125 BRIGHTWATER DR UNIT 1 ti
� • , FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
� � NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
��� 3 - � a Iq a ELEVATION CERTIFICATE
Important: Read the instructions on pa es 1-7.
-_ - - SECTION A-PROPERTY OWNER INFORMATION Fa Insurance Canpany Use:
BUILDING L�WNER'S NAME Policy Number
MENNA DEVELOPMENT
BUILDING STREET ADDRESS Qncluding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
125-1 BRIGHNVATER DRIVE
CIN STATE ZIP CODE
CLEARWATER BEACH FL 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Descrip6on,etc.)
LOT 6,BELLE AQUA VILLAS I
BUILDING USE(e.g.,Residen6al,Non-r�esidentiai,Addition,Accessory,etc. Use a Comments area,if necessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS(Type):
( ##°-##'-##.##" or #tk.##ft##°) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME&COMMUNITY NUMBER 82.COUNTY NAME 63.STATE
CLEARWATER 125095 P�NELLAS FLORIDA
84.MAP AND PANEL B7.FIRM PANEL 89.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX 86.FIRM INDEX DATE EFFECTIVEJREVISED DATE B8.FLOOD ZONE(S) (Zone A0,use deplh of flooding)
12509G4007 D 8119�91 811951 AE t 1
810.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in 89.
❑FIS Profile �FIRM ❑Community Detertnined ❑Other(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 Protected Area(OPA)? ❑Yes �No Designa6on 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 construc6on of the building is complete.
.Building Diagram Number 8(Select the building diagram most similar to the building for which tt�is oertificate 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,AR/AE,ARIA1-A30,AR/AH,ARIAO
Complete Items C3.-a-i below accorcling ho the building diagram specfied in Item C2.State the datum used.If the datum is different hom the datum used for the BFE in
Section B,convert the datum to that used for the BFE.Show field measuremenLs and datum conversion qlcula6on. Use the space provided or the Comments area of
Section D or Section G,as appropriate,to document the dah�m conversion.
Datum NGVD ConversionlComments
Eleva6on reference mark used LP 10 BNF�1 Does the elevatlon reference mark used appear on the FIRM? ❑Yes �No
o a)Top of bottom floor(induding basement or endosure) 7. 11 ft(m) � _;";3 ;
o b)Top of next higher floor 11.00 ft(m) � " ` �,`,.' "�''
o c)Bottom of lowest honzontal stluch�ral member(V zones only) WA._ft.(m) o o • -`�`'
o d)Attached garage(top of slab) 7. 11 ft(m) E� '� ; ;' _
o e)Lowest elevation of machinery andlor equipment W v � � °
f'S
servidng the building(Describe in a Comments area) rUA._ft.(m) E� '} s a���'' '
o �Lowest adjacent(finished)grade(LAG) 5.42 fl.(m) z'� a�°�`
o g)Highest adjacent(finished)grade(HAG) 5. 64 ft(m) � ' `' ,�;;';;-'°
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 7 � ,q,f�2 ���Of°�'
.. ..
o i)Total area of�I permanent openings(flood venLs)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 certify elevation information.
1 certify that the information in Sections A,B,and C on this certificate represents my besf efforts to interpret the data available.
1 undersfand 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&ASSOC.,INC
ADDRESS CITY STATE ZIP CODE
3301 DESOTO BOULEVARD PALM HARBOR FL 34683
SIGNATU DATE TELEPHONE
B N0.050242 7128105 727-784-5496
FEMA Form 81-31,January 2003 See reverse side for continuation. Repiaces all previous editions
a
�
IMPORTAN?: Ir these s�aces,copy the�orresponding inrormafion from Seciion A. �G�nsuiai�ce Ccmpany�s�. : � -
3UIL�ING STrZ��ADDRESS(inducirg?,pt,Unr�Sui�,and/or 3k1�.Na dn?�.RCU?�AND 30X N0.
1 � ,, �-�^ ) P�iicfNumder
.2., F �3RIGn�N�,�n DRIVc
�L=ARWA i�R 9�CH S�A�- Zl?COuE ;omoany rlAIC Numo=r
�� 33707
SECTION D-SURVEYOR,ENGINEtR,OR ARCHITECT CERTIFICATION(CONTINUED} •
Cooy 5oth sides of fhis Fievaiion Ceruncate ror(1 i�mmuniry oficiai,(2;insurar,�age�t�campany;and(3}ouilding owner.
�OMMEN i S --
❑Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NQT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zone AO and Zone A(without 8F�),compfete Items�1 through E4. If the Eievation Cerimca'te is intended tor use as suoeorting information for a LOMA or LOMR-F,
Secaon C must be comoleied.
�1.Building Diagram Numoer_(Sefect the buifding diagram most similar'to the ouiiding ror which this certificate is being completed-s2e pages 5 and 7. If no diagram ac�rately
rearesents the building,provide a skeich or pho'tograph.)
c2.Tne top of the bottom floor(induding baszment or endosurej of the building is _ft.(m)_in.(cm)�ai�ove or ❑oelow�check one)the highest adjac2nt grade. (Use
natural grade,if available),
E3.i=or Building Diagrams 6�with openings(see page 7),the next higherfloor or efevated floor(eievation b)or the building is _ft.(m)_In.(cm)above the highest adja�nt
grade. Complete items C3h and C3.i on front of form.
E4.The top oT the plafform of machinery andlor�uipment servicing the ouilding is _ft.(m)_in.(cml 0 above or ❑below(check one)the hiahest adiacent arade. (Use
natural grade,if available).
�5.For Zone AO only: If no flood depth number is available,is the top of the bcttom floor elevated in ae,ordance with the community's floodolain management or�inance?
❑Yes ❑No ❑Unknown. The local official must certify this Informauon in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owners authonzed represerrta6ve who completes Secoons A,B,C(Items C3.h and C3.i only),and E for Zone A(without a�EMA�ssued or community-
issued BFc�or Zone AO must sian here, i7�e sfafement�in Secfions A,8,C,and t are correcf io the t�eesf of my knowledge. •
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE Z1P CODE
SIGNATURE DATC TELCPHONE
COiViMENTS
❑Check here if attachments
SECTION G•COMMUNITY 1NFORMATION(OPTIONAL)
The local o�.CGaI�nmo is�u�nonze�:;y la ��r ordinance to administer the communitys floodplain management ordinance can complete Secfions A,B,C(or E),and G of this c�eva6on
Certificate. '-bmFi:te'ti�-d�pficabF;iterr;�)and sign below.
G i.❑i he informaaor��"'ecti�,C w�.s taken from other documeniation thai has been signed antl embossed by a iicensed surveyor,engineer,or architect wno is authorized by state
or iocai!aw to cefify�ievatior,;nformaaon. (Indicate the sour�e and date or the elevation data in the Comments area oelow.j
G2.❑A communin��ificial�mpleied Seciion E for a building located in Zone A(without a FEMA-issued or community-issued BFE;or Zone AG,
G3.❑The rolfowing i�rormauor(items G4-G9)is provided for�mmunity floodpiain management purposes.
G4.PERMIT NUMBER � G5. DATE PERM�ISSUED G&. DATE CERTIFICATE OF COMPLIANCFJOCCUPANCY ISSUED
i �
G7.This permit has been issued for.0 New Construction ❑Substantial Improvement
G8.cievation of as-ouiit towest floor(induding basement)or the ouilding is: _._;t,(mj Datum:
G9.BFt or(in Zone AO)depth of flooding at the buiiding site is: _ _ft.(m) �atum:
!OCAL OF=ICIAL'S NAME TITL�
COMMUNITI'NA.ME �E�FFHONE •
SIGNATURE pA i�
COMMENTS
❑Check here if attacnments
�_MA Form 81-31,January 2003 Rephaces all previous editions
� r
. � FEDERALEMERGENCYMANAGEMENTAGENCY O.M.B. No. 3067-0077
. NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
��� 3 - ►a Iq a ELEVATION CERTIFICATE
Important: Read the instructions on pages 1-7.
• - • SECTION A-PROPERTY OWNER INFORMATION Fa Insurance Corr�any Use:
ILDING OWNER'S NAME Policy Number
MENNA DEVELOPMENT
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,andlor Bidg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
125-1 BRIGHTWATER DRIVE
CIT`( STATE ZIP CODE
CLEARWATER BZfRC1'I"� FL 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
LOT 6,BELLE AQUA VILLAS I
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 Ma
p ❑Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
81.NFIP COMMUNITY NAME 8 COMMUNIN NUMBER B2.COUNIY NAME B3.STATE
CLEARWATER 125095 PINELLAS FLORIDA
84.MAP AND PANEL °'/ -- - B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER 85.SUFFIX B6.FIRM INDEX DATE EFFECTIVEIREVISED DATE B8.F100D ZONE(S) (Zone A0,use deptt�of flooding)
1250960007 D "'�' 8119�91 AE 11
610.Indicate the source of the Base Flood Elevation(BFE)dat�or base flood depth entered in 89.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Descxibe):
B11.Indicate the eleva6on datum used for the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Other(Describe):_
812.Is the building located in a Coastal Bamer Resources System(CBRS)area or Othervvise Protected Area(OPA)? ❑Yes �No Des' nation Dabe
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
Ci.Building elevations are based on:�ConstnKfion Drawings" ❑Building Under Construction' �Finished ConsUuction
*A new Elevation Certificate will be required when constn�ction of the building is compiete.
�uilding Diagram Number 8(Select the building diagrarn most similar to the building for which this cer�ficate is being completed-see pages 6 and 7. If no diagr�n
accurately represents the building,provide a sketch or photograph.)
C3.Elevatlons—Zones A1 A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AWA,AR/AE,AWA1-A30,AR/AH,ARIAO
Complete Items C3:a-i bebw accarding b ihe building diagram speafied in Item C2.State ihe datum used.If the datum is different from the datum used for fhe BFE in
Section B,convert the datum to that used for the BFE.Show field measuremenls and datum conversion ca�ula6on. Use the space provided or the Comments area of
Section D or Section G,as appropriate,to document the dah�m conversion.
Datum NGVD ConversionlComments
Elevation reference mark used LP 10 BNt�1 Does me elevation reference mark used appear on the FIRM? ❑Yes �No _
o a)Top of bottom floor(induding basement or endosure) 7. 11 ft(m) �
d
o b)Top of ne�higher floor 11.00 ft(m) � �` M;
o c)Boflom of lowest horizontal structurai member(V zones only) WA._ft(m) N�' ""�'' -
o d)Attached garage(top of slab) 7. 11 ft(m) E� ' : � ' � :
o e)Lowest elevation of machinery andlor equipment W � -°�
servicing the building(Describe in a Comments area) WA._ft.(m) �' �"':+ 7', �
o �Lowest adjacent(finished)grade(LAG) 5.42 ft(m) z'� `� � �
o g)Highest adjacent(finished)grade(HAG) 5. 64 ft.(m) �� �'`' � xri , ,``
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 7 J ,�r Z �e/re�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.
1 certify that the information rn Sections A,B,and C on this certificate r�presents my best efforts to inferpret fhe data available.
I understand fhat any false statement may be punisha6le by fine or imprisonmenf under 18 U.S.Code Section 1001
CERTIFIER'S NAME GEORGE A.SHIMP II LICENSE NUMBER 2512
�E PRESIDENT COMPANY NAME GEORGE A SHIMP II&ASSOC.,INC
�)DRESS CITY STATE ZIP CODE
3301 DESOTO BOULEVARD PALM HARBOR FL 34683
SIGNATU DATE TELEPHONE
B N0.050242 712&�05 727-784-5496
FG�AA Cnrm A1_1� lo..��-,...'�l1M n__ '_"'___ _��_ `__ __ ..�. _��. _ . _ .
,
1MPORTAI�IT: in these spaces,copy the�rresponding iniormaiion rrom Section A. ra�nsuraneecomrzny�s�: • .
BUILDING STRE^ADDr2ESS(fnduairx�Ani,Un'r�Sui�,and/or BI�.Nc.)OR?�.RO�Tc AND 30X N0. �auc�Numoer
125-� BRIGHT1NAi�R DRIVE -
CT' STA i� ZIP CODE ':;om�nv�:91G Num�c
CL=ARWR i tR B;�CH �! 33707 -_ f
SECTION D-SURVEYOR,ENGINECR,OR ARCH(TECT CERTIFICATION(CONTINUED) '•
Cooy both sides o��his Jevaiion Cerimcate ror(1)�mmuniry ofiiGal;(2;insurar�agenU�mpany,and�3j ouiiding owner.
COMMENTS --
❑Check here if at�achments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zone AO and Zone A(without BF�,compiete Items E1 through t4. If the Elevauon CerVncate is intended for use zs supoor�ng informauon for a LOMA or LOMR-F,
Secuon C musf be comoleted.
E1.Building Diaoram Number_(Selec;the building diagram most similar to the building for which this certi6cate is being canpleted—s2e pages 6 and 7. If no diagram ac�uratery
repres�nts the'twildng,provide a ske'tch or phoiograph.)
E2.The top of the bottom�1oor(induding basement or endasure)of the buiiding is _Y�(m)_in.(cm)❑above or ❑oelow(check onel the hiahest ad'}acznt grade. (Use
ratural grade,'rf available).
E3.For Building Diagrams 6�with openings(see page�,the nexi higherfloor or elevated floor(elevanon b)of the building is _ft.(m)_in.(cm)above the highest ada�nt
grade. Complete ifems C3.h and C3.i on front of form.
E4.The top o�the plafform of machinery and/or equipment servianq the buikfing is _ft.fm)_in.(cm)�above or ❑below(�edc onel the hiohest adiacent orade. (Use
natural grade,R available).
�5.For Zone AO only. If no floo;depth numoer is available,is the top of the bottom floor eleva'ted in a�ordance with the communitys floodplain management ordinan�?
❑Yes ❑No ❑Unknown. The local offiaal must cernfy this ir�ormaaon in Secuon G.
SECTION F-PROPERTY OWNEt�(OR OWNER'S REPRESEM'ATNE)CcRTIFiCATION
The property owner or owners authonzed reoreszntative who�mpietes SEC6ons A,B,C(Items C3.h and C3.i only),and E for Zone A(without a�EMA�ssued or canmunity-
issued BF�j or Zone AO must sign hera. i he statemenfs in Secnons A,Q C,and c are corrzcf ro the best of my knowledge. `.
PROPERTY OWNER'S OP.OWNER'S AllTHORIZ�REPRESENTA;IVE'S NAME
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
CO�IMENTS
❑Chedc here if attachments
SECTiON G-COMMUNfTY INFORMATION(OPTIONAL)
The local of��al who is.aUi�onz�by la.��r ordinance to adminisier the communitys floodplain management ordinance can complete Secoons A,B,C(or E�,and G oT this r7eva�on
Cer6ficate, �:omFlete;�,�a�pficaE!,iterr.(�)and sign below.
G1.❑The informauoc��''.ecti�;C w�s taken from other documen[ation that has been signed and embossed by a licensed surveyor,engineer,or archiiect wno is authonzed by state
or ioc�i faw to cer"t'rfy::ievaafio�,`niorma6on. (Indicaie the source and date of the elevation data in the Comments area below.)
G2.�A commurnN�offiaai�mpleted Secuon E r'or a buifding locaied in Zone A lwithout a FEMA-issued or communify-issued BF�or Zone A0,
G3.❑i he rollowing inrormation(Items G4-G9)is provided for�mmunity floodplain management purposes.
G4.PERMIT NUMBER I G5. DATE PERMfi ISSUED G6. DATE CER�IFICATE OF CONiPLIANCFJOCCUPANCY ISSUED
�
G7,This permit has been issued for.0 New Construc6on ❑Substanual Improvement
G8.Elevauon of as-builf lowest floor(nduding basement)of the ouilding is: _._ft.(m) Daium:
G9.BFE or(in�ne AO)depth of flooding at the buiiding sife is: _ _ft.(m) Datum:
LOCAL OFFICIAL'S NAME T1TL�
COMMUNITY NA.ME T�LEFHONE
SIGIVATURE DATE �
COMMEIV�S
❑Checic here if atfachments
. • .
� ��.��„
����' � CITYOFCLEARWATER
• �r,��a � ; �,,�� , .
�^�Y 4 � ,
�A^�,.rc �� � DEVELOPMENT & NEIGHBORHOGD SERVICES DEPARTMENT
, .�� h .
POST OFFICE BOX 474g� CLEARWATER� FLO�Dn 33758-4748
���� � MUNICIPAL SERVICES BUILDING, ZOO SOUTH MYRTLE AVENUE,CI.FARWATER,FLO�unn 33756
TELErxoNE(72� 562-4567 Fn�(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 shali 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 sedion(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(inciuding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
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
NFIP COMMUNITY NAME&COMMUNITY NUMBER 82.COUNTY NAME 63.STATE
B4.MAP AND PANEL B7.FIRM PANEL 89.BASE FLOOD ELEVATION(S)
NUMBER g5.SUFFIX 66.FIRM INDEX DATE EFFECTIVE/REVISED DATE BS.FLOOD ZONE(S) �Zone AO,use depth of flooding)
8/18/1992
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)
B11. 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 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 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)1ft.above adjencent grade
i) Total area of all permanent openings(flood vents)in C3.h sq.in.(sq.cm)
Comments:
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 HIBAARD,MAYOR
GEORGE N.CRE7'EKOS,COUNCILMGMBER JOIIN DORAN,COUNCILMEMBER
PAUL F.GIBSON,COUNCILMEMRGR � CARI.EN A.PE"1'ERSEN,COUNCILM@MRER
��EQUAL EMPLOYMENT AND AFFIftMA1'IVE AC1'ION EMPLOYER��
, , FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
.
- , NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
' ' f ����� �a��a ELEVATION CERTIFICATE
Im ortant: Read the instructions on a es 1-7.
SECTION A-PROPERTY OWNER INFORMATION Forinsurance Comparry 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
125-1 BRIGH'i1NATER DRIVE
C� STATE ZIP CODE
CLEARWATER FL 34630
PROPERTY DESCRIPTION(Lot and Biocic Numbers,Tax Parcel Number,legal Description,etc.)
LOT 1,BELLE AQUA VILLAS I
BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,eta Use a Comments area,if necessary.)
RESIDENTIAL •
LATITUDEILONGITUDE(OPTIONAL) HORIZONTAL DA7UM: SOURCE: GPS(Type):
� ##°-##'-##•##" ar ##.#►�� ❑NAD 1927 ❑NP,D 1983 ❑USGS Quad Map ❑Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61.NFIP COMMl1NITY NAME&COMMUNITY NUMBER 82 CWNTY NAME 83.STATE
CITY OF CLEARWATER 125096 PWELLAS FLORIDA
84.MAP AND PANEL B7.FIRM PANEL 89.SASE FLOOD ELEVATION(S)
NUMBER 85.SUFFIX B6.FIRM IN�EX DATE EFFECTIVEIREVISEO DATE 88.FLOOD ZONE(S) (Zone A0,use depih�flooding)
1250960007 D 8119/91 &119/91 AE 11
B10.Indicate the sauca of fhe Base Fiood Elevation(BFE)data or base flood depth entered in B9.
❑F1S Profile ❑F1RM ❑Community Determined ❑Ofher(Describe):
811.Indicate the elevation datum used for the BFE in B9.�NGVD 1929 ❑NAVD 1988 ❑Ofher(Describe):
812.Is the building located in a Coastal Bamer ResourCes System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No Desi na6on Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevaUons are based on:0 Construction Drawings' �Building Under Construc6on' ❑Fnished ConsUuction
`A new FJevafion Certificate will be required when construc�on of the building is complete.
�2.Building Diagram Number 8(Select fhe building diagram most similar to fhe building for which fhis certiflcate is being completed-see pages 6 and 7, If no diagram
accurately represents the buiiding,provide a sketch or photograph.)
C3.ElevaUons—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AWA,AWAE,AR/A1-A30,AR/AH,AWAO
Complete Items C3.-ai below ac,cording to fhe budding diagram specified in Item C2.State the datum used.If the datum is different from fhe 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 fhe space provided a the Comments area of
Sec6on D or Section G,as appropriate,to document the datum conversion.
Datum_ ConversionlComments
Elevation�eference mark used LP 10 BM#1 Does fhe elevaGon reference madc used appear on fhe FIRM7 ❑Yes �No
o a)i op of bottom 1oor(inauang basement or endosure) 7, 11 ft.(m) � ,
o b)Top of ne�higher floor 11,00 ft.(m) �' �
o c)Bottom of lowest horizontal structur�member(V zones only) NA._ft.(m)
o d)Attached garage(top of slab) 7. ��ft.m °°
- - � � s �
o e)Lowest elevation of machinery andlor equipment W '°
servicing the buiiding(Describe in a Comments area) NA._ft.(m) ��
o�Lowest adjacent(finished)grade(LAG) 5.42 fl.(m) z'.�
o g)Highest adjacent(finished)grade(HAG) 5. 64 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 1203.29 sq.in.(sq,cm) J
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.
1 certify that the information in Sections A,B,and C on this certificate represents my best efforts to interpret fhe dafa available.
1 understand that any false statement may 6e punishable by fine or imprisonment under 18 U S Code,Section 1001
CERTIFIER'S NAME GEORGE A.SHIMP il LICENSE NUMBER 2512
TITLE PRESIDENT COMPANY NAME GEORGE A.SHIMP II&ASSOC.,INC
ADORESS CITY STATE ZIP CODE
3301 DESOTO EVARD PALM HARBOR FL 34gg3
SIGNATU DATE TELEPHONE
BBN0:050242-1A 5/02l05 727-784-54g6
FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces all previous editions
: n ese spaces,co y the correspondin (nformatlo�from Section A
For lnsurancs Compapy Use:� ,
BUILDWG STREETADORESS(Induding Apt,Unk,Suife,and/orekig.No.)OR P,O.ROUT'E AND BOX N0. PoGcy Numher ':.
125-1 BRIGNTWATER DRIVE , �;
CiiY STATE ZIP CODE ComFarlYW�i�AlWnqe( ..
CLEARWATER �
34630 ,
SECTION D•8URVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED
Copy bofh sides of this ElevatJon Cerfificate fw(1}cornmunity o�iaal,(2)►nsurance agenUcompany,and(3)bu��ing owner. •
COMMEMS
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WIT OUTrBF�ments
For Zone AO and Zone A(withoui BFE),oomplete Iterns E1 through E4. If the Elevatlon Ce�dlcate is intended for use as suppoNng(nformaUon for a L�MA or IAMR-F,
SecUon C must be completed.
E1.Bu�ding Diagram Number_(Select the building c9apram most siMlar to the building for whk;h�ls ceNikate is being canpleted–see pagas 6 and 7, If no�agram aocurately
repnesents tt�b�lding,Provide a skeich a photograph,)
E2.The top of the bottom floor pnduding besement or�osure�of the buUding Is _ft.(m)_In,(cm)O above w ❑below(cheGc one)Ihe highest ac�acent grade. (Use
natural grade,ff availabie).
E3.Fw Bu��ng Diagrams 6�8 with openings(see page l�,thg next higherfloororelevated floor(elevabon b)of the building is _ft.(m),_in.(cm)above the highest ad)acent
g�ada C�otnplete items C3.h and C3.i on irant�fortn.
E4.The top of the plaaifortn of madiinery andlor equipment servicing the twiiding is _ft.(m)_in.(cm)[]above or ❑below(check one)ihe highest adJacent grade. (Use
natural grade,if availa�le).
E5.For Zone AO only: If no flood depth number(s aya(iable,is 1he top��e bottom 1��evated in accordance with the commur�t�s floodpiain management ordinnance?
❑Yes ❑No ❑Unknow�. The local offfdal must certify this infama�on in Section G �
SECTION F•PROPERTY OWNER OR OWNER'S REPRESENTATIVE CERTIFICATION
1'he propedy owner o�owner's auihotlzed representa�ve who completes Sec�iions A,B,C(Items C3.h and C3,1 oNy),and E for Zone A(without a FEMA-issued or cornmunity-
Issued BFE�or Zone AO must sign here. The statemenfs!n Sections A,8,C�ar►d E a�e cor�ect to the best of my knowledge.
PROPERIY OWNER'S OR OWNER'S AUTNORIZED REpRESENTATIVE'S NAME
ADDRESS CITY STATE Z1P COOE •
SIGNATURE DATE
TELEPHONE
COMMENTS
SECTION G-COMMUNITY INFORMATION OPTIONAL �Chedc here f�a�ac�ments
The local offidal who Is authorized by law u wd(n�nw to adrNnist�the conununiiys floodplain management adinance can compiete Sectlons A,8,C(or E�,ar�i G of�is FJevaUon
Ce�tlflCai�. Complete the aPPlicabls item(s)and sign below.
G1.0 The information in Sr�bon C was taken from ofhe�documentafion that has bcen signed and embossed by a Gcensed surveyor,engineer,or architect who Is authorized by slate
or locai law to�iify eievat�o�infom�aiion, (Indipte lh�sour ce and date of fhe eievation data in fhe Comments area below.)
a•I�A community offidal completed Sectfon E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone A0,
q.Q The foUowing infamatlon(Items G4-G9j(s provided for community(loodplain man�ement purposes.
G4.PERMIT NUMBER G5.DATE pERMtf ISSUED G6,pATE CERTIFICATE OF COMPLUWCElOCCUPANCY ISSUED
G7.This permit has been issued fw:[,J New Construd(on ❑Substan�al ImProvement
G8.Elevafion of as-bu�t lowest floor('�nduding basement)of the bu�ding fs:
G9.BFE or pn Zone AO)depih of fboding at the building site is: °'—ft'�m) Datum:
—.——�(m1 Daium:
LOCAL OFFIClAL'S NAME TITLE
CAMMUNITY NAME TELEPHONE
SIGNATURE DATE •
CAMMENTS
FEMA Form 81-31..lanuaro 2nn� Chedc here if attachments