FEMA-EC981109wrn --W- -�Z3 1 G 9 / 5 10-19-98P01 :02 RCVD
BUILDING PERMIT APPLICATION
-41 , -L Print or Type in a Clear, Legible Manner
Job Address: WO G )a 6.0
Lot: a� Block: Subdivision: `Q',
Owner ( Address.
Contractor: Q— Address:
Description of Work to be Done Class of Work: DrNew ❑ Addition
r
Area of Building in Square Feet
First Floor. I
Second Floor Tl J
NOTICE
Garage l 1
Other
3073 S,F
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 san6 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 dce not presume to
give authority to violate or cancel the provisions of any other federal, to or local law
regul constructio rformance of construction.
ti
IIA
Mgriature of Contractoror u orized Agent Print Name
e
Electrical Contractor Plumbing Contractor echanical Contractor
FPMC - 1 (4/94)
Date: 10— 1 (_ _ U e
Phase or Section Number:
InI M I&APT"
#:462-WO -S/&O 4 19
Phone #:
❑ Alteration ❑ Repair ❑ Demolition
A'60
Q0
Value of Work I o )a
to be Performed
A FOR OFFICE USE ONLY
BUILDING INSPECTION - WHITE, APPRAISAL - YELLOW, CUSTOMER - PINK
11
SA
9 — ti
O.M.B. NO. 3067-0077
ELEVATION CERTIFICATE Expires May 31, 1996
FEDERAL EMENGENCY 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.
OWNER'S
SECTION A PROPERTY INFORMATION I FOR INSURANCE COMPANY USE I
POLICY NUMBER
ADDRESS (Including Apt., Wt, Suite and/or Bldg. Number) OR P.O. ROUTE AND BOX NUMBER I COMPANY MAIC NUMBER
OTHER DESCRIPTION (Lot and Block
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
3. SUFFIX
4. DATE OF FIRM INDEX
5. FIRM ZONE
6. BASE FLOOD ELEVATION
(in AO ones, use depth)
48o d
1
7. Indicate Indicate the elevation datum system usedl.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: I I I I I I.L_J 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 .
2(a). FIRMZones Al -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation
of II — 1414 L7� . C 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 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 ❑ I .0 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 . ❑ 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: NGVD '29 ❑ Other (describe
under Comments on Page 2). (NOTE. if the elevation datum used in measuring the elevatio s 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: es ❑ No (See Instructions on Page 4)
S. The reference level elevation is based on• actual construction ❑ construction drawings
(NOTE. Use of construction drawings ' 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.) f ��
6. The elevation of the lowest grade immediately adjacent to the building is: l_1_il .Meet 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 I .❑ feet NGVD (or other FIRM datum–see Section B, Item 7).
?. Date of the start of construction or substantial improvement
FEMA Form 81.31, MAY 93 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION
.1
I r SECTON E CERTIFICATION -
;r
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.
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.
I certify that the information in Sections B and C on this cerlificate represents my best efforts to ' et the data available.
I understand that any false statement may be punishable by fine or imprisonment under -ion 1001.
. P1/L' T..f_
NAME
TITLE
LICENSE
COMPANY NAME
ADDRESS Y A 0 V. STATE ZIP
Copies should be made of this Certificate for: 1) community official, 2) insurance agent/company, and 3) building owner.
COMMENTS:
ON WITH ON PILES,
SLAB BASEMENT PIERS, OR COLUMNS
A v A A v
ZONES ZONES ZONES ZONES ZONES
. REFERENCE
LEVEL
REFERENCE
REFERENCE BASE
LEVEL
LEVEL FLOOD
ELEVATION d
!: •.::l:'rti:r.:t;.:$
BASE •• •ADJACENT :;•: . REFERENCE
FLWE
OOD
ELEVATION
FLOOD GRADE '•'t'' LEVEL
'iSa,
ELEVATION REFERENCE ADJACENT
LEVEL OMDE
'i4 �':.7 ''r:n'tt"•`i:l�i�l:i :.
,.: , 1:.r L,.
• ��i�'�::::i:, :•4::::::'{�¢Z:,fj:
ADJACENT .
v ..l. r•:
ADE i
tr(jt::'y.; GR •
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 2
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Inncwrttive Plow 1,1—
PLOT PLAN
For Triditioncil l lwfo I i, it
1" = 20'
LOT 28, ELOGK A
RI -ERV I ESTATES
A T
B ee tw e,.
(l -,i n The L i n e s
GOFPE, TEXAS
LL
.,,
FIRST TEXAS HOMCS
DROSTE
Resi tribal Designers and Plonner- �
rAX
NELSON ( )
Arlington, Texas Metre 517--261-4121 817 ;�74-4117
* Builder/Owner to verify and check nll aspects of this site and plot plan prior to any
construction
SURVEY PLAT OF
TO ALL PARTIES INTERESTED IN PREMISES SURVEYED:
t, L. YJ -0 A Re'steretbMICUional Land Survtytx, do birch certif} that a careful survey was male of the Frond Chic chtle under my c+ lkloh tit 111! folloAing desailied prnpeny.
jack-
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and there are encroachments upm the adj,tining property or the adjoining imprmements upon the deccrihed propeny knnwn is
14001 QLADC P01W (' hiZIV�E
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T�� of ('ad=44.9,46I CALU I"
'Fop of
LOT 28
PSL_Oc1` A
W8a1°4-1'o0't W
STATE OF TEXAS
COUNTY OF TARRANT
—To the Lienholders and/or the Owners of the Premises surveyed and Ic
The undersigned does hereby certify that this survey was this day made
on the ground of the property legally described hereon and is correct. and tha�
there are no discrepancies• conflicts, shortages in area, boundary line conflicts
encroachments• overlapping of improvements, visible lines or roads in place.
except :Is shown herenn, and that said Pr^rtr!y has ac'c^ss to rt^.d from c
dedicated roadway except as shown hereon.—
Dated:
BASIS FOR BEARING:
Order No. _
NOT FOR CONSTRUCTION
1 1! ion
-75.00' 1
I... t.•.:q' 2 -1
Uj-1)
L ' 415
FLOOD NOTE: t hereby certify that the property deSeribed herein
_ within a special flood harard thea its identified by the
Federal Insurance Administration, Department 0( 11ohling And Urban
Development, the flood hazard area being identified as
of the Federal Insurance Adnihilittahoh Flood Hazard
Boundary Map effective on
4
for the __ ...
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AP SURVEYING CO.
David Pollard RPS #1518
1003 Central Drive, Suite 309
Bedford, TX 76021 Metro (811) 201.1249
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