926 Deforest Rd 06/11/2002 13:30 9723043514 COPPELL FIRE DEPT PAGE 02
FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No 3067-0077`
• NATIONAL FLOOD INSURANCE PROGRAM Expires July 31,2002
ELEVATION CERTIFICATE
Important: Read the instructions on pages 1 -7.
SECTION A-PROPERTY OWNER INFORMATION :;FtirlInsutance;Company Use!!':i
BUILDING OWNER'S NAME :;:P..oliry.ffuilitkrr:! i
BU�j DING STRUT ADDRESS(including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO go)t tiafy`NAAtC;Nuiribei is;;:r;.i;' ';!
CITY STATE ZIP CODE
CofTe-u-• -TeNsosS -75E119
PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.)
L:.01 (o 'tat. g- 15 ".til I rJ DgCJP- IE�SiAr-1-~6 -t )F1 i ../
BUILDING USE(e.g.,Residential.Non-residential,Addition,Accessory,etc. Use Comments section if necessary.) •
12-. 5 1 Deer rr'/ 1.—.
LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM; SOURCE; LI OPS(Type); •
( #5°-##'-KW or 841.###W) LI NAD 1927 LI NAD 1983 LI USGS Quad Map LI Other
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
81.NFIP COMMUNITY NAME&COMMUNITY NUMBER B2.COUNTY NAME 83.STATE
C.O'PPFL1 4$Ol7a DPA Lh51 D 1S 7 r l 1-SCAS ,
B4.MAP AND PANEL - 85.SUFFIX Be.FIRM INDEX B7.FIRM PANEL 88.FLOOD 89.BASE FLOOD ELEVATION(S)
NUMBER DATE EFFECTIVE/REVISED DATE ZONES) (Zone AO,use depth of flooding)
• 4$0110 0010 E Art 1 L-i5 1994- A>fe I L- 15 ('94 ikt 4SZ
131 O.Indicate the source of the Base.Flood Elevation(BFE)data or base flood depth entered In B9.
IJ FIS Profile U FIRM ted.Community Determined LI Other(Describe):
B11.Indicate the elevation datum used for the BFE in 89:L 1IGVD 1929 Li NAVD 1988 .0 Other(Describe):
B12.Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? Li Yes bj,jdo
Designation Date; .
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
Cl.Building elevations are based en: UConstruction Drawings` 14@uilding Under Construction' IJFinished Construction
'A new Elevation Certificate will be required when construction of the building is complete.
C2.Building Diagram Number 1 (Select the building diagram most similar to the building for which this certificate is being completed-see
pages 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.)
C3.Elevations—Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE).AR.AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO
Complete Items C3a-i below according to the building diagram specified in Item C2.State the datum used. If the datum Is different from
the datum used for the BFE In Section B,convert the datum to that used for the BFE.Show field measurements and datum conversion
calculation. Use the space provided or the Comments area of Section D or Section G,as appropriate,to document the datum conversion.
Datum Conversion/Comments • .
Elevation reference mark used_r2Does the elevation reference mark used appear on the FIRM? U Yes QA.•o
❑ a)Top of bottom floor(including basement or enclosure) 459 . toy)
❑ b)Top of next higher floor ..:._.11(m)
❑ c)Bottom of lowest horizontal structural member(V zones only) _ft.(m) M ,0p;,s tSTE21.; • r
❑ d)Attached garage(top of slab) 41 9 •L ft.(m) W 1 ' ,e ( •,
❑ e)Lowest elevation of machinery and/or equipment '
servicing the building ft-(m) Erg' l A " •. RHO r ES
❑ f)Lowest adjacent grade(LAG) -i 5 '.g
1t.(m) `.•• r�•' iks:'• r
❑ g)Highest adjacent grade(HAG) tt•(m) . / �,.
❑ h)No.of permanent openings(flood vents)within 1 ft.above adjacent grade e /,
❑ I)Total area of all permanent openings(flood vents)in C3h Jam" sq.in.(sq.cm) i :Also.
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION
This 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 information in Sections A,B.and Con this certificate represents my best efforts to Interpret the data available.
I understand that any false statement maybe punishable by fine or imprisonment under 18 U.S.Code, Section 1001.
CEF C NALICEGO°J IER
TITLE � � A�Y 04,00 a.5
' A p�DSO CI KIT 8TA ZIP CODE
1%-)72.366.6.- �t e-_ i a�J T S 'Z��ts�38
SIGNATU � D/iTF.T 1 TELEPHONE 41 5-89 4o I�
Dig g7-2.4.701 °J�Z
FEMA Form la',AU a !9 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS