648 GULFVIEW BLVD S �-� � Gl.�?:.>�S.S
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B,No3067-0077 ;
NATIONAL FLOOD iNSURANCE PROGRAM FxpiresMay3�,f993 �
FLD�DPROOFING CERTiFtCATE �
.�
FOR NON-RESIDEMTIAL STRUCTURES ��`:
�The flaodproofing of non-residenfra!buitdings may be permitted as a»alternative ta elevating to or above the Base Flood Elevatian; j'
however,a!loodpraofing design certificatron is required. This form is to be used for that cer7ification. Fioodproofing of a resideniial �
building does not a/ter a communirys floodplain management elevatron requirements or ef/ect ihe inswance ratrng unless the ,'
community has been issued an exceptiorr by FEMA to a!!ow fioodproofed resrdentia!basements. The permrtfing ol a lJoodproofed
residentlal basement requrres a separafe certification specify/ng thet the desrgn complies with the loca!floodplain management i
ordinartce.
P�R INSURANCE COMPANY USE ��
BUILDING OWNER'S NAME POLICY NUMBER I��
Capeluto Family Partnership
STREET ADDRESS(Indudinp Apt.,Unit,Suite and/or Bldp.Number�OR P,O.ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
c/o Fox & Fax, P.A. , P.O. Box 5047
OTHER D SCRIPTtON(Lot and Block Numbere,etc.}
!9�E� �' ..��vrc,�l�`1�u� ��. .
cmr
Clearwater Florida 3t��1�
SECTION I FLOOD INSURANCE RATE MAP(FtRM)INFORMATION �i
P�ovide the foJlowing fram the proper F�RM:
�
COMMUNITY NUMBEA PANEL NUMBEA SUFFiX DATE OF FIF.:.1 INDEX FIRM 20NE BASE FLOOD ELEVA710N
1.25096 0007 D $ �, P�AO2ones,usedepih) ,
/ 9/91 AE 11 .0 1i
SECTION U FLOODPROOFING INFORMA'fiON (By a Asgistered Professfanal Engineer or Architect)
I'
Floodproofing Desfgn Elevation Intormation:
8uilding is fioodproofed to an elevation of !1 �.�; feet NGVD.(Elevation datum used must be the same as that
. on the FlRM.) �
Height of flaodproofing on the building above the lowest acljacent grade is �.�I !sei.
(NOTE:for insurance rating purpases,the building's floodproofed design e/evation must be at least one foot above the
Base Flood E/evation to receive rating credit. !f the buflding is ttoodproofed only io the Base Flood E/evation, then the
building's insurance rating will result in a higher premium.)
SECTION ilt CERTIFlCATlON (Sy a Regisiered Professlanal Engineer or Architect)
Non-Residentiai Ffoodpraofed Construction Certification:
!certify fhat based upon development and/or review of structura!design,specificalions,and plans for construction that
the desigrn and methods o/construction are in accordance wlth accepfed standa�ds of practice for meeting the following
provisions:
The structure,together with attendant utiliUes and sanitary facilities,is watertight to the floodproofed design
elevation indicated above,with walis that are substantially impermeable to the passage of water.
All structural components are capable of resisting hydrostatic and hydrodynamic flood forces,incfuding the �
effects of buoyancy,and anticipated debris irnpact forces.
1 certNy ihat fhe informafion on thrs certificate reprssanis my best efforts to interpret the data availab/e. 1 understand ihaf
any la/se statement may be punishable by line or imprisonment under 18 U.S. Code, Section 100T.
CERTlFfER'S NAME UCENSE NUM{BER(ot Affix Seal)
Barry P. Ullmann 75Z�.
TITLE COMPANY NAME
Architect Barry P. Ullmann, Inc.
ADDRESS CITY STATE ZIA I
1231 N. Hercu es Ave. Clearwater Florida 34625
uN RE DATE PHONE
� �l�-. 44z-4�a5
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Copies s made of this Csrtlflcate tow 1)community ofticial�2)insursn agenUcompany,and 3}bullding owner.
FEMA Porm 81�5.MAY 40 -. r REPLACES E8ITION OF IUN 87.WHIC'N f5 nHtA1 FTF .-,... ,._ ._ ,_ ._ _.