125 BRIGHTWATER DR UNIT 5 " FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
' • NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
�a�,3_ �a � �(p ELEVATION CERTIFICATE
Important: Read the instructions on a 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
12�5 BRIGHTWATER DRIVE
CITY STATE ZIP CODE
CLEARWATER BEACH FL 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parr.el Number,Legal Description,etc)
LOT 2,BELLE 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
81.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME 63.STATE
CLEARWATER 125095 PINELLAS FLORIDA
B4.MAP AND PANEL B7.FIRM PANEL B9.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVEA2EVISED DATE B8.FLOOD ZONE(S) (Zone A0,use dep�of flooding)
12509Fr0007 D 8/1951 8/19191 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(Descnbe):_
B11.Indicate the elevation datum used for the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Olher(Descnbe):_
612.Is the building located in a Coastal Bamer Resouroes System(CBRS)area or Otherwise Protecbed Area(OPA)? ❑Yes �No Desiqnation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building eleva6ons are based on:�Construction Drawings' ❑Building Under Construc6on' �Finished Construction
. "A new Eleva6on Certificate will be required when consUuction of the building is complete.
2.Building Diagram Number 8(Select the building diagram most similar to the building for which this certificate is being oompleted-see pages 6 and 7. If no diagram
aocurately 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,ARIAO
Complebe Items C3:a-i below aocording to the building diagram specified in Item C2.State the datum used.If the datum is different ftom the datum used for tt�e BFE in
Sec6on B,convert the datum to that used for the BFE.Show field measurements and datum conversion calculabon. Use the space provided or the Comments area of
Section D or Section G,as appropriate,to document the dalum conversion.
Datum NGVD ConversioNComments
Elevation reference mark used LP 10 BIvt�1 Does the elevafion reference mark used appear on Ihe FIRM? ❑Yes �No
o a)Top of bottom floor(induding basement or endosure) 7. 04 ft(m) �
�
o b)Top of ne�higher floor 11.00 ft.(m) �'
�
o c)Bottom of lowest horizontal struclural member(V zones only) WA.7 ft(m)
o d)Altached garage(top of slab) 7. 04 R(m) E-�
o e)Lowest elevation of machinery andlor equipment w f°
serviqng the building(Descnbe in a Comments area) WA._ft.(m) �'
E m
o �Lowest adjacent(finished)grade(LAG) 5.42 ft(m) z' �
��
o g)Highest adjacent(finished)grade(HAG) 5. 64 ft(m) �
o h)No.of permanent openings(flood vents)within 1 ft.above adjaoent grade 7 � xS►Y ���i•�eS
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 fhat the information in Sections A,B,and C on this certificate represents my best e(forts to interpret the data available.
1 understand that any false statement may be punishable by fine orimprisonmenf 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 DESOTO BOULEVARD PALM HARBOR FL 34683
SIGNATU DATE TELEPHONE
JOB N0.050242 7/2�05 727-784-5496
FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces all previous editions
IMPORTANT: in these spaces,copy the corresponding informa2ion from Se�ion A. Farinsu�ara:ComeanyJse. r �
BUIL7ING STnE-ADDRESS Qnduding Ao't,UnR Sui�.andlor 3Ia.'Ve.;OR-:�.ROL'i=AND BOX N0. ooiicy Number ':
12��BRIGHT�NA��:�DRNE
�''� ��%+i c ZjD COD"c �mpany yAIC Num�r
C��,4RW�I_!' ���1 �L 3J�b!
SECTION D-SURVEYOR,ENGINEER,OR ARCH{T�CT CERTIFiCATION (CONTINUED) •
�opy both sides ofi this 8evation Ceruncate for�'j community omGa!,�2)irsuran�ag�nt/compzny,and i3)buiiding owner.
COMMENTS -
❑Check here if attachments
SECTION t•BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
ror Zone AO and Zone A(without BFE),comoiete Items t1 througn�4. If the Eievation Certincate is intended for use as suppoRing Iniorma6on Tor a LOMA or LOMR-F;
S�aon C must be completed.
E1.Buiiding Diagram Number_(Seiect the buiiding diagram mosi similar to the ouilding for which this ceroncate is being compieted-see pages 6 and 7. if nc diagram accuraiely
reoresents the building,provide a sketch or photograph.j
E2.The too of the bottom floor(including basement or endesure)of ihe ouilding is _ft.(m)_in.jcmj�above or ❑below(chec�k one)the hiehest adjacent grade. (Use
ratural grade,R available;.
E�,ror Building Diagrams 6�with openings(see page 7),the nex higherfloor or elevated floor(elevafion b)of the buiiding is �ft.(m)_In.(cm)above the highest adia�nt
grade. Compiete items C3.h and C3.i on front of form.
�4.?"ne top of the plafform of machinery and/or�auipment s2.Ni7no±he buildinc is _ft.(ml_in.feml f_l above or I_j below fchec.k onel the highest adjacent grade. (Use
ratural grade,it available).
t5.For Zone AC onty: If no flood depth number is available,is the top of the bottom floor eievated ir accorcance with the�mmunity's floodplain management ordirance?
❑Yes ❑No ❑ Unknown. The local omcial must certify this Information in Secuon G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATiVE)CERTIFICATION
The prooerty owner or owne�s authonzed representauve wno completes Sections.A,B,C(Items C3.h and C3.i only),and E for Zone A(without a r=MA�ssued or�mmuniiy-
issued BFEj or Zone AO must sign here. i7�e sfaremenfs in Seciions A,6, C,and E are correct to fhe besf of my knowledge. •
PROP�RTY OWNER'S OR OWNER'S AUTHORIZD REPRESENTATIVE'S NAME
ADDRESS CITI' STAT` ZIP CODE
SIGNATURE DATE TcL=?HONE
COMMENTS
❑ Check here ii attachments
_ SECTION G-COMMUNfTY INFORMATION(OPTIONAL)
The local��5cial Nno,���.;honz=-:by -�,v cr ordinance to administer the community's floodplain management ordinance can complete Sections A,5,C(or E),and G of this Elevation
Cer'hficate .r,or�lete�:�e aopiic�_;ie it,;n(s)and sign below.
G1.[1 Tne i�fc^��n:;.�, Sec~'.�n C �s�aken from other documentation that has been signed and embossed by a licensed surveyor;engineer,or architect wno is authonzed by state
or Ic:.31 law to certi�;elevafi�,�irTOrmation. {Indicate the sourcz and date or the elevation data in the Comments area below.;
G2.❑,4 comm�.r'.ry�off��el�mpleted Secfion E for a building locate�in Zone A(without a FcMAassued or community�ssue�BF�)or Zone A0.
G3.[J Tne tolfowing intormation Qtems G4-u9)is provided Tor c�mmunity floodplain managemeni purposes.
G4.PERMIT NUMBER I G5, DATE P�RMIT ISSUED � G6. DATE CERTIFICA i C OF COMPLIANCFJOCCUPANCY ISSUED
I � I
G7.Tnis permit has ce�n issued tor. �New C�nstruction ❑Subs,anual improvement
G8.�evation of 2s-built lowest flo�r(incJuding basement)or the buiiding is: _,_ft.(mj Datum:
G9.BF�or(in Zone AO)depth or flooding at the building site Is: _ _ft.jm) Datum:
LOCAL OF�iCiAL'S NAME T1TLE
COMMUNI iY NAME T�LEPHQNE •
SIGNATUr`�E pqT�
COMMENTS
I Check nere if attachments
�=iNA Form 81-;,1. ,ianuary 20C3 Re�laces ali previcus ediiions
, - FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
� - • NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
�a�,3� �a � �� ELEVATION CERTIFICATE
Important: Read the instructions on pa es 1-7.
SECTION A-PROPERTY OWNER INFORMATION Ea lnsurance Canpany 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
125-5 BRIGHTWATER DRIVE
CITY STATE ZIP CODE
CLEARWATER BEAfoH--"' FL 33767
—
PROPERTYbESCRIPTION(Lot and Block Numbers,Tax Par�el Number,Legal Descnption,etc.)
LOT 2,BELLE AQUA VILIAS I
BUILDING USE(e.g.,Residen6al,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
81.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME 83.STATE
CLE�4RWATER 125095 PINELIAS FLORIDA
B4.MAP AND PANEL — , — B7.FIRM PANEL 69.RHSE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6.FIRM INDEX DATE EFFECTIVEA2EVISED DATE BB.FLOOD ZONE(S) (Zone A0,use depth of Aooding)
12509('r0007 D �@F�9f�1----� $119191 AE 11
B10.Indiqte the source of the Base Flood Elevation(BFE)data or base flood depth entered in 89.
❑FIS Profile �FIRM ❑Communily Determined ❑Ofher(Desaibe):_
B11.Indicate the elevation datum used for the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Olher(Describe):_
612.Is the building located in a Coastal Bartier Resour�es System(CBRS)area or Othervvise Protecbed Area(OPA)? ❑Yes �No Desgnation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building eleva6ons are based on:�Construc6on Drawings` ❑Building Under Construction' �Finished Construction
� 'A new Eleva�on Certificate will be required when construction of the building is complete.
.Building Diagram Number 8(Select the building diagram most similar to the building for which this certificate is being oompieGed-see pages 6 and 7. If no diagram
accurately represenfs 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,AWAE,AR/A1-A30,AR/AH,AR/AO
Complete Items C3:a-i bebw according�O fhe building diagram specified in Item C2.State the datum used.If the datum is different ftom the datum used for fhe BFE in
Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion ca�ulabon. Use the space provided or the Comments area of
Section D or Section G,as appropriate,to document the datum conversion.
Datum NGVD Conversion/Comments
Elevation reference mark used LP 10 BM#1 Does the elevation reference mark used appear on the FIRM? ❑Yes �No
o a)Top of bottom floor(induding basement or endosure) 7. 04 ft.(m) �
� . J�
o b)Top of next higher floor 11.00 ft(m) ; �
o c)BoUom of lowest horizontal structriral member(V zones oniy) WA.7 ft(m) o o <�' r �'
o d)Attached garage(top of slab) 7. 04 ft(m) E�
o e)Lowest elevation of machinery andlor equipment w 1° � �A
�.7 �: e.'. 'w' ���.
serviang the building(Descnbe in a Commenfs area) WA._ft.(m) E �
o �Lowest adjacent(finished)grade(LAG) 5.42 ft(m) z'.� �`'� �
o g)Highest adjacent(finished)grade(HAG) 5. 64 ft(m) "� ¢�
C
o h)No.of permanent openings(flood venLs)within 1 ft.above adjacent grade 7 J ' zS1Y� I'ro�!•/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.
I cerfify that the information in Sections A,B,and C on fhis certificate r�presenfs my best efforts fo interpret the dafa availa6le.
1 understand that any false statement 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
-
DRESS CIN STATE ZIP CODE
3301 DESOTO BOULEVARD PALM HARBOR FL 34683
SIGNATU DATE TELEPHONE
JOB N0.050242 7/28/05 727-784-5496
CC�AA C.......O� 7� 1...........'lnn'f .-.'_ ". . _ � . . . _ . ..
IMPORTANT: In these scaces,copy the correspondina inronnauon irom See"tion A. '-F�Insurar�Company�sc. +; ; •
9UILDING STRE-,�DRESS(Indudirg Aot,Unr Sui�,andlor�la;.Nc.;On=G.r(OU i c AND 30X N0. °oucy Number
"2��BRIGHTv�/A��-i DRIVE
�� ��a i� ZIP CODc Company�IAIC Nume2r -
C.:4RWA i tn BE,4�ri i=L 33767
SECTION D-SURVEYOR,ENGiNEER,OR ARCH{TECT CERT1FiCATION(CONTINUED} �
Copy boih sides oT this Jeva[ion C2rvncaie Tor(1 j communiiy omGa!,,2)irsuranw ag�n�company,and j3)ouildina owner.
COMMENTS --
❑Check here if attachmenfs
SECTION E•BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITMO!!T'BFE}
For Zone AC and Zone A(withoui BFE},comple'te Items E1 fhrough E4. If the Elevauon Cerfincate is intended for use as suppomng informa6on ior a LOMA or LOMR-F,
S�uon C musi be�mpleted.
E1.Buiiding Diagram Number_(Selerf the buiiding diagram masi similar to the buiiding for which this ceroncate is being completed—see pages 6 and 7. if no diagram accurately
represents the buiiding,provide a skeich or photograph.)
F2.The iop of the bottom floor(induding b2sement or endesure)of ihe buiiding is _ft.(m)_in.(cm)0 above or ❑below(check one)the highest adjacent grade. (Use
natural grade,if avaifable).
E3.For Buiiding Diagrams 6�8 with openings(s2�page 7),the ner higherfloor or elevated floor(elevaaon b)or the buiiding is _ft.(m)_in.(cm)above the highest adjac�nt
grade. Complete items C3.h and C3.i on front of form.
E4,Tne too of the ola�orm of machir�en�andlor eauioment servi�na the buildina is _ft.(,ml_in.(cml I`1 ab�ve or [,I below(,check onel t�e highest adjacent grade. (Use
natural grade,if available7.
_
E5.For Zone AO only: If no floJ depth number is availabie,is the top of the bottom floor�ievaied in accordance with the�mmunity's floodolain management ordinance?
❑Y� ❑No ❑ Unknown. The bcal omcial must cerfify this information in Secoon G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owner's author¢ed representauve wno completes Secuons,A,B,C(Items C3.h and C3.i only),and E for Zone A(without a FEMAassued or�mmuniiy-
issued BFE}or Zone AO must sign here. �e staiemenis in S�rions A,B,C,and E are correcf to fhe best of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTrIORfL�D REPREScNTATIVE'S NAME `'.
ADDRESS CIIY STATE Z1P CODE
SIGNATURF DATE TtLEPHONE
COMMENTS
❑ Check here R aftachments
SECTION G-COMMUNfTY INFORMATION(OPTIONAL)
The local o�cel wno,s a:�;honz>',by ��N cr ordinance to administer the�ammunity's floodplain managemenf ordinance can comple'te Sections A,B,C(or E),and G of this�evation
Cerfmcate. Cor.�lete,��e.applic:..:ie ii�:�(s)and sign below.
G1.�Tne infc�^~auca Ser`on C�;��s taken from other documentauon'that has been signed and embossed by a licensad surveyor,engineer,or architect wno is authonzed by staie
or Iccsl la�v to ceru,elevaf�c;n iniormation.(Indicate the sourr,�and date oi the elevafion daia in the Comments area below.)
G2.0 A commu�.ry bffi�ial�mpleted Section E for a building focated in Zone,4(without a FcMA�ssued or�mmunity�ssue�BF�)or Zone A0,
G3.[j The rollowing inrormation(Items G4-G9)is provided ror community floodplain management purposes.
� G4.PERMff NUMBER G5. DATE PERMCf iSSUED G6. DATE CERTIFICATE OF COMP�ANCEIOCCUPANCY ISSUED
G7,This permii has been issued ror. �New Canstruc�on ❑Substanaal Improvement
G8.Eievation of 2s-buiit lowest floor(induding basement)or the building is: _._ft.(m) Datum:
G9.BF�or(in Z�ne AO)depth m flooding at the builaing site is: _ _ft.(m) Datum:
LOCAL QFriCfAL'S NAME i I i'�
COMMUNI iY NAME TG�FPHONE
SIGNATURE CAT� �
COMMENTS
❑ Check nere if attachments
• . .
�� `.,� �A•.�;.
'` '� ' �°` * CITY OF CLEARWATER
� � ��� � ����� .
� ,n��
# °�° DEVELOPMENT & NEIGHBORHOGD SERVICES DEPARTMENT
POST�FFICE BOX 4748� CLEARWATER� FLOa►DA 33758-4748
MUNIC[PAL SERVICES BUILDING, lOO SOUTH MYRTLE AVENUE,CI.EARWATER, FLO�uDn 33756
TELEPxoNE (72� 562-4567 Fnx(72� 562-4576
MEMO OF REVIEW FOR CORRECTNESS & COMPLETION
In accordance with participation in the NFIP/CRS program, all elevation certificates are required to be reviewed for correctness and completion prior to
acceptance by the community. This complete form shall be attached to all elevation certificates maintained on file and provide with requested copies of
elevation certificates.
The attached elevation certificate requires corrections by the surveyor of section(s) prior to acceptance by the community
The attached elevation certificate is complete and correct
X Minor corrections have been made in the below marked sections by Community 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,Legai 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
64.MAP AND PANEL g5.SUFFIX 86.FIRM INDEX DATE B��FIRM PAVEL gg,FLOOD ZONE(S) B9�BASE FLOOD ELEVATION(S)
NUMBER $�18�1992 EFFECTIVE/REVISED DATE (Zone A0,use depth of flooding)
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
❑ FIS Profile ❑ FIRM ❑ Community Determined ❑ Other(Describe)
611. Indicate elevation datum used for BFE in 69: ❑ NGVD 1929 ❑ NAVD 1988 ❑ Other(Describe)
612. Is the building located in a Coastai 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 certificafes shall be maintained by the community and copies with the attached memo made availab/e by request
FRANK HIBRARD,MAYOR
GEORGE N.CRE'I'EKOS,COUNCILMEMBGR JOIIN DORAN,COUNCILMGMBER
PAUL F.GIBSON,COUNCILMCMAGR � CARI.BN A.PE7'BRSHN,COUNCILMCMBER
��EQUAL EMPLOYMEN'1'AND Af�FIRMA'I'IVE AC7'ION EMYLOYER��
FEDERAL EMERGENCY MANAGEMENT AGENCY p,M.B. No. 3067-0077
, . • NATIONAL F100D INSURANCE PROGRAM Expires December 31, 2005
� � � /� ELEVATION CERTIFICATE
�vv�`� �a�� Im ortant: Read the instructions on a es 1-7.
SECTION A-PROPERTY OWNER INFORMATION For�nsuranc�C«npany Use:
•BUILDING OWNER'S NAME Policy Numbec
MENNA DEVELOPMENT
BUILDING STREETADDRESS pnGuding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
12r5 BRIGHTWATER DRIVE
��TY STATE ZIP CODE
CIEARWATER FL 34630
PROPERTY DESCRIPTION(Lot and Blodc Numbers,Tax Parcel Number,Legal DescripUon,etc.) .
lOT 5,BEILE AQUA VIUAS I
BUILDING USE(e.g.,Residential,Non-residentlal,Addition,Accessory,eta Use a Comments area,'rf necessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS(Type):
( ��'�''�•�" °� �•�� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME&CONNMJNITY NUMBER B2.COUNTY NAME 83.STATE
CITY OF CLEARWATER 125096 pINELLAS FLORIDA
64.MAP AND PANEL B7.FIRM P.4NEL B9.BASE FL000 ELEVATION(S)
NUMBER 65.SUFFUC B6.FIRM INDEX DATE EFFECTIVFJREVISED DATE 88.FLOOD ZONE(S) (ZoneAO,use depm of flooding)
125096-0007 D 8119/91 8119/91 AE 11
B10.Indicate the source of the 8ase Flood Elevafion(BFE)data a base flood depfh entered in B9. �
❑FIS Profile ❑FIRM ❑Community Detemuned ❑Other(pesaibe);
B11.Indicate the elevation datum used for the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Ofher(Describe):
B12.Is the building located in a Coast�Barrier ResourCes System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No Des' nation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
Ci.Building elevaUons are based on;�Construction Drawings` �Buil�ng Under ConsUucUon' ❑Fnished ConsUucUon
*A new ElevaGon Cerfificate wiil be�quired when constructlon of the bu�ding is complete.
C2.Buiiding Diagram Number 8(Select fhe building diagram most similar to the buil�ng for which this certificate is being completed-see pages 6 and 7, If no diagram
accurately represents the building,provide a sketch a photograph.)
3.Elevations—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AWA,AR/AE,AWA1-A30,AR/AH,AWAO
Complete Items C3.-a-i below according to the building diagram specified in Item C2.State fhe datum used.If the datum is different from fhe datum used for the BFE in
Secfion B,convert the datum to that used for the BFE.Show field measurements and datum conversion calcula6on. Use fhe space provided a the Comments area of
Section D or Sedion G,as appropnate,to document the datum conversion.
Datum Conversion/Comments
Elevatlon reference mark used LP 10 BM#1 poes the elevation reference mark used appear on fhe FIRM? ❑Yes �No
o a;?op cf�ttcm�'�ccr(u�dudi�g basement or endosurej 7 04 ft.(m) �
o b)Top of next higher floor 11,00 ft.(m) �
o c)Bo�om of lowest horizontal structural member(V zones aily) NA._ft.(m) j
U N�? .
o d)Attached garage(top of slab) �, pq ft�m� w° , � ''�
o e)Lowest elevation of machinery and/or equipment
servicing the building(Desaibe in a Comments area) Np,,_ft,�m� �= x -��'`
o fl Lowest adjacent(finished)grade(LAG) 5.42 ft.(m) ' ` , � y�
z�
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 � #2512 5/02105
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 surveyor,engineer,or architect authorized by law to certify elevalion information.
1 certify fhat the information in Secfions A,B,and C on this certificafe represents my best efforfs to interpret the dafa available.
_I undersfand that any false statemenf may be punishable 6y 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 Z1P CODE
3301 DESOT LEVARD PALM HARBOR FL 346g3
SIGNATU DATE TELEPHONE
JOB N0,0502425A 5/02J05 727_784�5498
FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces all previous editions
IMPORTANT: In these spaces,copy the coITesponding information from Section A. For msuranc�company use:
BUILDING STREET ADDRESS(Induding Apt,Unit,Suite,andla Bkig.No.)OR P.O.R011iE AND BOX N0. Policy Number '
12�5 BRIGHTWATER DRIVE � � -
�� STATE ZIP CODE Company NAIC Number '
CLFARWATER �, 34630
SECTION D•SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this�evation Cerbficate for(1)canmunity oifidal,(2)insurance agenVcompany,and(3j building owner. �
COMMENTS
❑Checic here if a�achments
SECTION E-BUILDING 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. If the Elevaati�on Certificate is intended for use as suppo�ing informaUon for a LOMA or LOMR-F,
Section C must be completed.
E1.Bu�ding Diagram Number_(Sdect the building diagram most similar to the building for which this certificate is being completed—see pages 6 and 7. If no diagram accurately
rep�esents the buiiding,provide a sketch or photograph.)
E2.The top of the bottom floor(induding basement or endosure)of the building Is _n.(m)_in.(cm)�above or ❑below(chedc one)the highest adjacent grade. (Use
natural grade,if available).
E3.For Bu�ding Diagrams 6-8 with openings(see page 7�,1he next higher floor or elevated floor(elevafion b)of the building is _ft.(m)_in.(cm)above the highest�acent
grade. Complete items C3.h and C3.i on front�form.
E4.The top of the pla�am of machinery andlor equipment servidng the building is _ft.(m)_in.(cm)❑above or ❑below(check one)the highest adjacent grade. (Use
natural grade,if available),
E5.For Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with fhe communii�s floodplain management ordinarxe?
❑Yes ❑No ❑Unknown. The local�ficial must ceriify this information in Sec�on G.
SECTION F•PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owner's authorized repre.sentative who canpletes Seclions A,B,C ptems C3.h and C3.i only),and E for Zone A(wifhout a FEMA-issued or community-
issued BF�or Zone AO must sign here. The statements in Sections A,8,C,and E ere corred to the best of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP COOE �
SIGNATURE DATE TELEPHONE
COMMENTS
❑Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The loccal offiaal who is authorized by law or ordinance to administer the communitys floodplain management ordinance can complete SecGons A,B,C(or E),and G�fhis ElevaUon
Certificate. Complete the applicable item(s)and sign below.
G1.�The informafion in Section C was taken from othe�documentatlon ihat has been signed and embossed by a licensed surveyor,engineer,or arGhitect who is authorized by state
or focai law to certify elevalion information. (Indicate the sou�ce and date of ihe eleva6on data in the Comments area below.)
G2.�A community offiaal completed Sedion E for a building located in Zone A(without a FEMA-issued or community-issued BFE}or Zone A0.
G3.�The following informabon(Iterns G4-G9)is provided for communiry floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT�SSUED G6.DATE CERTIFICATE OF COMPLUWCE/OCCUPANCY 15SUED
G7.This permit has been issued for.�New Construction ❑Substantiai Improvement
G8,Eleva6on of as-built lowest floor(induding basement)of the building is; _._ft.(m) Datum:
G9.BFE or(in Zone AO)depth of flooding at the build�ng site is; _,_ft.(m) Datum:
LOCAL OFFtCIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE �
COMMENTS
❑Check here if attachments
FEMA Form 81-31,Januarv 2003 ao..i�,.oe���.,.e,,:..,,e e,�,+;,,....