FEMA-EC931025The City With A Beautiful Future
Building Inspections Division
BUILDING PERMIT APPLICATION
Print or Type in a Clear, Legible Manner i
Job Address: ---,7/,e 0a "i � y 4 �N r Date: �p
Lot: Block: 14 Subdivision: G�vu.✓rt i T�S Phase or Section Number:
Owner: Address: Phone #:
Contractor: Address: fyo,6 l�f,!<SC�' L�✓i�)`/��'hone #:�t1 -/7? c7
ILO'_ g- 7`v '
Description of Work to be Done Class of Work: &ge—w ❑Addition ❑ Alteration ❑ Repair ❑Demolition
�V1pCZ-J r=ya 7u� 3�e,52z4s 101x4
Area of Building in Square Feet
First Floor Garage Value of Work
to be Performed
Second Floor Other
GRAY AREA FOR OFFICE USE ONLY
NOTICE
Permit Fee: t receipt Number:
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
Zoning District: Occupancy Classification:
days at any time after work is commenced.
--1 y
Approved By: , Date:
I hereby certify that I have read and examined this application and know the same to be true
Comments:
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 a performance of constpuction.
Signature of C ntractor or Autho gent Print Name
Electrical Contractor Plumbing Contractor Mechanical Contractor
BIR -1 (2/82)
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Expires May 31, 1EVATION CERTIFICATE O.M.B. y31, 199933
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 LOMB).
Instructions for completing this form can be found on the following pages.
SECTION A PROPERTY INFORMATION FOR INSURANCE COMPANY USE
BUILDING OWNER'S NAME POLICY NUMBER
STREET ADDRESS (InAuding Apt., Unit, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the proper FIRM (See Instructions): min
O'
1. COMMUNITY NUMBER
2. PANEL NUMBER
3. SUFFIX
4. DATE OF FIRM INDEX
5. FIRM ZONE
6. BASE FLOOD ELEVATION
�Ol Q
Coto
d
IO-(io -1 /
(in AO Zones, use depth)
L491 '
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): ill 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: I I I I I . ❑ feet NGVD (or other FIRM datum -see Section B, Item 7).
SECTION C BUILDING ELEVATION INFORMATION
1. Using the Elevation Certificate Instructions, indica a the diagram number from the diagrams found on Pages 5 and 6 that best
describes the subject building's reference level V .
2(a). FIRM Zones Ai -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
of i1 60 .4 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 I I I I I ,❑ 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 1. ❑ 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. U 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
3. Indicate the elevation datum system used in determining the above reference level elevations: VNGVD '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.) ,-
4. Elevation reference mark used appears on FIRM: ❑ Yes�N�,o (See Instructions on Page 4)
5. The reference level elevation is based on: V act�u ns�uct�,❑ 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- �VI�.� feet NGVD (or other FIRM datum -see
Section B, Item 7).
SECTION D COMMUNITY INFORMATION
1. If 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 . ❑ feet NGVD (or other FIRM datum -see Section B, Item 7).
2. Date of the start of construction or substantial improvement
FEMA Form 81-31, MAY 90 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION
J06 C)0. 60'Xo3
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 BFE),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. �f: -
Reference level diagrams 6, 7 and 8 - Distinguishing Features—I aeltm&s to certify to breakaway/non-breakaway wall,
enclosure size, location of servicing equipment, area use, wall6 rea Feature(s), then list the Feature(s) not
included in the certification under Comments below. The diagrc _ 1, must still be entered.
/ certify that the information in Sections B and C on this certi
1 understand that any false statement may be punishable by
FIER'S
LIQ (Or
s to interpret the data available.
U.S. Code, Section 1001.
ZIP
I I - v vlff J - G
SIGNATURE c n /� f k I� f `,� ' /O _ �� DATE ��/HQIt� 5? J -
Copies should be made of this Certificate for: 1) community official, 2) insurance agent/company,,/a)nd 3) building owner.
COMMENTS:
ON WITH ON PILES,
SLAB BASEMENT PIERS, OR COLUMNS
A V A A V
ZONES ZONES ZONES ZONES ZONES
REFERENCE
REFERENCE L BASE LEVEL
REFERENCE
LEVEL FLOOD
LEVEL
ELEVATION
BASE • ..
FLOOD '"'' ADJACENT':: REFERENCE
BASE
FLOOD
ELEVATION REFERENCE ADJACENT GRADE LEVEL
ELEVATION
LEVEL GRADE
�•:.,:•i':.::,:.; :'::i:.'.: :':•.: ;.:`'.?
ADJACENT:::
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.
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