FEMA-EC980916® 08-07-98
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y With A Beautiful Future BUILDING PERMIT APPLICATION
/ �1014 Print or Type in a Clear, Legible Manner W I *-� a�3a
Job Address: 1 11 ; �.� Date: lu—�i
Lot: ao Block: Subdivision: j„S Phase or Section Number:
Owner�"� 5 �Y►�-r 5 Address^ ac=!e !o � ^% jcbofl[n#:I�—Ho 40-3�0,lo
Contractor: Address: Phone #:
Description of Work to be Done Class of Work: ---New ❑ Addition ❑ Alteration ❑ Repair ❑ Demolition
Area of Building in Square Feet
First Floor Garage L41 ) Value of Work
1 to be Performed �_
Second Floor Other t
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-w�ormance of construction.
1 LLAT\i t1
Si nature of Con i� or oro 'zed Agent Print Name
Electrical Contractor Plumbing Contractor echanical Contractor
FPMC - 1 (4/94)
BUILDING INSPECTION - WHITE, APPRAISAL - YELLOW, CUSTOMER - PINK
O.M.B. NO. 3067-0077
ELEVATION CERTIFICATE ExPiresMay 81,1996
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 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 I FOR INSURANCE COMPANY USE I
BUILDING OWNER'S NAME
STREET ADDRESS (including Apt. Unit , Suite andlor Bldg. Number) OR P.O. ROUTE AND BOX NUMBER
14
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IO ' P. I L2 t- ®le l Ill%
OTHER DESCRIPTION (Lot and Block Numbers, etc.)
POLICY NUMBER
COMPANY NAIC NUMBER
CITY STATE ZIP CODE
Lo p+E.11 Tx
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 Zo s, use depth)
O� I 0
, � �
� F,
7-
10
7. Indicate the elevation datum system used on the FIRM for Base Flood Elevations (BFE): LJ NGVD '29 U 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 ILJ 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). 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
of 14" A 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 .LJ 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. LL 1. LJ 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 I I LLJ 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 elevationsNGVD'29 El 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 ❑ No (See Instructions on Page 4)
5. The reference level elevation is based on: actual construction El 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: LLQ . U 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 I.0 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
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;r SECTION E CERTIFICATION
f 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.
t 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 NAMELICENSE NUMBER (or Affix Seal)
,��., all awn _ 1s148
TITLE COMPANY NAME
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
REFERENCY
LEVEL
REFERENCE
REFERENCE BASE
LEVEL
LEVEL FLOM
ELEVAIK)N
S:'(.:.;i:i: :+:.• :r::. I
BASE
':j'r::r}i,.::::.i.
'l:.:;
rRErEnENCEJ
BASE
FLOOD
ELEVATION_
GLEVEL
ELEVA xa REFERENCE ADJACENT+xi
LEVEL GRADE P.4;
:r:: rI'i �::Si:j•: _n.
:.1i. AQ1ACENi i'.
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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Innovative New Ideas
PLOT PLAN
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Design
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COPFELL, TX
FIR5T TEXA5 FIOME5
Residential Designers and
Planners
HEIDHRIEHT (F52 -1'I)
BRAV5MY 5/16/15
Ari'ington Texas Metro 817-261-4121 FAX 817-274-4717
I* Builder/Owner to verify and check all aspects of this site and plot plan prior to any construction
SURVEY PLAT OF
yTO AI.L PARTIES INTERESTED IN PREMISES SURVFlr-F.D:
I. (f q A Relrioered Pr ri..nal U o, "r• do VY certortif-y Ih/a1 a cue I survey war made the gu nd thir Banc under upenisi,n of the fotln inK described ppcnr
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VA there are _ encroachments upon the adjnininit property or the 10joinin(, improvements up<m the ""'tihed property known as
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GLADE, 1v011J-T DV -1t4 -E
IL130 M
STATE OF TEXAS
COUNTY OF TARRANT
"To the Lienholders andlor the Owners of the Premises surveyed and to
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 that
there are no discrepancies, conflicts, slxartages in area, boundary line conflicts.
encroachments. overlapping of improvements• visible lines or mads in place,
except m shown hnenn and tlrnt or%in pmperr, hos nt'ccss to ant! form a
dedicated roadway except as shown hereon.–
Dated:
BASIS FOR BEARING:
Order No. —____—_. ---__--
`OT FOR CONSTRUCTION
T-&gTlqg
FLOOD NOTE: I hereby certify that the property described herein
within a special flood hazard area as identified by the
Federal Insurance Administration, Department of Housing and Urban
Development. the flood hamrd wren being identified as
of the Federal Insurance AdminislrAtion Florid Hazard
Boundary Map effective onfor the
By:. _-1 -- --- -- --- ,-, - - ---
AP SURVEYING CO.
David Pollard RPS 111518
1903 Central Drive, Suite 309
Bedford. TX 76021 Metro (817) 267.1249
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