447 MANDALAY AVE A^
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8 �'�. � E�EVA710N CEi�TIFiCATE °�
} FEDERALEMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
y1QTEN'f10N: Use of this certiflcate does not arov�de a waiver of the flood insurance purchase requirement. This form is used only to
�roiride elevation irtformation n�ssary to ensure compliance with applicable community floodplain management ordinances,to
�rmine the proper insurance premwm rate. and/or to support a request for a Letter of Map Amendment or Revision (LOMA or�LOMR).
` instructions for completing this fonr�can be found on the following pages.
SECTION A PROPERTY INFORMATION �FOR INSURANCE COMPANV USE
BUILDING OWNER'S NAME POUCY NUMBER
R�E�2T �LM M�L
STREET ADDRESS(Including Apt..Unit,Suite and/or Bldg.Number)OR P.O.ROUTE ANO BOX NUMBER COMPANV NAIC NUMBER
�I y wl p�+ � .�� , .
OTHER DESCRIPTION(Lot and Block Numbers,etc.) � Pf� 15 T�, 80
�.o rS l Co, 17� l 8 , r 9 . t3 c�c..� � . �i iZ5 T •�Dr'i,a..l c e GL.c,�wk..w�+76ic.. $[�aca �i.c/L
CITY STATE ZIP CODE
C LvA�wpT�re �L 3 ���7
SECTION B FLOOD INSURANCE RATE MAP(FIRM) INFORMATION
Provide the following from the proper FIRM (See Instructions):
1.COMMUNITY NUMBER 2.PANEL NUMBER 3.SUFFIX 4.DATE OF FIRM INDEX 5.FIRM ZONE 6.BASE FLOOD ELEVATION
(in AO Zones,use depth)
IZS'o9(o 000� �j �'f r8 �9z �}-L �t
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations(BFE): ��'NGVd'29 J Oth�r�describe on back)
8. For Zones A or V,where no BFE is provided on the FIRM, and the communiry has established a B�E;or tnis buils�ing site, +rdicate
the community's BFE:' � �'.` feet NGVD (or other FIRM datum–see Section B, Item 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
�iescribes the subject building's reference level� .
� . FIRM Zones At-A30,AE,AH, and A(with BFE). The top of the reference level floor from the selected diagram is at an elevation
�- of� � ' �51 '7'feet NGVD (or other FIRM datum–see Section B, (tem 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'� ' ' ' !._;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 �.I�feet above i— or
below i_i (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 .�;feet above u or below i! (check
one)the highest grade adjacent to the building. If no flood depth number is avaitable, is the building's lowest floor(reference
level)efevated in accordance with the communiry's ftoodplain management ordinance? `; Yes J No iu� Unknown
3. Indicate the elevation datum system used in determining the above reference level elevations:i..�NGVD'29 �—' Other (describe
under Comments on Page 2). (NOTE: If the elevairon datum used in measuring ihe elevations is differeni than that used on
the FIRM (see Section B, ltem 7J, ihen convert the elevafions to the datum system used on the FIRM and show ihe conversion
equation under Commenis on Page 2.)
4. Elevation reference mark used appears on FIRM: '� Yes _I No (See Instructions on Page 4)
5.The reference level elevation is based on: actual construction ',_; construction drawings
(NOTE: Use ot consiructron drawings is only va/id if the building does noi yet have the reference level floor in place, in which
case this certificate will only be valid tor the bui/ding durrng the course of construction. A posf-consfrucfion E/evaf� ertificate
wil!be required once construction is complete.)
6.The eievation of the lowest grade immediatefy adjacent to the building Is: �5 .'S.feet NGVD (�e m-see
Section B. Item i 1. �
SECTION D COMMUNITY INFORMATION `�� G
' �f the community official responsible for verifying building elevations specifies that the ret el in d in �i���, Item 1
not the "lowest floor"as defined in the community's ffoodplain management ordinance, t vatio��the�bq�4��"lowest
�loor" as defined by the ordinance is: ._ feet NGVD (or other FIRM datum–se tion B,� ���
� A
"� Date of the start of construction or substantial improvement . �� : ��
, y' • G `.`y.
FEMA Form 81-31,MAY 93 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION
._ /. _ .. _ ..
/
SECTION E CERTIFICATION � � '
'7his certification is to be sig�reld by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation
informatiorr�wtiea tbeeie�ra�m�rrfort�tion for Znnes A1—A30,AE,AH,A(with BFE),V1—V30,VE, and V(with BFE) is required.
Commumf�r•a��o:aRe.a�o�ed by local law or ordirtance to provide floodplain management information, may also sign t�� �
certification. Irt the case of�:a�e5:AQ and.A•(without a FEMA or community issued BFE), a building officiat, a properry owner, or an !
owner's represerttative may;aisa sign the cer�fi�n.
Reference level diagrams 6,7 and 8-DistinguishingFeatures—If the certffier is�le cc c�rti'fy to b�akawaymon-breakaway wall,
enclosure size, location of seKVicing equipment,area use,wall opemngs,or unfimshed area Feahue(s),then iistthe Featurels) not
inctuded in the certification under Comments below. The diagram number,Sec�iort C, Item 1,must sti11 be errt+e�ed.
I certify that the information in Sections 8 and C on this certificate represents my best efiforts ro iMerpret ihe data avai/ab/e.
1 understand thaf any false sfatemeni may be punishable by fine or imprisonment under i8 U.S. Code, Section 1001.
CERTIFIER'S NAME LICENSE NUMBER(or Affix Seaq
�/�l�ti�/T E. CoR$/TT ���008
TITLE '" "" " COMPANY NAME
��.,f i�7��t-r L�►.i�� l�zFu sio..� �' �p� __ _
ADDFiESS � �i:l�"� �y r�� CITY STATE ZIP
1`a���"`��. '� "°�' � � � c. �,.�Er�,�r F� 3�� 9£�
SIGNATLIf�E'��'',. ���� ;`;.� '> DATE PHONE
- ��..yt.� � � , Sli!97 �8r�-�3�— iic��
r� �
CopiA��fq�uld. ma,�;�t-�tFras Certificate for: 1)community official,2)insurance agenUcompany,and 3)building owner.
;.����.� 6 � ^ _.
'*�� . 9Qa,`.Y r
h °�use � �
COMMEt�I�' :a��� �° ��'`
, '�:
.�,..r���aEk C.€:j�E igx�'
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��C. # �77 ! 7�-
ON WITH ON PIIES, �
SLAB BASEMEHT PIERS.OR COLUMNS
A V A A V
ZONES ZONES ZONES ZONES ZONES
REFERENCE
REFERENCE B�E IEVEL REFERENCE
LEVEL I FL�p LEVEL
ELEVATION
'�l� ♦
.. :... � , .. .... � .y.
�j.. �.�.:..:�.::�..'..... n .v.�.a_i+ ]r .
R"{.... ,�y: rt +'.,
,._::
..,i4'�.... ;�;`iaia :i`�s:.. i�1:,
':��:::�::::::;.�`. :'�S: BASE
BASE ._......... ;�,t.i::
FLOOD ..`::•.�'::�: AQIACENT�::•:�"r'.:: REFERENCE FLOOD
::(=i:{
CaiiADE � LEVEL ELEVATION
ELEVATION REFEFENCE pp,�qCENT '�rx
LEVEL GRAOE �~1`�
i\'�t:
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.:t:
!
� i:�. ::ri�i';".i::::;.i�J:':.j''.::]:. :�::?J:ADJACENT;�.
:�!f:,�. .. . ................ �' GRADE
...::.���::.`:�..:"7.�i:l:%.i�.^l::�1}�;::.. . .
The diagrams above illustrate the points at which the elevations shouid 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 all V Zones shoufd be measured at the bottom of the lowest horizontal structural member. `,
Page 2
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� 5 U ' �IJ � 4 FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077
� � ' NATIONAL FL•OOD INSURANCE PROGRAM Expires July 31, 2002
� ,
I
� � �F� c; � �cir� ELEVATION CERTIFICATE
Im ortant: Read the instructions on a es 1 -7.
VELOPh4�(vT SER'JIC�S DCPT SECTIONA-PROPERTYOWNERINFORMATION Forinsurance''CompanyUae.
Policy,Number �'!
BEACHCOMBER RESTAURANT ''
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number
CITY STATE ZIP CODE I
CLEARWATER BEACH FL. _ 34630
PROPERTY DESCRIPTION(Lot and Blocic Numbers,Tax Parcel Number,Legal Descnption,etc.)
PARCEL I D # 8 29 15-16416-002-0160
BUILDING USE(e.g.,Residential,Non-residantial,Adddion,Accessory,etc. Use a Comments area,�f necessary.)
�in�i occrnrniTjAL -
1\IIIY l�L�]l�JL11�
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: L�GPS(Type):
( �N°-�'-�.l1�' or iq�.#�M##°) L)NAD 1927 u NAD 1983 u USGS Quad Map L�Other:
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NFIP COMMUNITY NAME 8 COMMUNITY NUMBFR 52.GOUNTY NANiE E33.SiATE
CITY OF CLEARWATER 125096 PINELLAS I FLORIDA I
84.MAP AND PANEL 85.SUFFIX 66.FIRM IN� B7.FIRM PANEL B8.FLOOD 89.BASE FLOOD ELEVATION(S)
NUMBER DATE �"< EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use depth of flooding)
125096-0007 D 8-18-9a- 8-19-91 AE 11
810. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in 89.
U FIS Profile Lj FIRM �J Community Determined �_J Other(Describe):
B11. Indicate the elevation datum used for the BFE in 69: �X � NGVD 1929 �J NAVD 1988 �J Other(Describe):
B12. Is the building located in a Coastal Barrier Resouroes System(CBRS)area or Otherwise Proteded Area(OPA)? (_J Yes u No
Designation Date:
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
�ilding elevations are based on: L�Constn�ction Drawings" �jBuilding Under Construction' (X JFinished Construction
•A new Elevation Certificate will be required when construction of the building is complete.
C2. Building Diagram Number 1 (Select the building diagram most similar to the building for which this certificate is being completed-see
pages 6 and 7. If no diagram accucately 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 M.S.L. Conversion/Comments -
Elevation reference mark used Does the elevation reference mark used appear on the FIRM? �J Yes �_�Ido
❑ a)Top of bottom floor(inGuding basement or enclosure) 5 . 93 ft.(m) � -
❑ b)Top of next higher flonr NONE_ �ft.{m) `� �,.. ' ___
❑ c)Bottom of lowest horizontal structural member(V zones only) NONE _ft.(m) $�., '",�,a�rf�
❑ d)Attached garage(top of slab) NONE _ft.(m) g. ;��,
O e) Lowest elevation of machinery and/or equipment � ' �m �''�' �,, ';' r;��'� �
servicing the building(Describe in a Comments area.) ft.(m) , ;; � . � -�
0 �Lowest adjacent(finished)grade(LAG) 5 . 0 ft.(m)'z�- . _ � ��
0 g)Highest adjacent(finished)grade(HAG) 6 . 0 ft.(m)' � =�„` � `;
❑ h) No.of permanent openings(flood vents)within 1 ft.above adjacent grade 0 9` ;, > ,�r'�=
❑ i)Total area of all permanent openings(flood vents)in C3.h N A sq. in.(sq.cm) � #2�12=^ -
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 cerfily fhat the information in Sec6ons A, 8, and C on this certificate reprtssents my besf efforts to interpret the data available.
I understand that any false statement may be punishab/e by fine or imprisonment under 18 U.S. Code, Section 1001.
^r �KF��R��IMP I I LIZ512E NUMBER
� �SIDENT COMPANYNAME
GEORGE A. SHIMP II & ASSOC. INC.
ADDRESS CITY S TE E
PALM HARBOR �hL. ��66�
SIG R ,�n6#010587 $ Z�E�1 /�L�P�4y�
F MA Form 81-31,JUL 00 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
IMPORTANT: In these spaces,copy the corresponding information from Section A. For Insurance Company Use:
BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg. No.)OR P.O.ROUTE AND BOX NO. Policy Number
447 MANDALAY AVENUE • ,
CITY STATE ZIP CODE Company NAIC Number
LEARWA R F . 34630
SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION (CONTINUED) �
Copy both sides of this Elevation Certificate for(1)community o�ciai, (2)insurance agenVcompany,and (3)building owner.
COMMENTS
�_� Check here if attachments
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 Elevation Certificate is intended for use as supporting
information for a LOMA or LOMR-F,Section C must be completed.
E1. 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.)
E2.The top of the bottom floor(including basement or enclosure)of the building is L�_�ft.(m)�_L�in.(cm) ��above or ��below
(check one)the highest adjacent grade. (U�e natural grede, if available.)
E3. For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is
I_I_I ft•(m)LI_lin.(cm)above the highest adjacent grade. Complete Items C3.h and C3.i on front of form.
E4. For Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's
_ floodplain management ordinance?�I Yes _I No LI Unknown. The local official must certify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owner's authorized representative who completes Sections A, B,C(Items C3.h and C3.i only),and E for Zone A
(without a FEMA-issued or community-issued BFE)or Zone AO must sign here. The statements in Sections A, 8, C, and E a►e conect to
the best of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP CODE �
SIGNATURE DATE TELEPHONE
COMMENTS
( I Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
Sections A, B, C(or E),and G of this Elevation Certificate. Complete the applicable item(s)and sign below.
G1. L�The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor,
engineer,or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the
elevation data in the Comments area below.l
G2. ��A communiry official completed Seetion E for a building located in Zone A(without a FEM,4-issued or community-issued BFE)or
Zone AO.
G3. L�The following information(Items G4-G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY
ISSUED
G7.This permit has been issued for: L�New Constniction L)Substantial Improvement
G8. Elevation of as-built lowest floor(including basement)of the building is: _ft.(m)Datum:
G9. BFE or(in Zone AO)depth of flooding at the building site is: _ft.(m)Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS �
I � Check here if attachments
FEMA Form 81-31,JUL 00 REPLACES ALL PREVIOUS EDITIONS