveyo��engineer,or ard�it�t who is authorized by state
or local law to�ip�ev2fion i�fermation. (IncGcate ihe sauce and date of ihe elevatiai data in fhe Conunents area below,j
G2.�A corrurwnity offid�cnrnpleied S�n E for a building located ln Zone A(without a FEMA-issued or conmunity-issued BFE)or Zone A0.
G3.[]The following ir�fo�pa�on(Items G4-G9)is provided fa community floodplain mana9eme�nt purp��s.
G4.PERANT NUMBER G5. DATE PERMIT ISSUED G6.DATE CERTIEICATE OF COMPLUWCEIOCCUPANCY ISSUED
G7.m�s perr„it nas been issued t«:p N�v c«,stn�fiai p substar►tial Improvement
G8.Dev�ion�as-6�t lowest floa(kx�ud'u�g b�err�ent)of t�e building is: _:_�.(m) Datum:
G9.BFE o�(in Zone AO)deptli of floodng af the bu�ng site is: _._ft.(m) D�um:
LOCAL OFFICIAL'S NAME �
COMMUNITY NAME TELEPHONE
SIGNATURE DATE •
COMMEMS
❑Checfcc here if attachments
FEMA Fotm 81-31.Januarv 2003 ^--�---- -^-----,---- -,,.._ .
' ' . .
A�''!
t�► !'�t
41���1`'�L�c��� C I T Y O F C L E A R W A T E R
�'�° I
� ,���y�\� i, �„ �;,
�'r'a _.� "��
„�� ___ _ p` DEVELOPMENT & NEIGHBORHOOD SERVICES DEPARTMENT
v
:;��o�� --� ,ti �`1
,�����-�y�t�`�$�� POST OFFICE BOX 474H� CLEARWATER� F�oa,Dn 33758-4748
�--.qTE�,�1�� MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CLFARWATER,FLO�uDn 33756
�•'��`�,r� TELEPHONE��]2� 5�2-4567 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 ceRificates 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 5
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 ##.#�1###°) ❑ 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 83.STATE
64.MAP AND PANEL 67.FIRM PANEL 69.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVE/REVISED DATE B8�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 ❑ FIRM ❑ Community Determined ❑Other(Describe)
B11. Indicate elevation datum used for BFE in B9: ❑ NGVD 1929 ❑ NAVD 1988 ❑Other(Describe)
612. Is the buildin 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 eievations 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,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)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 O�cial:
�e/evafion certificates shall 6e maintained by the community and copies with the attached memo made available by request
FRANK HIARARD,MAYOR
GEORGE N.CRE7'EKOS,COUNCILMEMBER JOIIN DORAN,COUNCILMEMBER
PAUL F.GIBSON,COUNCILMEMRER � CARLCN A.PE7'@RSEN,COUNCILMEMBER
��EQUAL EMYLOYMEN'P AND AFFII2MA17VE AC1'ION EMYLOYER��
� • � � � FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
• ' NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
ELEVATION CERTIFICATE
� O1Q�3--� Im rtant: Read the instructions on a es 1-7.
SECTION A•PROPERTY OWNER INFORMATION Fa Insurar�oe Can�►y Use:
BUILDING OWNER'S NAME Policy Number
MENNA DEVELOPMENT
BUILDING STREETADDRESS pncluding Apt,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
120-5 BRIGHIWATER DRIVE
CITY STATE ZIP CODE
CLEARWATER FL 34630
PROPERTY DESCRIPTION(Lot and Blodc Numbers,Tax Parcel Number,Legal Description,etc.)
LOT 5,BELLE AQUA VILLAS II
BUILDING USE(e.g.,Residential,Non-residential,Addition,Acxsssory,etc. Use a Comments area,if neoessary.)
RESIDENTIAL
LATITUDEILONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS(Type):
( #�°-##'-##.#�' or �1#.#t�##' ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
81.NFIP COMMUNITY NANIE&CONWIUNITY NUMBER B2.COUNTY NAME B3.STATE
CIIY OF CLEARWATER 125096 PINELLAS FLORIDA
B4.MAP AND PANEL 67.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6.FIRM INOEX DATE EFFECTIVEIREVISED DATE 88.FLOOD ZONE(S) (Zaie A0,use deplh�floodQg)
12509Cr0007 D 8/19/91 8119(91 AE 11
B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9.
❑FIS Profile ❑FIRM ❑Community Detertnined ❑Other(Desaibel:
611.Indicate the elevation datum used for the BFE in 89;�NGVD 1929 ❑NAV01988 ❑Other(Desaibe);
B12.Is the building located in a Coastal Barrier ResourGes System(CBRS)area or Othervuise Protected Area(OPA)7 ❑Yes �No Designation Date
SECTION C•BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building�evations are based on:�Constniction Orawings" �Building Under Construction' ❑Fnished Construction
'A new Elevation CerUficate will be required when constn�ction of the building is oomplete.
•C2.Building Diagram Number 8(Select the building diagram most similar to the building for which this cerfificate is being canpleted-see pages 6 and 7. If no diagram
aocurately represents the buikJing,provide a sketch or photograph.)
C3.EJevations—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 accading 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
Section B,convert the datum to that used fa the BFE.Show fidd measurements and datum conversion calculation. Use the space provided or the Comments area of
Section D a Section G,as appropriate,to document the datum conversion.
Datum ConversionlComments
Elevatlon referenoe mark used tP 10 BM#1 Does the elevation reference madc used appear on the FIRM? ❑Yes �No
o a)Top of bottom floor(induding basement or endosure) 7.13 ft,(m) �
o b)Top of next higher floa 11.OB ft.(m) �'
o c)Bottom of lowest horizontal sUuctural member(V iones only) NA._ft.(m) �o
o d)Attached garage(top of slab) 7. 13 ft,(m) E�
o e)Lowest elevation of machinery andlor equipment W;
serviang the building(Describe in a Comments area) NA._ft.(m) E�
o fl Lowest adjaoent(finished)grade(LAG) 5.05 ft,(m) z'�
o g)Highest adjacent(finished)grade(HAG) 5. 08 ft.(m) � #2512 5/02105
o h)No,of permanent openings(flood vents)within 1 ft.above adjaoent grade 7 �
o i)Total area�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 ceRify etevation information,
I certify that the information in Sections A,8,and C on this certi�cate represents my best efforts to interpret fhe data available.
I understand fhat any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001,
CERTIFIER'S NAME �EORGE A.SHIMP II LICENSE NUMBER 2512
TITLE PRESIDENT COMPANY NAME GEORGE A.SHIMP II&ASSOC.,INC
* ADDRESS CITY STATE ZIP CODE
3301 DESOTO ULEVARD PALM HARBOR FL 34683
SIGNAT DATE TELEPHONE
JOB N0.050242-E 05/02/05 727-784-5496
FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces all previous editions
IMPORTANT: In these s aces,co the corres ndin informatlon from Section A. ' For�nswance Cornpany use. • , .
BUILDWG STREETADORESS(Indudirg Apt,Urrdt„Sui�,andlarBlde.No.)OR P.O.R011rE AND BOX N0, Pol�y Nwt�b9�' •
12a5 BRIGHTWATER DRIVE
� STATE ZIP CODE ;,
CLEARWATER � � ,�Y,�N��,�; � ��u:�`
,_.
_ 3ECTION D•SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
�PY both aides of ihis Elev�lon Certlficate for(1)oanmunity offidal,(2)insuranoe agenUcompany,and(3)bu�ding owner. •
COMMENTS
❑Chedc here if altac�menta
_ SECTION E•BUILDINO ELEVATION INFORMATION{SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE7
ForZone AO ar�i Zone A(wlU�out BFE),oompl�e Items E1 ttuough E4. If the Elevatlon CerUl�ate is Intended for use as suPpor�n9lniormation for a LAMA or LAMRf,
Sedion C must be completed.
E1.Buuding Diagram Number_(Salect Uie buUdir�g diagram most sM�ar to tl�e building for whk;h ih(s certificate is being oorripleled—sea pages 6 and 7. If no diagrarn accuralely
representa ihe buik9ng�Prov(de a sketch a photagraph,)
E2.The top af the boflom Aoa(induding baserr�ent or endosure)of ihe buUdin9 is _ft.(m)_in.(cm)O above or ❑below(chedc one)Ihe highest adjaoenl gtade. (Use
t18tUf81 Qf8d8,�f 8v811�1e).
E3.Fa Building Olaprams 6�8 wifh openin9s(�P��,ihe next higher floor a elevated floor(elevaUon b)of the buil�ng(s _it.(m)_in.(an)above ihe highest a�acent
9rade. Cornplete ttems p.h and p1 on front of form.
E4.Theiop of the plaiffam�machinery andlorequipment servidng the buiiding fs _ft(m)_in.(an)[�above or ❑below(chedc one)Ihe hfghest adjace�tt grade. (Use
natural grade,if available).
Eb.For Zone AO or�y: If no flaod depth number is av�lable,is the top of the botlom Aoor elevated in acoordance with the oommunity's noodplain mana�ement ordinance?
❑Yea ❑No ❑Unknown. The locai oifldal�stcerlify this infamaUon in SecUon G
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
�ProP�Y��'�'�'s authaized representative who oompletes SecUons A,B,C(Items C3.h and C3J oNy),and E for Zone A(wilhout a FEMAassued a communiry-
lesued BFE�a Zone AO must sign he�e. The sfafernanta In Secdons q,B,G and E are carecf fo the best of my knowleafge,
PROPERTY OWNER'S OR OVYNEI7S AUTHOWZED REPRESENTATIVES NAME •
ADDRESS CITY STATE 7Jp COpE
SIGNATURE DATE TELEPHONE
COMMENTS
❑Chedc here If attad�ments
_ SECTION t3•COMMUNITY INFORMATION(OPTIONAL) �--
The bcal offl�dal who Is authonzed by lawaord�n�oe lo administer the carmuniry's floodplain management or�nance can complete SecUons A,B,C(a�,and G of ihls Elevatlon
Certlflc;ate,Complete iha app�Cable ilern(s)and sign b�ow.
G1.[�The infortnation in SecUon C was taken from oiher documentation Uiat has been si�gned and embossed by a lioensed surveyo�,engineer�or arc��ilec�who is autliodzed by state
or local law to cer�y elevailon infortnaUan, (Ind�cate ihe souroe and date of the elevaUon data in the Commenls area below,)
G2.[]A cortu�wn(ly of�Cial oompleted Sedbn E fa a bu�ding bcated In 7:one A(without a FEMA�SSUed a c�rnwnity-issued BFE)ar Zone A0.
G3.0 The foUowing infamaUon(Items G4�G9)is provided fa oornmunfiy Aoodplain management purposes,
G4.PERANT NUMBER G5.DATE PERMIT ISSUED G6.DATE CERTIFICATE OF CONIPLIANCEJOCCUPANCY ISSUED
G7.This permit has been isstred for:[]New Construdbn ❑Substantiai Improvement
G8.Elevatlon of as-built lowest floor(induding basemenq of Uie building is: __fldml Datum;
G8.BFE o�(In Zone AO)depih�Aooding at the bu�ding site is: �_f4(m) OaUim:
LOCALOFFICIAL'S NAME � �, TITIE
�`"' �� 1��
COMMUNITY NAME � � `� TELEPHONE
�;M��.
SIGNATURE ��C Z � DATE �
COMMENTS
C3F=`i�1 ���a¢,i�e5,��'° ; 6^;
!`�Y" C)� �CL�A��JV�TE�
- ❑Chedc nere if a�ad�ments
FFMO Fnrm n1_Z� ��..�......�nne