FEMA-EC940317 (2)The City With A Beautiful Future BUILDING
9Building Inspections Division
PERMIT APPLICATION
I 9 -1) Y, I I Print or Tvoe in a Clear, Leuible Manner
Job Address: I O �g CIP�Cts S( Al �a
Date:
1 S 4
Lot: 00 Block: Subdivision: Phase or Section Number:
Owner: � —-ro�.1 S Address:
(�6�b �i rtclAs (c�4/ Phone #:
Contractor: Address:rI&E)o��Phone I!:
Description of Work to be Done Class of Work: B.New ❑Addition ❑ Alteration
❑ Repair ❑Demolition
Area of Building in Square Feet
First Floor zs�l 1� Garage Iso Value of Work
q2- to be Performed
Second Floor 2 Other/
L11/ / S GRAY AREA FOR OFFICE USE ONLY
NOTICE
Permit Fee: .
Receipt !Number:
ZoningDistrict:
Occupancy Classification:
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.
.Approved By,
>Date:'
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
'
Comments w : s: ;
® �
regulating construction or the performance of construction.64
'
N C�G�N�✓
SSigr a of Contra r or A—dKorized Agent Print Name
Electrical Contractor Plumbing Contractor Mechanical Contractor
BIR • 1 12/921
I
ELEVATION CERTIFICATE O.M.8`N03067-00i7
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 inlorrnation 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.
SECTION A PROPERTY INFORMATION FOh INSURANCE COMPANY USE
EUILUINCi OV tJEI('S NAME POLICY NUMBER
ST lit- E T AUUHE:SS (Includmy Apt . Ury(, Luaa anUlu( 1309. Nu- P.O. ROUTE AND BOX NUMBEH COMPANY NAIL NUM13ER
U f H%ii l LaGRIP] ]ON (Lut ,iud t3k.),k NuntWrs, etc.)
City
Z
STATE ZIP CODE
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the proper FIRM (See Instructions):
Ip(-UMMUNI TYN1NU.b113EH
2. PANLL NUM3LH
1 SUFFIX
4 F/IRMM—INDEX
5. FI,R/M ZONE
6. BASE FLOOD ELEVATION
lee—
7OAAIE�OF
G • /J,
/r
(in AO Zones, use depth)
i. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): F2WIS— b '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_J__ 1 X11 . L_-1 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 iiL .
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
OIL. 1 .k2feet 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 LL—I—I—L.1 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.LJ feet above ❑ or
below Ll (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 feet above ❑ or below ❑ (check
one) the highest grade adjacent to the building. If no flood depth number is available, is the buil g s lowest floor (reference
level) elevated in accordance with the community's floodplain management ordinance? Yes o ❑ Unknown
3. 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.)
a. Llevation reference mark usod appoars on FIRM: os ❑ No (Soo Instructions on Page 4)
5. The reference level elevation is based on: actual construction ❑ construction drawings
(NO I E: Use of construction drawings is only valid if the building does not yet have the reference level floor in place, in which
ease 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.)
5. The elevation of the lowest grade immediately adjacent to the building is:L1 1 4- LIJ feet NGVD (or other FIRM datum -see
Section B, Item 7).
;s J0 i if ILf i � NAME: LIC,[N:;E NUMBER (or Affix Seal)
76
71 It ` / COMPANY NAME
(,fly STATE ZIP
en
,r: iv i. rli
T77TTTT TiTTl TTTTL_1 _Li/ / / i
HR SURVEY PLATI HR
LOT 20, BLOCK E, OF GIBBS STATION PHASE TWO, AN ADDITION
TO THE CITY OF COPPELL, DALLAS COUNTY, TEXAS.
73.001
12.77'
100 YEAR FLOOD PLAIN
LOT 20
BLK. E
NICN
BANK
FORMBOARD
S UR VE Y
25' B UILDINC LINE
< N e,
4 k
�- CO
V O
I 10' UTILITY ESM'T —
64 r4 93 05'00" 5' TU ESM'T
67-331
8.8'
8.2'
8.0'
N
ti
\
8.0'
0
h
w
M
tv
N
LOT 19
8.0'
73.001
12.77'
100 YEAR FLOOD PLAIN
LOT 20
BLK. E
NICN
BANK
FORMBOARD
S UR VE Y
25' B UILDINC LINE
< N e,
4 k
�- CO
V O
I 10' UTILITY ESM'T —
64 r4 93 05'00" 5' TU ESM'T
67-331
8.8'
8.2'
N
ti
\
8.0'
0
h
w
LOT 21
8.1'
I hereby certify that on the �
day of 19fw-� thie survey was made on the ground as per the field notes shown on th{a survey
and is true, correct, and accurate as to the dimensions of the subject property and size, location and type of buildings and improvements therswk
if any. The survey shows all easements and visible easements of which I have knowledge or have been advised affecting the subject property.
There are no encroachments, conflicts, or protrusions visible on the ground other than those shown.
Date
.. JOB # .
HARRY. . . ✓. R0IIELL
CF No. 4597
�h r T L� A
v L1� t' L n d� L'�lll W Scale: 1 "=1 U1tVE!6J HA RR Y
1/2" Steel / Iron Rod Found O
1/2" Steel / Iron Rod Set
Property Line e^
Wood Fence — — --
Chain Link / Wire Fence X—X—X—X --x i
R0 WELL
Surveying & Engineering
1T'11 fern .Street Ste Z01