2701 VIA CIPRIANI CLUBHOUSE F��E3Z�L E�ilE3ZGEHdCY�AAAi�►G�3UIEiVT�►t;E�C'�
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Expires July 31, 2{3t32 �
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� Importan� Read the i�utructions on pa es 1 -T.
SECTION A-PROPE�tN OMINER lNFORMA iTION For tm:surar�ce Company tsse;.
BUILDINfu OWNER'S NAME . .pa�N��
ING STREET ADDRESS{Induding Apt,tJnit,Suite,andlor Bldg.No.)OR P.O.ROUTE AND 80X NO. Company NAIC Number
Bella io at Ba atch - Clubhouse - 2701 Via Cipriani -
�TE Z!P CODE
Clearwater, .::i. � 33764
PROPER7Y DESCRIATION{Lot and Bladc Numbers,Tax Parcel Number,Legal Description,etc.)
Tax Folio No. 29/29/16/00000/220/0200
BUILDING USE(e.g.,Residerniaf,Non-residentia4 flddidon,Accessory,etc. Use Commerns sectlon if necas.sary.)
Residential •
LATITIJDEILONGRUDE(OPl70NAL) HORtZONTAL DATUM: SOURCE: ❑Gi�S(TYPe)�-----
( #�-#!K-#i�.�#R' or #+R.�R°) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad AAap ❑Other.-----
8ECTiON B-FLOOD INSURANCE RATE INAP(F1RM�IWFORMATION
81.NFlP COMMUNITY NAME�COMMUNITf NUMBER 82 COUNTY NAME B3.STATE
Pinellas Count FL Unincor . 125139 Pinellas Florida !
84.NIAP AND PANEL 85.SUFFp( B6.FIRM INDDC B7_FlRM PANEL B8,FLOOD B9.BASE FLOOD ELEVATION(5. �
NUMBER DATE E��CTIVE/REVISED OATE ZONE(S) (Zone Aa,use depth of;toodirr�;
0128 D 8 18 92 8 19 91 AE i0 ;
810.Indic�te the sour�e of the 9ase Fiaod Elevation(BF�data or base flood depth er�ered in 89.
❑FiS Profile �FlRM ❑Community Determined ❑Other(Describe):----
B11. tndlcate the elevatlon datum used!or the BFE in 89:�NGVD 1929 ❑NAVD t988 ❑Other(Descnbe):____
B12.Is the bu�ding toc�ted in a Caastal Barrier Resources System(CSRS)area or Otherwise Protected Area(OPA)? ❑Yes �iVo �
Designation Date ----
SECT(ON C-BUILDiNG E!_EVATION INFORMATION{SURVEY REQUIRED)
C1.Building elevations are based on:Q Construdion Drawings' � Buiiding Under Ccnsbuction' ❑Fnished Construdion
'A new Elevation Certlficate un11 be required when consUudion of the building is complete. �
C2�ing Diagram Number 1(Seled the building diagram most sirtu7ar to the building for which this cerdficate is being compleied-see
es 6 and 7. If no diagram accurately represents the bu�ding.provide a sketch or photograph.}
C3. Elevations-Zones A1-A30,AE,AH,A(with BF�.VE,V1-V30.V(with BFE�,AR.AWA,AR/AE,AR/A1-A30,AR/AH,AR/AO
Camplete 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 8,cornert the datum to that used for the BFE Shaw field measurements and datum conv�rsion
cakkx� Use the space provided or the Comments area of Sec�ion D or Sedion G, as appropriate,to documertt the datum cornrersinr_
Datum�� CornersioNCommertts N,A_ \'';'�`''"
Elevation reference mark used Does the elevation reference mark used appear cn the FiRM? ❑Yes� ��°?a�o ,� �
❑ a)Top of bottom floor(induding basemerrt or endosure) I O .1 ft.(m) � f.4= „✓ °a.� .
❑ b)Top of ne�ct higherfloor n/a ._R.(m) ;:� ��°%��',,,� �°�'���-5'fa��, �
D c) Bottom of bwest horizontal strudura!member(V zones only) �1�• R(m) ��: m � �� '=� '; �,,` �, °
0 Attac�ed ) c' "� ° �'" �'
� 9arage(top of slab �[�. ft.(m) � ��- /� ,�
0 e)Lowest elevation af machinery andlor equipmerrt W� �� � �; �'.
� ��. ,. `�' ` ", � '� _
servicing the buiiding n/a -_ft-(m) �� -, ";� °; 's'`' ,�
� e' �. `,a
❑ �Lowest adjacent grdde(LAG) n/a •_g-(m) z�, '`�',
❑ g) Highest adjacent grade(HAG) �,_ff,�m� _,,.. .• .���
O h No.of ermanerit o � , '. ,��?�'�,
) p penings(flood vents)within 1 ft.above adac�nt grade nf a_ s� }3,
a )Total area of all permanerrt openings(flaod.vents)in C3h 0 sq.in. (sq.cm)
SECTION D-S.URVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This certi�on is to be signed and seaied by a iand surveyar,engineer,or archited authorized by law to�elevation information..
1 cer�ify that the infomraLion in Sections A, B, artd C on this cerhficafe►�preseMs my best efilorts Go interp�t the data availa6/e.
l understand fhat arry fa/se sfatement may be punishable by fine or imprisorrmenf under 18 U S Code, Sedion 1001
CERTfFiER S NAME L10E�I�SE NUMBER
_ Allan F_ OclLnrl _ PSM 59
T�T�-E COMPAiVY NAME
' Surve or and Ma er Kin En ineerin Associates Inc.
� -- CtTY STATE ZfP CODE
4921 o i '�i . 3 0 Tam a FL 33634
SiG TURE DATE TELEPHONE
8 -88 -8881 �
-�MA Form 81-3t,AUG 99 SEE REVERSE SIDE FOR CONTiNUATION REPtACES ALL PREVlOUS EDtfiO�iS
aAA�RT�+NT: An these�pacgs, �y�he�ara�sqsonding 6e�forma4ion�rom Secli�n.�►. �or tnsuranc�
�UIL.DING STREE�'ADQRESS{InCudhe9,�•,Unit,Su+te,and/or 81dg,svo.)OR 7�.0.ROUi'E Ai�tO BOX NO. . ��+�:�-: -�V
. .�A t Number': -
' t - Clubhouse - 2701 Via Cipri.ani P���" ' � �
ClTY Z!P CODE _'C- _ -� NAIC N�nber
Clearwater SFL� 33764 ��y
S���'iOlV �-SURV�IpR, ENGlNE�t,OR ARC3i1�'EC'T CERTiFiCA110N(CONTINUED) '
Copy both sides of this Elevatian Certificate far('!)community official,(2)�insuranc�agenflcomparry;and(3)buiiding owner.
COMMEtVTS
Ct�eck here if attachmer:�
SECTION E-BUILDING E1.�1lATtON INFORMATION(SURVEY NOT REQUlRED)FaR ZONE AO AND ZONE A(WITHOUT BFE)
For Zone AO and Zone A(without BF�,complete Items E1 through E4. If the Qevation Certficate is intended for use as supparting
information ibr a LOMA orLOMR-F, Section C must be comp/eted
E 1. Buiiding Diagram Number_(Seled the building diagram most similar#o the buiiding for which this certiiiic�te is being completed—see
pages 8 and 7. if no diagram accurately represents the buiiding, provide a ske�or photograph.j
E2 The top of the bottom floor('induding basement or endosure)of the building is _ft.(m)_in.(cm)�.above ar ❑below(chedc one)
the highest adJacerrt grade.
E3.Far Baiding Diagrams 6-8 with openings(see pag,e�,the nexf higher flnor or elevated flocr(eievation b)of the build'mg is
_ft.(m)_in.(cm)above the highest adjacent grade.
E4. For Zo�e AO only: If no flocd depth num6er is avaiiable,is the tcp af the bottom floor el�ated in ac.cordance with the comrtwniiy's
floadpiain management ordinance?Q Yes ❑iVo ❑Unknown The local offlcial must certify this information in Sectlon G
SE�TtON F-PROPERTY OWNER(OR OWNER'S.REPRESENTATIVE�C�RTlF1CATiON
The property owner a�owne�s authorized represerrtative vvho complete.s Sedions A,B,and E for Zone A(withaut a FEMAassued ar �
community-issued BFE�or Zone AO must sign here.
PROPERTY OWNER'S OR OYVNER'S AUTHORiZED REPRESENTATNE'S NAME
�d�� C� STATE Z1P CODE
SIGNATURE . DATE TELEPHONE
COMMEMS
_. . .
❑Checic here if attacf�mer�
SECTION G-COMMUNITY INFORMATION(OPTIONAL) �
The local offiaal who is aufhpriaed by law or ordinance to administer the community's floodplain management ordinance can compiete
3edions A, 8,C (or�.and G of this Elevation Certificate, Ccmplete the appGcable item(s)and sign below.
31.Q The infcrmatian in 5edian C was taken from other documeMatton that has been signed and embossed by a Iicensed surveyor;
engineer,cr a�hited who is authorized by state or locai iaw to certity elevation ir�fortnation. (Indcate the source and date of the
elevaticn daCa in the CammeMs area below.)
32.Q A c,ommvnity offiaal carr�pieted Sedion E for a building located in Zone A(without a FEMA-issued or communiiy-issued BF�or
Zone AO.
33. Q The following infoimabon(k�ms G4-G9)is provided for communiiy floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUEQ G8. DATE CERTIFICATE OF COAAArPL1ANCFJOCCUPANCY
�, ISSUED
�7.This pertnit has been issued for. ❑Wew ConsUvctian Q SubstarrtiaF`Improvemerrt
�8.Eievation cf as-buitt I.owest floor(induding basement)of the buiiding is: _ft.(rn) Datum:
�9. F�FE or(in Zone AO)depth of ftcoding at the buiiding site is: _ft.(m) Datum:_____
LOCAL OFFICWL'S NAME n�
COMMUNiTY NA11AE TELF�HONE
SFGNATURE DAi'E
COMMEM'S
- ❑Checic here if attachmen�s
EMA Form 8�-31,AUG 99 RFptACES ALL PREVIOUS EDITIONS