FEMA-EC010917BUILDING PERMIT APPLICATION
17// .0 % Print nr TvnP in a Clear_ l enihla Manner
t 1 y99
Job Address: q y g V6M&Z
Date:Sf
Lot: 9 Block: A Subdivision: L!oli � �S�-��-�
Phase or Section Number:
Owner Address: 1,-QG �&"e' f -y if- too
Rte. Tr '75013-7iia-9
Phone :
#
(� 177C
Contractor: �Ia ry)P-5 &„ s Address;5WF—A5 /IPJ F
Phone #: rlla - Q 9-,-1770 C;;<f
Description of Work to be Done Class of Work: 1ANew ❑ Addition ❑ Alteration ❑ Repair ❑ Demolition
y tA)
Area of Building in Square Feet
Feet
�First Floor &7" � Garage %33 Value of Workl
• } to be Performed �� � 1 �O
Second Floor -;21 dnn �3 Other � / C 1
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 construction of the performance of construction.
C'�'— D� ,- �' bAft
Permit Fee: 0
Receipt Number' d'`
Zoning District:
Occupancy Classification:
Approved By:
'Date:
Comments:
Signature of Contractor or Authorized AgentPrint Name
Eyye� Eia±,-ie, m , drlr�v�n� Air
Electrical Contractor Plumbing Contractor----' Mechanical Contractor
FPMC - 1 (4194)
BUILDING INSPECTION - WHITE, APPRAISAL - YELLOW, CUSTOMER - PINK
FEDERAL EMERGENCY MANAGEMENT AGENCY 0,M.B. No. 3067.-0077
y NATIONAL FLOOD INSURANCE PROGRAM Expires ,July 31, 2002
ELEVATION CERTIFICATE
•
Important: Read the instruc4ions on pages 1 - 7.
SECTION A - PROPERTY OWNER INFORMATION For Insurance Company Use:
BUILDING OWNER'S NAME Policy Number
BUILDING STREET AD,DRRE S (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number
9" IPECITY STATE ZIP CODE
C-OPPULL- 'rCXs4S -75o t y
PROPERTY DESCRIPTION o[ and Block Numbers, Tax Parcel Number, Legal Description, etc.)
BUILDING USE (e.g., Residential, Wo-h4esidential, Addition, Accessory,
section
LATITUDE/LONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: L—I GPS (Type):
( ##° - ##'- ##.##" or ##.°) LI NAD 1927 I_I NAD 1983
LL USGS Quad Map I—L Other:
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP COMMUNITY NAME 8 COMMUNITY NUMBER B2. COUNTY NAME B3. STATE
4-80r7o 5eikr J
B4. MAP AND PANEL
B5. SUFFIX
B6. FIRM INDEX
B7. FIRM PANEL
B8. FLOOD
B9. BASE FLOOD ELEVATION(S)
NUMBER
DATE
IkM
EFFECTIVE/REVISED DATE
ZONE(S)
(Zone AO, use depth of flooding)
4430 1-10 polo
E
L IS 1
L IS
610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9.
1_I FIS Profile 1_1 FIRM (Community Determined 1-1 Other (Describe):
1311. Indicate the elevation datum used for the BFE in 139: $41.NGVD 1929 1_1 NAVD 1988 1J Other (Describe):
B12. Is the building located in a Coastal_Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? 1_1 Yes W.No
Designation Date:
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: 1_1Construction Drawings* rpouilding Under Construction* 1-1Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Building Diagram Number _L_ (Select the building diagram most similar to the building for which this certificate is being completed - see
pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
C3. Elevations – Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, ARAE, AR/A1-A30, AR/AH, AR/AO
Complete Items C3a-i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from
the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion
calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion.
Datum Conversion/Comments
Elevation reference mark used C-AGAf1 tit. NiBt —oes the elevation reference mark used appear on the No
❑ a) Top of bottom floor (including basement or enclosure)..••
Tit
❑ b) Top of next higher floor _ ft.(m) � Q�GtSTEq�Oq�
❑ c) Bottom of lowest horizontal structural member (V zones only)tj IV_ ft.(m) so R
•.• •..*.Y •�......•..••
❑ d) Attached garage (top of slab)_ •z2 ft. (V) E R RY S. RHODES
❑ e) Lowest elevation of machinery and/or equipment *................
servicing the building Or ft (M) E a P.•�
❑ f) Lowest adjacent grade (LAG) 4% 9
❑ g) Highest adjacent grade (HAG) •lk ft. (m) 14
El
h) No. of permanent openings (flood vents) within 1 ft. above adjacen grade Wk 8i
❑ i) Total area of all permanent openings (flood vents) in C3h sq. in. (sq. cm) o�
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available.
I understand that any false statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
TITLE
4 -WQ-�
FEMA For&48 41, AUGV9 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS
IMPORTANT: In these spades, copy the corresponding information from Section A. For InsUrance Company'Use:
BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy,Number.
STATE ZIP CODE
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
COMMENTS
s;'
1-1 C��ck` 6 if attachments'
SECTION E -BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zone AO and Zone A (without BFE), complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting
information for a LOMA or LOMR-F, Section C must be completed.
E1. Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed —
see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.)
E2. The top of the bottom floor (including basement or enclosure) of the building is L-1_1 ft.(m) 1-1_lin.(cm) Ll above or Ll below
(check one) the hig"est.adjecent grade.
E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is
1-1-1 ft.(m) 1-1-1in.(cm) above the highest adjacent grade.
E4. For Zone AO only:, `If t(b•fbod depth numb).y i available;ise the top of the;bgttoM:fteor'gevqteitii 'pccordancewith the colnmunity;s' .
floodplain management ordinance? I_I Yes I_I No LI Unknown. The local official must certify this information in Section G.
SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION
The property owner or owner's authorized representative who completes Sections A', B, and E for Zone A (without a FEMA -issued or
commupityissued BFE) or Zone AO must sign here.
PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME
ADDRESS 'CITY STATE ZIP CODE
SIGNATURE DATE TELEPHONE
COMMENTS
1_1 Check here if attachments
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable�'item(Apd sign I love..
G1. I_I'The information in Section C was taken front othe"ocumentation that has been signed and embossed by a licensed surveyor,
engineer, or architect who is authorized by state or lgcal law to certify elevation information. (Indicate the source and date of the
elevation data in the Comments area below.)
G2.1 I A community official completed Section E,for.a building located in Zone A (without a FEMA -issued or community -issued BFE) or
Zone AO. '
G3. 1_1 The following information (Items G4 -G9) is provided for community floodplain management purposes.
.%% - •.•+
ISSUED
G7. This permit has been issued for: 1_1 New Construction L.._1 Substantial Improvement
G8. Elevation of as -built lowest floor (including basement) of the buDding is: _ ft.(m) Datum:
G9. BFE or (in Zone AO) depth of flooding at the building site is: _ ft.(m) Datum:
LOCAL OFFICIAL'S NAME TITLE
COMMUNITY NAME TELEPHONE
SIGNATURE DATE
COMMENTS
r ' I I Check here if attachments
FEMA Form 81-31, AUG 99 REPLACES ALL PREVIOUS EDITIONS