FEMA-EC021203TIONAL FLOOD INSURANCE PROGRAM J O.M.B.. No. 3067-b077
I Expires July 31,2002
ELEVATION CERTIFICATE
Important: Read the instructions on pa~les 1- 7,
SECTION A- PROPERTY OWNER INFORMATION For Insurance Company Use:
BUILDING OWNER'S NAME Policy Number
BRENTWOOD BUILDERS
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number
615 PRESTWICK COURT
CITY STATE ZIP CODE
COPPELL TX 75019
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 4, BLOCK A, PRESTVVlCK ADDITION
BUILDING USE (e.g., Residential, Non-residential, Addition, Aocessow, etc. Use a Comments area, if necessary.)
RESIDENTIAL
LATITUDE/LONGITUDE (OPTIONAL)HORIZONTAL DATUM: SOURCE: [] GPS (Type):__
NAD 1927 [] NAD 1983 [] USGS Quad Map [] Other: __
SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
El. NFIP COMMUNITY NAME & COMMUNITY NUMBER
COPPELL - 480170
B2. COUNTY NAME ED. STATE
DALLAS TX
B4. MAP AND PANEL
NUMBER
0155
RS. SUFFIX
J
FIRM INDEX DATE
8-23-01
B7. FIRM PANEL
EFFECTIVE/REVISED DATE
8-23-01
BB. FLOOD ZONE(S)
X
Bg. BASE FLOOD ELEVATION(S)
Zone AO, use deCh of f~x~ding)
N/A
El0. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9.
FIS Profile [] FIRM - [] Community Determined [] Other (Describe):__
B11. Indicate the elevation datum used for the BFE in B9: [] NGVD 1929 [] NAVD 1988 [] Other (Describe): __
B12. Is the building] located in a Coastal Barrier Resources System ICBRS/area or Otherwise Protected Area/OPAl? [] Yes [] No
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Dasi~nation Date
C1. Building elevations are based on: I--1 Construction Drawings* [] Building Under Construc'don* [] Finished Construction
A new Elevation Certificate will be required when construction of the building is complete.
C2. Building Diagram Number 1_ (Select the building diagram most similar to the building for which this certificate is being completed- see pages 6 and 7. If no diagram
accurately represents the building, provide a sketch or photograph.)
C3. Elevations-Zones Al-A30, AE, AH, A (with BFE), VE, VI-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 C2. 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. Show field measurements and datum conversion calculalion. Use the space provided or the Comments area of
Section D or Section G, as appropriate, to document the datum conversion.
Datum NGVD 1929 Conversion/Comments
Elevation reference mark used # Does the elevation reference mark used appear on the FIRM? [] Yes [] No
o a) Top of bottom floor (induding basement or endosure)
o b) Top of next higherflcor
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
servidng the building (Describe in a Comments area)
o 0 Lowest adjacent (finished) grade (LAG)
o g) Highest adjacent (finished) grade (HAG)
458. 9 ft.(m)
N/A..ft.(m)
N/A. 3.(m)
458. 9 ft(m)
N/A. O0 ft(m)
457.6 fl.(m)
458. Oft(m)
o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 0
o i) Total area of all permanent openings (flood vents) in C3.h N/A sq. in. (sq. cra)
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.
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 COMPANY NAME ANALYTICAL SURVEYS, INC.
ADDRESS
707 EASY STREET
SIGN~/
FE--MA FO~'"~-81-31, JUL O0 ~
CITY STATE ZIP CODE
GARLAND TX 75042
DATE TELEPHONE
12-03-02 972-272-6287
SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
For Insurance Company Use:I~PORT. ANT: In these spaces, copy the con'esl,..,ding information from Section A.
BUILDING STREET ADDRESS (Induding Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
61§ PRESTWlCK COURT
CITY STATE ZIP CODE
COPPELL TX 75019
SECTION D- SURVEYOR, ENGINEER, OR.ARCHITECT CERTIFICATION (CONTINUED
Pof~ Number
Company NAIC Number
Copy both sides of this Elevation CerlJficate for (1) community offidal, (2) insurance agent/company, and (3) building owner.
COMMENTS
BUILDING IS FORMS ONLY.
Check here if attachments
SECTION E- BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zone AO and Zone A (without BFE), complete Items E1 through E4. If the Elevation Certif]c~e is intended for use as supporting information 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 certificate is being completed - see pages 6 and 7. If no diagram accurately
represents the building, provide a sketch or photograph.)
E2. The top of the bottom floor (including basement or enclosure) of the building is _ ft.(m) _in.(cm) [] above 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 floor or elevated floor (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 bottom floor elevated in accordance with the community's floodplain management ordinance?
Yes [] No [] Unknown. The local offidal must certify this information in Section G.
SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections 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 Sections A, B, C, and E are correct 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 - COMMUNITY INFORMATION (OPTIONAL)
The local offidal 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 Bevation
Certificate. Complete the applicable item(s) and sign below.
Gl. [] The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by
state or local 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 G4-G9) is provided for community floodplain management purposes.
G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED
G7. This permit has been issued for: [] New Construction [] Substantial Improvement
G8. Elevation of as-built lowest floor (induding basement) of the building is:
G9. BFE or (in Zone AO) depth of flooding at the building site is:
E(m) Datum:__
ft.(m) Datum: __
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
Check here if attachments
FEMA Form 81-31, JUL O0 REPLACES ALL PREVIOUS EDITIONS