125 BRIGHTWATER DR UNIT 4 �
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
� _ , NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
��ao��- ��a��� ELEVATION CERTIFICATE
Important: Read the instructions on pa es 1•7.
SECTION A-PROPERTY OWNER INFORMATION For Insurance Canpany Use
BUILDING OWNER'S NAME Policy Number
MENNA DEVELOPMENT
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO Company NAIC Number
125-4 BRIGHTWATER DRIVE
CITY STATE ZIP CODE
CLEARWATER BEACH FL 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Paroel Number,Legal Description,etc.)
LOT 3,BELLE AQUA VILLAS I
BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,if nec;essary.)
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
B1.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME B3.STATE
CLEARWATER 125095 PINELLAS FLORIDA
B4.MAP AND PANEL B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER 85.SUFFIX 86.FIRM INDEX DATE EFFECTIVEIREVISED DATE 88.FLOOD ZONE(S) (Zone A0,use depih of flooding)
12509f'r0007 D 8/19191 8/19�J1 AE 11
B10.Indicate the source of fhe Base Flood Eleva6on(BFE)data or base flood depth entered in B9.
❑FIS Profile �FIRM ❑Community DeteRnined ❑Other(Descnbe):
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 Bartier Resources System(CBRS)area or Ofherwise ProtecDed Area(OPA)? ❑Yes �No Des' nation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:❑Construction Drawings` ❑Building Under Construction` �Finished Construction
. 'A new Eleva6on Certificate will be required when consUucbon of the building is camplete.
2.Buiiding Diagram Number 8(Select the building diagram most similar to the buiiding for which fhis certi6cate is being complebed-see pages 6 and 7. If no diagram
accurately represents the building,provide a sketch or photograph.)
C3.Eleva6ons—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,ARIAE,ARIA1-A30,AR/AH,AR/AO
Comple6e Items C3-a-i below aocording 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 calculabon. Use the space provided or tt�e Comments area of
Sec6on 0 or Section G,as appropriate,to document the datum conversion.
Datum NGVD Conve�sioNComments
Elevation reference mark used LP 10 Blvk#1 Dces fhe elevation referenoe mark used appear on the FIRM? ❑Yes �No
o a)Top of bottom floor(induding basement or endosure) 7. 07 ft(m) � w.: � ,��'
o b)Top of ne�higher floor 11.00 ft.(m) � • „�
o c)Bottom of lowest honzontal struch�ral member(V zones only) WA.7 ft.(m) � �' .
o d)Attached garage(top of slab) 07. 03 ft.(m) E o �� y_:`',�� '
o e)Lowest elevation of machinery andlor equipment w 10 �
� a ,, ~a �w
serviang the building(Descnbe in a Comments area) WA._ft.(m) �� �<� ,«.> '
o �Lowest adjacent(finished)grade(LAG) 5.42 ft(m) z'.� � ��
��
o g)Highest adjacenf(finished)grade(HAG) 5. 64 ft(m) � i"• �r;,,..
o h)No.of permanent openings(flood vents)within 1 ft above adjacent grade 7 � :�.'2 ,�,./'o�
o i)Total area of atl permanent openings(flood venfs)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 in Sections A,B,and C on fhis certificate represents my best e/forts to interpr�t the data available.
1 understand that any false sfatement may be punishable by fine or 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 II&ASSOC.,INC
•ADDRESS CITY STATE ZIP CODE
3301 DESOTO BOULEVARD PALM HARBOR FL 34683
SIGNATU DATE TELEPHONE
JOB N0.050242 7/28/05 727-784-5496
FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces all previous editions
,
IMPORi ANT: fn these spaces,eopy the corresponding informaiion Trom Section A. =orinsuranc�Com�r�-�{se: :': � �
3UI!7WG S iRE=;AuDRESS(Induding Api,Unf4 Suii�,ancUor 31dg.No.j OR?.Q ROUTE ANC?OX NC. �clicy NumCer
125-^3RIvnTWA-�R DRfVE
crr�
CV+RWATcR BEACH ��'A'` ZI?CCDE Company NAIC vumoer
a37o7 �
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIRCATION(CONTiNUED}
Copy both sides or this�levaiion Certincate ior ji)communiry oifiGai,�2;insuranw agen'vc�mpany:and(3)builcing owner.
COMMENTS --
❑Chedc here if attachments
SECTION E-BUILDING ELEVATION INFORMATIOtJ(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHqUT BFE�
ror Zone AO and Zone A(without BFE),com�lete Items E1 through E4. If the Eievation Certmcate is intende:i for use as supporting information for a LOMA or LOMR-F,
S�on C must'ee com�leted.
E1.Building Diagram Number_(Selec;the buiiding diagram most similar to f�e building for which this ceru6cate is being compieted—see pages o and?. If no diagram accurately
represents the building,provide a sketch or photograph.)
E2.The top of ihe bottom floor(including oasement or enclosure)or the buildina is _ft.(mj_in.(cm)�above or ❑below(cnedc one)the hignest adjacent grade. (l,�se
naturai grade,ir availabfel.
�3.For Buifding Diagrams 6�with openings(s2e page 7;,the ne�hiqnerfloor or elevat�i floor(elevaaon bl of the building is _ft.(mj_In.(cm)above the highest adja�nt
grade. Compiete items C3.h and C3.i on front of torm.
E4.The to�of the plafform oT machinery and/or equipment servicinq the buildina is _ft.(ml_in.(cml I_I ab�ve or f_1 below(check one)the highest adiacent grade. !Us2
natural grade,if available),
E5.For Zone AO only: If no flood depth number is available,is the too of the bottom fl�r elevated In acxordance with the community's flcodplain management ordinance?
❑Yes ❑No ❑Unknown. The local offiGal must certi"ry this informa5on in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATiVE)CERTIFICATION
The properry owner or owners authonzed representative who comple'tes Sections A,6,C(Items C3.h and C3J only),and E for Zone A(without a FEMA-issued or communiiy-
issued BF�)or Zone AO must sign here. 13ie sta"temenfs rn Secfions A,B,C,and E are correct to the oesf of my knowledge. •
PRQPERTY OWNER'S OR OWNER'S AUTHORIZ�D REPRE�E.NTATIVE'S NAME
ADDRESS CI i 1' STATE ZIP CODE
SIGNATURE DATE TEL�PHONE
COMMENTS
❑Check here if attachments
_���_ SECTION G•COMMUNITY INFORMATION(OPTiONAL}
The local ofi�ual�a�o is ai^�ionzE^by i,���or ordnance to administer�e community's floodpfain management ordinance can complete Sections A,5,C(or E),and G of ihis Elevafion
Ceriificate. '�orr::ete•��applic,�:e.it�;.;s)and sign below.
G1.�The inr'on-;��+ic,-:'r. �ec*�n C�r;=s taken from other d�umentauon that nas been signed and embossed by a licensed surveyor,engineer,or architect who is authonzed by sta[e
or loc;ai'aw to certiiy�levatio��information. (fndicate the sour�and date of the elevation data in the Comments area below.)
G2.❑,A commur,it;�ffir.:a!�mpleted Secfion E for a buiiding located in Zone A(without a�EMA�ssued or�mmunity-issued BFL)or Zone A0.
G3.[f The rollowing informauon(Items G4-G9)is provided for community floodplain management purposes.
G4.PERMff NUNiBER G5. DATE PERMIT ISSUED G6. DATE CERTIr"ICATE OF COMPLIANCFJOCCUPANCY ISSUED
G7.This permit has been issued for. ❑New Construction ❑Substantial Improvement
G8,Eievation of as-buiit lowesi floor(induding basement)of the buiiding is: _._ft.(m} Datum:
G9,BFE or(in Zone,40)depth of flooding at the building site is: _ _ft.{m) Catum:
LOCAL OFi=1CIAL'S NAME TITL=
COMMUNITI'NAME ?ELEPHONE �
SIGNATURE DATE
COMMENTS
❑ Check here if attachmenis
F=MA r=nrm F."._2? .lam:ani 7M'2 �__�---- -"-'-..._..- -�"'---
� FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
, NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
��pp�_ ��a��� ELEVATION CERTIFICATE
Important: Read the instructions on pages 1-7.
SECTION A-PROPERTY OWNER INFORMATION For Insuranoe Corr�any Use�
UILDING 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
1254 BRIGH7WATER DRIVE
C��' STATE ZIP CODE
CLEARWATER 8�42�hf'— FL 33767
PROPERN DESCRIPTION(Lot and Block Numbers,Tax ParGel Number,Legal Description,etc.)
LOT 3,BELLE AQUA VILLAS I
BUILDING USE(e.g.,Residen6ai,Non-residential,Addition,Aocessory,etc. Use a Comments area,if necessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):
( ##°-##'-##.�l#" or ##.�) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME 8 COMMUNITY NUMBER B2.COUNTY NAME B3.STATE
CLEARWATER 125095 PINELLAS FLORIOA
B4.MAP AND PANEL ...($ a-� 87.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER 85.SUFFIX 86.FIRM INDEX DATE EFFECTIVEA2EVISED DATE 88.FLOOD ZONE(S) (Zone A0,use ciepm of lboding)
125096-0007 D ---tCt�91�� 8/1 N91 AE 11
B10.Indicate the source of the Base Flood Eleva6on(BFE)data or base flood depth entered in B9.
❑FIS Profile �FIRM ❑Communiiy Determined ❑Other(Describe):_
611.Indicate the elevation datum used for the BFE in 69:�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 Desiqnation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevapons are based on:�Construction Drawings` ❑Building Under Construc�on* �Finished Construc6on
'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 tl�is certificate is being complefed-see pages 6 and 7. If no diagram
aa:urately represents tt�e building,provide a sketch or photograph.)
C3.Eleva6ons—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,ARIAE,AR/A1-A30,AR/AH,AR/AO
CanpleUe Items C3-a-i below acoording to the building diagram speafied 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 qlculafion. Use the space provided or ihe CommenLs area of
Sec6on D or Section G,as appropnate,to document the daU�m conversion.
Datum NGVD ConversionlComments
Elevation referenoe mark used LP 10 BMf#1 Dces the elevation reference mark used appear on the FIRM? ❑Yes �No
o a)Top of bottom floor(nduding basement or endosure) 7. O7 ft(m) � i
o b)Top of next higher floor 11.00 R(m) � -+ �; ..
o c)Bottom of lowest horizontal struchiral member(V zones only) WA.7 ft(m) =
o d)Attached garage(top of slab) 07. 03 ft.(m) E� � �
o e)Lowest elevabon of machinery and/or equipment W 1° :� ,
servidng the building(Describe in a Comments area) WA._ft.(m) E � e' ���- >�F '
o �Lowest adjacent(finished)grade(LAG) 5.42 ft(m) z'.� � `
�� �
o g)Highest adjacent(finished)grade(HAG) 5. 64 it(m) �< �
o h)No.of permanent openings(flood venLs)within 1 ft.above adjacent grade 7 J �J+z �of,�Jos F
o i)Total area of ail permanent openings(flood vents)in C3.h 1203.29 sq.in.(sq.cm) -
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICAT�ON
This certification is to be signed and sealed by a land suroeyor,engineer,or architect auihorized by law to certify elevation i�formation.
1 certify that the informafion in Sections A,B,and C on this certificate represents my best efforts to inferpret the data available.
1 understand thaf 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
DRESS CITY STATE ZIP CODE
3301 DESOTO BOULEVARD PALM HARBOR FL 34683
SIGNATU DATE TELEPHONE
JOB N0.050242 7/29�05 727-784-5496
FFMAFnrm A'1_�� .laniiarv�nn� c................_:a.,c,..,.,..,�:_.._�:__ ,-, � .. . ....
IMPORi ANT: in these spaces;capy the corresponding informaiion rrom Seciion A. ' ,orinsu�ancecom�;ny��e. , ,
9UI�ING S i�t E�ADQRESS(Induding.Ap't,Unt�Sui�,andlor 31dg.Nc.j QR°.0.ROUTE AND BOX NQ ':?ciicy Numbzr `
125—^ BRIvrT`�/�i'=R DRIVE
�� ��a� ZI.�CuDE C;mpany IVAIC Vumner
c�w�,i��a�acN =! ��s� �
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED} .
Copy both sid�s o��is 7evauon Cerfincaie ror(1)c�mmuniry omdai;j2)insuranw agen�company;and(3)ouilding owner.
COMMENTS --
❑Check here i�atfachments
SECTiON E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRE�)FOR ZONE AO AND ZONE A(WITHqlJT BFE�
For Zone AO and Zone A(without BF�,comoleie Items E1 through E4. If the Elevation C2rimcate is intended for use as supporting iniormafion ior a LOMA or LOMR-F,
Section C must be completed.
E1.Building Diagram Number_(Sele�i the building diagram most similar to tfie buiiding for which this ceruficate is being completed—see pages 6 and 7. If no diagram a�urately
represents the buiiding,provide a sketch or photoaraph.)
E2.The top of the bottom floor(including basement or endosure)oT the buiiding is _ft.(m}_in.(cm)�above or ❑below(che�one)the hignest�acent grade. (Use
ratural grade,ir available).
�3.For Buifding Diagrams 6-8 with openings(see page T,the next higner floor or elevated floor(elevanon b)of the building is _ft.(m)_in.(cm)above the highest adja�nt
grade. Complete items C3.h and C3.i on front of iorm.
E4.The top of the plafform of machinery and/or equipment servicina the buiidina is _ft(m)_In.fcml I-1 above or ❑below(check onel the hiahest adacent grade. !!�se
natural grade,it available).
E5.For Zone AO only: If no flood depth number is available,is the top of the bottom fl�r elevated in aaordance with the communit�s floodplain management ordinance?
❑Yes ❑No ❑Unknown. The local offiaal must certi"ry this informaaon in Sec6on G.
SECT�ON F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFiCATION
The properiy owner or owners authorize�representative who comple'tes Secfions A,6,C(Items C3.h and C3.i only),and E for Zone A(withou[a FEMA-issued or community-
issued BF�or Zone AO must sign here. 17�e sfa'tements in Sections A,B,C,and E are correct to fhe oesf of my knowledge. ,.
PROPERTY OWNER'SOR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CI iY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
❑ Check here if attachments
, SECTION G-COMMUNITY INFORMATION(OPTiONAL)
The local ofrn�al�n�`�o is ai�rnorizE^by I4:�or ordnan�to administer the community's floodplain management ordinancQ can complete Sec6ons A,6,C(or E),and G of this Devation
Ceraficate. ''.�m�ete���applica�:eit�;.�s)and sign below.
G1.�The inforr,atic,-::r �eC�•:n C U;s taken from other documentaiion that has been signed and emboss2d by a licensed surveyor,engineer,or ar�hitect who is authorized by state
or locai!aw to�ruiy�evatio��ir�ormauon. (fndicate fhe sour�and date of the elevation data in the Comments area below.)
G2.�A commur�t;�ffical completed Secaon E for a building located in Zone A(without a FEMA�ssued or community-issued Br�)or Zone A0.
G3.�The following informauon(Items G4-G9)is provided for�mmunity floodplain managemen't purposes.
G4.PERMIT NUMBER Cs5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF CONIPLIANCc10CCUPANCY ISSUED
G7.This permit has been issued for. ❑New Construction ❑Substantiai fmprovement
G8.Eievation of as-buitt low�i floor(induding basement)of the buifding is: _._ft.(m) Daium:
G9.BFE or(in Zone,40)depth of flooding at the building site is: _ _ft(m) Catum:
LOCAL OFFICIAL'S�IAME TITL�
COMMUNI iY NAME TE�F�HONE •
SIGNATURE DATE
COMMENTS
_ ! I Check here if attachments
;.:�r �,
�t �.y
` � ' *� �`"� CITY OF CLEARWATER
� DEVELOPMENT & NEIGHBORHOGD SERVICES DEPARTMENT
POST�FFICE BOX 4748� CLEARWATER� F�oa�DA 33758-4748
MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTLE AVENUE,CLEARWATER, FLO�uDn 33756
TFtEPHOtvE(72� 562-4567 Fa,�c(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
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 62.COUNTY NAME B3.STATE
�
B4.MAP AND PANEL 67.FIRM PANEL 69.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX 66. FIRM INDEX DATE EFFECTIVE/REVISED DATE B8•FLOOD ZONE(S) �Zone AO,use depth of flooding)
8/18/1992
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 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)1 ft.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:
�evation cerfificates shall be maintained by the community and copies with the attached memo made available by request
Fw,r�x HiR�n►u�,MAYOR
GEORGE N.CRE1'EKOS,COUNCILMEMBGR JOIIN DORAN,COUNCILMEMRER
PAUL F.GIBSON,COUNCILMEMBER � CARI.GN A.PE'PERSEN,COUNCIIMEMHCR
��EQUAL EMPLOYMENI'AND f�FF11tMA'fIVE ACI'lON EMPLOYF.K�
FEOERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
• • ' ELEVATION CERTIFICATE
'" O( � Im ortant: Read the instructions on a es 1•7.
SECTION A•PROPERTY OWNER INFORMATION For�nsurance Comparry use:
� BUILDING OWNER'S NAME PolicyNumber
MENNA DEVELOPMENT
BUILDWG STREET ADDRESS(InGuding Apt,Unit,Sufte,and/or Bldg.No.)OR P.O.ROUT'E AND BOX N0. Company NAIC Number
125-4 BRIGHTWATER DRIVE
��N STATE ZIP CODE
CLEARWATER FL 34630
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Pa�cel Number,Legal Description,etc.)
LOT 4,BEILE AQUA VILLAS i
BUILDING USE(e.g.,Residential,Non-residential,Addition,AccESSOry,etc. Use a Comments area,if necessary.)
RESIDENTiAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS(Type):
( ##°-##'-##.##" or ##.#�{###� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NF1P COMMUNITY NAME&COMAMJNITY NUMBEft B2.COUNTY NAME 83.STATE
CITY OF CLFARWATER 125096 PINELLAS FLORIDA
B4.MAP AND PANEL 87.FIRM PANEL 89,BASE FLOOD ELEVATION(S)
NUMBER 65.SUFFIX 86.FIRM INDEX DATE EFFECTIVF�REVISED DATE B8.FLOOD ZONE(S) (Zone A0,use deptli of floodingj
125096-0007 D 8119191 8�19/91 AE 11
B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9.
❑FIS Profile ❑FIRM ❑Community Determined ❑Other(pesaibe);
B11.Indicate the elevaiion datum used forthe BFE in B9:� NGVD 1929 ❑NAVD 1988 ❑Other(Describe):
B12.Is the buildinq located in a Coastal Bartier Resources System(CBRS)area o�Ofherwise Protected Area(OPA)? ❑Yes �No Des' nation Date
SECTION C•BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Buiiding elevations are based on:�ConstrucUon Drawings' �Buildng Under Construction* ❑Finished ConsUuc�on
*A new EJevafion Certificate wiu be required when consUuc6on of the building is complete.
�C2.Building Diagram Number 8(Select the building diagram most similar to the building for which this cerfificate is being completed-see pages 6 and 7. If no diagram
accurately represents fhe building,p�ovide a sketch or photograph.)
C3.ElevaGons—Zones A1 A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AWA1-A30,AR/AH,ARIAO
Complefe items C3.-ai below according to the building diagram specified in Item C2.State fhe datum used.If the dafum is different from ihe datum used fw fhe BFE in
Secfion B,conve�t the datum to that used for the BFE.Show field measurements and datum conve�ion ca�ulaGon. Use lhe space provided or the Comments area of
Section D or Section G,as appropriate,to document the dafum c�nversion.
Datum ConversioNComments
ElevaGon reference maric used LP 10 BM#1 Does the elevaGon reference maric used appear on fhe FIRM? ❑Yes �No
o a)i op oi�ottom floor(induding basement or endosure) 7, O7 ft.(m) @
o b)Top of next higher floor 11,00 ft,(m) �
o c)Bottom of lowest horizontal sUuctural member(V zones only) NA._ft.(m)
o d)Attached garage(to of slab o�
P ) 7. 07 ft.(m) w m , �
o e)Lowest eleva6on of machinery andlor equipment ;`' ,
seNiang the bu�ding(Describe in a Comments ar2a) NA,_ft,(m) `� �
�
o �Lowest adjacent(finished)grade(LAGj 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 1 3.29 sq,in.(sq,cm) J
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer,or architect authonzed by law to certify elevation information.
1 certify thaf fhe information in Sections A,B,and C on this certificate represents my best efforts to inferpret the data available.
I understand thaf any false statemenf 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
�DDRESS CITY STATE ZJP CODE
3301 DESOT0�8QDLEV RD PALM HARBOR FL 34683
SIGNATU � DATE TELEPHONE
JOB N0.050242�A 05I02105 727_7845496
FEMA Form 81-31,January 2003 See reverse side for continuation. Reolaces all orevious editions
.._ _ _ __ _ __
IMPORTANT; In these s aces,copy the correspondin information from Sectlon A 'For msurance Ca'npany Use.
BUILDWG STREETADORESS(Indud6�g Apt,UniC Suihe,arxila Bidg.No.)OR P.O.ROIITE AND BOX N0. Pollcy,Number
125-4 BRIGHTWATER DRIVE
CITY STATE ZIP CODE '�Company-NAIC Nw� ' �
CLEARWATER � gq�p _
SECTION D•SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of fhis Eieva�on Certificate for(1)caimunity offidal,(2)insurance agenticompany,and(3)bu�ding owner. �
COMMENTS
— ❑Chedc here if attachments
_ SECTION E•BUILDING ELEVATION lNFORMATION(SURVEY NOT REQUIREQ)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zone AO and Zone A(without BFE�,oomplete Items E1 through E4. If fhe QevaUon Certifipte is intended for use as suppoNng informabon for a LOMA or LOMR-F,
Sedion C must be completed.
E1.Bu�c�ng Diagram Number_(Select the buil�ng�iagram most sirrular fo the building for which fhis ce�tificate is being completed—see pages 6 and 7. if no diagram accurately
represents the iwilding�Provide a sketch or photograph.)
E2.The top of the bottom floor(indudf�basement or endosure)of the building is _ft.(m)_in.(cm)�above a ❑below(chedc one)Ihefiighest adJacent grade. (Use
natural grade,if availahle).
E3.For Bu�ding Oiagrams 6�8 with openings(see page�,the next higher floor o�elevaied floor(elevaGon b)of the building is _ft.(m)_in.(cm)above the highest adjacent
grade. Complete iterns C3.h and C3.i on iront of fortn.
E4.The top of the pla�orm of machinery and/or equipment serviang the buikiing is _ft.(m)_in,(cm)�]above a ❑below(checic one)ihe highest adjacent grade. (Use
naturai grade,if available).
Eb.For Zone AO mly: If no flood depth number is ava�able,is the top of the boaan floor elevated in acmrdance with ihe cammunitys Boodpl�in managemenl adinance?
❑Yes ❑No ❑Unknown. The local offidal must certify ihis infortnaUon in Section G
_ SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or ovmei's authonzed rep�esentative who complet�s Sections A,B,C(Items C3,h and C3.i a�ly),and E for Zone A(wiihout a FEMA-issued a community-
issued BF�or Zone AO must sign hera The statemenls in SecGons A,8,�and E are carect to the best ofmy knowledge.
PROPERTY OWNEI�S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADORESS CITY STATE Z1P CODE �
SIGNATURE DATE TELEPHONE
COMMENTS
❑Chedc here if attachments
_ SECTION G•COMMUNITY INFORMATION(OPTIONAL)
The local offid�who�s aufhor¢ed by law or ord�nance to administer the carununitys floodplain management or�inance can complete SecUons A,B,C(o�E�,and G of thfs QevaBon
CertifiCate. Complete fhe applicable item(s)and sign below,
G1.�The information in Section C was taken from other documentaUon that has been signed and emb�sed by a licensed suNeyor,engineer,or architect who Is authorized by siate
or local law to certify elevatJon information. (In�icate the�source and date of fhe elevatlon data in fhe Comrnents area below.)
G2.[�A community offldal completed Secfion E for a twikling located in Zone A(without a FEMAassued or community-issued BFE)or Zone A0.
G3.�The fouowing infamaUon(Items G4-G9)is provided for community floodplain management purposes.
G4.PERhNT NUMBER G5, OqTE pEWvt(f�SSUEp G6, pq7E CERTIFICATE OF COMPLIANCEIOCCUPANCY ISSUED
G7.This pem�it has bcen issued for.0 New ConsUudbn ❑Substantial Improvement
G8.Elevation of as-built lowest iloor Qnduding basement)of the building i�: _,_ft,(m) Datum:
G9.BFE or(in Zone AO)depth of flooding at the buiiding site is: _,._ft.(m) Oatum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE .
COMMENTS
❑Chedc here if attachments
Gcree c,,...,c� �a �.,_..__.�.,..�