FEMA-EC9310119,3(p
The City With A Beautiful Future BUILDING PERMIT APPLICATION
Building Inspe Diltision
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(`;% Print or Type in a Clear, Legible Manner
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Job Address: q a , I
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Date: Taa / q -R !
Lot: Block:
Subdivision:0 11
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Phase or Section Number:
Owner:
Address:
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Phone #:-KI
Contractor:
Address:
Phone #:
Description of Work to be Done
Class of Work:10-Ke-w'
[]Addition
❑ Alteration ❑ Repair ❑Demolition
of Building in Square Feet
First Floor�y q �
Second
Floor �31S�s
Garage V
Other
NOTICE
This permit becomes null and void if work or construction authorized is not commenced
within 180 days, or construction on work is suspended or abandoned for a period of 180
days at any time after work is commenced.
I hereby certify that I have read and examined this application and know the same to be true
and correct. All provisions of laws and ordinances governing this type of work will be
complied with whether specified herein or not. The granting of a permit does not presume to
give authority to violate or cancel the provisions of any other federal, state or local law
regulating construction or the performance of construction.
Gi
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Signawk of Contractor or Authorized Agent Print Name
Electrical Contractor Plumbing Co actor Mechanical Contractor
BIR . 1 (2/82)
Value of Work
to be Performed
GRAY AREA FOR OFFICE USE ONLY
ELEVATION CERTIFICATE 0.M.B. No 3067-0077
FEDERAL EMERGENCY MANAGEMENT AGENCY ExpiresMay 31, 1993
NATIONAL FLOOD INSURANCE PROGRAM
ATTENTION: Use of this certificate does not provide a waiver of the flood insurance purchase requirement. This form is used only to
provide elevation information necessary to ensure compliance with applicable community floodplain management ordinances, to
determine the proper insurance premium rate, and/or to support a request for a Letter of Map Amendment or Revision (COMA to
Instructions for completing this form can be found on the following pages. or LOMR).
BUILDING OWNER'S NAME SECTION A PROPERTY INFORMATION
FOR INSURANCE COMPANY USE
WESTCHESTER HOMES POLICY NUMBER
STREET ADDRESS (Including Apt., Unit, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER
924 BRENTWOOD DRIVE COMPANYNAICNUMBER
OTHER DESCRIPTION (Lot and Block Numbers, etc.)
CITY --_T.OT 35 BLOCK A VILLAGES OF COPPELL IIIB
COPPELL TRATE ZIP CODE
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the proper FIRM (See Instructions):
1. COMMUNITY NUMBER 2. PANEL NUMBER[71;Z
F FIRM INDEX S. FIRM ZONE 6. BASE FLOOD ELEVATION
480170 10 (in AO Zones, use depth)
16,199 AE 450.50
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ® NGVD '29 ❑ Other (describe on back)
B. For Zones A or V, where no BFE is provided on the FIRM, and the community has established a BFE for this building site, indicate
the community's BFE: I I I I I , LJ feet NGVD (or other FIRM datum—see Section B, Item 7),
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Certificate Instructions, indicate the diagram number from the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level --I-_ .
?(a). FIRM Zones Al -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
of Atd -12t.L J feet NGVD (or other FIRM datum—see Section B, Item 7).
(b). FIRM Zones V1 -V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from
the selected diagram, is at an elevation of ❑ III ❑ feet NGVD (or other FIRM datum—see Section B, Item 7).
(c). FIRM Zone A (without BFE). The floor used as the reference level from the selected diagram is L❑.❑ feet above ❑ or
below ❑ (check one) the highest grade adjacent to the building.
(d). FIRM Zone AO. The floor used as the reference level from the selected diagram is I . ❑ feet above ❑ or below ❑ (check
one) the highest grade adjacent to the building. If no flood depth number is available, is the building's lowest floor (reference
level) elevated in accordance with the community's floodplain management ordinance? ❑ Yes
❑ No El Unknown
Indicate the elevation datum system used in determining the above reference level elevations: ® NGVD '29 ❑ Other (describe
under Comments on Page 2). (NOTE. If the elevation datum used in measuring the elevations is different than that used on
the FIRM [see Section B, Item 7], then convert the elevations to the datum system used on the FIRM and show the conversion
equation under Comments on Page 2.)
Elevation reference mark used appears on FIRM: ❑ Yes EiNo (See Instructions on Page 4)
The reference level elevation is based on: EA actual construction ❑ construction drawings
(NOTE. Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which
case this certificate will only be valid for the building during the course of construction. A post -construction Elevation Certificate
will be required once construction is complete.)
The elevation of the lowest grade immediately adjacent to the building is: 4 S 5 .7 5 . ❑ feet NGVD (or other FIRM datum -see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
IT the community official responsible for verifying building elevations specifies that the reference level indicated in Section C, Item 1
is not the "lowest floor" as defined in the community's floodplain management ordinance, the elevation of the building's "lowest
floor" as defined by the ordinance is: I I I I I I . ❑ feet NGVD (or other FIRM datum—see Section B, Item 7).
Date of the start of construction or substantial improvement
' —.1 o I -.J1, MAT YV REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION
SECTION E CERTIFICATION
This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state or local law to certify elevation
information when the elevation Information for Zones Al—A30, AE, AH, A (with 13FE),V1—V30,VE, and V (with BFE) Is required.
Community officials who are authorized by local law or ordinance to provide floodplain management information, may also sign the
certification. In the case of Zones AO and A (without a FEMA or community issued BFE), a building official, a property owner, or an
owner's representative may also sign the certification.
Reference level diagrams 6, 7 and 8 - Distinguishing Features—If the certifier is unable to certify to breakaway/non-breakaway wall,
enclosure size, location of servicing equipment, area use, wall openings, or unfinished area Feature(s), then list the Feature(s) not
included in the certification under Comments below. The diagram number, Section C, Item 1, must still be entered.
1 certify that the information in Sections 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.
ROLAND RODRIGUEZ
R.P.L.S. 4987
CERTIFIER'S NAME LICENSE NUMBER (or Affix Seal)
MANAGER JAMES H. DOWDY & ASSOCIATES
TITLE COMPANY NAME
155
ADDRESS
SIGNATURE
DR
CITY STATE
( 817) 589-7107
DATE PHONE
Copies should be made of this Certificate for: 1) community official, 2) Insurance agent/company, and 3) building owner.
ZIP
COMMENTS: ELEVATION USED-- TOP OPERATING NUT OF FIRE HYDRANT 100' NnRTH
OF CHALFONT PLACE. ELEVATION 456.93 ft. AS SHOWN ON SUBDIVISION PLAT
RECORDED IN VOL. 92218, PG. 3565 DRDCT.
ON WITH ON PILES,
SLAB BASEMENT PIERS, OR COLUMNS
A V A A V
ZONES ZONES ZONES ZONES ZONES
REFERENCE
REFERENCE BASE LEVEL
REFERENCE
LEVEL FLOOD
LEVEL
ELEVATION
JAM M,
4R.
,`�::i';:+:. i;::i:.; {•::'::::.:
'ADJACENT
BASE
BASE ••. ::: REFERENCE
FLOOD ':::•'•::•:' �
FLOOD
ELEVATION REFERENCE ADJACENT GRADE '..�i' LEVEL
ELEVATION
LEVEL GRADE
f•'i !"'''?iii:°.
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....,
•..: ::.i•;:: , i ;::i•.; . • :.
:i, !ADJACENT
.;:•i: .'• •r..:.�..r:}'•:::p::::�1:,j::
GRADE
The diagrams above illustrate the points at which the elevations should be measured in A Zones and V Zones.
Elevations for all A Zones should be measured at the top of the reference level floor.
Elevations for all V Zones should be measured at the bottom of the lowest horizontal structural member.
Page P
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VILLA6F-5 ®f COPPF.L-L PHAeC: 111 5
COFFELL, TEXAS
09-13-1993 08:53AM 1 214 270 2471 P.02
REFERENCE NO: 39313
Lot 35, Block A, VILLAGES OF COPPELL PHASE III B, an Addition to the City of
Coppell, Dallas County, Texas.
"FORM SURVEY"
S.89°44'05" E. 50.0'
1/2" I.R. FND--� I I ---1/2" I.R. FND.
AT 110.19' AT 109.90'
LOT 35�
3'B.L. —"� n 0.13 ACRES '
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In� 34
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36 1
W 3.1'
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20' BUILDING
LINE
N 15' UTIL. ESM'T.
N.89`44'0511 W. 50.0'
1/2" I.R. FIND.
924 BRENTWOOD DRIVE
SURVEYORS CERTIFICATION
The undersigned Registered Public surveyor certifies to purchaser, Lender and Title Company as named above,
and their Underwriters that (A) this plat of survey and the property description set forth heron are a true
and correct representation of facts found at the time of an actual on—the—ground survey; (B) such survey was
conducted by the surveyor, or under his supervision; (C) all monuments shown hereon exist and the location,
size, and type of material are correctly shown; (D) except as shown, there are no visible encroachments or
right—of—ways onto the property there are no visible discrepancies, conflicts, shortages in area of boundary
line, except Gas shown; (E) the size location, and type of improvements are as shown hereon.
JAMES H. DOWDY &
JAMES H. DOWDY, R.P.L.S. No. 2970
ASSOCIATES, INC.
1550 NORWOOD, SUITE 410 10-4-93 ROLAND RODRIGUEZ, R.P.L.S. No. 4987
HURST, TEXAS 76054
THIS SURVEY NOT VALID WITHOUT EMBOSSED SEAL & ORIGINAL SIGNATURE
FENCE OVERHEAD ELEC,
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CONCRETE_ BECK —WOOD
R.R. TIE RETAINING WALL
BRICK WALL
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ROLAND HODRIGUEZ
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