FEMA-EC990622 (2)FPMC - 1 (4/94)
BUILDING INSPECTION - WHITE, APPRAISAL - YELLOW, CUSTOMER - PINK
ELEVATION CERTIFICATE
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 LOMR).
Instructions for completing this form can be found on the following pages.
BUILDING OWNER'S NAME
SECTION A PROPERTY INFORMATION FM INSURANCE COMPANY USE
POLICY NUMBER
STREET ADDRESS (Including Apt., Unit, Suite and/or Bldg Number) OR P.O. ROUTE AND BOX NUMBER I COMPANY NAIC NUMBER I
OTHER DESCRIPTION (Lot and Block Numbers, etc.)
4 ®T 1 Z, 9ZL )C '_ ----ate NI�L�iI/o.�.�
CITY STATE ZIP CODE
do�P�, �
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
S. BASE FLOOD ELEVATION
(in AO Zones, use depth)
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): LJ NGVD '29 U 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: i__LL_LLJ.0 feet NGVD (or other FIRM datum -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). FIRM Zones Al -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
of �_ _J_.1414L7J
5T feet NGVD (or other FIRM datum -see Section B, Item 7).
(b). FIRM Zones V1 -V30, 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 L -J__L J.__t_J.0 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 LLJ.0 feet above ❑ or
W below ❑ (check one the highest rade adjacent to the building. 445r �� ry' ' W4,6 T,VWeOV Ar- r*,g
A ) 9 9 1 g 4o&-,zsT j_z✓zG DF foer%!Bp9�12S
(d). FIRM Zone AO. The floor used as the reference level from the selected diagram is W .0 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 n No ❑ Unknown
3. Indicate the elevation datum system used in determining the above reference level elevations: ❑ NGVD '29 ❑ Other (describe
under Comments on Page 2). (NOTE: 11 the elevation datum used in measuring the elevations Is different than that used on
the FIRM [see Section B, Item 71, then convert the elevations to the datum system used on the FIRM and show the conversion
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: 1-1actualconstruction [I construction drawings
Cl (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: j I I I 1 1.0 feet NGVD (or other FIRM datum -see
Section B, Item 7).
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 Al -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 B 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.
cEnTIFIER'S NAME LICENSE ,NUMBER (or Aft Seal)
TITLE COMPANY NAME
ADDRESS CITY STATE ZIP
I30/ .t5 sT� J ,woeLTb4,, 7-X 7soob
SIGNATURE DATE PHONE
Copies should be made 01hls Certificate for: 1) community official, 2) Insurance agenVcompany, and 3) building owner.
COMMENTS: _ �����` �'O�i�'C�L �� 6 7-1a 01010V 7_11a:!!14
ST�_`Y__Q ••__
HR SURVEY PLAT'" HR
LOT 12 BLOCK E OF MAGNOLIA PARK ADDITION AN ADDITION TO THE CITY OF COPPELL
DALLAS COUNTY, TEXAS REC. IN VOL. 98145, PG. 506, P.R.D.C.T.
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I hereby certify that, on theVh day of JUN., 19 99, this survey was made on the ground and this survey plat has been prepared as per the field
notes thereby produ, --i, anul it properly represents the facts as found on the ground. This survey plat has been prepared in accordance with, and in
substantial compliaio • with , all rules and regulations promulgated by the Texas Hoard of Professional Land Surveying. Unless otherwise noted, the
surveyor has relied sol ^! ,,n the record data provided in the title commitment for the determination of the boundaries of the land parcel surveyed and for
any easements of record which may be shown or addressed on the survey. The survey shows visble easements, encroachments, conflicts, or
protrusions apparent on the ground.
Date JUNE. 22, 1999 �g of
C. ,10,1sTZ4-
�R°4-99-33609�n JOB # .
GF No. HARRY J. ROWELL
4597
Scale: 1" 20
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MADISON STREET
PLOT PLAN
SCALE 1/10"=1'-O"
LOT 12 BLOCK D
MAGNOLIA PARK
C OPPELL, TEXAS