Rosemount-RS020807
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FEDERAL EMERGENCY MANAGEMENT AGENCY.
NATIONAL FL.OOD INSURANCE PROGRAM
ELEVATION CERTIFICATEj~-'\."l
.. 0.M.B. No. 3067-0077
Expires July 31', 2002 ' ,
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BUILDING OWNER'S NAME
ZIP CODE
7501'
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO.
CITY
STATE
CDPP6\.l. .,...~
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
1.01'" 1- ~"'- '8 --ntE ~~e:-
BUILDING USE (e.g., Residential, Non-residentiat, Addition, Accessory, etc. Use Comments section if necessary.)
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LA TITUDElLONGITUDE (OPTIONAL)
( ##0 _ ##' _ ##.#If' or ##.#####")
HORIZONTAL DATUM:
~D 1927 LI NAD 1983
SOURCE: U GPS (Type):
U USGS Quad Map LI Other:
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B3.STATE
B2.~NAME
B6. FIRM INDEX B7. FIRM PANEL
DATE EFFECTIVE/REVISED DATE
B9. BASE FLOOD ELEVATION(S)
(Zone AO, use depth of flooding)
J""
B 10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9.
I_I FIS Profile L)4.EIRM 1-1 communi~ermined 1-1 Other (Describe):
B11. Indicate the elevation datum used for the BFE in B9: NGVD 1929 U NAVD 1988 U Other (Describe):
B12. Is the building located in a Coastal_Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)?
Designation Date:
I_I Yes ~o
SECTION C - BUILDING ELEVATION INFO MATION (SURVEY REQUIRED)
C1. Building elevations are based on: LIConstruction Drawings* IBuilding Under Construction* I-IFinished Construction
*A new Elevation Certificate rill be required when construction ofthe building is complete.
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, ARiA1-A30, ARiAH, 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
calcula~~.Di~space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion,
Datum Convers~!C~mments
Elevation reference mark used ~ ~M~ Does the elevation reference mark used appear on the FIR U Yes I No
o a) Top of bottom floor (including basement or enclosure) ~ .1!i ft.(.) I ~ 0 F r
D b) Top of next higher floor . _ ft.(m) '\~"G\'s'" "itl!.1:-1
D c) Bottom of lowest horizontal structural member (y zones only) . _ ft.(m) 1l ~ ~.,~~ ~6"'f
D d) Attached garage (top of slab) , ~ ft.(m) i'2:' ....
D e) Lowest elevation of machinery and/or equipment aIL ~~ .SA.R......,....... ..........
servicing the building ~ ' _ ft.(m) ~ i
D f) Lowest adjacent grade (LAG) ~.'11" ft.<-t) ~ ~
3lU)
D g) Highest adjacent grade (HAG) . ~ ft.(m)
D h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade ~
D i) Total area of all permanent openings (flood vents) in C3h tJ ~ sq. in. (sq. an)
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.
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ADDRESS
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REPLACES ALL PREVIOUS EDITIONS
SEE REVERSE SIDE FOR CONTINUATION
IMPORTANT.: In these spaces, copy the corresponding information from Section A.
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. R UTE AND BOX NO.
S .,~~
CITY STATE
CO
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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
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SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ~ON~ (ytJ~~
For Zone AO and Zone A (without BFE), complete Items E1 through E4. If the Elevation Certificate.is intended for use as supporting
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 endosure) of the building is LLI ft.(m) LUin.(cm) LI above or LI below
(check one) the hiQt1'~t adjacent grade. "'I" ' ," .' ;t, '..~,):" '; .i?t;. . \.;-~~; 1 ,\' .
E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is
LLI ft.(m) I_L~n.(cm) above the highest adjacent grade.
E4. For Zone AO oniY~ 'If t{~ flood depth 11~~er is available;, ia t.rn.r tal!' 6! ~ :~om ~.~ ~,l'8fiiQ~ccord~ with the ClI!~u!.'ltty;~. i " ..~:. .
floodplain management ordinance? LI Yes LI No Ll 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
DATE
STATE
TELEPHONE
ZIP CODE
ADDRESS
SIGNATURE
CITY
COMMENTS
U 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 ordina~. CO!'"e~e
Section~ A, B, C (or E), and G of this Elevation Certificate. Complete the applicable iteT~'N~.Q~~n~. . ...' , 'I' '
G1. I_I The information in Section C was tagtn fr9p1 other ~entation that has been sign8d and embossed by a licensed surveyor,
engineer, or architect who is authorized by state or iocal'law to certify elevation information. (Indicate the source and date of the
elevation data in the Comments area below.) .~ ' :
G2. LI A community official completed Section E;~ a buil~~.lpcated in Zone A (without a FEMA-issued or community-issued BFE) or
Zone AO. ' '.
G3. LI The following information (Items G4-G9) is provi~ for community floodplain management purposes.
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. PERMIT NU BER G5. DAoliE PIi T I If:D G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY
, .. t f\~' ',':, ISSUED
G7. Ttiis ~rmit has been issued for: LI New Constn.y:tion W Substantial Improvement
G8. Elevation of as-built lowest floor (including basement) of the bIilildlng 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:
TinE
COMMUNITY NAME
TELEPHONE
SIGNATURE
DATE
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COMMENTS
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1-1 Check here if attachments
REPLACES ALL PREVIOUS EDITIONS
FEMA Form 81-31, AUG 99
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CITY OF COPPELL
REVIEWED
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BY' ~.v-' 08DIT~t>"L ~."
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Approval of the plans and specifications shall not bep ~'ffi. Q
construed to mean constroclion in din:cl conflict , ~"" ~'5. ./
with the City ofCoppell Building Codes and Zonin .~ ..,\.?'~ $~ ./
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SAL T FINISH
WI ClRA Y DYE
/'1'W.
WALK
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253
R05EMOUNT
COURT
12'W.
DRIVE
151.'12'
SITE PLAN
SCALE: 1.=20'-0.
LOT 2. BL.OCK B
THE RESERVE
AN ADDITION TO THE
CITY OF COPPELL, TEXAS