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FEMA-EC110322US DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No 1660 0008 Federal Emergency Management Agency Expires March 31 2012 National Flood Insurance Program Important Read the instructions on pages 1 9 SECTION A PROPERTY INFORMATION Al Budding Owners Name x A2 Building Street Address including Apt Unit Suite andor Bldg No or PO Route and Box No 4 114 Olympia Lane City COPPELL State TEXAS ZIP Code 75019 A3 Property Description Lot and Block Numbers Tax Parcel Number Legal Description etc Lot 20 Block A ALEXANDER COURT A4 Building Use eg Residential Non Residential Addition Accessory etc RESIDENTIAL A5 LatitudeLongitude Lat Long Horizontal Datum NAD 1927 NAD 1 983 A6 Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance BY GOOGLE EARTH A7 Building Diagram Number A8 For a building with a crawlspace or enclosures A9 For a building with an attached garage a Square footage of crawlspace or endosures sq ft a Square footage of attached garage sq ft b No of permanent flood openings in the crawlspace or b No of permanent flood openings in the attached garage enclosures within 10 foot above adjacent grade within 10 foot above adjacent grade c Total net area of flood openings in A8b sq in c Total net area of flood openings in A9b sq in d Engineered flood openings Yes 0 No d Engineered flood openings Yes No SECTION B FLOOD INSURANCE RATE MAP FIRM INFORMATION B1 NFIP Community Name Community Number 82 County Name B3 State COPPELL 480170 DALLAS TX 84 MapPanel Number 85 Suffix B6 FIRM Index 87 FIRM Panel 88 Flood B9 Base Flood Elevations Zone Date EffectiveRevised Date Zones AO use base flood depth 48113C0155 J AUG2301 APR2308 LOMR AE 488 B10 Indicate the source of the Base Flood Elevation BFE data or base flood depth entered in Item B9 0 FIS Profile FIRM Community Determined Other Describe B11 Indicate elevation datum used for BFE in item 89 NGVD 1929 NAVD 1988 Other Describe B12 Is the building located in a Coastal Barrier Resources System CBRS area or Otherwise Protected Area OPA Yes X No Designation Date 0 CBRS OPA SECTION C BUILDING ELEVATION INFORMATION SURVEY REQUIRED C1 Building elevations are based on Construction Drawings Building Under Construction Finished Construction A new Elevation Certificate will be required when construction of the building is complete C2 Elevations Zones A1A30 AE AN A with BFE VE V1 V30 V with BFE AR ARA ARAE ARA1 A30 ARAH ARAO Complete Items C2ah below according to the building diagram specified in Item A7 Use the same datum as the BFE Benchmark Utilized CITY OF COPPELL GEODETIC 5 Vertical Datum NAVD 88 ConversionComments DATUM SHIFT 0026 PER VERTCON Check the measurement used a Top of bottom floor Including basement crawlspace or enclosure floor 493 7 feet meters Puerto Rico only b Top of the next higher floor feet meters Puerto Rico only c Bottom of the lowest horizontal structural member V Zones only D feet d Attached garage top of scab meters Puerto Rico only feet meters Puerto Rico only e Lowest elevation of machinery or equipment servicing the building feet meters Puerto Rico onlyDescribetypeofequipmentandlocationinComments f Lowest adjacent finished grade next to building LAG Q feet meters Puerto Rico only g Highest adjacent finished grade next to building HAG Q feet meters Puerto Rico only h Lowest adjacent grade at lowest elevation of deck or stairs including feet meters Puerto Rico onlystructuralsupport 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 certify that the information on this Certificate represents my best efforts to interpret the data availablelunderstandthatanyfalsestatementmaybepunishablebyfineorimprisonmentunder18USCodeSection1001 O FE TlCheckhereifcommentsareprovidedonbackofformWerelatitudeandlongitudeinSectionAprovidedbyayPGS Le q licensed lasurveyorYesNoO Certifiers Name License Number GLENN W MILLER Title GLENN W MILLER TEXAS N04223 n 4713CompanyNameRPLSGEODATASURVEYINGINC9o 4Z Address City State P ode 91SI I ITA1510GINADRIVEARLITEXAS761g ySignatureDateTelephone March 22 2011 811 261 2878 FEMA Form 81 31 Mar 09 See reverse side for continuation Replaces all previous editions IMPORTANT In these spaces copy the corresponding information from Section A Building Street Address induding Apt Unit Suite andor Bldg No or PO Route and Box No r 114 OFia Lane City State ZIP Code COPPELL TEXAS 75019 SECTION D SURVEYOR ENGINEER OR ARCHITECT CERTIFICATION CONTINUED Copy both sides of this Elevation Certificate for 1 community official 2 insurance agentcompany and 3 building owner Comments BENCH MARK CITY OF COPPELL GEODETTQ CONTROT POTNT NO5 ELEV 51324 Signature Date Check here if attachments SECTION E BUILDING ELEVATION INFORMATION SURVEY NOT REQUIRED FOR ZONE AO AND ZONE A WITHOUT BFE For Zones AO and A without BFE complete Items E1 E5 If the Certificate is intended to support a LOMA or LOMRF request complete Sections A B and C For Items E1 E4 use natural grade if available Check the measurement used In Puerto Rico only enter meters El Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade HAG and the lowest adjacent grade LAG a Top of bottom floor including basement c rawispace or endosure is feet meters above or below the HAG b Top of bottom floor induding basement crawlspace or enclosure is Qfeet Dmeters above or below the LAG E2 For Building Diagrams 6 9 with permanent flood openings provided in Sectiqn4 Items 8 mlor 9 see a es 89 of Instructions the next higher floor elevation C2b in the diagrams of the building is feet u meters above or u below the HAG E3 Attached garage top of slab is feet meters above or below the HAG E4 Top of platform of machinery andor equipment servicing the building is feet meters above or below the HAG E5 Zone AO only If no flood depth number is available is the top of the bottom floor elevated in accordance with the communitys floodplain management ordinance Yes J No 0 Unknown The local official must certify this information in Section G SECTION F PROPERTY OWNER OR OWNERS REPRESENTATIVE CERTIFICATION The property owner or owners authorized representative who completes Sections A 8 and E for Zone A without a FEMA issued or community issued BFE or Zone AO must sign here The statements In Sections A 8 and E are correct to the best of my knowledge Property Owners or Owners Authorized Representatives Name Address City State ZIP Code Signature Date Telephone Comments Check here if attachments SECTION G COMMUNITY INFORMATION OPTIONAL The local official who is authorized by law or ordinance to administer the communitys floodplain management ordinance can complete Sections A 8 C or E and G of this Elevation Certificate Complete the applicable items and sign below Check the measurement used in Items G8 and G9 G1 The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor engineer or architect who is authorized by law to certify elevation information Indicate the source and date of the elevation data in the Comments area below G2 A community offidal completed Section E for a building located in Zone A without a FEMA issued or community issued BFE or Zone AO G3 The following information Items G409 Is provided for community floodplain management purposes G4 Permit Number G5 Date Permit Issued J G6 Date Certificate Of ComplianceOccupancy Issued G7 This permit has been issued for New Construction Substantial Improvement G8 Elevation of as built lowest floor including basement of the building feet meters PR Datum G9 BFE or in Zone AO depth of flooding at the building site feet meters PR Datum G10 Communitys design flood elevation feet 0 meters PR Datum Local Officials Name Title Community Name Telephone Signature Date Comments Check here if attachments FEMA Form 81 31 Mar 09 Replaces all previous editions 11172 ri X e 3 sue s 7 ii e i 9 S EQt e A 44 r i 006 s W o t it t I o I I v y ryad Z art I I rs tr P II I I W II gInI I I e W co I o I W W oo IIIAlla l j M I as 1r P42 Iolk 111101Is 2 iI Sa i5 i in9M 6 Nco 0 ioI 1 N 1 o S I II 3 Tau r i Lll c ovaig 1aD I O L N I a y I N cao rn ma i 2 i1 I Q10 I 2 4 I it c8 m may I o I 21Y oo J I Wa a v1 I 8 ZniIr o LL 15d 1os 1 TA G o U tar i a o I c d o 60f 3 I f O O O I w 101 Z 030 O c Y la e y O t 5 30 8514 n O U 11 e aaii a4 sue Noe f2 1 A I 1i y I 256 R2 idnIg 1 i I R OIYM I PN Q E 114 114 ggiXi