FEMA-EC980518The City With ABeautiful Future BUILDING PERMIT APPLICATION
i �i`il t � ill
Print or Type in a Clear, Legible Manner
Job Address:I I ` Date:
L-6 — 7-76
1 \
Lot: Jl� Block: Subdivision: � v ; r „` Phase or Section Number:
Owner �Pt Address:YOz Phone #: , / �/O_
Contractor: �m Address: Phone #:
Description of Work to be Done Class of Work: New ❑ Addition ❑ Alteration ❑ Repair ❑ Demolition
5;oG I -e PG n; 1 v r do'o U
Area of Building in Square Feet
First Floor
- ;L 1 7% -
Second Floor
NOTICE
Garage
Other -
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 con tion of the performance of construction.
ignature of Contractor or Authorized Agent Print Name
Electrical Cont Plumbing Contractor Mechanical Contractor
FPMC - 1 (4/94)
Value of Work j� I00
m
l to be Perfored (0co
OFFICE USE ONLY
BUILDING INSPECTION - WHITE, APPRAISAL - YELLOW, CUSTOMER - PINK
O.M.B. NO. 3067-0077
ELEVATION CERTIFICATE Expires May 3i, 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 FOR INSURANCE COMPANY USE
BUILDING OWNER'S NAME POLICY NUMBER
STREET ADDRESS (Including Apt., Unit�S1e and/or Bldg. NumAr) OR P.O. ROUTE AND BOX NUMBER COMPANY MAIC NUMBER
OTHER DESCRIPTION (Lot and Block Numbers, etc.)
L. oT L2, IRt 't)"y 1 &A7 9Ftiw tE S
CITY STATE 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 Zones, use depth)
1
7. Indicate the elevation datum system used 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: L__L_L_L ❑.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
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 11141461.E 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.
theselected diagram, is at an elevation of 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 ❑ 1. Ll 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 elevati ns 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: XYes ❑ No (See Instructions on Page 4)
5. The reference level elevation is based onInly
actual construction [I construction drawings
(NOTE: Use of construction drawings isalid 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: 1 1 14417 .IJ 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 LJ 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
l information when the elevation information for Zones Ai—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.
certify that the information in Sections 8 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 NAME LICENSE NUMBER (or Affix Seal)
77
ADDRESS
: iit_
SIGNATURE
Copies should be made of this Certificate for: 1)
COMMENTS:
COMPANY NAME
STATE
�X
Z6 7 -
official, 2) insurance agent/company, and 3) building owner.
ZIP
WITH ON PILES,
ON
BASEMENT PIERS, on COLUMNS
SLAB
A V A A V
ZONES ZONES ZONES ZONES ZONES
REFERENCE
LEVEL
REFERENCE
REFERENCE BASE
LEVEL
LEVEL FLOOD
` ELEVAI ION
To
Ji ::;°(;a. -•-...; ::r:'tii af4
BASE
•:::• .
BASE •:.:. ' �•�i? REFERENCE
FLOOD "
..:::•'f?:: ADJACENT ,•.,. •
FLOOD GRADE I; t'; LEVEL
ELEVATION
ELEVATION REFERENCE ADJACENT
W
LEVEL GRADE
.. ..:.}�:�::•..�.::.:. ... •'71111:•'>':
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
... r --- �_'------------------------SURVEY PLAT OF
TO ALL PARTIES INTERESTED IN PREMISES SURVEYED'
' t, V,dW/ -T
V'w-!. ,\ Register r rnfesvio f.arul Sarceyor.do hereby certify Ihel a careful purvey wav made nl the frnUnJ ihi< dalrer my�•uren' inn
--__. and there are _ encroachmenu upon the adjoining property or the 9,1fuiniq improvements upon the dew'rihed property knn%n at
'0
.. tip' u„r-.
LOT Z3
1x-33 GLADE PoiAj r D vE
e 50 trx. t0.l✓. �,
Yz "f/,e
STATE OF TEXAS
COUNTY OF TARRANT
"To the Lienholder% and/or the Owners of the Premisee 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, shortages in area, boundary line conflicts,
encroachments, overlapping of improvements. visible lines or roads in place,
except as shnwn hereon, anrt tbnt %aid property has access to and front a
dedicnied roadway except as shown hereon."
Daled
OASIS I.OR BEARING:
Order No. --_-- -------_- NOT FOR CONSTRUCTION
fnllnwinit Jescrihed prrpem.
Lor Z/
r
SIAL E:
I I. = 20,
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FLOOD NOTE: 1 hereby certify that the property described herein
— within a special flood hazard Area as identified by 1
Federal Insurance Administration, Department of Housing and Urh
Development, the flood hazard area being identified as
of the Federal Insurance Administration Flood if,,,
floundary Map effective on -- _—_
for the
fly-- ------------- ---- — -
Ar SUhVEYING CO.
David Pollard 1If S 01518
1903 Central Drive, Suite 309
Redford, TX 76021 Metro (817) 267.1249
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Innovative New Ideas
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Residential Designers and Planners qq
Ai lingtoll, TeAUj Met',)611--LG1-4121 fAX 817-GlY— 111
PLOT PLAN
LOT 22, BLOCK A
RIVE=RVIFW F -STAT[ S
GOPPELL, TEXAS
FIRST TEXAS HOMES
ELSADI
SEVIL-B (Fl S34)
« 13uiltler��Ownel to verify and check all aspects of this site and plvt plan prix; to any �-unstructiun