649 BAYWAY BLVD N' - C� /,���f.,
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.No3067-OQ77
NATIONAL FLOOD INSURANCE PROGRAM fxpiresMay3i, t993
FLOODPROOFING CERTtFICATE
fOR NON-RESIDENTIAL STRUCTURES
�The floodproofrng o1 non-resldeRtra!buildings may be permitted as an a/ternative to elevating to or above tha Base Flood Elevation;
however,a f/oodproofing design certifrcatron rs raqurred. This form rs to be used for that certification. Floodproofing of a residential
building does noi alter a community's floodplain managem�nt elevation requrrements or effecf the insurance rafing unless ihe
community has bean issued an sxception by FEMA to a!!ow fioodproofed residentia!basements. The permitting of a floodproofed
residentia!basement requires a separate certificatron specitying that the design complies wifh the Iocal 1laodplain management j
ordinance. ;_:
FOR lNSURANCE CaMPANY USE I,I
BUIIDINd OWNER'S NAME POI.ICY NUMBER '{'
Capeluta Family Partnership !.
STREET ADDRESS(Inoludinp Apt.,Unit,Suite and/or Bldg.Number)OR P.O.ROUTE AND BOX NUMBER COMPANY NAIC NUMBER �li
cfo Fox & Fox, P.A. , P.O. Bax 5047
OTHERp�E,SCRIPTkON(Lot and Btock Numbers,etc.) I�p
- �oY7 ,�A��v'i9y ,�L.dz? . �f
C�T�' STATE 21P CODE �I
Clearwater Florida 3�618 '��
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SECTION{ FLOOD INSURANCE RATE MAP(FERM)INFORMATION i��;
Provide the fol4owing from the proper FIRM: ��
I'F
COMMUNkTY NUi�ABER PANEL NUMBER SUFFiX DATE OF FIF...3INDEX FIRM ZONE BASE PLOOD ELEVATION !'•
{in AO Zones.use depih)
125096 Ofl07 D $I19�9Z AE �1 .0 G
i;
SECTION fl FLO�DPRO�FlNG INFORMATiON {By a Registered Professional Engineer or Archttect) �k
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Floodproof{ng Deslgn Elevation Informatfon: �,
,
Building is fioadproofed to an elsvation of I I I !1 'I �.�Q feet NGVD. (Elevation datum used musi be the same as that ��
• on the FIHM.) ��
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Height ot floodproafing on the builciing above the lawest adjacent grade is �f.�Q fnei. (:
�,;;
(NOTE:/or insurance rating purposes, the building's tloodproofed design elevation must be ai least one foot above the I'
Base Fieod Flevation to receive rating credit. If the building is floodproofed only to the Base Flood Elevation, then the I��
building's insurarrce rating will rgsult in a higher premium.) i,
SECTION 111 CERTIFtCATION (By a Registered Professional Engineer or Arch[tecty I
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F
Non-Residential Pkood roofed Construction Certification: �'�
P ,,;
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!certify that based upon development and/or revisw of structura!design,specilications,and plans ior consfruction that ';
tha oesign and metho�s of ce.nstrucfi�n are in ac�ord2nce with accepied standards ut p�actice for meeting the following ;;
provisiarrs: ;�
�„
The structure,togeiher with attendant utilities and sanitary facilities, is watertight to the ftoodproofed design j','
elevation indicated above,with walls that are substantially impermsable to the passage af watec ;'r
All structural components are capable of resisting hydrostatic and hydrodynamic flood forces,including the ��
effects of buoyancy,and anticipated debris impact forces. F
i�;
/certi/y thaf ihe information on ihis certificate represents my best efforts fo interpret the data available. 1 understand that I!
any false statement may be punishable by hne or imprisonment under 18 U.S. Code, Section J 001. �
CEiiTIFIER'S NAME LICENSE NUMBER(or Aflix Seaq �
Barry P. Ullmann 7521� �.
TITLE COMPANY NAME �
Architect Baxry P. Ullmann� Inc . �
ADQRESS ClTY STATE ZIP
1231 N. Hercules Ave. Clearwater Florida �62
NAT pAT PHONE �i
9 92- 441-4�0� i
Copies shoul made o1#hls Cs�tlttcate for:1}cpmmunity ofticial,2)insura ce agenUcompany,and 3)building owner.
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