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2717 VIA CIPRIANI BLDG 600 FEDERAL EMERGENCY MANAGEMEN�AGENCY Q.�.g, No. 3067-01�7? � _ NA7I�NAL FLOOD INSURAAICE PROGI�AM �p��uiy 31, 2002 � E��A�� t:E��F�C:A�� Important Read tfie instructiorn.�on es 1 -7. SECTION A-PROPERTY OWNER INFORMATION For�nsurance Company llse: BUILDIN6 OWNER'S NAME . Polky Number ING STREEP ADDRESS(Induding Apk,Unit,Suite,andJor Bld .No.)OR P.O.ROU't'E ANQ BOX NO. Campany NAIC Nurt�ber Bellagio at Baywatch - Building #600 - 271� Via Cipriani .. ;. C� ' �� Z!P CODE Clearwater, i. 33764 PROPER7Y DESCRlPTION(Lot and Blodc Numbers,Tax Parcel Number,Legai Description,etc.) Tax Folio No. 29/29/16/00000/220/0200 BUlLDING USE(e.g.,Residentlal.Non-residential,Addition,Accessory,etc. Use Comments sedion if necessary.) Residential LATITUDFJLONGfTUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑G?S(Type):_____ ( #�It°-##'-##.##' or #�.� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.----- SECTiON B-FLOOD INSURANCE RATE AAAP(FiRAA)INFaRMAT10N B1.NFIP COMMUNITY NAME�COMMUNITY NUMBER B2.COUNTY NAME B3.STA7E Pinellas Count FL Unincor . 125139 Pinellas Florida � 84.MAP AND PANEL 65.SUFFIX B6.FiRM INDDC 67.FIRM PANEL 88.FLOOD B9.BI�.SE FLOO�ELE1/AT10N(S ( NUMBEft DATE EFFECTIVElREVISED DATE ZONE(S) (Zone AO,use depth of 9ood'mg; 0128 D 8 18 92 8 19 91 AE Ip 810. Indicate the source of the 8ase Flaod Elevation(BF�data or base flood depth er�tered in 69. ❑ FIS Profile �FIRM ❑Community Detertnined ❑Ofher(Describe):____ 811.Indicate the eleva�on datum used for the BFE in 69:�NGVD 1929 ❑NAVD 1988 ❑Other(Describe):___ 612.Is the building located in a Coastal Barrier Resources System(CSRS)area or Othervuise Proteded Area(OPA)? ❑Yes� No Designation Date_____ SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Buiiding elevations are based on:�Construdion Drawings` Q Buiiding Under Construdion' ❑Finished Construction 'A new Elevatlon Certificate will be required when construGion of the building is complete. � C�ding Diagram Number 1 (Seled the buiiding diagram most sirtular to the buiiding for which lhis certificate is being completed-see es 6 and 7. If no dtagram accuratety represents the.building.provide a sketch or photograph.) C3. Elevations-Zones A1-A30,AE,AH,A(with BFE7,VE,V1-V30,V(with BF�,AR.AR/A,AR/AE.AR/A1 A30,AR/AH,AR/AO Complete Items C3a-i below according to the building diagram speccifified in Item C2:State the datum used. If the datum is differec�t from the datum used for the BFE in Sedion B,cornert the datum to that used for the BFE. Show field measurements and datum conversion calcul Q�Use the space provided or the Comments area of Sedion D or Sedion G,as appropriate,to document the datum corrversi:r-_ Datum�32?� CornersioNComments NJA_ �la�,,;�,�,�?;f` Elevation reference mark used Does the elevation reference mark used appearon the FIRM? ❑Yes :�'�tb G:'� � �-�, ❑ a)Top of bottom floor(indudng basement or endosure) 10 , 1 �.(m) � �, ❑ b)Top of next higher floor n/a , g,�m� � , . -� L'/�S� 4 c) Bottom of lowest horizontal strudurai member(V zanes only) n/a . ft. m �� -`'`� etl��. �� e, -,..�,. ( ) �� ,/� �� s ��- 0 �Attached garage(top of slab) n/a , ft.(m) u,� '�''"�, ��'`d��7� f� ❑ e) Lowest elevation of machinery and/ar equipment - --- �- ° servicing the buildin9 n/a ._ft.(m) S�.. � � � � -� � : ❑ �Lowest adjacent grade(LAG) n/a g, m E � � ( ) z'.� �� . ❑ g) Highest adjacent grade(HAG) n/a,_}t,�m� ��' '"�a� ,� °�s,�� ;.•�,'��' 0 h) No.of permaner�t openings(flood vents)within 1 ft.above adjace�t grade_n/a $� �. ��h,� ^� �*,"��;��'� 0 )Total area of all permanent ope�ings(flood.verrts)in C3h o sq.in. (sq.cm) - 'A��,A,�,e... SECTION D-S.URVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION This cerhf�ation is to be signed and sealed by a land surveyor,engineer,o�archited authorized by law to certify elevation infortnation, I ceKify that the infonnation in Sections A, B, and C on this cerGificate isp�sents my best efforfs to int+eipret the data available. !undersfand that any false stateme»t may be punishable by fine or imprisonment under 18 U S Code Section 1001 CERTIFlER S NAME LICF�1�$�,NUMBER Allan F_ OclnnA� PSM 7y n COMPANY NAME �rofessional 5urveyor and Mapper Kincr Encrineerinq Associates, Inc '4 S`' C� STATE ZIP CODE 4921 M i 1 H . S e 0 ` Tam a FL 33634 SI RE � DATE TELEPHONE 8 3-88 -888 � FEMA Fortn 81-31,AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDtTf�iS 9MP�R'��9VT: !n these spaces, c��Oy the corresponding ir�formation from Seclion�A. ,::�or insurance Camp�arry�1se - -;: .�UILDING STRE�T,�DDRESS(lnduding Apt,Unit,Suite,and/or Bldg,No.)OR P.O.ROUTE APID BOX NO. pa��r -_ Bella io at Ba atch - Buildin #600 - 2717 Via Ci riani �� A� Z!P CODE Company NA1C Number Clearwater FL 33764 SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFlCATION(CONTlNUED) � Copy both sides of this Elevation Certificate for(1)community offiaal, (2)insurance agenUcomparry and(3)buitding owner COMMENTS ❑Checic here if attachmer�s SECTION E BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND 20NE A(WITHOUT BFE} For Zone AO and Zone A(without BFE�,complete Items E1 through E4. If the Elevation CertiBcate is inter►ded for use as supporfing information for a LOMA or LOMR-F, Secbon C must be completed. E1.Buiiding Diagram Number_(Seled 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 bulding;provide a sketch or photograph.) E2.The top of the bottom floor(induding basement or endosure)of the buifding is �ft.(m)_in.(cm)❑.above or ❑ below(d�edc one) - the highest adjacertt grade. E3.For Buiiding Diagrams 6-8 with openings{see pag,e�,the next higher floor or elevated ftoor(ele�ation b)of the building is _ft.(m)_in.(cm)above the highest adjaceM grade. , E4.For Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the communii�s floodplain management ordinance?0 Yes �No ❑Unknown The local official must cefify this infortnaticn in Sedion G SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owners authorized representative who completes Sections A,B,and E for Zone A(wfthout a FEMA-issued or community-issued BF�or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATNE'S NAME ADDRESS CCTY STATE Z1P CODE SIGNATURE . DATE TELEPHONE COMMEM'S ❑ Check here if attachmer� SECTION G-COMMUNITY INFORMATION(OPTIONAL� � The Iocal official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B,C-(or E�,anc�G of ihis Elevation Certificate. Complete the applicable item(s)and sign belaw. G1. Q The ir�formation in Sect€on C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer,or 3rchitect whn is authorized by state or local law to cer4fy elevatfon information. (In�cate the source and date of the elevation data in the Gomments area below.) G2.Q A commu�ity�ffiaal con-epleted Section E for a building located in Zone A(without a FEMA-issued or community-issued BF�or Zone AO. 33. Q The follcrn�ng ir.fomt�tion {ltems G4G9)is provided for community floodplain management purposes. G4.PERMIT NUMBER G5. DATE PEiRMIT�SSUED G6. DATE CERTIFICATE OF COMPUANCEIOCCUPANCY ISSUED 37.This pertnit has been issued for. ❑ New Canstruction�Substantial lmprovement 38. Elevation cf as-built towest floor{inctuding basement)of the building is: ft.(m) Datum: 39. f�FE or(in Zone AO)depth of ftooding at the building site is: _ft.{m) Datum:_____ IOCAL OFFiCU1L�s rw�e n-� COMMUNITY NAME TELEPHONE swrvATURE DATE COMMENTS — ❑ Checic here if attachmer�fis 'EMA Form 81-31,AUG 99 REPLACES ALL PREVIOUS EDlTIONS