2722 VIA TIVOLI BLDG 400 _ .
FEDERAi_EliAERGENCY MANAGEAAENT AGE9VCY �
NATIONAL FLOOD INSUR.4AiCE PROGRAM 0.11Afl.B. No. 3067-0137? �
. EL�AT901V CEFtT1FiCATE �pires Juiy 31, 2002
a
Importar� Read the instructior�s on es 1 -7.
SECTION A-PR�PERTY OWNER INFORMATtON Fcr fnsurance Company Cise; �
BUILDING OWNER'S NAME F?olicy Number
�ING STREET ADDRESS(Induding Apt,Unit.Suite andJor Bidg.Nq_)OR P.O ROlJTE AND BOX NO. Company NAIC Number
Bellagio at Baywatch - Building #40d - 272"L Via TivoYi
Clearwater, :�� �FL T33764E
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 Commerrts sedion if necessary.)
Residential
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE ❑GPS(Type):_____
( ##°-##'-##.#�" or ##.� ❑NAD 1927 ❑NAD 1983 ❑USGS Quad Map ❑Other._____
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
B1.NF(P COMMUNITY NAME 8�COMMUNITY NUMBER B2.COUNTY NAME B3.STATE �
Pinellas Count FL Unincor . 125139 Pinellas Florida i
84.MAP AND PANEL 65.SUFFIX 86.FIRM INDDC B7_FiRM PANEL 88.FLOOD B9.BASE FLOOD E3.EVATION� �
NUMBER DATE EFFECTNEiREVISED DATE ZONE(S) (Zone AO,use depth of;boding;
0128 D 8 18 92 8 19 91 AE 10
B10. Indicate the source of the Base Flood Elevation(BF�dat�or base flood depth entered in B9.
❑ F!S Profite �FiRM ❑Community Determined ❑Other(Describe):_____
B11. Indicate the elevatlon datum used far the BFE in 89:�NGVD 1929 ❑NAVD 1988 ❑Other(Describe):____
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Othervvise Proteded Area(OPA)? ❑Yes� No �
Designafion Date ____
SECTION C-BUILDlNG ELEVATION INFORMATIaN(SURVEY REQUIRED)
C1. Buiiding efevations are based on:�Construdion Drawings' 0 Building Under Construdion" ❑Finished Construdion
'A new Elevation Certificate wiii be required when construdion of the buiiding is complete. �
C2,�ilding Diagram Number 1 (Seled the building diagram mast sirru7ar to the buiiding for which this certificate is being compieted-see
�jes 6 and 7. tf no diagram accuratety 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 dififererrt 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�j�Use the space provided or the Comments area of Section D or Sedion G, as appropnate,to docum�a��e�datum co+�versi�-_
Datum�32?3 CornersioNComments NJA_ `':��' - � ,���, -
Elevation reference mahc used Does the elevation reference ma�lc used appear on the FIRM*? `[�;�le�'��l��•r4 � ��,��'
❑ a)Top of bottom floor�nduding basement or endosure) 10 . 1 ft,(m) °`� � � Q� ;���;; �� � .
❑ b)Top of ne�ct higher floo� n�a {�,�m) .eA �; ..����/ ��.�Gf4s'-,
nc
0 c)Bottom of lowest horizontai�ral member(V zones only) n/a . R.(m) °-„' ` ""� � � r�+
� v .
❑ �Attached garage(top of slab) n�a _ft-(m) . Q '�� _!'� t~ �
❑ e)Lowest elevation of machinery and/or equipment �'�3 `r'-�,°, .,�w � � ,� '
senricing the building n/a ft.(m) E� �;� ��
❑ �Lowest adjacent grade(LAG) n�a tt.(m) z° '�;�y. ��'� .
, �� � ;
❑ g) Highest adjacent grade(HAG) n�a _ft.(m) �m. ' ,�,,, �.;;r���'�
O h) No.of permanent openings(flood vents)within 1 R abave adjace�t grade_n/a � �' �:�-.
0 )Total area of all pertnanerrt openings(flood.vents)in C3h � sq.in. (sq.cm) .
SECTION D-S.URVEYOR,ENGINEER,.OR ARCHITECT CSRTIFiCAT10N
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certHjr etevation informaticn..
1 ce�tify that the infom►a6on in Sectiars A, B, and C on this certificafe represenfs my best efforts to inteipiet the data available.
!understand that any false sfatement may 6e punishable by fine orimprisonmeht under 18 U.S. Code, Sec�ion 1001.
CERTIFIER'S NAAAE UCF�I�I$�,NUMBER
Allan E_ Oslundr PSM 6�ti
n�rofessional Surveyor and Mapper C�a�En�neerin Associates, Inc.
� CfTY STATE ZIP CODE
4921 M 'a1 te. 30 - ' Tam a FL 33634
_.
Sl TURE ,' �, / �:- DATE TELEPHONE
��'�x��"z'�"� � 813-88 -8881
FEMA FoRn 81-31,AUG 99 SEE REVERSE S10E FOR CONTtNUATiON REPLACES ALL PREVIOUS EDITI�.S
. _ .
9MP�R'T,�eNT: 8n these�paces, capy g}�e car��ooding informatton from Seclion.4.
;:�or tnsurance Cqmpany Us�, _ , ;
SUILDING STRE�?,�DDRESS(tnduding Apt,Unit,Suite,and/or 81dg.No.)OR P.O.ROUTE APID 80X NO. pc' Number::
'o at Ba atch - Building #400 - 2722 Via Tivoli � .
�� STATE Z1P CODE C an IVAIC N�m�ber
Cleanaater FL � �='y
33764
SECTfON D-SURVEYOR, ENGINEER,OR ARCFiITECT C�RTiFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community officiai, (2)insurance agenUcompany, and(3)building owner.
COMMENTS
SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED FOR ZONE AO AND ZON�here ifi attachmer�
� (WITHOUT BFE)
For Zone AO and Zone A(without BF�,compiete Items E1 through E4. If the Eleva6on Certificate is intended for use as supporting
infomration f+or a LOMA or LOMR-F, Sectlon C must be completed.
E1.Buiiding Diagram Number_{Seled the buildi�g dlagram rrwst similar to the building for which this certificate is being compieted-see
pages B and 7. If no diagram acxuratety represents the buiiding;provide a sketch or photograph.)
E2.The top of the bottom flaor(induding basement or endosure)af the building is _ft,(m)_in,(cm)0 above or ❑ below(chedc one)
- the highest adjacerrt grade.
E3.For Buiiding Diagrams 6-S with openings(see pag,e�,the next higher floor or elevated flaor(eievation b)of the building is
_ft.(m)_in.(cm)above the highest adjacent grade.
E4.Far Zone AO ony: If no 800d depth number is avaiiable,is the top of the bottom floor elevated in accordance with the comrrwnii�s �
floodplain management ordinance?Q Yes �(Va ❑Unknown The local official must certify this infortnation in Section G
SECTiON F•PROPERTY OWIVER(OR OWNER'S REPRESENTATIVE)CERTIFlCATION
The property owner o�owne�s authorized representative who completes Sedions A,B,and E for Zone A(without a FEMA-issued or
community-issued SF�or Zone AO must sign here.
PROPERTY OWNEit'S OR OWNER'S AUTHORIZED REPRESENTATNE'S NAME
ADDRESS CtTY STATE ZIp CODE
SIGNATURE • DATE TELEPMONE
COMMENTS
❑ Check here if attachmer:�
SECTION G-COMMUNITY INFORMATION(OPT'IONAL) '
The local offiaal who is authoeiz.ed by law or ordinance to administer the community's floodplain management ordinance can complete
Secctions A, B,C (or E),arad G of this Elevation Certificate. Complete the applipble item(s)and sign beiow.
G1. �The infoRnation�n SeaYion C was taken from other documentation that has been signed and embossed by a licensed surveyor,
engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the
elevation data in the Commer�is area below.)
32. 0 A commeinity official complete!i Sedion E for a building lacated in Zone A(without a FEMA-issued or community-issued BFE7 or
Zone AO.
�3. ❑The foltowing information(items G4-G9)is provided for community floodplain managemeM purposes.
G4.PERMIT NUMBEFt G5. DATE PEWNIT ISSUEQ G6. DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY
ISSUED
37.This permit has been issued for. ❑New Construdion�Substantial lmprovemerrt
38. Elevation of as-buiit lowest floor(induding basement)cf the building is: ft.(m) Datum:
39. QFE or(in Zone AO)depth of flooding at the building site is: _ft.{m) Datum:
LOCAL OFFtCWL'S NAME �E -----
COMMUNITY NAME TELF�HONE
SIGNATURE DATE
COMMEIYTS
❑ Checic here if attachmen�s
'EMA Form 81-31,AUG 99 REPLACES ALL PREVIOUS EDITIONS