125 BRIGHTWATER DR UNIT 6 • • FEDERAL EMERGENCY MANAGEMENT AGENCY
' � ` NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077
Expires December 31, 2005
��d0o 3--���i�-- ELEVATION CERTIFICATE
Important: Read the instructions on pa es 1•7.
SECTION A-PROPERTY OWNER INFORMATION For Insurance Cary�any Use�
BUILDING OWNER'S NAME Policy Number
MENNA DEVELOPMENT
BUILDING STREET AODRESS(Inciuding Apt.,Unit,Suite,and/or Bldg.No.)OR P,O.ROUTE AND BOX NO Company NAIC Number
125-6 BRIGHTWATER DRIVE
CITY STATE ZIP CODE
CLEARWATER BEACH FL 33767
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Par�ei Number,Legal Description,etc.)
LOT 1,BELLE AQUA VILLAS I
BUILDING USE(e.g.,Residential,Non-r�esidential,Addition,Accessory,etc. Use a Comments area,if necessary.)
RESIDENTIAL
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: GPS(Type):
( ##°-##'-##.##" or ##.#l�l#� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
Bt.NFIP COMMUNITY NAME$COMMUNITY NUMBER 62.COUNTY NAME B3.STATE
CLF.ARWATER 125095 PINELLAS FLORIDA
B4.MAP AND PANEL 87.FIRM PANEL 69.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX B6.f IRM INDEX DATE EFFECTIVEIf2EVISED DATE B8.FLOOD ZONE(S) (Zone A0,use deplh of flooding)
1250960007 D 9�19191 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(Describe):
B11.Indicate the eleva6on datum used for the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Other(Descnbe):_
B12.Is the building located in a Coastal Bamer Resources System(CBRS)area or Othervvise Protected Area(OPA)? ❑Yes �No Designa6on Dat�
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:❑Construc�on Drawings` ❑Buiiding Under Construction' �Finished Construction
� 'A new Elevation Certificate will be required when constn�ction 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 completed-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(wifh BFE),VE,V1-V30,V(with BFE),AR,AWA,AR/AE,AWA1-A30,AR/AH,AR/AO
Complebe Items C3.-a-i below according to the building diagram specified in Item C2.State the datum used.If the datum is dift�rent from the datum used for the BFE in
Section B,convert the datum to that used for the BFE.Show field measur�menL�and datum conversion calculation. Use the space provided or the Comments area of
Sec6on D or Section G,as appropriate,to document fhe dalum conversion.
Datum NGVD Conver�ioNCommenfs
Elevation reference mark used LP 10 BIvt�1 Does the elevation reference mark used appear on the FIRM? ❑Yes �No
o a)Top of bottom floor(induding basement or endasure) 7. 03 ft(m) � y�'' ' }�� �
o b)Top of next higher floor 11.00 ft.(m) �'
o c)Bottom of lowest honzontal struclural member(V zones only) WA._ft.(m) y� , J -
o d)Attached garage(top of slab) 7. 03 R(m) E� •Q` c:�,�a -
o e)Lowest elevaUon of machinery andlor equipment w; ° , '� �
servidng the building(Descnbe in a Comments area) WA._ft.(m) �; -= �
o �Lowest adjacent(finished)grade(LAG) 5.42 ft(m) z'.� -
o g)Highest adjacent(finished)grade(HAG) 5. 64 R(m) �� • *�'' 'r
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 7 � lSix ro�lo�o� .
o i)Total area of all permanent openings(flood venls)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,8,and C on this certificate represents my best efforts fo interpr�t 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
•TITLE PRESIDENT COMPANY NAME GEORGE A.SHIMP II&ASSOC.,INC
ADDRESS GTY STATE ZIP CODE
3301 DESOTO BOULEVARD PALM HARBOR FL 34683 ;
SIGNATU DATE TELEPHONE
JOB N0.050242 7I28105 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 inTOrmation from Se�ion A. Fx insur�.nw�amoany Us�: '- '
BUI;.,71NG SlRE-ADDRESS ilnduding Ap�.Unrt,Sui�,andlor 91de.��a)C�?�.RCL i c AND 30X NG. �oiic�Nurr�r
12�3P.IGHTWATCR DRIVE
��" S�A i c ZIP CODE Compariy;VAIC Nurwer
Ci.11RWAT�BEACii FL ?3761 �
SECTION D-SURVEYOR,ENGINECR,OR ARCHITECT CERTIFICATION(CONTINUED)
Cooy both sid�s of'�nis�evauon Ceruncaie fer(ij communiry omGaL(2;insuran�;agenUcompany,and;31 buiidina owner.
COMMEIvTS -- —
❑Chedc here if attachments
ScCTION E-BUILdING ELEVATION INFORMATION(SURVEY NQT REQUIREd}FOR ZONE AO AND ZONE A(WITHOUT BFE)
�or Z^,ne AG and Zone,A(without BF�),complete Items�1 through E4, If the Eievauon Certmcate is Intended ior use as suppornng inrormation for a LOMA or LOMR-r,
Se:;tion C must be completed.
c i.B�iiding Diagram Number_(Seleci the ouiiding diagram most simiiar to the building ror wnich this certincate is being compleied–see pages 6 and�. If no diagram ac;,urately
represents`�he building,provide a sketcn or pnotograph.j
E2.The top or"the bottom floor(induding basement or endesure;or the building Is _ft.(ml_in.(cm)�above or ❑below�G�eck one)the hignest adjacent grade. (Use
natural grade,if availablel.
E3.For Building Diagrams 6-8 with openinps(see page 7),the ne�hiaherfloor or elevated floor(elevation b)of the building is _ft.l;mj_in.(cm)above the hignest adjacent .
grade. Compleie items C3.h and C3.i on front o�form,
E4.TIIE tOD Of II12 Di2�01TT1 Oi fT1�CCI11flEN 8(1(jl0f eOUI�fTl2t12 52NIG(14}I12 SUIIdl�4!S _ft.(,,Rll_If1.IC(Tl�I�BIYJVe Of ❑below±check onel the nighest adiacent grade, !Use
raturai grade,if avaifable).
E5.For Zone AO only: If no flood depth number is available,is the top or the bottom floor elevaied in accordance with the community's floodplain management ordirance?
❑Yes ❑No ❑Unknown. The local officiai must cerfify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATiVE)CERTIFICATION
The property owner or owne?s authonzed representative who compietes Secbons A,B,C(Items C3.h and C3.i only),and E for Zone A(without a�EMA-issued or communi"ry-
issued BF��or Zone AG must sign here. The statements in Seciions A,8, C,and E arn correct"ro the best of my knowledge. •
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CiTY STATE Z1P CODE
SIGNATURE DAT� i E!�PHONE
COMMENTS �
_ ❑ Chedc here if attachments
�_�_ _� SECTION G-COMMUN(TY INFORNfATION(OPTIONAL}
The local,�`iaa mc's�:nonze.:by 1-���or ordinan�to administer the community's floodplain management ordinance'can comolete Sectiors A,B,C(or E),and G or this Elevation
Certmcate. Cor,;.lete°e�oolic;^�e i'tem(s'and sign below.
G',�The inforrr�iic,i�,�� '!on C vas taken from other documentation that has been signed and emboss2d by a licersed surveyor,engineer,or ar�hitec;who is authonzed by s'tate
or la:,� �w to certify�leva6on informa6on. (Indicate the sour�e ana date of the elevation data in the Comments area below.)
G2,0 A commur,,:; �:°:�-i�mplet�!Section F for a building located in Zone A(without a FcMAassued or community�ssued BFE?or Zane AC.
G3.[The tollowing inrormauon(Items G4-G9)is provided ior o�mmuni'ry flocdplain management purposes.
G4.P�RMIT NUMBER G5. DATE PERMIT ISSUED Go. DATE C�RTIFICA i t GF COMPLIANCEIOCCUPANCY lSSUED I
� �
G7.This Fermit has be°n issued tor. ❑New Construdion ❑Substantial improvement
G8.�evation or as-built lowest floor(induding basement;of the buiiding is: _._ft.i m) Datum:
G?.BF=or(in Zone AO)depth of flooding at the ouilding siie is: _ _ft.(mj Catum:
�OCAL QFrICiAL'S NAME TITL�
C�MMUNITY NAME T��=PHONE •
JIGNA,I!JRE DP,TE
COMMENTS
❑ �heGk here iT attachments
==;viA=orm 31-�1,January 20�3 neplaces all arevious�ciiEions
• FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
' NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
��d0o 3_���i�- ELEVATION CERTIFICATE
Important: Read the instructions on pa es 1-7.
SECTION A-PROPERTY OWNER INFORMATION Fa�,�,rar,�ca�ny u�:
UILDING OWNER'S NAME Policy Number
MENNA DEVELOPMENT
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bidg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
1256 BRIGHTWATER DRIVE
CITY STATE ZIP CODE
CLEARWATER R�,.�°�`r-- FL 33767
PROPERIY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
LOT 1,BELLE AQUA VILLAS I
BUILDING USE(e.g.,Residential,Non-residen6al,Addition,Accessory,etc. Use a Comments area,if necessary.)
RESIDENTIAL
IATITUDE/LONGITUDE(OPTIONAI) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):
( ##°-##'-##.#1�" or ##.� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)iNFORMATION
81.NFIP COMMUNITY NAME&COMMUNITY NUMBER 82.CWNTY NAME 83.STATE
CLEARWATER 125095 PINELtAS FLORIDA
B4.MAP AND PANEL �— ^ a B7.FIRM PANEL 69.BASE FLOOD ELEVATION(S)
NUMBER 85.SUFFIX B6.FIRM INDEX DATE EFFECTIVErREVISED DATE 88.FLOOD ZONE(S) (Zone A0,use depC�of flooding)
12509Fi0007 D 9L191S3-- 8/19i91 AE t1
B10.Indicate fhe souroe of the Base Flood Elevation(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 ❑Olher(Desaibe):_
B12.Is the building located in a Coastal Bamer Resources System(CBRS)area or Othervvise Proteched Area(OPA)? ❑Yes �No Desiqnation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevations are based on:�ConstrucUon Drawings* ❑Building Under Construction* �Finished Constnu:tion
� A new Etevation Certificate wiil be required when construction of the building is complete.
.Building Diagram Number 8(Se�ect the building diagram most similar to the building(or which fhis cettificate is being completed-see pages 6 and 7. If no diagram
aocurately represents the buikJing,provide a sketch or photograph.)
C3.ElevaUons—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
CompleGe Items C3-a-i below aocording b ihe building diagram speafied in Item C2.State the datum used.If the datum is different from ihe datum used for the BFE in
Sec6on B,convert the datum to ihat used for the BFE.Show field measurements and datum conversion calculabon. Use the space provided or ihe Comments area of
Sec�on D or Sec6on G,as appropnate,to document fhe datum conversion. .
Datum NGVD ConversioNComments
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 a endosure) 7. 03 ft(m) � }�
o b)Top of next higher floor 11.00 ft(m) �' �
o c)Bottom of lowest honzontal struch�ral member(V zones only) WA._ft.(m) J ,�,
o O ^r
o d)Attached garage(top of slab) 7. 03 ft(m) E� * ` �F i'
_ w � J.,�
o e)Lowest elevation of machinery andlor equipment _ � �
senridng the building(Desaibe in a Comments area) WA._ft.(m) E� " :
o �Lowest adjacent(finished)grade(L4G) 5.42 ft(m) z'.�� '
o g)Highest adjacent(finished)grade(HAG) 5. 64 ft(m) �N = �,
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 7 � 2S�x ro��o'et ' .
o i)Total area of ail permanent openings(flood venLs)in C3.h 1203.29 sq.in.(sq.cm)
SECTION D-SURVEYOR,ENGINEER,ORARCHffECT 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 fhaf the information in Sections A,B,and C on this certificate represenfs my best efforfs to interpret 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
�ADDRESS CITY STATE ZIP CODE
3301 DESOTO BOULEVARD PALM HARBOR FL 34683
SIGNATU DATE TELEPHONE
JOB N0.050242 7/28105 727-784-5496
FFMG Fnrm R1_71 I�n��on��nm c..................�a.,a.....,...�;.,....i:,... ^--�--'--""-..._.._ _.....---
IMPORTANT: In these spaces,copy the corresponding iniorma'tion irom Sec-iion A. ''F�;insurnw camoanv�1se: � `
�UILDING S iZi-E�i ADDR�SS jlnduding Ao�,Unr4 Sui�,andlor Bldc.Ne.)CR°.0.RCU i t AIVD 90X NC. ?oiicv Niimeer =
12�-o SP.IGHTW�TER DRIVE
CITY S i A i t ZIP CODE �ompany?U�,iC Num�er
CL=�2WAT=r�9EACH t'L 3J�b( - r�
t
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Cooy both sides of�his�evauon Cer�ficate tor(i j communiry o�ndal,(2;insurn�aa�nUcompany,and;31 buiiding owner.
COMMEIvTS "-
❑Chedc here if attachments
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED}FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zone AG and Zone,A(wifhout BF�,complete items E1 through E4. If the Eleva6on Ceruficate is intended ior use as suoporong inrormation for a LOMA or LOMR-F,
Secuon C must be compieted.
E i.Buiiding Diagram Numher_(Select the buifding diagram most similar to the building ror which this cer6ncate is being compleied—see pages 6 and�. If no diagram a�uraiely
represents the building,provide a sketch or pnotograph.)
t2.The top or the bottom floor(induding basement or endosure;or the buiiding is _ft.(m)_in.(em)�above or ❑below(check one)the highest adjacent grade. (Use
natural grade,'rf available).
E3.For Building Diagrams 6-8 with openinos(see page 7),the next hiaherfloor orelevated floor(elevation b)ofthe building is _ft.(mj_in.(cm)aoove the highest adja�nt
grade. Compleie items C3.h and C3.i on front oi form.
E4.The top of the olafform of machinery and/or eouiomeni seroicina the building Is _ft.!ml_in.(,cml[]ab�ve or ❑below(checic onel the highest adiac�nt grade. �Use
ratural grade,i�available).
- - - _ _
E5.For Zone AO only: If no flood depth number is available,is fhe top of the bottom floor elevaie:i in accordance with the community's floodpiain management ordinance?
❑Yes ❑No ❑Unlmown. The Ic�al offiaal must certify this inforrra6on in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPftESEtdTATIVE)CERTIFICATION
The prnperry owner or owners author¢ed representative who completes Sections A,B,C(Items C3.h and C3.i only),and E for Zone A(without a FEMA-issued or communi'ry-
issued BF�or Zone AO must sign here. The sfafemenrs in Secnons A,5,C,and E are correct"ro fhe best of my knowledge. �
°ROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TE�HONE
COMMENTS
❑Chedc here if attachments
SECTION G-COMMUN(TY INFORMATION(OPTIONAL)
The local ofiaa .vnc� :nonze_:5y i���or ordinan�to administer the community's floodpiain managemen"t ordinance'can complete Sedions A,B,C(or�,and G of this Eleva6on
Cemficaie. Cor.°leie°E�ppfi�^ie iiem(sl and sign below.
G1.�The inforrr�tic,i�.��.'!on C Nas;aken from other documeniation that hzs been signed and embossed by a licensed surveyor,engineer,or ar�hitect who is authonzed by state
or la,y'aw;o cera"ry�levation information. (Indicate the sour�and date of the elevation data in the Comments area below.)
G2.��1 commur�,;i�:r:;�:���mp{eted S�tion E Tor a building located in Zone A(without a FEMAassued or community�ssued BFE)or Zone A0.
G?.[�The rollowing inrormation(Items G4-G9)is orovided for�mmuni'ry floodplain management purposes.
G4.PERMIT NUMBER G5. DAT RERMIT iSSUED G6. DA'i'E CERTIFICATE GF COMPLIANCEIOCCUPANCY ISSUED
G7.This permit has oeen issu�for. ❑New Consiruction ❑Subs'tantial Improvement
G8.Ele��ation of as-built lowest floor(induding basement)of the buiiding is: _._ft.(m) Qatum:
G?.BF�or(in Zone AO)depth o�flooding at the building site is _ _ft.(m) Qaium:
LOCAL OFrICIAL'S NANiE TITL�
COMMUNITY NAME T���PHONE �
SIGNA.TURE DA.TE
COMMEN�S •
❑ Chec,k nere if attachments
z _ __
� .
�: �
�
`� °� '�� " 'i° C ITY OF C LEARWATER
� �
�� � � ; .
� � �'�'E � DEVELOPMENT & NEIGHBORHOGD SERVICES DEPARTMENT
� ,��., _
'�"� POST OFFICE BOX 474g� CLEARWATER� FLO�DA 33758-4748
y '-
.,>� MUNICIPAL SERVICES BUILDING, IOO SOUTH MYRTI.E AVENUE,CI.EARWATER, FLO�uDn 33756
TFCEPxoNS (72� 562-4567 F.ax(727) 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,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 g5.SUFFIX 66.FIRM INDEX DATE B��FIRM PANEL 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 69.
❑ FIS Profile ❑ FIRM ❑ Community Determined ❑Other(Describe)
611. Indicate elevation datum used for BFE in B9: ❑ NGVD 1929 ❑ NAVD 1988 ❑Other(Describe)
B12. 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 buiiding(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 O�cial:
�evation certificates sha/l be maintained by the community and copies with the attached memo made available by request
FRANK HIBI3ARI>,MAYOR '
G@ORGE N.CRE7'CKOS,COUNCILMEMBER JOIIN DORAN,COUNCILMEMALR
PAUL F.GIASON,COUNCILMEMRBR � CARI.@N A.P@7'ERSEN,COUNCILMEMBER
��EQUAL EMNLOYMEN7'AND AFF11tMA7'IVE AC770N EMPLOYEK�
_ i ____ _ ___
� � FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
. �
NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005
• 2 �} ELEVATION CERTIFICATE
D�`�' j ai vl� Im ortant: Read the instructions on a es 1-7.
SECTION A-PROPERTY OWNER INFORMATION For Insuiance c,anpany use:
�BUILDING OWNER'S NAME Policy_Number
MENNA DEVELOPMENT
BUILDING STREEr ADDRESS(Including Apt,Und,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
125-6 BRIGHTWATER DRIVE
CITY STATE ZIP CODE .
CLEARWATER FL 34630
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcei Number,Legal Descrip6on,eta)
LOT 6,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):
���'�'#�•�" o� �#•�� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.
SECTION B•FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
81.NFIP COA�AUNITY NAME&COAMNUNIN NUMBER 62 CWNTY NAME B3.STATE
CITY OF CLEARWATER 125096 PINELLAS FLORIDA
B4.MAP AND PANEL 87.FIRM PANEL 69.BASE FLOOD ELEVATION(S)
NUMBER B5.SUFFIX 86.FIRM INDEX DATE EFFECTIVE�REVISED DATE B8.FLOOD ZONE(S) (Zone A0,use�pth of flooding)
12509Cr0007 D $119�91 8119/91 AE 11
B10.Indicate the source of the Base Flood Elevatlon(BFE)data or base flood depth entered in B9.
❑FIS Profile ❑FIRM ❑Community Detemuned ❑Other(pescrit�e);
B11.In�icate the elevaUon datum used for the BFE in B9:NGVD� 1929 ❑NAVD 1988 ❑Other(Describe):_
B12.Is the building located in a Coastal Bamer Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑Yes �No Desi nation Date
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
C1.Building elevatlons are based on:�Construc�on Drawings' �Building Under ConsUuction' ❑Finished Construction
*A new Elevation Cerfificate wilt be required when consUucction of the building is complete,
�C2 Building Diagram Number 8(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 fhe 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
Complete Items C3:a-i below acco�ding to fhe building diagram specified in Item C2.State fhe 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 ConversionlComments
Eleva6on reference mark used LP 10 BM#1 Dces the elevaUon reference mark used appear on the FIRM? ❑Yes �No
o a)Top of uottom floor(induding basement or endosure) 7. 03 ft.(m) m
o b)Top of next higher floor �� ,pp��m) �n
o c)Bottom of lowest honzontal structural member(V zones only) NA,_ft.(m)
o d)Attached garage(top of slab) 7. 03 ft.(m) �°
w m
o e)Lowest e levatlon of machinery andlor equipment - �
servidng the building(Desaibe in a Comments area) NA,_ft,(m) �_ .
o �Lowest adjacent(finished)grade(LAG) 5.42 ft.(m) z m
o g)Highest adjacent(finished)grade(HAG) 5. 64 ft.(m) "N #2512 5/02/05
o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 7 �
o i)Total area af 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 elevation information,
I cerfify that fhe information in Sections A,B,and C on this cerfificafe represents my best efforts to interpret the data availab/e.
1 undersfand thaf any false statemenf may be punishable by fine or impnsonment under 18 U S Code,Section 1001
CERTIFIER'S NAME GEORGE A.SHIMP II UCENSE NUMBER 2512
TITLE PRESIDENT COMPANY NAME GEORGE A.SHIMP II&ASSOC.,INC
'�DDRESS CITY STATE ZIP CODE
3301 DESO OULEVARD PALM HARBOR FL 346g3
SIGN DATE TELEPHONE
B N0.050242-G 5/05l05 727-784-5496
FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces all previous editions
IMPORTANT: In these spaces,co y the corresponding Informatlon from Section A ''Fw ineuianoa cr.mpany l:se ='' '
BUII.DWG STREETADORESS(Indudir�g Apt,Urut Suile,andla Bldg.No.)OR P.O.ROUTE AND BOX N0. Pol�y Num�er.
125-6 BRIGHTWATER DRIVE • '
� 5TATE Z1P COOE Con�anY,NA+��NUp?I�G ' ;:
ClFARWATER FL 34630
SECTION D•SURVEYOR,ENGiNEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy bofh sides of this Elevatlon Certlficate fw(1)cwnmuNty o�idai,(2)insurance apenUcompany,and(3)building owner, �
CAMMENTS
❑Chedc here if attachments
_ SECTION E•BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO ANQ ZONE A(WITHOUT BFE)
For Zone AO and Zone A(�nthout BFE�,complete Items E1 through E4. If the Elevatlon Ce�ificate is(ntended for use as supporUng Informatlon for a LOMA w LOMR-F,
SecUon C must be completed.
E1.Building Diagram Number_(Select the building c�agram most similar to the building fo�which this ceNficate Is being completed—see pages 6 and 7, If no diagram acaraleiy
represents the twilding,Provide a sketch or photograph.)
E2.The top of ihe bottwn floor(Induding bas�t or endosure)of the buUd(ng(s _R(m)_in•(cm)�above or ❑below(check one)the highest adJacent grade. (Use
natural grade,if available).
E3.Fa'8u��ing Dla9rarr�s 6-8 wiih apenin9s�See Pa98 7)�the next higherfloor welevated floor(elevation b)of 1he twilding is _ft.(m)_in.(cm)above ihe h(ghest adjacent
grade. Complete iterr�s C3.h and C3a on front of form.
E4.The 1op of the pla�orm of machinery andlor equfpment servidng ihe building is _ft.(m)_in.(cm)�above or ❑below(chedc one)Iha highesi adjacent grade. (Use
natural grade,if available).
E5.ForZoneAO only: If no flood depfh number is av�lable,is lhe top of the bottan floor elevated in accordance with ihe communitys�oodplaln management ord(nance?
❑Yes ❑No ❑Unknown.The bcal offidal must cerUfy this InfamaGon in SecUon G
_ SECTION F•PROPERTY OWNER(OR OWNER'S REPRESENf�ATIVE)CERTIFiCATION
1'he properiy owner or owners authorized representative who completes SeGions A,B,C(items C3.h and C3J aily),and E for Zone A(wiihout a FEMA-issued or canmunity-
Issued BF�or Zone AO must sign here. Trie statements!n SecGons A,B,C,and E are cort�to the best of my knowledge.
PROPERTY OWNEf�S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE Z1P CODE �
SIGNATURE DATE TELEPHONE
COMMENTS
❑Chedc he�e if attachments
SECTiON G•COMMUNITY INFORMATION(OPTIONAL)
The local oifiaal who is authonzed by law oradinance to adnuNster ihe canmunity's floodplain management ord(nance can com�ete SecUons A,B,C(or�,arid G of�is Elevaiion
Certiflcate. Compteie fhe applicable item(s)and sign below.
G1.[J The infortnation in Seclion C was taken fran ofher documentaGon that has been signed and embossed by a�censed survayor,engineer,or architecc�who fs authorized by slate
o�locai law to certi�y elevation infortnation. (Indicate fh9 sou�ce and date of the elevaUon data in Ihe Comments area below.)
G2.�A communiry offid�completed Section E for a buiiding located in Zone A(wiftwut a FEMA-issued or wrrmunity-issued BFE)or Zone A0,
G3.[]The following infortnation(Items C�9j is provkied for commuNty floodp�ain management purposes.
�'P�N��� � ��PE���� G6.DATE CERTIFICATE OF COMPLIANCFJOCCUPANCY ISSIJED
G7.Tlus perrnit has been issued for:�New ConsUu� ❑SubstanGal Improvement
G8.EJevation of as-bu�t lowest floor(induding basement)of the tw�ding is: _._ft.(m) D��
G9.BFE or(in Znne AO)depih of 1looding atthe building site is: _._ft.(m) Oatum
LOCALOFFICIAL'S NAME - TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE �
COMMENTS
❑Chadc here if attac;hments
��ree c o� �, �