FEMA-EC990302BUILDING INSPECTION - WHITE, APPRAISAL - YELLOW, CUSTOMER - PINK
U.M.B. NO. 3067-0077
ELEVATION CERTIFICATE Expires May 31, 1996
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to
provide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to
determine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (LOMA or LOMB).
Instructions for completing this form can be found on the following pages.
SECTION A PROPERTY INFORMATION I FOR INSURANCE COMPANY USE I
BUILDING OWNER'S NA E POLICY NUMBER
STREET ADDRESS (Including Apt., Unit, SQe and/or Bldg. Number) OR P.O. ROUAND BOX NUMBER COMPANY NAIC NUMBER
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OTHER DESCRIPTION (Lot and Block Numbers, etc.
d) A21 JE u/�e�t
STATE ZIP CODE
CITY STATE
go 1V
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the proper FIRM (See Instructions):
1. COMMUNITY NUMBER
2. PANEL NUMBER
3. SUFFIX
4. DATE OF FIRM INDEX
5. FIRM ZONE
6. BASE FLOOD ELEVATION `
(in AO Zones, use depth)
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447
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): NGVD'29 LJ Other (describe on back)
8. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate
the community's BFE: feet NGVD (or other FIRM daturn—see Section B, Item 7).
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level I
2(a). FIRMZo�ne, Al -A00, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
S �
of L�LLL1.L� feet NGVD (or other FIRM datum—see Section B, Item 7).
(b). FIRM Zones V1430, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from
the selected diagram, is at an elevation of I I I I I I .❑ feet NGVD (or other FIRM datum—see Section B, Item 7).
(c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is I.❑ feet above ❑ or
below ❑ (check one) the highest grade adjacent to the building.
(d). FIRM Zone AO. The floor used as the reference level from the selected diagram is I I LU feet above ❑ or below ❑ (check
one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference
level) elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown
3.. Indicate the elevation datum system used in determining the above reference level elevations: V NGVD'29 ❑ Other (describe
under Comments on Page 2). (NOTE: If the elevation datum used in measuring the elevations is different than that used on
the FIRM (see Section B, Item 7], then convert the elevations to the datum system used on the FIRM and show the oonversion
equation under Comments on Page 2.)
4. Elevation reference mark used appears on FIRM: Yes No (See Instructions on Page 4)
5. The reference level elevation is based on: / actual construction ❑ construction drawings
(NOTE: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which
case this certificate will only be valid for the building during the course of construction. A post -construction Elevation Certificate
will be required once construction is complete.)
6. The elevation of the lowest grade immediately adjacent to the building is: L_L-tLi .0 feet NGVD (or other FIRM datum -see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
1. If the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1
is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest
floor" as defined by the ordinance is: feet NGVD (or other FIRM datum—see Section B, Item 7).
2. Date of the start of construction or substantial improvement
FEMA Form 81-31, MAY 93 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION"
SECTION E CERTIFICATION
This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation
.information when the elevation information for Zones Ai—A30, AE, AH, A (with BFE),V1—V30,VE, and V (with BFE) is required.
Community officials who are authorized by local law or ordinance to provide floodplain management information, may also sign the
certification. In the case of Zones AO and A (without a FEMA or community issued BFE), a building official,.a property owner, or an
owner's representative may also sign the certification.
Reference level diagrams 6, 7 and 8 - Distinguishing Features—If the certifier is unable to certify to breakaway/non-breakaway wall,
enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) not
included in the certification under Comments below. The diagram number, Section C, Item 1, must still be entered.
I certify that the information in Sections 8 and C on this certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIER'S NAMa—� LICENSE NUMBER (or Affix Seal)
h'A0 I i a( �f?fl _ --- ------------�� g -----
NAME
. P. L.
STATE ZIP
% 7G ozl
Copies should be made of this Certificate for: 1) community official, 2) insurance agent/company, and 3) building owner.
COMMENTS:
ON
SLAB
A v
ZONES ZONES
REFERENCE
LEVEL
BASE
FLOOD
ELEVATION
REFERENCE ADJACENT
LEVEL GRADE
GRADE
Willi
BASEMENT
A
Ir ZONES
BASE
FLOOD
REFERENCE
ON PILE5,
PIERS, OR COLUMNS
The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones.
Elevations for all A Zones should be measured at the top of the reference level floor.
Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member.
Page 2
' SUFI ;:Y PLAT OF
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STATE OF TEXAS
COUNTY OF TARRANT I Z Ict
the Lienholders and/or the Owners of rhe Premises surveyed and to FLOOD NOTE: I hereby certify that the property described herein
within a special flood hazard Arlo aS identified by the
The undersigned does hereby certify that this survey was this day made Federal Insurance Administration, DePartment of I ttowing and Urban
on the ground of the property legally described hereon and is correct. and that Development, the flood hazard arca being identified As I
there are no discrepancies• conflicts. shortages in area. boundary line conflicts, _ of the Federal Insurance Adminilstration Plotdi Hazard
encroachments, overlapping of improvements, visible lines or roads in place, Boundary Map effective on
except as vhnwn herf-on.,an,l thps eairt rr-r^r!, has acc•••s to and front a t
for the---- -
dedicated roadway except as shown hereon." —
Dated: 1
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AP SURVEYING CO.
BASIS FOR [SEARING: David Pollard RPS 01518
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Order No. ____-_-_ .-_�__.� 1903 Central Drive, Suite 309
NOT FOR CONSTRUCTION Bedford, TX 76021 Metro (817) ,281i•1249
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14 2 C -,i V-A P E V 1 V -VE. D PL) V E V OLlARD
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STATE OF TEXAS
COUNTY OF TARRANT I Z Ict
the Lienholders and/or the Owners of rhe Premises surveyed and to FLOOD NOTE: I hereby certify that the property described herein
within a special flood hazard Arlo aS identified by the
The undersigned does hereby certify that this survey was this day made Federal Insurance Administration, DePartment of I ttowing and Urban
on the ground of the property legally described hereon and is correct. and that Development, the flood hazard arca being identified As I
there are no discrepancies• conflicts. shortages in area. boundary line conflicts, _ of the Federal Insurance Adminilstration Plotdi Hazard
encroachments, overlapping of improvements, visible lines or roads in place, Boundary Map effective on
except as vhnwn herf-on.,an,l thps eairt rr-r^r!, has acc•••s to and front a t
for the---- -
dedicated roadway except as shown hereon." —
Dated: 1
„ ley: ------------------------•- --•--- •-
AP SURVEYING CO.
BASIS FOR [SEARING: David Pollard RPS 01518
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Order No. ____-_-_ .-_�__.� 1903 Central Drive, Suite 309
NOT FOR CONSTRUCTION Bedford, TX 76021 Metro (817) ,281i•1249
SUFI -Y PLAT OF
TO ALL PART'IE'S INTERESTED IN PREMISES SURVEN'Fl): A
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COUNTY OF TARRANT r
"In the Lienholders and/or the Owners of the PrenticeN surveyed and to FLOOD NOTE: 1 hereby certify that Ire property described herein
within a special flood hazard Area 119 Identified by the
YThe undersigned does hereby certify that this survey was this day made Federal Insurance Administration, Deparlmeni Ar; Howking and Urhun
on the ground of the properly legally described hereon and 1% correct, and that Developmem. the flood hazard arca being identified 19 . I
there are no discrepancies, conflicts. shortages in area, boundary line conflict%. of the Federal Insurance Adm{nWration Mood Nazatd
encroac•hntents, overlapping of improvements, visible lines or roads in place, Boundary Mop effective on
ex(ept ac ahnwn hrreon„nnd thp, aatilr.rn art•, ('9N n,-• % q It, Sia! (rata a
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dedicated n,adway except as shown hereon.” - --- -__ —
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Dated: Ily:
BASIS FOR BEARING: AP SURVEYING CO.
David Pollard RPS 01518
Onler No. ' 1003 Central Drive, Suite 309
NOT FOR CONSTRUCT ION Medford, TX 76021 Metro (817) 281.1249
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STATE OF TFXAS UP,
COUNTY OF TARRANT r
"In the Lienholders and/or the Owners of the PrenticeN surveyed and to FLOOD NOTE: 1 hereby certify that Ire property described herein
within a special flood hazard Area 119 Identified by the
YThe undersigned does hereby certify that this survey was this day made Federal Insurance Administration, Deparlmeni Ar; Howking and Urhun
on the ground of the properly legally described hereon and 1% correct, and that Developmem. the flood hazard arca being identified 19 . I
there are no discrepancies, conflicts. shortages in area, boundary line conflict%. of the Federal Insurance Adm{nWration Mood Nazatd
encroac•hntents, overlapping of improvements, visible lines or roads in place, Boundary Mop effective on
ex(ept ac ahnwn hrreon„nnd thp, aatilr.rn art•, ('9N n,-• % q It, Sia! (rata a
. f_., ,.. for Ihc, ,
dedicated n,adway except as shown hereon.” - --- -__ —
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Dated: Ily:
BASIS FOR BEARING: AP SURVEYING CO.
David Pollard RPS 01518
Onler No. ' 1003 Central Drive, Suite 309
NOT FOR CONSTRUCT ION Medford, TX 76021 Metro (817) 281.1249
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Builder/Owner to verify and check all aspects of this site and plot plan prior to any construction
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FIRST TEXAS HOMES
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Residential Designers and Planners
BROOKFIELD (178443)
Arlington, Texos Metro 817-261-4121 FAX 817-274-4717