Penfolds-RS040730
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I1l>.i\OI1~L ~lOOO INSURANCE PROGRAM
ELEVATION CERTIFICATE
O.MB. No 3067-0077
Expires December 31 , 2005
SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use'
BUILDING OWNER'S NAME Policy Number
BUILDING STREET ADDRESS (Including Apt. Unit, Suite, and/C" Bldg. No.) OR p.o. ROUTE AND BOX NO Company NAIC Number
718 PENNFOLDS LANE
Important' Read the instructions on pages 1 - 7,
CITY STATE
COPPELL TX
PRo"PERTY'DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
LOT 9 BLOCK B THE RESERVE
BUILDING USE (e,g". Residential, Non-residential. Addition, Accessory, etc. Use a Comments area, if necessary.)
RESEIDENTIAL
LATITUDE/LONGITUDE (OPTIONAL)
(##'_##'_####" or ##._")
ZIP CODE
75019
HORIZONTAL DATUM
IZl NAD 1927 0 NAD 1983
SOURCE: 0 GPS (Type)_
o USGS Quad Map
IZl Other: FIRM
B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER ~ B2. COUNTY NAME
COPPELL 480170 DALLAS
-.-.-.--,'-- -_.'--- - ---.-
184 MAPANDPANELn - -,- - --- -sf fiRM PANEL ---r--
. NUMBER B5. SUFFIX B6. FIRM INDEX DATE EFFECTIVE/REVISED DATE B8. FLOOD ZONE(S)
48113C0155 J AUG23200 AUG23200 X AE
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered In B9
o FIS Profile ~ FIRM 0 Community Determined 0 Other (Describe):_
B11 Indicate the elevation datum used for the BFE In B9 ~ NGVD 192q 0 NAVD 1988 0 Other (Describe): -
B12.ls the bUilding located In a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area OPA? 0 Yes ~ No Desi nation Date
SECTION C _ BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: 0 Construction Drawings* L8J Building Under Construction* 0 Finished Construction
*A new Elevation Cer1iflcate will be required when construction of the building is complete.
C2. BUliding Diagram Number 1 (Select the bUilding diagram most similar to the building for which Ihis certificate is being competed 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, APJA, APJAE, APJA1-A30, APJAH, APJAO
Complete Items C3-a-i below aocordlng to the building diagram specified in IIem C2. State the datum used. If the datum is different from the datum used for the BFE in
Section B, converi 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
Datum NGVD 1927 Conversion/Comments BM PROVIDED BY ENGINEER
Elevation reference mark used BM 498.78 Does the elevation reference mark used appear on the FIRM? 0 Yes LSl No
() a) Top of bottom floor (including basement or enclosure) 509. 52 ft.(m)
() b) Top of next higher floor NA . - ft.(m)
n c) Bottom of lowest horizontal structural member (V zones only) NA , _ft,(m)
() d) Attached garage (top of slab) NA. _ft.(m)
() e) Lowest elevation of machinery and/or equipment
servicing the building (Describe in a Comments area) NA. _ft.(m)
() D Lowest adjacent (finished) grade (LAG) 508. 50 ft.(m)
() g) Highest adjacent (finished) grade (HAG) 508 70 ft.(m)
o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade NA
o i) Total area of all permanent openings (flood vents) in C3.h NA sq, in. (sq. cm)
SECTION B _ FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
I B3. STATE
TEXAS
I
".J
89 BASE FLOOD ELE,A ~ 101,,01 I
(Zone AO, use depth of floocling)
5000
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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 G, and C on this certificate represents my best efforts to interpret the data available.
I understand Ihat any lalse statement may be pumshable by fme or Imprisonment under 18 US. Code, Section 1001
CERTIFIER'S NAME BARRY RHODES LICENSE NUMBER 3691
COMPANY NAME BARRY RHODES
TITLE OWNER
ADDRESS --- -.--~-"
7509 PENNRIDGE CIRCLE
SIGNATURE
CITY
ROWLETT
DATE
07-30-2004
ST4TE
TX
TELEPHONE
972-475-8940
ZIP CODE
75088
FEMA Form 81-3
See reverse side for continuation
Replaces all previous editions
..
IMPOR rANT: In these spaces, copy the corresponding information from Section A.
8UILDIi',G STREET ADDRESS Ilndudlng Apt, Unl\, SUite, andlm Bid" No.) OR FO, ROUlE ~ND BOX NO
718 PENN FOLDS LANE
For Insurance Company Use:
Policy Number
STATE
TX
ZIP CODE
75<l19
Company NAIC Number
CITY
COPPELL
SECTION D. SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both Sides of this Elevation Certificate for (1) community official, (2) InSurance agenVcompany, and (3) bUilding owner
COMMENTS
o 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, II the Elevation Certificate 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 fioor (including basement or enclosure) of the bUilding is _ tt,(m) _in,(cm) 0 above or 0 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 ficor or elevated ficor (elevation b) ollhe building IS _ ft,(m) _In,(cm) above the highest adjacent
grade, Complete Items C3h and C31 on front 01 form,
E4 The top of the plattorm 01 machinery and/or equipment serviCing the bUilding is _ ft,(m) _in,(cm) 0 above or 0 below (check one) jhe highest adjacent grade (Use
natural grade, if available)
E5. For Zone AO only II no ftocd depth number is available, IS the top of the bottom floor elevated in accordance with the community's floodplain management ordinance?
Dyes 0 No 0 Unknown The iocal official musl certify this information in Section G,
SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owners authorized representative who completes Seclions A, B, C (Items C3h and C31 only), and E for Zone A (without a FEMA-issued or communlty-
Issued BFE) or Zone AO must sign here, The statements In Sections A, B, C, and E are correcl to the best of my knowledge,
PROPERTY OWNERS OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
-_.-._--"--~_.__.._- ------ .------------
CiTY
STATE
ZIP CODE
ADDRESS
- SIGNATURE
DATE
TELEPHONE
COMMENTS
o 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. 0 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 certlly elevation informatiOn (Indicate the source and date of the elevation data In the Comments area below,)
G2, 0 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. 0 The following information (Items G4-G9) is provided for community floodplain management purposes
I G4PERMIT NUMBER G5 DATE PERMIT ISSUED G6, DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED
I
G7. This permit has been issued for: 0 New Construdion 0 Substantial Improvement
G8 Elevation of as-bUilt lowest ftcor (including basement) of the building is
G9, BFE or (in Zone AO) depth of ftcoding at the bUilding site is:
1
I
~
__ft,(m)
_,_ft,(m)
Datum
Datum:
TiTLE
TELEPHONE
DATE
LOCAL OFFICIALS NAME
COMMUNITY NAME
SIGNATURE
COMMENTS
o Check here if attachments
FEMA Form 81-31, January 2003
Replaces all previous editions