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2733 VIA CIPRIANI BLDG 800 � FEDERAL EMERGENCY MANAGEMENN�'AGEAICY o �.�. (�o. 3067-007? . NATtO1VAL FLOOD INSUR4NCE PROGR.+►M �p�res Juiy 31, 2002 EL�AT901d CERT1FiGATE Irnportant Read tfie instructlons on es 1 -T. SECTION A-PROPE3ZTY OWNER INFORMATION E�or(nsurance Cort�any tlse: BUILDIN OVVNER'S NAME Polky Number ING STREET ADDRESS{Ir�duding Apt,Unit,Suite,and/or Bldg.No_)OR P.O.ROUTE ANQ BOX NO. Company NAIC Nurnber Bella io at Ba atch - Building #800 - 2733 Via Cipriani � Clearwater, :�. �� Z1P CODE 33764 PROPERTY DESCRIPTION(Lot and 81odc Numbers.Tax Parcel Number,Legal Description,etc.) Tax Folio No. 29/29/16/00000/220/0200 BUILDING USE(e.g.,Residential,Mon-rcsidential,Addition,Accessory,eta Use Commerrts section if�ecessary.) Residential LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):_____ ( �#°-##'-##.#IX' or ##.�k°) �NAD 192T ❑NAD 1983 ❑USGS Quad Map ❑Other.----- SECTION 6-FLOOD INSURANCE RATE MAP(FiRM) INFORMATfON B1.NFiP COMMUNITY NAME�COMMUNITY NUMBER B2.COUNTY NAME B3.STATE � Pinellas Count FL Unincor . 125139 Pinellas Florida � B4.MAP AND PANEL B5.SUFFIX B6.FiRM INDDC 67.FiRM PANEL B8.FLOOD B9.BASE FLOOD ELEVATiON(a NUMBER DATE EFFECTIVEIREVISED DATE ZONE(S) (Zone AO,use depth of;loodirtg; 0128 D 8 18 92 8 19 91 AE 10 810. Indicate the saurce of the 8ase Flood Elevation(BFE�data or base flood depth entered in B9. ❑FIS Profile �FiRM ❑Community Detertnined ❑Other(Describe):_____ B 11.Indicate the elevabon datum used fo�the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Other(Describe):____ B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Othervuise Proteded Area(OPA)? ❑Yes � No � Designation Date ____ SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1.Building elevations are besed on:0 Construdion Drawings' 0 Buiiding Under Construdion* ❑Finished Construction 'A new Elevation Certlficate wiii be required when consUudion of the building is complete. � C2�iding Diagram Number 1 (Seled the building diagram most simi7ar to the building for which this certificate is being completed-see es 6 and 7. If no dlagram accurately represents the.buiiding.provide a sketch or photograph.) C3. Elevations-Zones A1-A30,AE,AH,A(with BF�.VE,V1-V30,V(with BF�,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 ditfererrt from the datum used for the BFE in Sedion B,corwert the datum to that used for the BFE. Show fietd measurements and datum conversion calcul Use the space provided or the Comments area of Section D or Section G, as appropriate,to documen;�.��n.�orrversi�r-_ Datum�� ConversioNCamments NJA_ ` -' ° � ,,�;. .., Elevation reference mark used Does the elevation reference mark used appear on the F1RM? ❑Yev'�~ s�;�°`° '� ;¢'�''r�, ' O a)Tap of bottom floor(induding basemerrt or endosure} 10 . 1 }t,(m� � e � ��. •,� �, ❑ b)Top of nent higher floor n/a . R(m) N ,�.5/� �..1.G„�s� � p,�,, 4 c)Bottom of lowest horizontal strudural member(V zones only) n/a . tt.(m) � `'°• � 2� e��y ❑ c�Attached garage(top of slab) n�a }�(m� � � /�t�;'�� r�� W� ; �.;, � ��,, �:, J-- �. � ❑ e)Lowest elevation of machinery andlor equipmerrt �, � ' , serviang ihe buildin9 n/a _$.(m) �3 '�' .. O fl Lowest adjacent grade(LAG) n/a g,�m� � � i�, #°�'� �� : �: ��y�=�� ;` � 0 g) Highest adjacent grade(HAG) n/a,_g.�m� ��' ��: : .��,g .'.��"�" ,K•�; 0 h)No.of permaneM openings(flood vents)within 1 ft.above adjacerrt grade_n/a � 4 )Total area of all pertnanent openings(flood.verrts)in C3h � sq.in. (sq.cm) 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 iriformation.. 1 ceitify that the fnforma�on in Sections A, 8, and C on this certificate represents my best efforts to inteipiet the data available. !understand that any false stai+ement may be punishable by fine or imprisonment under 18 U S Code Sedion 1001 CERTIFIER'S Nr4ME UCF��NUMBER A1 1 an F_ (�G 1 tmc3� PSM T� COMPANY NAME �rofessional Surveyor and Mapper Kina Enqineerinq Associates, Inc '4 � C� STATE ZIP CODE 4921 Memorial Ste. - Tam a FL 33634 Sl TURE � � p 4/��/Ol TELEPHONE / �'"� " 8 3-88 -888 � FEMA Form 81-31,AUG 99 SEE REVERSE SIOE FOR CONTINUATION REPLACES ALL PREVIOUS EDffIC1�S �MP�RT�e➢VT: 1n 4hese�paces,capy�e�arresponding information�rom Seclion,�1. �or tnsurance Camp�arry,tlse ;- �UIIDiNG STRE�I',4DDRESS pnduding Apt,,Unit,Suite,and/or Bidg.No.)OR P.O.ROUTE APID BOX NO. ;Po' Number:: - Bella io at Ba watch - Buildin 8 - - � ��TM �A� Z!P CODE �Company NAIC Nimiber Clearwater FL 33764 - SE�TION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTiFiCAT10N(CC3NTINUED) ' Copy both sides of this E3evatia� Certificate for(1)community official, (2)insurance agenUcompany, and(3)buitding awner. COMMENTS ❑ Check here ifi attachmer,�€s 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 Elevation Certficate is intended for use as supporting informabon for a LOMA or LOMR-F, Section C must be comp/eteaC E 1.Buiiding Dlagram 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 acxurately represents the bu7ding;provide a sketch or photograph.) E2.The top of the bottom floor(including basement or endosure)of the building is _ft.(m)_in.(cm)�above or ❑below(d�edc one) - the highest adjaceM 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)above the highest adjacetrt grade. E4.For Zane 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?0 Yes 0 No ❑ Unknown TF�e local offiaal must ceraty this information in Sec�ion G SECTiON F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERT7FlCATION The property owner or owner's authorized rep�+esentative who completes Sedions A,B,and E for Zone A(without a FEf1AA-issued or community-issued BF�or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATNE'S NAME ADDRESS CITY STATE ZIP CODE S�GNATURE . DATE TELEPHONE COMMENTS ❑ Check here if attachmer� SECTION G-COMMUNITY INFORMATION(OPTIONAL) ' The local offical wha is auttNxized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B,C(ar�,and G�f this Elevation Certificate. Complete the applicable item(s)and sign below. G1. ❑The i�ortnation in Seciion C was taken from other documerrtation that has been signed and embossed by a licensed surveyor, engineer,or architect who is authorized by state or local taw to cerGfy elevation infortnation. (In�cate the source and date of the elevation data in the Comments area below.) 32. �A communiiy officiat sompleted Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE�or Zone Aa. 33. ❑The following information(Items G4-G9)is provided for cammunity floodplain managemerrt purposes. G4.PERMIT NUMBER G5. DATE PEiiMIT ISSUED G6. DATE CERTIFtCATE OF COMPLIANCEIOCCUPANCY ISSUED �7.This permit has been issued for. ❑New Construdion❑ Substarttial Improvement 38. Elevation of as-built towest flaor Cnduding basement)of the building is: _ft.(m) Datum: 39. k�FE or(in Zone AO)depth af flooding at the building site is: _ft.(m) Datum:_____ LOCAL OFFtCWL'S NAME �,E COMMUNITY NAME TEi.EPHONE SIGNATURE DATE COMMENTS — ❑ Checfc here if attachmer�s 'EMA Form 81-31,AUG 99 REPLACES ALL PREVtOUS EDITIONS