2704 VIA MURANO CLUBHOUSE _ _ _
_ __ ___ _ .
F��E�i.4L E�1AEitGENCY�AAAIAGElYIEAIT AiGE�C� �.AA.B. �G. 30S7-0i�77^
• NATt�FdAL�L,C3OD tNSUR�NC��ROGRAM �xpires July 31, 20�2 �
�. C I �'DO � .V � � !�> ��.������ �r����F�C1���
., i importar� Read the instructions on es 1 -T.
SECTION A-PROPE�tN OWNER INFORMATION E'cr fnsuraace Corr�pany t3,se;
BUILDING OWNER'S NAME .Poliry Number �
ING STREEf ADORESS(Induding Apt.,tJnit,Suite and/or Bidq.No.}OR P.O.ROUTE AND BOX NQ. Company NAIC Nurr�ber
Venezia at Baywatch - Clubhouse - 2'!04 Via Murano --
Clearwater, .::i, . �FL 233764E
PROPERTY DESCRIPTI0IV(Lot and Blodc Numbers,Tax Parc:el Namber,l,eqal Desuiption,etc.)
Tax Folio No. 29/29/16/00000/220/0200
BUILDING USE(e.g.,Residerrtial, Non-residerdial,AddWon,Accessory,etc. Use Corrxner�ts secdon if necessary.)
Residential �
LATITUDEILONGITUDE(OPTIONAL) HORIZONTAL OATUM: SOURCE ❑GPS(Type):_____
( �#°-#�F'-�#.�#" cr #�.�) ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other.-----
SECTION �-FLOOD INSURANCE RATE MAP(FiRM�INFORMATION
81.NFlP COMMUNITY NAME�COMMUNIT(NUMBER BZ COUNTY NAME 83.STATE �
Pinellas Count , FL Unincor . 125139 Pinellas Florida �
84.MAP AND PANEL 65.SiJFFlX 8B.FIRM INDDC 87_FlRM PANEL 88.Fl.00D 89.BASE FIaOD ElEVATION(� �
NUMBER DATE E�EECTiVE/REVISED DATE ZONE(S) (Zone AO,use depth of 9ood'mg;
0128 D 8 18 92 8 19 91 AE IO i
810.Indicate the source of the Base Flood Elevatlon(BFE�data or base flood depth er�tered in 89.
❑ FiS Profile �FiRM ❑Community Detemtined ❑Other(Describe):-----
B11, tndicate the elevation datum used for the BFE in 89:�NGVD 1929 ❑NAVD t988 ❑Other(Describe):_____
812. Is the budding located in a Coastal Barrier Resources System(CBRS)area or Othervuise Proteded Area(�PA)? ❑Yes �No -
Designation Date ____
SECTION C-BUILDING ELE1/AT10N lNFORNIATION(SURVEY REQUIRED)
C1.Building elevatlons are based on:Q Construdion Drawings• � Building Under Construdion' ❑Fn�shed Caastrudion
'A new Elevatton CerMicate will be required when consVuc�ion of the building is complete. �
C2.��ding Diagram Number?-(Seled the bw'iding diagram most sirru'tar to the building for which this ce�te is being completed-see
es 6 and 7. ff no diagram accurately represerTts the bu�ding.provide a sketch or photograph.}
C3.Elevations-Zones A1-A30,AE,AH,A(wi�BF�.VE.V1-V30,V(with BF�,AR,AR/A.AR/AE,AR/A1 A30,ARJAH,AR/AO
Cornplete items C3a-i below according to the buiiding diagram specified in Item C2:State the datum used. If 2he datum is differerrt irom
the datum used far the BFE in Sedion B,cornert the datum to that used far the BFE.Show field measurements and datum conversion
caku Use the space provided or the Comments area of Section D or Section G,as appropriate,to docu��h�s:datum cornrersic-_
Datum�� CornersioNCammeM,s NJA_ �, _ °�,�;��� ,,;� ,
Elevatian reference mark used Does the elevation reference maric used appear on the F1RM? j� �-lVo���� �
❑ a)Top of bottom floor(induding basemerrt or endosure) Z 0 .1 ft.(m) � � �
❑ b)Top of next higher floor n/a ,it.(m) `�-S''� sG=x`�S'�
� � �y ���' '?d '`'� ,��.. 'W "
0 c) Bottom of lowest horizor�tal strucxura!member(V zones only) ziL�_•ft-(m) .� � �j�""-3 C,�-r.��;-' ' `�.� " �
a � =>- ,
❑ �Aitact�ed 9ara9e(toP of slab) I1L��-ft-(m) � �� <;: i�s �-
u�� o L!'j .�- �,., ar
0 e)Lrnv�t elevat(on af machinery and/or equipmerrt � ., A ,�,.��
servicing the buiiding n/a ._ft.(m) �� ° > � '`��
O �Lowest adjacent grade(LAG) n1a • ft-(m) z'� y� ,�„ •,y 3�••• y.R
0 g) Highest adjacent grade(HAG) n(�,_ft.(m) � " ��o�� .,�. ��f���
O h) No.of permanerrt openings(flood vents)within 1 ft.above adjacent grade nJa_ $ ',�> ,
❑ )Total area af all permanent.apenings(fload.verrt.$)in C3h 0 sq.in. (sq.cm} "
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFfCATION
This certification is to be signed and sealed by a Iand surveycr,engineer,or archited authorized by law to certify elevation infortnation..
!certify that fhe in�bimation in Sectio�s A, B, and C an this certihcate represenfs my best etTods to interp�et the data available.
!understand that an fa/ss sfatemerrt ma be unishable b fine or i risonment under 18 U.S Code, Sec�ion 1001.
CERTIFlER'S NAME UC� NUMBER
Allan F Oslund, PSM
T�T� COMPANY NAME
Surve or and Ma er Kin En ineerin Associates Inc.
� C1TY STATE ZfP CODE
4921 r' 1 00 Tatn a FL 33634
S!G RE DATE TELEPHONE
1"30 O1 8 3-88 -8881 �
=EMA Fortn 81-3t,AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDR1�,5
iMP�R'���T: �n tffese��Sacas,�sa�sy�he��ra�espondPng 6e�foema�don�m Section�.
�UILDING STREEi'�1DDRE5S(Inclvdi �.�or Insyranco CompanY Use:.::`...__°=
R9�•.U��k Suite,and/or 8tdg.No.)OR P.O.FZOUTE AND 60X NO. Fo" �Alumber�. ' -
..:::: -_,::. ,
ezia at Ba atch - Clubhouse - 2704 Via Murano . �-- �•� - - - :
C1TY -::... -: � . _ _
Clearwater �L� Z!P CODE -C�N,q�C I��as�er -
33764
SE�TiOiV �-SURVEYOR,EAIGiP1E�3�,OR ARC�itTECT C�RTiFiCATION�CONTINUED)
Capy both sides of this Elevatio�Certificate fir(1}community ofticial,{2)�insurance ageM/company;and(3)buiid�ng owner. �
COMMEiVTS
Check here if attacftmer�
SECTION E-BUILDING ELEVATION INFORMATlON(SURVEY NOT REQUIRED)�OR ZONE AO AND ZONE A(WITHOUT BFE)
For Zone AO and Zone A(without BFE),complete Items E1 through E4. lf the Elevation Cert�cat�is interrded for use as supporting
irrformation ibr a LOMA or LOMR-F, Section C must be completed
E1.Buiiding Diagram Number_(Seled the building diagram most simiiar to the buiiding for which�is certificate is being compleled—see
pages 8 and 7. If no diagram acxvrately represents the budding,provide a sketcf�or photograph.)
EZ The top of the bottom floor fnciuding basement or endosure)of the buiiding is _ft,(m)_in.(cm)�above ar ❑below(chedc one)
the highest adJacerrt grade.
E3.For Building Diagrams 6-8 with openings(see pag,e 7),the next higher flaor or alevated flaor(el�vation b)of the building is
_ft.(m)_in•(cm)above the highest adjacent grade.
E4. For Zone AO only: If no 8oed depth number is ava�7able,is the top of the bottom floor el�ated in accxrdance with the communii�s
_ floodplain man�ement ord'mance?�Yes Q No ❑Unknown The bcal official must certity this infom�ation in Seaiun G
SECTiON F PROPERTY OWNER(OR 01NNER'S REPRESENTATNE)CERTIFICATION
The property cwner or awne�s authorized represerrtative who completes Sedie�s A,B,and E for Zone A(without a FEMA-issued or
community-issued BF�or Zone AO must sign her+e.
PROPERTY OWNER'S OR OWNER'S AUTHORlZED REPRESENTA S NAME
���� C� STATE Z1?CODE
SIGNATURE . Dq'TE TELEpHONE
COMMEAITS
❑Checic here if attachmer�s
SEC770N t3-COMMUNITY INFORMATION(OPTIONAL� �
the local offiaal v►�ho is authorized by law or ordinance to adminiater the communiiy's floodplain managemerrt ordinance can compiete
3ec�ions A, 8,C(or�,and G of this Elevatiun Certificate. Complete the app6cabie item(s)and sign betow.
31. Q The informa�an m Sec°�on C was taken from other documentation that has been signed and embossed by a licensed su rv e yor;
e n g i n e e r,o r a r c h i�e c t w h�a i s a u t ho ri z e d b y s t a t e or l o c a l l a w to certify elevat(on informa�on. (Indcate the souroe and date of the
elevatior.data in tne Cama�nts area below.)
32.Q A communiiy ot�ciai completee�Sedion E for a building loqted in Zone A(without a FEMA-issued or communiiy-issued BF�or
Zone�AO.
�3. �The folk�wing infonnation(ft�ms G4G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT iSSUED G6. DATE CER7'IFlCATE OF COMPLIANCEIOCCUPANCY
ISSUEfl
�7.This permit has been issued for. ❑New CansUvc�ion Q SubstarrtiaF"Imp�vemerrt
i8. Elevation uf as-built I.owest floor Cnclttding basement)of the bu�7ding is: ft.(m) Datum:
i9.QFE or(in Zone AO)depth of flooding at the buiiding site is: _R(m) Datum:
LOCAL OFFICIAL'S NAME �E -----
COMMUNITY NAME TELEPHONE
SiGNATURE DATE
COAAMENTS
❑Ct�ecic here if attachmer�
EAAH Fortn 81-31.AUG 99 REPLACES ALL PREVIOUS EDITiONS