FEMA-EC030422IONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
Im~.,lznt P__~,~ the instr,__,,~_'_.rm on ~ges 1- 7.
SECTION A- PRO~m f OWNER INFORMATION
BUILDING OVVNER'S NAME
BRENTWOOD BUILDERS
BUILDING STREET ADDRESS (Including ApL, Unit, Suite, andJor Bldg. No.) OR P.O. ROUTE AND BOX NO.
610 PRESTWICK COURT
CITY STATE
COPPF! I TX
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Desuip~;on, etc.)
LOT 3, BLOCK B, PRESTWICK ADDITION
O.M.B. No. 30'67-007¢.
Expires July'31, 20~)2
ziP CODE
75019
BUILDING USE (e.g., Residen~al, Non-residential, Addition, Accessory, etc. Use a C,u,¥.Tents a;ea, if n~,-y.)
RESIDENTIAL
LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: I-I ~ (Type):
f' or ~./~;~;;.'~) I'-I NAD 1927 I-1 NAD 1983 [] USGS Quad Map
SECTION B- FLOOD INSURANCE RATE MAP {FIRM) INFORMATION
IBI' NFIP COMMUNrfY NAME & COMMUNrrY NUMBERCOPPELL-
480170 IB2. COUNTY NAME
DALLAS IB3. STATE
TX
r-] Other:__
I
B4. MAP AND PANEL BS. SUFFIX I I B7. FIRM PANEL
NUMBER I B6, FIRM INDEX DATEI EFFECTIVF_~SED DATE B8. FLOOO ZONE(S)
0155 J 8-23-01 8-23-01 X
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9.
FIS Profile [] FIRM [] Community Determined [] Other (Describe):
Bll. Indicate the elevation datum used for the BFE in Bg: [] NGVD 1929 [] NAVD 1988 [] Other (Deschbe):
B12. Is.the buildinc, I located in a C _~___~ Banier Resources System ICBRS) area or Othem,ise Protected Ama (OPA)? [] Yes [] No DesicjnaJon Date__
SECTION C - BU!LDING ri LWATION INFORMATION {SURVEY REQbi~a~.D)
Bg. BASE FLO00 ELEVATION(S)
Zone AO, use de~ of f~od~g)
N/A
Cl. Building elevations are based on: [] Consffuction Drawings* [] Building U~ Consffuction* [] Rnished ~
A new Elevation Certif~.,ate will be required whe~ construction of the building is complete.
C2. Building Diagram Number I (Select the building diagram most similar to the building for which this certif~ate is being completed - see pages 6 and 7. ff no diagram
accurately represents the building, provide a sketch or photograph.)
C3. Elevations- Zones Al-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, AR/A, AR/AE, AR/Al-A30, AR/AH, AR/AO
Complete Items C3.-a-i below according to the building diagram specified in Item 02. State the datum used. If the datum is different from the datum used for the BFE in
Section B, convert the datum to that used for the BFE. Shew field measurements and datum conversion calculation. Use the space provided or the Comments area of
Section D or Section G, as appropriate, to document the datum conva'sion.
Datum NGVD 1929 Conversion/Comments
Elevation reference mark used # Does the devation reference rna'k used appear on lhe FIRM?. [] Yes 15~ No
o a) Top of bottom floor (including basement or enclosure)
o b) Top of next higher floor
o c) Bottom of lowest horizontal structural member (V zones only)
o d) Attached garage (top of slab)
o e) Lowest elevation of machinery and/or equipment
sewidng the building (Describe in a Comments area)
o 0 Lowest adjacent (finished) grade (LAG)
o g) Highest adjacent (finished) grade (HAG)
45J. 24._~.(m)
N/A. _.ff.(m)
N/A..___ff.(m)
N/A. __ff.(m)
N/A. 00lt.(m)
457.72 lt.(m)
458. 12 ft.(m)
o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 0
o i) Total area of all permanent openings (tbod vents)in C3.h N/A scl. in. (sq. cm)
SECTION D - SURVEYOR, ENGINEEE, OR ARCHITECT CEI~I iFICATiON
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
I certify that the information in Sections A, 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.
CERTIFIER'S NAME ROBERT C. MYERS LICENSE NUMBER 3963
TITLE VICE- PRESIDENT
ADDRESS
COMPANY NAME ANALYTICAL SURVEYS, INC.
CITY STATE ZiP CODE
707 EASY STREET
SIGNAT ~
I='~MA Fo--rrn 81-31, JUL
GARLAND TX 75042
DATE
22-03
TELE~%'H, ONE
972-272-6287
SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
II~RTANT: In these spaces, copy the correslX~_~g information from Section A.
BUILDING STREET ADDRESS (Induding Apt., Un, it, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
610 PRESTWICK COURT '
I~ Numba-
NA~;NumberCITYSTATEZIPCOOE
COPPELL TX 75019
SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevetion Certificate for (1) community of~dal, (2) insurance agent/company, and (3) building owner.
COMMENTS
BUILDING IS FORMS ONLY.
Check here if attachments
SECTION E- BUILBING ELEVATION INFORMATION (SURVEY NOT REQUIREB) FOR ZONE AO AND ZONE A {IMTHOUT BFE)
For Zone AO and Zone A (without BFE), complete Items E1 through E4. If the Bevation Cede is intended for use as supporting informatk)n for a LOMA or LOMR-F,
Section C must be completed.
El. Building Diagram Number_(Select the building diagram most similar to the building for which this catificae is being compleled- see pages 6 and 7. If no diagram accuraety
represents the building, provide a sketch or photograph.)
E2. The top of the bottom floor (induding basement or enclosure) of the building is _ ft.(m) _in.(cm) I--I atx)ve or [] below (check one) the highest adjacent grade. (Use
natural grade, if available).
E3. For Building Diagrams 6-8 with openings (see page 7), the next higher tkx~r or elevated tk~or (elevation b) of the building is _ ft.(m)_in.(cm) above the highest adjacent
grade. Complete items C3.h and C3.i on front of form.
E4. For Zone AO only: If no flood depth number is available, is the top of the boltom floor elevated in accordance with the community's f,:x:,:lplain management ordinance?
Yes [] No [] Unknown. The local oftldal must certJf~this infon'nalJon in Sention G.
SECTION F- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owners authorized representaWe who completes Sedions 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 Seclk)ns A, B, C, and E are caTect to the best of my knowledge.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVES NAME
ADDRESS CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
Check here if attachments
SECTION G - COMMUNn'Y INFORMATION (OPTIONAL)
The local ofldal who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation
Certificate. Complete the applicable item(s) and sign below.
Gl. [] The information in Section C was taken from olher documentation that has been signed and embossed by a licensed surveyor, engineer, or architec~ who is authorized by
state or local law to cetify elevation information. (Indicae the source and date of the eleva'~on data in the ~ts area below.)
G2. [] A community offidal completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BI:E) or Zone AO.
G3. [] The following information (Items C-:-:-~9) is provided for community floodplain management purposes.
G4. PERMIT NUMBER C-E,. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF ~CE/OCCUPANCY ISSUED
GT. This permit has been issued for: [] New Construction [] Substantial Improvement
GS. Elevation of as-built lowest floor (including basement) of the building is: . .__fl.(m) Datum: __
Gg. BFE or (in Zone AO) depth of flooding at the building site is: __ _ ft.(m) Datum: __
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
Check here if attachments
i:i::~/iA I:nrm Rt.9,1 .ti II nn REPLACES ALL PREVIOUS EDITIONS