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850 ELDORADO AVE ELEVATION CERTIFICATE O.M.B. No. 3067•0077 FEDERAL EMERGENCY MANAGEMENT AGENCY �P�res July 31, 1999 NATIONAL FLOOD INSURANCE PROGRAM ATTENTION: Use of this certificate does not provide a waivar of the flood insurance purchase requirement.This form is used onfy to pro- vide etevation information necessary to ensure compliance with applicable community floodplain management ordinances,to determine ��proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMR).You are not 3uired to respond to this collection of information unless a valid OMB control number is displayed in the upper right corner of this form. I�structions for completing this form can be found on the following pages. SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE BUILDING OWNER'S NAME POLICY NUMBER THt)MAS & KATHLEEN SHERMAN STREE7 AODRESS(Including Apt.,Unit,Suite and/or Bldg.Number)OR P.O.ROU7E AND BOX NUMBER COMPANY NAIC NUMBEH 850 ELDORADO AVENUE OTHER DESCFIPTION(Lot and Block Numbers,etc.) LOT 1 BLOCK 7 MANDALAY CITY STATE ZIP CODE CLEARWATER BEACH FL. SEC'IOi�� B FLOOD fNSURANCE RATE MAP(FIRM)INFORMATION Provide the following from the proper FIRM (See Instructions): t.COMMUNITY NUMBER 2.PANEL NUMBER 3.SUfFIX 4.DATE OF FIFM INDEX 5.FIRM ZONE 6.BASE F�00�ELEVATION (in AO Zorres,use depth) 125096 0007 D 8-19-91 AE 12 7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations(BFE): ❑NGVD'29 ❑Other(describe on back) 8. For Zones A or V,where no BFE is provided on the FIRM,and the community has established a BFE for this building site, indicate the community's BFE:� I I I i I.0 feet NGVD (or other FIRM datum—see Section B, Iterr 7). SECTION C BUILDING ELEVATION INFORMATION 1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best i�escribes the subject building's reference level�_ . ). FIRM Zones A1-A30,AE,AH,and A(with BFE). The top of the reference level floor from the selected diagram is at an elevation of I I I I 18I.0 feet NGVD(or other FIRM datum—see Section B, Item 7). (b). FIRM Zones V1-V30, VE,and V(with BFE). The bottom of the lowest horizontal structural member of the reference level from the selected diagram, is at an elevation of��.0 feet NGVD(or other FIRM datum—see Section B, Item 7). (c). FIRM Zone A(without BFE). The floor used as the reference level from the selected diagram is W.0 feet above❑ or below❑ (check one) the highest grade adjacent to the building. (d). FIRM Zone AO. The floor used as the reference level from the selected diagram is W.U feet above❑ or below❑ (check one)the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor(reference level)elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown 3. Indicate the elevation datum system used in determining the above reference level elevations:� NGVD'29 ❑ Other(describe under Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different than thaf used on the FIRM (see Section B, Item 7j, then convert the elevations to the datum sysfem used on the FIRM and show the conversion equation under Comments on Page 2.) 4. Elevation reference mark used appears on FIRM: ❑ Yes � No (See Instructions on Page 4) 5.The reference level elevation is based on: � actual construction ❑ constructicn drawings (NOTE: Use ol construction drawings is only valid if the building does not yet have the re%rence/evel l/oor in place, in which case this certificate wiN only be valid lor the building during the course ol construction. A post-construction Elevation Certilicate wi11 be required once construction is complete.) 6.The elevation of the lowest grade immediately adjacent to the building is:( �� I I 17 I.U feet NGVD (or other FIRM datum-see Section B, ttem 7). SECTION D COMMUNITY INFORMATION �If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1 s not the"lowest floor"as defined in the community's floodplain management ordinance,the elevation of the building's"lowest floor"as defined by the ordinance is: �_��L�.0 feet NGVD(or other FIRM datum—see Section B, Item 7). 2. Date of the start of construction or substantial improvement . FEMA Form 81-31, AUG 96 REPIACES ALL PREVIOUS EDIT10N5 SEE REVERSE SIDE FOR CONTINUATION SECTION E CERTIFICATION This certification is to be signed by a land surveyor,engineer,or architect who is authorized by state or local law to certify elevation information when the elevation information for Zones A1—A30,AE,AH, A(with BFE),Vt—V30,VE, and V(with BFE) is required. Community officials who are auihorized by local law or ordinance to provide floodplain management information, may also sign the certification. In the case of Zones AO and A (without a FEMA or community issued BFE), a building official, a property owner,or a, owner's representative may also sign the certification. Reference levef diagrams 6, 7 and S - Distinguishing Features—If the certifier is unable to certity to breakaway/non-breakaway wall, enclosure size, location of servicing equipment, area use,wall openings, or unfinished area Feature(s),then list the Feature(s) not included in the certification under Comments befow. The diagram number, Section C, Item 1, must still be entered. 1 certify that the information in Sections B and C on this certificate represents my best efforis to interpret the data available. !understand that any fa/se statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME LICENSE NUMBER(or AHix Seal) GEORGE A. SHIMP II 2512 TITLE COMPANY NAME PRESIDENT GEORGE A. SHIMP II & ASSOC. INC. ADDRESS CITY STATE ZIP 3211 U.S. AL7. 19N. PALM HARBOR FL. 34683 SIGNA �� 6 # 970406 8A7 97 78 N 496 Copies should be made of this Certificate for:1)community official,2)insurance agent/company,and 3)building owner. COMMENTS: � ON WITM ON PILES, S�pg BASEMENT PIERS,OR COIUMNS A V A A V ZONES ZONES ZONES ZONES ZONES REFERENGE �EyE� REFEPENCE REFERENCE BASE LEVEI LEVEL FLOOD ELEVATION t4.:. BASE BASE � AQIACENT REFERENCE F�� FIOOD :':�.. .:� GRADE LEVEL ELEVAT�pN ELEVATiON qEfERENCE A0.IACENT LEVEL GRADE _:.�-�+:��':. ��ADJACENT;. � m �.: . . . GRADE ° ..:.:.�:.RS/t�.�.�..:�...-.:.`�.�..�.-..:..-�G�.'�:'�: . The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones. Elevations for all A Zones should be measured at the top of the reference level floor. � Elevations for ali V Zones should be measured at the bottom of the lowest horizontal structurai member. Page 2