437 GULFVIEW BLVDDEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
FLOODPROOFING CERTIFICATE
FOR NON-RESIDENTIAL STRUCTURES
Papervvork Burden DisGosure Notice
OMB Control Number. 1660-0008
Expiration: 41 /30/2018
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, Papervvork
Reduction Project (1660-0008). NOTE: Do not send your completed form to this address.
General: This inforrnation 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 meaningfulty in the Federal papervvork review process.
Public Law 96-511, amended; 44 U.S.C. 3507; and 5 CFR 1320.
Privacy Act Statement
Title 44 CFR § 61.7 and 61.8.
IPrincipal Purpose(s): This information is being col►ected for the primary purpose of estimating 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 generalty permitted under 5 U.S.C. § 552a(b) of the Privacy Act of 1974,
as amended. This inctudes using this information as necessary and authori2ed by the routine uses published in DHS/FEMA-003 — National
Ftood 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.
closure: The disclosure of information on this form is voluntary; however, failure to provide the information requested may result in
inability to obtain flood insurance through the National Flood Insurance Program or being subject to higher premium rates for flood
irance. Information will oniy be released as permitted by law.
Purpose of the Floodproofing Certificate
for Non-Residential Structures
IUnder the National Flood Insurance Program (NFIP), the floodproofing of non-residential buildings may be permitted as an alternative to
elevating to or above the Base Flood Elevation (BFE). A floodproofing design certification is required for non-residentiai structures that are
floodproofed. This form is to be used for that certification.
floodproofed building is a building that has been designed and constructed to be watertight (substantialiy impermeable to floodwaters)
;low the BFE and with structurai components having the capability of resisting hydrostatic and hydrodynamic loads and effects of
ioyancy. Before a floodproofed building is designed, numerous planning considerations, inGuding flood waming time, uses of the building,
ode of entry to and exit from the building and the site in general, floodwater velocities, flood depths, debris impact potential, and flood
�quency, must be addressed to ensure that dry floodproofing will be a viable floodplain management measure.
minimum NFIP requirement is to floodproof a building to the BFE. However, when it is rated for flood insurance one-foot is subtracted
the floodproofed elevation. Therefore, a building has to be floodproofed to one foot above the BFE to receive the same favorable flood
�ance rates as a building elsvated to the BFE.
'Additional guidance can be found in FEMA Publication 936, Floodproofing Non-Residential Buildings (2013), available on FEMA's website at
https:/lwww.fema.gov/media-library/assets/documents/34270.
D�ne 1 i.f A
e
FLOODPROOFING CERTIFICATE
FOR NON-RESIDENTIAL STRUCTURES (Continued)
The floodpr�fing of non-residential buildings may be permitted as an altemative to elevating to or above the Base Flood Elevation;
�owever, a floodproofing design certification is required. This form is to be used for that certification. Floodproofing of a residential building
�oes not alter a community's floodplain management elevation requirements or affect the insurance rating unless the community has been
ssued an exception by FEMA to allow floodproofed residential basements. The permitting of a floodproofed residential basement requires a
separate certification specifying that the design compties with the local floodplain management ordinance.
BUILDING OWNER'S NAME
FOR INSURANCE COMPANY USE
BEACH FAMILY PARTNERSHIP, LLC
POLICY NUMBER
STREET ADDRESS (Including Apt., Unit, Suite, and/or Bidg. Number) OR P.O. ROUTE AND BOX
NUMBER
437 GULFVIEW BOULEVARD
COMPANY NAIC NUMBER
OTHER DESCRIPTION (Lot and Block Numbers, etc.)
LOT 81, LLOYD-WHtTE SKINNERS, PLAT BOOK 13, PAGE 12
CITY CLEARWATER I STATEFL I Zip Code 33767
SECTION I— FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the proper FIRM:
COMMUNITY NUMBER PANEL NUMBER SUFFIX DATE OF FIRM INDEX FIRM ZONE BASE FLOOD ELEVATION
(in AO Zones, Use pepth)
125096 12103C0102 G 09/03/2003 AE 12.0'
Indicate elevation datum used for Base Flood Elevation shown above: � NGVD 1929 � NAVD 1988 ❑ Other/Source:
�Ca.l wlr 11 — �'LVVU�RVVrCN CLCVAI IV1V l.Cl'i
elevations must be based on finished construction.
�odproofing Elevation Information:
Iding is floodp�oofed to an elevation of 13 . 0
� NGVD 1929 � NAVD 1988 � Other/Source:
a
feet (In Puerto Rico only:
Elevation datum used must be the same as that used for the Base Flood Etevation.)
of floodproofing on the building above the lowest adjacent grade is 8.6
rr Unnumbered A Zones Only:
ghest adjacent (finished) grade next to the building (HAG)
❑ NGVD 1929 � NAVD 1988 ❑ OtheNSource: _
meters).
feet (In Puerto Rico only:
feet (In Puerto Rico only:
�
, or
meters).
meters).
(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. See the Instructions section for information on documentation that must accompany this certificate if being submitted for flood
insurance rating purposes.)
FEMA Form 086-0-34 (6/15) - Page 2 of 4
�
FLOODPROOFING CERTIFICATE
FOR NON-RESIDENTIAL STRUCTURES (Continued)
437 GULFVIEW BOULEVARD CLEARWATER
Non-Residential Floodproofed Elevation Information Certification:
FL
33767
Section 11 certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information
I certify that the informafion in Section ll on this Certificate represents a true and accurate interpretation and determination by
the undersigned using the availab/e information and data. 1 understand that any fatse statement may be punishab/e by fine or
imprisonment under 18 U. S. Code, Section 1001.
CERTIFIER'S NAME LICENSE NUMBER (or Affix Seal) ���
. . 4� �'
Robert J Aude, AIA 6859 � � ��%,,• "• • . , , � � J �
TITLE COMPANY NAME �' � f'-�
� �
U" `°,j' �° ; c�'
.
Principal Aude Smith Architecture, Inc. AIA � 3�� �' '� y
•� ,��s �
ADD ESS CITY STATE I �.�, � `°' ��-
r, Y" ' _i: . _ e�e : �
748 Broadway, Suite 202 Dunedin Fiorida 34698 °ak, �°� ��k•,� � ,=.��
: ti� +'a `'��l i P�
51GNATURE DATE ' � PHONE '• �-'�,�°°<e � , ��''�
� � � � +1 (727) 785-4441 , � � 3 � `', � ,1 e �` K
__ _ � �t,,� ' __ .
��.. ��.�� �n — r�.,vvrRVa,r�u ��K � ir�cP►i icin (�sy a Kegistereci Professional Engineer or ArcM�tect) .Y
Non-Residential Floodproofed Construction Certification:
l certify the structure, based upon development and/or review of the design, specifications, as-built drawings for construction and physica!
inspection, has been designed and constructed in accordance with the accepted standards of practice (ASCE 2405, ASCE 2414 or their
equivalent) and any alterations also meet those standaMs and the following provisions.
The structure, together with attendant utilities and sanitary facilities is watertight to the floodproofed design elevation indicated above,
is substantially impermeable to the passage of water, and shall perform in accordance with the 44 Code of Federai Regulations
(44 CFR 60.3(c)(3).
All structural components are capable of resisting hydrostatic and hydrodynamic flood forces, including the effects of buoyancy, and
anticipated debris impact forces.
! certify that the information in Section lll on this certificate represents a true and accurate determination by the undersigned using the
available informafion and data. l understand that any fa/se statement may be punishable by fine or imprisonment under 18 U. S. Code,
Section 1001.
Alan C. Plants, P.E.
TITLE
Structural Engineer
208 South Lake Avenue
pages of
owner.
and all
6859
�OMPANY NAME
Winslow Engineering Group, Inc.
Lakeland
DATE
Sep 2, 2016
Fiorida 133801
10NE
+1 (863) 682-1848
,
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Page 3 of 4