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2741 VIA CIPRIANI BLDG 900 — _ ___ FED�RAi.EMERGEAICY MANAGEMEN�AGEAICY p,�,B. (yo. 30&7-0(377 AIATIONAL F�OOD INSUR�►AICIE PROGf�,4M �pires Juiy 31, 2002 , , EL�A�901V CEf�TlFaCATE importar� Read tt�e instructions on pa es 1 -7. SECTION A-PROPE32TY OWNER INFORMATION For�r�urance Corr�any Use: BUILDING OWNER'S NAME Policy Number ING STREET ADDRESS{Induding Apt,Unit,Suite,andlor 81dg.No_)OR P.O.ROtJTE AND BOX NO. Campany NAIC Number Bella io at Ba atch - Building #900 - 2741 Via Cipriani C� ST�TE Z!P CODE Clearwater, :::�, 33764 PROPERTY DESCRIPTION(Lot and Blodc Numbers,Tax Parcel Number,Legal Description,etc.) Tax Folio No. 29/29/16/00000/220/0200 BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,eta Use Comments secf(on if necessary.) Residential LATITUDFILONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):_____ ( #!�°-##'-##.##" or �f#.#�°) ❑NAD 1827 ❑NAD 1983 ❑USGS Quad Map ❑Other.----- SECTiON B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP COMMUNITY NAME�COMMUNITY NUMBER 62.COUNTY NAME B3.STATE Pinellas Count FL Unincor . 125139 Pinellas Florida � 84.MAP AND PANEL B5.SUFFIX 86.FIRM INDDC 67.F1RM PANEL B8.FLOOD B9.BASE FLOOD ELEVATION� NUMBEft DATE EFFECTIVEJREVISED DATE ZONE(S) (Zone AO,use depth of lfood'a�; 0128 D 8 18 92 8 19 91 AE 10 B10.Indicate the source of the Base Flood Elevation(BFE7 data or base flood depth entered in 69. ❑ FIS Profile �FiRM ❑Community Determined ❑Other(Describe}:____ 611.Indicate the elevatlon datum used fo�the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Other(Describe):____ 612.ls the building located in a Coastal Barrier Resources System(CSRS)area or Otheivuise Proteded Area(OPA)? ❑Yes � No � Designation Date ____ SECTION C-BUILDlNG ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on:Q Construc�ion Drawings` 0 Buiidfng Under Construdion" ❑Finished Construdion 'A new Elevation Certiiicate wili be required when construcbon of the building is ramplete. � C�Iding Diagram Numbe�1 (Seled the buiiding diagram mast simlar to the buiiding for which this certificate is being completed-see es 6 and 7. If no diagram accurately represents the.building.provide a sketcfi or photograph.) C3. Elevations—Zones A1-A30,AE,AH,A(with BFE).VE,V1-V30,V{with BF�,AR.AR/A,AR/AE,AR/A1 A30,AR/AN,AR/AO Complete Items C3a-i below acxording to the building diagram specified in Item C2.State the datum used. If the datum is differertt from the datum used for the BFE in Sedion B, cornert the datum to that used fo�the BFE.Show fieid measurements and datum conversion catcul��p�,Use the space provided ar the Comments area of Sedion D or Section G,as appropriate,to document t��datum carnrersi�-_ Datum ���� CornersioNComments N�A_ .. , ,,���'��. ;; "< Elevation reference mark used Does the elevation reference mark used appearon the F1RM� ;��'Y�� � � �A r�` ❑ a)Top of bottom floor�nduding basement or endosure) 10 , 1 }t, m � ;: • a��� � 0 b)Top of ne�ct higher floo� n a , ��mj � ,� /� ,��,� � �° 0 c)Boitom of lowest horizontal structural member(V zones only) n/a . R(m) = ' =S���'� � '+ ,3. . J; O d)Attached garage(tcp of siab) n/a ,_�(m) �� ' ��?Z 3r�. ��/� '. ,-;. ❑ e)Lowest elevatlon of machinery and/or equipment W " > � � � �' �' `- servicing the buiiding n/a _g,�m� g � �°, `i ` �; ;`� �> ❑ fl Lowest adjacent grade(LAG) n/a _R(m) �� C� �`� ❑ g) Highest adjacent grade(HAG) n�a _}�,(m� :�' �, ,s p � ,,,����,��,�,`v, 0 h) No.of permanerrt openings(flood vents)within 1 ft.above adjacerrt grade_n/a � � ���*`"�° ❑ )Total area of all pertnanentopenings(flood.vents)in C3h � sq.in. (sq,cm) � SECTION D-S.URVEYOR,ENG{NEER,OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor,engineer,or archited authorized by law to certNy elevation ir�fortnatian., I certify that the informa�ion in Sections A,B, and C on this ce►tificate represents my best efforts to inteip�t the data available. !understand that any false stat+ement may be punishab/e by flne o�imprisonmeht under 18 U S Code SecHon 1001 CERTIFIER'S NAME UCF�i�$,E,NUMBER Allan F_ Oclund PSM �ti T� COMPANY NAME �rofessional Surveyor and Mapper �,ncr EnQineerinq Associates, Inc �S`' C� STATE Z!P CODE 492 M ri 5te. Tam a FL 33634 SI TUR DATE TELEPHONE 4 23 O1 8 3-88 -888 ' FEMA FoRn 81-31,AUG 99 SEE REVERSE S1DE FOR CONTiNUATION REPLACES ALL PREVIOUS EDITIC�S BMP�RTis►AIT: 8n 4hese spac�s,c�py the correspo�ding informat�on from Sec4ion.4. ,;�or Insurance Camparry t1se, '- : , _ .. :.. BUILDING STREET,4DDRESS(Indading Apt.,Unit,Suite,andlor 81dg.No.)OR P.O.ROUTE AfVD 80X NO. pol�r Numbet: - -- ,.., __ :.: Be a io at Ba - g - • -- - - -. .. g ywatch Buildin #900 2741 Via Cipriani � ClTY STATE Z!P CODE Company NAIC Nimiber Clearwater FL 33764 - SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT C�RTiFiCAT10N(CONTINUED) . Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agenUcompacry,and(3)bui(ding owner COMMENTS ❑ Check 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 BF�,complete Items E1 through E4. If the Elevation Ceitificate is intended for use as supporting information fo�a LOMA or LOMR F, Section C must be comp/eteal. E1. Buiiding Oiagram Number_(Select the building diagram most similar to the building for which this certifificate is being completed—see pages 6 and 7. If no diagram accurately represents the buiiding;provide a sketch or photograph.) E2.The top of the bottom flaor(ncluding basement or endasure)of the building is `ft.(m)_in.(cm)�above or ❑ below{chedc one) - the highest adjacer�t grade. E3.For Building Diagrams 6-8 with openings(see page�,the next higher floor or elevated floor(eievation b)of the building is _ft.(m)_in.(cm)above the highest adjacent grade. E4.For Zone AO aniy: If no flood depth number is ava�iable,is the top af the bottom flaor elevated in accordance with the communit}�s ' floodplain management ordinance?Q Yes �No ❑Unknown The local offiaal must cerMy this information in Seccti�on G SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATIDN The property owner or owners authorized representative who completes Sedions A,B,and E for Zone A(without a FEMA-issued o� community-issued BF�or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATNE'S NAME ADDRESS CfTY STATE ZIP CODE SIGNATURE . DATE TELEPHQNE COMMENTS ❑Check here if attachmer.� SECTION G-COMMUNITY INFORMATION(OPTIONAL) � The local offiaal who is a�thorized by law or ordinance to administer the community's floodplain management ordinance can complete Secctions A, B,C(or�,and G of this Elevation Certificate. Complete the applicable item(s)and sign below. G1. Q The infortna�on in Section!C was taken from other documerrtation that has been signed and embossed by a licensed surveyor, engineer,or arr.hitect who is authorized by state or local law to certify elevation infortnation. (Indcate the source and date of the eleva�on data in the Comments area below.) 32.�A community official complet�d Section E for a building located in Zone A(without a FENW-issued or community-issued BFE7 or Zone AO. 33. Q The foltowin�iMortnation(ltems G4G9)is provided for communiiy floodplain management purposes. G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCElOCCUPANCY ISSUED 37.This permit has been issued for. ❑New Construdion�Substarttial;lmprovemerrt 38. Elevation cf as-buiit lewest fleor(induding basement)of the building is: R(m) Datum: 39. f�FE or(in Zone AO)depth of flooding at the building site is: _ft.(m) Datum:_____ LOCAL OFFICWL'S NAME �,E COMMUNITY NAME TELEPHONE SIGNATURE pq� COMMENTS — ❑ Checic here if attact�mems 'EMA Form 81-31,AUG 99 REPlACES ALL PREVIOUS EDITIONS