125 BRIGHTWATER DR UNIT 2 , FEDERALEMERGENCYMANAGEMENTAGENCY O.M.B. No. 3067-0077
NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
����� I a �� 3 ELEVATION CERTIFICATE
Im rtant: Read the instructions on pa es 1-7.
SECTION A•PROPERTY OWNER INFORMATION Fa Insurance Car�panyUse:
BUILDING OWNER'S NAME Policy Number
MENNA DEVELOPMENT
BUILDING STREET ADDRESS(InGuding Apt.,Unit,Suite,and/or Bidg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
12�2 BRIGHNVATER DRIVE
CIN STATE ZIP CODE
CLEARWATER BEACH FL 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Pam.el Number,Legal Description,etc.) '
LOT 5,BELLE AQUA VILLAS I
BUILDING USE(e.g.,Residential,Non-residentiai,Addi6on,Accessory,etc. Use a Commenis area,if necessary.)
RESIDENTIAL
LATITUDEJLONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS(Type):
( ##°-##'-##.##" or ##.#1�##� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad MaP ❑Other
SECTION B•FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME B3.STATE
CLEARWATER 125095 PINELLAS FLORIDA
B4.MAP AND PANEL 67.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVEIREVISED DATE B8 FLOOD ZONE(S) (Zone A0,use deplh of flooding)
125096-0007 D 8/19i91 8/19191 AE 11
B10.Indiqte the source of the Base Flood Elevabon(BFE)data or base flood depth entered in B9.
❑FIS Profile �FIRM ❑Community Determined ❑Other(Describe):_
B11.Indicate the elevation datum used for the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Other(Descnbe):_
B12.Is the building located in a Coastal Bamer Resouroes System(CBRS)area or Othervvise Protected Area(OPA)� ❑Yes �No Desiqna6on Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:❑Construction Drawings* ❑Building Under Construction' �Finished Construction
• '4 new Eleva6on Certificate will be required when construction of the building is complete.
2.6�ilding Diagram Number 8(Select the building diagram most similar to the building for which this oertificate is being oomple6ed-see pages 6 and 7. If no diagram
accurately represents the building,provide a sketch or photograph.)
C3.Elevafions—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,ARIA,AR/AE,AR/A1-A30,AR/AH,AR/AO
Complete Items C3.-a-i below according to the building diagram specfied in Item C2.State the datum used.If the datum is difterent from the datum used for Ihe BFE in
Sec6on B,convert the datum to that used for the BFE.Show field measuremenls and datum conversion calcula6on. Use tlie space provided or fhe CommenCs area of
Section D or Secfion G,as appropnate,to document the datum conversion.
Datum NGVD ConversioNComments
Elevation reference mark used LP 10 BMq1 Does ihe eleva6on reference mark used appear on Ihe FIRM? ❑Yes �No
o a)Top of bottom floor(induding basement or endosure) 7. �2 ft(m� -
N ! �'�- .1¢u f_�..�
o b)Top of next higher floor 11.00 R(m) � .�, �- .
o c)Bottom of lowest honzontal sUuctural member(V zones only) WA.7 ft.(m) N� �.
o d)Attached garage(top of slab) 7, �2 ft(m) E° �f'' 'a
o e)Lowest elevation of machinery andlor equipment w " ;,.; e.
�� c:
sennang the building(Descnbe in a Comments area) WA._ft.(m) a� # � „
o �Lowest adjacent(finished)grade(LAG) 5.42 ft(m) Z.m ' �(�" '
o g)Highest adjacent(finished)grade(HAG) 5. 64 ft(m) ��' ' , tr ,, e -��^
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 7 � 2srz ►v�+e�rd���
o i)Total area of all permanent openings(flood venis)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 etevation information.
I certify that the information in Sections A,B,and C on this certificate r�presents my best efforfs to interpret the data available.
1 understand that any false stafement may be punishable by fine or imprisonment under 18 U S Code Secfion 1001
CERTIFIER S NAME GEORGE A.SNIMP 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
SIG DATE TELEPHONE
JOB N0.050242 7/2g/p5 �2�_�84-5496
FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces all previous editions
IMPORTANT: ln these spaces,copy tne corresponaing information from Se�ion A. -G insuran��omoarrv�,se ' , .
BUIL7ING S�=��RESS Qndudir�Apl,Uni�Suii�,ancU'er 51dg.No.)OR r C.ROI,i=AND 30X N0. Poocf NumDer
i2�-2 BRI�HTWAT�R DRIVE
J,,..� �;q i- ZfP COC� u�moany NAtC Numoer
�;=ARWA i_�3E4Cn �! 3�07 �
SECTION D•SURVEYOR,ENGINEER,OR ARCHITtC7 CERTIFICATION(CONTINUED)
Copy both sides or this Elevation Ceruncate Tor(1)�ammunm omda!,j2)insuran�_agenUcomcany,and(3)buiiding owner.
��MMENTS --
❑Check here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO ANO ZONE A(WITHOU7 BFE)
For Zone AO and Zone A(without 3F�,�mplete Items E1 throuan�4. If the Eievaticn Certincate ls intended for use as supooriing InTOrma�on ror a LOMA or LOMR-F,
Secaon C mus't oe completed.
E?.3uiiding Diagram Numoer_(Select the building diagram most simiiar to Vie building ior wnich this certincate is being comoleted—see pages o and 7 If no diagram ac;,�rately
represenis the building,pr�vide a sketcn or photograpn.�
E2.Tne iop of the bottom floor(including h�sement or endosurel of the buildina is _ft.(m),in.(cm)�above or ❑beiow(check one)the hiahest adjacent grade, (Use
natural grade,if available).
E3.For Building Diagrams 6�with openings,see page 7i,the ne�higherfloor or elevated floor(elevation b)of the building ls _ft.(mj_in.(cm)above the hignest adjacent
grade. Complete items C3.h and C3.i on front of torm.
E4.?he too oT the olatform or machinery andlor eauioment servicine the building Is _ft.(ml_in.icmi�above or i 1 below(check onel the nighest adiacent arade. (Use
natural grade,if available).
�5.i=or Zone AO only: If no flood depth number is avaiiable,is the top of the bottom floor�levated in acc�rdance with the�mmunity's floodplain management ordinance?
❑Yes ❑No ❑Unknown. The local offiaal must certify this information ir Secuon G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFiCATION
The property owner or owne�s authonzed representa6ve wno o�mpietes Sections A,B,C(Items C3.h and C3.i only),and E ror Zone A(without a FEMA�ssued or communi'ry-
issued BFE)or Zone AO must sign here. rhe s'ta[ements rn Seci�ons A,B,C,and�are ronecf ro the best or my knowledge. •
FROPER�1'OWNER'S OR OWNER'S AUTHORIZEC nEPREScNTA i I!/E'S NAME
ADDRESS CI i`( STATE ZIP CODE
SiGNATURE
DATE TELEPHONE
COMMENTS
❑Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The local c��aal�r,nc,���:hon�_'by .w or ordinance to administer the community's floaipkain managemeni ordinance can complete Seciions A,8,C(or E),and G or this�levation
�ertificate :or oiete r-t apoGc�_ie ite:�(s;and sign below.
G1.�The Infc,�-'aucr Ser�'^n C�,�?s�zken from other d�umentation that has't�n signec and emboss�d by a licensed suroeyor,engineer,or architect who is authonzed by state
or Ie^..�I law to ce�v�; eieva6�n iniormation. (Indicate the source and da#e of the�levaaon data in the Comments area below.)
G2.�A comn��i'r;�ofi aaJ c�mpleted Secfion E Tor a buiiding loca'te�in Zone A(without a F�MA-issued or community-+ssued BF�;or Zone,40.
G3.�The tollowing inrormation(Items G4-�°)is provided for community floodpiain management pur�ses.
i C'�4.P�RMIT NUMBEn G5. DATE°ERMIT ISSUED G6. DATE r.ER i IFICAiF OF COMPLIANCE/OCCUPANCY ISSUED
�
�
G7.This permii has been issued for. 0 New Cons'truction ❑Substantiai Improvement
G8.Eievation or as-�uilt lowest floor(including basement)of the building is: _._ft.(m) Catum:
G9.BFE or�in Zone AO)depth or flooding at the ouiiding site is: _ _ft.(mj Datum:
LOCAL OF�1CIAL'S NAME TITLE
COMMUNI?"NAIv1E TEL�°HONE �
SIGNA i URE �A�`
�OMMEtiT�
'^�heck here if attachments
u
Reniaces all DrevlouS eciitlon5
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
, NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
��c.�1�3- I a ►� 3 ELEVATION CERTIFICATE
Important: Read the instructions on pa es 1-7.
SECTION A-PROPERTY OWNER INFORMATION For Insurance Car�pany Use:
UILDING OWNER'S NAME Policy Number
MENNA DEVELOPMENT
BUILDING STREET ADDRESS(InGuding Apt,Unit,Suite,and/or Bidg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
12�2 BRIGHTWATER DRIVE
CITY STATE ZIP CODE
CLEARWATER B�CI�' FL 33767
PROPER�TY DESCRIPTION(Lot and Block Numbers,Tax Parr.el Number,Legai Descnption,etc.)
LOT 5,BELLE AQUA VILLAS I
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 ##.##�J##� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
61.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME 83.STATE
CLEARWATER 125095 PINELLAS FLORIDA
B4.MAP AND PANEL $ 1 q"Z B7.FIRM PANEL B9.&4SE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6.FIR INDEX DATE EFFECTIVEIF2EVISED DATE 88.FLOOD ZONE(S) (Zone A0,use deplh of flooding)
125096-0007 D �'�/9r" �19191 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(Desaibe):_
B11.Indicate the elevation datum used for the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Other(Describe):_
B12.Is the building located in a Coastal Bamer Resourc�s System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No Desiqnation 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 construcUon of the building is compiete.
Building Diagram Number B(Select the buikiing diagram most similar to the building for which this ce�tificate is being completed-see paaqees 6 and 7. If no diagram
aocurately represents ihe building,provide a sketch or photograph.)
C3.Elevafions—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AWq AR/AE,AR/A1-A30,AR/AH,AR/AO
Compiete Items C3.-a-i below according ho fhe building diagram specfied in Item C2.State the datum used.If the datum is difierent irom the datum used for the BFE in
Section B,o�nvert the datum to that used for the BFE.Show field measurements and datum conversion ca�ulation. Use the space provided or the Commenis area of
Section D or Section�,as appropriate,to document the datum oonversion.
Datum NGVD ConversioNComments
Elevation reference mark used LP 10 Btvt�1 Does the elevation reference mark used appear on the FIRM? ❑Yes �No
o a)Top of bottom floor(induding basement or endosure} 7. 12 ft.(m) � ,
o b)Top of next higher floor 11.00 ft.(m) �' ,
a
o c)Bottom of lowest horizontal sUuch�ral member(V zones only) WA.7 ft.(m) N R -
o d)Attached garage(top of slab) 7. 12 ft(m) E� � -✓'j "
o e)Lowest elevation of machinery andlor equipment W� �,r �
servicing fhe buitding(Desaibe in a Commenis area) WA._ft.(m) E� � �
o �Lowest adjacent(finished)grade(LAG) 5.42 ft(m) z'� J ' � "� -
o g)Highest adjacent(finished)grade(HAG) 5. 64 ft(m) �� ° .d"r''
y�..
o h)No.of permanent openings(flood venfs)within 1 ft.above adjacent grade 7 � �Sfz �o��e 10�,�
o i)Total area of all permanent openings(flood venfs)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.
I certify that the information in Sections A,B,and C on fhis certificate represents my 6est efforts to interpret the data available.
1 undersfand thaf any false statement may be punishable by fine oi imprisonment under 18 U.S.Code Secfion 1001.
CERTIFIER'S NAME GEORGE A.SHIMP II LICENSE NUMBER 2512
TITLE PRESIDENT COMPANY NAME GEORGE A.SHIMP il&ASSOC.,INC
--
�ADDRESS CITY STATE ZIP CODE
3301 DESO BOULEVARD PALM HARBOR FL 34683
SIGN DATE TELEPHONE
JOB N0.050242 7128/05 727-784-5496
�
GF�AA G,,..,. A�_z� i�..���..,�nno c,.,. _.......---`�-`--�--.:_.._.:__ � ..__,. ., . ....
IMPOKTANT: in these spaces,copy the correspanaing inTOrrrfaiion from Se�ion A. =a�nsuran�romoam,�!s�, � � .
BUIL:�INv S�-ADORESS(Induding Apt;Unit Suite,ancUor Bldc.No.)OR r.v.ROU i t AND BOX N0. '?ouc,y Nurr�
i2�2 SRI�HTWAI�R DRIVC
Cfil' STAi= JP COD� >:�,omcany NAIC Numoer -
�`ARWA i!-�9E4C'r. �! 3��
SEGTION D•SURVEYOR,ENGINEER,OR ARCHfTECT CERTIF1CATlON(CONTINUED} �•
Copy ooth sides or this EJevauon Ceruncate ror(1)�ammunm omdai;(21 insuranw aoeni/comcany:and(3)buiiding owne�.
COMMEIVTS `"
❑Check here rr attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zone AO and Zone A(withou�3F�,complete Items E1 througn E4. If the�evation Cerimcate is infended for use as supporiing information ior a LOMA or LOMR-F,
Secoon C must be compleied.
t i.Building Diagram Numoer_(Select the building diagram most similar to the buifding for wnich this cer6ficate is being completed—see pages 6 and 7. if no diagram accurately
r�presents the building,provide a sketch or photoaraph.)
E2.The top of the bottom floor(induding basement or endosure)of the building is _ft.(m)_in.(cm)�above or ❑below(cneck one)the hiohest�acent grade. (Use
naturdl grade,'rf available).
�3.For Building Diagrams 6-8 with openings,see page 7),fhe ne�higherfloor or elevated floor(elevauon b)of the buiiding is _f�.(mj_in.(cm)above the highest adjacent
grade. Complete items C3.h and C3.i on front of torm.
E4.The top of the olatform oi machinery ancUor eauioment serviang the building is _ft.(ml_in.(cml�above or f_l below lcheck onel the highest adjac.,�nt grade. (Use
natural arade,if available).
t5.For Zone AO oniy: If nc flood depth number is available,is the too of the bottom floor�levated in acc�rdance with fhe�mmunit�s floodpfain management ordinance?
❑Yes ❑No ❑Unknown. The local offiaal must cerUfy this information in Secaon G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFiCATION
The property owner or owners authoriz�representative who completes 5ections A,B,C(ftems C3.h and C3.i only),and E for Zone A(without a FEMA-issued or community-
lssued BF�or Zone AO must sign here. The s'ratemenfs in Seciions A.,B,C,and E are corred io the best of my know�edge. •
PROPERI'OWNER'S OR OWNER'S,4UTHORIZFD REPRESENTATIVE'S NAME �
ADORESS CI iY STATE ZlP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
❑Chec}c here if attachments
SECTION G-COMMUNfTY INFORMATION(OPTIONAL)
The local cr�dal�Nno,��:�onr�'by _w or adinancz to administer the cammunity's floodplain managemeni ordinance can complete Sections A,B,C(or�,and G of this Elevation
�eNncate Cor elete r,a apoli��ie iteM(sj and sign below.
G1.�The infcr�atic^ `S��n C��;as taken from other tlocumentation that has�n signed and emboss�d by a licensed surveyor,engineer,or ar�hiteci who is aufhorized by state
or Icczl law'to ce�;elevatic��infiormauon. (Indicate the source and da#e of the eleva'von data in the Comments area below.)
G2.�A comnu�ifi/�fr�d�l campleted Se�Gon E for a buiiding located in Zone A(withoui a FEMA-issued or community�ssued BF�)or Zone A0.
G3.�The rollowing inrorma6on(Items G4-G9)is provided for community floodpiain management purposes.
G4.PERMff NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COtv1PLIANCFJOCCUPANCY ISSUED
I
Gi.This permit has been issued for. �New Construction ❑Substantial Improvemenf
G8.Eleva6on of as-�uilt lowest floor(induding basement)of the building is: _._ft.(m) Datum:
G9.BFE or(in Zone AO)depth o�flooding a't the buiiding site is _ _ft.(mj Datum:
LOCAL OF=ICIAL'S NAME TITLE
COMMUNI?Y NAME TCLEPHONE •
S{GNtiTURE DATE
COMMENTS
❑Gheck here if attachments
. • . „
K
` � A� � � f� C ITY OF C LEARWATER
� � .
� ���:
k ,x �
�. DEVELOPMENT & NEIGHBORH0C7D SERVICES DEPARTMENT
�t f POST�FFICE BOX 474g� CLEARWATER� FLOa�DA 33758-4748
MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CLEARWATER,FLO�unn 33756
TELErxorrE(72� 562-4567 Fnx(72'� 562-4576
MEMO OF REVIEW FOR CORRECTNESS 8� COMPLETION
In accordance with participation in the NFIP/CRS program,all elevation certificates are required to be reviewed for correctness and completion prior to
acceptance by the community. This complete form shall be attached to all elevation certificates maintained on file and provide with requested copies of
elevation certificates.
The attached elevation certificate requires corrections by the surveyor of section(s) prior to acceptance by the community
The attached elevation certificate is complete and correct
X Minor corrections have been made in the below marked sections by Community 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
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
i.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.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 $��$�1992 EFFECTIVE/REVISED DATE (Zone AO,use depth of flooding)
B10. 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 69:� NGVD 1929 ❑ NAVD 1988 ❑ Other(Describe)
612. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes ❑No Designation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1. Building elevations are based on: ❑Construction Drawings* ❑ Building Under Construction' ❑Finished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
C2. Building Diagram Number (Select the building diagram most similar to the building for which this 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:
�evafion certificates shall be maintained by the community and copies with the attached memo made availab/e by request
FRANK HIRBAW),MAYOR
GEORGE N.CRE7'EKOS,COUNCILMGMBER JOIIN DORAN,COUNCILMEMRER
PAUL F.GBSON,COUNCILMEMAER � CARLEN A.PE"I'ERSEN,COUNCILMEMBER
��EQUAL EMPLOYMENT AND AFFIRMA'PIVE ACf10N EMPLOYEK�
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
. NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
� ��(,���� f�,�� ELEVATION CERTIFICATE
Im ortant: Read the instructions on a es 1-7.
SECTION A-PROPERTY OWNER INFORMATION F«�nsurance c.ompany use:
• BUILDING OWNER'S NAME Policy Number
MENNA DEVELOPMENT
BUILDING STREETADDRESS(Including Apt,Unit,Suite,ancUor Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
125-2 BRIGHTWATER DRIVE
C�N STATE ZIP CODE
CLEARWATER FL 34630
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Descnption,etc.)
LOT 2,BELLE AQUA VILLAS I
BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,eta Use a Comments area,if necessary.)
RESIDENTIAL
LATITUDElLONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS(Type):
( ##°-##'-##•##" or ##•###�#� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B•FLOOD INSURANCE RATE MAP(F1RM)INFORMATION
Bi.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.CWMY NAME B3.STATE
Cf1Y OF CLEARWATER 125096 PINELLAS FLORIDA
84.MAP AND PANEL B7.FIRM PANE! 89.BASE FL000 ELEVATION(S)
NUMBER 85.SUFFIX 86.FIRM INDEX DATE EFFECTIVF�REVISED DATE 88.FLOOD ZONE(S) (Zone A0,use depfh of flooding)
12509Cr0007 D 8/19�J1 8119/91 AE 11
610.Indicate the source of the Base Flood ElevaGon(BFE)data or base flood depth entered in 69.
❑FIS Profile ❑FIRM ❑Community DeteRnined ❑Ofher(Desaibe);
811.Indicate the elevation datum used fa the BFE in 89:�NGVD 1929 ❑NAVD 1988 ❑Ofher(Describe):
612,Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected A�ea(OPA)7 ❑Yes �No Des' nation Date
SECTI�N C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:�Construction Drawings' �Building Under Construcfion' ❑Finished ConsUuction
'A new Elevafion Cerfificate will be required when consUuction of the building is complete.
�C2.Buiiding Diagram Number 8(Select the bu�ding diagram most similar to the building for which this certificate is being compiefed-see pages 6 and 7. If no diagram
accurately represents the building,provide a sketch or photograph.)
C3.Elevations—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AWA,AR/AE,AWA1-A30,AWAH,AR/AO
Com�ete Items C3;a-i below according to the building diagram speci�ed 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 conversion calculation, Use the space provided or 1he Comments area of
Section D or Secfion G,as appropriate,to document the datum conversion.
Datum Conversion/Comments
Elevation refe�ence mark used LP 10 BM#1 Does the eleva6on reference mark used appear on the FIRM? ❑Yes �No
o a)Tap of bottom floor(inciuding basement or endosure) 7, 12 ft.(m) �
o b)Top of next higher floor 11.00 ft.(m) �'
o c)Bottom of lowest horizontal structural member(V zones only) NA,_ft.(m) N�
o d)Attached garage(top of slab) 7. 12 ft.(m) E�
o e)Lowest elevaGon of machinery and/or equipment W �
serviang the building(Describe in a Comments area) NA,_ft.(m) `_
o fl Lowest adjacent(finished)grade(LAG) 5.42 ft.(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•SURVEYQR,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 informafion in Sections A,8,and C on this cerfificate represents my besf efforfs to interpret the data avai(able.
_!undersfand fhat any false statement may be punishable by fine or impnsonment 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
DDRESS CITY STATE ZIP CODE
3301 DESOT ULEVARD PALM HARBOR FL 346g3
SIGNAT _ DATE TELEPHONE
JOB N0.050242-2A 5/02105 727-784-5496
FEMA Form 81-31,January 2003 See reverse side for continuation. Repiaces all previous editions
imt�vRravT, intheses aces,co the coRespondin Informatlon from Section A. `'For(nsuranca c,ornpany use '' �"�
BUILDWG STREE'f ADORESS(Indud)ng qpt,Untl,Suiie,andla Bklg.No.}OR P,O.R0l1TE AND 80X N0. Po NurttG�r '
125�2 BRIGHTWATER DRIVE �'
OLEP�RWATER STATE ZJP CODE Ca�t�r��+(�� � , 1 , ' .
� � �� � ,, ;
. �'�.4J;``....'x"k i i�. . .�.�,y,,.�.!G,
SECTION 0-3URVEYOR,ENGINEER,OR ARCHITECT CERTIFiCATION CONTINUED)
�PY both sides of fhis devatlon Certltkate for(1)corrununiiy ofildal,(2)insurance agenUcompany�and(3)lw�ding ownar. •
COMMENTS
SECTION E•6UILOING ELEVATION INFORMATiON(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(W T OUTrBFE)�ments
For Zone AO and Zone A(uwthout BFE),c o m p lete�(�t�s E 1 U t r o u g h E 4. i f i h e E iev a Uon Ce r U flca te is i nten ded iw use as suppo�ing informa�on for a LOMA a LAMR-F,
Sectl�C must be wmplefed.
E1.8u�ding Dlagram Number_(Select ihe bupding d(�ram most�n�ar to ihe buiid(ng for whid��is cerUficate is being oompleted–see pages 6 and 7. If no diagram accurataly
represents the building,Provide a sketch a photoAraph•)
EZ.The top of the bottom floor(induding besement ar endosure)of the building is _iL(m)_In,�cm)�ab�ve or ❑below(checac one)ihe highest adJaC�tt grade. (Use
natural grade,ff availlabie).
E3.For B�Iding Olagrams 6-8 with W�aNn9s(see P89e��Ihe next highertlooror elevated iloor(elevaUon b)of the buil�ng is _ft.(m)_,Gt.(cm)above Ihe hiphest adJacent
gr�ie. Gom�ete!lems C3.h and q.i ori tront of torm.
E4.The top of the plaBorm of madunery andlor equipment serviang the buiiding is _it(m)_In,(cm)[J above or ❑below(check one)Ihe highest adJacent grade. (Use
natural grade,if available).
E5.ForZoneAO only: If noflood depfh numberis avaUable,is the top of ihe bottom floor elevated in acoordance wlth ihe wmmunit}�s noodplain managementordfnancel
❑Yes ❑No ❑Unknown. The bcal�ffdal must thia fnfamatlon In Secflon G.
3ECTION F-PROPERTY OWNER OR OWNER'S REPRESENTATIVE CERTIFiCATION
The Pmperty oumer w owners aufhorized representative who cornpletes Sec�lona A,B,C(Items C3.h and C3J a�lyj,and E for Zone A(wphout a FEMAassu�a canmunily-
issued BFE�or Zone AO must sfgn here. The sfatemenis in Secdons A,��and F are c�fo the best o(my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZEp REpREgENTATIVE'S NAME
ADDRESS Clr( STATE ZIP COOE �
SIGNATURE DATE
TELEPHONE
COMMENTS
SEGTION G•COMMUNtTY INFORMATION OPTIONAL �Chedc here if attachments
The loal offidal who is aufhorized by law or ordlc�ance to administer fhe canmuni s
���e. appiicable it � fl0°dP��managemenl ordinance can complete SecUons A,B,C(or E),and G of ittis Elevatlon
ComFlete.ihe em(s)and s(gn below.
G1.❑The informatla�in Sectlon C was talcen irom olher documentai(on that has baen si9ned and embossed by a�censed suroeyor,engineer,or architec;t who fs aulhotized by slale
or tocal Iaw io cerfity elevatlon Information. (Indipte fhe sourre and date of ihe elevatlon daia in the Cortunents area below.)
�.C�A communliy a�fdai compieted Secfion E for a bu0ding located in ZoneA(wittwut a FEMA-issued orcwrunuNly�ssued BFE)or Zone A0.
G3.�The fouowing Infotmaflon(Iterns G4-Gg)is provfdad fw co�r�muNiy floodplain man ement
aA P�rpos�•
G4.PERMIT NUMBFR G5.Oq'iE PERIWi'ISSUED G6.DATE CERTIFiCATE OF COMPLWJCEIOCCUPANCY 15SUE0
G7.This pem�it has been issued fa:0 New Cons� ❑Su����rovement
G8.Elevatlon of as-buUtlowestfloorQr�luding basemenq ofthe building Is:
G9.BFE or(in Zone AO)depfh of flooding at ihe buil�in8 site fs: --—n�(m) Daium
—:—�(m) Datum
I.00AL OFFiCIAL'S NAME TiTLE
COMMUNITY NA(v1E TEIEPHONE
SIGNATURE OATE •
COMMENTS
�-•-•�• – -� - _ ❑Chedc he�e If aitachments