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509 MANDALAY (CLUBHOUSE) � O 1 � I FEDERAL EMERGENCY MANAGEMENT AGENCY �, ,�(,r�a,3"— �� O.M.E3. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM Expires fJecember 31,2005 �� M��n��y " ELEVATION CERTIFICATE --- �Ub�I��SPi Important: Read the instructions on pages 1-7, SECTION A•PROPERTY OWNER INFORMATION Fcx insurance Company Use:` dUILDfNG OWNER'S NAME Policy Number" J.M.C.Design&Development Corp. BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number 501-525 Mandalay Avenue(Belle Harbor) CITY STATE ZIP CODE Clearwater FL 33767 PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Lot 1"Belle Harbor"as recorded in Plat Book 125,Page 15 of the Public Records of Pinellas Counry,Florida BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use a Comments area,if necessary.j I�lulti-story residen6al LATITUDEILONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type): ( �°-##'-##.##" or ##.#�#1#°) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other: SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 61.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME B3.STATE � CAy of Clearwater,Fbrida 125096 Pinellas FL 64.MAP AND PANEL B7.FIRM PANEL B9,BASL FLOOD ELEVATION(S) NUMBER B5.SUFFIX B6.FIRM INDEX DATE E=FFECTIV6REVISED DATE B8.FLOOD ZONE(S} (Zone A0,use depth of flooding) 1250960007 D 0811911991 0811911991 AE 10&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 elevation tlatum used for the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Other(Describe):�_ B12.Is he building located in a Coastal Barrier Resources System(CBRS)area a Otherwise Protected Area(OPA)? ❑Yes ❑No Desi�nation Date_ � SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1.Building elevations are based on:0 Construction Drawings' ❑Buildiny Under Construction' �Finished Constructian �� 'A new Elevation Cer6ficate will be required when consUucfion of the building is camplete. •.Buiiding Diagram Number 7(Select the building diagram most similar to the building for which this certific;ate is being completed-see pages 6 and 7. If no diagram aaxuately represents the building,provide a sketch a photograph.) C�.ElevaGons—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR1A0 Canplete Items C3.-a-i below according to the building diagram spec�ed in Item C2,State the datum used.If the datum is different from the datum used for the BFE in Seclion B,convert the datum to that used fa 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 ElevaGon reference mark used 5_1 Does the elevaGon reference mark used appear on lhe FIRM? ❑Yes �No — � o a)Top of boflom floor(induding basement or enclosure) 7, 1 ft.(m) � � »� o b)Top of next higher floor 11.1 ft.(m) � };, o c)Bottan of lowest haizontal structural member(V zones only) _ft.(m) ��(} o d)Attached garage(top of slab) 7. 1 ft.(m) W� �� o e)Lowest elevation of machinery andlor equipment _� �� ,�� servicing the building(Describe in a Comments area) 2.0 ft.(m) °= �,� �j� o f1 Lowest adjacent(finished)grade(�AG) 6.7 ft.(m) z� �,6� '�`�� o g)Highest adjacent(finished)grade(HAG) 7. 4 ft.(m) �� `�� Q`�\ o h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade 12 � o i I Total area of ail permanent openings(flood vents)in C3.h 108,288 sq.in.(sq.an) �—i�- SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION ^ �� This cerlification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information. 1 certi�y that the information in Sections A,B,and C on this certificate represents my best e(forts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonmenf under 18 U S Code Section 1001 C;ERTIFIER'S NAME Samuel Mark Beach LICENSE NUMBER LS 6261 T ITLE Professional Surveyor and Mapper COMPANY NAME Florida Design Consultanls,inc. �DDRESS CITY STATE ZIP CODE 3�30 Starkey Boulevard New Pat Richey FL 34655 �IGNATURE DATE TELEPHONE K.. 03/10/2005 (727)84g-7588 FEMA Form 81-31,January 2003 See reverse side for continuation. Replaces ali previous editions IMP RTANT: In these spaces,copy the corresponding information from Section A. � � Fa i��s�ra��com�any u�: � BUILUING STREET ADDRESS(Induding Apt,Uni�Suite,and�or Bk1g.No.)OR P.O.ROUTE AND BOX N0. Polic�Nufnber • 501�25 Mandalay Avenue(Belle Hart�or) . ��; STATE ZIP CODE Company IVAIC Number Clearvuater FL 33767 SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CQNTINUED) � _ �py both sides of this Elevation Cer'Uficate for(1)community official,(2)insurance agenUcompany,and(3)building owner.,__ __ CC MMENTS C3 a-Elevation given is lowest garage floor elevaGon. __ __ C3 e-Elevation given is the botom of the elevata shaft. See atta�ed Architects plan for calcula6ons and flood vent locations. �Check here if attachments SECTION E•BUILDING ELEVATION INFORMATION(SURVEIf NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For�one AO and Zone A(without BFE),complete Items E1 through E4. If the Elevaiion Certificate is intended for use as supporting information for a LOMA or LOMR-F, Secti�n C must be compieted. E1.6uilding Diagram Number_(Select the building diagram most similar to the building for which this certrficate is being completed–see payes 6 and 7. If no diagram acx;urately represents the building,provide a sketch a photograph.) E2.The tcp of the bottom floor(including basement a enclosure)of the building is __ft.(m)_in.(an)�above or ❑t�elow(check one)the highest adjacent grade. (Use natural grade,'rf available). E3.Fa Buiiding Diagrams 6-8 with openings(see page 7),the next higher floa or elevated floor(elevation b)of the building is _ft.(m)_in.(cm)ak�ove the highest acijacent grade. Complete items C3.h and C3.i on iront of fam. E4.The tcp of the platform of machinery andlor equipment servicing the building is __,fl.(m)_in.(cm)0 above or ❑below(check one)the highest adjacent grade. (Use natural grade,'rf available). E5.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 floaiplain manageinent ordinance? ]Yes ❑No ❑Unknown. The local offiaal must certify this informalion in Seclion G. �� SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION __�� The properiy owner or owners authorized representa6ve who completes Sections A,B,C(Items C3.h and C3.i only),and E for Zone A(without a FEMA-issued or community- iss aed BFE)or Zone AO must sign here. The statements in Sections A,B,C,and E are co�rect to the best of my knowledge. PF.OPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAML ��DRESS CIIY �STATE ZIP CODE SIGNATURE DATE TELEPHONE CUMMENTS ❑Chec;k here if attachments SECTION G-COMMUNITY INFORMATION(OPTIONAI_) The local��aai who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,E3,C(or E),and G of this Elevation Cer�'icate. Complete the applicable item(s)and sign below. G1.�j The infamation in Seclion C was taken from other da;umentation that has been signed and embossed by a licensed surveyor,engineer,or architect vvho is authonzed by state or local law to certify elevation information, (Indicate the source and date of the eleva6on data in the Comments area below.) G2.]A community offiaal canpleted Section E for a building located in Zone A(without a FEMA-issued a a�mmunity-issued BFE)a Zone A0. G3.]The following information(Items G4-G9)is provided for community floodplain managerrient purposes. G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6.DATE CERTIFICATE OF COMPLIANCFJOCCIIPANCY ISSUED �--- ------------ — G7.This permit has been issued for. ❑New Construction ❑Substantial Improvement G8.=1evaUon of as-built laivest floor(including basement)of the building is: __._ft.(m) Datum:_ G9.3FE�x(in Zone AO)depth of flooding at the building site is: ,._fl.(rn) Datum:_ LC�CAL OFFICIAL'S NAME TITL.E COMMUNITY NAME TELEPHONE SIGNATURE DATE � �MMENTS ❑Check here if attachments FEMA Form 81-31,January 2003 Replaces all previous editions