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2749 VIA CIPRIANI BLDG 1000 FEDERAL EMERGENCY MANAGEMENT AGENCY � NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077 Expires July 31, 2082 �' ELEVATION CERTIFICATE ' Importar� Read the instructlons on es 1 -7. SECTION A-PROPERTY OWNER INFORMATION For Cnsurance Company Use: ING OYIMER'S NAME Poliry Number LDING STREET ADORESS(Induding Apt.,Unit.Suite,and/or Bidg.No_)OR P.O.ROUTE AND BOX NO. Company NAIC Number B t Ba atch - Buildin #1000 - 2749 Via Ci riani _ CITY � �FL 33764E Clearwater, ), PROPERTY DESCRIPTION(Lot and Blodc Numbers,Tax Parcel Number,Legal Descripticn,etc.) Tax Folio No. 29/29/16/00000/220/0200 BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,eta Use Comments section if necessary_) Residential LATITUDFILONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):_____ ( ##°-##'-##.##" or ##.#####' ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other._____ SECTION B-FLOOD INSURANCE RATE MAP(FiRM)INFORMATION 81.NFIP COMMUNITY NAME�COMMUNITY NUMBER B2.COUNTY NAME B3.STATE � Pinellas Count FL Unincor . 125139 Pinellas Florida i 84.MAP AND PANEL 65.SUFFIX B6.FIRM INDEX 67.FIRM PANEL B8,FLOOD B9.BASE FLOOD ELEVATION(.='. NUMBER DATE EFFEC71VE1REVISED DATE ZONE(S) (Zone AO,use depth oE tloodirt�; 0128 D 8 18 92 8 19 91 AE 10 810. Indicate the source of the Base Flood Elevation(BF�data or base flood depth eMered in B9. ❑FIS Profile �FIRM ❑Community Determined ❑ather(Describe):_____ 611. Indicate the elevation datum used for the BFE in 89:�NGVD 1929 ❑ NAVD 1988 ❑Other(Describe):_____ B12. Is the buiiding located in a Coastal Bamer Resources System(CBRS)a�ea ar Othervvise Proteded Area(OPA)? ❑Yes � No Designation Date_____ SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1.Building elevations are based on:❑Construdion Drawings' Q Building Under Construction" ❑Finished ConsVuction 'A new Elevatian Certificate wiil be required when construction of the building is complete. C�ilding Diagram Number 1(Seled the building diagram most similar to the building for which this certificate is being completed-see ges 6 and 7. If no diagram accurately represents the 6uilding,provide a sketct�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 C3a-i below according to the building diagram specified in Item C2: State the datum used. If the datum is differerrt from the datum used for the BFE in Sedion B,convert the datum to that used for the BFE. Shaw field measurements and datum conversion ca�ul�}�Q�,Use the space provided or the Comments area of Section D or Section G,as appropriate,to document the datum conversin-_ Datuml32� ConversioNComments NJA_ ��,�z�,, Elevation reference mark used Does the elevation reference marlc used a `�+ ppear on the FIRM? ❑Yes �"t�` .,;,� �� ' ❑ a)Top of bottom floor(nduding basement or endosure) 10 .1 ft.(m) � ,.��° ?, ' ,,. � % � ,_ ❑ b)Top of next higherfloor n/a ,it.(m) �' /`-'j�� r5�'� ; 0 c) Bottom of lowest horizontal structural member(V zones only) n/a ._ft.(m) �; _' � '� �, � � .`'.'� �o �-�� L� � T -r� ❑ d)Attached garage(top of slab) �, ft,(m) W� e _�' a ��" �', .,��' 0 e)Lowest elevation of machinery and/or equipment � �� ' servicing the building n/a ,_ft.(m) E 3`�� s ��' ❑ fl Lowest adjacent grade(LAG) n/a •�ft-(n'�) z'� , �' °,''y �= �" `"`, , ❑ g) Highest adjacent grade(HAG) n a._ft-(m) ��'�'�; °fipa�� ,. �' �,�°'��` ❑ h) No.of permanent openings(flood vents)within 1 ft.above adjacent grade n�a_ s� + ; �� c ��' a )Total area of alt permanent openings(flood.verrts)in C3h 0 sq.in. (sq.cm) �` �p t :. �� 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., l certify that the infomtation in Sections A, B, and C on this ce►tificate iepresents my best efl`orts to inte�pret the data available. _I undersfand that any false statement may be punishable by fine or imprisonment under 18 U.S Code, Section 1001 CERTtFIER S NAME UCE�tJ�NUMBER A1 1 an F_ OS 1 md. P M 6 T�T� COMPANY NAME ofessional Surve or and Ma er Kin En ineerin Associates Inc. SS CITY STATE ZIP CODE 4921 orial e. Tam a FL 33634 SIGNATURE DATE TELEPHONE -t 5 4 813-88 -8881 � FEMA Fortn 81-31,AUG 99 SEE REVERSE SIDE FOR CONTfNUATION REPLACES ALL PREVIOUS EDIT10�?wS IMPORTANT: In these spaces,copy the corresponding information from Section A. For Insurance Compa�y� BUILDiNG STREET ADDRSSS(Induding Apt.,Unit,Suite,andlor Bidg,No.)OR P.O.ROUTE AND BOX NO. !Potiry Number - Bella io at Baywatch - Building #1000 - 2749 Via Cipriani CITY STATE ZIP CODE `Company NAIC N�nber t FL 33764 SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community offiaai,(2)insurance agenUcomparry,and(3)buiiding owner. COMMENTS ❑ Check here if attachmer€s SECTtON 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 Eleva6on Cerdficate 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 compieted-see pages 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.) E2.The top of the bottom floor(ncluding basement or endosure)of the building is _ft,(m)_in.(cm) ❑above or ❑ below(checfc one) the highest adjacent grade. E3. For Building Diagrams 6-8 with openings(see page�,the next higher floor or elevated floor(elevation b)of the building is _ft.(m)_in.(cm)above the highest adjacent 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 community's floodplain management ordinance?�Yes �No ❑ Unknown The local offiaal must certify this information in Section G SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owner's autho�zed representative who completes Sections A, B,and E for Zone A(without a FEMA-issued ar community-issued BFE)or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTNORlZED REPRESENTATNE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS ❑ Check here if attachmer:� SECTION G-COMMUNITY INFORMATION(OPTIONAL) The local offiaal who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sedions A, F3,C(or�,��d G of this Elevation Certificate. Complete the applicable item(s)and sign below. G1. �The information in Sec::�n C was taken from other documentation that has been signed and embossed by a ficensed surveyor; engineer,cr architect wt'o is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevatic,n data in the Comments area below.) G2.[�A c�mme,:nity official s.ompiet�d Section E for a building located in Zone A(without a FEMA-issued or community-issued BF�o� Zone AO. G3. ❑The foll�wing inforniation(Items G4-G9)is provided for community floodplain management purposes. G4.PERMlT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPUANCEIOCCUPANCY ISSUED G7.This permit has been issued for: ❑ New Construction�Substantial lmprovement G8. Elevation of as-built lowest floor(including basement)of the building is: _ft.(m) Datum: G9. QFE 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 ❑Check here if attachmer�s =EMA Form 81-31,AUG 99 REPLACES ALL PREVIOUS EDITIONS