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FEMA-EC100409US 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 Building Owners Name A2 Building Street Address including Apt Unit Suite andor Bldg No or PO Route and Box No 5 224 Olympia Lane City Coppell Texas 750 Code A3 Property Description Lot and Block Numbers Tax Parcel Number Legal Description etc Lot 12 Block A ALEXANDER COURT A4 Building Use eg Residential Non Residential Addition Accessory etc Residential A5 LatitudeLongitude Lat Long Horizontal Datum NAD 1927 NAD 1983 A6 Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance 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 enclosures 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 No d Engineered flood openings Yes No SECTION B FLOOD INSURANCE RATE MAP FIRM INFORMATION B1 NFIP Community Name Community Number B2 County Name B3 State Coppell Texas 480170 Dallas Texas B4 MapPanel Number B5 Suffix B6 FIRM Index B7 FIRM Panel B8 Flood B9 Base Flood Elevations Zone 48113C0155 J Date EffectiveRevised Date Zones AO use base flood depth Aug232001 Apr242008 AE Xshaded 49110 B10 Indicate the source of the Base Flood Elevation BFE data or base flood depth entered in Item B9 FIS Profile FIRM Community Determined Other Describe LOMR Case No 07 06 2203P B11 Indicate elevation datum used for BFE in Item B9 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 No Designation Date 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 AH A with BFE VE V1 V30 V with BFE AR ARA ARAE ARA1A30 ARAH ARA0 Complete Items C2a h below according to the building diagram specified in Item A7 Use the same datum as the BFE Benchmark Utilized City of Coppell Mon 5 Vertical Datum GPS ConversionComments Check the measurement used a Top of bottom floor including basement crawlspace or enclosure floor 4948 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 feet meters Puerto Rico only d Attached garage top of slab n feet meters Puerto Rico only e Lowest elevation of machinery or equipment servicing the building feet meters Puerto Rico only Describe type of equipment and location in Comments f Lowest adjacent finished grade next to building LAG n feet meters Puerto Rico only g Highest adjacent finished grade next to building HAG feet meters Puerto Rico only h Lowest adjacent grade at lowest elevation of deck or stairs including feet meters Puerto Rico only structural support 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 available I understand that any false statement may be punishable by fine or imprisonment under 18 US Code Section 1001 4EQFqCheckhere11oncommentsareprovidedbackofformWerelatitudeandlongitudeinSectionAvidedbyaqPSTc licensed land surveyor Yes 1No co40 9rpt0 Certifiers N License Nu loafSennWMillerStateofTexasNo4223 GLENN M MILLER Title Company Name o Address R P L S GEODATA SURVEYING INC State ZiP Code 9 4223 N O 1510 Gina Drive lington Texas 76013 1SCJFRVy Signs Date Telephone r 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 including Apt Unit Suite andor Bldg No or PO Route and Box No 224 Dympia 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 BFE Elevations taken from LOMB dated April 24 2008 Case No 07 06 2203P 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 LOMR F 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 crawlspace or enclosure is feet meters above or below the HAG b Top of bottom floor including basement crawlspace or enclosure is feet meters above or below the LAG E2 For Building Diagrams 69 with permanent flood openings provided in Secti9pUlt Items 8 or 9 see awes 89 of Instructions the next higher floor elevation C2b in the diagrams of the building is feet U meters U above or LI 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 No 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 B 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 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 B 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 official 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 G4G9 is provided for community floodplain management purposes G4 Permit Number G5 Date Permit Issued G6 Date Certificate Of ComplianceOccupancy Issued G7 This permit has been issued for New Construction Substantial improvement G8 Elevation of asbuilt 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 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