The proposed building site is in or very near a designated Special Flood Hazard Area shown on the FEMA
FIRM panel. The minimum Finished Floor is one foot (1’) above the Base Flood Elevation as required by City
Ordinance No. 7115.
Before a building permit will be issued, this form must be filled out, signed, and sealed by a land surveyor,
engineer, or architect licensed in the State of Texas to certify elevation information.
When the floors and site grading are complete, the builder must hire a registered land surveyor, engineer, or
architect to complete an Elevation Certificate and submit a copy to Engineering Services Division. NO FINAL
INSPECTION will be scheduled for this structure until the Elevation Certificate is submitted. Flood insurance
may be required as a condition of any loan on this structure; the insurance cost will be based on the Elevation
Certificate that is required for permit compliance.
Date: Property Address:
FIRM Panel No.: Flood Zone:
Is any part of the Property in a Floodway? YES NO
Benchmark Datum: NGVD 1929 NAVD 1988 Other (Describe):
Benchmark Elevation:
( use registered City benchmark and provide City I.D. / Location) ( show conversion to BFE datum, if not the same )
Base Flood Elevation (BFE):
( indicate BFE datum: NGVD1929, NAVD1988 )
Indicate source of BFE: FIS Profile Community Other (Describe):
FIRM Determined
Minimum F.F. Elevation:
( top of bottom floor slab elevation ) ( indicate BFE datum: NGVD1929, NAVD1988 )
Engineer / Surveyor / Architect:
( print or type name and registration number ) ( Company Name ) ( phone number )
Seal , Sign , and Date Here
Code Enforcement Division
Building Permit No.:
Building Permit Date:
Engineering Division
City of Midland Floodplain Administrator Date
M:\FLOODPLAIN INFORMATION\Floodplain Forms\Floodplain PreCon Compliance Form 1311.doc Form Updated November 2013