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401 POINSETTIA AVEUS. DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY National Flood Insurance Program FLOODPROOFING CERTIFICATE FOR NON-RESIDENTIAL STRUCTURES OMB No. 1660-0008 Expiration Date: July 31, 2015 The floodproofing of non-residential buildings may be permitted as an alternative to elevating to or above the Base Flood Elevation; however, a floodproofing design certification is required. This form is to be used for that certification. Floodproofing of a residential building does not alter a community's floodplain management elevation requirements or affect the insurance rating unless the community has been issued an exception by FEMA to allow floodproofed residential basements. The permitting of a floodproofed residential basement requires a separate certification specifying that the design complies with the local floodplain management ordinance. Lots 1 and 2 of C+W Subdivision as Recorded in Subdivision Plat Book 137 BUILDING OWNER'S NAME Walgreens Company Store No. 15435 STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER 401 Poinsettia Ave. OTHER DESCRIPTION (Lot and Block Numbers, etc.) Lots 11, 12, 13, & 14, Biodt B, Barbour -Morrow Subdivision, Plat Book 23, Page 45, of the Public Records of Pinellas County, Fkxida CITY Clearwater Beach STATE FL ZIP CODE 33767 SECTION 1 - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM: COMMUNITY NUMBER 12103C PANEL NUMBER 0102 SUFFIX G DATE OF FIRM INDEX 09/03/2003 FIRM ZONE AE BASE FLOOD ELEVATION On AO Zones, Use Depth) 11.00 ndieete-elevation-datum-used-for-Bese-Fl0od-Elevation-shownabove. 0 NGVO-1929--0-NAVD-1988—G0t SECTION 11 - FLOODPROOFING INFORMATION (By a Registered Professional Engineer or Architect) Elevations are based on: 0 Construction Drawings 0 Building Under Construction tiFinished Construction Floodproofing Design Elevation Information: �, Building Is floodproofed to an elevation of 12 00 feet (In Puerto Rico only: _ _ meters). 0 NGVD 1929 �l NAVD 1988 0 Other/Source- (Elevation datum used must be the same as that used for the Base Flood Elevation.) Height of floodproofing on the building above the lowest adjacent grade is 6.0 feet (In Puerto Rico only' meters). For Unnumbered A Zones Only: Highest adjacent (finished) grade next to the building (HAG) feet (In Puerto Rico only: meters) ❑ NGVD 1929 0 NAVD 1988 0 Other/Source- (NOTE: For insurance rating purposes, the building's floodproofed design elevation must be at least 1 foot above the Base Flood Elevation to receive rating credit. If the building is floodproofed only to the Base Flood Elevation, then the building's Insurance rating will result In a higher premium.) SECTION 1I1- CERTIFICATION (By a Registered Professional Engineer or Architect) Non -Residential Floodprooted Construction Certification: I certify that, based upon development and/or review of structural design, specifications, and plans for construction, the design and methods of construction are in accordance with accepted standards of practice for meeting the following provisions: The structure, together with attendant utilities and sanitary facilities, Is watertight to the floodproofed design elevation indicated above, with walls that are substantially impermeable to the passage of water. An structural components are capable of resisting hydrostatic and hydrodynamic flood forces, including the effects of buoyancy, and anticipated debris impact forces. 1 certify that the information on this certificate represents my best efforts to interpret the data available.) understand that any false statement may be punishable by fine or Imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME Guy F. Faber LICENSE NUMBER (or MAo Seal) FL License No. AR0015323 TITLE President COMPANY NAME FWH Architects, Inc. ADDRESS 3336 Grand SIGNATURE Ste 201 CITY Holiday STATE FL ZIP CODE 3469C DATE 10/21/2013 PHONE (727) 815-3336 dpies should be made of this Certificate for: 1) community official, 2) Insurance agent/company, and 3) building owner. FEMA Form- 086-0-34 (7/12) REPLACES ALL PREVIOUS EDITIONS N 0_1 S om rn Z COCif rn O rn VL9Z :# sent/ F-056 CO 41. 0 c7 N 0 J z rn Qi rn National Flood Insurance Program FLOODPROOFING CERTIFICATE FOR NON-RESIDENTIAL STRUCTURES Paperwork Reduction Act Notice General: This information is provided pursuant to Public Law 96-511 (the Paperwork Reduction Act of 1980, as amended), dated December 11, 1980, to allow the public to participate more fully and meaningfully in the Federal paperwork review process. Authority: Public Law 96-511, amended; 44 U.S.C. 3507; and 5 CFR 1320. Paperwork Burden Disclosure Notice: Public reporting burden for this data collection is estimated to average 3.25 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting this form. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 1800 South Bell Street, Arlington, VA 20598-3005, Paperwork Reduction Project (1660-0008). NOTE: Do not send your completed form to this address. Privacy Act Statement Authority: Title 44 CFR § 61.7 and 61.8. Principal Purpose(s): This information is being collected for the primary purpose of estimate the risk premium rates necessary to provide flood insurance for new or substantially Improved structures in designated Special Flood Hazard Areas. Routine Use(s): The information on this form may be disclosed as generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act of 1974, as amended. This includes using this information as necessary and authorized by the routine uses published in DHS/FEMA-003 — National Flood Insurance Program Files System or Records Notice 73 Fed. Reg. 77747 (December 19, 2008); DHS/FEMA/NFIP/LOMA-1— National Flood Insurance Program (NAP) Letter of Map Amendment (LOMA) System of Records Notice 71 Fed. Reg. 7990 (February 15, 2006); and upon written request, written consent, by agreement, or as required by law. Disclosure: The disclosure of information on this form is voluntary; however, failure to provide the information requested may result in the inability to obtain flood insurance through the National Flood Insurance Program or may be subject to higher premium rates for flood insurance. Information will only be released as permitted by law. FEMA Form 086-0-34 (7/12) F-056 ' f • 7 , � U.S. DEPARTMENT OF HOMELAND SECURITY �OODPROOFING CERTIFICATE FEDERAI EMERGENCY MANAGEMENT AGENCY FOR NON-RESIDENTIAL STRUCTURES National Flood Insurancc Program OMB No. 1660-0008 Expiration Date: July 31, 2015 The floodproofing of non-residential buildings may be permitted as an alternative to elevating to or above the Base Flood Elevation; however, a floodproofing design certification is required. This form is to be used for that certification. Floodproofing of a residential building does not alter a community's floodplain management elevation requirements or affect the insurance rating unless the community has been issued an exception by FEMA to allow floodproofed residential basements. The permitting of a floodproofed residential basement requires a separate certification specifying that the design complies with the locai floodplain management ordinance. Lots 1 and 2 of C+W Subdivision as Recorded in Subdivision Plat Book 137 BUILDING OWNER'S NAME Walgreens Company Store No,15435 STREET ADDRESS (Including Apt., Unil, Suite, and/or Bldg. Number) OR P.O. ROUTE AND 80X NUMBER 401 Poinsettia Ave. OTHER DESCRIPTION (Lot and Block Numbers, etc.) lots 11, 12, 13, & 14, Block B, Barbour-Morrow Subdivision, Pfat Book 23, Page �� 45, of the Public Records of Pinellas County, Florida �� ,�� x... c�� Clearwater Beach sTnrE ZIPCODE FL 33767 SECTION I— FLOOD INSURANCE RATE MAP (FlRM) INFORMATION Provlde the following from the proper FIRM: ---„9i¢BE�CICV1ftBR-98i11tihH9C9-f8f-B89C-FI99�-EICV8ff0f�-Sh6wR-8b6vC.-8-N • SECTION 11 - FLOODPROOFlNG INFORMATION (By a Registered Professional Engineer or Architect) Elevations are based on: ❑ ConsVuctlon Drawings ❑ Building Under ConsVuctlon �Finishetl Constructlon Floodprooflng Design Elevatlon Information: Building is floodproofed to an elevation of 12 00 feet (In Puerto Rico only: -. (Elevation datum used must be the same as that used for the Base Flood Elevation.) Height of floodproofing on the building above the lowest adjacent grade is 6.0 For Unnumbered A Zones Only: meters). ❑ NGVD 1929 `� NAVD 1988 ❑ Other/Source: feet (In Puerto Rico only: meters). Highest adjacent (finished) grade next to the building (HAG) . feet (In Puerto Rico only: . meters) ❑ NGVD 1929 ❑ NAVD 1988 ❑ O[her/Source: (NOTE: For insurance rating purposes, the building's floodproofed des(gn elevation must be at least 1 foot above the Base Flood Elevation to receive rating credit. If the buiiding is floodproofed only to the Base Flood Eievation, then the building's insurance rating will result in a higher premium.) SECTION 111- CERTIFlCATION (By a Registered Professional Engineer or Architect) Non-Residential Floodproofed Construction CertiflCatlon: 1 Certify that, based upon developmen[ and/orreview of structural design, specifications, and plans for construction, the design and methods of construction are in accordance with accepted standards of practice for meeting the following provisions: The structure, together with attendant utilities and sanitary facilities, is watertight to the floodproofed design elevation indicated above, with walls that are substantially impermeable to the passage of water. All structural components are capable of resisting hytlrostatic and hydrodynamic flood torces, including [he effects of buoyancy, and anticipated debris impact forces. 1 certify that the information on this certificate represents my best efforts to interpret the data available. l understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. CERTIFIER'S NAME Guy F. Faber TITLE President ADDRESS 3336 Grand SIGNATURE ° % "1 . ' FEMA Form� A86-034 (7/12) 201 LICENSENUMBER(orAffixSeal) FL LiCense No. AR0015323 COMPANYNAME FWH Architects, (C1C. ciTr Holiday srnre F� ZIPCODE 3469C DATE 1U/21/2013 PHONE �727� g15-3336 iies should be mads of this Certificate for: 1) community official, 2) Insurance agent/company, and 3) building owner. REPLACES ALL PREVIOIIS EDITIONS � D � � � � � � � � � � � m O � y � � O N � � � O � O y (n � �rn m � � � � D � o� <� � rn N � v D f-056 �►' National Flood Insurance Program FLOODPROOFING CERTIFICATE FOR NON-RESIDENTIAL STRUCTURES Paperwork Reduction Act Notice General: This information is provided pursuant to Public Law 96-511(the Papervvork Reduction Act of 1980, as amended), dated December 11, 1980, to allow the public to participate more fully and meaningfully ir� the Federal paperwork review process. Authority: Public Law 96-511, amended; 44 U.S.C. 3507; and 5 CFR 1320. Papervvork Burden Dtsclosure Notice: Public reporting burden for this data collection is e5timated to average 3.25 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and submitting this form. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency, 1800 South Bell Street, Arlington, VA 20598-3005, Paperwork Reduction Project (166Q0008). NOTE: Do �ot send your completed form to thfs address. Privacy Act Statement Authority: Title 44 CFR § 61.7 and 61.8. Principal Pu�pose(s): This information is being collected for the primary purpose of estimate the risk premium rates necessary to provide fiood insurance for new or substantialty improved structures in designated Special Flood Hazard Areas. Routine Use(s): The information on this form may be disclosed as generally permitted under 5 U.S.C. § 552a(b) of the Privacy Act of 1974, as amended, This includes using this information as necessary and authorized by the routine uses published in DHS/FEMA-003 — National Flood Insurance Program Files System or Records Notice 73 Fed. Reg. 77747 (December 19, 2008); DHS/FEMA/NFIP/LOMA-1— National Flood Insurance Program (NFIP) Letter of Map Amendment (LOMA) System of Records Notice 71 Fed. Reg. 7990 (February 15, 2006); and upon written request, written consent, by agreement, or as required by law. Disclosure: The disclosure of information on this form is voluntary; however, failure to provide the information requested may result in the inability to obtain flood insurance through the National Flood Insurance Program or may be subject to higher premium rates for flood insurance. Information will only be released as permitted by law. FEMA form 086-034 (7/12) F-056