2738 VIA TIVOLI BLDG 200 _ ___ _ _ __ _ __ _
FEDERAL EMEitGENCY MANAGEAAENT AGEAICY
. NATIONAL FLOOD INSUR.4PICE PROGRAM �•�-B• �o. 3067-0i�77 �
F�pires Juiy 31, 20a2
� EL�A►TIOIV CERT�FaGATE
importar� Read the instructions an es 1 -T.
SECTION A-PROPERTY OWNElZ INFORMATtON F�or fnsurance Company t1se;
BUILDING OWNER'S NAME Policy►Number
�NC�STREET AD�RES (Indudingq��.,Unit ,and/ . o. P. ROUTE AND BOX NO. Company NAIC Number
se agio at Baywatc�h - suilding #�`�� — �5�'��'i��ivo�l.i - .
Clearwater, �. �FL- 33764E
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.,Residentlal.Non-residential,Addition,Accessory,etc. Use Comments secdon if necessary.)
Residential
L4TITUDFJLONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑G?S{Type):_____
( �k°-##'-##.#�" or ##.� 0 iVAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other._____
SECTi�N B-FLOOD INSURANCE RATE MAP(FiRM)INFORMATION
B1.NF(P COMMUNITY NAME 8 COMMUNITY NUMBER 62.COUNTY NAME B3.STATE i
Pinellas Count FL Unincor . 125139 Pinellas Florida i
84.MAP AND PANEi. B5.SUEFIX B6.FIRM INDD( B7.FIRM PANEL B8.FLO�D B9.BASE FLOOD E3.EVATION(5 �
NUMBER DATE EFFECTNElREVISED DATE ZONE(S) (Zone AO,use depth of 9oodir�;
0128 D 8 18 92 8 19 91 AE i0
B10. Indicate the sour+ce of the Base Flood Elevation{BFE7 data or base flood depth entered in 69.
❑ FIS Prcfile �FIRM ❑Communiiy Detertnined ❑Other(Describe):_____
B11. Indicate the elevation datum used for the BFE in 89:�NGVD 1829 ❑ NAVD 1988 ❑Other(Describe):_____
812. Is the buiiding located in a Caastal Barrier Resources System(CSRS)area or Othervvise Proteded Area(OPA)? ❑Yes� No
Designation Date ____
SECTION C-BUILDING ELEVATION INF�RMATION(SURVEY REQUIRED)
C1.Buiiding elevations are based on:(]Construction Drawings* 0 Building Under Construdion* ❑Fnished Construction
'A new Elevatton Cettificate will be r+equired when construdion of the building is complete. �
C�ding Diagram Number 1 (Seled the buiiding diagram most sirtular to the building for which this cefificate is being completed-see
es 6 and 7. If no dlagram accurately represents the.building.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 beiow axord(ng to the building diagram specified in Item C2.State the datum used. If the datum is dififiererrt 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 Section G, as appropnate,to document. '��tum co+�versia-_.
Datum�� CornersioNCommerrts NJA_ ,,�"�a�O�a���� i`v��r-
.
Eievation reference mark used Does the elevation reference mark used appear on the FIRM?�Q.��IV�t;,� �1e��"��"
❑ a)Top of bottom floor(ndu�ng basement or endosure) l0 . 1 �,�m� a � , � : > ° .�
w /���°r''w 4r�` `>�y�
❑ b)Top of ne�ct higher floo� n/a , }t,(m) d � : ...�- F , �
� c) Bottom of lowest horizontal strudurai member(V zones only) n/a ft.(m) `" � 'o �+,� � � ' ` �° ;:
❑ c�Attached garage(top of slab) n�a ._}t.�m� '.�� '���-G��,�ur�� �.9 . .
❑ e) Lowest elevation of machinery and/or equipment ���` w� �� ' ;°' � �`' � .
senricing the building n/a g,�m� E� �`� �` �a ' �'�� "�"
❑ fl Lowest adjacent grade(LAG) n/a {�,(m� _� , ;r ����.� ,
0 g)Highest adjacent grade(HAG) n/a._ft.(m� �".'�"^ `aa ' �,' °" '`�''
0 h No.of ermanent o n � X �� f� �'��i�t,
) p penings(flood vents)within 1 ft.above adjacerrt grade__ /a � a, , ,�.�_
- �.. �, � _. .
❑ )Total area of all permanent.openings(flood-verrts)in C3h � sq.in. (sq.cm) � ,
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFlCATION ��—
This certification is to be signed and sealed by a land surveyor,engineer,or arc�itect authorized by law to certify elevation information,
I certify that the infom►ation in Sections A, B,and C on this certificate represents my best efforts to inteipnet the data available.
I understand fhat any false statement may be punishable by fine or imprisonmelnt under 18 U S Cade Section 1001
CERTIFIER S NAME UCE�1�$,F�NUMBER
Allan F_ n�Tunr3+ PQM �y
T� COMPANY NAME
�rofessional Surveyor and Mapper �.nq EnQineerinq Associates, Inc
� CI'TY STATE ZIP CODE
492 or' St . 00 Tam a FL 33634
SI R �� DATE TELEPHONE
�'`-�--�l � 5 0 8 3-88 -888 �
FEMA Form 81-31,AUG 99 8EE REVERSE S1DE FOR CONTINUATION REPLACES ALL PREVIOUS EDfTIQ�S
BMP�RT�,9VT: !n lhese spac�s,emPy the carresQonding information from Seclion.�1. ::�or tnsurance Campany Use ::;
BUILDING STRE�T.4DDRESS(Induding Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE APID BOX NO. ;PoGcyNumbet:: -
Bel io t Ba atch - Buildin #200 - 2738 Via Tivoli
CITY STATE ZIP CODE �Campany iVAIC Nianber
Clearwater FL 33764
SE�TION D-SURVEYOR, ENGINEE#�,OR ARC7i1TECT CERTIFlCATION(CONTINUED)
Copy both sides of this Eievation Certificate for(1)community official, (2}insurance agenUcompany,and(3)buiiding owner.
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 2one A(without BF�,complete Items E1 through E4. If the Elevation Cedfficate is intended for use as supporting
information 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 compieted—see
pages 6 and 7. If no diagram accurately represents the buiiding;provide a sketch or phatograph.)
F2.The top of the botiom floor(ncluding basement or endosure)of the building is _ft.(m)_in.(cm)Q above or ❑ below(checic one)
- the highest adjacerrt grade.
E3.For Building Diagrams 6-8 with openings{see page�,the next higher floor or efevated floor(elevation b)of the building is
_ft.(m)_in.(cm)above the highest adjacerrt grade.
E4.For Zone AO anly: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the communii�s ,
_ floodplain management ordinance?Q Yes � No ❑ Unknown The loca(offiaal must certify this infortnation in Sedion G
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATNE)CERTIFICATION
The propert}r owner or owners authorized representative who completes Sedions A,B,and E for Zone A(without a FEMA-issued or
community-issued BFE7 or Zone AO must sign here.
PROPERTY OWNER'S OR OWNER'SAUTHORIZED REPRESENTATNE'S NAME
ADDRESS CCiY STATE Z1P CODE
SiGNATURE . �-�
TELEPHONE
COMMENTS
❑ Check here if attachmer:�
SECTION G-COMMUNITY INFORMATION (OPTIONAL) �
The local official who is autha�ized by!aw or ordinance to administer the community's floodplsin management ordinance can compfete
Sedions A, B�C(or E),and G of th6s Elevation Certficate. Complete the applicable iterrt(s)and sign below.
G1.�The information ir Section C vvas taken from other documentatio�that has been signed and embossed by a licensed surveyor,
engineer,n.�ar+�Hitect wr�o is authorized by state or local law to certify elevation ir�formation. (Indcate the source and date of the
elevaticsr;data ir.#he Carnment�area below.)
32.Q A comm�nity offiaal complete�3ection E for a building located in Zone A(without a FEMA-issued or community-issued BFE7 or
Zone AO.
33. Q The following i�7formatien(lrems G4G9)is provided for community floodplain management purposes.
G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFtCATE OF COMPLIANCE/OCCUPANCY
� ISSUED
37.This pertnit has been issued for. ❑ New Construccfion❑ Substantial:lmprovement
�8. Elevation cf as-built lowest floor Cnduding basement)of the building is: _ft.(m) Datum:
�9. f�FE or(in Zone AO)depth af floodirtg at the building site is: _ft.(m) Datum:_____
LOCAL OFFICWL'S NAME -�E
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
❑Check here if attachmerns
'EMA Form 81-31,AUG 99 REPlACES ALL PREVIOUS EDlTIONS