The URL can be used to link to this page

FEMA-EC940107ww The wf�A�� BUILDING PERMIT APPLICATION JM o Q� , Building Inspections Division Print or Type in a Clear, Legible Manner ! Job Address: o �.� Date: Lot: Block: Subdivision: I r Phase or Section Number: Owner:M� Address: O O S %SG Phone N: Contractor:Address: SIU e� .y Description of Work to be Done Class of Work: fes' New ❑Addition ❑ Alteration ❑ Repair ❑Demolition �,A73Z' Alg a,- G"a A, S 17�7% Area of Building inSquareFeet First Floor i- {— Garage Value of Work to be Performed F�o�Qd d Second Floor Other o20 41t:- GRAY AREA FOR OFFICE USE ONLY 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 %natruction or the performance of construction. (plSignat�f Contractor or Authorized Agent /Print Name /hVicAL Electrical Contractor Plumbing Contractor T Mechanical Contractor BIR - 1 12+921 ELEVATION CERTIFICATE O.M.B.No30670077 FEDERAL EMERGENCY MANAGEMENT AGENCY 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 (LOMA or LOMR). Instructions for completing this form can be found on the following pages. BUILDING OWNER'S NAME SECTION A PROPERTY INFORMATION I FOH INSURANCE COMPANY USE POLICY NUMBER STREET ADDRESS (Including Apt.. Unit, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBERI COMPANY NAIC NUMBER &e9 /��ac.EJ .sem A �-T OTHER DESCRIPTION (Lot and Block Numbers, etc.) LD T 3 Bloc/� / ��G G� �� Dov � i � oma✓ CITY STATE ZIP CODE r0PP.6LZ_ 7-lk�. SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Provide the following from the proper FIRM (See Instructions): 7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ❑ NGVD '29 ®'Other (describe on back) 8. 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: L 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 . 2(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 / .0 feet NGVD (or other FIRM datum—see Section B, Item 7). �? (b). FIRM Zones V1 430, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from qthe selected diagram, is at an elevation of I .LJ 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 LLJ .LJ 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 w.Lj 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 ❑ Unknown d3. 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 71, then convert the elevations to the datum system used on the FIRM and show the conversion equation under Comments on Page 2.) 4. Elevation reference mark used appears on FIRM: ❑ Yes ❑ No (See Instructions on Page 4) 5. The reference level elevation is based on: ❑ 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.) 6. The elevation of the lowest grade immediately adjacent to the building is: I I I5011 I . U feet NGVD (or other FIRM datum -see Section B, Item 7). C'ER/TIFIER'S NAME LICENSE NUMBER (or Affix Seal) /74rry fi'ornie// 46 Z 78 TITLE COMPANY NAME �'r�crrrfeer 1-714,-,rV &M/e//�11554is. Inc. ADDREMS of CITY STATE ZIP 13o/ rie 69rro//1o,7. 7-Y. 75006 SIGNATURE n7 DATE PHONE 9q, 15 55? 7;--MMUNITY NUMBER 2. PANEL NUMBER 3. SUFFIX 4. DATE OF FIRM INDEX 5. FIRM ZONE 6. BASE FLOOD ELEVATION 4O / n DQ `� (in AO Zones, use depth) 7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ❑ NGVD '29 ®'Other (describe on back) 8. 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: L 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 . 2(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 / .0 feet NGVD (or other FIRM datum—see Section B, Item 7). �? (b). FIRM Zones V1 430, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level from qthe selected diagram, is at an elevation of I .LJ 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 LLJ .LJ 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 w.Lj 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 ❑ Unknown d3. 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 71, then convert the elevations to the datum system used on the FIRM and show the conversion equation under Comments on Page 2.) 4. Elevation reference mark used appears on FIRM: ❑ Yes ❑ No (See Instructions on Page 4) 5. The reference level elevation is based on: ❑ 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.) 6. The elevation of the lowest grade immediately adjacent to the building is: I I I5011 I . U feet NGVD (or other FIRM datum -see Section B, Item 7). C'ER/TIFIER'S NAME LICENSE NUMBER (or Affix Seal) /74rry fi'ornie// 46 Z 78 TITLE COMPANY NAME �'r�crrrfeer 1-714,-,rV &M/e//�11554is. Inc. ADDREMS of CITY STATE ZIP 13o/ rie 69rro//1o,7. 7-Y. 75006 SIGNATURE n7 DATE PHONE 9q, 15 55? F.E.M.A. LETTER REQUIRED. VT MINIMUM ff. f:?,o-r 1�� Lc>T 3 �t. 'SIG G�