2746 VIA TIVOLI BLDG 100 _ __ _r __
— � FEDERAL EMEitGENCY MANAGEMEN�AGEAICY p,�,g. yo. 3067-0l377 �
NATlONAL FLOOD INSUR.�AiCE PROGRAAA �pires July 3'I, 2002
� EL�1i�1TtO1V CERTIFiCATE
. Importarrt: Read tfie instrvctio�an a es 1 -7.
SECTlON A-PROPERTY OWNER INFORMATtON F'or fnsurance Cort�a�ry 11se;
BUILDING OWNER'S NAME . Poiiry Number
, -
ING SIREET ADDRESS(Induding Apt,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Campany NAIC Number
Bella io at Ba atch - Building #100 - 2746 Via Tivoli
... _
C1 arwater, :i, �FL- Z33764E
PROPERTY DESCRlPTION(Lot and Biodc Numbers,Tax Parcel Number,Legal Description,eta)
Tax Folio No. 29/29/16/00000/220/0200
BUILDING USE(e.g.,Residentiai.Non-residential,Addition,Accessory,etc. Use Comments sedion if necessary.)
Residential
LATITUDFILONGITUDE(OPTIONAL) HORIZOHTAL DATUM: SOURCE: ❑GPS(Type)_____
( #�°-##'-##.##' or �.� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map �Other._____
SECTiON B-FLOOD INSURANCE RATE MAP(F1RM) INFORMA7fON
81.NFiP COMMUNITY NAME 8�COMMUNITY NUMBER B2.COUNTY NAME B3.STATE
Pinellas Count FL Unincor . 125139 Pinellas Florida f
84.MAP AND PANEL 65.SUEFIX 86.FIRM INDDC 67_FiRM PANEL B8.FLOOD B9.BASE FLOOD EiEVATiON(� E
NUMBER DATE EFFECTIVE/REVISED DA7E ZONE(S) (Zone AO,use depfh of lbodir�; �
0128 D 8 18 92 8 19 91 AE 10
810.Indlcate the source of the Base Flood Elevation(BFE7 data or base flood depth er�fiered in 69.
❑ FIS Profile �FIRM ❑Community Determined ❑Other(Describe):_____
B11. Indicate the elevation datum used for the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Other(Describe):____
B12. Is the buiiding located in a Coastal Barrier Resources System(CBRS)area or Othervuise Proteded Area(OPA)? ❑Yes � Nc
Designation Date_____
SECTION C-BUILDING ELEVATION INFORMATfON(SURVEY REQUIRED)
C1.Buiiding elewations are based an:(]Construdion Drawings` � Buiiding Under Ccnstruction' ❑Finished Construction
'A new Elevation Certificate will be required when construc�ion of the building is compiete. �
C2 Iding Diagram Number 1 (Select the building diagram most sim�7ar to the buiiding for which this certficate is being completed-see
��;:J 6 and 7. If no dlagram accurately represents the.buiiding.provide a sketch or photagraph.)
C3. Elevations-Zones A1-A30,AE,AH,A(with BFE7,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,cornert 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 Seation G,as appropriate,to dxument the datum cor�versirr._
Datum�� ConversioNCamments NJA_ �,�,�,a��a�����py�_��� ��.
Elevation reference mark used Does the elevation reference mark used appear on the FIRM? ;�]Ye�` � �;
0 a)Top of bottom floor�nduding basement or endosure) 10 , 1 g,�m� a � � �p=a e , � , �.
❑ b)Top of next higher floor n/a , ft.(m) �' ��!�����'"��� ��� �'
❑ c) Bottom of lawest horizoMal structural member(V zones only} n/a . ft.(m) �o, xw' o ��� '� �"° �"_ '�
❑ c�Attached garage(top of slab) n/a . R.(m) �'�:/Z��'/`- '. �
❑ e)Lowest elevation af machinery and/or equipment W� :;:� a �^ �' � �� '::� "``
servicing the building n/a �{,�m� 8 5 � ��;, ,�,; s;; !� ;
O �Lowest adjacent grade{LAG) n/a ��m� � z � _9 =:_ �, „� �.. ,�,.�;. , .
�'�-,/� �
❑ g)Highest adjacent grade(HAG) n/a._ft.(m) �y �-=,���, �
❑ h) No.of permanent openings(flood vents)within 1 R above adjacerrt grade_n/a � u PaA�a'�" _;�,���j�
0 )Total area of all permanent openings(flood-vents)in C3h � sq.in. (sq.cm) �
SECTION D-SURVEYOR,ENGiNEER,OR ARCHITECT CERTIFlCATION
This cerdfic�tion is to be s9gned and sealed by a land surveyar,engineer,or arct�itect authorized by faw to cerdfy elevation information,
t certify that the infom►afion in Sections A, 8, and C on this ce�Gficate represents my best efforts to inteipref the data available. _,
!unde�stand that any false statement may be punishab/e by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIER'S NAAAE UCE�1�$�,NUMBER
All�n F_ Oslund� PSM 7ti
n COMPANY NAME
_ �rofessional Surveyor and Mapper Kinq Enaineerin Associates, Inc.
�� CRY STATE ZIP CODE
.�_�21 Memori Ste Tam a FL 33634
Sl�. ��n� DATE TELEPHONE
3fi��a� 813-880-8881 �
F�MA Form 81-31,AUG 99 SEE REVERSE S1DE FOR CONTtNUAT10N REPLACES ALL PREVIOUS EDITlOR�S
�MP�RT,�,NT: 8n 4hese spacas,���Oy ghe carresg�onding information Yr�om Section,�►. .. ,:�or Insurance Company!� —
�UILDiNG STRE�7',qDDRESS(Indudi�g Apt Unit,Suite,andlor 8�.No.)OR P.O.ROUTE APID BOX NO.
Bellagio at Baywatch - Building #100 - 2746 Via Tivoli Po' Numtier, -
�.:..
C1TY STATE ZIP CODE .
Clearwater FL Campany NAIC N��
33764 ' °
SECTION D-SURVEYOR, ENGINEE�2,OR ARC�iITECT C�RTIFICATION(CONTINUED)
Copy bath sides of this Eievatian Certificate for(1)community official,(2)insurance agenUcompany,and(3)building owner.
COMMENTS
SECTION E-BUILDING ELEIIATION INFORMATION(SURVEY NOT REQUIRED FOR ZONE AO AND ZONE Ahere ifi attachmer.�
� (WITHOUT BFE)
For Zone AO and Zone A(without BFE),complete Items E1 through E4. !f the Elevation CeKificate is intei►ded for use as supporting
in�ormatian for a LOMA or LOMR-F SecSon C must be completed.
E1.Buiiding Diagram Number_(Select the building diagram most similar to the building for which this certificate is being compleied—ses
pages 6 and 7. If no diagram accurately represents the building;provide a sketch or photograph.)
E2.The top of the bottom flaor(inciuding basement or endosure)of the building is _ft,(m)_in,(cm)�al�ove or ❑ below(chedc one)
- the highest adjacern grade.
E3.For Building Diagrams 6-8 with openings(see pag,e�,the neict higher floor or elevated floor(eievation b)of the building is
_ft.(m)_in.(cm)abcve the highest adjacent grade.
E4.For Zone AO oNy: If no flood depth number is avaiiable,is the top of the bottom floor elevated in accordance with the communii�s ,
floodplain management ordinance?[�Yes 0 No ❑ Unknown The locat offiaal must certify this information in Section G
SECTION F PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFlCATION
The property owner o�owners authorized representative who completes Sections A, B,and E for Zone A(without a FEMA-issued or �
community-issued BF�or Zone AO must sign here.
PROPERTY OWNER'S OR OWNER'SAUTHORIZED REPRESENTATNE'S NAME
���� Cm' STATE Z1P CODE
SIGNATURE . DATE TELEpyONE �
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 E),anci G of this Elevatlon Certificate. Complete the appl(cable item(s)and sign beiow.
G1. �The information in Sectioe;C was taken from other documentation that has been signed and embossed by a licensed surveyor,
engineer,or�;rchitect who is aufhorized by state or locai law to certify elevation information. (Indcate the source and date of the
e;levatian data in the Ccmmei�ts area below.)
32.�A comr�tunity official completed�edion E for a building located in Zone A(without a FEMA-issued or community-issued BF�or
Zone A�.
33. �The foltowing infeemation(lfiems G4G9)is provided for community floodplain management purposes.
G4.PERMIT PfUMBER G5. DATE PEi2MIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCElOCCUPANCY
ISSUED
37.This permit has been issued for. ❑New Construc�fion�Substaritial Improvemerrt
38. Elevation cf as-buiit lowest floor(induding basement)of the building is: ft.(m) Datum:
39. f�FE or(in Zone AO)depth of floodi�g at the building site is: _ft.(m) Datum:
LOCAL OFFICWL'S NAME -�E
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS ,
�
❑ Checic here if attachn -ms
'EMA Form 81-31,AUG 99 REPlACES ALL PREVIOUS EDlTIONS