2709 VIA CIPRIANI BLDG 500 __ __ _ _
_ _ _ _
F��E�L E�i9E�2GEHdCY�lANAG�PUfEA1T�GEl�IC� p.�l.�. �lo. 3067-0�77 �
AIATi�MAL�L�QD�iSUR��IC��ROGF�Ai�A �Qi�s Juiy 3'1, 2fl(32
. ��...�/�1���� �����F�C��� �
Im�crtar� Read the instructlo�on pa es 1 -T.
SECTIOfd�►-PROPE�t'PY 01NNER lNFORMA iTiON Fcr fnsurance Comparry t�e;
BUILDING OWNER'S NAAAE . �Polfry Numher
!NG STREET ADORESS(Induding,ApLt Unit,g ite andlo g .Nq.j O P.O..R0t1TE AND BOX NO. Company NAIC Number
Bellagio at Baywatcli - Building #�Ob - �7�� Via �ipriani
Clearwater, .::i. �� Z1P CODE
33764
PROPERTY DESCftIPT10N Lot and Blodc Nurtfbers,Tax Parcel Number,Legal Description,etc.)
Tax Folio No. 29/�29/16/00000/220/0200
HUILDING USE(e.g.,Residernial.Non-re.sidential,Addibon,Accessory,et� Use Ccmmerns seWon if necassary.)
Residential •
LATITUDEILONGITtJDE(OP710NAL) HORtZONTAL DATUM: SOURCE ❑GPS(Type):_____
{ ;4qK'-#I�'-#i�.�IR' ar #�.�) ❑NAD 1927 ❑NAD 1983 ❑USGS Gluad Map ❑Other.-----
SECTION B-FLOOD INSURANCE RATE NIAP(F1RM)INFORMATION
81.NFlP COMMUNIT`(NAME�COMMUNIT'!NUMBER BZ COUNTY NAME g3,�'q�
Pinellas Count FL Unincor . 125139 Pinellas Florida �
84.MAP AND PANEL 85.SUFFlX 86.FiRM INDDC 87_FiRM PANEi. BS.FLO00 B9.BASS Fi.QOD E1.EVAl10N�a �
NUMBER DATE E��CTIVE/REVISED DATE ZONE(S) (Zone AO,use depth of;foodirg;
0128 D 8 18 92 8 19 91 AE ZO f
B10.indic�te the saur�ce of the Sase Flood Elevation(BF�data or base flood depth er�ered in 89.
❑ F1S Profile 0 F1RM ❑Communiiy Detertnined ❑Other(Describe):____
B11. tndicate the elevatlon datum used!or the BFE in 89:�NGVD 1929 ❑NAVD 1988 ❑Other(Descxibe):____
B12. Is the buiiding located in a Caastal 8arrier Resources System(CBRS)area ar Othervvise Proteded Area(OPA)? ❑Yes�No �
Designation Date ----
SECTiON C-BUiLDING ELEVATION INFORMA770N(SURVEY REQUIRED)
C1.Buiiding elevations are based on:Q Construction Drawings' � Buiiding Under Construdion' ❑Finished Construdiai
•A new Elevation Certiiicate unli be required when construdion of the building is complete. �
C2�ing Diagram Number 1(Seled the bwld'mg d'iagram most sirtuYar to the buildi�g for which this ce�ificate is being completed-see
es 6 and 7. If no diagram accurately represents the buiiding.provide a sketch or photograph.}
C3.Elevatio�s-Zones A1-A30,AE,AH,A(with BF�.VE,V1-V30,V(with BEE�,AR,ARJA,ARlAE,AR/A1-A30,AR/AH,AR/AO
Complete Items C3a-i below acxording to the building diagram specified in ttem C2:State the datum used.If the datum is differerrt from
the datum used for the BFE in Sedion B,cornert the datum to that used far the BFE Show field measurements and datum conversion
calcti Use the space provided or the Comments area of Sedion D ar Secti�on G, as appropriate,to documer�t the datum cornrersia-_
Datum�� CarwwersioNCommerrts NJA_ `_µa:y}4Y, , .
Elevation rBference maric used Does the elevation reference mark used appear on the FIRM? ❑Yesa� hla;y� �
❑ a)Top of bottom floor(�nduding basemerrt or endosure) 10 . .2 ft.(m) �; � _: , .
❑ b)Top of next higherfloor n/a . ft.(m) � �'.5�,� ���G:�.,9
D c Botbm of lowest horizorrtai strudura!member � ,J �� �.
) (V zones onh�) n/a . R.(m) ��. �-3 � ;�'- .;y; �.a, .�; �
0 �Attacl�ed garage(top of slab) n/a• ft-(m) �� ���"..�� ��~�f; `��
0 e)Lawest elevatlon of rrraG�inery andlor equipmerrt �' �° � � . '�,� �. � - b
a
serviang the buiiding n/a ._R.(m) �� � �,T� �°.
❑ fl Lowest adjacent grade MG) ft. m z� ' � � �"+ �
n/a •_ ( ) ;.K:
0 g)Highest adacent grade(HAGj �•_fr.(m) � �s� �-'°;a�„i .� ."�'�,�'
O h) No.of permanerit openings(flood vents)within 1 ft.above adjacent grade nf a_ s� 's g� s ��,�`
� ��
0 )Total area of aU permanentupenings(flaod.verns)in C3h 0 sq.in. (sq.cm) * '�"a,,�A �'"� .
SECTtON D-S.URVEYOR,ENGINEER,OR ARCHITECT CERTiFICATION " �
This certifica�on is to be signed and sealed by a land surveyor,engineer, or architect authorized by law to certify elevation informatian,
i certify that the informa6on in Secdions A, 8, and C on this cerfificate�epresents my best efforts to interp�et the data available.
1 understand fhat any fa/se sfat�emerit may be punishabfe by Sne or imprisarment under 18 U S Code, Sectfo� 1001
CERTIFlER S NAME I.1C�$F�NUMBER
All'an F Oal �nA� P4M �7
T�� COMPANY NAAAE
5urve or and Ma er Kin En ineerin Associates Inc.
CITY STATE ZfP CODE
4921 Mem . te 3 - Tam a FL 33634
SiG RE % �" . � ��30/Ol TEL.EPHONE
`�.� 8 3-88 -8881 �
_ � �__.__
=�MA Form 81-31,AUG 99 SEE RE1/ERSE SIDE FOR CONTiNUATION REPLACES ALL PREVIOUS EDIT10�i5
dAAPS7R'T�►��': �n 3hese spac�s,�cs�sy�e��n�sponding drrtorma43on ffrom Sec3ion�►. �:For Insu,ranc�
�UILDING ST12E�TADDRESS Indudin � �a��tlse:;=_:'. :_
( g ApL,Unit,Suite,and/or 8( ,No.)OR�.0.�QUiElWD BOX NO. �po' ����•.
Bellagio at Baywatch - Building #500 - 2709 �lia Cipriani - �'-�•- - -
� C!7'Y ... - -:::- +� . _ �
Clearwater �L� �P 6C.40DE 'Company NAIC Number -
SECTiON �-SURVEYOR,EAIGiNE�3�,OF2 ARC�it'TEC�C�R71F{CATlON(CONTINUED)
Capy both sides of this Elevatian Cartifipte for(1)ccmmuniiy official,{2)�insurance agerit/company;and(3)buiiding ovmer.
COMMEi'�TS
Check here if attacf�mera�
SECTION E-BUIi.D1NG ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND�NE A(WtTHOUT BF'�)
For Zone AO and Zone A(without BF�.complete Items E1 through E4. If the Elevafion Certffi'cat+s is interxled for use as supporting
infomration�or a LOMA or LDMR-F, Sectforr C must be camp/et+ed
E 1.Buiiding Diagram Num6er_(Select the building diagram most similar to the bw'iding for which this cesfificate is being completed—see
pages 8 and 7. If no diagram accvrately represents the building,provide a sketct�or phatograph.)
E2 The top of the bottom floor(induding basement or endosure)of the building is _ft.(m)_in.(cm)0.above or ❑below(chedc one)
the highest adJacent grade.
E3. For Building Diagrarrts g.g with openings(ses pag,e�,U�e next higher floor or alevated floot(elevation b)of the budding is
_ft.(m)_in.(cm)above the higt�est adjacent grade.
E4. For Zone AO only: If no fload depth number is available,is the top of the bottom floor elevated in accordance with the community's
_ floodplain management ordinance?Q Yes Q No ❑Unknowm The loca!ofliaal must certity this information in Sectlon G
SE�TiON F-PROPER7Y OWNER(OR OINNER'S REPRESENTATNE)CERTIFICATION
The property owner or awners authorized represer�taWe who completes Sedicns A,B,and E far Zone A(without a FEMprissued or �
community-issued BF�or Zone AO must sign here.
PROPERTY OWNER'S OR OWNER'S AUTHQWZEp REpRESENTATNE'S lW4ME
���� C� STATE Zl?CODE
SIGNATURE . DATE TELEPHONE
COMMEiVTS
- ❑Checic here if attachmer�
SEC'170N G-COMMUNITY INFORMATION(OPTIONAL) �
The local offidal who is authorized by law or ordlnance to�nister the communiiy's floodplain managemerrt ordinance can complete
3edions A, 8,C�cr�.and G�f this Elevaticn Certificate. Complete the app6cabie item(s)and sign bebw.
31. Q The informatlon in Section�was taken from other documentation that has been signed and embossed by a acensed surveyar;
engineer,or ar�.hited who is�uthorized by state or lopl Iaw to certity elevatfon informaticn. (Ind'�ate the sour�e and date of the
elevatior data i�the Ccmrnettts area below.)
32.�A camrtnlnity�cial completed Sedion E fcr a building lopted in Zone A(without a FEMA-issued cr communiiy-issued SF�or
Zane AC.
�3. Q The foilowirsg infor*natinn(items G4-G9)is provided for community floodplain management purposes.
G4.PERMIT IdtJMBER G5. DATE PERMIT ISSUED G6. QATE CERTIFlCATE OF COMPLtANCElOCCUPANCY
Y, ISSUED
�7.This permit has been issued far. ❑New Construdion Q SubstarrtiaF'improveme�
�8. Etevation af as-buJt Iowest floor(indudtng basemerrt)of the buitding is: . ft.(m) Datum:
�9.QFE or(in Zone AO)depth of flooding at the buiiding site is: _ft.{m) Datum:-----
LOCAL OFFlCIAL.'S NAME �E
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
❑Checfc here if attacfime�ts
EMA Form 81-31,AUG 99 ' REPLACES ALL PREVIOUS EDITiONS