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2730 VIA TIVOLI BLDG 300 FEDERAL EMERGENCY MANAGEMEN'�'AGENGY '� NATtONAL FLOOD INSUR.�►►NC�PROGRAM O.�fl.B. No. 3067-04�?7 ' Expires Juiy 31, 20fl2 . EL�ATIOIV CERTlF1CATE Importar� Read the instructior�a an es 1 -7. SECTION A-PROPE�tTY OWNER INFORMATtON FFor tnsurance Cort�any 11se; BUILDING OVVNER'S NAME Poiiry Number ING STREEt'ADDRESS qnduding Apt.,Unit,Suite,andlor Bldg.No.)OR P.O.ROUTE ANQ BOX NO. Company NAIC Number Clearwater, :�, �� ZIP CODE 33764 PROPERTY DESCRIPTION(Lot and Blodc Numbers,Tax Parcel Number,Legal D�aiption,etc.) Tax Folio No. 29/29/16/00000/220/0200 BUILDING USE(e.g.,Residentfal,Non-residential,Addition,Accessory,etc. Use Comments secxion if necessary.) Residential LATITl1DFJLONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE ❑GPS(Type):_____ ( #�-##'-##.##' or �I#.� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other._____ SECTION B-FLOOD INSURANCE RATE MAP(FIRM) INFORMATION Bi.NFIP COMMUNITY NAME 8�COMMUNITY NUMBER BZ.COUNTY NAME B3.STATE � Pinellas Count FL Unincor . 125139 Pinellas Florida � 84.MAP AND PANEL B5.SUFFIX B6.FIRM INDDC B7_FlRM PANEL B8.FLOOD 89.BASE FLOOD ELEVATION� ( NUMBER DATE EFFECTNElREVISED DATE ZONE(S) (Zone AO,use depth of Sbodirus; � 0128 D 8 18 92 8 19 91 AE 10 •. t B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth errtered in B9. ❑ FIS Profile �FIRM ❑Ccmmunity Determined ❑Other(Describe):_____ 611.Indicate the elevation datum used for the BFE in B9:�NGVD 1929 ❑NAVD 1988 ❑Other(Describe):___ 812. Is the buiiding located in a Coastal Barrier Resources System(CSRS)area ar Othervuise Proteded Area(OPA)? ❑Yes� No � Designation Date ____ SECTION C-BUILDING ELEVATION INFORMATIaN(SURVEY REQUIRED) C1. Buiiding elevations are based on:�Construdion Drawings' Q Building Under Construction' ❑Fnished ConsUuction 'A new Elevation Certificate will be required when construdion of the buiiding is complete. � C2�Iding Diagram Number 1 (Select the building diagram most sirtular to the buiiding for which this certificate is being completed-see �es 6 and 7. tf no diagram accurately represents the.building.provide a sicetch or photograph.) C3. Elevatians-Zones A1-A30,AE,AH,A(with BF�,VE,V1-V30,V(with BFE7,AR,AR/A.AR/AE,AR/A1 A30,AR/AH,AR/AO Complete Items C3a-i below acxording to the building diagram specified in Item C2 State the datum used. If the datum is difrerecrt 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 Q�Use the space provided or the Comments area of Seciion D or Sedion G,as approp�ate,to document'th�!d�tum carnersia_ Datum�J2� CornersioNCamments NJA_ �:. .,��'��°�''��"�?�+� Elevation reference mark used Does the elevation reference mark used appear on the F1RM?��. m� �lo "� +L ti;�� ❑ a)Top of boitom floor(ndu�ng basement or endosure) 10 , 1 g,�m) � � ' ' � ❑ b)Top of next higher floor n/a , ft.(m) N =��"��S�, - 4 c) Bottom of lowest horizontal structurai member(V zones only) n/a . ft.(m) � ' � '" �� :� � ��-_-z�. _ � ❑ d)Attached garage(top of slab) n�a •_ft-(m) � r � �; � �� , � ❑ e)Lowest elevatlon of machinery and/or equipment - �iO°' ° ,-� � � , : � � servicing the building n/a , }�,(m� ��j , _° � � . . ❑ fl Lowest adjacent grade(LAG) n/a 8.(m) �',z�►'„ ,,� � �=' ,�i 0 g) Highest adjacent grade(HAG) n/a._}�(m) .. ��' ':,4 ,�'_ •, �;,ti� O h) No.of permanent openings(flood vents)within 1 ft.a6ove adjace�t grade_n/a �' �' ' �L��' - '� ."a,� .a._, . ¢ ❑ )Total area of al!permanent.openings(flood.ver�ts)in C3h 0 sq.in. (sq.cm) �� SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT C8Rl1FiCATION � This certifification is to be signed and sealed by a land surveyor,engineer,or archited authorized by law to certKy elevation ir�formation.. I ceitify that the infoima0ion in Sections A, B, and C an this certificafe represents my best efforts to interpref the data available. I undersfand that any fa/se stat+ementmay be punishable by fine orimprisonmeht under 18 U S Code Section l001 CERTIFIER'S NAAAE L1CF�$�,NUMBER Allan F_ Osli�nd� PSM �f 7ti T� COMPANY NAME �rofessional Surveyor and Mapper �nq EnQineerinq Associates, Inc A � CITf STATE ZIP CODE 4921 emor' H Ste. Tam a FL 33634 SI UR � DATE TELEPHONE � % _ 2. 26 813-88 -888 ' FEMA Fortn 81-31,AUG 99 SEE REVERSE SiOE FOR CONTiNUATION REPLACES ALL PREVIOUS EDIT10�+►.S �MP�RTA9VT: 9n 4hese spaces, cmpy�he corr�ponding informatton from Section,4. „�or tnsurancs Campa�r Use :; .�UILDING STRE�f,�DDRESS(Induding Apt,Unit,Suite,and/or Bidg.Na.)OR P.O.ROUTE AP1D BOX NO. Po' Number: '. Bella io at Ba atch - Building #300 - 2730 Via Tivoli - �° • CITY STATE Z!P CODE `Com n NAtC Nianber Clearwater �:.Y FL 33764 - SECTION D-SURVEYOR,ENGINEER,OR ARCBi1TECT C�RTIFlCA�ION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community officiat, (2)insurance agenUcampany, and(3)building owner. COMMENTS Check here if attachmer-.Es SECTION E-BUILDING ELEVAT'ION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zone AO and Zone A(without BFE7,complete Items E1 through E4. If the E/evation Certificate is intended for use as supporting iniormation for a LOMA or LOMR-F, Section C must be comp/efed. E1.Building Diagram Number_(Select the building diagram most similar to the building for which this certifificate is being completed—ses pages 6 and 7. If no diagram acarately represents the buiiding;provide a sketch or photograph.) E2.The top of the bottom fleor(including basement or endosure)of the building is �,ft.(m)_in.(cm)�above o� ❑below(checic one) - the highest adjacer�t grade. E3.For Building Diagrams 6-8 with openings(see page�,the next higher floor or elevated floor(eievation b)of the building is _R.(m)_in.(cm)abo+re the highest adjacent grade. E4.For Zone AO aniy: If no flood depth number is avaiiable,is the top of the bottom floor elevated in axordance with the communii�s � _ floodplain management ordinance?�Yes ❑No ❑ Unknown The local offiaal must certifjt this information in Section G SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATNE�CERTIFICATI�N The property owner or owners authorized represer�tative who completes Secaons A,B,and E for Zone A(without a FEMA-issued ar community-issued SF�or Zone AO must sign here. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATNE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE . DATE TELEPyONE COMMENTS ❑ Check here if attachmer� SECTION G-COMMUNITY INFORMATION (OPTIONAL) � The local offiaa!who is authorrized by law o�ordinance to administer the community's floodplain management ordinance can complete Secbons A, B,C(or E7,and G of t�is Elevation Certificate. Complete the applicable item(s)and sign below. G1. 0 The infortnation in Sedion C�vas taken from other dxumeMation that has been signed and embossed by a licensed surveyor, engineer,or arGhitect wha is authorized by state or local law to certify elevation information. (In�cate the source and date of the etevatiora data in the Corr.ments area below.) 32.�A cnmmunity official corrapieted Section E for a building located in Zone A(without a FEMA-issued or community-issued 8F�or Zone AO. 33. Q The foltowing informatian (tt�ms G4-G9)is provided for community floodplain management purposes. G4.PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFtCATE OF COMPLIANCFJOCCUPANCY ISSUED �7.This pertnit has been issued for. ❑ New Canstruction❑ Substarrtial'Improvemerrt 38. Elevation cf as-buili lowest flaor Cncluding basement)of the building is: _ft.(m) Datum: 39. Q,FE or(in Zone AO)depth of flooding at the building site is: _ft.(m) Datum:_____ LOCAL.OFFlCU1L'S NAME n�E COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS ❑ Checfc here if attacl�mems 'EMA Form 81-31,AUG 99 REPlACES ALL PREVIOUS EDITIONS