Bethel W-RS030804
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
a.M.B. No. 3067-0077
Expires "Jl1ly 31, 2002
1m ortant: Read the instructions on a es 1 -7.
SECTION A - PROPERTY OWNER INFORMATION
For Insurance Company Use:
Policy Number
BUILDING OWNER'S NAME
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
"'2-~o 1<0 AD
CITY ,/"I STATE
CoPyt:5U- ~
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LoT 1 "B W Uc::.... \ 13e:'11-\ ~ 'RD AD f-;S ( A=\ES
BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use Comments section if necessary.)
\2'F-St (> E'kIT1 Art-
LATITUDE/LONGITUDE (OPTIONAL) HORIZONTA~ATUM: SOURCE: LI GPS (Type):
( ##0 _ ##' _ ##.W or ##.#####0) LI NAD 1927 NAD 1983 LI USGS Quad Map
Company NAIC Number
ZIP CODE 1-
ISo\
~Other:
"F f fZ../IA...
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B3. STATE
B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER
GdPPeu.- tQO 1,0
84. MAP AND PANEL
NUMBER
G \
B10, Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9.
I_I FIS Profile ~IRM 1-' Community Determined 1-' Other (Describe):
B11. Indicate the elevation datum used for the BFE in B9: ~GVD 1929 I_I NA VD 1988 1-' Other (Describe):
B12. Is the building located in a Coastal_Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)?
Designation Date:
B5. SUFFIX
B9. BASE FLOOD ELEVATION(S)
(Zone AO, use doth of flooding)
. ~
I_I Yes I~No
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: LIConstruction Drawings* ~uilding Under Construction* '-'Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete. t=O~
C2. Building Diagram Number -L (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 A1-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, ARIA, ARlAE, ARlA1-A30, ARlAH, ARlAO
Complete Items C3a-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
calculation. Use the space provided or the Comments area of Section 0 or Section G, as appropriate, to document the datum conversion.
DatumU l:,.VD "'i"l'l Conversion/Comments
Elevation reference mark used Does the elevation reference mark used appear on the FIRM? 1-' Yes No
o a) Top of bottom floor (includin basement or enclosure) ~.., .81 ft.(. ;ij ~
o b) Top of next higher floor -ITJr . ft.(m) ~ ... ~.9....,t -t:
o c) Bottom of lowest horizontal structural member (V zones only) kilt-. = ft.(m) !! ~ ~~~~G'*STE~fo"
o d) Attached garage (top of slab) ~ . _ ft.(m) ~ -g /
o e) Lowest elevation of machinery and/or equipment ~ :
.11 B 5
servicing the building ~ . _ ft.(m) E 10
o f) Lowest adjacent grade (LAG) ~ . .1k>tt.(IIij:i ,~
.,CI)
o g) Highest adjacent grade (HAG) 500 .€L- ft.~ ~
o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade --A.ti:::. ~
o i) Total area of all permanent openings (flood vents) in C3h ~ sq. in. (sq. em)
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 cerlify 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.
CERT~Y12~f~ LICENSE NUMBER 3io'l (
TITLE OvJ N e:R..
ADDRESS ST T.
TELEPHONE
REPLACES ALL PREVIOUS EDITIONS
For Insurance Company Use:
Pol~cy' NU~ber
CITY STATE ZIP CODE Company NAIC Number
~EU- ,
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
COMMENTS
I_I 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 Cerlificate is intended for use as supporling
information for a LOMA or LOMR-F, Section C must be completed.
E1. 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 1_1_1 ft.(m) LLlin.(cm) LI above or LI below
(check one) the highest adjacent grade.
E3, For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is
I_LI ft.(m) I_Llin,(cm) above the highest adjacent grade.
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? I I Yes LI No I I Unknown. The local official 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, and E for Zone A (without a FEMA-issued or
community-issued BFE) or Zone AO must sign here.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS
SIGNATURE
COMMENTS
CITY
STATE
ZIP CODE
DATE
TELEPHONE
I Check here if attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local official 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.
G1. I_I 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. I_I 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. 1-' 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: LI New Construction LI Substantial Improvement
G8. Elevation of as-built lowest floor (including basement) of the building is:
G9. BFE or (in Zone AO) depth of flooding at the building site is:
LOCAL OFFICIAL'S NAME
. _ ft.(m) Datum:
. _ ft.(m) Datum:
TITLE
COMMUNITY NAME
TELEPHONE
SIGNATURE
DATE
COMMENTS
FEMA Form 81-31, AUG 99
I Check here if attachments
REPLACES ALL PREVIOUS EDITIONS
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APPROX. LOC. OF
100 YR. FLOOD PLAIN
(VERIFY LOC. ON SITE)
POQ.. LOCATION
DECK BY .
POOL CNTRCTR.
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BY 01/liNER
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pJNS ARE REVIEWED FOn-
t..PPROV AL OF SINGLE
FAI"ILY RESIDENCE ONLY.
~THER DEPICTIONS OR
C ~L-OUTS ON PLOT PLAN
HAl E NOT BEEN REVIEWED
4'D ARE rou APPROVED.
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BETHEl.. ROAD EST A TES
DALLAS COUNTY
COPPELL, TEXAS'
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260 8ETI-EL ROAD
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