Fema Form 81-65 - Floodproofing Certificate For Non-Residential Structures - 1999-2002
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2O.M.B. NO. 36067-0077
Expires July 31, 2002
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
FLOODPROOFING CERTIFICATE
FOR NON-RESIDENTIAL STRUCTURES
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 of 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.
For insurance company use
______________________________
Building Owner’s Name
Policy Number
______________________________
Street Address
) or P.O. Route and Box Number
(including Apt., Unit, Suite, and/or Bldg. Number
Company NAIC Number
Other Description
(Lot and block Numbers, etc.)
City
State
Zip Code
Section I Flood Insurance Rate Map (Firm) Information
Provide the following from the proper Firm:
Community Numbers
Panel Numbers
Suffix
Date of Firm Index
Firm Zone
Bas Flood Elevation
(In AO Zones, Use Depth)
Section II Flood Information
(By a Registered Professional Engineer or Architect)
Floodproofing Design Elevation Information
Building is floodproofed to an elevation of _____________ feet NGVD. (Elevation datum used must be the same as that on the FIRM)
Height of floodproofing on the building above the lowest adjacent grade is _______________ feet.
(Note: for insurance rating purposes, the building’s floodproofed design elevation must be at least one 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 III Certification
(By Registered Professional Engineer or Architect)
Non-Residential Floodproofed Construction Certification:
I certify that, based upon development and/or review or 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 flood proofed design elevation indicated
above, with walls that are substantially impermeable to the passage of water.
All structural components are capable of resisting hydrostatic and hydrodynamic flood forces, including the effects of buoyancy,
and anticipated debris impact forces.
I certify that the information on this certificated represents my best efforts to interpret the data available. I understand that any false statment
may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
Certifier’s Name
License Number (or Affix Seal)
Title
Company Name
Address
City
State
Zip Code
Signature
Date
Phone
Copies should be made of this Certificate 1) community official, 2) Insurance agent/company, and 3) building owner.
FEMA Form 81-65, AUG 99
Replaces all previous editions
F-056 (8/99)
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