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2757 VIA CIPRIANI BLDG 1100 _� FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. NO. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM � � ELEVATION CERTIFICATE Expires July 31, 2002 Important: Read the instructions on a es 1 -T. ' SECTION A-PROPERTY OWNER INFORMATION For Insurance Company Use; DING OWNER'S NAME Policy Number t' BUILDING STREET ADDRESS(InGuding Apt.,.Unit,Suite,and/or Bld .No.)OR P.O.RQUT�AND BOX NO. Company NAIC Number Bella io at Baywatch - Building #1100 - 27�7 Via Cipriani . CITY ' ST�TE ZIP 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,Addition,Accessory,etc. Use Comments sedion if necessary.) Residential LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑GPS(Type):_____ ( ##°-##'-##.##" or ##.#11�#� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other._____ SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME 63.STATE E Pinellas Count , FL Unincor . 125139 Pinellas Florida i 84.MAP AND PANEL 65.SUFFIX B6.FIRM INDEX 87_FIRM PANEL B8.FLOOD 69.BASE FLOOD ELEVATION� � NUMBER DATE EFFECTiVElREVISED DATE ZONE(S) (Zone AO,use depth of fbodirr7i 0128 D 8 18 92 8 19 91 AE 10 B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in 69. ❑ FIS Profile �FIRM ❑Community Determined ❑Other(Describe):_____ 611. Indicate the elevation datum used for the BFE in 89:�NGVD 1929 ❑ NAVD 1988 ❑Other(Describe):___ 612. Is the building located in a Coastal Barrier Resources System(CBRS)area or Othervvise Protected Area(OPA)? ❑Yes� No Designation Date_____ SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1.Building elevations are based on:❑Construction Drawings; Q Building Under Construction' ❑ Finished Construction 'A new Elevation Certficate will be required when construction of the building is complete. �uilding Diagram Numberl (Seled the building diagram most similar to the building for which this certficate is being completed-see pages 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.) C3. Elevations-Zones A1-A30,AE,AH,A(with BFE),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,convert the datum to that used for the BFE. Show field measurements and datum conversion calcula�}�Use the space provided or the Comments area of Sedion D or Section G,as appropriate,to document Ui�datum conversrr_ Datum� ConversioNComments NJA_ *�' �,��'��a�"��?;��, Elevation reference mark used Does the elevation reference mark used appear on the FIRM?�'�Ye� 'No'�"�.- ti��,q.;�'�� ❑ a)Top of bottom floor(induding basement or enclosure) 10 .1 ft.(m) � �.� ,a- °� ".� ❑ b)Top of next higherfloor n/a ._ft.(m) o �,,,S�w ��S'� 4' D c) Bottom of lowest horizontal structural member(V zones only) n/a ._ft.(m) �o ;�„'f?� �` �3 f"' 1� ; �; ❑ d)Attached garage(top of slab) �._ft.(m) �� ' j`--��..�� =: w m 6 0 �- ��:� �"" � . _� , D e) Lowest elevation of machinery and/or equipment �:, a r- .,.� / servicing the building n/a ._ft.(m) �� °�� r'��.', ', '~ r_~�c �.' ^ ❑ �Lowest adjacent grade(LAG) n/a ._ft.(m) ' � � . ' ' ❑ g)Highest adjacent grade(HAG) n a._ft.(m) �� '' �' '�� d�'•••a.,••°�s�+�� ❑ h) No.of permanent openings(flood vents)within 1 ft.above adjacent grade n�a_ � YS ;,�iEi�� t� �, � a i)Total area of all permanent openings(flood.vents)in C3h 0 sq. in. (sq.cm) ��r: .°'�",R�*�°`'-^'^ 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 certfy that the informa6on in SecSons A, B, and C on this ce►tficate represents my best efforts to interpret the data available. 1 understand that any false statement may be punishab/e by fine orimprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME LICE�t�I$.�,,NUMBER Allan F_ Oslund, PSM 65y TITLE COMPANY NAME rofessional Surveyor and Mapper Kin En ineerin Associates, Inc. ESS CITY STATE ZIP CODE 4921 emor' w . 0 Tam a FL 33634 SIGNATURE DATE TELEPHONE 5/4/0� 813-880-8881 FEMA FoRn 81-31,AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDIT10tS IMPORTANT: In these spaces,copy the corresponding information from Section A. For Insurance Company Use: BUILDiNG STREETADDRESS(Induding Apt.,Unft,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Polic,y'Number Bella io at Baywatch - Building #1100 - 2757 Via Cipriani ��N STATE ZIP CODE Company NAIC Nurnber FL 33764 SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community offic'ial, (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 BFE) For Zone AO and Zone A(without BFE),complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. Building 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(including basement or enGosure)of the buitding is _ft.(m)_in.(cm) �above or ❑ below(checfc one) the highest adjacent grade. E3. For Building 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 onty: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community�s floodplain management ordinance?Q Yes ❑ No ❑ Unknown The local official must certity this information in Section G SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B,and E for Zone A(without a FEMA-issued o� community-issued BFE)or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATNE'S NAME ADDRESS CITY STATE ZIP CODE • SIGNATURE DATE TELEPHONE COMMENTS ❑ Check here if attachmer:�s SECTION G-COMMUNITY INFORMATION(OPTIONAL) The local offiaa!who is authorized by law or ordinance to administer the community's floodplain management ordinance qn complete Sections A, B,C (or E),and G of this Elevation Certificate. Complete the applicable item(s)and sign below. G1.Q The information in Sectian C was taken from other documentation that has been signed and embossed by a licensed surveyor; engin�eer,or archited wh�is authorized by state or local law to certify elevatio�information. (Indicate the source and date of the elevation data in the Comr�ents area below.) G2. []A co►nmunity official��ompleted Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3. Q The folluwing inf�ormatior�(Items G4G9)is provided for community floodplain management purposes. G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7.This permit has been issued for: ❑ New Construction Q Substantial Improvement G8. Elevation of as-built lowest floor(including basemeni)of the building is: _ft.(m) Datum: G9. B: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 attachme�s FEMA Form 81-31,AUG 99 REPLACES ALL PREVIOUS EDITIONS