FEMA-EC980617 (3)�Cr�A"�� M 4 z�-�b7
Te tWith Beautiful Future BUILDING PERMIT APPLICATION
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Job Address: / Aclr�
Date:
�IT
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Jim_ CQPPEL
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APR
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Lot: Block: 16 Subdivision: t lU`,au �5� Phase or Section Number:
Owner �� zi!Sj 9�'�S Address: 0,&,,e'Phone #:90— �v —3601—
Contractor:
360Contractor: S Address: Phone #:
Description of Work to be Done Class of Work: New ❑ Addition ❑ Alteration ❑ Repair ❑ Demolition
Area of Building in Square Feet
First Floor 00
Second Floor d
NOTICE
Garage ' 91 0
`
✓
Other S
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.
Signature of Contractor or Authorized Agent Print Name
Aaoil
Electrical ontractor Plumbing Contractor Mechanical Contractor
Value of Work /�s O j to ca
to be Performed `
FPMC - 1 (4/94)
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BUILDING INSPECTION - WHITE, APPRAISAL - YELLOW, CUSTOMER - PINK 2
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O.M.B. NO. 3067-0077
ELEVATION CERTIFICATE Expires May 31,.1996
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 onto
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.
SECTION A PROPERTY INFORMATION I FOR INSURANCE COMPANY USE I
BUILDING OWNER'S POLICY NUMBER
J = Irz��r i`xa
STREET ADDRESS (Including Apt., Unit, SuA_and/pr Bldg. Number) OR P.O. ROUTE AND BOX NUMBER COMPANY NAIC NUMBER
OTHER DESCRIPTION (Lot an Block Numbers, etc.) -
1 ri"r 7d, l 7e le
CITY STATE ZIP CODE
top E. [_ `T—g2s45
SECTION B FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Provide the following from the proper FIRM (See Instructions):
11.. COMMUNITY NUMBER
2. PANEL NUMBER
3. SUFFIX
4. DATE F FIRM INDEX
9�
5. FIRM ZONE
� �
, 6. BASE FLOOD ELEVATION
, (in A� nes, use depth)
C 0� 0
4E7�,�Xj
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE) -,L'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 .1J 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). FIRMS 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 I l ll�fl l . 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
the selected diagram, is at an elevation of II 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 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 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: LTJ 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: 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: 1 1 1 1 1 I . Ll 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 93 REPLACES ALL PREVIOUS EDITIONS SEE REVERSE SIDE FOR CONTINUATION
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 8FE),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 certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFIER'S NAM-� LICENSE NUMBER (or Affix Seal)
Yt b l c� 1A 40 /,!57/A -
r,TCOMPANY NAME
cC2
STATE
Copies should be made of this Certificate for: 1) community official,
COMMENTS:
ON WITH
SLAB BASEMENT
A V A
ZONES ZONES Ir ZONES
nest' �_ ADJACENT
FLOOD ..•.: GRADE
ELEVATION REFERENCE ADJACENT
LEVEL GRADE
insurance agent/company, and 3) building owner.
BASE
FLOOD
ON PILES,
PIERS, OR COLUMNS
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
9003
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For Traditional Home Design
etween The Ll.nes
Rn;dmfml Dmgrws and pWmws
.77shf"ton. TeKG3 Metro 8I7-261-4121 FAX al -,F-274-4717
LLIMder/Owner to eLn�Y and check oil aspects of thisLte
and plot plan prior to any construction
M SLtRVEY PLAT OF
TOALL PARTIES INTERESTED IN PRENIIWS SURVEYED:
and there are encrmchmenn upon the adjoining property of the adjoining Impmventenis upon the described property known Is
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STATE OF TEXAS \�V COUNTY OF TARRANT
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"To the Lienholders and/or the Owners of the Premises surveyed and to FLOOD NOTE: I hereby certify that the property dt!sctibld hetEirk
within a special hood hazard ertsy as Identified by -the
The undersigned does hereby certify that this survey was this day made Federal Insurance Administration, Department of Housing !nd Urban
on the ground of the property legally described hereon and Is correct. and that Development, the flood hazard area being identified as '
there are no discrepancies, conflicts. shortages In area, boundary line conflicts, of the Federal Insurance Administratioti Flood Nazard
encroachments, overlapping of Improvements, visible lines or roads In place, Boundary Map effective on
except os shown hereon, and that said property has access to and from a
dedicated roadway except as shown hereon." for the _
Dated:
OASIS FOR BEARING: AP SURVEYING CO.
David Pollard RPS 311518
Order No. 1903 Central Drive, Suite 309
NOT FOR CONSTRUCTION Bedford, TX 76021 Metro (817) 2814240
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STATE OF TEXAS \�V COUNTY OF TARRANT
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"To the Lienholders and/or the Owners of the Premises surveyed and to FLOOD NOTE: I hereby certify that the property dt!sctibld hetEirk
within a special hood hazard ertsy as Identified by -the
The undersigned does hereby certify that this survey was this day made Federal Insurance Administration, Department of Housing !nd Urban
on the ground of the property legally described hereon and Is correct. and that Development, the flood hazard area being identified as '
there are no discrepancies, conflicts. shortages In area, boundary line conflicts, of the Federal Insurance Administratioti Flood Nazard
encroachments, overlapping of Improvements, visible lines or roads In place, Boundary Map effective on
except os shown hereon, and that said property has access to and from a
dedicated roadway except as shown hereon." for the _
Dated:
OASIS FOR BEARING: AP SURVEYING CO.
David Pollard RPS 311518
Order No. 1903 Central Drive, Suite 309
NOT FOR CONSTRUCTION Bedford, TX 76021 Metro (817) 2814240
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