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2765 VIA CIPRIANI BLDG 1200 FEDERAL EMERGENCY MANAGEMENT AGENCY � NATIONAL FLOOD INSURANCE PROGRAM O.M.B. No. 3067-0077 , . ELEVATION CERTIFICATE �P�res July 31, 2oa2 Importan� Read the irestructions on pa es 1 -7. SECTION A-PROPERTY OWNER INFORMATION For fnsurance Company Use: ING OWNER'S NAME poliry Number B jl,plNG STRF�E'�ADDRF�S�(Indt�in��t Unit.�i��and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Company NAIC Number Bellagio a aywa c u ing _ 2765 Via Cipriani CITY ' ST�TE Z1P 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,AddiGon,Accessory,eta Use Comments seciion if necessary.) Residential LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):_____ ( ##°-##'-##.�l#" or ##.#####� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other._____ SECTION 8-fLOOD INSURANCE RATE MAP(FIRM)INFORMATION 81.NFIP COMMUNITY NAME 8�COMMUNITY NUMBER B2.COUNTY NAME B3.STATE j Pinellas Count FL Unincor . 125139 Pinellas Florida i 84.MAP AND PANEL 85.SUFFiX B6.FIRM INDEX 67_FIRM PANEl. 88.FLOOD B9.BASE FLOOD El.EVATION� NUMBER DATE EFFECTNE/REVISED DATE ZONE(S) (Zone AO,use depth of;bodi�:: � 0128 D 8 18 92 8 19 91 AE 10 B10. Indicate the source of the Base Flood Elevation(BF�data or base flood depth eMered in B9. ❑ FIS Profile �FIRM ❑Community Determined ❑Other(Describe):_____ B11. Indicate the elevation datum used for the BFE in 69: �NGVD 1929 ❑NAVD 1988 ❑Other(Describe):___ B12. Is the building located in a Coastal Bamer Resources System(CBRS)area or Othervvise Proteded Area(OPA)? ❑Yes � No Designation Date_____ SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based o�:Q Construdion Drawings' � Building Under Construction' ❑Finished Construdion 'A new Elevation Certificate will be required when construdion of the building is complete. ilding Diagram Number 1(Select the building diagram most similar to the building for which this certificate is being completed-see ages 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.) C3. Elevations-Zones A1-A30,AE,AH,A(with BF�,VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO Complete Items C3a-i below acxording to the building diagram specified in Item C2. State the datum used. If the datum is d'rffererrt from the datum used for the BFE in Sedion B,convert the datum to that used for the BFE. Show field measurements and datum conversion calcul�}' Use the space provided or the Comments area of Section D or Section G,as appropriate,to document the datum corrversi�-_ Datuml� Conversion/Comments NJA_ ,� ,��=t,; �� - - � �� .n ....9��,��... ` Elevation reference mark used Does the elevation reference maric used appear on the FIRM? �Ya'� � I�$ �, �., ❑ a)Top of bottom floor(nduding basement or endosure) 10 .l ft.(m) �; ' -",: _,��' "�t , ❑ b)Top of next higher floor n/a _ft(m) � �„S'�'� ��'—�� 0 c) Bottom of lowest horizontal structural member(V zones onty) n/a , ft.(m) �� `��" � �� .� b '•;'�� ,, ❑ d)Attached garage(top of slab) n/a. tt.(m) �.� ��°.�-��'� ' � � ., ❑ e)Lowest elevation of machinery and/or equipment W;: . n »��' ` '° 1-- f ' � � •< --� #� serviang the building n/a ._ft.(m) .S°� ° �� ' �i� �x ' � Q�/J1� �9 ❑ fl Lowest adjacent grade(LAG) n/a ,_ft.(rri) z,� „ � `_ ' ❑ Hi hest ad'acent rade HAG n � .,X , �' �`''i.,s$,�Y,. '"` 9) 9 1 9 ( ) �,._ft.(m) �'�a � ��. ❑ h) No.of permanent openings(flood vents)within 1 ft.above adjacent grade nfa_ � `Ys��`r r ��, +. ❑ )Total area of all permanent openings(flood�vents)in C3h 0 sq.in. (sq.cm) "'h��-�-w- SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation�information.; I certify that the informabon in Secbons A, B, and C on this certificate represents my best efforts to inteip�et the data available. � 1 unde�stand that any false statement may be punishable by fine or imprisonment under 18 U.S Code, SecGon 1001 CERTIFIER S NAME LICF�I�1$�,NUMBER Allan F_ Ocl �nd� p�nrt 65y T�T� COMPANY NAME ��feGGi�nal SLrvevor and Mapper Kinq Enqineerin Associates, Inc. ESS CITY STATE ZIP CODE 4921 orial te. Tam a FL 33634 SIGNATURE DATE TELEPHONE �� ,.—�� 6/12/O1 813 880 8881 � FEMA FoRn 81-31,AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVtOUS EDITIO�S iMPORTANT: In these spaces, copy the correspo�ding information from Section A. ;:For Insurance Comparry, *l,se; BUILDING STREET ADDRESS(Induding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.RQUTE AND BOX NO. !Polic,y Number , , ' _,. Bella io at Ba watch - Building #1200 - 2765 Via Cipriani ;. ; , GITY STATE ZIP CODE 'Com Clearwater FL pany NAIC Number 33764 SECTION D-SURVEYOR,ENGiNEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agenUcompany,and(3)buiiding owner. ° COMMENTS � ❑ Check here if attachmer�s SECTION E BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A{WITHOUT BFEj For Zone AO and Zone A(without BFE),complete Items E1 through'E4. If the Elevation Certiflcate is intended for use as supporting informa6on for a LOMA or LOMR-F, Section C must be completed. E1.Buiiding Diagram Number_(Select 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 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(checic one) the highest adjacerrt grade. E3. For Buiiding 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 accardance with the communii�s floodplain management ordinance?Q Yes �No ❑ Unknown The local offiaal must certify this infortnation in Secaon 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(without a FEMA issued or community-issued BFE)or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATNE'S NAME ADORESS CITY STATE ZIP CODE S�GNATURE DATE TELEPHONE COMMENTS ❑ Check here if attachmer.� SECTION G-COMMUNITY INFORMATION(OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B,C(or�,and G of this Elevation Certificate. Complete the applicable item(s)and sign below. G1. Q The information in Sedion C was taken from other documentation that has besn signed and embossed by a licensed surveyor, engiiieer,or architect who is authorized by state or local law to certify elevatfon information. (Indicate the source and date of the elevatio�a data in�the Comments area below.) G2.0 A comrtsunity offi�al comuleted Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE7 or Zone AO. G3. 0 The#ollowina infArmat�on(Items G4-G9)is provided for community floodplain management purposes. ' G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY ISSUED G7.This permit has been issued for: ❑ New Construction Q Substantial lmprovement G8. Elevation of as-built I.owest floor(including basement)of the building is: _ft.(m) Datum: G9. �FE 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 attachmerns =EMA Form 81-31,AUG 99 REPLACES ALL PREVIOUS EDITIONS