FEMA-EC030509FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
Important: Read the instructions on pages I - 7.
SECTION A- PROPERTY OWNER INFORMATION
BUILDINGOWNER'SNAMEHOLMESBUILDERSBUILDINGSTREETADDRESS (IncludingApt., Unit, Suite, and/or
Bldg No.) ORP.O. ROUTEANDBOXNO.O.M.B. No. 3067-0077ExpiresJuly31, 2002PolicyNumber618DEFORESTCOURTCompanyNAICNumberCITYSTATEZIPCODECOPPELLTX75067PROPERTYDESCRIPTION (LotandBlockNumbers, TaxParcelNumber, LegalDescription, etc.)LOT14, BLOCKADEFORESTCOURTBUILDINGUSE (e,g., Residentiat, Non-residentiatiAddition, Accessory, etc. UseaCommentsarea, ifnecessary)RESIDENTIALLATITUDE/LONGITUDE (OPTIONAL) HORIZONTALDATUM: SOURCE: [] GPS (Type):orfCiC..'.?:.'.'.?.'/') [] NAD1927 [] NAD1983 [] USGSQuadMap [] Other: FIRMC~ ~ONB - FLOODINSURANCERATEMAP (FIRM) INFORMATIONBI. NFIPCOMMUNITYNAME & COiV~IUNITYNUMBERB2. COUNTYNAMEB3STATECOPPELL480170DALLASTXB4. MAPANDPANELB5. SUFFIXB7. FIRMPANELBg. BASEFLOOOELEVATION(S)NUMBERB6. FIRMINDEXDATEEFFECTIVE/REVISEDDATEBB. FLOODZONE(S) (ZoneAO, usedepthoffloodi~g)4~113C0155J ~23/20012/5f2003XNAB10. IndicatethesourceoftheBaseFloedElevation (BFE) dataorbaseflooddepthenteredinB9.FISProftie [] FIRM [] CommunityDetermined [] Other (Deschhe):B11. IndicatetheelevationdatumusedfortheBFEinB9: [] NGVD1929 [] NAVD1988 [] Other (Descdde):B12. IsthebuildinglocatedinaCoastalBar~erResoorcesS),stemtCBRSIareaor (>then,viseProtectedArea/OPA)? [] Yes [] NoDesignationDateSECTIONC - BUILDINGELEVATIONINFORMATION (SURVEYREQUIRED)C1. Buildingelevationsarebasedon: [] ConstructionDrawings* [] BuildingUnderConstruction* [] FinishedConstructionAnewBevationCertificatewillberequiredwhencmstructiono[thebuildingiscomplete.C2. BuildingDiagramNumber _1 (Selectthebuildingdiagrammostsimilartothebuildingforwhichthiscertificateisbeingcompleted- se~ pages6and7. Ifnodiagramescuratelyrepresentsthebuilding, provideasketchorphotograph.)C3. Elevations- ZonesAl-A30, AE, AH, A (w~hBFE), VE, VI-V30, V (v,ithBFE), AR, AR, A, APJAE, APJA1-A30, AR/AH, APJAOCompleteItemsC3.-a-ibelowaccordingtothebuildingdiagramspecifiedinItemC2. Statethedatumused. IfthedatumisdifferentfromthedatumusedfortheBFEinSectionB, convertthedatumtothatusedfortheBFEShowf~eldmeasurementsanddatumconversioncalculation. UsethespaceprovidedortheCommentsareaofSectionOorSectionG, asappmphate, todocumentthedatumconversion.DatumNGVD1929Co:~version/CommentsBMONRECORDEDPLATElevationreferencemarkused456.93DoestheelevationreferencemarkusedappearontheFIRM? [] Yes [] Noa) Topofbottomfloor (includingbasementorendceure) 457. 86ft.(m)b) TopefnexthlgherfloorNA. ft(m)c) Bottomoflowesthorizontalstructuralmember (Vzonesrely) NA. tt.(m)d) Attachedgarage (topofslab) N~A __ft.(m)e) LowestelevetJonofmachineryand/orequipmentse~vidngthebuilding (DescddeinaCommentsarea) NA. _lt.(m)Lowestadjacent (finished) grade (LAG) 456.66ft.(m)g) Highestadjacent (finished) grade (HAG) 457. 0~7ft.(m)oh) No. ofpermanentopenings (floodvents) within1lt. aboveadiacentgradeNAoi) Totalareaofallpermaqentopenings (floodvents) inC3. hNAsq. in. (sq. cra)SECTIOND - SURVEYOR, ENGINEER, ORARCHITECTCERTIFICATIONThiscertificationistobesignedandsealedbyalandsurveyor, engineer, orarchitectauthorizedbylawtocedifyelevationinformationIcertifythattheinformationinSectionsA, B, andConthiscertificaterepresentsmybestefforfstointerpretthedataavailable.Iunderstandthatanyfalsestatementmaybepunishablebyfineorimprisonmentunder18U.S. Code, Section100'1CERTIFIERSNAMEBARRYRHODESLICENSENUMBER369'~TITLEOWNERCOMPANYNAME BARRY
MPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use:
BUIL~ING $ I ~:~ I ADDRESS (Induding Apt, Unit SMile, ar~ BIdg, No.) OR P.O. ROUTE AND BOX NO. Po~cy Number
618 DEFORST COURT
CITY STATE ZIP COOE Company NAIC Number
COPPELL TX 75067
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUER
Copy both sides of this Elevation Certificate for (1) community of~dal, (2) insurance agent/company, and (3) building owner.
COMMENTS
Check here if attachments
SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A 0NITHOUT BFE)
For Zone AO and Zone A (without BFE}, complete Items E1 through E4. If the Elevation Cer~ficate is interfled for use as supporting information for a LOMA or LOMR-Fr
SeelJon C must be completed.
El. Building Diagram Number _(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.)
E2. The top of the bottom floor (induding basement or enclosure) of the building is _ fl.(m)_in (cm) [] above or [] below (check one) the highest adjacent grade. (Use
natural grade, if available).
E3. For Building Diagrams 68 with openings (see page 7), the next higher floor or elevatad floor (elevation b) of the building is _ fl.(m)__in.(cm) above the highest adjacent
grade. Complete items C3.h ~d C3.i on front of form.
E4. For Zone AO only: If no flood depth number is available, is the top of the bofiom floor elevated in accordance with the communit,/s floodplain management ordinance?
E]Yes E~No I-]Unknown. ThelocalolttcialmustcertifytblsinformationinSeetionG
SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The propedy owner or owneCs authodzad representetJve who CO~Tlpletes Sec~ons A, B, C (Items C3, h and C3,i only), and E for Zone A (without a FEMA-issued or community
issued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and E are correct to the best of my knowledge,
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS CITY STATE ZIP CODE
SIGNATUP~E DATE TELEPHONE
COMMENTS
Check here if attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local o'[fldel who is authorized by law or ordinance to administer the communi[y's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation
Cediflcate. Complete the applicable item(s) and sign below.
Gt [] The information in Section C wes taken from other documentation that has been signed and embossed by a licensed su~'eyor, engineer, or arebltest who is authorized by
state or Iooal law to certify elevation information. (Indicete the source and date of the elevation data in the Comments area ~aw )
G2. [] A community offidal completed Section E for a building located in Zone A (without a FEMA-issued or oommunityqssued BFE) or Zone AO.
G3 [] The following information (Items G4-G9) is provided for community floodplain management purpeses~
IG4, PERMITNUMBER
I G5. DATEPERMITISSUED
G7. This permit hes been issued for: I-] New Construction [-] Substantial lmpmvement
GS. Elevation of es-built lowest floor (including basement) of the building is:
Gg. BFE or (in Zone AO) depth of flooding at the building site is:
LOCAL OFFICIAL'S NAME
DATE CERTF~CATE OF COMPLIANCE/OCCUPANCY ISSUED
fi(m) Datum:
fl.(m) Datum:
TITLE
COMMUNITYNAME TELEPHONE
SIGNATURE DATE
COMMENTS
Check here if attachments
FEMA Form 81-31, JUL O0 REPLACES ALL PREVIOUS EDITIONS