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2773 VIA CIPRIANI BLDG 1300 F�DE�AL EMERGENCY MAAIAGEiYIEPdT AGEAICY o,� g yyo. 3067-0077 � AIATIONAL F�OOp INSUR�4NC�PROGRAiN Expires July 31, 20t�2 � • EL��►-roo� c��iFOC�►�� Importan� Read the inatructions on es 1 -7. . SECTION A-PROPERTY OWNER 1NFORMATION Fcr fnsurance Company Use; ING OWNER'S NAME Po1Try Number ING STREET ADDRESS(Iruludin�Apt.,Unit,$uite and/or B,l� No. ,OR�O.ROUTE AND BOX NO. Company NAIC Number Bellagio at Baywatch - Building if13b0 - 2 3 �ia ipriani Cle rwater, .::�, �� Z1P CODE 33764 PROPERTY DESCRIPTION(Lot and Blodc Numbers,Tax Parcel Number,Legal Desc�tion,etc.) Tax Folio No. 29/29/16/00000/220/0200 BUILDING USE(e.g.,Residential, Non-residential,AddiGon,Accessory,eta Use CorrxneMS section if necessary.) Residential LATCRJDElLONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):_____ { �k°-�J#'-##.#�k' cr #�t.###If#' ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other._____ 3ECTiON B-FLOOD INSURANCE RATE MAP(FIRM)INFaRMAT10N 81.NFIP COMMUNITY NAME 8�COMMUNITY NUMBER 82.COUNTY NAME 83.STATE f Pinellas Count FL Unincor . 125139 Pinellas Florida i 84.MAP AND PANEL B5.SUFFlX B6.FIRM INDDC 67.FiRM PANEL B8.FLO�D 89.BASE FIOOD ELPVATION(� � NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use depth of;boding; 0128 D 8 18 92 8 19 91 AE 10 f 610. indic�te the saurce of the Base Flood Elevation(BF�data or base flood de�h er�red in 69. ❑ FIS Profile �FiRM ❑Community Determined ❑Other(Describe):_____ 811. Indicate the elevatlon datum used for the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑O#her(Describe):___ 812. Is the buiid'mg located in a Caastal Barrier Resources System(CBRS)area or Otherwise Proteded Area(OPA]? ❑Yes � No � Designatian Date_____ SECTION C-BUILDING ELEVATION INFORMATlON(SURVEY REQUIRED) C1. Building elevations are based on:�ConstrucGon Drawings' Q Building Under Consbuctian' ❑Finished Cor�struction 'A new Elevatian Certiiicate wiil be required when construdion of the buiiding is complete. C iding Diagram Number 1(Selec;t the building diagram most similar to the buiiding for which this cerGficate is being completed-see ges 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.) C3.Eievations-Zones A1-A30,AE,AH,A(wi�BF�.VE,V1-V30,V(with BFE7,AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO Complete Items C3a-i below according to the buiiding diagram specified in Item 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 for the BFE. Show field measurements and datum cornersion ca�ui Use the space provided or the Commerrts area of Sedion D ar Sedion G,as appropriate,to dacument the d�t'�m corniersi*r_ Datum�� ConversioNComments NJA_ '�_ »�.�'�"'�'' � '�'� Elevation reference mark used Does the elevation reference mark used appear on the FIRM? ❑Yes �J R�� ``�, �'� ` �� _ ❑ a)Top o f b o ttom floor(induding basement or endosure) 10 .1 R.(m) m ��k _ , �,R ,� � i �,�,;�� 0 b)Top of next higher floor i�, m N f��'� �� "� � `� n/a ._ ( ) _ 0 c) Bottom of lowest horizontal strudural member N zones only) n/a •_ft.(m) �a °' �� -' �- '. � � ❑ �Attached garage(tap of slab) n/a, ft,�m� °� .�v -1;�-O I", °F. `� °. r� �...� ❑ e) Lowest elevation of machinery and/or equipment �m ��;° �";"'�'°°'� '` � `�� serviang the building R m �� ~ � � n/a •_ � ) � ,� ��, `'`�n = O fl Lowest adjacent grade(LAG) n/a •_ft.(m) z � � �' � � . `�� O g) Highest adjacent grade(NAG) n a. ft,�m� :� ,�'�as ��' °,,��.�'��rlw ❑ h No.of ertnanent o nin s flood vents within 1 ft.above ad'acent rade n a ' � ) P Pe � 9 ( ) 1 9 f__ � y e"4q��'A' }oa� 0 )Total area af all permanent openings(flood.veMs)in C3h 0 sq.in. (sq.cm) µ -,.,..,._,. . . SECTION D-S.URVEYOR,ENGINEER,OR ARCNITECT CERTIFICATION This certification is to be signed and seaied by a land surveyor,engineer,or architect authorized by law to certify elevation information.. - I cerbfy that the information in Sections A, B, and C on this certficate�epresents my best etforts to interp�et the data available. 1 undersfand that any false statement may 6e punishable by fine or fmprisonment under 18 U S Code Secdon 1001 CERTIFIER S NAME UC��NUMBER Allan F_ OG1»nr7� P4M T�T�-E COMPANY NAME Surve or and Ma er Kin En ineerin Associates Inc. SS CITY STATE ZIP CODE 4921 M i 1 S Tam a FL 33634 SIGNATURE -� .�� 6A1�2/�1 81�880E8881 � FEMA Form 8'i-31,AUG 99 SEE RE1/ERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIO�S iMPOR�A�IT: 1n these.paces, c��sy 3he�om�esponding anfortnation from Sec�ion�►. ,;:For insurance ComQanY.�Us+e:.:::''. .�; BUILDING STREET ADDRESS Qnctuding,4pL,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE ANO BOX NO. Pol' Number: - Bella io at Ba atch - Buildin #1300 - 2773 Via C' � C1T'Y STATE ZIP CODE -Camparry NAIC Number � C FL 33764 SECTlON D-SURVE1fOR,ENGINEER,OR l�1RCiiITIECT CERTiFiCATION(CONTINUED) � Copy both sides of this Elevation Certificate for(1)community offiaal,{2)insurance agenUcompany,and(3)buiiding owner. ' COMMEAITS ` ❑Check here if attachmergs SECTION 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. !f the Eleva6on Certifrcate is interrded for use as suppofing informakon for a LOMA or LOMR F, Section C must be completed E1. Buiiding Diagram Number_(Select the building diagram most similar to the buiiding for which this certificate is being.compleied-see pages 6 and 7. If no diagram accurately represents the buiiding, provide a sketcti or photograph.) E2.The top of the bottom floor(induding 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 pag,e�,the next higher floor or elevated floor(elevatian b)of the building is _ft.(m)_in.(cm)above the highest adjacent grade. E4.Far Zone AO only: If no flood depttt number is available,is the top of the bottom flaor elevated in acxordance with the communit}�s floodplain management ordinance?Q Yes �No ❑Unknown The local offiaal must certify this information in Secaon G SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFiCATION The property owne�or owners authorized representative who completes Sedions A, B,and E far Zone A(without a FEMA-issued or community-issued BF�or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESEidTATNE'S NAME ADDRESS ClTY STATE 21P CODE - SIGNATURE • DATE TELEPHONE COMMENTS _. ❑ Check here if attachmer.� SECTION G-COMMUNITY INFORMATION(OPTIONAL) The loql official who is ai�thorized by law or ordinance to administer the community's floodplain manageme�t ordinance pn complete Sedions A, B,C(or�,and v ef this Elevation Certificate. Complete the appGcabie item(s)and sign below. G1.C Y'he inf�rmatlon in Seciion C was taken from other documentation that has been signed and embossed by a licensed sunreyor, enginser,ar archi3ed who is authorized by state or local law to certify elevation ir�formation. (Indcate the source and date of the elwat�an data in t!�Cor:enents area below.) G2.�A cammunity offiaai corr�leted Section E for a building located in Zone A(without a FEMA-issued or communiiy-issued BF�or Zone AO. 33. Q The follor�ving informa��n fltems G4-G9)is provided for community floodplain management purposes. G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERl'IFICATE OF COMPLIANCE/OCCUPANCY ISSUED �7.Th�s permd has been�ssued for. ❑New Construction Q SubstaMiaF�lmprovement �8. Elevation of as-built lowest floor(including basement)of the buiiding is; ft.(m) Datum: �9. $FE or(in Zone AO)depth of flooding at the building site is: _ft.(m) Datum:_____ LOCAL OFFICIAL'S NAME T� COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMElYTS ❑Checic here if attact�merns �EMA Form 81-31,AUG 99 REPLACES ALL PREVIOUS EDI'PIONS